Objective:To comprehensively search, evaluate and summarize the relevant evidence of early ambulation in patients with total knee arthroplasty (TKA), so as to provide evidence-based basis for the nursing practice of early ambulation in patients with TKA.Methods:Clinical decisions, best practice manuals, guidelines, systematic reviews, expert consensus and evidence summaries for early postoperative ambulation of TKA patients were searched by computer on PubMed, Web of Science, BMJ Best Practice, Cochrane Library, UpToDate, OVID, CINAHL, Embase, Joanna Briggs Institute (JBI) Centre for Evidence-based Health Care, Physiotherapy Evidence Database, China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc, Guidelines International Network, National Guideline Clearinghouse, National Institute for Health and Care Excellence, Canadian Medical Association Clinical Practice Guideline, Scottish Intercollegiate Guidelines Network, American Academy of Orthopaedic Surgeons and American Association of Hip and Knee Surgeons. The retrieval time was from the establishment of the databases to March 31, 2023. Four nursing graduate students trained in evidence-based nursing systems independently evaluated the quality of the included literature and divided the evidence levels according to the JBI Evidence Pre Grading System (2014 edition) .Results:A total of 15 articles were included, including four clinical decision papers, three guidelines, six expert consensus papers, one evidence summary and one systematic review. According to the judgment of professionals, 23 pieces of best evidence were formed from seven aspects, including the director of ambulation, evaluation before ambulation, ambulation planning, ambulation timing, ambulation content, ambulation evaluation and health education.Conclusions:The best evidence of early postoperative ambulation of patients with TKA summarized in this study is scientific and practical, which can provide evidence-based basis for clinical nursing work.

Objective:To explore the experience and feelings of undergraduate nurses in low-value care de-implementation, so as to provide reference for formulating specific strategies for low-value care de-implementation.Methods:From July to October 2023, purposive sampling was used to select 14 full-time undergraduate nurses from the First Affiliated Hospital of Zhengzhou University as research subjects. The phenomenological research method was used to conduct semi-structured in-depth interviews, and Colaizzi 7-step analysis method was used to analyze the data.Results:Three themes were extracted in total. Highly recognizing the low-value care de-implementation included reducing nurses' workload, improving patients' medical experience, and promoting harmonious nurse-patient relationships. Cognitive dissonance for low-value care de-implementation involved low efficiency cognition and maintaining a wait-and-see attitude. Low-value care de-implementation was hindered by multiple factors, including a lack of critical thinking, concerns about medical nursing risks, a lack of evidence-based nursing skills, a lack of organizational support, and a lack of medical knowledge among patients.Conclusions:Undergraduate nurses highly recognize the significance of low-value care de-implementation, but still face many challenges in their clinical practice. Multiple measures should be taken to promote the low-value care de-implementation in clinical practice.

Objective:To develop a virtual reality (VR) exercise rehabilitation system for home-based patients with spinal cord injury, and test patients' acceptance and experience.Methods:The VR exercise rehabilitation system for home-based patients with spinal cord injury was developed by a multidisciplinary team based on the home rehabilitation needs, evidence, and clinical experience of spinal cord injury patients, and further improved after recommendations from experts and patients. From February to July 2024, convenience sampling was used to select 148 patients with spinal cord injuries admitted to the Department of Spinal Cord and Neurological Function Reconstruction at the China Rehabilitation Research Center. Acceptance Questionnaire was used to investigate patients' acceptance of the system. Thirteen patients with spinal cord injuries were selected for semi-structured interviews to explore the themes of their experiences using VR exercise rehabilitation system for home-based patients with spinal cord injury.Results:A VR exercise rehabilitation system for home-based patients with spinal cord injury was developed, which includes four aspects of personal profile, personal assessment, training selection, and care knowledge. The total acceptance score of this system among 148 patients was (87.69±1.59). Through semi-structured interviews, three themes were identified involving excellent experience, expectation of rehabilitation effects, satisfaction with functionality and hope for continuous system updates.Conclusions:The design of VR exercise rehabilitation system for home-based patients with spinal cord injury is scientifically reasonable, which can further verify the rehabilitation effect of the system.

【Objective】 To evaluate the safety and efficacy of the collection of peripheral blood stem cells (PBSCs) in pediatric patients with thalassemia major (TM) weighing 20 kg or less. 【Methods】 PBSCs collection data of 170 pediatric patients with TM weighing 20 kg or less from January 2013 to December 2020 in our center were reviewed. Safety was assessed by the occurrence of adverse events during apheresis procedures, and efficacy was evaluated by the number of CD34+ cells collected. 【Results】 A total of 171 PBSCs procedures were performed on 170 patients with TM weighing 20 kg or less, with a median age of (4.98±1.53) years and a median weight of (17.30±2.18) kg. The probability of collecting at least 1×10⁶ CD34+ cells/kg during a single course of apheresis was 99.41% (169/170), with a median (5.88±4.23) ×10⁶ CD34+ cells collected per kg of weight of the recipient. A minimum pre-apheresis hemoglobin (Hb) of 60 g/L in patients with TM weighing 20 kg or less was safe and feasible. The most common adverse event of G-CSF mobilization in TM patients is bone pain, with the incidence of 7.65% (13/170), which was higher than that of healthy children donors in our center. The most common adverse events during the collection were pain at the puncture site of the femoral vein (6.47%, 11/170) and low pressure of the fluid (2.92%, 5/170). And no serious complications related to PBSCs mobilization, central venous catheter(CVC)placement or the apheresis procedure occurred. 【Conclusion】 PBSCs collection by COM.TEC blood cell separator in children weighing 20 kg or less is safe and efficacious.

Life-space, as a multidimensional structure, is an important indicator for measuring individual movement. Since the first proposal of life-space in 1985, it has gradually been applied in multiple fields. At present, the development of life-space in foreign countries is becoming increasingly mature, while there is little research on this aspect in China. This article reviews the definition, evaluation tools, and application progress of life-space in cardiac rehabilitation, so as to provide reference for the research and application of life-space in home-based cardiac rehabilitation in China.

Objective:To construct a risk prediction model for unplanned readmission of patients undergoing cardiac resynchronization therapy (CRT) and verify the performance of the model.Methods:Using convenience sampling, patients who underwent CRT at the Department of Cardiovascular of the First Affiliated Hospital of Zhengzhou University from July 2017 to July 2020 were selected as the modeling group ( n=279) and the internal validation group ( n=120). CRT patients admitted to the Department of Cardiovascular of the First Affiliated Hospital of Zhengzhou University from August 2021 to August 2022 due to the same or related diseases were selected as the external validation group ( n=86). Multivariate Logistic regression was used to explore the influencing factors of unplanned readmission of CRT patients and establish the prediction model. The fitting effect and discrimination of the model were evaluated through the Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve. The nomogram was established based on R-4.1.2 and Rstudio software. Results:The multivariate Logistic regression analysis showed that creatinine, left atrial diameter, pulmonary artery systolic pressure, New York Heart Association (NYHA) classification, and body mass index (BMI) were risk factors for unplanned readmission in CRT patients, with statistically significant differences ( P<0.05). The prediction model formula was: P=1/{1+exp[- (0.792×creatinine+1.408×left atrial inner diameter+0.887×pulmonary artery systolic pressure+0.769×NYHA classification-0.970×BMI-2.266) ]}. The area under the ROC curve was 0.874, the maximum value of the Jordan index was 0.636, the optimal threshold was 0.256, the sensitivity was 0.826, and the specificity was 0.810. The accuracy of internal validation and external validation was 90.00% and 90.70%, respectively. Conclusions:The constructed prediction model for unplanned readmission of CRT patients has good predictive performance, and the visualized nomogram improves the practical performance of the model. It helps medical and nursing staff identify high-risk groups of unplanned readmission of CRT patients in the early stage and provides a basis for formulating nursing strategies for different risk groups.

Objective:To explore effects of health education based on teach-back method on functional exercise compliance in patients with kinesophobia after total knee arthroplasty (TKA) .Methods:Using the convenient sampling method, a total of 104 patients with TKA kinesiophobia who were admitted to First Ward of Department of Orthopedics in the First Affiliated Hospital of Zhengzhou University from August 2019 to November 2020 were selected as the research objects. Among them, 52 patients admitted from August 2019 to March 2020 were set as the control group, while 52 patients admitted from April to November 2020 were set as the experimental group. They were respectively given routine health education and health education based on teach-back method. Before the intervention and 2 weeks after the intervention, the differences in Functional Exercise Compliance Scale for Orthopedic Patients, Hospital for Special Surgery Knee Score (HSS) and Modified Barthel Index (MBI) scores were compared between the two groups.Results:After implementing the health education intervention program based on the teach-back method, the total score of Functional Exercise Compliance Scale for Orthopedic Patients of patients and dimensions scores of exercise compliance related to physical aspects, the exercise compliance related to psychological aspects and the exercise compliance related to active learning in the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of HSS and MBI in the experimental group were higher than those in the control group after intervention, and the differences were statistically significant ( P<0.01) . Conclusions:The health education intervention program based on the teach-back method is scientific and reliable, which can effectively improve the functional exercise compliance of TKA patients with kinesiophobia, promote recovery of knee joint function and improve their activities of daily living.

Objective:To construct an early rehabilitation program suitable for patients with cervical spondylosis after minimally invasive cervical laminoplasty and explore its clinical effect, in order to promote postoperative spinal cord function recovery and reduce complications.Methods:The early rehabilitation program after minimally invasive cervical laminoplasty was constructed by literature search, research group discussion and two rounds of Delphi expert correspondence. The convenient sampling was used to select 136 patients who underwent minimally invasive cervical laminoplasty by the posterior cervical approach who were admitted to the First Affiliated Hospital of Zhengzhou University from May 2018 to May 2020. They were divided into control group and observation group by the random number table method, with 68 cases in each group. The control group underwent rehabilitation according to the conventional rehabilitation methods after cervical spine surgery, while the observation group was given the early rehabilitation program intervention after minimally invasive cervical laminoplasty. They were followed up 12 months after surgery. The differences in Japanese Orthopaedic Association Scores (JOA) score, Neck Disability Index (NDI) score and Visual Analogue Scale (VAS) for axial pain were compared between the two groups before intervention and 12 months after surgery.Results:There were no statistically significant differences in the JOA, NDI and VAS scores between the two groups before intervention ( P>0.05) . After 12 months of follow-up, there was no statistically significant difference in the cervical spine JOA score between the two groups ( t=1.655, P=0.101) . The NDI score of the observation group [ (17.68±5.73) ] was lower than that of the control group [ (27.39±11.01) ] , and the difference was statistically significant ( t=-5.846, P<0.01) . The VAS score of the observation group [ (1.59±0.86) ] was lower than that of the control group [ (2.31±1.12) ] , and the difference was statistically significant ( t=-3.801, P<0.01) . Conclusions:The early rehabilitation program after minimally invasive cervical laminoplasty constructed in this study is scientific and reliable, which is helpful to improve the cervical spine function and daily activities of patients with cervical spondylosis after surgery and reduce the occurrence of axial pain.

Objective:To study the feasibility and safety in treatment of trauma to right posterior liver using laparoscopic surgery with patients in the left semiprone position.Methods:The clinical data of consecutive patients who were diagnosed to have trauma to the right posterior liver and were treated with laparoscopic surgery with patients in the left semiprone position at the Department of Hepatobiliary Surgery, the Affiliated Hospital of Youjiang Medical University for Nationalities between February 2016 and August 2020 were retrospectively analysed. The patients’ gender, age, mechanisms of injury, operative methods, operative time, amounts of abdominal effusion, degrees of liver injury, extents of intraoperative bleeding, amounts of postoperative drainage, lengths of postoperative hospital stay, and major postoperative complications were recorded and analyzed.Results:Among the 18 patients, there were 16 males and 2 females, aged (41.6±14.4) years. The mechanisms of liver trauma were caused by fall injury ( n=10), traffic accidents ( n=4), blunt injury ( n=2) and penetrating injury ( n=2). The levels of injuries were level Ⅲ in 16 patients and level Ⅳ in 2 patients. Laparoscopic suture repair was performed in 8 patients, partial hepatectomy in 4 patients, electrocoagulation hemostasis in 4 patients and ligation of bleeding vessels in 2 patients. All were successful in hemostasis. Abdominal effusion was (1 528.8±373.2) ml, intraoperative blood loss (80.6±16.7) ml, operation time (88.5±9.1) min, postoperative hospital stay 7 days and postoperative total drainage (93.8±13.6) ml. Ten patients were complicated with right pleural effusion, and they recovered with conservative treatment. There were no bile leakage, infection and other complications. Conclusion:Trauma to right posterior liver treated with laparoscopic with surgery patients in the left semiprone position had the advantages of adequate exposure which facilitated surgical hemostasis, resulting in minimal collateral damages and short hospital stay. The treatment was feasibility and safe.

Objective:To explore the application effect of co management mode in the prevention of perioperative venous thromboembolism (VTE) in elderly patients with hip fractures.Methods:Using the convenient sampling method, a total of 146 elderly patients with hip fractures who were admitted to the First Affiliated Hospital of Zhengzhou University from January to December 2019 were selected as the research objects. A total of 73 patients admitted from January to June 2019 were set as the control group and they were given routine venous thrombosis risk assessment, treatment, education and so on, while 73 patients admitted from July to December 2019 were set as the experimental group and they were given management according to co-management mode. The incidence of VTE, first out-of-bed activity time, hospital stays and expenses, awareness rate of VTE-related knowledge and level of DVT health belief were compared between the two groups.Results:After implementing the co management mode, the incidence of postoperative VTE in the experimental group was lower than that in the control group ( P<0.05) . The first out-of-bed activity time and hospital days in the experimental group were shorter than those in the control group, the hospital expense was lower than that in the control group, and DVT health belief score and VTE-related knowledge score were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The scores of disease susceptibility, disease severity, health behavior benefits and self-efficacy in DVT health beliefs in the experimental group were higher than those in the control group ( P<0.05) . There was no statistically significant difference in the scores of obstacle and health motivation dimensions of healthy behaviors between the two groups ( P>0.05) . Conclusions:The application of co-management mode in elderly patients with hip fractures during the perioperative period can improve DVT health beliefs of patients and improve their VTE-related knowledge mastery, shorten the hospital stay, effectively prevent the occurrence of VTE and promote rapid recovery of patients.