Application of Clinical Care Pathway in Perioperative Patients with Autologous Arteriovenous Fistula Balloon Expansion

[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.

Psychological and social aspects of infertility in men： an overview of the evidence and implications for psychologically informed clinical care and future research

Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology （ART） treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.

Research Progress on Clinical Nursing of Hypertension

High-quality nursing care can greatly reduce the occurrence of nursing accidents and help patients maintain better physical and mental health.For patients with hypertension,special attention should be given to clinical nursing.Providing scientific medication guidance,along with psychological support,can improve their medication compliance and establish a good doctor-patient relationship,aiding in their faster recovery.Based on a review of relevant literature and the author's practical experience,this paper first analyzes the content and requirements of clinical nursing for hypertension,then discusses the main factors that restrict the effectiveness of clinical nursing for hypertension,and finally suggests improvements to the clinical nursing model for hypertension to serve as a reference for colleagues.

Current Research Progress of Central Venous Catheter-Associated Fibrin Sheath Prevention and Nursing Care

With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in central venous catheterization,which has always been a major problem in intravenous therapy.So the prevention and treatment of fibrin sheath has become a hot spot of research in recent years.Hence,this paper summarizes the research on fibrin sheath in recent years.

A Study of Health Prescribing for Children with Tourette’s Disorders in Children’s Health Education Specialty Care Clinics

Objective:This study designs and implements the health prescription of children’s health education specialized nursing clinic based on the physical and mental characteristics of children with Tourette’s syndrome.Methods:Applying the evidence-based nursing model and nursing intervention theory based on the survey research by searching China Knowledge Network,Wanfang Database and Wipro Chinese Science and Technology Journal Database,the study collected the literature on the health prescription intervention research in children’s Tourette’s disorders health education in children’s health education of specialized nursing outpatient clinic for review and combined with the specialty characteristics to formulate“Children’s Tourette’s Disorder Health Education Prescription.”Results:Tourette’s syndrome in children is a common pediatric neurological disorder,mainly manifested as involuntary,rapid and repeated muscle twitching and vocal tics,which brings serious psychological pressure and life disturbance to the affected children.Conclusion:For children with Tourette’s syndrome,healthcare professionals should give enough care and understanding to the children and their parents,provide timely and effective health education to them,help them improve their bad behavioral habits,establish correct cognitive attitudes,enhance self-confidence,improve patient compliance,reduce the frequency of recurrence,reduce the incidence of complications and promote children’s physical and mental health development.

Clinical nursing care of a nurse diagnosed with COVID-19in Wuhan Union Hospital

The coronavirus disease (COVID‑19) has claimed thousands of lives. The patients have been quarantined and treated in special shelter hospitals,and mild illness accounts for the majority of the total number of patients. This article reports one case of the first batches of infected medicalstaff, who got infected with 2019 novel coronavirus and later discharged 2 weeks after receiving treatment and nursing care in Wuhan UnionHospital. Considering all aspects of the patient’s hospitalization, the patient was performed ward environment management, medical nursing,symptomatic treatment, nutrition management, vital signs monitoring, observation and nursing, psychological assessment and support, andinfection protection and management. As the earliest successful case of cure, the patient’s manifestations are classical and common. Moreover,we hope to share it with colleagues to fight against COVID‑19 for reference. The treatment and nursing guidelines can be applied to treat a largenumber of mild cases, thus improving the discharge rate of patients and reducing the pressure of epidemic situation.

Forecasting patient demand at urgent care clinics using explainable machine learning

Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to surges in patient flows.The delays arising from inadequate staffing levels during these periods have been linked with adverse clinical outcomes.Previous research into forecasting patient flows has mostly used statistical techniques.These studies have also predominately focussed on short‐term forecasts,which have limited practicality for the resourcing of medical personnel.This study joins an emerging body of work which seeks to explore the potential of machine learning algorithms to generate accurate forecasts of patient presentations.Our research uses datasets covering 10 years from two large urgent care clinics to develop long‐term patient flow forecasts up to one quarter ahead using a range of state‐of‐the‐art algo-rithms.A distinctive feature of this study is the use of eXplainable Artificial Intelligence(XAI)tools like Shapely and LIME that enable an in‐depth analysis of the behaviour of the models,which would otherwise be uninterpretable.These analysis tools enabled us to explore the ability of the models to adapt to the volatility in patient demand during the COVID‐19 pandemic lockdowns and to identify the most impactful variables,resulting in valuable insights into their performance.The results showed that a novel combination of advanced univariate models like Prophet as well as gradient boosting,into an ensemble,delivered the most accurate and consistent solutions on average.This approach generated improvements in the range of 16%-30%over the existing in‐house methods for esti-mating the daily patient flows 90 days ahead.

Advances in post intensive care unit care: A narrative review

As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after at times prolonged treatment,sometimes in isolation.These survivors have a lower life expectancy and a poorer quality of life.They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services,the so-called post intensive care syndrome(PICS).But it is not only the patient who is the sufferer.The mental health of the loved ones and family members may also be affected,which is termed as PICS-family.In this review,we shall be reviewing the definition,epidemiology,clinical features,diagnosis and evaluation,treatment and follow up of PICS.We shall also focus on measures to prevent,rehabilitate and understand the ICU stay from patients’perspective on how to redesign the ICU,post ICU care needs for a better patient outcome.

Analysis of status quo and research progress in nursing care for different typed coronavirus disease 2019: A literature review

At present,patients with coronavirus disease 2019(COVID‑19)are showing a surge in the world,to explore the clinical characteristics,treatment,and care of different types of COVID‑19.The authors reviewed the existing literature,selected,and analyzed the diagnosis and treatment records of 11 patients with COVID‑19 who were initially cured,including patient information,clinical manifestations,auxiliary examination results,treatment principles,nursing evaluation,nursing goals,nursing diagnosis,and nursing measures,and found clinical similarities and differences in the care of different types of patients.Among them,nine patients recovered and discharged after receiving treatment,and two died.As there is no specific medicine,only symptomatic treatment and supportive treatment can be given.Eleven common nursing measures and special nursing measures of different levels were carried out for patients diagnosed with mild,common,severe,and critical illnesses,and different treatment methods were given according to the severity of signs and symptoms.By summarizing the similarities and differences of clinical nursing interventions,we hope to help improve the quality of care for patients diagnosed with COVID‑19.

Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data

Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan;additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012;the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people;clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713;confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed;clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.

Development and Practice of Integrated Nursing Model NNN Link for Breastfeeding Clinical Nursing Model as a Whole

Objective: To establish breastfeeding clinical holistic nursing model used in clinical nursing and teaching, it is possible to improve nurses and nursing students to master knowledge of breastfeeding, analysis, judgment, decision-making and the ability to care-related issues, promoting pure improve breastfeeding rates. Method: 1) The North American Nursing Diagnosis Nursing Association (NANDA), Nursing Outcomes Classification (NOC) and Nursing Classification (NIC) link (NNN link) clinical clues reasoning to determine the contents of the questionnaire were used. Then, the Delphi method to care was used. 2) The survey questionnaire was designed. The content included the clinical holistic nursing care model in breastfeeding and the model’s use situation. 3) Questionnaire survey: in the national midwifery care industries, volunteers were collected who were willing to use the breastfeeding clinical holistic nursing care model in the nursing work. We issued 98 questionnaires and took back 76 valid questionnaires. Results: The construction of the breastfeeding clinical holistic nursing model includes 9 nursing diagnoses which contain the breastfeeding effective, the lack of knowledge, the decision conflicts, the risk of breast tenderness, the risk of cracked nipple, the invalid hazard occurring in breastfeeding, the risk of caregiver role strain, the risk of breast feeding jaundice and the ineffective community coping, 18 nursing outcomes and 64 nursing measures. In the composition of breastfeeding after clinical holistic nursing model in clinical practice, 100% of obstetric nurses think that the breastfeeding nursing model can promote the nursing staff to care patients according to the nursing process, can help nurses to analyze, evaluate, make decision, and care about breastfeeding related problems, as well as can promote the mother’s milk feeding rate. Conclusion: The establishment of the breastfeeding nursing model provides a learning material for obstetric breast-feeding. Moreover, nursing diagnosis, nursing outcomes and nursing measures correspond according to the form of chart, which are easy to use and find. The breastfeeding clinical holistic nursing model is practicing in clinical nursing, which can help nursing staff to improve the ability of nursing personnel according to evidence-based nursing patients, to improve the ability of nursing personnel analysis, evaluation, decision-making and nursing in breastfeeding problems and to promote the rate of breastfeeding.

Comprehensively evaluate the short outcome of small bowel obstruction:A novel medical-economic score system

BACKGROUND Small bowel obstruction(SBO)still imposes a substantial burden on the health care system.Traditional evaluation systems for SBO outcomes only focus on a single element.The comprehensive evaluation of outcomes for patients with SBO remains poorly studied.Early intensive clinical care would effectively improve the short-term outcomes for SBO,however,the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined.AIM We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status.METHODS Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO(SiBO)group and the strangulated SBO(StBO)group.A principal component(PC)analysis was applied for data simplification and the extraction of patient characteristics,followed by separation of the high PC score group and the low PC score group.We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes.Receiver operating characteristic curves were drawn,and the areas under the curve(AUCs)were calculated to assess the effectiveness of the predictive models.RESULTS Of the 281 patients,45 patients(16.0%)were found to have StBO,whereas 236 patients(84.0%)had SiBO.Regarding standardized length of stay(LOS),total hospital cost and the presence of severe adverse events(SAEs),a novel principal component was extracted(PC score=0.429×LOS+0.444×total hospital cost+0.291×SAE).In the multivariate analysis,risk statuses related to poor results for SiBO patients,including a low lymphocyte to monocyte ratio(OR=0.656),radiological features of a lack of small bowel feces signs(OR=0.316)and mural thickening(OR=1.338),were identified as risk factors.For the StBO group,higher BUN levels(OR=1.478)and lower lymphocytes levels(OR=0.071)were observed.The AUCs of the predictive models for poor outcomes were 0.715(95%CI:0.635-0.795)and 0.874(95%CI:0.762-0.986)for SiBO and StBO stratification,respectively.CONCLUSION The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden.According to the relative risk factors,early tailored intervention would improve the short-term outcomes.

Improving health care usage in a very low birth weight population

Background:Prematurity is the biggest contributor to admissions in the neonatal intensive care unit(NICU).The period following hospital discharge is a vital continuum for the very low birth weight(VLBW)infant The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.Methods:All outpatient health care usage by VLBW infants born in the study year(cases)was retrospectively tracked through 12 months of age.A cohort of healthy newborn infants were matched by birthdate to each VLBW infant(controls)and similarly tracked.Results:In this study,there were 85 cases and 85 controls.The mean gestational age at birth for the cases was 29.1±2.7 weeks with a mean birth weight of 1079±263 g.That of the controls was 38.9±13 weeks and 3202±447 g.Over 90%of both populations had Medicaid coverage.All VLBW infants received care at the Special Care Developmental Follow-Up Clinic.When compared with the controls,VLBW infants discharged from the NICU made fewer acute,unscheduled visits to the Emergency Department or Urgent Care Clinic(2.3±2.5 vs.3.7±3.5;P=0.007)despite their high-risk medical and social status.Their growth pattern showed significant"catch-up"and was similar to the matched controls at the last scheduled visit for each group.Conclusions:Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.

Current understanding of the chronic stress response to burn injury from human studies

There is a marked inflammatory and hypermetabolic response following a burn injury.The inter-linked responses are more pronounced than for other forms of trauma and can persist for≥3 years post-injury in burned patients.After a burn,patients have an increased risk of diseases of ageing including cancer,diabetes and cardiovascular disease,highlighting the need for effective long-term strategies to ameliorate the stress response post-burn.Current therapeutic strategies for post-burn recovery include removal of damaged tissue with surgical excision and wound repair,nutritional supplementation and rehabilitative exercise.These strategies aim to minimize the hypermetabolic and inflammatory responses,as well as reducing the loss of lean body mass.This review briefly summarises the inflammatory and hypermetabolic responses and provides an update on the current therapeutic strategies for burned patients.The review examines the persistent nutritional challenge of ensuring sufficient energy intake of each macronutrient to fuel the hypermetabolic and counteract the catabolic response of burn injury,whilst reducing periods of hyperglycaemia and hypertriglyceridemia.Patients require individualized treatment options tailored to unique systemic responses following a burn,facilitated by a precision medicine approach to improve clinical and physiological outcomes in burned patients.Thus,this review discusses the utility of metabolic flexibility assessment to aid clinical decision making and prescription relating to nutritional supplementation and rehabilitative exercise in the burned patient.