Effect of cetuximab plus FOLFOX4 regimen on clinical outcomes in advanced gastric carcinoma patients receiving evidence-based care

BACKGROUND Although chemotherapy is effective for treating advanced gastric carcinoma(aGC),it may lead to an adverse prognosis.Establishing a highly effective and low-toxicity chemotherapy regimen is necessary for improving efficacy and outcomes in aGC patients.AIM To determine the efficacy and safety of cetuximab(CET)combined with the FOLFOX4 regimen(infusional fluorouracil,folinic acid,and oxaliplatin)as firstline therapy for patients with aGC,who received evidence-based care(EBC).METHODS A total of 117 aGC patients who received EBC from March 2019 to March 2022 were enrolled.Of these,60 in the research group(RG)received CET+FOLFOX4 as first-line therapy,whereas 57 in the control group(CG)received FOLFOX4.The efficacy[clinical response rate(RR)and disease control rate(DCR)],safety(liver and kidney dysfunction,leukopenia,thrombocytopenia,rash,and diarrhea),serum tumor marker expression[STMs;carbohydrate antigen(CA)19-9,CA72-4,and carcinoembryonic antigen(CEA)],inflammatory indicators[interleukin(IL)-2 and IL-10],and quality of life(QOL)of the two groups were compared.RESULTS A markedly higher RR and DCR were observed in the RG compared with the CG,with an equivalent safety profile between the two groups.RG exhibited notably reduced CA19-9,CA72-4,CEA,and IL-2 levels following treatment,which were lower than the pre-treatment levels and those in the CG.Post-treatment IL-10 was statistically increased in RG,higher than the pre-treatment level and the CG.Moreover,a significantly improved QOL was evident in the RG.CONCLUSION The CET+FOLFOX4 regimen is highly effective as first-line treatment for aGC patients receiving EBC.It facilitates the suppression of STMs,ameliorates the serum inflammatory microenvironment,and enhances QOL,without increased adverse drug effects.

Application Analysis of Doctor-Nurse Cooperation Follow-up Model Based on the Internet Platform in Continuation Care of Patients after Urooncology Surgery

Objective:To explore the application effect of a doctor-nurse cooperation follow-up model based on an Internet platform in the continuation of care for patients after uro-oncology surgery.Methods:A convenient sampling method was used to select patients with urinary system tumors who underwent surgery in the Department of Urology in Grade III A general hospital in Shanghai from May to August 2022.Patients who underwent surgery from May to June 2022 were assigned to the control group,and those who underwent surgery from July to August 2022 were assigned to the experimental group.The control group received routine post-discharge nursing health education and telephone follow-up.On the basis of routine discharge guidance,the experimental group implemented the intervention method based on the Internet platform in continuation care.The levels of self-management efficacy,satisfaction,and incidence of unplanned readmission were compared one month after discharge between the two groups.Results:One month after discharge,the self-management efficacy of the experimental group(90.15±7.92)was significantly higher than that of the control group(79.10±7.84),and the patient satisfaction score(97.83±2.32)was significantly higher than that of the control group(90.23±2.58),with statistical significance(P<0.05).Additionally,the incidence of unplanned readmissions within one month after discharge in the experimental group(1.59%)was slightly lower than that in the control group(4.84%).Conclusion:The doctor-nurse cooperation follow-up model based on the Internet platform in continuation care can significantly improve the self-management efficiency of patients after discharge and enhance patient satisfaction,providing a new approach for discharge follow-up of urological tumor patients after surgery.

Analysis of the Nursing Effect of Continuity of Care on Elderly Patients with Coronary Heart Disease Unstable Angina and its Impact on Quality of Life

Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method.The nursing effect and quality of life of the observation group(continuity nursing)and the control group(routine nursing)were compared.Results:The total effective rate of nursing care was 96.00%observation group and 80.00%for the control group,and the differences were significant(χ2=6.061,P<0.05).Patients in the observation group had fewer episodes(1.42±0.21)times/week and a shorter duration(5.46±0.39)min,which were better than the control group(t=3.465,2.973;P<0.05).The depression self-rating depression scale(SDS)score(42.16±6.64)and anxiety self-rating scale(SAS)score(32.26±7.35)in the observation group were lower and the quality of life was higher as compared to that of the control group(P<0.05).Conclusion:Continuous nursing care improved the nursing effect of elderly CHD with UAP patients,promoted the alleviation of UAP symptoms,improved patient mentality,and improved their quality of life.Hence,continuous nursing care possesses significant clinical application value.

Personalized and continuous care intervention affects rehabilitation,living quality,and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide.With progress in treatment methods and levels,the overall survival period has been prolonged,and the demand for quality care has increased.AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer.METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University(January 2021 to July 2023)were retrospectively selected as research participants.Among them,134 received routine care intervention(routing group)and 66 received personalized and continuous care(intervention group).Self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores,including limb shoulder joint activity,complication rate,and care satisfaction,were compared between both groups after care.RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care.The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care.The range of motion of shoulder anteflexion,posterior extension,abduction,internal rotation,and external rotation in the intervention group was higher than that in the routing group one month after care.The incidence of postoperative complications was 18.18%lower in the intervention group than in the routing group(34.33%;P<0.05).Satisfaction with care was 90.91% higher in the intervention group than in the routing group(78.36%;P<0.05).CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer,quicken rehabilitation of limb function,decrease the incidence of complications,and improve living quality and care satisfaction.

Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease

BACKGROUND Despite sharing similar pathogenic factors,cancer and coronary heart disease(CHD)occur in comparable populations at similar ages and possess similar susceptibility factors.Consequently,it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD,a trend that is steadily rising.AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention(PCI).METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group(n=38)and the control group(n=41).In the intervention group,continuing care was provided,while in the control group,routine care was provided.An evaluation of cardiac and pulmonary function,medication compliance,a 6-min walk test,and patient quality of life was performed.RESULTS Differences between the two groups were significant in left ventricular ejection fraction,6-min walk test,oxygen uptake,quality of life and medication compliance(P<0.05).In comparison with the control group,the enhancement in the intervention group was more significant.The intervention group had more patients with high medication compliance than the control group,with a statistically significant difference(P<0.05).CONCLUSION After undergoing PCI,lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function,medications compliance,and quality of life.

Application Effect of WeChat Platform Continuity of Care Model Based on KAP Theory on Self-Management of Stroke Patients with Hypertension

Objective: To explore the impact of the WeChat platform continuity of care model based on the KAP (knowledge, attitudes, and practices) theory on the self-management of stroke patients with hypertension after discharge from the hospital. Methods: 62 stroke patients with hypertension discharged from the rehabilitation department of a tertiary A hospital in Nanning City, Guangxi Zhuang Autonomous Region, from October 2022 to April 2023 were sampled by convenience sampling method. Patients discharged from Rehabilitation I were included in the control group, and conventional nursing care was used;while patients discharged from Rehabilitation II were included in the observation group, and WeChat platform continuity of nursing care model based on the KAP theory was implemented. The intervention effect of the two groups was compared. Results: After 4 and 12 weeks of intervention, the diastolic and systolic blood pressure of the patients in the observation group were lower than those in the control group (P < 0.05);after 12 weeks of intervention, the rate of medication adherence and the score of adherence to hypertension treatment in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion: The application of the WeChat platform continuity of care model based on KAP theory to stroke patients with hypertension can improve blood pressure, medication adherence rate, hypertension treatment adherence, and overall enhance the self-management level of these patients.

Necessary prerequisites for evidence-based practice:results of investigating nurses'informatics competency and information literacy skills

This study aimed to evaluate the correlation between nursing informatics(NI)competency and information literacy skills for evidencebased practice(EBP)among intensive care nurses.This cross-sectional study was conducted on 184 nurses working in intensive care units(ICUs).The study data were collected through demographic information,Nursing Informatics Competency Assessment Tool(NICAT),and information literacy skills for EBP questionnaires.The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills,respectively.They received a moderate score for the use of different information resources but a low score for information searching skills,different search features,and knowledge about search operators,and only 31.5%of the nurses selected the most appropriate statement.NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales(P<0.05).Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making.Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

Effect of Continuous Care on Postpartum Anxiety among Primipara Mothers in China

Objective:The purpose of this study was to evaluate the effect of continuous care on postpartum anxiety in primipara mothers in China.Methods:A quasi-experimental,non-equivalent control group design was employed.The initial screening involved 120 primipara women from two hospitals in Shandong Province.Based on the inclusion criteria,60 eligible primipara mothers were selected to participate in the study.Results:The findings indicated that continuous care significantly reduced the anxiety levels of primipara mothers,as shown by a marked decrease in the scores on a researcher-developed anxiety scale.Conclusion:Continuous care has been proven to be an effective intervention for alleviating postpartum anxiety in Chinese primipara mothers and has a positive impact on their mental health and postpartum recovery.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Clinical application of multidisciplinary team-and evidence-based practice project in gynecological patients with perioperative hypothermia

BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.

Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

BACKGROUND The emergency department plays a crucial role in providing acute care to patients.Nursing interventions in this setting are essential for improving the continuity of care,enhancing patients’self-care abilities,and reducing psychological symp-toms.AIM To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department.METHODS A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023.The patients were divided into two groups:The control group(conventional nursing intervention)and the observation group(conventional nursing intervention+emergency department nursing intervention).The two groups were compared regarding continuity of care,self-care ability,psychological symptoms,and satisfaction with care.RESULTS The emergency department nursing interventions significantly improved the continuity of care,enhanced patients’self-care abilities,and reduced psycho-logical symptoms such as anxiety and depression.CONCLUSION Nursing interventions in the emergency department positively impact continuity of care,self-care,and psychological symptoms.However,it is important to acknowledge the limitations of this study,including the small number of studies,variable methodological quality,and the heterogeneity of the study population.Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department.Additionally,efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

The artificial intelligence evidence-based medicine pyramid

Several studies exist in the literature regarding the exploitation of artificial intelligence in intensive care.However,an important gap between clinical research and daily clinical practice still exists that can only be bridged by robust validation studies carried out by multidisciplinary teams.

Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage

BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.

Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease

BACKGROUND There are relatively few studies on continuing care of coronary heart disease(CHD),and its research value needs to be further clarified.AIM To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD.METHODS This is a retrospective study with patients from January 2021 to 2023.The study was divided into two groups with 30 participants in each group.Self-rating anxiety scale(SAS)and Self-rating depression scale(SDS)were used to assess patients'anxiety and depression,and medical coping questionnaire was used to assess patients'coping styles.The pelvic floor dysfunction questionnaire(PFDI-20)was used to assess the status of pelvic floor function,including bladder symptoms,intestinal symptoms,and pelvic symptoms.RESULTS SAS score decreased from 57.33±3.01before treatment to 41.33±3.42 after treatment,SDS score decreased from 50.40±1.45 to 39.47±1.57.The decrease of these two indexes was statistically significant(P<0.05).PFDI-20 scores decreased from the mean 16.83±1.72 before treatment to 10.47±1.3the mean after treatment,which was statistically significant(P<0.05).CONCLUSION The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients'treatment compliance,reducing anxiety and depression levels,and improving coping styles and pelvic floor functional status.

Reality of evidence-based practice in palliative care

There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine(EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard' randomised controlled trials(RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle(noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach' are likely to pose the correct clinical questions and derive evidencebased yet clinically relevant outcomes.

Evidence-based Care for Rehabilitation Nursing Effect of Patients with Patellar Fracture

Objective.To analyze the effect of applying evidence-based care in rehabilitation nursing effect of patients with patellar fractures.Methods.A total of 54 patients with patellar fractures were randomly selected from the hospital.The diagnosis and treatment time were from the beginning of July 2018 to end of June 2019.The digital table grouping was adopted to divide patients into two groups with each group consists of 27 patients with this disease.Both groups underwent routine nursing and the experimental group with increased evidence-based care.Results.Compared with the control group,the knee function evaluation,complications and nursing satisfaction of the experimental group were more ideal,and the difference was statistically significant(P<0.05).Conclusion.Evidence-based care in rehabilitation nursing of patients with patellar fracture can obtain ideal nursing effect.

Evidence-Based Practice and Job Satisfaction of Nurses in Long-Term Care

Purpose: The purpose of this study was to identify the relationship between evidence-based practice (EBP) and job satisfaction among nurses working in long-term care facilities. Methods: The study used a descriptive cross-sectional design. A total of 146 nurses working in 6 long-term care facilities in South Korea self-reported their perception of EBP implementation, barriers to research utilization, and job satisfaction. Results: The level of job satisfaction was higher in nurses who were single, older, more experienced, and had a higher income. Lower perceived barriers to research utilization were associated with greater job satisfaction. However, there was no significant relationship between a level of EBP implementation and job satisfaction. Factors influencing job satisfaction included lower barriers to the organization and communication domains of research utilization, being unmarried and older. Conclusion: Decreasing barriers to research utilization may improve the job satisfaction of nurses working in long-term care facilities.

A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

Continuing Care for Older Patients During the Transitional Period

Background： The world is facing increasing pressure with the continuous growth of the older population. Older patients are usually discharged with complex medical problems, high stress and vulnerability, and these factors place the elderly at risk for poor outcomes. Purpose： The present review summarizes a method for providing appropriate and affordable health services by nursing professionals to meet older patient＇s health care needs during their transitional period which is defined as a period from discharge after hospitalization for a major disorder to recovery in a home setting. Summary： Older patients with chronic diseases need seamless health care during a transitional period-a highly stressful and vulnerable period for them. Nurse professionals can conduct decent discharge planning to assist older patients with transitional problems through continuous healthcare. This review summarized the need of continuing care for older patients during the transitional period, the definition of discharge planning, the conceptual framework of discharge planning, and the professionals involved in discharge planning. It also highlighted the problems of discharge planning and follow-up intervention implementation in the mainland of China. Clinical implications： Inadequate discharge planning and follow-up were leading factors associ- ated with the readmission of discharged older patients. Further nursing-led discharge planning should be reinforced in China.

Pros and cons of continuous glucose monitoring in the intensive care unit

Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit(ICU).In addition,severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy.The innovation of continuous glucose monitoring(CGM)may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia,which may decrease the potential complications in patients in the ICU.The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels;thus,there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients.Recently,the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control,which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.In this mini-review paper,we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.