This consensus was developed to standardize clinical nursing practice for adult patients with non-HIV-associated cryptococcal meningitis， with the goal of enhancing the quality of care and improving patient prognosis. The development process involved systematic evidence retrieval from major Chinese and English databases， supplemented by in-depth interviews with clinical specialists， leading to the formulation of a preliminary draft. Subsequent revisions through two rounds of Delphi expert consultations and one multidisciplinary panel meeting culminated in the finalized consensus. The framework encompasses six critical domains： comprehensive nursing assessment， intravenous therapy and pharmacotherapeutic management， nursing care for related symptoms， perioperative nursing care， prevention and management of common complications， and structured rehabilitation. Particular emphasis is placed on holistic patient evaluation， tailored therapeutic drug monitoring， early recognition of complications， and integrated rehabilitative continuity. This consensus seeks to deliver an evidence-based， standardized operational framework for specialized nursing practice， thereby safeguarding therapeutic efficacy and promoting excellence in patient care.
In response to the clinical needs and patient expectations regarding adult enterostomy care in China， the Wound， Ostomy and Continence Nursing Committee of Chinese Nursing Association cooperated with Professional Committee of Integrated Nursing for Colorectal Cancer of China Anti-cancer Association and Evidence-based Nursing Center of Peking University Health Science Center to organize a panel of national experts in relevant field to form a guideline development team. Following the WHO Handbook for Guideline Development， the team systematically reviewed literature and conducted rigorous quality assessments addressing defined clinical issues. Through expert consensus meetings， recommendations were formulated， and the initial draft of the Guideline for Adult Enterostomy Care （hereinafter referred to as the Guideline） was prepared. The draft Guideline underwent review by 24 experts from various regions across China. Based on their feedback， the Guideline was revised， and a final expert meeting was convened to formulate the final version. The finalized Guideline covers four major aspects： preoperative care， postoperative care， rehabilitation care， and management of enterostomy and peristomal skin complications， comprising a total of 89 recommendations. Based on the best evidence available， current domestic clinical practices， and professional judgment， the Guideline is highly scientific and practical， which can be applied to guide clinical practice in adult enterostomy care.
Health education，as an essential component of patient-centered nursing services，spans the entire care continuum including patient visits， hospitalization， and post-discharge follow-up. However， constrained by limited nursing staff and increasing workloads， traditional approaches often face clear limitations such as insufficient personalization，low implementation efficiency，and limited patient engagement. In recent years，artificial intelligence—particularly multi-agent systems based on large language models—has demonstrated unique advantages in natural language interaction，autonomous perception，and reasoning-based decision-making，offering new opportunities for the intelligent transformation of nursing health education. This paper focuses on the applications and practical challenges of multi-agent systems in nursing health education. From the perspectives of precision， adaptability， workload reduction， interactivity， and scalability，it outlines innovative pathways through which multi-agent systems can empower health education. Furthermore， based on different clinical application scenarios and practice functions， the paper identifies potential configurations of multi-agent systems and their collaborative modes that may support health education. The aim is to provide insights for advancing the practical implementation of multi-agent systems in nursing practice.
Objective To explore the role of “Information-Knowledge-Attitude-Practice （IKAP）” education model in the management of symptom clusters of patients with chronic obstructive pulmonary disease （COPD）， and assess the feasibility of mitigating symptom clusters. Methods COPD patients admitted to Department of Pulmonary & Critical Care Medicine of the Third Affiliated Hospital of Sun Yat-sen University in 2024 were recruited by convenience sampling. In this non-concurrent prospective study， 63 patients hospitalized from January to May 2024 were included in the control group and received regular health education and follow-up. 62 patients hospitalized from August to December 2024 were enrolled in the intervention group and received IKAP health education and follow-up. The improvement of symptom clusters was assessed by using COPD Assessment Test （CAT） and modified Medical Research Council Dyspnea Scores （mMRC）. The anxiety state of patients was evaluated by HAMD-17 and HAMA. The health status was assessed by using St. George’s Respiratory Questionnaire （SGRQ）. The treatment compliance was evaluated using Chronic Disease Self-Efficacy Scale （CDSES） and pulmonary rehabilitation program compliance questionnaire. The objective respiratory function was assessed by comparison of PaO2， PaCO2 and SpO2 before and after intervention. Results There were no significant differences in clinical characteristics between two groups （all P > 0.05） before treatment. After IKAP health education， the score of CAT was （12.87±4.74）， 2.00 （1.00，2.00） for mMRC， （18.37±5.23） for HAMD-17， 3.00 （2.00，4.25） for HAMA， 20.15 （11.70，29.85） for SGRQ and （44.33±8.88） mmHg for PaCO2 were significantly lower than （20.14±8.02）， 2.00 （1.00，3.00）， （23.11±9.05）， 4.00 （2.00，6.00）， 26.70 （14.30，35.50） and （51.57±12.88） mmHg in the control group， respectively （all P < 0.05）. In the intervention group， PaO2 was measured as （84.64±15.47） mmHg， SpO2 was （94.69±2.37）%， CDSES was （26.82±3.57） and pulmonary rehabilitation program compliance was （21.82±2.43）， significantly higher than （72.92±13.10） mmHg， （92.32±2.47）%， （19.67±2.21） and （14.97±2.01） in the control group， respectively （all P < 0.05）. Conclusions Application of IKAP education model in the management of symptom clusters of COPD patients could improve the quality of life by enhancing patients’ self-management ability and treatment compliance as well as reducing the events of hypoxemia and hypercapnia. IKAP model provides a beneficial health education strategy for long-term management of COPD patients.
Objective To evaluate the scientificity of artificial intelligence （AI）-based localization model for venous puncture sites in contrast-enhanced imaging examination and evaluate its clinical efficacy. Methods A prospective observational study was conducted. A total of 433 patients who underwent contrast-enhanced imaging examination at Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Shenshan Central Hospital of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 25 to July 11， 2025 were collected. Data were summarized and analyzed with reference to the indicators in the standardized application of a three-level evaluation model for inspecting peripheral venous access through image enhancement. Multimodal data were collected to establish an intelligent data preprocessing framework and develop an AI-based localization model for venous puncture sites in contrast-enhanced imaging examination. Taking the puncture sites confirmed by nurses with more than 5 years of working experience in Radiology Department as the gold standard， the degree of agreement between the puncture sites recommended by the AI-based localization model and the gold standard was evaluated. Results Among 433 patients， 380 cases were allocated into the low-risk group and 53 into the high-risk group. The Dice coefficient and Intersection over Union （IoU） of the AI-based localization model were 0.593 1 and 0.496 8， respectively， with an overall accuracy of 0.967 1. In the low-risk group， the Dice coefficient and IoU were 0.617 8 and 0.506 9， the recall rate reached 0.791 2， and the MLE score was 68.07， respectively. In the high-risk group， the Dice coefficient and IoU were 0.553 1 and 0.478 2， the recall rate was 0.702 4， and the MLE score was 64.18， respectively. There were significant differences in the Dice coefficient， IoU， accuracy rate， recall rate and MLE score between the low-risk and high-risk groups （all P < 0.001）. In the age stratification analysis， the Dice coefficients in the youth， middle-aged and middle-aged groups were 0.581 0， 0.659 8 and 0.629 2， and the IoU was 0.456 3， 0.502 1 and 0.529 8， the accuracy rates exceeded 0.95 and the recall rates were 0.635 0， 0.759 1 and 0.710 4， respectively. The Dice coefficient and IoU in the elderly group were 0.550 6 and 0.524 7， the accuracy rate was 0.946 3 and recall rate was 0.670 1， respectively. There was statistical significance in each index between any of two groups （all P < 0.05）. Conclusion The AI-based localization model established in this study can effectively improve the robustness of puncture site localization， provide consistent explanations aligned with clinical intuition， and offer an efficient， safe guidance regimen for selecting venous puncture sites.
Objective To investigate the prevalence of frailty among patients with post-stroke dysphagia at one month after discharge and analyze its influencing factors. Methods A convenience sample of 206 patients with post-stroke dysphagia admitted to the First Affiliated Hospital of Zhengzhou University was enrolled. Relevant data at admission， discharge， and one month post-discharge were collected. The level of frailty and associated factors at one month post-discharge were assessed using univariate analysis and ordinal logistic regression analysis. Results The prevalence of frailty among patients with post-stroke dysphagia at one month post-discharge was 78.2%， comprising 18.0% in pre-frailty and 60.2% in full frailty. High admission modified Rankin Scale （mRS） score （OR=1.842， P = 0.004）， high discharge Nutritional Risk Screening 2002 （NRS 2002） total score （OR=1.420， P = 0.031）， and high discharge frailty level （OR=6.218， P < 0.001） were the risk factors for frailty at one month post-discharge in patients with post-stroke dysphagia. Absence of comorbidities （OR=0.177， P = 0.002） and high body mass index （BMI， OR=0.377， P = 0.001） were the protective factors. Conclusions Patients with dysphagia after stroke exhibit a high incidence of frailty at one month post-discharge， influenced by multiple factors including admission mRS score， discharge NRS 2002 score， discharge frailty grade， comorbidities， and BMI， etc. Healthcare institutions are advised to establish multidisciplinary collaborative management systems for comprehensive intervention.
Objective To analyze the independent risk factors for diabetic nephropathy （DN） in obese patients with type 2 diabetes mellitus （T2DM）， and to construct and validate a nomogram-based assessment model for the risk of DN in obese T2DM patients. Methods 370 obese T2DM patients treated at the Department of Endocrinology and Metabolic Diseases， the Third Affiliated Hospital of Sun Yat-sen University between January 2021 and December 2023 were retrospectively enrolled. According to urinary albumin/creatinine ratio （ACR）， all patients were categorized into the DN （n = 79） and non-DN （n = 291） cohorts， and then randomly allocated into the training （70%， n = 259） and validation （30%， n = 111） groups. Comprehensive clinical data including laboratory parameters and comorbidities were collected. Variable selection was optimized using LASSO regression， and a nomogram assessment model was constructed based on multivariate Logistic regression analysis. The discriminatory performance， calibration accuracy， and clinical applicability of the model were assessed utilizing the receiver operating characteristic （ROC） curve， Hosmer-Lemeshow （H-L） test， and decision curve analysis （DCA）， respectively. Results Significant intergroup differences were observed in age， duration of diabetes， hypertension， hyperlipidemia， osteoporosis， cerebral infarction， coronary artery disease， systolic blood pressure， waist circumference， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， albumin （ALB）， blood urea nitrogen （BUN）， creatinine （Cr）， and cystatin C （CysC） （all P < 0.05）. LASSO regression identified seven candidate factors， and multivariate Logistic regression confirmed that duration of diabetes （OR=1.174， 95% CI=1.098-1.265）， hypertension （OR=10.332， 95% CI=3.941-31.499）， ALB （OR=0.840， 95% CI=0.752-0.931）， and Cr （OR=1.016， 95% CI=1.005-1.029） as significant influencing factors for DN （all P < 0.05）. Based on these findings， a nomogram assessment model was constructed. The nomogram demonstrated excellent discrimination： the area under the ROC curve （AUC）=0.913 （95% CI=0.871-0.955） in the training cohort， and AUC=0.919 （95% CI=0.856-0.982） in the validation cohort. H-L goodness-of-fit tests indicated satisfactory calibration in both cohorts （training set： χ 2= 4.048， P = 0.853； validation set： χ 2=6.162， P = 0.629）. Conclusion Duration of diabetes， hypertension， serum Cr， and ALB levels constitute significant influencing factors for DN development in obese T2DM patients. The validated nomogram incorporating these four parameters provides clinically applicable risk stratification for this population.
Objective To evaluate the long-term effectiveness of a remote case management model in the post-discharge follow-up for patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods A total of 200 CHD patients who underwent PCI at the First Affiliated Hospital of Jinan University were selected as study participants. 100 patients enrolled in 2021 were assigned into the control group and received conventional discharge guidance and outpatient follow-up， while 100 patients enrolled from February to June 2023 were assigned into the intervention group and received a remote case management model supported by a multidisciplinary team （including comprehensive assessment， individualized planning， telephone/WeChat follow-up， and specialized nursing clinics）. After 12 months of intervention， comparisons were made between the two groups regarding metabolic indicators （blood lipids， blood glucose， renal function， etc.）， left ventricular ejection fraction （LVEF）， medication adherence （MMAS-8 scale）， and the incidence of major adverse cardiovascular events （MACE）. Results After 12 months of intervention， patients in the intervention group showed significantly better outcomes than their counterparts in the control group in fasting blood glucose [（5.59±1.22） vs. （6.01±1.63） mmol/L， P = 0.040]， glycated hemoglobin [（5.97±0.74）% vs. （6.34±1.10）%， P = 0.006]， total cholesterol [（3.26±0.77）vs.（3.55±0.99） mmol/L， P = 0.019]， triglycerides [（1.32±0.81） vs. （1.73±1.14）mmol/L， P = 0.004]， low-density lipoprotein [（1.64±0.55） vs. （1.84±0.76）mmol/L， P = 0.036]， uric acid [（396.24±93.91） vs. （434.48±113.74）μmol/L， P = 0.010]， and creatinine [（84.15±26.29）μmol/L vs. （97.76±50.18）μmol/L， P = 0.017]. In the intervention group， the medication adherence score was significantly higher [（7.04±0.85）μmol/L vs. （6.52±0.94）μmol/L， P < 0.001]， and the incidence of MACE was significantly lower （6.0% vs. 16.0%， P = 0.024） compared with those in the control group. No significant differences were observed in LVEF and high-density lipoprotein levels between two groups （both P > 0.05）. Conclusions The implementation of a remote case management model for CHD patients after PCI can improve medication adherence， optimize risk factors such as glucose and lipid metabolism， and reduce the incidence of MACE. It is an effective secondary prevention management strategy worthy of clinical promotion and application.
Objective To explore the relationship between rehabilitation exercise adherence， health beliefs and family care in stroke patients， as well as the influencing factors. Methods A total of 201 stroke patients treated in the Department of Neurology， the Third Affiliated Hospital of Sun Yat-sen University， from November 1， 2024 to January 25， 2025 were enrolled in this study. Among them， 130 were male and 71 were female， with a mean age of （64.2±13.3） years. A questionnaire survey was conducted using a general information questionnaire， the Exercise Adherence Questionnaire （EAQ）， the Short Form Health Belief Model Scale （SF-HBMS） and the Family Adaptation， Partnership， Growth， Affection， Resolve Index （APGAR） for the stroke patients. The differences of measurement data with normal distribution between groups were compared using t-test or one-way analysis of variance. The relationships between rehabilitation exercise adherence， health beliefs and family care were analyzed by Pearson correlation analysis. The influencing factors of rehabilitation exercise adherence were analyzed by multiple linear regression analysis. Results The stroke patients showed an overall moderate level of rehabilitation exercise adherence， with an adherence index of （65.21±16.48） %. Specifically， 33.8% demonstrated high adherence， 45.8% moderate adherence and 20.4% low adherence. Health beliefs were at a moderate level， with a score of 71.24±12.39. Family care was overall good， with a score of 7.39±2.42， and 68.6% of the patients demonstrated good family functioning. Stroke patients showed a positive correlation between rehabilitation exercise adherence and both health beliefs （r = 0.701， P < 0.01） and family care （r = 0.659， P < 0.01）. Health beliefs were also positively correlated with family care （r = 0.673， P < 0.01）. Multiple linear regression analysis indicated that health beliefs， family care， age， employment status and self-care ability were the main factors influencing rehabilitation exercise adherence， collectively accounting for 61.6% of the variance in adherence （F = 18.795， P < 0.001）. Conclusions Stroke patients exhibit a moderate level of rehabilitation exercise adherence. Health beliefs and family care are the significant influencing factors for the adherence to rehabilitation exercises.
Objective To summarize self-care experience of patients with indwelling catheter for percutaneous transhepatic cholangiography and drainage （PTCD）， analyze obstacle and promotive factors， providing evidence for improving self-care behaviors of these patients. Methods Using descriptive qualitative method， Capability-Opportunity-Motivation-Behavior （COM-B） model was used as the theoretical framework. Patients undergoing PTCD in Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from February to August 2024 were enrolled in this study. The eligible subjects were screened by focal sampling method. Relevant data were collected by semi-structured interviews. Interview data were systematically analyzed by quantitative content analysis method. Results According to the interview content， obstacle factors were extracted as 3 themes and 9 sub-themes： lack of self-care capability （lack of PTCD-related knowledge and weak capability for handling accidents）， lack of self-care motivation （symptom distress， decreased self-efficiency， limited daily life and sense of shame）， and weak social support system （access to medical resources， lack of family support for solitary individuals， stigma and exclusion in social network）. Promotive factors included 3 themes of strong autonomous learning capability， positive feedback to symptom management， and collaborative support from family and Internet hospitals. Conclusion Patients with indwelling catheter of PTCD face multiple challenges in the process of self-care. It is necessary to strengthen health education， improve health literacy levels， enhance inner driving force and improve social support system， aiming to improve self-care behaviors of these patients.
Myasthenia gravis （MG) is manifested with prolonged treatment duration, fluctuating symptoms and potential lethality, and imposes a significant disease burden on both patients and their families, necessitating long-term and effective health management. Digital health technologies demonstrate significant potential in the health management of MG patients. Digital symptom assessment employs artificial intelligence to achieve objective quantification of ptosis, respiratory function, and vital signs, thereby enhancing the accuracy of remote assessment. Remote dynamic monitoring integrates data related to symptoms, medication and physiological parameters via mobile platforms and wearable devices and enables continuous monitoring and early warning, thereby elevating patients’ self-management capabilities. Digital health cognitive guidance, facilitated by large language models and digital video platforms, can provide personalized health education, promote knowledge dissemination and address the limitations of traditional educational resources. This review summarizes the applications of digital symptom assessment, remote dynamic monitoring and digital health education in MG patients, aiming to provide insights for future digital health management strategies for MG patients.
With the aging of the population and improvements in medical services， the demand for surgical procedures among patients has been steadily increasing. However， while surgery helps control diseases， it also causes damage to the body. Elderly patients， due to reduced cardiopulmonary compensatory capacity， have significantly higher rates of perioperative complications and mortality. Prehabilitation is a process based on the principles of enhanced recovery after surgery （ERAS）， involving a series of measures implemented in the preoperative phase to enhance patients’ tolerance to upcoming physiological stress. These measures aim to strengthen functional reserves， optimize nutritional status， and improve psychological well-being， thereby reducing the incidence of postoperative complications and enhancing postoperative quality of life. This article reviews the current research progress on the application of prehabilitation strategies in elderly surgical patients， including the concept of prehabilitation， its current status， specific intervention measures， recommended application timing， challenges faced， and its application outcomes in elderly surgical patients. The aim is to provide clinical guidance for developing standardized prehabilitation intervention protocols for the elderly， with the goal of improving the prognosis of elderly surgical patients.
