Objective： To explore the status quo of exercise self⁃efficacy in middle⁃aged and elderly patients with type 2 diabetes mellitus and analyze its influencing factors，so as to provide evidence for improving exercise self⁃efficacy. Methods： A total of 263 middle⁃aged and elderly patients with type 2 diabetes were selected from two Class A hospitals in Luzhou City from February to April 2023 by convenience sampling method.General data questionnaire，exercise self⁃efficacy scale，self⁃care ability scale and social support scale were used to investigate.Random forest algorithm was used to screen and rank the factors affecting exercise self⁃efficacy，and linear regression analysis was conducted to analyze the factors affecting exercise self⁃efficacy in middle⁃aged and elderly patients with type 2 diabetes. Results： The exercise self⁃efficacy score of middle⁃aged and elderly patients with type 2 diabetes was 55.10±9.35 points.Random forest algorithm showed that irregular exercise habits，self⁃care ability and social support were the top 3 variables before the disease.Residence，complications，irregular exercise habits before the disease，understanding of the benefits of exercise for diabetes，self⁃care ability and social support were factors influencing exercise self⁃efficacy in middle⁃aged and elderly patients with type 2 diabetes（<0.05）. Conclusion： Exercise self⁃efficacy of middle⁃aged and elderly patients with type 2 diabetes is at the lower level of medium.Medical staff can conduct targeted intervention according to relevant influencing factors，fully mobilize the exercise enthusiasm of patients，strengthen their social support system，and improve the exercise self⁃efficacy of patients.

Objective： To track the dynamic changes of psychological resilience of patients after total knee arthroplasty and to explore the related influencing factors of trajectory. Methods： Patients who underwent total knee arthroplasty in a tertiary grade A hospital in Qingdao from July 2022 to February 2023 were investigated on the day of admission，3 days after operation，on the day of suture removal 2 weeks after operation，on the day of follow up 1 month after operation and at a follow⁃up visit of 3 months after operation.The group⁃based trajectory model was used to identify the trajectory and category of psychological resilience.Logistic regression analysis was used to analyze the influencing factors of different trajectories. Results： After model fitting，four different psychological resilience trajectories were obtained，which were low psychological resilience stable group，medium psychological resilience stable group，low psychological resilience decline group and high psychological resilience rising group.Logistic regression analysis showed that education level，social support and positive and negative emotion were the influencing factors of psychological resilience in patients with TKA. Conclusion： There are four heterogeneous trajectory subgroups of psychological resilience in patients with TKA，and they change with time，but most patients can maintain a stable level after operation.Education level，perceived social support and positive and negative emotion were the influencing factors of patients' psychological resilience.

Objective： To construct a symptom network based on complex network analysis for breast cancer in stay⁃at⁃home period after chemotherapy，and to identify the core symptom and the influencing factors，so as to provide a basis for constructing an accurate symptom management plan. Methods： The M.D.Anderson Symptom Inventory⁃Chinese version was used to investigate the occurrence of symptoms in 478 breast cancer patients who were discharged from eight hospitals in Hunan province after chemotherapy and were in stay⁃at⁃home period.Symptom networks were constructed using R language and explored for strength，tight centrality and mediated centrality based on Spearman correlation and the Fruchterman-Reingold algorithm.Binary Logistic regression analysis was used to identify influencing factors. Results： Symptom network analysis revealed that the core symptom of breast cancer in stay⁃at⁃home period after chemotherapy was fatigue；binary Logistic regression analysis revealed that surgery，present residence，and chemotherapy cycle were influenting factors. Conclusion： Fatigue is the core symptom of breast cancer in stay⁃at⁃home period after chemotherapy.It is recommended that health care professionals should strengthen health education before patients are discharged from hospital，and instruct patients to report and deal with their symptoms actively to improve their quality of life in stay⁃at⁃home period.

Objective： To develop a questionnaire on the knowledge⁃attitude⁃practice（KAP） of blood phosphorus control in hemodialysis patients and to test its reliability and validity. Methods： According to the theory of KAP，the item pool was preliminarily developed through literature review and interviews with 5 experts.Delphi method was applied to consult 15 experts，and the first draft was formed according to the opinions of experts.A preliminary scale was used to investigate 298 hemodialysis patients in three centers of one hospital，and item analysis，reliability test and exploratory factor analysis were carried out.20 patients were retested after 1 week interval. Results： The answer rates of the two rounds consultation were 100%，and the expert authority was 0.960.The Kendall coordination coefficient of the two rounds were 0.132，0.112（all <0.05）.The formal KAP questionnaire of blood phosphorus control included 37 items in knowledge，attitude，behavior 3 dimensions.The overall content validity was 0.99，Cronbach's α coefficient was 0.943，the retest reliability was 0.959.Exploratory factor analysis produced 6 factors，2 factors in the knowledge dimension，1 factor in the attitude dimension，and 3 factors in the behavior dimension.The cumulative variance contribution rate was 68.276%，and the load of each item on each factor was>0.4. Conclusion： The questionnaire has good reliability and validity，and can be used to evaluate the KAP of blood phosphorus control in hemodialysis patients.

Objective： To investigate the risk factors of peripherally inserted central catheter（PICC） related upper limb venous thrombosis in lung cancer patients undergoing chemotherapy，construct a Nomogram model of the risk，and further verify the predictive value of this model. Methods： A total of 391 patients with primary lung cancer undergoing chemotherapy in the Department of Respiratory Medicine of our hospital from January 2014 to December 2020 were selected.The clinical data of the patients were compared and the independent risk factors of PICC⁃related upper limb venous thrombosis in patients with lung cancer undergoing chemotherapy were analyzed by multivariate Logistic regression model.R software integrates independent risk factors and constructs Nomogram models. Results： PICC-related upper limb vein thrombosis occurred in 89 patients（22.76%） receiving chemotherapy for lung cancer.BMI（≥27.49 kg/m），diabetes（yes），FIB（≥3.60 g/L），APTT（≥33 s），D⁃D（≥0.90 mg/L） and CRP （≥5.80 mg/L） were independent risk factors for PICC⁃related upper limb venous thrombosis in patients with lung cancer chemotherapy（<0.05）.The prediction of this Nomogram model is in good agreement with the actual observation，with a C⁃index of 0.832（95%CI 0.793⁃0.866），When the risk threshold is>0.05，this Nomogram model can provide additional clinical net benefit over individual risk factors in predicting the high risk of PICC related upper limb venous thrombosis in lung cancer chemotherapy patients. Conclusion： This Nomogram model based on BMI，diabetes，FIB，APTT，D⁃D，CRP and other independent risk factors is feasible to predict PICC⁃related upper limb venous thrombosis in patients with lung cancer chemotherapy，and can provide a important reference for clinical risk stratification and nursing strategy.

Objective： To explore the influence of different postures on the patient's breathing and comfort during anesthesia recovery after laparoscopic cholecystectomy were studied. Methods： A total of 236 patients who undergoing laparoscopic cholecystectomy（LC） were selected by convenience sampling.We divided the patients into four groups：group A（supine），group B（15° semi⁃recumbent），group C（30° semi⁃recumbent） and group D（progressive semi⁃recumbent） randomly，59 cases in each group.Patients' SPO，RR，Peak expiratory flow rate（PEF），forced expiratory volume（FVC），forced expiratory volume in one second（FEV），FEV/FVC，maximum inspiratory pressure（MIP），maximum expiratory pressure（MEP），respiratory complications，comfort was compared among four groups. Results： The values of PEF，FVC，FEV1，MIP and MEP in group B，C and D at 1 hour and 2 hours after the laryngeal mask was removed were higher than A group（<0.05）.FEV1/FVC of group B，group C and group D were higher than supine group at 2 hours after the laryngeal mask was removed（<0.05）.The MEP value of group C was higher than group B at 2 hours after the laryngeal mask was removed.The MIP and MEP values of the group D were higher than group B at 2 hours after the laryngeal mask was removed（<0.05）.Kolcaba Comfort scores of group B，group C and group D were higher than group A（<0.05）.The score of Kolcaba Comfort Scale in group D was higher than that in group A，B and C（<0.05）.There was no statistical significance in SPO，RR，respiratory complications，blood pressure，mean arterial pressure，body temperature，pain level，level of wakefulness between the four groups（>0.05）. Conclusion： 15° semi⁃supine position，30° semi-supine position and progressive semi⁃supine position after laryngeal mask removal after LC is conducive to lung ventilation and respiratory mechanical effect，and can obtain better comfort.The 30°semi⁃decubitus position and progressive semi⁃decubitus position are most conducive to the work of respiratory muscle，and the comfort of progressive semi⁃supine position is the best.

Objective： To explore the relationship between eating habits and multiple chronic diseases in the elderly and the risk factors，and to build a prediction model according to the risk factors. Methods： 484 elderly patients with chronic diseases admitted to our hospital from January 2020 to December 2023 were selected as the modeling group，including 363 patients with multiple chronic diseases（case group） and 121 patients with single chronic disease（control group）.Another 161 elderly patients with chronic diseases were selected as verification group.Obtain general information and eating habits of patients.The relationship between eating habits and multiple chronic diseases in the elderly was discussed by multivariate Logistic regression analysis，and the influencing factors were screened.According to the screened influencing factors，a Nomograph risk model was constructed，and the predictive effectiveness of the model was evaluated. Results： Eating too fast，eating too full，eating fried and pickled foods ≥4 d per week，being over 80 years old，having BMI>24.0 kg/m and having a family history were the influencing factors of multiple chronic diseases in the elderly（<0.05），while consumption of fresh vegetables and fruits ≥4 d per week and consumption of fish ≥4 d per week were protective factors（<0.05）.Based on the above influencing factors，the risk nomogram model was constructed.The internal verification results showed that the area under ROC curve was 0.873（95%CI 0.810⁃0.941），and the average absolute error between the actual value and the predicted value showed by the calibration curve was 0.025；The internal verification results show that the area under ROC curve was 0.912（95%CI 0.823⁃0.986），and the analysis of calibration curve showed that the average absolute error between the actual value and the predicted value was 0.022. Conclusion： Eating too fast，eating too full，eating fried and pickled food for ≥4 d per week，being over 80 years old，having BMI>24.0 kg/m and having a family history are the influencing factors of multiple chronic diseases in the elderly.The nomogram model based on this is helpful for the health management of such patients.