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To develop and validate a tool to estimate the risk of central venous catheter-related thrombosis (CRT) in children with congenital heart disease.
Children with congenital heart disease face an elevated risk of CRT, which is closely linked to adverse clinical outcomes. Early detection of CRT may improve prognosis and reduce mortality. However, no specific tools currently exist to effectively assess it.
A cross-sectional study.
From January 2020 to April 2023, we enrolled 503 children with congenital heart disease. Four hundred and three were assigned to the modelling cohort and 100 to the validation cohort. Using binary logistic regression, a predictive model was constructed, followed by the development of a dynamic online nomogram. The model's internal and external verification were performed using ROC analysis, the Hosmer–Lemeshow test, and decision curve analysis, respectively. The study adhered to the TRIPOD guidelines.
The prevalence of CRT in the modelling cohort and validation cohort was 23.57% and 21.00%, respectively. Logistic regression analysis identified duration of catheterization, length of ICU stay, duration of sedation, fibrinogen ≥ 4 g/L and platelet count ≥ 400 × 109/L as independent predictive factors for CRT, all of which were incorporated into the nomogram. The nomogram achieved an AUC of 0.866 in the modelling cohort and 0.761 in the validation cohort, demonstrating strong discriminatory power. In both cohorts, the calibration curve indicated good agreement and decision curve analysis confirmed its significant clinical utility.
We developed a dynamic online nomogram that demonstrated strong predictive accuracy and was practical for identifying CRT in children with congenital heart disease.
This nomogram enables healthcare providers to estimate the risk of CRT in children with congenital heart disease, offering an effective tool for risk stratification and a basis for implementing targeted interventions.
No patient or public contribution.
The objective of this study was to investigate the risk factors for post-operative hypothermia in adult patients and to develop a prediction model.
Post-operative hypothermia is one of the most common complications and thus increases the degree of clinical and nursing risk. The previous studies mainly focused on intraoperative or post-operative hypothermia with limited data.
Cohort study.
A total of 99,644 records including anaesthesia and post-anesthesia care files were retrieved from October 1, 2021 to February 10, 2023, including 89,663 files in the training group and 9981 files in the validation group. The primary outcome was the incidence of post-operative hypothermia in the post-anesthesia care unit. Multivariate logistic regression was used to identify risk factors for post-operative hypothermia. A logistic regression nomogram was subsequently created to predict the probability of post-operative hypothermia during the post-anesthesia care unit stay.
The independent risk factors for post-operative hypothermia included male sex, age, low body mass index, anaesthesia duration, chest surgery and urological surgery. A nomogram was established to predict the probability of post-operative hypothermia during the post-anesthesia care unit stay. In the model, the areas under the receiver operating characteristic curve values in the training and validation groups were 0.86 and 0.87, respectively. The Brier scores in the training and validation groups were 3.46% and 3.34%, respectively.
In this study, the incidence of post-operative hypothermia was 3.6%. The following variables are independently associated with post-operative hypothermia: age, male sex, BMI, duration of anaesthesia, surgical type and anaesthesia type. A novel prediction model is feasible for predicting the probability of post-operative hypothermia during the post-anaesthesia care unit stay.
TRIPOD + AI checklist.
Nurses can utilise the predictive model to assess the risk of post-operative hypothermia, offering valuable guidance for implementing preventive measures.
No patient or public contribution.
To investigate evidence-based practices and examine rates of adherence to bundles on maintenance of central venous catheters among intensive care unit nurses in 22 selected hospitals.
Although there has been an overwhelming increase in the use of evidence-based practices to reduce Central Line-Associated Bloodstream Infections, also known as bundles, there continues to be a considerable gap between clinical practice and evidence.
This study employs a multi-center cross-sectional design.
Registered nurses who worked in the ICUs of 22 selected hospitals were included. Evidence-based procedures were developed based on Central Line Bundles, which include an 11-area and 35-item checklist. Rates of adherence to bundles were calculated and analysed after reaching 22,000 central line days in 22 units. The study was reported using the STROBE checklist.
The average adherence rate to evidence-based procedures for CVC maintenance among ICU nurses in the 22 units was 87.40%. The adherence rate of five areas of the evidence-based procedure based on the Central Line bundle was above 90%, including ‘Selection of regulated skin disinfectants’, ‘Tube sealing’, ‘Tube flushing’, ‘Dressing and catheter fixation’ and ‘Sterilized skin and catheter’. The three lowest-achieving areas of bundles were ‘Catheter and insertion site assessment,’ ‘Hand hygiene’ and ‘Sterilized catheter access hubs’. The lowest-achieving item of bundles is ‘Assess during multidisciplinary patient care rounds with signature confirmation’. The adherence rates in hospitals where CLABSI occurred were all less than 90%.
ICU nurses' adherence to maintenance bundles for CVC is moderate, implying that boosting adherence rates is critical for improved results. As a result, comparable studies should be done in ICUs where the bundle has been deployed to assess and improve adherence rates through effective interventions. To minimise CLABSI in future practice, novel strategies must be developed and implemented via continued education and regular evaluation.
We registered the trial with the US Clinical Trials Registry (ID: NCT06085690, Name: Multicenter Clinical Translational Study of ‘ICU-NO CRBSI’ Based on Improvement Science, https://ichgcp.net/clinical-trials-registry/NCT06085690)
Nurse administrators and policymakers can develop strategies and interventions for improving the quality of CVC care toward evidence-based practice. Minimising the gaps between evidence and practice will reduce the incidence of CLABSI to enhance the survival of critically ill patients.
In addressing the status of evidence-based practices among ICU nurses, this study enhances healthcare quality and outcomes.
There was no patient or public contribution.
To evaluate the effectiveness of positive psychological interventions on quality of life, positive psychological outcomes and negative psychological outcomes in patients with cancer.
Patients with cancer often suffer from various psychological problems and have a poor quality of life. Positive psychological interventions have been increasingly applied to patients with cancer, but the results of these studies have not been synthesized.
A systematic review and meta-analysis of randomized controlled trials according to PRISMA.
Six English databases and four Chinese databases were searched from the inception to December 2022. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias tool. RevMan was used for meta-analysis.
Twenty-nine randomized controlled trials examined the effects of positive psychological interventions including meaning therapy, dignity therapy, positive psychotherapy, mindfulness- based intervention, life review, expressive writing intervention, acceptance and commitment psychotherapy, attention and interpretation therapy, compassion training and spiritual therapy on patients with cancer. Positive psychological interventions significantly improved the quality of life, enhanced positive psychological outcomes including well-being, meaning of life, self-esteem, optimism, resilience and self-efficacy and alleviated negative psychological outcomes including depression, anxiety and hopelessness. However, the heterogeneity of some outcomes was rather high, due to the wide diversity of the interventions included.
Positive psychological interventions have potentially positive effects on improving quality of life, enhancing positive psychological outcomes and alleviating negative psychological outcomes in patients with cancer. However, due to the heterogeneity and the lack of follow-up studies, more high-quality studies are needed to confirm the results of our review and to clarify the long-term effects of positive psychological interventions.
As feasible psychological interventions, healthcare professionals can consider applying appropriate positive psychological interventions according to the condition of cancer patients.
No patient or public contribution.
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