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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 evaluate the accuracy of different pressure injury risk assessment tools in paediatrics and identify risk assessment tools with the best predictive performance.
A systematic review and network meta-analysis.
Eight electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, China Knowledge Resource Integrated Database, Weipu Database, Wanfang Database and Chinese Biomedical Database were comprehensively searched. The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines 2020. Two researchers independently conducted article screening, data extraction and quality assessment. Statistical analysis was performed using R 4.3.1 and Stata 14.0.
A total of 20 articles were included in this study, involving 4908 patients and 13 pressure injury risk assessment tools for children, of which 15 articles were included in the network meta-analysis. The results showed that the Paediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET) had the highest superiority index, with the relative sensitivity (0.7, 95% confidence interval, CI: 0.0–1.5) and the relative specificity (1.4, 95% CI: 0.7–1.8). The next was Braden-Q combined with the Glamorgan scale, with a superiority index of 7.08, a relative sensitivity of 1.1 (95% CI: 0.5–1.5) and a relative specificity of 1.3 (95% CI: 0.8–1.7).
This study suggested that the PPUPET can comprehensively evaluate medical device-related pressure injuries in children, the Braden-Q scale had a better predictive performance for children aged 21 days–8 years in general paediatric departments, and the Glamorgan scale was suitable in the Paediatric Intensive Care Unit.
This review highlights that clinical practitioners should select appropriate assessment tools based on different departments and the age of children to accurately assess the risk of pressure injuries in children.
No Patient or Public Contribution.
PROSPERO CRD42023470769. http://www.crd.york.ac.uk/PROSPERO/#recordDetails.
To identify and synthesise the qualitative evidence that is available regarding reducing the turnover of hospital nurses from their own perspectives.
A qualitative systematic review using the meta-aggregation design.
Qualitative studies either in English or in Chinese, dating from 2018 to 2023, were obtained from eight databases, including CINAHL, PubMed, Web of Science, Embase, Ovid, and Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and the China Biomedical Database.
Studies were screened using pre-determined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines.
Sixteen papers were included that explored nurses' perspectives on enhancing their retention or reducing staff turnover. We developed three synthesised findings and 12 categories from 64 identified findings, including (1) individual adjustment strategy: professional pride, self-growth and psychological adjustment; (2) social support strategy: constructive workplace relationships, balancing work life and recognition of nursing and (3) organisational change strategy: embracing management and leadership, promote nursing professionalisation, workload management and support, flexible work patterns and opportunities, supporting personal career development and competitive salary.
This review provides an in-depth and meaningful understanding of nurses' own perceptions and suggestions for enhancing nursing turnover, which will call for a wide range of measures targeting the individual, social and organisational levels.
This study contributes important knowledge to help improve hospital nurse's turnover, which can provide evidence to support nurse managers, other stakeholders and policymakers in correspondingly developing effective measures to address nurse turnover.
There was no direct contribution from patient or caregiver to this study because the data of this study originated from published papers.
Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU.
To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU.
Multicentre prospective study.
A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately.
Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group.
This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups.
Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI.
None.
Conduct a systematic review of existing studies on intrinsic capacity (IC) and a meta-analysis of studies to assess the overall effectiveness of ICOPE in improving IC in older adults.
Ten databases were systematically searched from inception to November 8, 2023, and the search was last updated on January 2, 2024. Randomised controlled trials (RCTs) were included. The main outcomes were IC (cognition, psychological, sensory, vitality and locomotion).
The results showed ICOPE had a significant effect in improving cognitive function (SMD = 0.36; 95% CI, 0.17 to 0.56, p < 0.001, 12 RCTs, 7926 participants) and depressive symptoms (SMD = −0.70; 95% CI, −0.96 to −0.43, p < 0.001, 26 RCTs, 11,034 participants), but there was no statistically significant difference in improving locomotion (SMD = 0.16; 95% CI, −0.03 to 0.34, p = 0.098, 3 RCTs, 1580 participants). Meta-regression analysis shows that intervention duration should be paid attention to when the source of heterogeneity is discussed on the cognition.
The results suggest that ICOPE may be a potentially effective approach to help improve the IC in older adults, showing significant potential for improving cognitive function and reducing depressive symptoms in particular.
ICOPE is expected to provide effective strategies to enhance issues such as IC and may be an innovative way to improve the overall health of older adults. This result provides strong support for geriatric nursing practice and encourages the adoption of ICOPE as a viable nursing approach to promote healthy ageing.
To pool existing studies to assess the overall effectiveness of integrated care for older adults (ICOPE)-based interventions in improving depressive symptoms in older adults.
A systematic review and meta-analysis.
Ten databases were systematically searched from inception to 15 July 2023 and the search was last updated on 2 September 2023.
Standardized mean difference (SMD) was calculated using random effects models. RoB 2 and GRADEpro GDT were used to assess the methodological quality and confidence in the cumulative evidence. Funnel plots, egger's test and begg's test were used to analyse publication bias. Sensitivity, subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity.
The results of 18 studies showed ICOPE-based interventions had a significant effect on improving depressive symptoms (SMD = −.84; 95% CI, −1.20 to −.3647; p < .001; 18 RCTs, 5010 participants; very low-quality evidence). Subgroup analysis showed the intervention group was characterized by mean age (70–80 years old), intervention duration between 6 to 12 months, gender (female <50%), non-frail older adults, depressed older adults and mixed integration appeared to be more effective. Sensitivity analysis found the results to be robust.
ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults.
Healthcare professionals are expected to use ICOPE as one of the interventions for depressive symptoms in older adults, and this ICOPE could provide more comprehensive care services for older adults to reduce depressive symptoms.
ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. ICOPE-based interventions had a significant effect on reducing depressive symptoms in the older adults. The intervention group characterized by mean age of older adults, intervention duration, gender ratio, health condition and integration types may influence the effect size.
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
To evaluate the predictive validity and reliability of the Waterlow scale in critically adult hospitalised patients.
A multi-centre cohort study.
This study was conducted in 72 intensive care units (ICUs) in 38 tertiary hospitals in Gansu Province, China. All adults admitted to the ICU for greater than or equal to 24 h without pressure injury (PI) on admission were screened by the Waterlow scale on admission, during ICU stay and ICU discharge from April 2021 to February 2023. Receiver operating characteristic (ROC) curves were used to determine a potential cut-off value for critical adult hospitalised patients. Cut-off values were then determined using Youden's index, and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated based on these cut-off values. Test–retest reliability was used to evaluate inter-rater reliability.
A total of 5874 critical patients on admission were included, and 5125 of them were assessed regularly. The area under curve (AUC) was 0.623 (95% CI, 0.574–0.690), with a cut-off score of 19 showing the best balance among sensitivity of 62.7%, specificity of 57.4%, positive predictive value of 2.07% and negative predictive value of 99.08%. The test–retest reliability between the first assessment and the regular assessment was 0.447.
The Waterlow scale shows insufficient predictive validity and reliability in discriminating critical adults at risk of PI development. To further modify the items of the Waterlow scale, exploring specific risk factors for PI in the ICU and clarifying their impact degree was necessary. Risk predictive models or better tools are inevitable in the future.
Patients or family members supported nurses with PI risk assessment, skin examination and other activities during the inquiry.
(i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention.
A multi-centre prospective cohort study.
A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two-stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause-specific hazard model and verified using a sub-distribution hazard model. STROBE guidelines were followed in reporting this study.
Three thousand one hundred and sixty-six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double-lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause-specific hazard model. Higher BMI became an independent risk factor in the sub-distribution hazard model.
Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors.
Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies.
Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form.
The first step in preventing pressure injuries (PIs), which represent a significant burden on intensive care unit (ICU) patients and the health care system, is to assess the risk for developing PIs. A valid risk assessment scale is essential to evaluate the risk and avoid PIs.
To compare the predictive validity of the Braden scale and Waterlow scale in ICUs.
A multicentre, prospective and cross-sectional study.
We conducted this study among 6416 patients admitted to ICUs in Gansu province of China from April 2021 to October 2022. The incidence and characteristics of PIs were collected. The risk assessment of PIs was determined using the Braden and Waterlow scale. The sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve of the two scales were compared.
Out of 5903 patients, 72 (1.2%) developed PIs. The sensitivity, specificity, positive and negative predictive, and the area under the curve of the Braden scale were 77.8%, 50.9%, 0.014 and 0.996, and 0.689, respectively. These values for the Waterlow scale were 54.2%, 71.1%, 0.017, 0.994 and 0.651.
Both scales could be used for risk assessment of PIs in ICU patients. However, the accuracy of visual inspection for assessment of skin colour, nursing preventive measures for patients and scales inter-rater inconsistency may limited the predictive validity statistics.
Both scales could be used for PIs risk assessment. The low specificity of the Braden scale and low sensitivity of the Waterlow scale remind medical staff to use them in combination with clinical judgement and other objective indicators.
This study was designed to enhance the management of PIs. Patients and the general public were not involved in the study design, analysis, and interpretation of the data or manuscript preparation.
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