Abstract Background Intra-hospital transfers (IHT) of hospitalized children are unavoidable practices often performed with emergency patients and postoperative patients. Standardizing IHT processes to minimize adverse events might improve children’s outcomes. We developed an evidence-based clinical practice IHT guideline for hospitalized children. The aim of this study was to evaluate the implementation process and the effectiveness of the implementation of this guideline on patient outcomes, healthcare professionals’ knowledge and behavior, and hospital organizational context. Methods A type III hybrid effectiveness-implementation design was adopted, using a pre-post intervention trial (January-December 2024). Data of patient demographics, transport-related outcomes, and healthcare providers’ knowledge and compliance were collected. We used the RE-AIM framework to assess effectiveness across four dimensions: Reach, Effectiveness, Adoption, and Implementation. Totally, 110 healthcare professionals conducted 213 IHTs of eligible children (109 children in the pre-intervention group and 104 in post-intervention group). Results The Reach outcomes demonstrated that participation among hospitalized children ( n = 312) was suboptimal at 33% (104/312). No differences were observed between the pre- and post-intervention group regarding gender, disease distribution, or pediatric early warning scores. The implementation showed favorable outcomes in the dimensions Effectiveness, Adoption, and Implementation. Healthcare professionals engagement was 95%, with 86% (19/22) of the implementation strategies successfully completed. Healthcare professionals’ knowledge in the pre-intervention group ( n = 109) improved from median 40 (IQR 28;52) to median 76 (IQR 64;84) in the post-intervention group ( n = 104; p < 0.001). Clinically, the new guideline reduced adverse events (12 vs 4; p = 0.047), reduced the median minutes of bedside handover time from 5 (IQR 3;7) to 4 (IQR 3;5; p < 0.001), and improved handover information completeness from median score of 5 (IQR 4;6) to 20 (IQR 12;23, p < 0.001). The total transport time increased from 14 to 19 minutes in the post-intervention group ( p < 0.05), while no significant changes were observed in handover interruptions or post-transfer vital sign stability ( p > 0.05). Conclusion The RE-AIM-based evaluation confirmed that the implementation strategies effectively enhanced healthcare professionals’ knowledge and compliance while reducing adverse events and optimizing handover efficiency. However, the limited patient participation rate and increased transport duration highlight areas requiring further refinement to maximize the guideline’s impact. Trial registration ClinicalTrials.gov, NCT06512805. Registered 27 June 2024.

Background:Peripheral arterial catheterization (PAC) is widely used in pediatric intensive care units (PICUs) for continuous hemodynamic monitoring and arterial blood sampling. However, achieving successful arterial access in critically ill children remains technically challenging, and evidence regarding factors associated with first-attempt success is limited. Methods:A prospective observational cohort study was conducted in a tertiary PICU. Critically ill children who underwent PAC between April 2024 and May 2025 were included. Each catheterization procedure was treated as the unit of analysis, with clustering at the patient level. Patient-, disease-, procedure-, and peri-procedural variables were collected. The primary outcome was first-attempt success, defined as successful arterial catheterization within a single skin puncture at the intended site with limited needle redirection, resulting in a functional arterial line suitable for continuous blood pressure monitoring or arterial blood gas sampling. Factors associated with first-attempt success were evaluated using multivariable generalized estimating equation (GEE) logistic regression models. Results:A total of 320 PAC procedures were analyzed, with an overall first-attempt success rate of 65% (208/320). In multivariable GEE logistic regression analysis, insertion site and catheterization technique were independently associated with first-attempt success. Compared with radial artery catheterization, cannulation at the dorsalis pedis artery (OR 0.41, 95% CI 0.20-0.83), and ulnar artery (OR 0.35, 95% CI 0.13-0.98) was associated with lower odds of success. Ultrasound-guided catheterization was associated with higher odds of first-attempt success compared with the blind technique (OR 2.10, 95% CI 1.08-4.08). Using early ultrasound rescue at the second attempt as the reference, ultrasound introduced after the fourth attempt was associated with a higher number of cannulation attempts (IRR 3.81, 95% CI 2.05-7.08). Conclusion:First-attempt success of PAC in critically ill children is influenced by both puncture site and catheterization technique. Preferential use of the radial artery and ultrasound guidance may improve cannulation success in the PICU. Early adoption of ultrasound guidance after failed landmark-guided attempts may help reduce repeated cannulation attempts.

AIMS:Pain is common and challenging to assess in the paediatric intensive care unit (PICU), highlighting the need for targeted training. We previously developed PainScan, a visualization-based training platform and aimed to investigate the efficacy of PainScan in improving PICU nurses' pain assessment competencies and to describe their learning experience with PainScan. DESIGN:This study employed a mixed-methods design, integrating a superiority, randomized parallel controlled trial with embedded qualitative research. The RCT component of this study was prospectively registered at ClinicalTrials.gov (NCT06431802) prior to participant enrollment. METHODS:Eligible PICU nurses from a tertiary children's hospital in Shanghai, China, took part in the trial. 70 PICU nurses were recruited and randomly assigned to either the PainScan training group or the on-site training group using stratified randomization, with 35 individuals in each group, over 4 weeks. Primary outcomes were PICU nurses' knowledge and skill levels in pain assessment. Outcome assessors were blinded to group allocation. Following the training, a descriptive qualitative study was conducted using semi-structured interviews with 11 PICU nurses, who had participated in PainScan training, to gain insights into their learning experience. RESULTS:A total of 69 participants (35 in the PainScan group, 34 in the on-site training group) were included in the primary outcome analysis, as one participant (1.4%) in the on-site training group withdrew due to a rotation change. Both PainScan training and on-site training significantly improved PICU nurses' knowledge (PainScan: t = 10.249, on-site: t = 10.592, both p < 0.001) and skill levels in pain assessment (PainScan: Z = -5.138, on-site: Z = -4.847, both p < 0.001). Compared to traditional on-site training, the PainScan showed superior skill development (Z = -3.644, p < 0.001). Qualitative findings revealed that the platform: (1) competency enhancement in pain assessment through PainScan training; (2) advantages of the digital learning platform; and (3) limitations of the PainScan training. CONCLUSION:PainScan effectively enhanced PICU nurses' pain assessment competencies. It also enriched their learning experience through a realistic, immersive and flexible approach. However, improvements are needed in supervision, engagement and scalability. REPORTING METHODS:The randomized controlled trial was reported according to CONSORT 2025, and the qualitative component was reported following COREQ. PATIENT OR PUBLIC CONTRIBUTION:This study shows that PainScan is a practical and cost-effective training tool for PICU nurses. It can enhance pain assessment skills with flexible learning. Addressing feedback on supervision and engagement could further optimize its use in clinical practice to improve patient care.

BACKGROUND:Most critically ill children in the paediatric intensive care unit (PICU) are immobilised. Prolonged immobilisation in the PICU negatively affects children's physical health outcomes. AIM:The aim of the study was to evaluate the effectiveness of an early progressive exercise (EPE) intervention to improve the PICU-acquired muscle weakness and to assess the safety of the EPE intervention. STUDY DESIGN:A single-centre pre- and post-intervention design was adopted. The intervention was the EPE starting within 48-72 h after PICU admission. Primary outcome was the 7-day difference of right rectus femoris muscle cross-sectional area (RRMCSA). Secondary outcomes were the 7-day difference of right rectus femoris muscle thickness (RRMT), the 7-day difference of the right thigh leg circumference, length-of-stay, functional status score (FSS) and the incidence of intervention-related adverse events. RESULTS:Included were 29 children in the pre-intervention group and 32 children in the post-intervention group who did not require mechanical ventilation during PICU admission. The 7-day difference of RRMCSA in the post-intervention group was smaller than in the pre-intervention group, (-0.13 ± 0.13 cm2 versus -0.28 ± 0.10 cm2, p < 0.001). The RRMT at 7-day was also smaller in the post-intervention group (-0.08 ± 0.09 cm versus -0.23 ± 0.08 cm, p < 0.001). FSS of the post-intervention group was significantly lower than that of the pre-intervention group (p < 0.05). Differences in right thigh circumference, and length-of-stay were not observed between both groups. Children in the post-intervention group completed a total of 224 exercise sessions (completion rate 99.2%). No adverse events were observed. CONCLUSIONS:EPE slowed muscle atrophy and was safe and feasible in children without mechanical ventilatory support in the PICU. Further research needs to confirm early rehabilitation on short-term and long-term physical health outcomes after PICU discharge. RELEVANCE TO CLINICAL PRACTICE:PICU nurses should consider using early progressive exercise in critically ill children in the PICU and have parents involved in these early rehabilitation programmes. TRIAL REGISTRATION:Chinese Clinical Trial Registry https://www.chictr.org.cn/indexEN.html number: ChiCTR2100047629.

The optimal timing of the first dressing change after central venous catheter (CVC) insertion remains unclear. To test whether a first dressing change at seven days is non-inferior to an additional change at 24 h, we conducted a multicenter randomized controlled non-inferiority trial in four Chinese pediatric ICUs (April 2021-December 2022). A total of 280 patients aged 1 month to 18 years with a newly inserted CVC were randomly assigned to the control group (dressing change at 24 h, then every seven days) or the experimental group (first dressing change at seven days). The primary outcome was skin bacterial colonization under the transparent dressing, assessed at day 7 (experimental) and day 8 (control). In the intention-to-treat population, colonization occurred in 25.6% of experimental patients and 26.8% of controls (difference, - 1.1%; 95% CI, - 13.0% to 10.7%), with the upper CI limit below the prespecified noninferiority margin of 20%. Catheter related bloodstream infection(CRBSI) rates were 1.42 vs. 2.72 per 1,000 catheter days (no significant difference). Only one skin injury occurred. Delaying the first dressing change to seven days did not increase skin bacterial colonization and showed no significant difference in CRBSI, suggesting that this practice is safe with respect to colonization risk. Definitive conclusions regarding infection safety require a larger trial.

INTRODUCTION:Arterial catheters are widely used in intensive care units for continuous hemodynamic monitoring and blood collection. Evidence-based practices for arterial catheter maintenance are not strictly followed by all medical staff in the pediatric intensive care unit. OBJECTIVE:This study aimed to improve compliance with evidence-based practices for arterial catheter management in critically ill children in a Chinese pediatric intensive care unit. METHODS:The JBI Evidence Implementation Framework was used to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. An arterial catheter management strategy for critically ill children was developed based on the identified barriers, along with a simulation training module and a supply of 10-ml prefilled normal saline flush syringe. Field observations, a review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices. RESULTS:Thirteen criteria were audited in the baseline and follow-up audits using 220 and 212 peripheral arterial catheters, respectively. In the follow-up audit, compliance with all criteria increased and the indwelling time of the peripheral arterial catheter was prolonged. CONCLUSIONS:The JBI Evidence Implementation Framework was used to improve compliance with the best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A642.

Central venous catheterization is a routine procedure in clinical practice, but it can result in severe and costly central line-associated bloodstream infections (CLABSIs), the risk of which may vary by insertion sites. This study sought to evaluate and compare the incidence of CLABSI in critically ill patients between internal jugular and subclavian sites, and to explore the correlation between insertion site and risk of CLABSI. This research encompassed critically ill patients with Central venous catheters (CVCs) placed in the internal jugular or subclavian site from ICUs of 22 public tertiary hospitals throughout China, from September 4, 2023, to February 29, 2024. The incidence of CLABSI was calculated and compared between the two groups using Poisson regression. The association between insertion site and CLABSI risk was assessed using univariable and multivariable Cox proportional hazards regression models, with additional adjustments for center-effects using a frailty model. Among 2,379 patients analyzed, the internal jugular site was the predominant insertion site (68.3

Background/Objectives: Sleep disturbances have an impact on children’s physical and psychological development, yet little is known about the changes and factors influencing sleep after PICU discharge. To explore the trajectory of changes in sleep quality of critically ill children and to identify factors affecting sleep quality three months after Pediatric Intensive Care Unit (PICU) discharge. Methods: A longitudinal observation study was conducted between November 2022 and November 2023 at a tertiary children’s hospital. The Children’s Sleep Habits Questionnaire (CSHQ) was used at six time points: PICU-admission (T0), 1 week (T1), 2 weeks (T2), 1 month (T3), 2 months (T4), and 3 months (T5) after PICU discharge. The CSHQ is a 33-item parent-report outcome measure evaluating sleep problems. Total scores range between 33 and 99 points. A score of ≤41 indicates normal sleep; a score of >41 indicates sleep disturbance. Data were analyzed using the latent category growth model, univariate analysis, and multifactorial logistic regression. Results: Parents of 237 children completed all follow-up surveys. Prevalence of sleep disorders at T0-T5 of children with a score >41 were 46.5%, 83.5%, 69.7%, 54.3%, 50.2%, and 51.7%, respectively. General linear modeling revealed significant changes in CSHQ scores over time (F = 63.77, p < 0.05). The trajectories of identifying sleep changes were divided into three latent categories: High Sleep Disorder Group (n = 15, 6.33%), Moderate Sleep Disorder Group (n = 110, 45.2%), and No Sleep Disorder Group (n = 115, 48.52%). The trajectories were significantly different among preschool age, baseline sleep habit scores, surgery, and length-of-stay in pediatric wards (p < 0.05). The child’s age and surgical history were independent factors of sleep disturbance. Conclusions: The observed peak in sleep disturbances at 1-month post-PICU suggests that this period may be a critical window to develop and implement targeted interventions to improve sleep. The persistent sleep disorders highlight the need for long-term monitoring.

BackgroundEnteral feeding tubes are widely used in pediatric patients, but tube-related complications remain a safety concern. Understanding current practice and nurses’ knowledge is essential for improving the safety of enteral feeding tube placement and guiding evidence-based pediatric care.AimTo investigate the current status of enteral feeding tube placements in hospitalized children in China and to evaluate nurses’ knowledge and experience of enteral feeding tube management.MethodsA cross-sectional point-prevalence study was conducted between 4 and 20 December 2024 across 52 hospitals in China to identify hospitalized children with enteral feeding tubes. Data were collected by trained nurses. Concurrently, a survey was conducted among 11,787 pediatric nurses in the same hospitals. Descriptive statistics and binary logistic regression analysis were used.ResultsA total of 2,875 children with enteral feeding tubes were included. The national prevalence of enteral feeding tube placement was 7.7% (2,875/37,114) of all hospitalized children. The highest rates were observed in general hospitals with pediatric departments (14.4%), followed by maternal and child health hospitals (11.6%) and children’s hospitals (6.4%). Pediatric intensive care units (PICUs) (39.2%) and neonatal units (35.5%) were the primary units where patients with enteral feeding tubes were located. Orogastric (54.9%) and nasogastric (41.1%) tubes constituted the majority of feeding tube types. Among 11,787 nurses, 91.0% reported gastric tube placement experience, yet only 19.2% knew the nasal-tip-earlobe-midpoint-umbilicus method for correct tube length measurement and 8.8% were aware of the recommended protocol when gastric contents cannot be aspirated from the tube. Only 7.0% had post-pyloric tube placement experience, and 51.6% were unaware of the recommended flushing frequency of every 4–6 h during continuous infusion. After adjustment, nurses’ correct responses showed item-specific associations with geographic region, hospital type, department type, and nurse-level characteristics. Nurses in East China and South China generally had higher odds of correct responses for most knowledge items, and nurses from general hospitals with pediatric departments and PICUs showed higher odds for selected items. Higher education level and managerial position were associated with correct responses to some items, whereas longer pediatric nursing experience was not consistently associated with higher knowledge accuracy. Bedside ultrasound and X-ray were the primary tools for post-pyloric tube placement guidance and post-placement verification, respectively.ConclusionThis nationwide study identified substantial and item-specific gaps in pediatric nurses’ evidence-based knowledge of enteral feeding tube management. Standardized institutional protocols and targeted evidence-based education tailored to clinical settings and specific knowledge deficits are needed to improve the safety and quality of pediatric enteral tube feeding care.

Introduction and objectives:Hypothermia commonly occurs in trauma patients. Evidence-based practices for hypothermia prevention are not strictly followed by all medical staff in the emergency department. This study aimed to assess compliance with evidence-based practices regarding goal-oriented temperature management for severely traumatized children in a Chinese hospital.Methods:This project used the JBI Evidence Implementation Framework to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. A goal-oriented temperature management strategy for trauma patients was developed based on the identified barriers, along with a simulation training module, and the supply of warming materials. Field observation, review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices.Results:Twelve criteria were audited in the baseline and follow-up audits, with 11 and 37 trauma patients, respectively. In the follow-up audit, compliance with all criteria increased, with a reduction in shivering and cold discomfort scores. Except for two patients who died, hypothermia did not occur in any of the patients.Conclusions:The JBI Evidence Implementation Framework was used to successfully improve compliance with best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff.Spanish abstract:http://links.lww.com/IJEBH/A234

Background: Central venous catheters (CVCs) are crucial for critically ill patients but pose risks of complications and unplanned removal, which can interrupt treatment, prolong hospital stays, and increase mortality. This investigation sought to examine the occurrence and risk factors for unplanned CVC removal among intensive care patients in China. Methods: A multicenter cohort study was conducted across 22 public tertiary hospitals throughout China, from September 4, 2023, to February 29, 2024, enrolling critically ill patients with CVCs. Cox proportional hazards regression models were used to assess the risk factors for unplanned CVC removal. Results: The study comprised a total of 2680 first-time CVC insertion events (one per patient) in critically ill patients. 1151 (42.95%) CVCs were removed; most (n = 832, 31.04%) were elective. A total of 153 CVCs were removed prematurely (5.71%; 95% CI: 4.84-6.68), and infection-related complication was the leading cause (n = 124, 4.63%; 95% CI: 3.85-5.50; 5.26 per 1000 CVC days). Independent risk factors included male gender (HR, 2.04; 95% CI: 1.40-2.99; p < 0.001), neurological disorders (HR, 2.41; 95% CI: 1.50-3.86; p < 0.001), and mechanical ventilation (HR, 1.71; 95% CI: 1.09-2.70; p=0.02), while urgent insertion reduced the risk (HR, 0.52; 95% CI: 0.29-0.92; p=0.02). In subgroup analysis, diagnosis with neurological disorders (HR, 2.31; 95% CI 1.40-3.81, p=0.001), and urgent CVC insertion (HR, 0.41; 95% CI 0.21-0.82, p=0.01) were significantly associated with unplanned CVC removal in males but not in females (p > 0.05). No significant interactions were found between gender and diagnosis, mechanical ventilation, or urgent insertion (all p > 0.05). Conclusions: Unplanned CVC removal occurred in 5.71% of cases, primarily due to infection. Identified risk factors (male gender, neurological disorders, and mechanical ventilation) and protective factors (urgent insertion) highlight targets for preventive strategies in critical care.

Enterostomy is utilized to mitigate severe clinical symptoms in children with very early-onset inflammatory bowel disease (VEO-IBD) and to provide a window for stem cell transplantation. Nevertheless, the incidence of postoperative complications is significant, and there is currently a lack of research exploring the risk factors associated with complications related to the stoma and incision following the procedure. The objective of this study is to investigate the risk factors for stoma and incision complications after enterostomy in patients with VEO-IBD. From January 2015 to December 2023, 49 children with VEO-IBD who underwent enterostomy were enrolled in the study. Demographic characteristics, blood biochemical indices, weighted Pediatric Crohn’s Disease Activity Index (wPCDAI), and enterostomy-related information were prospectively collected. Multivariate logistic regression was employed to identify the risk factors for ostomy and incision-related complications. All 49 included VEO-IBD children had interleukin-10 (IL-10) signaling defects, with 27 (55.1

Prune belly syndrome (PBS), a rare congenital disorder characterized by the absence of abdominal wall musculature and abnormalities in the genitourinary tract, is primarily linked to the urethral obstruction during fetal development. Given the overall rarity of the PBS and its multisystem involvement, there is currently no consensus on the optimal management strategy for PBS patients. This case report elaborated the comprehensive therapeutic outcomes of a patient with PBS, who had previously undergone several surgeries, including vesicoscopic cross-trigonal ureteral reimplantation, and first-stage Fowler-Stephens orchiopexy (FSO) for right cryptorchidism. At the age of seven, the patient underwent one-stage FSO combined with microvascular anastomosis for the left intra-abdominal testis. With appropriate perioperative management, the left testis was successfully survived. Herein, we presented an illustrative case to serve as a treatment reference for PBS patients.

Aims This study aimed to examine the impact of synchronous online learning on the effectiveness of theoretical training and self-efficacy among newly graduated pediatric nurses. Design It is a prospective randomized controlled trial. Methods The sample comprised 45 newly graduated pediatric nurses randomly assigned to an experimental cohort group or a cohort group. The control group underwent traditional face-to-face teaching, whereas the experimental group engaged in synchronous online learning. A comparative analysis encompassed the test scores from post-session 10-minute assessments (T2), evaluations conducted after one week (T3), and those after one month (T4), alongside their academic self-efficacy scores. Results Forty-five newly graduated pediatric nurses participated with 23 allocated to the control cohort and 22 allocated to the experimental cohort. The baseline characteristics revealed no statistically significant disparities between the two groups. The post-session 10-minute assessment (T2) revealed a slight, yet not statistically significant, advantage for the experimental group over the control group. However, in contrast, the experimental cohort exhibited significantly superior performance compared to the control group during theoretical evaluations conducted one week (T3) and one month (T4) after training (p<0.001). In terms of academic self-efficacy, the experimental group demonstrated significantly higher scores than their counterparts in the control group. Conclusions Synchronous online learning that is meticulously structured and closely monitored has the potential to enhance the efficacy of theoretical training and boost academic self-efficacy among new graduate nurses.

BACKGROUND:Globally, there has been a general decline in the occurrence of central line-associated bloodstream infection (CLABSI). Still, CLABSI remains a common healthcare-associated infection in the ICUs of hospitals in developing countries. AIM:The aim of the study was to assess knowledge, attitude and practice among ICU nurses in China concerning CLABSI prevention. STUDY DESIGN:A multicentre, cross-sectional study was designed. A self-designed questionnaire, informed by a literature review and expert consultation, was utilised to assess the knowledge, attitude and practice of ICU nurses. The widely used electronic data collection tool in China, known as the Wen Juan Xing platform, facilitated data gathering via the internet. A total of 989 ICU nursing staff from 22 large tertiary public hospitals in China completed the online survey between 1 May 2024 and 30 June 2024. RESULTS:The proportion of ICU nurses with good (≥ 80% accurate response) knowledge, attitude and practice was 31.14%, 45.50% and 89.99%, respectively. ICU nurses' knowledge and attitude were mainly influenced by their age, ICU experience and professional level, meanwhile, their practice differences were found by their gender and educational level. In addition, nursing programs or processes, previous training experience and whether need more information were significantly associated with nurses' knowledge, attitude and practice. CONCLUSIONS:In summary, Chinese ICU nurses demonstrated inadequate levels of knowledge and attitude towards CLABSI prevention. Study findings suggest that arranging training in refreshing, taking advantage of experienced nurses' leading roles and changing safety culture might be useful in enhancing ICU nurses' knowledge, attitude and practice. RELEVANCE TO CLINICAL PRACTICE:The results of this research imply that the government, nursing associations and hospitals themselves should provide tailored training programs, improve safety culture and explore dynamic assessment methods to promote optimal knowledge, attitude and practice relevant to CLABSI prevention among ICU nurses in China.

Automatic pain assessment for non-communicative children is in high demand. However, the availability of related training datasets remains limited. This study focuses on creating a large-scale dataset of pain facial expressions specifically for Chinese critically ill children and evaluating its utility using deep learning models. Data were gathered from two intensive care units at Children's Hospital of Fudan University. The dataset, named pain facial expression of critically ill children (PFECIC), includes 119 pain expression videos and 6951 images collected from 53 children between December 2022 and January 2023. All videos and images were independently triple labeled according to five pain levels. The PFECIC dataset was evaluated through deep learning experiments, demonstrating strong performance metrics: 88.3% accuracy, 88.3% precision, 88.7% recall, an F1-score of 88.5%, and a false-positive rate of 3.0%. Prediction errors were mostly associated with labels close to the true values. Comparative analysis with the classification of pain expressions (COPE) dataset highlighted the superiority of PFECIC in terms of accuracy, validity, and comprehensiveness.

Background: With the advancement of medical technology, 85% of adolescent and young adult with congenital heart disease (CHD) can survive into adulthood. However, during their transition to the adult medical system, they face management gaps such as a high treatment interruption rate and increased psychosocial risks. Aims: To identify, describe and map the existing evidence on transitional care interventions for adolescents and young adults(AYAs) with CHD. Methods: PubMed, Web of Science, EMBASE, EBSCo, Cochrane Library, CBM, CNKI, Wang Fang, VIP Database, and article reference lists were searched for randomized controlled trials (RCTs) and systematic reviews (SRs) in February 2025. Study quality was evaluated using the Cochrane Handbook (Version 5.1.0) risk of bias tool. Evidence mapping (EM) visually represented research quality, outcomes, and sample sizes via the PyMeta website. Results: Eleven RCTs (1,075 patients, 45% female) met inclusion criteria. Intervention durations ranged from 1 hour to 24 weeks, with follow-up from 1 to 24 months. One low-quality, five medium-quality, and five high-quality RCTs were included from Canada (n=4), France (n=2), South Korea (n=1), Netherlands (n=2), Germany (n=1), and China (n=1). Studies focused on 10-25 year olds with moderate-to-severe CHD, assessing effectiveness by tracking disease knowledge, quality-of-life, and readiness for adult care. Conclusions Existing studies consistently support transition programs for enhancing disease knowledge, self-efficacy, and reducing follow-up losses. However, findings on exercise interventions' impact on quality of life are contradictory, and psychosocial intervention remains significantly understudied. Therefore, developing personalized interventions tailored to varying CHD severities, and tracking long-term effects, is essential.

OBJECTIVE:The aim of this study is to assess catheter-related bloodstream infections (CRBSIs) in Chinese intensive care units (ICUs), covering prevalence, risk factors, pathogen distribution, and impacts of outcome. METHODS:A cross-sectional study was conducted in ICUs across 22 tertiary hospitals (2023-2024), with CRBSI diagnoses following Chinese national guidelines. Data were analyzed using R software (version 4.4.2), employing chi-square tests, robust Poisson regression, and Bayesian logistic regression (P < .05). RESULTS:The prevalence of CRBSI was 1.19% (1.53/1000 catheter days, 32 patients, and 36 episodes). Risk factors included no formal education/illiteracy (OR: 1.995-9.604), circulatory diseases (OR: 1.142-5.787), complex/rare diseases (OR: 2.417-13.048), and multiple catheterizations (OR: 4.502-15.093). The subclavian vein was safest (femoral/axillary OR: 4.01-6.86). Gram-negatives predominated (47.22%). Each additional day of catheter dwell days increased CRBSI risk by 4.33% (95% CI: 3.04%-5.20%), and each additional ICU stay raised risk by 4.2% (95% CI: 2.9%-5.1%). CRBSI increased mortality (OR: 8.65), prolonged ICU stay (mean increase of 9.09 days), and additional costs (¥122 539.56 per case, approximately $17 505.65). CONCLUSION:CRBSI significantly worsens outcomes and costs in Chinese ICUs. Prioritizing subclavian catheterization, infection prevention bundles, and gram-negative antimicrobial stewardship is essential. Further research is needed to validate these interventions across diverse settings.

Objectives:This review aimed to systematically synthesize the available research on the disclosure of diagnosis and related issues in childhood cancer from the perspectives of healthcare professionals, with the goal of informing the optimization of disclosure processes and meeting the communication needs of affected families. Methods:In accordance with the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews, the convergent segregated approach was used in this review. Articles were retrieved from 11 databases, including PubMed, Web of Science, CINAHL, CENTRAL, Embase, Ovid/Medline, PsycINFO, PsycArticles, Scopus, ERIC, and China National Knowledge Infrastructure (CNKI). The quality of the selected articles was assessed using the Mixed Method Appraisal Tool (MMAT). The review protocol was registered on PROSPERO (CRD42024542746). Results:A total of 21 studies from 10 countries were included. Their methodological quality was generally medium to high, with MMAT scores ranging from 60 % to 100 %. The synthesis yielded three core themes: 1) the spectrum of professional and societal attitudes toward disclosure; 2) the dynamic practices of navigating disclosure amid uncertainty, including timing and environment, stakeholders, and content of disclosure; and 3) factors influencing disclosure, including children's, parental, healthcare professionals', and socio-cultural factors. Conclusions:This review synthesized the perspectives and experiences of healthcare professionals regarding disclosure in childhood cancer, highlighting the complexity and multidimensional nature of this process in clinical practice. Future research should further investigate the experiences and needs of children and their parents, explore cultural variations in disclosure practices, develop context-appropriate assessment tools, and construct multidimensional intervention strategies to enhance the humanistic care and professional effectiveness of the disclosure process.