BackgroundThe development of care-sensitive quality indicators represents an essential component of care management. Currently, there exists no objective, scientific, and sensitive assessment framework for evaluating sepsis care quality management in China.Methods and designThis mixed-methods investigation employed a three-phase design. Initially, a systematic literature review (2014–2024) across four databases identified evidence regarding sepsis care quality. Subsequently, semi-structured interviews were conducted with five clinical experts from emergency departments and intensive care units (ICUs) to examine their perspectives on nursing-sensitive quality indicators (NSQIs). Finally, a modified Delphi process engaged a multidisciplinary panel to refine and validate sepsis-specific NSQIs through systematic consensus-building.ResultsTwo rounds of expert consultation were completed with a questionnaire return rate of 100%. Sixteen experts, consisting of 10 nurses and 6 physicians, participated in the first and second rounds of the Delphi survey, respectively. The mean score of the expert authority coefficient Cr for the two rounds was 0.95 and 0.96 (Cr ≥ 0.7). The coordination coefficient (Kendall W) was 0.120-0.316 (p < 0.001) in the first round and 0.116–0.142 (p < 0.001) in the second round, both of which reached a significant consensus. A comprehensive list of sensitive indicators for sepsis care quality was established, encompassing three primary, nine secondary, and 30 tertiary indicators.ConclusionThe established NSQIs encompass three fundamental dimensions of sepsis care quality: importance, rationality, and feasibility.Clinical practice implicationsThis research provides a valuable framework for evaluating clinical care quality in sepsis management.

Background Currently, there are no objective, scientific, and sensitive assessment frameworks for evaluating sepsis care quality management in China. This study aimed to address this gap by developing and validating nursing-sensitive quality indicators (NSQIs) tailored to sepsis management in Chinese clinical settings. Methods This mixed-methods investigation involved three phases. A systematic literature review (2014–2024) across four databases identified evidence regarding sepsis care quality. Subsequently, semi-structured interviews were conducted with 16 clinical experts from emergency departments (EDs) and intensive care units (ICUs) to examine their perspectives on NSQIs. Finally, a modified Delphi process engaged a multidisciplinary panel to refine and validate sepsis-specific NSQIs through a systematic consensus-building process. Result Two rounds of expert consultation were completed, with a 100% questionnaire return rate. Sixteen experts (10 nurses and six physicians) participated in the first and second rounds of the Delphi survey. The mean score of the expert authority coefficient for the two rounds was 0.96. The range of Kendall W values was 0.120–0.316 (P < 0.001). A comprehensive list of sensitive indicators for sepsis care quality was established, encompassing three primary, nine secondary, and 30 tertiary indicators. Conclusion The established NSQIs encompass three fundamental dimensions of sepsis care quality: importance, rationality, and operational feasibility. This two-round Delphi process achieved expert consensus, confirming the system’s alignment with clinical guidelines and feasibility. Clinical practice implications: This research provides a valuable framework for evaluating clinical care quality in sepsis management.

BACKGROUND:Prone position has been reported to improve prognosis and reduce mortality in COVID-19 patients, but poor patient tolerance and complications remain an issue. AIM:This study aimed to compare the modified vs. conventional prone position on pressure injuries in COVID-19 patients in adult intensive care units (ICU). STUDY DESIGN:This retrospective comparative study enrolled COVID-19-positive patients who were admitted to the emergency adult ICU of a tertiary general hospital between December 2022 and January 2023. All data were extracted from patient charts. The primary outcome was pressure injury. During the study period, pressure injuries were evaluated using the staging system of the International Clinical Practice Guideline for the prevention and treatment of pressure injuries in 2019. RESULTS:A total of 39 COVID-19-positive patients (16 females) were included, and 19 patients received the modified prone position. Compared to those with the conventional prone position, patients with the modified prone position had significantly lower occurrence of pressure injury (3 (25.0%) vs. 9 (75.0%), p = 0.044), eyelid oedema (2 (10.5%) vs. 9 (45.0%), p = 0.031) and facial oedema (5 (26.3%) vs. 13 (65%), p = 0.024) and significantly higher daily continuous prone position time (9.16 ± 3.01 vs. 6.50 ± 2.14, p = 0.003). The occurrence site and stage of pressure injury, transcutaneous blood oxygen saturation, airway adverse events and brachial plexus injury were comparable between the groups (all p > 0.05). CONCLUSION:Compared to the conventional prone position, the modified prone position may significantly reduce the occurrence of pressure injuries and improve patient tolerance in COVID-19 patients in the adult ICU. RELEVANCE TO CLINICAL PRACTICE:These findings provide guidance for critical care nurses to implement prone positioning interventions.

BackgroundFangcang shelter hospitals are quarantine facilities offering primary medical treatment for mild and asymptomatic SARS-CoV-2 cases. Little is known about the age-specific prevalence of insomnia among patients in Fangcang shelter hospitals, particularly in older age groups.MethodsThis cross-sectional study was conducted in the three largest Fangcang shelter hospitals during the lockdown period, from March to May 2022, in Shanghai. The patients’ demographic and medical information was recorded. Insomnia was defined according to the prescriptions for zolpidem and estazolam. The overall and age-specific prevalence and the risk factors of insomnia were investigated through regression models.ResultsA total of 2,39,448 patients were included in this study (59.09% of the patients were male, the median age was 42, and 73.41% of the patients were asymptomatic), with the prevalence of insomnia being 3.1%. The prevalence of insomnia varied across different age groups (<18 years: 0.23%, 18–64 years: 2.64%, and ≥65 years: 10.36%). SARS-CoV-2 vaccine, regardless of the number of doses, was significantly associated with a decreased risk of insomnia for the group aged ≥65 years. Three doses of the vaccine reduced the risk of insomnia for patients aged 18–64 years. An extra day in the hospital significantly increased the risk of insomnia by approximately 10% for all age groups. Mild symptoms were significantly associated with a higher risk of insomnia among patients aged <65 years old, while being male and residing in the surrounding area were negatively associated with insomnia for all adults.ConclusionThis study observed that older patients were a high-risk population for developing insomnia in Fangcang shelter hospitals. SARS-CoV-2 vaccination might decrease the risk of insomnia in adults, especially the older adult, which indicates the benefits of vaccination for reducing insomnia among infected patients.

Backgrounds The widespread coronavirus disease 2019 (COVID-19) outbreak impacted the mental health of infected patients admitted to Fangcang shelter hospital a large-scale, temporary structure converted from existing public venues to isolate patients with mild or moderate symptoms of COVID-19 infection. Objective This study aimed to investigate the risk factors of the infected patients from a new pharmacological perspective based on psychiatric drug consumption rather than questionnaires for the first time. Methods We summarised the medical information and analysed the prevalence proportion, characteristics, and the related risk factors of omicron variants infected patients in the Fangcang Shelter Hospital of the National Exhibition and Convention Center (Shanghai) from 9 April 2022 to 31 May 2022. Results In this study, 6,218 individuals at 3.57% of all admitted patients in the Fangcang shelter were collected suffering from mental health problems in severe conditions including schizophrenia, depression, insomnia, and anxiety who needed psychiatric drug intervention. In the group, 97.44% experienced their first prescription of psychiatric drugs and had no diagnosed historical psychiatric diseases. Further analysis indicated that female sex, no vaccination, older age, longer hospitalization time, and more comorbidities were independent risk factors for the drug-intervened patients. Conclusion This is the first study to analyse the mental health problems of omicron variants infected patients hospitalised in Fangcang shelter hospitals. The research demonstrated the necessity of potential mental and psychological service development in Fangcang shelters during the COVID-19 pandemic and other public emergency responses.

目的 构建应急状态下重症监护室护士俯卧位治疗混合式培训课程,并评价其实施效果,为进一步开展急危重症护理培训提供依据.方法 通过文献检索、德尔菲专家咨询法构建重症监护室俯卧位治疗培训课程(线上线下混合教学模式).2022年12月—2023年1月,选取上海交通大学医学院附属瑞金医院急诊监护室和急诊缓冲监护室58名护士作为研究对象,比较培训前后护士理论知识、临床实操评分,以及对测评培训的满意度.结果 针对课程的2轮专家咨询问卷有效回收率均为100％,专家的权威系数为0.795,肯德尔和谐系数分别为0.196、0.318.课程设置内容效度指数S-CVI/UA和S-CVI/Ave均为0.948.俯卧位治疗混合式课程包括线上线下培训共计10学时.培训后护士理论知识为(89.68±12.51)分,高于培训前的(35.48±15.24)分;培训后临床实操评分为(91.97±3.75)分,高于培训前的(66.45±8.85)分;以上差异均具有统计学意义(P＜0.05).学员对培训的满意度评分为(11.9± 0.32)分,接近满分(12分).结论 本课程设置科学合理.重大传染病疫情下,采用线上线下混合式培训模式开展俯卧位治疗培训,能进一步提升ICU护士专项护理技能,可为急危重症护理教学工作提供理论依据.

目的 调查分析上海市急诊专科护士的核心能力,为进一步构建急诊专科护士延续性培训方案提供依据.方法 采用整群抽样法,于2020年7月2-9日,应用自行设计的急诊专科护士核心能力自评表对上海市63所医院的1 097名急诊专科护士进行调查.结果 上海市急诊专科护士核心能力总得分为(240.49±31.84)分,条目均分为(4.45±0.16)分;6个维度条目均分由高到低分别为评判性思维能力、专业实践能力、专业态度、沟通协调能力、管理能力和专业发展能力.多元线性回归分析结果显示:医院等级、本人目前职务、最终学历对急诊专科护士核心能力的影响有统计学意义(P＜0.05),而工作编制、性别、年龄、急诊工作年限、获得急诊急救护理适任证书的年限对核心能力的影响无统计学意义(P＞0.05).结论 上海市急诊专科护士总体核心能力处于中等偏上水平,其评判性思维能力较好,管理能力与专业发展能力相对较薄弱.护理管理者应在制订延续培训方案中加强管理能力与专业发展能力的建设,并建立急诊专科护士电子档案,纳入个人继续教育培训信息,以进一步完善急诊专科人才建设.

BackgroundAcute pancreatitis (AP) is the most common gastrointestinal disease requiring hospital admission. AP patients are categorized as mild, moderately severe, and severe AP (SAP). For SAP patients, malnutrition increases susceptibility to infection and mortality. The Nutritional Risk Screening 2002 (NRS 2002), the Nutrition Risk in Critically Ill (NUTRIC) score and modified Nutrition Risk in Critically Ill (mNUTRIC) are nutritional risk screening tools of critically ill patients and have not been validated in patients with SAP. It is essential to evaluate the prognostic performance of these nutritional risk screening tools.Materials and methodsA retrospective study was designed to validate the NRS 2002, NUTRIC, and mNUTRIC when applied to SAP patients. Receiver operating characteristic curves were plotted to investigate the predictive ability of clinical outcomes by comparing areas under the curve (AUC). Appropriate cut-offs were calculated by using Youden’s index. Patients were identified as being at high nutritional risk according to the calculated cut-off values. The effects of different scoring systems on mortalities were calculated using the Cox proportional hazards model. Logistic regression was used to assess the association between the energy provision and 28-day mortality.ResultsFrom January 2013 to December 2019, 234 SAP patients were included and analyzed. Patients categorized as high nutritional risk by the NRS 2002 (12.6% versus 1.9% for 28-day and 20.5% versus 3.7% for 90-day), NUTRIC (16.2% versus 0.0% for 28-day and 27.0% versus 0.0% for 90-day), and mNUTRIC (16.4% versus 0.0% for 28-day and 26.4% versus 0.8% for 90-day) had significant higher mortality than those categorized as low nutritional risk. The NUTRIC (AUC: 0.861 for 28-day mortality and 0.871 for 90-day mortality, both cut-off value ≥3) and mNUTRIC (AUC: 0.838 for 28-day and 0.828 for 90-day mortality, both cut-off value ≥3) showed better predictive ability of the 28- and 90-day mortality than the NRS 2002 (AUC: 0.706 for 28-day mortality and 0.695 for 90-day mortality, both cut-off value ≥5).ConclusionThe NRS 2002, NUTRIC, and mNUTRIC scores were predictors for the 28- and 90-day mortalities. The NUTRIC and mNUTRIC showed better predictive ability compared with the NRS 2002 when applied to SAP patients.

目的 设计输液滴速计数器,评价其应用效果.方法 输液滴速计数器由输液器卡扣、显示器、启动/模式切换按钮、电池、蜂鸣器、红外线感应区等组成.在试验室中,将该计数器测得的输液滴速与输液泵设定的输液滴速进行比较,评价该计数器滴数计数的准确率.采用便利抽样法,选取2020年3月—5月在上海市某三级甲等综合医院急诊科输液的200例患者作为应用对象,按患者输液时座位的序号分为试验组103例、对照组97例.试验组使用计数器进行计数,对照组使用人工计数的方式进行计数.比较两组预计输液完成时间与实际输液完成时间的差值,静脉炎、外渗、导管堵塞、回血的发生率,患者满意率.收集护士使用该计数器的满意率.结果 在试验室检测中,该计数器滴速计数的准确率为99.6％,计数器显示滴数与输液泵设置滴数比较,差异无统计学意义(P=0.829).临床应用过程中,试验组预计输液完成时间与实际输液完成时间的差值小于对照组,回血发生率低于对照组,患者满意率高于对照组,差异具有统计学意义(P<0.05).护士满意率为96.1％.结论 输液滴速计数器的准确性较高,使用该计数器有利于控制输液滴数,降低回血的发生率,提高患者满意率.

Objective: To construct a training program on emergency response ability for all staff in emergency medical wards under COVID-19 epidemic, and to evaluate its clinical effect. Methods: A targeted training program for emergency response ability of all staff in the emergency medical ward was established through literature review, brain storming and online conference discussion. The scheme includes seven modules: training system, training plan, training outline, training course, teaching team, training materials and teaching evaluation. For medical staff, other staff (nursing workers, work attendance, cleaning), patients and family members of different categories of personnel, advanced version, basic version and popular science version are designed respectively, and the training content closely fitted the needs of epidemic prevention and skills required in different groups. During the period from April 5 to May 10, 2022, the training program was conducted to train the emergency response ability in all staff,and effect was evaluated using questionnaires invstigation before and after training, oral questions, operation assessment and on-site inspection, and the incidence of clinical actual infection was monitered. Results: The score after traning on response ability to infectious disease emergencies in medical staff( 161.27±14.13) was higher than before the training (143.38±23.10) (P<0.05). After the training, the qualified rate of "hand hygiene" and "wearing and taking off isolation clothes" in nursing workers, cleaning workers and work attendance increased from 62.5% (before the training) to 100.0%, and the qualified rate of oral question answering increased from 50.0% (before the training) to 87.5%. The correct wearing rate of masks for patients and their families increased from 66.1% to 89.3%, and the standard rate of hand hygiene increased from 75.0% to 92.0%. The score on satisfaction was (16.36±2.03), which indicates that all staff had a good experience of participating in the training process. There were no case of novel coronavirus infection. Conclusions: Under the background of COVID-19 epidemic, the whole staff-emergency capacity training program established in this study is reasonable and feasible, which can effectively improve the emergency capacity of personnel, urge everyone to participate in nosocomial infection prevention and control, and ensure the normal epidemic control in the ward.

探索在新型冠状病毒（新冠）感染疫情防控中的大型方舱医院药品保障管理模式。根据方舱医院规模及收治新冠感染者特征，成立应急药品管理团队，搭建药品管理组织架构、建立规章制度；根据方舱医院的运行特点，制定和调整药品目录，规范申领、调拨流程，并加强特殊药品的管理；依据感染者的需求，开展多元化药学服务，指导患者用药。本团队建立了针对大型方舱医院运行的特色药品保障体系，分为中心药库及二级药库进行药品保障管理，在做到保障基本医疗药品供应的同时，提供药学服务以确保患者的用药安全。本团队建立的方舱药品保障管理模式，可为应对突发公共卫生事件时药品保障及完善服务患者提供参考。

新型冠状病毒(新冠)奥密克戎变异株感染疫情在上海蔓延,面对重大传染病疫情,为保障上海市民正常就医,我院急诊科采取一系列措施积极应对,快速反应.从平时"常态管理模式"切换为"应急管理模式",从"人员"设置、物资"申领"、"运输"、"存储"、"发放"5个方面调整管理策略,通过设置物资保障岗位、应用信息化物资管理系统、划分物流运输"三区"、设立二级库房管理和落实精准化物资管控共5项具体措施的实施.实现科学、有效、规范的物资管理,确保疫情时期急诊科物资保障工作顺利进行,为进一步规划和完善突发公共事件中应急物资的储备、运输、调配管理体系提供参考和依据,促进提高急诊科应对突发公共卫生事件的应急能力.

Hospital culture plays an important role in the orderly operation of large shelter hospitals as well as epidemic prevention and control.From April to May 2022, the shelter hospital of the National Convention and Exhibition Center(Shanghai) had created the large shelter hospital culture co-built by doctors and patients with a greater sense of belonging by taking measures such as joint party building between doctors and patients, giving play to the vanguard force of party members, carrying out various forms of cultural, sports and science popularization activities, encouraging enthusiastic patients to participate in activity planning, focusing on key groups, formulating shelter " residents convention", and so on. These measures ultimately formed cultural adaptation, cultural synchronization and cultural shaping, which were conducive to enhancing the empathy of doctors and patients, improving the effectiveness of medical implementation, and promoting the standardization of shelter management system. This harmonious, warm and autonomous culture co-built by doctors and patients effectively ensures the safe and orderly operation of the shelter hospital, and provides reference for the construction of the cultural system of large shelter hospitals in China.

目的 探讨医疗装置配置在超大型方舱医院运行保障中的作用。方法 从医疗装置基本情况、面临挑战、建议对策等方面，总结瑞金医院方舱医院管理团队在国展中心(上海)方舱医院医疗装置配备工作中的经验，为超大型方舱医院的运行保障提供借鉴。结果 自2022年3月以来，上海紧急启动建设市区两级方舱医院，用于收治轻症及无症状感染者，以快速阻断疫情传播。国展中心(上海)方舱医院瑞金医院方舱医院规模最大，总床位近5万张，收治患者174 308例。瑞金医院方舱医院管理团队全程参与了该方舱医院的开仓和运行，并为方舱医院正常运行提供医疗装置保障。结论 瑞金医院方舱医院管理团队保障了国展中心(上海)方舱医院医疗装置配置，为其正常运行提供条件，但战时状态下快速部署、灵活机动地装备方舱医院应对重大突发公共卫生事件仍需探索。

大型方舱医院作为一个突发公共事件或灾害救援中的特殊医疗空间,受到社会广泛关注.探索方舱医院文化体系建设,通过党建文化、精神文化、制度文化、行为文化和社群文化建设,形成文化合力,营造和谐医院氛围,提升医疗执行效能,为方舱医院管理目标的实现,提供文化保障.

目的 探讨基于智慧医疗的O2O导诊模式在门诊预检分诊中的应用效果.方法 选取上海市某三级甲等综合医院门诊患者为研究对象,根据纳入和排除标准,选择O2O导诊模式实施前(2020年5-11月)患者(对照组)与实施后(2021年5-11月)患者(观察组),各1 000名.对照组实施由现场护士与导诊机器人共同分诊的线下导诊模式,观察组在线下导诊模式的基础上增加线上导诊,比较两组患者的分诊等待时间、分诊准确率和患者满意率的异同.结果 与O2O导诊模式实施前比较,实施后不同学历患者的分诊等待时间均显著缩短(P＜0.001),分诊准确率提升(P＜0.001),患者在流程便捷、智能导诊系统操作简单、护士服务态度、门诊健康教育的满意率均显著提高(P＜0.001).结论 门诊预检分诊实施O2O导诊模式可有效缩短患者分诊等待时间,提高分诊准确率和患者满意率,有利于优化门诊护理服务质量,提高资源利用率.

目的 构建急诊护士创伤救治核心能力评价指标和培训课程,为进一步开展急诊护士创伤救治临床实践培训提供依据.方法 基于文献回顾和半结构式访谈结果,设计急诊护士创伤救治核心能力评价指标与培训课程咨询问卷,采用德尔菲法选取15名专家进行2轮咨询,确定急诊护士创伤救护核心能力和培训课程构架.结果 2轮专家咨询问卷有效回收率分别为100％和86.67％,专家的权威系数为0.85,肯德尔和谐系数分别为0.389、0.268 (P＜0.05).构建的急诊护士创伤救治核心能力共有6项一级指标(专业态度、创伤救治专业能力、评判性思维能力、创伤救治管理能力、沟通协调能力和专业发展能力)、21项二级指标和47项三级指标.核心能力各维度指标权重系数为:一级指标0.149～0.187;二级指标0.041～0.053;三级指标0.019～0.023.该指标体系的总体Cronbach's α系数为0.964,内容效度指数S-CVI/UA和S-CVI/Ave均为0.948.培训课程包含理论课、workshop、情景模拟、小组讨论、考核共计26学时.培训课程各条目权重系数为0.037～0.043,Cronbach's α系数为0.950,内容效度指数-CVI/UA和S-CVI/Ave均为0.988.结论 构建的急诊护士创伤救治核心能力评价指标体系科学、可靠、完整;培训课程突出创伤救治护理特色,满足核心能力要求,培训方式和考核方法多样,能为进一步开展急诊护士创伤救治的临床实践培训提供参考依据.

Trauma center is an important link of trauma treatment, which is beneficial for professional integrated treatment of trauma patients and reduction of disability and death rate. The establishment of trauma rescue and treatment system is conducive to improving the regional trauma treatment capacity, rationalizing the layout of medical resources and standardizing the trauma treatment. Making full use of geographic information system (GIS) to analyze the big data such as the number of trauma patients, population, ground traffic situation and geographic information in the region and scientifically plan the number and location of trauma centers in the region is crucial to further optimize the geographic layout of trauma treatment centers, coordinate regional trauma treatment resources and improve the overall treatment capacity and is conducive to optimizing trauma treatment resources, improving regional trauma treatment capacity and reducing the disability and death rate of trauma patients. Based on domestic and foreign literature researches, the authors discuss how to use GIS to optimize the trauma rescue and treatment system in China in order to provide a useful reference for construction of regional trauma rescue and treatment system.

充分发挥社会工作志愿者的专业优势,支持广大社工、义工和志愿者在方舱医院开展心理疏导、情绪支持、保障支持等服务,对于方舱医院医疗工作的安全、有序、高效运行具有重要意义.探索在大型方舱医院建立社会工作志愿者的组织与管理体系,发挥专业优势、接受专业培训、运用专业方法、提供专业支持,传递人文关怀与抗疫信心,有助于共同坚守疫情防控的心理战线与有力配合方舱工作的有序开展.

方舱医院具有设计、施工周期短，基础设施简单，床位数量大，收治患者密度高，运行周转快，医疗、护理和运行保障团队多为临时组建等特点。方舱护理工作强度大、部分患者存在病情变化的风险、患者个性化需求难以得到满足等，使方舱医院护理工作的开展面临巨大挑战。本团队根据方舱医院的运行特点，构建方舱医院护理管理体系，包括护理管理组织构架、人力资源管理、质量控制体系、运行管理体系、应急处置体系、服务保障体系、沟通联络体系和人文关怀体系，为方舱医院护理工作的开展提供指导，有效保障了方舱医院护理工作安全、有序、高效地运行。