Rationale: Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique. Patient concerns: A case of a 60-year-old female experienced the rare yet critical complication of a misplaced nasoenteric tube entering the thoracic cavity during a blind insertion procedure for enteral nutrition following a liver transplant. Diagnosis: Following liver transplantation, the patient was diagnosed with severe pneumonia, a right-sided hydropneumothorax, and severe malnutrition. Interventions: After the misplacement of the nasoenteric tube into the pleural cavity was detected from the chest X-ray, the tube was immediately removed, and the pneumothorax was actively managed. Subsequently, with the support of contrast radiography, the nasoenteric tube was successfully reinserted to provide the patient with nutritional support and promote rehabilitation. Outcomes: The patient responded well to the intervention and was discharged in stable condition following complete recovery. Lessons: The case prompts a reevaluation of blind placement techniques and calls for the adoption of more reliable technologies to prevent similar incidents and ensure patient safety, such as electromagnetic and visualized guided placement technique.

Mobile applications, as innovative tools for promoting bystander cardiopulmonary resuscitation (CPR), have demonstrated potential to improve outcomes for patients experiencing out-of-hospital cardiac arrest (OHCA). This meta-analysis sought to systematically review the technical features of existing mobile applications and evaluate their impact on OHCA patient outcomes under various emergency response strategies. The findings aimed to guide the development and optimization of prehospital public emergency response systems. A systematic search was conducted in databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP), SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library, from inception to August 2023. The included studies involved notifying citizens via text messages or smartphone applications to act as first responders or volunteers in OHCA cases. Using a random effects model and subgroup analysis, we synthesized the results to identify sources of heterogeneity and assess outcomes. Thirteen mobile applications were included, with an average activation rate of 35.3

To analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance. A total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer–Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model. The prevalence of frailty in elderly patients with CHD was 30.07

Introduction: Critically ill patients are at a heightened risk for post-traumatic stress disorder (PTSD). While the intensive care unit (ICU) diary has been shown to improve the mental health and quality of life of ICU patients, the handwritten version still has some limitations such as a lack of support for multimedia content and writing by remote family members, as well as being time-consuming and labour-intensive. We hypothesise that constructing an ICU electronic diary platform based on a co-design approach and verifying its applicability could alleviate these limitations, making the ICU diary more convenient for users. Methods and analysis: This sequential exploratory mixed-methods study will consist of four consecutive phases: understanding the ICU diary research content and implementation, developing an ICU electronic diary platform after conducting qualitative interviews with stakeholders, verifying the applicability of the platform and verifying its effectiveness. Ethics and dissemination: Ethics approval was obtained from the Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2023-602). The results of this study will be distributed through peer-reviewed journals. Trial registration number: Chinese Clinical Trial Register (ChiCTR2400079903).

ObjectiveTo evaluate the current status of Chinese public’s knowledge, attitudes, practices (KAP) and self-efficacy regarding cardiopulmonary resuscitation (CPR), and to analyze the factors that influence KAP and self-efficacy.MethodsAn online cross-sectional survey was conducted from February to June 2022 in Mainland China via a self-designed self-filled questionnaire. Potential participants were recruited through WeChat by convenience sampling and snowball sampling methods. Descriptive and quantitative analyses were used for statistical analysis.ResultsThe survey included 4,450 participants from 31 provinces, autonomous regions, or municipalities across Mainland China, aged 18 or above. The public’s average understanding (clear and very clear) of the knowledge regarding CPR was 67.4% (3,000/4,450), with an average proportion of positive attitudes at 96.8% (4,308/4,450). In practice, the average proportion of good practices was 92.8% (4,130/4,450), while the percentage of good self-efficacy averaged at 58.9% (2,621/4,450), only 42.4% (1,885/4,450) of the participants had confidence in the correct use of automated external defibrillator (AED). Pearson correlation analysis showed a significantly positive correlation among knowledge, attitude, practice, and self-efficacy (p < 0.01). Multiple linear regression analysis revealed that several factors have a significant influence on the public’s CPR KAP and self-efficacy, including ever having received CPR training (p < 0.001), hearing about AED (p < 0.001), performing CPR on others (p < 0.001), hearing about CPR (p < 0.001), occupation (p < 0.001), personal health status (p < 0.001), education level (p < 0.001), gender (p < 0.001), and encountering someone in need of CPR (p = 0.021).ConclusionThe Chinese public demonstrates good knowledge of CPR, positive attitude, and high willingness to perform CPR. However, there is still room for improvement in the mastery of some professional knowledge points related to CPR and AED. It should be noted that knowledge, attitude, practice, and self-efficacy are interrelated and influence each other. Factors such as prior CPR training, hearing about AED, having performed CPR before, hearing about CPR, occupation, personal health status, education level, gender, and having encountered someone in need of CPR have a significant impact on the public’s KAP and self-efficacy.

目的 综述重症监护后综合征患者(post-intensive care syndrome,PICS)的干预管理策略,为形成统一、规范、安全的管理方案和促进临床深入实践提供借鉴.方法 结合国内外文献,对PICS的管理进行探讨,分析并总结其概述、疾病负担、干预实施者和干预对象、干预时间及场所、干预内容、干预效果评价等.结果 ICU阶段的干预主要是预防性干预.干预时机、场所、效果评价指标等没有统一的标准.ICU后干预报道较少,ICU内的干预效果未能高质量的延续至病房及家庭/社区.结论 重症监护后综合征患者的管理普遍存在重ICU内、轻ICU后,重院内、轻院外及重预防、轻康复等问题.未来的工作应侧重于研究现有干预措施对患者预后的影响,探索具有潜在益处的新干预措施,并确定最有效的ICU后护理模式,以患者和家属为中心,建立起一个从ICU到社区或基层医疗的连续护理体系,实现筛查、治疗、康复闭环管理路径,将精准干预与全程照护相结合,针对性、阶段性实施干预管理,逐渐形成重症监护后综合征患者全过程、全周期健康管理模式.

At present ICU transition management in China is still in the exploration stage, and the existing research results are difficult to be promoted in the clinic, and the management plan lacks unified and feasible standards. This paper introduces the concept and model of ICU transition management, and provides an overview of the current situation of ICU transition management for patients transferred out of ICU, adverse outcomes for patients transferred out of ICU, and the content of ICU transition management for patients transferred out of ICU, aiming to provide a reference for the formation of a unified and standardized ICU transition management scheme.

INTRODUCTION:Critically ill patients are at risk of developing postintensive care syndrome (PICS), which is manifested by physical, psychological and cognitive impairment. Currently, there are no programmes that combine early warning systems with interventions for PICS. We hypothesise that a comprehensive care model for PICS based on an early warning system would reduce medical costs and the incidence of PICS.METHODS AND ANALYSIS:The Intensive Care Unit (ICU) -Ward-Family/Community whole-course care (IWF/C Care) trial will be a unicentric, randomised, controlled trial. A total of 138 ICU patients from two ICUs at a university hospital in Guizhou province, China, will be enrolled in February 2023. The inclusion criteria are an age of 18 years or older, an ICU stay of more than 48 hours, provide informed consent and the ability to communicate normally. Patients will be followed for 12 months and randomised in a 1:1:1 ratio to three groups.INTERVENTIONS:Patients in intervention group 1 will be assessed by the PICS early warning system within 24 hours of ICU discharge, and precise interventions will be carried out according to the results; that is, high-risk patients will receive care based on the IWF/C Care model and low-risk patients will receive routine care. All patients in intervention group 2 will receive care based on the IWF/C Care model. The control group will receive routine care. The primary endpoints are the incidence of PICS and quality of life. The secondary endpoints include the incidence of adverse events: the unplanned readmission rate, cost-effectiveness, and the experiences and feelings of patients receiving care based on the IWF/C Care model. The incidence of PICS will be measured at ICU discharge, general ward discharge, the home/community stage and 1 month and 3, 6, 9, and 12 months after discharge.ETHICS AND DISSEMINATION:Ethics approval was obtained from Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2022-780). The results of this study will be distributed through peer-reviewed journals.TRIAL REGISTRATION NUMBER:ChiCTR2300068135.

目的:构建基于PDC&SA的立体交互式护理质量安全管理模式,探讨在跌倒/坠床中应用效果.方法:2017年以来我院以患者安全为轴心,以科室-片区-护理部为三级监控主体,以"重点科室、重点患者、重点环节、重点时段、重点护士"为监控维度,实行全面质量控制、关注重点、立体沟通,以PDC&SA循环为管理方法,点线面环环相扣,实现多维度、多层面的立体交互式护理质量评价与持续改进,观察跌倒/坠床实施效果.结果:2020年跌倒/坠床护理风险评估率、风险评估准确率、高风险预防措施落实率、健康教育落实率均高于2018、2019年(P<0.05);跌倒/坠床发生率由0.031‰下降至0.024‰.结论:基于PDC&SA的立体交互式护理质量安全管理模式可提高护理风险管理能力,有效保障患者安全.

Background: Coronavirus disease (COVID-19) has become a pandemic. The knowledge, attitudes, and practices (KAP) of the public play a major role in the prevention and control of infectious diseases. The objective of the present study was to evaluate the KAP of the Chinese public and to assess potential influencing factors related to practices. Methods: A cross-sectional online survey was conducted in China in February 2020 via a self-designed questionnaire comprising 33 questions assessing KAP. Results: For the 2,136 respondents from 30 provinces or municipalities in China, the accurate response rate for the knowledge section ranged from 72.7% to 99.5%, and the average was 91.2%. Regarding attitude section, the percentage of positive attitudes (“strongly agree” and “agree”) ranged from 94.7% to 99.7%, and the average value was 98.0%. The good practices (“always” and “often”) results ranged from 76.1% to 99.5%, and the average value was 96.8%. The independent samples t-test revealed that gender and ethnic differences had no effect on knowledge, attitude or behaviour (P>0.05). However, knowledge was associated with age (t=4.842, p<0.001), marital status (t=-5.323, p<0.001), education level (t=8.441, p<0.001), occupation (t=-10.858, p<0.001), and place of residence (t=7.929, p<0.001). Similarly, attitude was associated with marital status (t=-2.383, p=0.017), education level (t=2.106, p=0.035), occupation (t=-4.834, p<0.001), and place of residence (t=4.242, p<0.001). The multiple linear regression analysis results showed that the factors influencing practices were knowledge (t=-3.281, p=0.001), attitude (t=18.756, p<0.001), occupation (t=-3.860, p<0.001), education level (t=3.136, p=0.002), and place of residence (t=3.257, p=0.001). Conclusions: The Chinese public exhibited a good level of knowledge of COVID-19, a positive attitude, and high adherence to good practices. COVID-19-related knowledge, attitudes and practices were affected by age, marital status, education level, occupation, and place of residence to varying degrees. In addition, practices were affected by knowledge and attitudes towards COVID-19.

Rationale: Coronavirus disease 2019 (COVID-19) has emerged as a rapidly spreading communicable disease affecting individuals worldwide. Patients with diabetes are more vulnerable to the disease, and the mortality is higher than in those without diabetes. We reported a severe COVID-19 patient with diabetes and shared our experience with blood glucose management. Patient concerns: A 64-year-old female diabetes patient was admitted to the intensive care unit due to productive coughing for 8 days without any obvious cause. The results of blood gas analysis indicated that the partial pressure of oxygen was 84 mm Hg with oxygen 8 L/min, and the oxygenation index was less than 200 mm Hg. In addition, postprandial blood glucose levels were abnormal (29.9 mmol/L). Diagnoses: The patient was diagnosed with COVID-19 (severe type) and type 2 diabetes. Interventions: Comprehensive interventions including establishing a multidisciplinary team, closely monitoring her blood glucose level, an individualized diabetes diet, early activities, psychological care, etc, were performed to control blood glucose while actively treating COVID-19 infection. Outcomes: After the comprehensive measures, the patient's blood glucose level gradually became stable, and the patient was discharged after 20 days of hospitalization. Lessons: This case indicated that the comprehensive measures performed by a multidisciplinary team achieved good treatment effects on a COVID-19 patient with diabetes. Targeted treatment and nursing methods should be performed based on patients’ actual situations in clinical practice.

Background: In recent years, the flipped classroom approach has been broadly applied to nursing courses in China. However, a systematic and quantitative assessment of the outcomes of this approach has not been conducted. Objective: The purpose of the meta-analysis is to evaluate the effectiveness of the flipped classroom pedagogy in Chinese baccalaureate nursing education. Design: Meta-analysis of randomized controlled studies. Data source: All randomized controlled trials relevant to the use of flipped classrooms in Chinese nursing education were retrieved from the following databases from their date of inception through September 23, 2017: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, the China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Scientific Journals Database. Search terms including "flipp*", "inverted", "classroom", and "nurs*" were used to identify potential studies. We also manually searched the reference lists of the retrieved articles to identify potentially relevant studies. Review methods: Two reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane risk-of-bias tool was used to evaluate the quality of the studies. RevMan (Version 5.3) was used to analyze the data. Theoretical knowledge scores and skill scores (continuous data) were synthesized using the standardized mean difference (SMD) and 95% confidence interval (CI). The statistical heterogeneity of the included studies was analyzed by calculating the 12 statistic and applying a chi-square test. Publication bias was assessed by funnel plots. The quality of the combined results was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: Eleven randomized controlled trials published between 2015 and 2017 were selected. All the included studies had a moderate possibility of bias due to low methodological quality. The meta-analysis indicated that the theoretical knowledge scores and skill scores were significantly higher in the flipped classroom group than in the traditional lectures group (SMD = 1.06, 95% CI: 0.70-1.41, P < 0.001, and SMD = 1.40, 95% CI: 0.46-2.34, P < 0.001). There was no significant publication bias indicated in the primary analysis. Sensitivity analysis showed that the results of our meta-analysis were reliable. The evidence grades of the results regarding the theoretical knowledge and skill scores were low and very low, respectively. Conclusion: Flipped classroom pedagogy is more effective than traditional lectures at improving students' theoretical knowledge and skill scores. Given the limitations of the included studies, more robust randomized controlled trials are warranted in a variety of educational settings to confirm our findings.