This case report highlights the experience of formulating nurse-led health education or intervention for a patient with cardiovascular and cerebrovascular comorbidity. Nursing care was guided by Omaha system. The risk factors of a patient with cardio-cerebral comorbidity were evaluated and intervened from four dimensions: health-related behavior, physiology, social psychology and environment. Some risk factors that affected the progression of the patient's disease still existed, such as second-hand smoke in the environment, social drinking, alternative therapies, and sitting for a long time. Alternative therapies such as Raw Garlic & Vinegar Soak, Corn Silk Decoction, Sesame Seed & Black Bean Porridge were also used by the patient to treat diseases. The patient lacked some self-management abilities, such as not of attending regular follow-up, no home blood-pressure measurement, no regular monitoring in lipid management and diabetes management, Family members and the patient had no knowledge of first aid, identification and knowledge about cardiac and cerebrovascular adverse event management. 3 months later, the patient's health-related behaviors had improved, such as actively avoiding second-hand smoke, paying attention to his nutritional status, and engaging in scientific exercise. At the same time, his self-management skills had also been enhanced, such as mastering knowledge related to first aid and attending follow-up visits on time.

Objectives To systematically review and critically evaluate the risk prediction models for DVT in patients with sICH and provide references for clinical practice. Methods PubMed, Web of Science, The Cochrane Library, CINAHL, Embase, Scopus, CNKI, Wanfang Database, and China Science and VIP were searched from inception to July 15, 2025. Two researchers independently screened the literature, extracted data and assessed the risk of bias and applicability using the PROBAST checklist. The AUC values were pooled using a random-effects model. Sensitivity and subgroup analyses were conducted to explore potential sources of heterogeneity. Results A total of 9414 studies were initially identified, 19 risk prediction models were developed across the 15 included studies. The reported AUC across the 15 included studies ranged from 0.710 to 0.988. The pooled AUC for the 11 validated models was 0.82 (95% confidence interval: 0.78-0.85). Age, D-dimer levels, hematoma volume, and GCS score on admission emerged as the most frequently significant predictors of DVT in sICH patients. Conclusions Existing models show promising but not yet robust discriminative properties. Owing to the high risk of bias and substantial heterogeneity across studies, these models cannot be directly applied to routine clinical decision-making. Key variables including age, D-dimer level, hematoma volume and GCS score can support qualitative clinical risk stratification, and provide practical reference for formulating precise and individualized thromboprophylaxis strategies for sICH patients.

BACKGROUND:Medical escort services assist outpatients in navigating complex healthcare processes. Although previous studies have examined factors associated with demand for medical escort services among outpatients, evidence remains limited on the classification and prioritization of service attributes. The Kano model is useful for classifying service attributes and prioritizing service improvement. This study applied the Kano model to classify and prioritize service attributes of medical escort services among outpatients. METHODS:A cross-sectional study was conducted in the outpatient departments of a tertiary hospital in Beijing between July and August 2025. Multivariable logistic regression was used to identify factors associated with reported demand for medical escort services. The Kano model and importance-satisfaction analysis were used to categorize service attributes and prioritize areas for improvement. RESULTS:Overall, 61.9% of outpatients reported a demand to use medical escort services. Female patients and those with chronic comorbidities were more likely to report demand, whereas patients aged ≥60 years and unemployed patients were less likely to do so. Among the 17 service items, nine were classified as attractive attributes and eight as one-dimensional attributes. Importance-satisfaction quadrant analysis showed that core process-oriented services were concentrated in high-priority quadrants. Among patients reporting demand for medical escort services, four attributes shifted quadrants relative to the overall sample, indicating different priority patterns. CONCLUSION:Outpatients showed substantial demand for medical escort services, and Kano-based prioritization identified core process-oriented support as central to service delivery. These core services should be delivered reliably. Service design should also be tailored to patient characteristics and reported demand to support patient-centered, resource-efficient program development.

IntroductionCerebral small vessel disease (CSVD) and motoric cognitive risk syndrome (MCR) are both associated with adverse outcomes in older adults. Factors associated with MCR in CSVD remain poorly understood. We aimed to explore factors associated with MCR and its components (slow gait and subjective cognitive complaints [SCCs]) in CSVD, and to evaluate exploratory association-based multivariable models.MethodsThis cross-sectional study included CSVD patients aged ≥55 years without possible dementia based on education-adjusted MoCA screening from the cognitive subgroup of a national registry. Demographics, clinical variables, physical activity, and CSVD neuroimaging markers were assessed. MCR was defined as co-existing slow gait (age- and sex-adjusted) and SCCs (single-item memory complaint from the 15-item Geriatric Depression Scale). Logistic regression and receiver operating characteristic analyses were performed to identify associated factors and evaluate models. Firth penalized logistic regression and bootstrap internal validation were additionally performed to assess sparse-data bias and optimism in model discrimination.ResultsAmong 225 patients (mean age 65.4 years, 54.2% male), MCR prevalence was 16.4%. In multivariable models, MCR was associated with lower average systolic blood pressure and high total CSVD burden, while physical inactivity showed a positive but imprecise association because of sparse exposure. SCCs were associated with greater juxtacortical white matter hyperintensity volume and higher total CSVD burden. Slow gait was associated with dyslipidemia, poorer functional status, and higher basal ganglia perivascular spaces. The comprehensive exploratory model integrating demographic, clinical, and neuroimaging factors achieved areas under the curve of 0.732 for MCR, 0.733 for SCCs, and 0.770 for slow gait; the corresponding optimism-corrected AUCs were 0.691, 0.696, and 0.725, respectively.ConclusionIn this exploratory cross-sectional analysis, MCR in CSVD patients showed associations with vascular, lifestyle-related, and neuroimaging markers. However, given the small number of MCR events, the single-item SCC assessment, the lack of temporality, and the limited persistence of associations after FDR correction, these findings should be interpreted as hypothesis-generating.

Abstract Background and aims During stroke recovery, patients frequently experience multiple interacting symptoms that limit rehabilitation participation. Symptom network analysis provides a data-driven approach to identify “core symptoms” that may sustain the symptom system and represent high-impact intervention targets. Identifying core symptoms may guide symptom-targeted rehabilitation strategies. We aimed to map the evidence on how core symptoms are identified using symptom network methods in stroke populations and summarize core symptoms reported. Methods Following the Joanna Briggs Institute scoping review methodology, we searched nine databases (MEDLINE, PubMed, EMBASE, Web of Science, ScienceDirect, CBM, CNKI, VIP, and Wanfang) from inception to August 26, 2025. Studies applying symptom network analysis to adults with stroke and reporting core symptoms using centrality metrics were included. We charted methodological features and synthesized reported core symptoms and rehabilitation-related applications. Results Eighteen studies (n=195–2185) were included. Core symptom identification commonly relied on validated symptom scales, symptom preprocessing, Gaussian graphical models with EBICglasso, and centrality indices, particularly expected influence and strength. Across multidimensional networks, the most consistently reported core symptoms were impaired self-care, reduced mobility, pain, fatigue, decreased attention, worry, and low confidence in rehabilitation. In single-domain networks, sadness and loneliness were most frequently identified. Several studies incorporated external variables (e.g., outcomes and disease characteristics), enabling exploration of symptom–outcome pathways. Conclusions Core symptoms during stroke recovery span physical, psychological, and cognitive domains and may represent high-impact targets to improve rehabilitation engagement and functional recovery. Future research should standardize core symptom identification and test whether targeting core symptoms improves symptom burden and rehabilitation outcomes. Conflict of interest Yunting Wu: nothing to disclose. Weige Sun: nothing to disclose. Fei Wu: nothing to disclose. Ran Zhang: nothing to disclose. Tong Wang: nothing to disclose. Minghui Liu: nothing to disclose. Yuying Wang: nothing to disclose. Weixin Cai: nothing to disclose.

PURPOSE:Delayed discharge rate in ambulatory surgery is a vital medical service quality metric, yet current evidence on the delayed discharge rate and risk factors in ambulatory surgery patients remains unclear. This study seeks to determine the incidence and pinpoint key risk factors to guide clinical practice and quality enhancement. DESIGN:Systematic review and meta-analysis. METHODS:Two researchers independently searched 10 databases until April 7, 2025. Quality assessment used Newcastle-Ottawa Scale. Meta-analysis was performed using Review Manager 5.3, with sensitivity analysis conducted via the leave-one-out method. Publication bias was evaluated using Egger's test and funnel plots in Stata 17.0. The GRADE approach was applied to determine the evidence quality. FINDINGS:Fourteen studies involving 41,862 patients were included. The pooled delayed discharge rate was 20%. Meta-analysis identified the following risk factors, sociodemographic (age [MD=2.88], female [OR=1.24], prior surgery [OR=1.44], non-local care [OR=1.51]); preoperative (diabetes [OR=1.27], cardiac insufficiency [OR=2.23], pulmonary insufficiency [OR=2.06], ASA≥3 [OR=4.08]); intraoperative (prolonged duration [MD=11.60]); postoperative (nausea/vomiting [OR=2.36], pain [OR=4.63] and abnormal body temperature [OR = 4.85]). CONCLUSIONS:Multifactorial delayed discharge necessitates multidisciplinary collaboration for risk stratification and personalized management to standardize ambulatory surgery practices.

BackgroundDelirium remains a prevalent and serious complication in intensive care units (ICUs), yet the translation of evidence-based monitoring and management into routine nursing practice faces persistent implementation gaps. Sustainable and scalable educational strategies are urgently needed to address this challenge.ObjectivesThis study employed a mixed-methods approach to comprehensively evaluate the impact of a train-the-trainer (TTT) delirium education program using a multidimensional outcome framework. Quantitatively, we assessed changes in ICU nurses’ competencies across the learning, behavior, and results levels of the Kirkpatrick model. Qualitatively, we explored the underlying experiential mechanisms and contextual drivers to explain the quantitative outcomes and inform program optimization.MethodsA mixed-methods quasi-experimental study with an embedded qualitative component was conducted in a tertiary ICU in China. Forty-seven nurses participated in the TTT program. Quantitative data acquisition included validated instruments for delirium knowledge assessment, standardized clinical simulation evaluations using the CAM-ICU tool, and the General Self-Efficacy Scale, collected at baseline and three months post-intervention. For qualitative data acquisition, semi-structured interviews were conducted with 12 purposively sampled nurses to explore experiential learning trajectories, behavioral drivers, and implementation barriers. Thematic analysis was guided by Social Cognitive Theory and performed using systematic coding procedures.ResultsQuantitative analysis revealed statistically significant improvements across all outcome metrics: delirium knowledge scores (p < 0.05), clinical assessment accuracy (p < 0.05), and self-efficacy (p < 0.001). Qualitative analysis identified four core thematic patterns: (1) Experiential learning trilogy—simulation, practice, and teaching; (2) From experience to evidence—the construction of clinical confidence; (3) Environmental forces—barriers and facilitators in practice implementation; and (4) Systemic spillover effects—enhanced interprofessional communication and recognition of hypoactive delirium. Nurses also provided actionable recommendations for training optimization, notably the need for standardized video resources to ensure content consistency.ConclusionThe TTT program significantly enhanced ICU nurses’ delirium care competencies, driven by simulation-based practice, repeated application, and peer teaching. Contextual challenges and the need for standardized video resources inform future implementation and fidelity considerations. This study provides a feasible, scalable framework for evidence-based delirium care.

Background:Early rehabilitation is vital for functional recovery in critically ill patients. Virtual reality-based early rehabilitation intervention (VR-ERI) is an emerging strategy, but evidence on its feasibility, safety, and efficacy remains inconsistent and unsynthesized. Objective:We synthesized evidence from randomized controlled trials (RCTs) on the feasibility and safety of VR-ERI in adult critically ill patients and evaluated its effects on functional outcomes during intensive care unit (ICU) stay and at short-term follow-up (≤3 months post ICU). Methods:Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched 10 databases (eg, PubMed, Web of Science, Cochrane Library, and Embase) from inception to October 5, 2025, for Chinese and English publications. We included RCTs comparing VR-ERI with control measures initiated early (within 72 h of ICU admission) in adults. FW and YW independently screened studies and extracted data; YW and YX independently conducted the revised Cochrane Risk of Bias tool assessment. Data were synthesized narratively or via meta-analysis in R Studio using a random-effects model (Hartung-Knapp-Sidik-Jonkman adjustment). Effects were expressed as standardized mean differences (SMD; with Hedges g correction) with 95% CIs and 95% prediction intervals (95% PIs). Subgroup and sensitivity analyses were performed to explore heterogeneity and assess robustness. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the quality of evidence. Results:Sixteen RCTs (published 2020-2025) involving 1356 patients were included. Bias assessment found 1 study at low risk, 5 with some concerns, and 10 at high risk. Meta-analysis suggested potential trends for VR-ERI in improving ICU anxiety (SMD -0.86, 95% CI -1.85 to 0.13, 95% PI -3.75 to 2.03; very low certainty) and subjective sleep quality (SMD 3.36, 95% CI 0.77-5.94; very low certainty), with a more pronounced effect in the Richards-Campbell Sleep Questionnaire-assessed subgroup (SMD 5.12, 95% CI 0.54-9.71). At follow-up, VR-ERI showed trends toward improved balance (Berg Balance Scale: SMD 0.97, 95% CI 0.74-1.20, 95% PI 0.37-1.58; moderate certainty), limb motor function (Fugl-Meyer: SMD 1.40, 95% CI -0.23 to 3.02; low certainty), and cognitive function (SMD 0.78, 95% CI 0.16-1.39; low certainty). No significant differences were found for objective sleep measures or ICU pain (low to very low certainty). No serious adverse events were reported; only a few studies mentioned mild reactions, such as dizziness, nausea, and fatigue. Conclusions:This review indicates VR-ERI's potential to improve anxiety, subjective sleep, balance, cognition, and motor function in early ICU rehabilitation, while its effects on pain and objective sleep remain unclear and safety protocols need refinement. Given the high risk of bias, substantial heterogeneity, and imprecision, the overall certainty of evidence is low. Thus, VR-ERI may serve as a nonpharmacological adjunct, but its clinical translation requires consideration of cost and patient suitability, and more rigorous research is needed.

BackgroundEndovascular therapy (EVT) is proven to be both effective and safe for treating acute anterior circulation large vessel occlusion stroke (ACLVOS). Malignant cerebral edema (MCE) can emerge as a severe complication following ET. Predicting acute ACLVOS patients at risk of MCE is crucial for prevention, management, and medical decision-making. The predictive performance and predictive factors of MCE models are not yet well understood.AimsTo identify risk prediction models and potential predictive factors for malignant cerebral edema (MCE) after endovascular therapy (EVT) in patients with acute anterior circulation large vessel occlusion stroke (ACLVOS).Study designWe conducted a systematic search of studies using eight databases from inception until December 31st, 2024. Data extraction followed the critical appraisal and data extraction for systematic reviews of prediction modelling studies (CHARMS) Checklist. And We used the prediction model risk of bias assessment tool (PROBAST) tool to assess the risk of bias and applicability.ResultsWe included 21 articles identifying 30 MCE prediction models. The most common predictors of MCE were the National Institutes of Health Stroke Scale (NIHSS) score, collateral score, and Alberta Stroke Program Early Computed Tomography Score (ASPECTS). All included studies exhibited a high risk of bias. Seventeen studies raised significant applicability concerns, whereas five studies posed lower applicability concerns.ConclusionThis systematic review confirms the feasibility of predicting MCE risk after EVT in ACLVOS patients using existing models and highlights key predictive factors. However, the high risk of bias across studies limits their clinical applicability.Relevance to clinical practiceThis study empowers ICU nurses to accurately identify the risk levels of MCE and implement targeted monitoring strategies.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024564544, CRD42024564544.

Abstract Background and aims Cerebral small vessel disease (CSVD) and heart disease share common vascular pathologies and exhibit high clinical comorbidity. Patients with these conditions often suffer from multiple symptoms. Therefore, this study aims to explore the symptom clusters in patients with CSVD and comorbid heart disease, including core symptoms and bridge symptoms, to provide insights for identifying more precise intervention targets. Methods This patients recruited from the China Imaging-based Biobank of Cerebral Small Vessel Diseases (CIBB-CSVD) at Beijing Tiantan Hospital between January 2020 and May 2023. Symptom clusters were extracted using exploratory factor analysis. Finally, network structures were constructed with the “qgraph” packages in R to characterize symptom relationships and calculate centrality indices. The bootnet package was used to evaluate the accuracy and stability. Results This study included a total of 648 patients, with an average age of 67.61 ± 8.29 years. A total of three symptom clusters were extracted: the pain-emotion-cognitive symptom cluster, the urgency urinary disorder symptom cluster, and the abnormal urination rhythm symptom cluster (Figure 1). Based on node centrality indices (Figure 2), difficulty in holding urine was identified as the core symptom. Frequent urination was selected as the key bridge symptom.The case-dropping bootstrap showed good centrality stability (exceeding the recommended threshold of 0.7), and the nonparametric bootstrap indicated adequate edge-weight accuracy with relatively narrow 95% confidence intervals (Figure 3). Conclusions This study identified core and bridge symptoms within symptom clusters of CSVD-heart disease comorbidity, providing precise targets for integrated management and a novel network-based intervention framework. Conflict of interest Weige Sun, Yunting Wu, Xuejiao Zhou, Ran Zhang, Weixin Cai: nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Results Figure 3 - belongs to Results

BACKGROUND:The number of predictive models for assessing the risk of subsyndromal delirium (SSD) in critically ill patients is increasing, yet the quality and applicability of these models in clinical practice remain unclear. AIM:To systematically review and critically evaluate the existing risk prediction models. STUDY DESIGN:Eleven Chinese and English databases, including PubMed, Web of Science and Embase, were searched from their inception to August 16, 2024. Two researchers independently screened the literature, extracted data and assessed the risk of bias and applicability using the prediction model risk of bias assessment tool. Meta-analysis was conducted using Stata 17.0. RESULTS:Eight studies were included. The SSD incidence in ICU patients ranged from 8.97% to 34.5%. The most commonly used predictors were the APACHE II score and age. The reported area under the curve (AUC) ranged from 0.788 to 0.923, with the pooled AUC value for the five validated models being 0.87 (95% CI: 0.82-0.92). Six studies had a high risk of bias, while two had an unclear risk. CONCLUSIONS:The eight included models demonstrated good performance in early identification and screening of high-risk critically ill patients for SSD, but they all exhibited a high risk of bias regarding model quality. RELEVANCE TO CLINICAL PRACTICE:ICU professionals should carefully select and validate existing models based on their specific clinical settings before applying them. Alternatively, they can conduct new models incorporating multimodal data and artificial intelligence algorithms, utilizing large sample sizes, robust research designs and multi-center external validation.

PURPOSE:To develop and implement an evidence-based perioperative health education program for patients undergoing daytime anorectal surgery, and to enhance patients' knowledge scores pertaining to anorectal diseases. DESIGN:An evidence-based quality improvement project. METHODS:Adhering to the evidence-based practice model of the Joanna Briggs Institute, we developed 17 audit criteria grounded in the best available evidence. This evidence-based practice was subsequently applied to patients scheduled for daytime anorectal surgery between March 2023 and May 2024. The project progressed through three distinct phases: a baseline audit, implementation of practice changes, and a post evidence application audit. Specifically, we compared the execution rates of the audit criteria by the nursing staff, patients' scores on anorectal disease knowledge, patient satisfaction, and incidence of postoperative complications before and after implementation of the evidence-based practice. FINDINGS:After implementation of the evidence-based practice, there was a statistically significant difference in the execution rates of audit indicators 1, 2, 5, 6, 8, and 10 to 17 (P < .05). After implementation, patients' average score on anorectal disease knowledge was 74.14 ± 14.40, higher than the average baseline audit phase score of 63.67 ± 12.31 (P = .004). Patients were likely to recommend the hospital's daytime anorectal surgery to others (P = .036). There were no statistically significant differences in patient satisfaction scores or complication incidence between the two groups. CONCLUSIONS:Current evidence suggests that the program may regulate nurse behavior, enhance patients' health knowledge, and improve patients' overall medical experience. Continuous quality supervision and audit should be further conducted in the future.

Aim: To design nursing management training systems based on the Kemp model and role theory, enhance new nurse managers (NNMs)' core competencies, and facilitate role transition. Background: Amid the diverse and intricate practical setting of policy development and execution, NNMs frequently confront numerous challenges as they transition into their roles. Although training programs strive to boost their core competencies and facilitate adaptation to new positions, most overlook the unique needs and individual traits of these managers. In addition, educational models and role theory are seldom woven into the design and assessment of such training initiatives. Methods: A pre-post quasiexperimental pilot study was conducted at a tertiary hospital in Beijing, following the TREND guidelines from September to November 2024. Fourteen NNMs received core competency training program based on the Kemp model and role theory. Formative evaluation of NNMs during training used classroom questioning, homework, and reflective journal. A month post-training, summative evaluation was conducted using the Nurse Manager Competency Assessment Questionnaire and semistructured interviews. Data were analyzed using SPSS 25.0, Nvivo 12.0, and Colaizzi's thematic analysis. Results: Compared with pretraining, the overall core competency (134.93 ± 11.81 vs. 146.79 ± 13.92) and behavioral competency (46.64 ± 5.47 vs. 52.93 ± 5.72) of the NNMs showed significant improvement (p < 0.05). Five themes emerged, including role awareness awakening and cognitive restructuring, capability adjustment in role practice, role identity and coconstruction of team culture, the tension between role expectations and career development, role cultivation and continuous professional development. Conclusions: The training program, blending the Kemp model with role theory, effectively tackles the hurdles NNMs face in role transition. It boosts their core competencies and fosters role adaptation and growth, providing healthcare institutions with replicable strategies to refine support systems for nurse managers (NMs) during this phase. Implications for Nursing Management: Integrating the Kemp model-role theory framework into policy-driven, competency-based leadership development enhances the role adaptability and psychological resilience of NMs across global healthcare systems.

AIM:To investigate the challenges and needs of new nurse managers transitioning from staff nurses to manager roles. BACKGROUND:Nursing managers are often selected based on clinical expertise, not proven leadership skills. Their complex roles and evolving healthcare policies result in heightened expectations from society, institutions, patients, and staff. The often-overlooked transition phase from staff nurse to manager presents distinct challenges and needs. Clarifying these aspects is crucial for developing effective nursing policies and improvement initiatives. METHODS:A phenomenological qualitative study was conducted at a tertiary hospital in Beijing, following the COREQ guidelines from April to June 2023. Fourteen new nurse managers were interviewed using a semi-structured interview guide based on the role theory. Data were analyzed using Nvivo 12.0 and Colaizzi's thematic analysis. RESULTS:Four themes emerged, including role ambiguity (adjustment difficulties, unclear expectations, poor handling), role conflict (inconsistencies between work and family, management, competencies), role learning (self-improvement, external support, resilience), and role behaviors (summarizing experiences, time management, promoting coworkers, research capability). DISCUSSION:Identifying the difficulties and needs of new nurse managers during their role transition can help healthcare organizations develop tailored training, external support, positive psychology, and academic advancement strategies. CONCLUSIONS:New nurse managers face significant transition obstacles, necessitating comprehensive support. This prompts healthcare organizations to adopt best practices for facilitating role adaptation and talent development. IMPLICATIONS FOR NURSING AND HEALTH POLICY:To ensure the successful adaptation of new nurse managers, comprehensive and tailored strategies should be developed based on identified transition challenges and needs. This support will enhance their competencies and stress management. Nursing policymakers should encourage new nurse managers to participate in the formulation of policies and training programs.

BackgroundDecision aids (DAs) have been proposed to support patients and families with disease information processing and decision-making, but their effectiveness for critically ill patients and their families is incompletely understood.AimTo systematically synthesize evidence on the effectiveness of the DAs on the prognosis of critically ill patients and knowledge, anxiety, depression and decisional conflict of their family members.Study DesignSystematic review and meta-analysis. We conducted a systematic search of literature using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature database, Scopus, PsycNet, CNKI and Wanfang Database from the inception of the databases until May 2023 to identify randomized clinical trials (RCTs) describing DAs interventions targeted at adult intensive care unit (ICU) patients or their families. We also searched grey literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey and GreyNet International.ResultsSeven RCTs were included in the review. Meta-analysis identified longer hospital length of stay (LOS) among all patients compared with usual care (mean difference [MD] = 5.64 days, 95% confidence interval, CI [0.29, 10.98], p = .04), but not in surviving patients (MD = 2.09 days, 95% CI [-3.70, 7.89], p = .48). However, there was no evidence of an effect of DAs on hospital mortality (RR = 1.25, 95% CI [0.92, 1.70], p = .15), ICU LOS (MD = 3.77 days, 95% CI [-0.17, 7.70], p = .06) and length of mechanical ventilation (MD = 0.88 days, 95% CI [-2.22, 3.97], p = .58). DAs led to a statistically significant improvement in family members' knowledge (standard mean difference = 0.84, 95% CI [0.12, 1.56], p = .02). We found no significant effect of DAs on anxiety, depression, post-traumatic stress disorder, decisional conflict and quality of communication of family members.ConclusionsThis review provides effective evidence that DAs can potentially improve the knowledge level of family members while prolonging the hospital LOS among critically ill patients.Relevance to Clinical PracticeWell-designed large-scale studies with DAs tailored to the individuals' preferences and existing cultural values are warranted.

This study was based on the Kano model and rely on the Internet hospital to build a day surgery patient full-process nursing service platform. Based on the Internet hospital’s HIS system, nursing Yuanzhuo system, patient mobile terminal (WeChat) and other information systems. The platform was designed by following the WHO’s conceptual framework for developing a scaling-up strategy. It was tested and refined by a pilot in a hospital in China. The full-process care platform for day surgery patients realizes information interconnection and interoperability of patient surgical consultation, surgical inquiries, and postoperative follow-up. It consists of a WeChat applet (client) and an online website (server). Pre-experiment results show that patients are more likely to recommend the hospital’s day surgery to others. The mHealth-based perioperative full-process nursing service platform for day surgery patients can initially meet the health education needs, surgical consultation needs and follow-up needs of day surgery patients.

Background There is substantial evidence to support the use of several methods for preventing deep-vein thrombosis (DVT) following intracerebral hemorrhage (ICH). However, the extent to which these measures are implemented in clinical practice and the factors influencing patients’ receipt of preventive measures remain unclear. Therefore, we aimed to evaluate the rate of the early implementation of DVT prophylaxis and the factors associated with its success in patients with ICH. Methods This study enrolled 49,950 patients with spontaneous ICH from the Chinese Stroke Center Alliance (CSCA) between August 2015 and July 2019. Early DVT prophylaxis implementation was defined as an intervention occurring within 48 h after admission. Univariate and multivariate logistic regression analyses were conducted to identify the rate and factors associated with the implementation of early prophylaxis for DVT in patients with ICH. Results Among the 49,950 ICH patients, the rate of early DVT prophylaxis implementation was 49.9%, the rate of early mobilization implementation was 29.49%, and that of pharmacological prophylaxis was 2.02%. Factors associated with an increased likelihood of early DVT prophylaxis being administered in the multivariable model included receiving early rehabilitation therapy (odds ratio [OR], 2.531); admission to stroke unit (OR 2.231); admission to intensive care unit (OR 1.975); being located in central (OR 1.879) or eastern regions (OR 1.529); having a history of chronic obstructive pulmonary disease (OR 1.292), ischemic stroke (OR 1.245), coronary heart disease or myocardial infarction (OR 1.2); taking antihypertensive drugs (OR 1.136); and having a higher Glasgow Coma Scale (GCS) score (OR 1.045). Conversely, being male (OR 0.936), being hospitalized in tertiary hospitals (OR 0.778), and having a previous intracranial hemorrhage (OR 0.733) were associated with a lower likelihood of early DVT prophylaxis being administered in patients with ICH. Conclusions The implementation rate of early DVT prophylaxis among Chinese patients with ICH was subpar, with pharmacological prophylaxis showing the lowest prevalence. Various controllable factors exerted an impact on the implementation of early DVT prophylaxis in this population.

BACKGROUND:No large-scale, multicenter studies have explored the incidence rate and predictors of deep vein thrombosis (DVT) in patients with acute ischemic stroke (AIS). We aimed to determine the risk factors of DVT, and assess the association between DVT and clinical outcomes in AIS patients. METHODS:In total, 106,612 patients with AIS enrolled in the Chinese Stroke Center Alliance between August 2015 and July 2019 were included. The predictors of DVT in AIS patients were screened based on the logistic regression analysis for the comparison of the characteristics and clinical outcomes of patients with and without DVT. RESULTS:The overall incidence of DVT after AIS was 4.7%. Factors associated with increased incidence of DVT included advanced age, female sex, high admission National Institutes of Health Stroke Scale score, history of cerebral hemorrhage, transient ischemic attack (TIA), dyslipidemia, atrial fibrillation, and peripheral vascular disease, International Normalized Ratio (INR) <0.8 or >1.5, and blood uric acid >420 μmol/L. Ambulation and early antithrombotic therapy were associated with a lower incidence of DVT. Patients with DVT was associated with longer hospital stay (OR=1.44, 95% CI: 1.35-1.54), and higher in-hospital mortality (OR=1.68, 95% CI: 1.25-2.27). CONCLUSIONS:This large-scale, multi-center study showed that the occurrence of DVT in AIS patients is associated with various modifiable and objective indicators, such as abnormal INR and uric acid >420 μmol/L. Ambulatory status and early antithrombotic therapy can reduce the occurrence of DVT in AIS patients. In AIS patients, DVT may prolong the hospital stay and increase the risk of in-hospital mortality. Future research should focus on the clinical implementation of existing evidence on DVT prevention in AIS patients.

Objective The types and number of day surgeries have significantly increased, but the construction of the whole process nursing service system (WPNSS) for preoperative education, intraoperative cooperation, postoperative knowledge, and follow-up for day surgery patients is still in the exploratory stage. The aim of this study is to establish the WPNSS for day surgery patients using the Kano model and to preliminarily assess its efficacy. Methods WPNSS for day surgery was devised leveraging Internet hospital information systems and patient mobile terminals (WeChat), guided by the World Health Organization's conceptual framework for scaling-up strategies. The system was methodically developed, progressing from defining the overall framework to delineating modular functions and developing specific educational materials and tools. A pilot test was conducted in a hospital in China. Results WPNSS, a patient-centric remote education and monitoring system, seamlessly amalgamates health education, online consultations, and follow-up functionalities; offering semi-automated surgical consultations, inquiry services, and postoperative follow-ups, as well as autonomously disseminating perioperative health education content. Comprising both client and server components, patients utilizing the system are inclined to recommend day surgery at the hospital to others Conclusions WPNSS delivers personalized and precise health education, consultation, and postoperative follow-up services for day surgery patients. Current results suggest that the WPNSS may improve patients’ experience. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066782).

目的:了解护理管理者在管理智慧病房过程中的真实体验,为智慧病房的建设及管理提供参考依据.方法:采用目的抽样法于2020年1月—2020年2月运用现象学研究方法对8名护理管理者进行半结构式面对面深度访谈,运用Colaizz 7步分析法进行资料整理分析,提炼主题.结果:提炼出智慧病房建设对护士管理的影响、智慧病房建设对病人管理的影响、对智慧病房建设的建议3个主题.结论:护理管理者对智慧病房建设认可度较高,为更好地实现智慧病房的建设与管理,护理管理者应加强自身的信息能力,开展多种形式的培训工作,多方共同努力才能为智慧病房的运转创造良好的条件.