Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

AIMS AND OBJECTIVES: To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. BACKGROUND: China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. DESIGN: Prospective. METHODS: A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. RESULTS: Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. CONCLUSION: Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. RELEVANCE TO CLINICAL PRACTICE: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.

Using the Delphi method to develop nursing-sensitive quality indicators for the NICU.

AIMS AND OBJECTIVES: To develop nursing-sensitive quality indicators consistent with current medical practices in Chinese neonatal intensive care units. BACKGROUND: The development of nursing-sensitive quality indicators has become a top priority in nursing management. To the best of our knowledge, there has been no objective, scientific and sensitive evaluation of the quality of neonatal intensive care unit nursing in China. DESIGN: A modified Delphi technique was used to seek opinions from experts about what should be used and prioritised as indicators of quality care in neonatal intensive care unit nursing. METHODS: Based on a literature review, we identified 21 indicators of nursing-sensitive quality in the neonatal intensive care unit. Our group of 11 consultants chose 13 indicators to be discussed using the Delphi method. In October and November 2014, 39 neonatal intensive care unit experts in 18 tertiary hospitals spread across six provinces participated in two rounds of Delphi panels. RESULTS: Of the 13 indicators discussed, 11 were identified as indicators of nursing-sensitive quality in the neonatal intensive care unit: rate of nosocomial infections, rate of accidental endotracheal extubation, rate of errors in medication administration, rate of treatment for pain, rate of peripheral venous extravasation, rate of compliance with handwashing techniques, incidence of pressure ulcers, incidence of noise, the bed-to-care ratio, the proportion of nurses with greater than five years neonatal intensive care unit experience and incidence of retinopathy. CONCLUSIONS: The 11 neonatal intensive care unit nursing-sensitive indicators identified by the Delphi method integrated with basic Chinese practices provide a basis for nursing management and the monitoring of nursing quality. RELEVANCE TO CLINICAL PRACTICE: This study identified nursing-sensitive quality indicators for neonatal intensive care unit care that are suitable for current clinical practice in China.

Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China.

BACKGROUND: Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking. OBJECTIVE: This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China. METHODS: Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR. RESULTS: Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count. CONCLUSIONS: Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs.

The application of clinical pathways in laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay, costs, and the outcomes of patients undergoing LC. DATA SOURCES: Data were extracted from the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index (CMCI), Chinese Medical Current Contents (CMCC), and China BioMedical Literature Database (CBM). We also searched the reference lists of the relevant articles and conference articles. Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software (version 5.0). RESULTS: A total of 7 trials with 1187 patients were included. The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95% CI: -2.65 to -1.16, P<0.00001], lower cost [standard mean difference=-0.69, 95% CI: -0.82 to -0.56, P<0.00001], and better questionnaires based satisfaction with the medical services. CONCLUSIONS: The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However, there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.

Effect of low-fat diet on breast cancer survival: a meta-analysis.

BACKGROUND: Even though many studies have examined the possible effect of low-fat diet on breast cancer survival, the relationship remains unclear. OBJECTIVES: To summarize the current evidence about the effect of post-diagnostic low-fat diet on recurrence and all-cause mortality of breast cancer. METHODS: We conducted a search of Pubmed, Embase, Web of Science, and Cochrane Library and as a result two randomized controlled trials (RCT) and one large multi-center prospective cohort study with 9,966 breast cancer patients were included in this report. RESULTS: Post-diagnostic low-fat diet reduced risk of recurrence of breast cancer by 23% (HR=0.77, 95%CI 0.63 to 0.94, P=0.009) and all cause mortality of breast cancer by 17% (HR=0.83, 95%CI 0.69 to 1.00, P=0.05). CONCLUSIONS: This meta-analysis suggested the post-diagnostic low-fat diet can improve breast cancer survival by reducing risk of recurrence. However, more trials of the relationship between low-fat diet and all- cause mortality of breast cancer are still needed.

Carotenoid intake and esophageal cancer risk: a meta-analysis.

This meta-analysis was conducted to evaluate the association between intake of carotenoids and risk of esophageal cancer. A systematic search using PubMed, Cochrane Library, Web of Science, Scopus, CNKI, and CBM (updated to 6 May 2012) identified ten articles meeting the inclusion criteria with 1,958 cases of esophageal cancer and 4,529 controls. Higher intake of beta-carotene, alpha-carotene, lycopene, beta-cryptoxanthin, lutein, and zeaxanthin reduced esophageal cancer risk with pooled ORs of 0.58 (95% CI 0.44, 0.77), 0.81 (95% CI 0.70, 0.94), 0.75 (95% CI 0.64, 0.86), 0.80 (95% CI 0.66, 0.97), and 0.71 (95% CI 0.59, 0.87), respectively. In subgroup analyses, beta-carotene showed protective effects against esophageal adenocarcinoma in studies located in Europe and North America. Alpha-carotene, lycopene, and beta-cryptoxanthin showed protection against esophageal squamous cell cancer. This meta-analysis suggested that higher intake of carotenoids (beta-carotene, alpha- carotene, lycopene, beta-cryptoxanthin, lutein, and zeaxanthin) is associated with lower risk of esophageal cancer. Further research with large-sample studies need to be conducted to better clarify the potentially protective mechanisms of carotenoid associations risk of different types of esophageal cancer.

Technical aspects of biliary reconstruction in adult living donor liver transplantation.

BACKGROUND: The last decade has witnessed great progress in living donor liver transplantation worldwide. However, biliary complications are more common in partial liver transplantation than in whole liver transplantation. This is due to an impaired blood supply of the hilar bile duct during organ procurement and recipient surgery, commonly encountered anatomical variations, a relatively small graft duct, and complicated surgical techniques used in biliary reconstruction. DATA SOURCES: MEDLINE and PubMed were searched for articles on "living donor liver transplantation", "biliary complication", "anatomical variation", "biliary reconstruction", "stenting" and related topics. RESULT: In this review, biliary complications were analyzed with respect to anatomical variation, surgical techniques in biliary reconstruction, and protection of the arterial plexus of the hilar bile duct. CONCLUSION: Transecting the donor bile duct at the right place to secure a larger bile duct stump, anastomosing techniques, and stenting methods as well as preserving the blood supply to the bile duct are all important in reducing biliary complications.