[Analysis of the factors influencing prognosis of the adult in-hospital cardiac arrest].

OBJECTIVE: To explore the factors influencing prognosis of patients with in-hospital cardiac arrest (IHCA). METHODS: A retrospective observational study was conducted. The clinical data of patients who developed IHCA and underwent cardiopulmonary resuscitation (CPR) at the Second Xiangya Hospital of Central South University from January 1, 2016, to December 31, 2022 were analyzed. The patients' information, including gender, age, medical history, pre-cardiac arrest related parameters [1-hour pre-cardiac arrest neurological function, 24-hour pre-cardiac arrest hemoglobin (Hb) levels, 1-hour pre-cardiac arrest vital signs], initial CPR-related factors (implementation time and location, initial rhythm, ventilation method, defibrillation and resuscitation drugs) as well as restoration of spontaneous circulation (ROSC) related parameters (vital signs at ROSC and 1 hour after ROSC, 24-hour post-cardiac arrest Hb, and IHCA events), were collected through the hospital's electronic medical record system. The clinical data were compared between ROSC and non-ROSC patients as well as between patients with favorable neurological function [cerebral performance category (CPC) grades 1-2] and unfavorable neurological function (CPC grades 3-5) at 28 days. The factors with statistical significance in univariate analysis and clinical significance were enrolled in a binary multivariate Logistic regression model to analyze the influencing factors of ROSC and neurological function at 28 days after ROSC. The predictive value of factors influencing neurological function at 28 days was assessed using receiver operator characteristic curve (ROC curve). RESULTS: A total of 277 IHCA-CPR patients were enrolled, of which 230 achieved ROSC (83.0%) and 47 were not achieved (17.0%). Compared with non-ROSC patients, ROSC patients had lower prevalence of cerebrovascular disease history and proportion of adrenaline usage, but a higher proportion of initial shockable rhythms. In the multivariate Logistic regression analysis, it was found that using a bag-mask ventilation+endotracheal intubation (compared with a bag-mask ventilation alone) was beneficial for achieving ROSC in IHCA-CPR patients [odds ratio (OR) = 2.895, 95% confidence interval (95%CI) was 1.204-6.962, P = 0.018], while a initial non-shockable rhythm was not conducive to achieving ROSC in IHCA-CPR patients (OR = 0.349, 95%CI was 0.147-0.831, P = 0.017). Among the 230 ROSC patients, 42 had good neurological function at 28 days (18.3%), and 188 had poor neurological function (81.7%). Compared with the patients with good neurological function, the patients with the poor neurological function were older and had a higher prevalence of 1-hour pre-cardiac arrest neurological dysfunction and low perfusion, initial non-shockable rhythms, endotracheal intubation, and usage of adrenaline, vasopressors and sodium bicarbonate, a lower proportion of defibrillation and antiarrhythmic medication usage as well as lower 24-hour post-cardiac arrest Hb levels. The multivariate Logistic regression analysis revealed that female (OR = 6.449, 95%CI was 1.837-22.642, P = 0.004), older age (OR = 1.054, 95%CI was 1.017-1.093, P = 0.004), 1-hour pre-cardiac arrest neurological dysfunction (OR = 25.044, 95%CI was 2.737-229.169, P = 0.004), 1-hour pre-cardiac arrest low perfusion (OR = 3.880, 95%CI was 1.306-11.524, P = 0.028), endotracheal intubation (compared with a bag-mask ventilation; OR = 8.712, 95%CI was 1.402-54.141, P = 0.020) and face mask+endotracheal intubation during CPR (compared with a bag-mask ventilation; OR = 11.089, 95%CI was 3.482-35.320, P = 0.000), IHCA events > 1 time (OR = 4.221, 95%CI was 1.249-14.226, P = 0.020) were positively associated with poor neurological function at 28 days, which were independent risk factors those were not conducive to 28-day neurological function recovery after ROSC in IHCA-CPR patients. In contrast, usage of antiarrhythmic medication (OR = 0.345, 95%CI was 0.134-0.890, P = 0.028) and 24-hour post-cardiac arrest Hb (OR = 0.983, 95%CI was 0.966-0.999, P = 0.043) were negatively associated with poor neurological function at 28 days, which were protective factors those were beneficial for the recovery of neurological function. ROC curve analysis showed that the area under the ROC curve (AUC) of 24-hour post-cardiac arrest Hb for predicting poor neurological function at 28 days after ROSC in IHCA-CPR patients was 0.659 (95%CI was 0.577-0.742), with a cut-off value of 99.5 g/L (sensitivity was 76.2%, specificity was 57.8%). CONCLUSIONS: Defibrillation and tracheal intubation during CPR are crucial for IHCA patients. It was also observed that patients with low Hb (< 99.5 g/L should be of high concern), older age, 1-hour pre-cardiac arrest neurological function and hypoperfusion, and IHCA events > 1 time were significantly related to unfavorable neurological outcome in adult resuscitated patients with IHCA.

Perception and needs: a qualitative study on sense of job security among nurses in central and western China.

AIMS: To explore nurses' perceptions of sense of job security and their needs to improve it. DESIGN: A descriptive qualitative study employed an in-depth, in-person interview from February to April in 2021. The data analysis software NVivo V.11.0 was used to assist with the data organisation, and content analysis methods were conducted to explore key concepts. SETTING: Three tertiary hospitals in central and western China were selected by convenience sampling method. PARTICIPANTS: A total of 20 nurses participated in this study. RESULTS: Four categories and 13 subcategories were extracted. The four main categories included: (1) enrich connotation of sense of job security; 2) challenges to sense of job security; (3) consequences of a sense of insecurity; and (4) the need to improve nurses' sense of job security. CONCLUSIONS: Nurses expressed a multidimensional perception of a sense of security about the nursing profession, and they highlighted the importance of communication skills training and supervisors' humanistic care and support. It is necessary to improve the training system for nurses' ability improvement, a harmonious work environment, policies and psychological health support to enhance their sense of job security.

Public willingness, attitudes and related factors toward cardiopulmonary resuscitation: A grounded theory study.

OBJECTIVES: Despite receiving cardiopulmonary resuscitation (CPR) training, over 50% of bystanders were unable to actually perform CPR. Understanding public willingness and attitudes toward bystander CPR is crucial in explaining whether people initiate CPR. This study aimed to develop a theoretical understanding of factors that influence the public's willingness and attitudes to perform CPR. DESIGN: This was a qualitative study using the grounded theory method. METHODS: The data were collected from semi-structured interviews with 28 participants between August 2022 and November 2022. Purposive sampling and theoretical sampling were used to recruit participants. Interviews were recorded and transcribed. Data were analyzed using open, axial, and selective coding. RESULTS: Nine categories and 24 subcategories were summarized from four aspects: willingness, attitudes, implementation, and training. Willingness included self-willingness, self-perception, and societal factors; attitudes covered personality traits, reactions to patients and environment; implementation comprised knowledge and skills, situational coping, and risk perception; training included CPR training accessibility and barriers to CPR training. A theoretical framework of public CPR willingness, attitudes, and their influencing factors was developed. CONCLUSION: The public's CPR willingness, attitudes, training, and implementation were interrelated and influential. The findings may have significant implications for the development of legislation and policy related to CPR popularization and training.

[Characteristics and resuscitation effects of out-of-hospital sudden death: a study based on Internet data].

OBJECTIVE: To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies. METHODS: The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death. RESULTS: 177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC (n = 104), sudden death in non-ROSC patients (n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically (n = 91) showed similar characteristics compared with patients who recovered consciousness (n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio (OR) = 8.06, 95% confidence interval (95%CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95%CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95%CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95%CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. CONCLUSIONS: Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.

Continuous compression with asynchronous ventilation improves CPR prognosis? A meta-analysis from human and animal studies.

BACKGROUND: The cardiopulmonary resuscitation (CPR) compression to ventilation strategy remains controversial. We conducted a meta-analysis to compare the outcomes between continuous chest compressions CPR with asynchronous ventilation (CCC-CPR) and interrupted chest compressions CPR with synchronous ventilation (ICC-CPR) in cardiac arrest. METHODS: PubMed, Web of Science, Embase, MEDLINE (Ovid/LWW) and the Cochrane Libraries were searched up from inception to July 31, 2022. Human and animal studies comparing CCC-CPR versus ICC-CPR were included. Outcome variables were return of spontaneous circulation (ROSC), time to ROSC, survival to discharge, 1-month survival, survival at 4 h, good neurological function, mean arterial pressure (MAP) and other clinical parameters. Jadad Scale and Newcastle-Ottawa Scale were used to assess the study quality and risk of bias. RESULTS: The systematic search identified eight studies on humans and twelve studies on animal trials. There were no significant differences in ROSC (odd ratios [OR] 1.07; 95% confidence interval [CI]: 0.86-1.32; P = 0.55), survival to hospital discharge (OR 1.04; 95%CI 0.77-1.42; P = 0.79), 1-month survival (OR 1.07; 95%CI 0.84-1.36; P = 0.57), and good neurological outcome (OR 0.92; 95%CI 0.84-1.01, P = 0.09) between CCC-CPR and ICC-CPR in human studies. In animal trials, CCC-CPR had significantly higher rate of ROSC (OR = 1.81; 95% CI: 0.94-3.49; P = 0.07), survival at 4 h (OR 2.57; 95% CI: 1.16-5.72; P = 0.02) and MAP (mean difference [MD] 0.79, 95% CI: 0.04-1.53; P = 0.04), even though no significant differences in ROSC time, arterial potential of hydrogen (pH) and partial tension of carbon dioxide (PaCO2). CONCLUSION: CCC-CPR did not show superiority in human outcomes compared with ICC-CPR, but its effect value was significantly increased in animal experiments. We should take the positive outcomes from animals and apply them to human models, and more physiological mechanisms need to be confirmed in CPR patients with different compression-ventilation strategies to improve the prognosis of cardiac arrest.

Psychological experience among internship nurses at different internship stages: A qualitative study.

AIM: Some studies have found that clinical practice has caused great pressure and negative psychological experience to nursing students. Therefore, this study aimed to identify psychological experience at different internship stages among internship nurses. DESIGN: A qualitative study. METHODS: In this qualitative study, one-to-one in-depth interviews and mixed data analysis strategies were conducted among internship nurses from May 2018 to February 2019. RESULTS: The pressure of the initial stage was operational pressure (80.0%), intermediate stage was nurse-patient communication (50.0%), and last stage was employment pressure (70.6%). Nursing students mainly expected to improve their operational and communication skills, and to acquire clinical experience, thinking ability and frontier knowledge. 62.5% students said ambivalent on "let us practice with being monitored," especially in the last stage (88.2%). Clinical nursing teaching should pay attention to this dynamic experience and their factors and take corresponding measures to improve the quality of internship.

Outcome of cardiopulmonary resuscitation with different ventilation modes in adults: A meta-analysis.

BACKGROUND: The optimal airway management strategy for cardiac arrest remains unclear. This study aimed to compare the effects of different initial airway interventions on improving clinical outcomes based on the 2010 cardiopulmonary resuscitation (CPR) guidelines and later. METHODS: We searched PubMed, EMBASE, and the Cochrane Library for CPR articles tailored to each database from October 19, 2010, to July 31, 2021, to compare endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BMV). The initial results and long-term results were investigated by meta-analysis. RESULTS: Twenty-five articles (n = 196,486) were included. The ROSC rate in the ETI group (ES = 0.49, 95% CI: 0.38-0.59) was significantly higher than that in the SGA group (ES = 0.27, 95% CI: 0.20-0.34) and BMV group (ES = 0.24, 95% CI: 0.17-0.31). The rate of ROSC upon admission to the hospital in the ETI group (ES = 0.27, 95% CI: 0.13-0.42) was significantly higher than that in the SGA group (ES = 0.18, 95% CI: 0.13-0.23) and BMV group (ES = 0.16, 95% CI: 0.10-0.22). Compared with the BMV group (ES = 0.09, 95% CI: 0.04-0.14) and the SGA group (ES = 0.08, 95% CI: 0.05-0.10), the ETI group (ES = 0.14, 95% CI: 0.10-0.17) had a higher discharge rate, but all of the groups had the same neurological outcome (ETI group [ES = 0.06, 95% CI: 0.04-0.08], BMV group [ES = 0.05, 95% CI: 0.03-0.08] and SGA group [ES = 0.04, 95% CI: 0.03-0.05]). CONCLUSIONS: Opening the airway is significantly associated with improved clinical outcomes, and the findings suggest that effective ETI based on mask ventilation should be implemented as early as possible once the patient has experienced cardiac arrest.

The relationship of sleep quality among internship nurses with clinical learning environment and mental stress: a cross-sectional survey.

BACKGROUND: Previous evidence has supported an association between sleep quality and psychological stress. However, the association between internship nurses' sleep status and its relevant factors is poorly understood. OBJECTIVE: The aim of this study was to investigate sleep quality and its related factors in clinical learning environment and mental stress. METHODS: A cross-sectional survey was conducted by three instruments: Clinical Learning Environment, Supervision, and Nurse Teacher Evaluation Scale (CLES + T), Stress Rating Scale for practicing nurses (SRS) and Pittsburgh Sleep Quality Index (PSQI). RESULTS: A total of 508 (91.86%) of 553 students experienced poor sleep quality. The structural equation model showed a correlation of the PSQI with the CLES + T (r = -0.21, p < 0.001), a correlation of the PSQI with the SRS (r = 0.32, p < 0.001), and a correlation of the SRS with the CLES + T (r = -0.22, p < 0.001). Linear regression analysis showed that education (B = -0.56, p < 0.001), willingness to engage in nursing after graduation (B = -0.75, p < 0.001), pedagogical atmosphere in the ward (B = -0.05, p < 0.001) measured by the CLES + T, workload (B = 0.11, p = 0.01), interpersonal relationships (B = -0.12, p = 0.03), and conflicts between study and work (B = 0.12, p < 0.001) on the SRS were significant factors influencing the PSQI. CONCLUSIONS: Poor sleep quality is common among internship nurses and it's affected by clinical environment and mental stress. It's necessary to apply more tailored education programs to promote nursing development.

Identifying a Clinical Risk Triage Score for Adult Emergency Department.

Emergency triage is crucial for the treatment and prognosis of emergency patients, but its validity needs further improvement. The purpose of this study was to identify a risk score for adult triage. We conducted a regression analysis of physiological and biochemical data from 1,522 adult patients. A 60-point triage scoring model included temperature, pulse, systolic blood pressure, oxygen saturation, consciousness, dyspnea, admission mode, syncope history, chest pain or chest tightness, complexion, hematochezia or hematemesis, hemoptysis, white blood count, creatinine, bicarbonate, platelets, and creatine kinase. The area under curve in predicting ICU admission was 0.929 (95% CI [0.913-0.944]) for the derivation cohort and 0.911 (95% CI [0.884-0.938]) for the validation cohort. Four categories: critical level (≥13 points), severe level (6-12 points), urgency level (1-5 points), and sub-acute level (0 points) were divided, which significantly distinguished the severity of emergency patients.

Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes.

BACKGROUND: The diagnosis and treatment of invasive fungal infection (IFI) are still challenging due to its complexity and non-specificity. This study was aimed to investigate the clinical features, diagnosis process, and outcomes of patients with emerging IFIs. METHODS: A retrospective review of emerging IFIs in adult patients at a university hospital in China was conducted; diagnoses were based on the criteria of EORTC/MSG 2008. RESULTS: 145 IFI patients (pulmonary, intestinal and urinary) were enrolled in this study, including 80 proven (55.2%), 59 probable (40.7%), or 6 possible IFIs (4.1%). Among the 126 pulmonary IFIs, the positivity rate for sputum microscopy, sputum culture, and 1.3-ß-D-glucan (BG) test was 54.0%, 44.4%, and 37.3%, respectively. Among the 19 intestinal and urinary IFIs, routine examination of stool or urine and their culture were the main methods of detection. Positive results of 75 detected fungal strains from the samples showed that 30 cases were complicated with one or more bacterial infections. The average length of hospital stay of IFI patients was 14.0 (10.0, 20.0) days. The time from admission to antifungal therapy initiation (P<0.001), liver cirrhosis (P<0.001), hematological tumor (P<0.001), coinfection (P=0.019) and immune diseases (P=0.025) were independent predictors of prolonged hospitalization. CONCLUSION: Delayed time was the primary predictor of prolonged hospitalization. This prediction is suggested to improve IFI diagnostic and therapeutic process of IFI to promote prognosis.

Comparison of Reliability and Validity of the Chinese Four-Level and Three-District Triage Standard and the Australasian Triage Scale.

Emergency triage is an important tool for prioritizing urgent or critical patients, and its effect needs to be investigated and evaluated. This observational study aimed to compare the reliability and validity of the Chinese four-level and three-district triage standard (CHT) and the Australasian Triage Scale (ATS) in an adult emergency department of a general hospital in China. From 2016-01 to 2017-01, twelve nurses independently performed on-site triage of 254 patients and 1552 patients to assess the scales' reliability and validity, respectively. The interrater reliability, as assessed by the weighted k scores, was 0.686 (95% CI 0.608-0.757) for the CHT and 0.731 (95% CI 0.663-0.790) for the ATS, and the k scores between the CHT and the ATS were 0.630 (95% CI 0.594-0.669). Temperature, respiration, pulse, blood oxygen saturation, waiting time, treatment time, emergency disposition, hospitalization rate, and mortality were significantly associated with the triage levels of the CHT and ATS (p < 0.001). The area under the receiver operating characteristic (AUROC) curve values of the CHT and ATS for predicting intensive care treatment were 0.845 (95% CI: 0.825-0.866) and 0.740 (95% CI: 0.715-0.765), respectively. The reliability and validity of the CHT and ATS were moderate, and both of them can be used to identify critical patients in emergency departments. It is necessary to further improve the triage system in terms of structure and content.

The Role of Serum Tenascin-C in Predicting In-Hospital Death in Acute Aortic Dissection.

Tenascin-C (TNC) is involved in aortic disease pathophysiology. This study aims to evaluate TNC's value for predicting in-hospital death in acute aortic dissection (AD).We prospectively enrolled consecutive patients with suspected acute AD within 48 hours from symptom onset. Serum TNC and C-reactive protein (CRP) levels were examined on admission. Their baseline clinical characteristics and serum D-Dimer (DD) were collected. The endpoint was in-hospital death from AD.In the study cohort,78 survivors and 31 non-survivors with acute AD were enrolled. Compared to survivors, elevated median levels of serum TNC (141.10 pg/mL versus 75.30 pg/mL, P < 0.001), DD (8.74 µg/mL versus 4.58 µg/mL, P < 0.001), and CRP (19.20 mg/L versus 13.40 mg/L, P < 0.001) were found in non-survivors. Multiple logistic regressions revealed TNC, DD, and CRP were independent predictors of in-hospital death from acute AD. The OR and 95% CI were 1.038, 1.017-1.055; 1.084, 1.009-1.165 and 1.386, 1.107-1.643, respectively. Furthermore, TNC's sensitivity and specificity in predicting in-hospital death in acute AD were 83.87% and 83.33%. The combination of TNC and DD can improve the sensitivity and specificity to 90.30% and 88.46%.TNC is a valuable biomarker for predicting in-hospital death from acute AD. The combination of TNC and DD can improve predictions of in-hospital death from acute AD.

[Reliability and validity of four-level and three-district triage standards in emergency department: a randomized sampling cross-sectional study of 1 106 adult patients].

OBJECTIVE: To evaluate the reliability and validity of three-district and four-level triage standards in adult emergency department. METHODS: A randomized sampling cross-sectional study was conducted. A total of 1 106 emergency adult patients admitted to the Second Xiangya Hospital of Central South University in Hunan Province from December 2015 to April 2016 were enrolled. The triage was independently performed by 12 nurses according to the emergency triage criteria. Based on the shift style, 2 nurses were assigned to each shift as the triage guider and assistant respectively, who did the triage for every patient independently. The clinical data were recorded as follows: the demographic data, emergency information (triage time, emergency way, complaints, vital signs, and conscious state), triage information (triage level, admitted department), waiting time, treatment time, destination and outcomes. The reliability of three-district and four-level triage standards was analyzed by Spearman correlation, and the receiver operating characteristic curve (ROC) was plotted to evaluate its validity. RESULTS: (1) A total of 254 patients were enrolled for reliability evaluation in the first 2 weeks of the study. The overall internal consistency rate of the triage instructors and the triage assistants was 72%, the total Kappa value was 0.686 [95% confidence interval (95%CI) = 0.608-0.757, P < 0.001]. (2) Validity analysis showed that in the 1 125 emergency patients collected during the study, a total of 1 106 patients were finally enrolled in the analysis excluding the patients who refused to accept the treatment, whose data was incomplete and who was diagnosed as prehospital death. With the increase of three-district and four-level triage level, a significant increase was showed in the waiting time of patients, the treatment time, and the retention rate; on the contrary, the salvage rate, the hospitalization rate, hospitalization time, emergency mortality, in-hospital mortality and total mortality rate were decreased [the waiting time of patients from triage level 1 to 4 (minutes) was 1.00 (1.00, 1.75), 1.00 (1.00, 5.00), 8.00 (2.00, 23.00), 10.00 (4.50, 28.00), the treatment received time (minutes) was 1.00 (1.00, 10.00), 6.00 (1.00, 23.00), 48.00 (25.00, 105.00), 87.00 (41.00, 140.00), the retention rate was 4.76%, 10.94%, 55.91%, 42.86%, the salvage rate was 95.24%, 87.94%, 20.81%, 0%, the hospitalization rate was 57.14%, 70.98%, 53.62%, 20.41%, the hospitalization time (days) was 19.50 (9.75, 28.00), 11.00 (8.00, 17.00), 12.00 (8.25, 17.00), 10.50 (8.75, 15.25), the emergency mortality was 19.05%, 6.92%, 1.41%, 0%, the in-hospital mortality was 16.67%, 15.09%, 6.25%, 0%, and the total mortality rate was 28.57%, 17.63%, 4.76%, 0%, all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of three-district and four-level triage standards for identifying patients needed an immediate intervention (triage level 1 to 2) was 0.854 (95%CI = 0.831-0.878), and the sensitivity and specificity were 78.62% and 89.89%, respectively, the misdiagnosis rate was 10.11%, and the missed diagnosis rate was 21.38%. CONCLUSIONS: The three-district and four-level triage standards were proved to be a reliable and valid instrument, which can distinguish the severity of the disease and help nurses to triage patients correctly.

Peripheral intravenous catheters in situ for more than 96 h in adults: What factors affect removal?

Peripheral intravenous catheters (PIVC) are widely used in clinical nursing, but indwelling time remains a subject of debate. This study aimed to assess the risk factors for PIVC phlebitis in adults and provide a basis for indwelling time decisions. A total of 189 first-time PIVC patients in the emergency ward were assessed between May and October 2015. Data were retrieved for patient characteristics and PIVC assessment records. This study showed that over two-thirds (67.72%) of PIVCs were removed because of phlebitis, including oedema (37.57%), rubefaction (33.33%), pain (32.28%), slow infusion speed (13.23%) and accidental extrusion (2.12%). PIVC indwelling time in the planned removal group was higher than that obtained for the unplanned removal group: 152.42 (74.58) vs. 94.64 (50.15) h, P < 0.001. At indwelling times > 96 h, 28.57% (n = 54) of catheters caused phlebitis, although 23.28% (n = 44) showed no phlebitis. PIVC phlebitis was associated with treatment with compound amino acid infusion (OR: 2.624), site at the elbow joint (OR: 3.049), haemoglobin level (OR: 2.492), white cell count (OR: 2.196) and catheter size (OR: 1.837). Study findings suggest that PIVC might be used for longer durations based on nursing assessments and health education.

Meta-analysis of outcomes of the 2005 and 2010 cardiopulmonary resuscitation guidelines for adults with in-hospital cardiac arrest.

OBJECTIVES: The post-cardiac arrest survival rate has remained low since the 2010 cardiopulmonary resuscitation (CPR) guidelines were published. The present study aimed to review the 2010 vs 2005 CPR guideline outcomes in adults with in-hospital cardiac arrest. METHODS: The Pub Med, EMBASE, and Cochrane Library databases were searched for articles published between January 2006 and July 2015. We extracted the following from observational studies and intervention studies: first author's name, publication year, study duration, age of study population, and sample size. The primary outcome variables were return of spontaneous circulation (ROSC) and survival to discharge. The data were divided into 2005 (data collected before December 2010) and 2010 (data collected in December 2010 or later) CPR guidelines groups. RESULTS: Twenty-four original articles (77,605 patients) were included. Statistically significant heterogeneity (ROSC: P<.01, I(2)=97.9%; survival to discharge: P<.01, I(2)=98.3%) was seen, and a random-effects model was used to pool the outcomes. The pooled ROSC rate for the 2010 group (n=5; mean, 48%; 95% confidence interval [CI], 0.38-0.58) was only slightly higher than that of the 2005 group (n=19; mean, 47%; 95% CI, 0.38-0.57). The opposite result was noted in the pooled survival to discharge rates (2010: n=5, mean, 14%; 95% CI, 0.08-0.20 vs 2005: n=19; mean, 15%; 95% CI, 0.10-0.20). There was actually no significant difference in ROSC or survival to discharge outcomes between the 2 groups. CONCLUSIONS: The 2010 CPR guidelines emphasized that high-quality chest compressions can increase the ROSC rate but did not show to improve long-term results.

Association of uric acid with traditional inflammatory factors in stroke.

Uric acid (UA) plays an important role in the oxidant stress that causes inflammation. We assessed the association between UA and neutrophil ratio, white blood cell (WBC) count and blood lipid in 524 patients admitted with stroke. Stroke patients with a neutrophil ratio >70% displayed significantly lower UA levels than those with a neutrophil ratio ≤70% (p < 0.05). According to UA quartiles, neutrophil ratio, WBC count, and high-density lipoprotein cholesterol in the UA grade 1 group (≤214.10 µmol/L) were significantly increased over those in other UA grade groups. The results of stepwise regression analysis found that UA levels were inversely associated with neutrophil ratios (B ± SE = -1.11 ± 0.35), high-density lipoprotein cholesterol (B ± SE = -46.18 ± 14.17), total cholesterol (B ± SE = 9.82 ± 3.66), blood urea nitrogen (B ± SE = 6.30 ± 1.73), and creatinine (B ± SE = 0.63 ± 0.10). There is a correlationship between lower serum uric acid with neutrophil ratios in inflammation associated with stroke and the reasons need to be investigated further.

[Associations of blood pressure, glucose or lipids with stroke in different age or gender].

OBJECTIVE: To investigate the relationship between blood pressure, blood glucose or blood lipids and patients with cerebral infarction (CI) or intracerebral hemorrhage (ICH) in different age or gender. METHODS: Th e case-control study consecutively recruited patients with fi rst-ever-in-a-lifetime CI (n=358) and ICH (n=230) and community-acquired pneumonia (n=165) as controls between January 2010 and December 2013 at the Second Xiangya Hospital of Central South University. The patients with CI or ICH were divided into the young group, the middle-aged group and the older group, and the risk factors were compared between the 3 groups. The patients with CI or ICH were respectively further divided into the male group and the female group. The blood pressure, glucose and lipids were measured. RESULTS: Data from logistic regression models showed that CI was closely associated with high blood pressure, hypertension, diabetes mellitus (DM) or fasting plasma glucose (FPG) (P< 0.05), and ICH was closely related to high blood pressure, hypertension, low density lipoproteincholesterol (LDL-C), FPG, serum creatinine (SCr) or alcohol drinking (P< 0.05); hypertension was the main risk factor for stroke. The odds ratios for the young, the middle-aged and older group were 10.43, 4.74 and 7.39 respectively (P< 0.05). Systolic blood pressure (OR=28.74) was the important risk factor for the young stroke, and the OR is 2.81 for the middle-aged stroke. Diastolic blood pressure (OR=2.96) and DM (OR=6.25) were the risk factor for the middle-aged stroke. LDL-C (OR=2.87) was a risk factor for the older stroke; the mean levels of diastolic blood pressure in males were significantly increased compared with that in females with CI, while the mean levels of TC, HDL-C or LDL-C in females were significantly higher than that in males with ICH (P< 0.05). CONCLUSION: Hypertension, systolic blood pressure in particular, is the most common risk factor for young stroke patients. DM and hypertension are the risk factors for the middle-aged patients, while hypertension, DM, LDL-C and alcohol consuming are the risk factors for the aged patients.