The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China.

AIMS: Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. DESIGN: A single-centre pre- and post-control design was used. METHODS: The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. RESULTS: The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. CONCLUSION: A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. IMPACT: This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.

Cardiovascular disease risk prediction models in the Chinese population- a systematic review and meta-analysis.

BACKGROUND: There is an increasing prevalence of cardiovascular disease (CVD) in China, which represents the leading cause of mortality. Precise CVD risk identification is the fundamental prevention component. This study sought to systematically review the CVD risk prediction models derived and/or validated in the Chinese population to promote primary CVD prevention. METHODS: Reports were included if they derived or validated one or more CVD risk prediction models in the Chinese population. PubMed, Embase, CINAHL, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP database, etc., were searched. The risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed in R using the package metamisc. RESULTS: From 55,183 records, 22 studies were included. Twelve studies derived 18 CVD risk prediction models, of which seven models were derived based on a multicentre cohort including more than two provinces of mainland China, and one was a model developed based on a New Zealand cohort including Chinese individuals. The number of predictors ranged from 6 to 22. The definitions of predicted outcomes showed considerable heterogeneity. Fourteen articles described 29 validations of 8 models. The Framingham model and pooled cohort equations (PCEs) are the most frequently validated foreign tools. Discrimination was acceptable and similar for men and women among models (0.60-0.83). The calibration estimates changed substantially from one population to another. Prediction for atherosclerotic cardiovascular disease Risk in China (China-PAR) showed good calibration [observed/expected events ratio = 0.99, 95% PI (0.57,1.70)] and female sex [1.10, 95% PI (0.23,5.16)]. CONCLUSIONS: Several models have been developed or validated in the Chinese population. The usefulness of most of the models remains unclear due to incomplete external validation and head-to-head comparison. Future research should focus on externally validating or tailoring these models to local settings. TRAIL REGISTRATION: This systematic review was registered at PROSPERO (International Prospective Register of Systematic Reviews, CRD42021277453).

Reliability and validity of the four-level Chinese emergency triage scale in mainland China: A multicenter assessment.

BACKGROUND: An effective emergency triage system is lacking in mainland China. The Chinese Emergency Triage Scale (CETS) was developed based on vital complaints and vital parameters, according to Chinese data. OBJECTIVE: The aim of this study was to assess the reliability and validity of the CETS by emergency department (ED) nurses in eight EDs in mainland China. DESIGN: A cross-sectional multi-center study was conducted. SETTINGS: Eight EDs in the eastern, western, northern, and central areas of mainland China. PARTICIPANTS: A total of 51 ED nurses and 8000 active ED patients participated in the study between May and September 2018 in eight EDs. METHODS: Standardized triage scenarios and active patients were assigned to nurses who used the CETS for evaluative purposes. Accuracy was defined by concordance with the key for the scenarios and was calculated as percentages. Inter-rater reliability was measured by weighted κ to compare the triage nurse's rating with the research nurse's acuity level for each patient. The triage time and clinical outcome of 1000 active patients per site also were collected. The criterion-related validity of the CETS was evaluated; criteria included ED mortality, number of patients discharged, and admission to ICU or general ward. The relationship between the CETS acuity levels triaged by the research nurse and four possible outcomes was assessed with a cross-classification table, using a chi-square test. The ability of the CETS to predict ED mortality was assessed via the receiver-operating characteristic (ROC) area under the curve (AUC). RESULTS: Mean pooled accuracy from all sites was 89.4% (95% CI = 86.9%-91.8%), and the proportion of over-triage slightly exceeded under-triage (6.5% vs. 4.1%). There was no difference in accuracy between sites or according to nurse experience. Inter-rater reliability values for triage nurses and research nurses were 0.96 (95% CI = 0.95-0.97), based on the quadratic weight κ. Trauma cases were assigned to triage with greater accuracy than were nontrauma cases, both for the scenarios and for active patients. The average triage time of ED nurses in all sites was 151.5 ±â€¯26.3 s, using the computer-based triage instrument. The chi-square test showed that there was a significant difference in triage time between the CETS levels (p < 0.001). The AUC was 0.968 (95% CI = 0.958-0.979). CONCLUSIONS: The CETS is a reliable system for ED triage and can promote rapid and effective triage in mainland China.

Effect of peer education on improving compliance of cardiac rehabilitation in patients with coronary heart disease / 中国实用护理杂志

Objective:To evaluate the effect of peer education on improving compliance of cardiac rehabilitation in patients with coronary heart disease.Methods:Totally 64 patients were randomly divided into two groups, namely, the experimental group and the control group with 32 cases in each group. Patients in the experimental group received routine education, nursing, and rehabilitation, plus the peer education treatment, whereas the control group only received routine treatment. The time lasts for 6 months. The compliance of cardiac rehabilitation and the score of China Questionnaire of Quality of Life in Patients with Cardiovascular Diseases (CQQC) were measured after 1 month, 3month and 6 month.Results:After 1, 3, and 6 months of intervention, the compliance of cardiac rehabilitation in the intervention group increased by 18.75%, 21.37%, and 21.88%, respectively, compared with the control group. After the first and third months of intervention, there was a statistically significant difference in the compliance rate of rehabilitation exercise between the intervention group and the control group ( χ2 values were 18.050, 16.946, respectively, P <0.05), and at the sixth month after intervention, the compliance of the two groups of patients with cardiac rehabilitation was not statistically significant ( χ2 value was 6.489, P> 0.05). After 1, 3, and 6 months of intervention, the quality of life scores of the intervention group were (88.68 ± 6.65), (81.90 ± 6.78), and (76.33 ± 5.90) points, and the quality of life scores of the control group were (84.75 ± 4.72), (75.67 ± 5.88), and (74.71 ± 9.47) points. There was significant difference in the scores of the two groups in the first and third months after the intervention ( t values were 2.235, 2.520, respectively, P<0.05); and in the sixth month after the intervention, the difference in the scores of the two groups wasn`t statistically significant ( t value was 1.049, P >0.05). Conclusion:Peer education can improve the compliance of cardiac rehabilitation and the score of CQQC in patients with coronary heart disease in 3 month, but further research is needed to confirm the long-term effect of peer education.

Effect of Otago exercise program on the elderly′s falls:a Meta-analysis / 中国实用护理杂志

Objective To evaluate the effect of Otago exercise program on the elderly′s falls. Methods The relevant randomized controlled trials were searched from PubMed, Web of science, Scopus,CINAHL,Chinese Biomedical Literature Database,China National Knowledge Infrastructure and Wanfang database. According to the inclusion and exclusion criteria two reviewers screened literature, extracted data and assessed the quality of included studies, using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 independently. Meta-analysis was conducted using RevMan5.3. Results Totally 16 randomized controlled trials were included. Meta-analysis showed that Otago exercise program can reduce the incidence of falls(ratio ratio was 0.85,P=0.000 6),improve falls efficacy (standardized mean number difference was 0.67, 0.43, all P<0.05), enhance elderly′ s balance (standardized mean number difference was 0.65,P<0.01)and mobility(mean number difference was-5.46, P=0.000 1),but can′t effectively reduce the incidence of falls related injury(ratio ratio was 0.98,P=0.78). Conclusions Otago exercise program is effective to improve falls efficacy, enhance balance and mobility,reduce the incidence of falls.It is suggested to promote clinical use.

Early enteral nutrition support dose selection in critically ill patients: a Meta analysis / 中华急诊医学杂志

Objective To systematically evaluate the optimal dose of early enteral nutrition support in critically ill patients.Methods Systematic search database including PubMed,Web of science,Scopus,CINAHL,CBM,CNKI.RCTs about early enteral nutrition dose selections in critically ill patients were chosen according to include and exclude criteria by two researchers independently.Cochrane system evaluation manual bias risk assessment was used to evaluate quality of literature.RevMan5.3 Meta analysis software was used to analyze the data.Results A total of 1 571 literatures were retrieved and 8 RCT studies were included,2 713 subjects in total.Meta analysis results showed that there were statistically significant differences in mechanical ventilation time,incidence of diarrhea,and utilization rate of gastro dynamic drugs between trophic feeding and full feeding (P＜0.05).There were no statistically significant differences in mortality,length of stay,incidence of nosocomial infections,reflux,vomiting,constipation,etc.(P＞0.05).Conclusions Trophic feeding has familiar effects on mortality,length of hospital stay compared to full feeding,but it can help to shorten ICU mechanical ventilation time,improve the gastrointestinal tolerability.