To explore the impact of the 6S management model-based nursing program on clinical outcomes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). A retrospective analysis included clinical data from 144 AMI patients who underwent PCI at the Second Hospital of Hebei Medical University between January 2024 to October 2025. Patients were matched 1:1 to an observation group (6S nursing) and a control group (conventional nursing), with 72 cases in each group. Rehabilitation-related indicators, cardiac function indexes, activities of daily living (ADL), anxiety levels, and adverse cardiac events were compared between the two groups. The observation group reported lower postoperative oral intake and ambulation times, shorter hospital stays, shorter time to resolution of ipsilateral limb swelling and longer 6-Minute Walk Test (6MWT) distances (P<0.05). Baseline Left Ventricular Ejection Fraction (LVEF), Left Ventricular End-Diastolic Diameter (LVEDD), Barthel Index (BI) and Self-rating Anxiety Scale (SAS) values showed no between-group differences (P>0.05). Post-intervention, both groups had higher LVEF and BI and lower LVEDD and SAS levels (P<0.05), with the observation group showing more favorable results (P<0.05). Compared with the control group, the incidence of adverse cardiac events such as angina pectoris and severe arrhythmia after PCI were significantly lower in the observation group (P<0.05). Compared with conventional nursing care, the 6S management model-based nursing program was associated with more favorable rehabilitation-related indicators, improved cardiac function, better activities of daily living, lower anxiety levels, and reduced incidences of specific adverse cardiac events in AMI patients after PCI. The 6S model optimizes inpatient outcomes by establishing standardized nursing processes, strengthening safety awareness, and ensuring the rigorous execution of rehabilitation measures.
This study aimed to investigate the effectiveness of safety care and clinical nursing pathways in patients undergoing cardiovascular intervention. This single-center, single-blind, randomized controlled trial enrolled 100 patients who underwent cardiovascular intervention. Patients were randomly assigned to a control group (receiving standard nursing care) or an experimental group (receiving safety care and clinical nursing pathway interventions in addition to the standard care) (n = 50 each). The primary outcome measure included anxiety and depression symptoms assessed using the Hamilton Anxiety and Hamilton Depression (HAMA and HAMD) rating scales. Secondary outcome measures included cardiac function recovery time, surgery time, surgical vascular puncture success rate, puncture preparation time, and hospital stay, along with adverse events and complications, quality of life, and nursing satisfaction. In the experimental group, post-intervention HAMA (6.42 ± 2.41) and HAMD (6.32 ± 1.44) scores were significantly lower than those in the control group (9.24 ± 1.52, 8.76 ± 1.59) (p < 0.05). The incidence of adverse reactions was lower in the experimental group (12.0%) than in the control group (30.0%) (p < 0.05). Surgery time (45.60 ± 2.98 min) and puncture preparation time (5.08 ± 1.09 min) were shorter, and the vascular puncture success rate was higher (96.0%) in the experimental group; quality-of-life scores and nursing satisfaction were also higher in the experimental group (p < 0.05). Safety care and clinical nursing pathways may be effective in reducing anxiety and depression, lowering adverse reactions, shortening operation and puncture preparation times, increasing the success rate of vascular puncture, improving health knowledge, boosting patient satisfaction, and enhancing quality of life in patients undergoing cardiovascular intervention.
Basic life support (BLS) competence is a core professional skill for nursing students, yet conventional training often fails to achieve durable gains in knowledge, psychomotor performance, and clinical transfer. This study evaluated the effectiveness of a Miller's pyramid-based HeartCode BLS teaching model compared with traditional instruction in undergraduate nursing students. In this randomized controlled trial, 229 eligible nursing students were enrolled and assigned to a control group (n = 115) or an observation group (n = 114). The observation group received a HeartCode BLS teaching model structured according to Miller's pyramid, whereas the control group received conventional BLS teaching. Outcomes were assessed using the Kirkpatrick four-level evaluation framework, including post-training theoretical examination scores, 1-week skill performance, CPR quality indicators, 3-month high-fidelity simulation-based comprehensive application ability, and learner satisfaction. Between-group comparisons were conducted using chi-square tests, independent-samples t-tests, Mann-Whitney U tests, and repeated-measures ANOVA, as appropriate. Baseline characteristics and pre-training scores were comparable between groups. After training, the observation group achieved significantly higher scores than the control group in theoretical knowledge (74.29 ± 9.94 vs. 68.81 ± 9.33), CPR skills (85.92 ± 8.67 vs. 79.80 ± 7.56), and defibrillation skills (85.48 ± 8.63 vs. 78.86 ± 5.77; all p < 0.001). CPR quality indicators, including compression depth, compression rate, chest recoil, and bag-valve-mask ventilation, were also significantly better in the observation group (all p < 0.001). A greater proportion of students in the observation group maintained total compression interruption times below 30 s (57.0% vs. 25.2%; p < 0.001). Learner satisfaction was consistently higher across all domains (all p < 0.001). At 3 months, the observation group also outperformed the control group in emergency judgment and decision-making, emergency procedure execution, team communication and collaboration, and total simulation score (all p < 0.001). A Miller's Pyramid-based HeartCode BLS teaching model was associated with significantly improved immediate learning outcomes, CPR quality, learner satisfaction, and mid-term integrated clinical performance among nursing students. This theory-informed, feedback-enabled instructional strategy may offer a scalable and effective approach for optimizing BLS education in undergraduate nursing, although multicenter studies with longer follow-up are needed to confirm generalizability and long-term retention.
In Germany, 80-90% of people require palliative care in the final stages of life. Inpatient care facilities are increasingly becoming the final place of residence for many people, and therefore also often their place of death. Inadequate identification of palliative care needs can result in substandard palliative care in nursing homes, where residents are often admitted to the hospital towards the end of their lives. This study investigated whether a special palliative care qualifications for nursing staff could improve the care for residents in inpatient care facilities. A cluster-randomised intervention study was conducted. Nursing staff from the participating care facilities in the intervention group took part in the 40-hour 'Palliative Care - Multiprofessional' basic qualification course. The outcomes were the use of specialised outpatient palliative care, and the documentation of palliative-relevant symptoms and measures for residents in the three months prior to their death. Data from the patient records were assessed and statistically analysed. During the observation period, 119 residents deceased in the 10 participating nursing homes (5 of which were in the intervention group), of whom 42 were in the intervention group and 77 were in the control group. Specialised outpatient palliative care was documented for 19.0% of residents in the intervention group and 9.1% of residents in the control group. Pain was documented in 57.1% of residents in the intervention group versus 49.4% in the control group. This palliative symptom was documented 225 times in total. An appropriate subsequent measure was documented in 150 cases (73.6% in the intervention group versus 61.9% in the control group). Logistic multilevel analysis showed that residents in the intervention group were more likely to receive a measure for a documented pain event (OR 1.804). The results show that having a qualification in palliative care leads to palliative symptoms being identified more accurately and appropriate measures being implemented more effectively. Using data from real healthcare settings is challenging because there are no overall standards. Nevertheless, the results reflect real healthcare practice. Advanced training in palliative care helps improves the care provided to palliative residents in nursing homes. Trained staff can help to identify the need for care more accurately and ensure that appropriate palliative care is provided. German Clinical Trials Register, DRKS00020749 ( https://drks.de/search/en/trial/DRKS00020749/entails ), 7 May 2020.
Florence Matilda Saunders was a pioneer of the district nursing service in Peterborough and founded the Peterborough District Nursing Association in 1886. She was the first district nurse and lady superintendent of the Association. She was devoted to caring for the sick poor and relieving their pain and suffering. Although her work could be challenging at times, she was determined to make the service a success. She accepted no remuneration for the work that she did and was a generous benefactor of the Association. When she died in 1904, the Peterborough District Nursing Association became known as the Florence Saunders District Nursing Association in honour of her memory.
The number of older adults being discharged to a skilled nursing facility (SNF) after surgery continues to rise. Prior studies have shown that gabapentinoid prescribing after surgery is increasing, though this work only studied patients transitioning from hospital to home. Therefore, we aim to describe both use and prolonged use of gabapentinoids for older adults who are discharged to SNF and then home after surgery. We conducted a retrospective analysis by merging patient data from Medicare Carrier, MedPAR, and Outpatient Files with Medicare Part D for 2013-2020. We included patients ≥ 66 years at time of procedure undergoing one of 14 common surgeries performed in older adults whose discharge was to SNF then home. The total study cohort included 79,417 patients who were discharged to a SNF. Median length of SNF stay was 15 days (IQR 10, 22 days). A total of 3182 (4%) received a new gabapentinoid prescription. Of these, 38% (n = 1219) had prolonged use. On multivariable logistic regression, we found that female sex, gabapentinoid days supply, emergency surgery, non-orthopedic and nonvascular surgery, and higher area deprivation index were associated with prolonged use. Of our cohort, 38% had prolonged use, more than 1.5 times the proportion of prolonged use found in a past study among patients being discharged directly home. Importantly, patients who were sicker and more disadvantaged were more likely to have prolonged use. Our study highlights that additional work needs to focus on understanding and preventing inappropriate prolonged use of gabapentinoids after SNF discharge.
Mental health professionals are confronted with chronic conditions in their clinical practice. What patients experience outside of crisis periods is of concern to them, just as it is to every citizen. In the current context, where the healthcare system has been stretched to its limits, the concept of recovery is gaining momentum. It is important to ask: what does this signify?
Access to dermatologic care remains a persistent challenge in the United States, particularly in rural and underserved areas. Delays in dermatologic evaluation and treatment are compounded by provider shortages, long wait times, and geographic barriers. Emerging tools such as artificial intelligence (AI), AI-assisted triage, and teledermatology platforms might offer scalable solutions to improve access and reduce delays. This article evaluates whether AI-assisted technology, compared to traditional in-person dermatology care, shortens wait times to less than 30 days for patients living in provider shortage areas. A systematic review was conducted between March and June 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and academic library databases were queried using the following Boolean queries: "Artificial intelligence triage dermatology" and "dermatology AND access AND teledermatology AND care AND wait times." Studies were screened for relevance, and 41 met the inclusion criteria. A narrative synthesis was used due to heterogeneity in study designs and outcome measures. Each study was appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Included studies demonstrated that AI-assisted technologies, particularly when integrated into teledermatology systems, significantly reduced dermatology wait times, often to fewer than 30 days. Store-and-forward platforms enabled expedited triage, while AI-supported decision tools improved diagnostic accuracy (85-97% sensitivity) and reduced unnecessary referrals. Task shifting to nonspecialist providers with AI support was found to be safe and effective. Despite promising outcomes, concerns related to image quality, algorithmic bias, and uneven implementation remain. AI-assisted dermatologic tools show strong potential to improve access to care and reduce wait times in provider shortage areas. These technologies could support timely diagnosis, streamline referrals, and enable safe task shifting to primary care teams. Importantly, findings highlight the role of nurse practitioners (NPs), particularly those with limited dermatology training, in leveraging AI as both an educational and clinical decision support tool. By providing differential diagnoses, confidence scores, and visual explanations, AI can strengthen NP diagnostic confidence, reduce unnecessary referrals, and expand access to timely dermatologic care in underserved settings. Future research should focus on implementation in resource-limited settings, nurse-led AI triage models, and long-term health outcomes.
This study aimed to identify factors influencing the frequency of fresh mother's own milk feeding during the first 7 days of life in very low birth weight infants (VLBWIs), in order to inform evidence-based nursing interventions. A retrospective case-control study was conducted. A total of 917 VLBWIs admitted to the neonatal intensive care unit of a tertiary maternity hospital in Zhejiang Province, China, between January 2020 and December 2023, were enrolled using convenience sampling. Based on the number of adequate fresh mother's own milk feedings, infants were categorized into three ordinal groups: 0 times, 1-13 times, and ≥14 times. Univariate ordinal logistic regression was used to screen for statistically significant variables, which were subsequently included in a multivariate ordinal logistic regression model to adjust for confounders and identify independent factors. Multivariate analysis identified multiple gestation (odds ratio [OR] = 0.66, 95% confidence interval [CI]: 0.50-0.87) and higher CRIB-II score (OR = 0.90, 95% CI: 0.81-0.99) as significant risk factors for reduced feeding frequency. In contrast, several protective factors were confirmed: two or more telephone follow-ups (OR = 1.68, 95% CI: 1.27-2.23), parental participation in offline professional educational sessions (OR = 2.78, 95% CI: 1.63-4.77), father as primary milk transporter (OR = 1.96, 95% CI: 1.25-3.09), higher paternal education level (OR = 3.03, 95% CI: 1.30-10.58), and cesarean delivery (OR = 1.96, 95% CI: 1.44-2.68). The frequency of early fresh mother's own milk feeding in VLBWIs is influenced by a constellation of neonatal, interventional, and familial factors. To effectively promote feeding practices, clinical care should implement an integrated model that encompasses risk assessment (e.g., for multiples and infants with high illness severity), systematic nursing interventions (including structured follow-up and parent education), and enhanced family support, with a particular emphasis on paternal engagement.
The indispensable role of nurses in healthcare systems is widely recognized, as they contribute significantly to the effectiveness and continuity of healthcare delivery. However, nurse attrition has emerged as a growing concern in fragile and resource-limited settings such as Somalia, with serious consequences for health service provision. This study aimed to explore the key factors contributing to nurse attrition in Somalia and to examine the perceived implications of nurse attrition for the healthcare system from the perspectives of former nurses and healthcare administrators. A qualitative descriptive study was conducted in the Benadir region, involving 42 former qualified nurses and 8 healthcare administrators, representing both genders. In-depth interviews were conducted with former nurses to explore their motivations for entering the nursing profession, their professional experiences, and the factors leading to their attrition. Semi-structured interviews with healthcare administrators focused on understanding the broader implications of nurse attrition within the healthcare system. Data were analyzed using reflexive thematic analysis to identify and interpret central themes. Nurses often enter the profession driven by compassion and the desire to impact patient lives positively. However, disparities between initial expectations and realities of nursing practice, including inadequate compensation, burnout, unfavorable working conditions, job dissatisfaction, strained nurse-doctor relationships, and community misconceptions about the nursing role, contribute to nurse attrition. These contributory factors have several negative consequences, including a shortage of nurses, reduced care quality, increased workload for remaining nurses, longer patient wait times, limited access to healthcare services, higher operational expenses, added responsibilities for doctors, and lasting effects on public health. Nurse attrition is a complex process influenced by various factors. To mitigate its impact on healthcare systems, policymakers and healthcare administrators must allocate resources strategically, focus on comprehensive planning, and prioritize the recognition, support, and retention of nurses within the healthcare framework.
Non-communicable diseases (NCDs) are a growing health burden in low- and middle-income countries, with hypertension and poor glycaemic control being key contributors. This study aimed to assess the prevalence, awareness, and misinformation surrounding hypertension and diabetes in Bangladesh, identifying high-risk groups. Data from the nationally representative 2022 Bangladesh Demographic Health Survey were analysed, covering 13,344 adults aged 17-95 years. We applied complex survey weighted regression modelling, spatial analysis, and machine learning techniques to explore trends, regional disparities, and factors influencing NCD awareness. The prevalence of hypertension (≥ 140/90 mm Hg) or diabetes (blood glucose ≥ 126 mg/dL or 7.0 mmol/L) was 31%, rising to 52% among adults aged 50 + . Notably, 17% of affected individuals in this age group were unaware of their condition. Among adults aged 50 + , 34% had undiagnosed hypertension, while 38% across all ages were unaware of their diabetes. Females developed hypertension earlier than males. Regional disparities were evident, with the highest NCD prevalence in Feni (40%), Naogaon (37%), and Natore (36%). Awareness varied by age, sex, BMI, and mobile phone ownership, which was linked to misinformation. Adults aged 30-39 had 2.11 times higher odds of unawareness (95% CI: 1.75, 2.56), rising to 5.61 times in those aged 70 + (95% CI: 4.36, 7.20) compared to those under 30. Obese individuals were 3.07 times more likely to be unaware than those classified as underweight (95% CI: 2.33, 4.05). This study reveals gaps in health literacy and screening access, contributing to the escalating NCD burden in Bangladesh.
The purpose of this study is to compare health outcomes and flourishing between children (age 6-17) whose mothers experience high versus low exposure to post-separation abuse and coercive control (PSA). Exploratory sequential mixed-methods study. Cross-sectional survey with community-based, convenience sample of family court-involved mothers in the United States (N = 497). Independent variable measured by subscales of the Healthcare, Economic, and Legal PSA and Coercive Tactics Scale (HELP-T). Health outcomes measured by items from National Survey of Children's Health. Children whose mothers experience more frequent PSA face a dual burden: increased odds of unmet mental health needs coupled with increased odds of mental health diagnoses, somatic symptoms and special health care needs. Children in the high-exposure Healthcare PSA group were twice as likely (aOR: 2.01, p-value < 0.001, 95% CI: 1.4-2.9) to report stomach/intestinal problems, 2.3 times more likely (p-value < 0.001, 95% CI: 1.5-3.4) to report chronic pain including headaches in the last 12 months, 2.13 times more likely (p-value < 0.001, 95% CI: 1.4-3.8) to have ever received a diagnosis of anxiety and 2.72 times (p-value < 0.001, 95% CI: 1.60-4.63) more likely to have unmet mental health needs as compared to children in the low-exposure group. The findings from this study advance the growing body of evidence on how co-parent perpetrated PSA and coercive control harm children's health and access to healthcare. This study is the first to our knowledge to demonstrate the association between maternal exposure to co-parent perpetrated PSA and children's health outcomes, establishing a foundation for future intervention work to improve children's health and access to health care. Members of the public were involved in recruitment and cognitive interviewing.
Clinical practice guidelines (CPGs) are intended to improve health and reduce disease burden, yet their global status and their association with disease burden remain unknown. This longitudinal ecological study analyzes the quantity and quality of CPGs and explores their associations with disease burden. From 1995 to 2023, 10,657 CPGs were published, with the number of CPGs in 2023 being 5.15 times the number of CPGs in 1995. Europe contributed 40.2% of all CPGs, while CPGs from Africa accounted for only 0.8% of and showed minimal growth. Treatment CPGs contributed the most (45.0%), while diagnosis CPGs showed the fastest growth. Prevention CPGs (8.4%) and nursing CPGs (5.3%) and rehabilitation CPGs were less common, with rehabilitation CPGs showing the slowest growth. The 3-year update rate of CPG is 23.8%. Quality assessment of 1633 CPGs using AGREE II revealed substantial variation across domains. Overall 37.8% CPGs achieved scores above 70% per domain, while the "applicability" domain had the lowest median score (36%). Cross-region CPGs and CPGs for neoplasms exhibited the highest AGREE II scores, with the median score exceeding 70% in 3/6 domains. In contrast, CPGs from Asia and CPGs for cardiovascular diseases did not exceed the 70% threshold in any domain. Neither the quantity nor the quality of CPGs was significantly associated with disease burden at the national level. In conclusion, this study reveals that the quantity of CPGs has increased over the past three decades, although geographic and thematic differences remain. Future opportunities for CPG development include improving the AGREE II scores and focusing on less represented areas including rehabilitation, nursing and prevention.
Self-stigma, psychological distress, and suicidality are interrelated constructs in schizophrenia, yet their temporal relationships remain unclear. This study examined reciprocal relationships among self-stigma, psychological distress, and suicidality in individuals with schizophrenia using a cross-lagged model over one year. Participants with schizophrenia were recruited from a psychiatric teaching hospital in southern Taiwan. Data were collected at five time points, each three months apart, over a one-year follow-up period. Among the 241 participants, 137 completed all five times of measures. Self-stigma was measured using the Self-Stigma Scale-Short (SSS-S), psychological distress using the Depression, Anxiety, Stress Scale-21 (DASS-21), and suicidality using the suicidality module of the Mini International Neuropsychiatric Interview (MINI). Random-intercept cross-lagged panel models were employed to examine bidirectional relationships for two datasets: entire participants (i.e., 241 with full information maximum likelihood handling missing values) and 137 participants. The models demonstrated excellent fit (comparative fit index [CFI] = 0.991 and 0.995, root mean square error of approximation [RMSEA] = 0.051 and 0.032). Significant bidirectional effects were found between self-stigma and psychological distress across multiple waves (β = 0.13-0.36). Psychological distress related to subsequent suicidality (β = 0.16-0.19), while suicidality related to subsequent distress (β = 0.15-0.16) and subsequent self-stigma (β = 0.15-0.19). Self-stigma and suicidality rates remained relatively stable over time. Self-stigma and psychological distress sometimes exhibited reciprocal relationships over time, with distress serving as a key pathway to suicidality in schizophrenia. However, such reciprocal relationships were not consistent throughout the five-wave measures. These findings support integrated interventions targeting both self-stigma and psychological distress to reduce suicide risk.
In situ simulation (ISS) has seen broad use in academic emergency medicine (EM). Studies with limited clinical data suggest a dual paradigm model to assess the efficacy of these educational activities based on their impact on both ongoing and future quality of care. We conducted a retrospective cohort study to assess the impact of government-mandated mass casualty incident (MCI) ISS drills on ongoing department operations and quality clinical care. We conducted a retrospective study of patients presenting to an adult tertiary academic emergency department during scheduled and unscheduled ISS MCI drills. We assessed the impact of ISS on operational and triage metrics by comparing scheduled and unscheduled drills. Being treated during an ongoing MCI ISS, in both the scheduled and unscheduled simulation formats, was associated with a higher average door to triage times (20.6 min in the MCI ISS cohort vs 15.8 min in the control cohort; p<0.005) and lower Canadian Triage and Acuity Scale (CTAS) scores (CTAS 1 and 2: 0.8% and 14.5% in the MCI ISS cohort vs 1.6% and 17.1% in the control cohort, p<0.025). Secondary analysis, evaluating differences between case and control cohorts in distinct scheduled and unscheduled ISS subgroups, showed that unscheduled but not scheduled ISS were associated with higher average door to triage times (29.0 min in the unscheduled MCI ISS case cohort vs 21.2 min in the unscheduled MCI ISS control cohort; p<0.001) and lower CTAS acuity scores (CTAS 1 and 2: 0.0% and 17.9% in the unscheduled MCI ISS cohort vs 2.8% and 27.9% in the unscheduled MCI ISS control cohort; p<0.001). In this study, there was a significant association between increased door to triage time and lower acuity triage score designation for patients treated during an ongoing MCI ISS education drill. Secondary analysis demonstrated that these findings were only observed during unscheduled simulations, suggesting that the effects may be modifiable.
Background/Objectives: Routine replacement of peripheral intravenous catheters (PIVCs) every 72-96 h remains common practice despite growing guideline support for clinically indicated replacement. Evidence from Asian healthcare settings remains limited. Methods: A non-inferiority, cluster-randomised crossover trial was conducted from January to July 2021 across eight wards of a tertiary care hospital in South Korea. Adults requiring peripheral IV therapy for ≥96 h were allocated to routine 96-h replacement or clinically indicated replacement. The primary outcome was phlebitis incidence; a non-inferiority margin of 5% (absolute risk difference) was prespecified. Results: Among 1324 participants, phlebitis occurred in 12.6% (clinically indicated) vs. 11.7% (routine) (ARD 1.44 pp, 95% CI -1.47 to 4.35), meeting non-inferiority. No catheter-related bloodstream infections were observed in either group. The clinically indicated group required fewer catheter insertions (mean 1.77 vs. 2.16; p < 0.001) and had longer dwell times (mean 112.0 vs. 89.6 h; p < 0.001). Conclusions: Clinically indicated PIVC replacement was non-inferior to routine scheduled replacement for phlebitis and was associated with fewer insertions and longer dwell times, supporting its use in routine clinical practice.
To evaluate the clinical efficacy of a self‑management intervention programme based on symptom management theory for patients with neurogenic bladder (NB). One hundred NB patients treated at a rehabilitation centre between May 2023 and May 2025 who met the inclusion criteria were randomly assigned to two groups (n = 50 each). The control group received routine nursing care, while the observation group received the theory‑based self‑management intervention. Outcomes included self‑management capability, quality of life, voiding parameters (bladder capacity, residual urine volume, daily voiding frequency), NB symptoms, anxiety/depression, and neurogenic bowel function. After 4 weeks, the observation group showed higher self‑management scores and bladder capacity than the control group [57 (49,66) vs. 35 (28,42) points; (376.18 ± 59.65) vs. (224.38 ± 38.13) mL], and lower quality‑of‑life scores, residual urine volume, and daily voiding frequency [(15.10 ± 5.12) vs. (22.02 ± 5.64) points; (103.56 ± 24.25) vs. (155.18 ± 57.43) mL; (9.72 ± 2.33) vs. (17.52 ± 2.87) times; all P < 0.05]. Symptom scores (NBSS, NBDS, SAS, SDS) were also lower in the observation group (P < 0.05). The programme enhances self‑management, improves bladder function, alleviates symptoms, and increases quality of life in NB patients.
The aim of this study is to determine the predictive power of the National Early Warning Score in identifying the outcomes of intensive care unit (ICU) patients. In this study, 300 patients hospitalized in the ICUs (medical and general) of two teaching hospitals affiliated with Tehran University of Medical Sciences were evaluated and followed up for 30 days between June 2023 and April 2024. The samples were selected by convenience sampling based on inclusion criteria. A checklist containing the components of early warning criteria introduced by Braden, SOFA and APACHE II, as well as outcomes of hospitalization in the ward, was used. The early warning criteria were assessed by the researcher at the time of admission, as well as 6 and 24 h after the admission of patients to ICU. The collected data were analysed by SPSS-27 and STATA-14 software using Kruskal-Wallis, Pearson and chi-square tests, as well as the area under the receiver operating characteristic (ROC) curve of early warning system. The mean age of patients was 41 years (31-56), and 63.70% of them were male. Comparison of the area under the ROC curve of early warning tool showed that the early warning score in predicting death at the time of admission, 6 h after admission and 24 h after admission was 0.697, 0.712 and 0.87, respectively. Also, this score in predicting adverse outcomes at the time of admission, 6 h after admission and 24 h after admission was 0.700, 0.784 and 0.936, respectively. In other words, the early warning system had a good predictive power in indicating the occurrence of outcomes at all three times (at admission, 6 hours after admission and 24 h after admission), but the best time to predict death and adverse outcomes was estimated to be 24 h after admission. By evaluating the predictive power of early warning score in identifying the outcomes of patients hospitalized in ICUs, we found that the early warning score at 24 h after admission had a higher predictive power than other times.
Heat waves are increasingly recognized as an environmental determinant of chronic kidney disease (CKD). However, the CKD burden attributable to heat waves and associated healthcare inequalities, particularly under future climate change, remains insufficiently characterized. Based on two nationally representative cross-sectional surveys in China, we established climate region-specific exposure-response functions between heat waves and CKD. Then, we conducted 1-km grid-level health impact assessments integrating the most up-to-date nationally representative CKD prevalence data, temperature projections, population estimates, and socioeconomic indicators. The analyses focused on stages 4-5 CKD (advanced CKD), given its progressive nature and requirements for continuous medical treatment. Heat wave-attributable CKD burden was quantified as attributable cases (ACs), attributable fractions (AFs), and population attributable fractions (PAFs). Projections for 2030-2090 were generated under multiple Shared Socioeconomic Pathways (SSPs). Hospital accessibility was evaluated using AC-weighted driving times and accessibility scores, with inequality assessed via Gini indices and Lorenz curves. In 2020, an estimated 491,362 (227,772-694,191) stages 4-5 CKD cases (about 30.06% of all cases and 45.31 per 100,000 adults) were attributable to heat waves, disproportionately affecting rural areas (PAF: 47.08 per 100,000) and subtropical and tropical regions (PAF: 52.43 per 100,000) compared to their counterparts. Projections indicated increasing trends in PAFs under high-emission scenarios (e.g., SSP5-8.5 showing > 2-fold increase in 2090). The average driving time to the nearest hospital for ACs was 15.8 (7.6-22.3) minutes, with rural areas showing significantly longer times (20.4 min) and lower accessibility. The national Gini index for hospital accessibility was 0.45, indicating high inequality, and the inequality might persist across all future climate scenarios. Heat waves are associated with a substantial and spatially uneven burden of advanced CKD in China, compounded by significant inequalities in hospital accessibility. These inequalities may persist under future climate change given current hospital accessibility settings. Not applicable.
The prescription of multiple drugs increases the likelihood of drug interactions, making the use of drugs in intensive care unit patients challenging. To analyze the occurrence of hyperpolypharmacy and potential drug interactions between centrally-acting drugs and drugs from other pharmacological classes on the first and last day of admission to an intensive care unit. Descriptive study with patients in a hospital in the state of São Paulo, Brazil. The study included patients of both sexes over the age of 18. The patients included had been in the ICU for three days or more, had multiple diagnoses and were taking centrally-acting drugs. Data was collected using the Philips Tasy health management software, that provides information on age, gender, marital status, outcome, polypharmacy, hyperpolypharmacy and results of laboratory blood tests. Data was also collected on prescribed medication. Micromedex® software was used to analyze the occurrence of potential drug interactions and a logistic regression model was used to analyze the data. A higher risk of death was identified in patients aged 40-59 years (OR = 7.36; P = .010; CI 1.39-38.80) and in those taking cardiovascular medications that interact with other medications (OR = 4.41; P = .007; CI 1.48-13.08). Severe drug interactions were associated with regular documentation (OR = 3.54; P = .014; CI 1.32-9.46) and an unspecified time of onset (OR = 27.76; P < .001; CI 7.53-102.2). Moderate drug interactions were associated with the time of onset: a nonspecific onset increased the incidence by 13.13 times (P < .001; CI 3.24-53.17), while a delayed onset increased this probability by 24.85 times (P < .001; CI 5.32-115.9). The results reveal the need to invest in educational strategies to reduce drug interactions in the intensive care unit, with a view to identifying potential drug interactions at an early stage.