Development of an evidence-based nursing practice program for preventing unplanned endotracheal extubations in the intensive care unit: A Delphi method study.

AIMS: This study aims to develop an evidence-based nursing practice program to prevent unplanned endotracheal extubation (UEE) among adult patients in the intensive care unit (ICU). DESIGN: This study uses the Delphi method to develop an evidence-based nursing practice program. METHODS: A comprehensive review of 18 databases and evidence-based websites was conducted to gather, assess and synthesize evidence on preventing UEEs in adult patients. Using this synthesized evidence, a questionnaire was formulated for further investigation. Subsequently, input was solicited from experts through Delphi surveys to establish an evidence-based nursing practice protocol for preventing UEEs in adult ICU patients. Consistency in consultation results guided subsequent rounds of consultation. RESULTS: The developed program comprised 43 evidence items categorized into nine dimensions, including risk assessment for unplanned extubation, sedation, analgesia, delirium, balloon management, psychosocial care, early extubation, catheter immobilization and protective restraints. Two rounds of expert inquiry yielded recovery rates of 94.7% and 100% for the first and second questionnaires, respectively. Kendall W values ranged from .224 to .353 (p < .001). CONCLUSION: This study developed an evidence-based nursing practice program to prevent UEE in adult ICU patients, employing evidence-based practices and Delphi expert consultation methods. However, further validation of the program's effectiveness is warranted. REPORTING METHOD: Findings were reported according to the Standards for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION: Nurses contributed to the study by participating in investigations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The program developed in this study offers an evidence-based framework for preventing unplanned extubation in hospitals, thereby reducing its incidence and enhancing the quality of nursing care.

Development and validation of early prediction models for new-onset functional impairment in patients after being transferred from the ICU.

A significant number of intensive care unit (ICU) survivors experience new-onset functional impairments that impede their activities of daily living (ADL). Currently, no effective assessment tools are available to identify these high-risk patients. This study aims to develop an interpretable machine learning (ML) model for predicting the onset of functional impairment in critically ill patients. Data for this study were sourced from a comprehensive hospital in China, focusing on adult patients admitted to the ICU from August 2022 to August 2023 without prior functional impairments. A least absolute shrinkage and selection operator (LASSO) model was utilized to select predictors for inclusion in the model. Four models, logistic regression, support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost), were constructed and validated. Model performance was assessed using the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Additionally, the DALEX package was employed to enhance the interpretability of the final models. The study ultimately included 1,380 patients, with 684 (49.6%) exhibiting new-onset functional impairment on the seventh day after leaving the ICU. Among the four models evaluated, the SVM model demonstrated the best performance, with an AUC of 0.909, accuracy of 0.838, sensitivity of 0.902, specificity of 0.772, PPV of 0.802, and NPV of 0.886. ML models are reliable tools for predicting new-onset functional impairments in critically ill patients. Notably, the SVM model emerged as the most effective, enabling early identification of patients at high risk and facilitating the implementation of timely interventions to improve ADL.

Prevention of unplanned endotracheal extubation in intensive care unit: An overview of systematic reviews.

AIMS: This study was performed to identify and summarize systematic reviews focusing on the prevention of unplanned endotracheal extubation in the intensive care unit. DESIGN: Overview of systematic reviews. METHODS: This overview was conducted according to the Preferred Reporting Items for Overviews of Systematic Reviews, including the harms checklist. A literature search of PubMed, the Cochrane Library, CINAH, Embase, Web of Science, SINOMED and PROSPERO was performed from January 1, 2005-June 1, 2021. A systematic review focusing on unplanned extubation was included, resulting in an evidence summary. RESULTS: Thirteen systematic reviews were included. A summary of evidence on unplanned endotracheal extubation was developed, and the main contents were risk factors, preventive measures and prognosis. The most important nursing measures were restraint, fixation of the tracheal tube, continuous quality improvement, psychological care and use of a root cause analysis for the occurrence of unplanned endotracheal extubation. CONCLUSIONS: This overview re-evaluated risk factors and preventive measures for unplanned endotracheal extubation in the intensive care unit, resulting in a summary of evidence for preventing unplanned endotracheal extubation and providing direction for future research. TRIAL REGISTRATION DETAILS: The study was registered on the PROSPERO website.

Upregulation of adenosine A2A receptors induced by atypical antipsychotics and its correlation with sensory gating in schizophrenia patients.

Sensory gating deficits have been found in patients with schizophrenia and their unaffected relatives. However, the underlying neurobiological mechanism of this deficit remains unclear. Pre-clinical studies have implicated adenosine in sensory gating deficits in schizophrenia. Therefore, the current study investigated a possible relationship between peripheral adenosine A2A receptor (ADORA2A) and sensory gating indices (P50 measures) in medication-free schizophrenia (n=31) and healthy (n=21) groups. The effects of six-week antipsychotic treatment were examined. At baseline, schizophrenia patients showed impaired sensory gating compared to healthy controls. However, there was no significant difference in ADORA2A gene expression among groups. In addition, ADORA2A expression was not correlated with sensory gating at any time point. Following treatment, we found a significant upregulation of ADORA2A expression. Intriguingly, we observed a significant positive association between ADORA2A upregulation and baseline P50 amplitudes in the schizophrenia group. A main finding of the current pilot study is the upregulation of ADORA2A expression following treatment with antipsychotics. In addition, this upregulation was predicted by baseline P50 amplitude, an observation that awaits replication in an expanded sample.

[Clinical study on patients with advanced gastric cancer treated with oxaliplatin combining with hydroxycamptothecine].

BACKGROUND AND OBJECTIVE: Internal and external physiological research showed oxaliplatin could obviously suppress several kinds of tumors in combination with most anti-cancer drugs and help these drugs to kill the tumor cells. This study was designed to investigate the initial curative effects and tolerance of patients with advanced gastric cancer of treatment with combination of oxaliplatin (L-OHP) and hydroxycamptothecine (HCPT). We compared this treatment with traditional chemotherapy. METHODS: In a non-randomized manner, 43 patients with advanced gastric cancer were divided into treatment group (L-OHP plus HCPT) and control group (VP-16 + CF + 5-FU) (ELF). Among these patients, 28 were male and 15 were female. The median age was 59. Karnofsky performance status(KPS) scale was more than 60. We compared the initial curative effects and tolerance between these two groups. RESULTS: The beneficial effects for the treatment group (24 cases) and control group (19 cases) were 58.3% (14/24) and 42.1% (8/19), respectively. Obviously, the beneficial effects to the treatment group were higher than that of the control group (P < 0.05). The side effects of both groups included bone marrow suppression, nausea, vomiting, stomatitis, neuritis, phlebitis, hair loss, and so on. But they were slight (within I and II degree). CONCLUSIONS: The use of L-OHP plus HCPT appears to be a very good treatment for patients with advanced gastric cancer. The patients can tolerate the side effects.