Effects of a special continuous quality improvement in nursing on the management of adverse care events: a retrospective study.

OBJECTIVE: To explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events. METHODS: The implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015-2018) and after implementation (2019-2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups. RESULTS: The rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X2 = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001). CONCLUSION: The direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.

Prognostic impact of lung ultrasound detected B-lines on hospitalised ischaemic heart failure with mildly reduced ejection fraction patients.

OBJECTIVES: Prognostic impact of lung ultrasound-derived B-lines (LUS-BL) in heart failure with mildly reduced left ventricular ejection fraction (HFmrEF) patients remains elusive. We evaluated the correlation between LUS-BL and prognosis in HFmrEF patients. METHODS: This is a subgroup analysis based on our previously published retrospective study with 1691 HFmrEF patients. This subgroup analysis involved 574 patients with LUS-BL results at admission. After discharge, patients underwent clinical follow-up for a minimum of 1 year through telephone, clinical visits or community visits. The primary endpoint was defined as cardiovascular (CV) event, including CV-related mortality or HF hospitalisation at 90 days and 1 year after discharge. RESULTS: CV event at 90 days was significantly increased with higher LUS-BL number (0, 1-2, 3-9 and ≥10: 20%, 14%, 18% and 33%, p=0.008), while CV event rate at 1 year was similar among groups (45% vs 45% vs 42% vs 50%, p=0.573). Older age, hypertension (HR=2.06, 95% CI 1.31 to 3.25), higher right ventricular diameter (>23 mm, HR=2.008, 95% CI 1.37 to 2.94), increased ratio of early transmitral flow velocity to early mitral annular velocity (>24, HR=1.79, 95% CI 1.11 to 2.26) and higher LUS-BL number (>11, HR=1.510, 95% CI 1.01 to 2.26) were identified as independent determinants associated with increased risk of CV event at 90 days after discharge. The Harrell's C-Statistic analysis, based on the Cox regression models, demonstrated a significant improvement in the predictive ability of the model that incorporated both clinical and echocardiographic risk factors along with LUS-BL (areas under the curve (AUC)=0.72) compared with the model comprising only clinical risk factors and LUS-BL (AUC=0.69, p=0.036), or to the model with echocardiographic risk factors and LUS-BL (AUC=0.68, p=0.025). CONCLUSION: In HFmrEF patients with ischaemic heart disease, admission LUS-BL>11 is independently associated with an increased risk of CV event at 90 days following discharge.

Impact of atrial fibrillation on cerebro-cardiovascular outcome of heart failure with mildly-reduced ejection fraction.

AIMS: Atrial fibrillation (AF) and heart failure (HF) often co-exist and are closely intertwined. The impact of AF on the outcome of patients with heart failure with mildly-reduced ejection fraction (HFmrEF) is not fully clear. This study aimed to investigate the impact of AF on the outcomes of hospitalized HFmrEF patients. METHODS AND RESULTS: The study included 1691 consecutive patients with HFmrEF (mean 68.2 years, 64.8% male) including 296 AF patients. Patients completed 1 year and mean of 33 month clinical follow-up after discharge by telephone interview, clinical visit, or community visit. The primary endpoint was cerebro-cardiovascular events (CCE, composite of HF rehospitalization, stroke, or cardiovascular death). After propensity score matching, 296 patients were included into the AF group (mean 71.5 years) and 592 patients into the non-AF group (mean 70.6 years). After propensity score matching, CCE at 1 year (59.1% vs. 48.5%, P = 0.003) and at a mean of 33 month (77.0% vs. 70.6%, P = 0.043). AF was independently associated with increased CCE within 1 year (HR = 1.31, 95% CI 1.07 to 1.61, P = 0.010) and at 33 months (HR = 1.20, 95% CI 1.00 to 1.43, P = 0.050) post-discharge after adjusted for other clinical confounders including discharge heart rate, NT-proBNP, haemoglobin, and uric acid. CONCLUSIONS: AF is independently associated with an increased risk of CCE in HFmrEF patients within 1 year and at a mean of 33 months after discharge.

The effect of life events, resilience, self-esteem, and coping styles on aggressive behavior among left-behind adolescents: Structural equation modeling.

Introduction: Without parental support, left-behind adolescents are more likely than their peers to experience negative emotions and demonstrate aggressive behavior in the same frustrating situation. However, research on this subject has been sparse. To fill this gap and identify potential targets for intervention, this study sought to examine the relationships among factors influencing left-behind adolescents' aggressive behavior. Methods: A total of 751 left-behind adolescents were enrolled in a cross-sectional survey, with data collected using the Adolescent Self-Rating Life Events Checklist, Resilience Scale for Chinese Adolescents, Rosenberg Self-Esteem Scale, Coping Style Questionnaire, and Buss-Warren Aggression Questionnaire. The structural equation model was used for data analysis. Results: The results showed that left-behind adolescents reported higher levels of aggression. Further, the factors found to have a direct or indirect effect on aggressive behavior included life events, resilience, self-esteem, positive coping, negative coping, and household income. The results of confirmatory factor analysis indicated goodness of fit. In the face of negative life events, left-behind adolescents with high resilience, self-esteem, and positive coping were less likely to exhibit aggressive behavior (P < 0.05). Discussion: Left-behind adolescents can reduce their aggressive behavior by assuaging the adverse effects of life events via increased resilience and self-esteem as well as the adoption of positive coping strategies.

[Correlation of obesity with C-reactive protein, leptin and insulin sensitive index in children].

OBJECTIVE: To study the correlation between obesity and hypersensitive C-reactive protein (hsCRP), leptin, and insulin sensitive index (ISI) in children. METHODS: The subjects included 69 obese volunteers and 30 age and gender-matched normal volunteers who were recruited from 13702 children aged 2 to 18 years in Xiangtan City by sampling survey. The body mass index (BMI), hsCRP, leptin, fasting plasma glucose (FPG), and fasting insulin (INS) were tested, and then the ISI was calculated. The results between the obese and normal children were compared. The correlation between the parameters was evaluated. RESULTS: The values of hsCRP, leptin and INS in obese children were significantly higher than those in the normal controls (P < 0.01), but the ISI in obese children was significantly lower than that in normal controls (P < 0.01). The BMI was significantly positively correlated with the values of hsCRP, leptin and INS (r=0.225, P < 0.05; r=0.776, P < 0.01; r=0.568, P < 0.01), but was significantly negatively correlated with the ISI (r=-0.889, P < 0.01). There was a positive correlation between the value of hsCRP and the values of FPG and INS (r=0.429, P < 0.01; r=0.206, P < 0.05), and there was a negative correlation between the value of hsCRP and the ISI (r=-0.889, P < 0.01). The value of leptin significantly positively correlated with the values of INS and BMI, and significantly negatively correlated with the ISI. CONCLUSIONS: Insulin resistance and leptin resistance exist in obese children. The inflammatory factors such as CRP and leptin may be involved in the pathogenesis of obesity.