Construction of Hospice Care Evaluation System for Terminally Ill Patients in ICU.

Background: Terminally ill patients can benefit from hospice care, which specifically addresses the needs of patients and families affected by terminal illness. However, there is a lack of standardized evaluation criteria to assess the quality of hospice care for terminally ill patients in the ICU, and it is impossible to evaluate the service quality of hospice care. To use the Delphi method to construct a hospice care system for terminally ill patients in ICU that meets clinical needs, and to provide theoretical support for nursing decision-making of terminally ill patients in clinical ICU. Methods: Obtain relevant literatures by entering specific key words into the database, the hospice care nursing system for terminally ill patients in ICU was preliminarily drawn up by literature analysis, and 24 experts in this field were consulted for 3 rounds by Delphi method to discuss the development status of hospice care and finally establish the hospice care nursing system. Results: In the three rounds of letter inquiries, the positive coefficients of experts were all high, the expert authority coefficient (Cr) were 0.864, 0.849, 0.832, and the expert opinion coordination coefficient(W) were 0.186, 0.319, 0.224; The system includes 8 first-level indicators, 27 second-level indicators and 9 third-level indicators. Conclusion: In this study, three rounds of Delphi consultation methods were used to construct an evaluation index system for the nursing quality of hospice care for ICU patients. The evaluation indicators formulated closely focus on the physiological and psychological characteristics of ICU patients, which can provide a better reference for ICU patients with advanced life in the future.

Controlled Dissociation of Polymeric Micelles in Response to Oxidative Stress.

Nanoparticle-based drug carriers that can respond to oxidative stress in tumor tissue have attracted attention for site-specific drug release. Taking advantage of the characteristic microenvironment in tumors, one of the attractive directions in drug delivery research is to design drug carriers that release drugs upon oxidation. A strategy to incorporate oxidation-sensitive thioether motifs such as thiomorpholine acrylamide (TMAM) to drug carriers has been often used to achieve oxidation-induced dissociation, thereby targeted drug release. However, those delivery systems often suffer from a slow dissociation rate due to the intrinsic hydrophobicity of the thioether structures. In this study, we aimed to enhance the dissociation rate of TMAM-based micelles upon oxidation. The random copolymers of N-isopropylacrylamide and TMAM (P(NIPAM/TMAM)) were designed as an oxidation-sensitive segment that showed a fast response to oxidative stress. We first synthesized P(NIPAM/TMAM) copolymers with different NIPAM:TMAM molar ratios. Those copolymers exhibited low critical solution temperatures (LCSTs) below 32 °C, which shifted to higher temperatures after oxidation. The changes in LCSTs depend on the NIPAM:TMAM molar ratios. At the NIPAM:TMAM molar ratio of 82:18, the LCSTs before and after oxidation were 17 and 54 °C, respectively. We then prepared micelles from the diblock copolymers of poly(N-acryloyl morpholine) (PAM) and P(NIPAM/TMAM). The micelles showed an accelerated dissociation rate upon oxidation compared to the micelles without NIPAM units. Furthermore, the doxorubicin (Dox)-loaded micelles showed enhanced relative toxicity in human colorectal cancer (HT29) cells over human umbilical vein endothelial cells (HUVECs). Our novel strategy to design an oxidation-sensitive micellar core comprising a P(NIPAM/TMAM) segment can be used as a chemotherapeutic delivery system that responds to an oxidative tumor microenvironment in an appropriate time scale.

'Internet+' comprehensive nursing training course in the post-epidemic era-an exploration of the mixed teaching mode: a randomized trial.

Objective: To explore the effect of the application of the 'Internet+' nursing teaching mode on the comprehensive teaching 'Fundamentals of Nursing'. Trial design: Parallel design and convenient sampling were used to select vocational nursing students from the Nursing College of Capital Medical University. Methods: Selected students were randomly divided into two groups. The control group consisted of 30 students in Grade 2020 higher vocational nursing education (traditional teaching mode). The observation group consisted of 30 students in Grade 2021 higher vocational nursing education (Internet+ mixed teaching mode). Training assessment results, automatic learning ability, professional identity, and satisfaction were compared between the two groups. Results: Compared with the control group, the students in the observation group scored higher in the following operation practices: venous blood sampling, intradermal injection, cardiopulmonary resuscitation (CPR), sputum aspiration, and putting on and taking off robes (84.01 ± 0.87 vs. 92.14 ± 1.23; 91.41 ± 0.82 vs. 96.86 ± 0.27; 87.56 ± 0.31 vs. 93.91 ± 2.79; 88.11 ± 0.51 vs. 93.75 ± 0.29; and 82.29 ± 0.29 vs. 90.96 ± 0.34, respectively, with p < 0.05 for all scores). The total scores for autonomous learning ability and subjective satisfaction were also higher in the observation group compared with the control group (82.98 ± 4.72 vs. 93.17 ± 5.01 and 96.67% vs. 90.00%, respectively, with p < 0.05 for all scores). Conclusion: In the post-epidemic era, the 'Internet+ hybrid teaching mode' was applied to comprehensive nursing teaching. This changed the traditional education mode, which focuses only on professional knowledge. The 'Internet+' teaching mode results showed that the professional, ideological, and political courses exhibited the same value guidance, which improved students' independent learning ability, practical operation ability, professional identity, and satisfaction.

Effect of online modified mindfulness-based stress reduction training on the resilience of nursing interns in China.

AIM: This study aimed to adopt online mindfulness-based stress reduction (MBSR) training to increase the resilience of nursing interns and help them to achieve a smooth transition. DESIGN: A one-group pretest-posttest study design was used. METHODS: A total of 119 college nursing interns were recruited from 12 tertiary hospitals in Beijing on Feb.20, 2021. The MBSR training was organized into 4 weeks of courses, conducted online using Tencent Meeting and taught by a certified teacher at the Oxford Mindfulness Centre. Resilience was assessed before and 2 weeks after the training, respectively, using Resilience Scale for Chinese Adolescents via an online questionnaire tool. RESULTS: Seventy-nine college nursing interns finished both of the resilience questionnaire surveys. The mean resilience values before and after the training were 98.7 ± 13.69 and 104.57 ± 16.64 respectively. The 4-week online MBSR training considerably increased the resilience of nursing interns. This can be an effective measure to maintain a balanced state among nursing interns and help them smoothly transition from school to clinical practice. No Patient or Public Contribution.

The Efficacy of Hospice Care for Terminally Ill Emergency Patients During the Coronavirus 2019 Pandemic.

Objective: This study aimed to explore the efficacy of hospice care for terminally ill emergency patients in the COVID-19 context. Methods: A total of 86 terminally ill emergency patients at the authors' hospital from February 2020 to October 2020 were included in this study, they were randomly allocated into a control (n = 42) and an intervention (n = 44) group, respectively. The control group received routine nursing care, and the intervention group received hospice care. Results: Following treatment, the survival time (as the primary outcome) in the intervention group was longer than in the control group (P < 0.05). Distress thermometer and psychological pain-related factor scores for the intervention group were lower than those of the control group (P < 0.001 for both). The comfort scores of all dimensions in the intervention group were higher than in the control group (P < 0.05). The scores for survival puzzle, symptom distress, independence, and mental well-being in all dimensions related to a sense of dignity were lower in the intervention than in the control group (P < 0.05 for all). The intervention group's yield, avoidance, and total scores were lower than in the control group, whereas the face score was higher than in the control group (P < 0.05 for all). Conclusion: In the current COVID-19 context, the telehealth (psychological, physical, online remote support, critical illness communication, and death education) approach adopted by the Anning care team for terminally ill emergency patients and other aspects of peace care could help improve the physical and mental health of patients. Hospice care can minimise the physical and psychological pain of terminally ill patients in the emergency department and assist them in their final stage of life by providing a calming and comfortable environment.

Red blood cell distribution width is associated with frailty in older inpatients in China: Sex differences in a cross-sectional study.

AIMS: Although some studies have investigated an association between inflammatory marker and frailty, little is known about the relationship of red blood cell volume distribution width (RDW) and frailty. This study aimed to determine whether there were sex-specific associations of RDW and frailty among older hospitalized patients. METHODS: A cross-sectional study was conducted in a comprehensive tertiary hospital in mainland China between February 2015 and November 2017. Hospitalized patients aged 60 years and above were included. Frailty was defined according to Fried's frailty phenotype. Data on patients' demographics, clinical characteristics, and inflammatory markers were collected. The association was evaluated by using the linear and logistic regression modeling. RESULTS: The frailty prevalence was 26.65% (89/334) in men and 28.07% (80/285) in women. After adjusting for all covariates, patients in the 4th RDW quartile exhibited an increased risk of frailty compared with those of the 1st RDW quartile [men: odds ratio (OR) = 2.26; 95%CI = 1.01, 5.07; women: OR = 6.29; 95%CI = 2.11, 18.71]. P for trend were < 0.05 for all models. CONCLUSIONS: An increased RDW among older inpatients was more strongly associated with a corresponding increased risk of frailty in women than in men. Our findings suggest that there were sex differences in the association between elevated RDW levels and frailty among older inpatients. These results may provide support for the intervention decision-making.

The mediating role of resilience between work-family conflict and career development among Chinese nurses: A cross-sectional study.

AIM: To investigate the association between work-family conflicts and career development with resilience among nurses. BACKGROUND: Nurses tend to have high levels of work-family conflict. Resilience may affect their individual career development, the stability of the nursing team and the quality of nursing care. METHODS: A cross-sectional survey using correlational design was conducted in mainland China. Data were collected using demographic and career development questionnaire, work-family conflict and resilience scale. RESULTS: A total of 70,932 nurses were included. The total score for work-family conflict was relatively high (38.37 ± 12.82). Work-family conflict of nurses had a significant negative correlation with career development (r = -0.35, p < .001) and with resilience (r = -0.23, p < .001), while resilience had a significant positive correlation with career development (r = 0.62, p < .001). Resilience plays a mediating role between work-family conflict and career development. CONCLUSIONS: The work-family conflict had a significant negative correlation with career development among nurses. Resilience has a mediating role between work-family conflict and career development. Nursing managers could reduce the level of work-family conflict by enhancing nurses' resilience. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should prioritize the improvement of resilience through training and education, enhancing nurses' ability to address work-family conflicts.

Effect Modification by Sex of the Hemoglobin Concentration on Frailty Risk in Hospitalized Older Patients.

BACKGROUND: Hemoglobin concentration differs by sex, possibly affecting any association between hemoglobin and frailty. This study aimed to evaluate the potential interaction effect of hemoglobin and sex on frailty in Chinese older inpatients. METHODS: A cross-sectional study was conducted between February 2015 and November 2017 in a tertiary hospital. Frailty was defined by the Fried phenotype. Hemoglobin concentration was measured with a standard procedure. Covariates included demographics, clinical characteristics, and serum biomarkers. Logistic regression was applied to examine the association between hemoglobin concentration and frailty. The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were used to evaluate the additive interaction. RESULTS: A total of 619 older inpatients [mean age 69.26±7.44 years; 334 men, 285 women] were included. The mean hemoglobin concentration was significantly lower in the elderly who were frail (11.9 g/L in frail versus 13.1g/L in non-frail; p<0.001). In the multivariable regression models, lower hemoglobin in patients was significantly associated with frailty (adjusted odds ratio (OR) = 2.51, 95% CI:1.37, 4.60). The stratified analyses indicated that lower hemoglobin was associated with frailty among older inpatients with different characteristics. Female inpatients with lower hemoglobin had the highest risk of frailty (adjusted OR=6.43, 95%: 2.38, 17.3); there were interactions between hemoglobin and sex on the development of frailty (RERI=4.30, 95% CI=-1.41, 10.01; AP=0.67, 95% CI=0.37, 0.97;SI=4.80, 95% CI=1.22, 18.84). CONCLUSIONS AND IMPLICATIONS: Our study provided evidence that sex and lower hemoglobin have an interaction effect on frailty; it is suggested that clinicians may consider sex-specific strategies for the elderly to conform the concept of precision medicine.

Catalyst-Free Multicomponent Cyclopolymerizations of Diisocyanides, Activated Alkynes, and 1,4-Dibromo-2,3-Butanedione: a Facile Strategy toward Functional Polyiminofurans Containing Bromomethyl Groups.

Polymers containing iminofuran (PIFs) are rarely reported due to the lack of simple and effective synthesis methods. In this work, a novel multicomponent cyclopolymerization (MCCP) of diisocyanides, activated alkynes, and 1,4-dibromo-2,3-butanedione using catalyst-free one-pot reactions under mild conditions to prepare PIFs containing bromomethyl groups is reported. PIFs with good solubility and thermal stability are obtained with high Mw s (up to 19 600) and good yields (up to 89.5%) under optimized polymerization conditions. The structure of the PIFs is characterized by nuclear magnetic resonance, Fourier transform infrared spectroscopy, and gel permeation chromatography. The photophysical properties indicate that polymers P1a2b3 and P1c2b3 have cluster-triggered emission characteristics. Thin films made from PIFs quickly degrade under UV irradiation. Moreover, the obtained polymers are decorated with bromomethyl and carboxylate groups in the side chain, which can be postfunctionalized to prepare multifunctional materials, such as star branched polymers and biomedical carrier materials. Thus, this work not only enriches the field of polymerization based on isocyanates and activated alkynes but also provides a facile strategy toward functional iminofuran polymers.

The association between sociodemographic factors, frailty, and health-related quality of life in older inpatients: a cross-sectional study.

PURPOSE: This cross-sectional study aims to explore the association between frailty and domains of quality of life (QOL) among hospitalized patients in older age under consideration of the sociodemographic characteristics. METHODS: Older inpatients in a comprehensive tertiary hospital in China were involved. Data including sociodemographic, clinical diagnosis, frailty status, and QOL were collected through questionnaires and physical assessments. Frailty was measured using the frailty phenotype defined by Fried. QOL was determined by completion of version 2 of the 12-item Short Form Survey (SF-12v2). Multivariable linear regression and structural equation modeling were applied to estimate associations between frailty and QOL. RESULTS: 260 older inpatients were enrolled and classified as frail (31.92%), pre-frail (39.62%), and robust (28.46%). Patients with frailty were older and were more likely to have severe comorbidity, higher nutritional risk score and lower body mass index, activities of daily living score (P < 0.05). As the extent of frailty increased, the patients in old age experienced poor QOL in most of dimensions. Five multiple linear regression models indicated that the estimated differences in the physical component summary of QOL were lower for the frail and pre-frail groups versus the robust group. After adjusting all covariates, the coefficients were - 7.72 (- 11.04, - 4.41) and - 16.48 (- 20.37, - 12.58) for pre-frail and frail, respectively. Structural equation modeling results showed that sociodemographic characteristics directly affected QOL, while others played an indirect role in reducing their QOL by causing frailty. CONCLUSIONS: Frailty is prevalent in hospitalized patients having older age. Patients with frailty would experience poor QOL, especially in the dimension of physical health. To promote healthy aging, further studies into how frailty influences the QOL is warranted.

Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery.

Purpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailty assessment improves the predictive ability of the American Society of Anesthesiologists (ASA) score, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Estimation of Physiologic Ability and Surgical Stress (E-PASS) score. Patients and methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients undergoing major thoracic or abdominal surgery were included. Frailty phenotype and ASA, POSSUM, and E-PASS scores were assessed. Demographic, preoperative, and surgical variables were extracted from medical records. Primary outcome measure was in-hospital Clavien-Dindo ≥ grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty. Results: Prevalence of frailty was 26.12%. Significant differences were observed between the frail and non-frail groups with respect to age, Activities of Daily Living, Charlson Comorbidity Index, respiratory function, presence of malignancy, serum albumin, prealbumin, and hemoglobin levels (P<0.05). ASA, POSSUM, and E-PASS scores were higher in the frail group. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital [odds ratio: 16.59, 95% CI: 4.56-60.40, P<0.001]. The area under the curve (AUC) for frailty was 0.762 (95% CI: 0.703-0.814). The AUC for ASA, POSSUM, and E-PASS for prediction of complications was 0.751 (95% CI: 0.692-0.804), 0.762 (95% CI: 0.704-0.814), and 0.824 (95% CI: 0.771-0.870), respectively. Addition of frailty assessment increased the AUC to 0.858 (95% CI: 0.808-0.899), 0.842 (95% CI: 0.790-0.885), and 0.854 (95% CI: 0.803-0.896), respectively. Conclusion: Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing major thoracic and abdominal surgery. Frailty assessment can improve the predictive ability of current surgical risk assessment tools. Frailty phenotype should be considered perioperatively. Frailty assessment could also expand the scope for nurses to evaluate patients for safety management.

Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis.

BACKGROUND: Frailty has been generally been associated with adverse events in older patients under surgery. Frailty phenotype is the most widely used instrument in the research literature. However the effect of the frailty phenotype on post-operative events was still unclear. The purpose of this systematic review was to explore the association between frailty phenotype and post-operative complications among surgical patients aged 60 years and over. METHODS: Relevant studies were identified by systematically searching of PubMed, Embase, the Cochrane Library and the Web of Science databases from their beginning to March 2017. Both random-effects models and fixed-effects models were used to combine the risk ratios (RRs) and 95% confidence intervals (CIs). A subgroup analysis was performed to identify the sources of heterogeneity and a sensitivity analysis to identify the strength of the results. RESULTS: Twelve prospective cohort studies involving a total of 2278 patients were included. The risk of post-operative complications in the frail group was higher than the non-frail group (RR: 1.6; 95% CI: 1.60-2.13). Compared with the robust group, geriatric patients with frailty or pre-frailty had a higher risk of post-operative complications. The RRs were 1.77 (95% CI: 1.40-2.25) and 1.45 (95% CI: 1.17-1.80), respectively. CONCLUSION: Frailty phenotype should be considered as a useful risk assessment tool for preoperative evaluations of geriatric patients by medical staff.

Application of case mix index in the allocation of nursing human resources.

AIM: To investigate the feasibility of the case mix index and compare the allocation of nursing human resources between two departments of a hospital with different case mix indexes in China. BACKGROUND: The case mix index is used to assess the resource allocation of all cases in two departments of a hospital. Its values can determine the resource allocation required to diagnose and treat the patients. METHODS: Clinical data were obtained from 23 different departments in 2015 and analysed retrospectively from October to November, 2016. Factors influencing the allocation of registered nurses were identified, and balanced quantities of patients with different case mix indexes were chosen from two departments. Spearman correlation analysis was performed. RESULTS: The per capita nursing workload was significant (r = .669, p = .000). The length of hospital stay, quantity of nurses, and department case mix index were correlated with the nursing workload (t = 4.211, p = .000; t = 2.962, p = .008; t = 2.266, p = .035). Education levels (Z = -1.391, p = .164) and the professional titles (Z = -1.832, p = .067) of the nurses were not statistically significant, whereas the registered nurse level differed between two departments (Z = -2.125, p = .034). CONCLUSION: The case management index provides references for the efficient allocation of registered nurses in clinical practice.