The incidence and risk factors of unplanned removal of peripherally inserted central catheters among adult patients: A multi-centre cohort study.

AIMS AND OBJECTIVES: (i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention. DESIGN: A multi-centre prospective cohort study. METHODS: A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two-stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause-specific hazard model and verified using a sub-distribution hazard model. STROBE guidelines were followed in reporting this study. RESULTS: Three thousand one hundred and sixty-six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double-lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause-specific hazard model. Higher BMI became an independent risk factor in the sub-distribution hazard model. CONCLUSIONS: Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors. RELEVANCE TO CLINICAL PRACTICE: Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies. PATIENT OR PUBLIC CONTRIBUTION: Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form.

FvMYB108, a MYB Gene from Fragaria vesca, Positively Regulates Cold and Salt Tolerance of Arabidopsis.

MYB (myoblast) protein comes in large quantities and a wide variety of types and plays a role in most eukaryotes in the form of transcription factors (TFs). One of its important functions is to regulate plant responses to various stresses. However, the role of MYB TFs in regulating stress tolerance in strawberries is not yet well understood. Therefore, in order to investigate the response of MYB family members to abiotic stress in strawberries, a new MYB TF gene was cloned from Fragaria vesca (a diploid strawberry) and named FvMYB108 based on its structural characteristics and evolutionary relationships. After a bioinformatics analysis, it was determined that the gene belongs to the R2R3-MYB subfamily, and its conserved domain, phylogenetic relationships, predicted protein structure and physicochemical properties, subcellular localization, etc. were analyzed. After qPCR analysis of the expression level of FvMYB108 in organs, such as the roots, stems, and leaves of strawberries, it was found that this gene is more easily expressed in young leaves and roots. After multiple stress treatments, it was found that the target gene in young leaves and roots is more sensitive to low temperatures and salt stimulation. After these two stress treatments, various physiological and biochemical indicators related to stress in transgenic Arabidopsis showed corresponding changes, indicating that FvMYB108 may be involved in regulating the plant's ability to cope with cold and high-salt stress. Further research has found that the overexpression of this gene can upregulate the expression of AtCBF1, AtCOR47, AtERD10, and AtDREB1A related to low-temperature stress, as well as AtCCA1, AtRD29a, AtP5CS1, and AtSnRK2.4 related to salt stress, enhancing the ability of overexpressed plants to cope with stress.

The practice and facilitators of, and barriers to, implementing individualized repositioning frequency: A national cross-sectional survey of critical care nurses.

AIMS: To understand the clinical status of implementing individualized repositioning frequency-and its barriers and facilitators-among critical care nurses in China, in view of developing targeted intervention strategies and improving guideline implementation. DESIGN: A cross-sectional survey. METHODS: A self-report questionnaire was developed with reference to the Theoretical Domains Framework and administered to critical care nurses in 15 hospitals across eastern, southern, western, northern, and central geographical areas of China from 20 February 2023 to 16 March 2023. Data were collected for personal demographics, clinical practice status, and from Likert-type responses about barriers to and facilitators of implementing individualized repositioning frequency. RESULTS: In total, 574 effective questionnaires were collected. Only 3.8 % of respondents reported that their hospital/ward uses an individualized repositioning frequency rule. Six facilitator domains identified were: social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; and intentions. Seven barrier domains were: knowledge; skills; goals; memory, attention and decision processes; environmental context and resources; social influences; and behavioral regulation. Inferential analysis showed that critical care nurses who had higher degrees, more years of work, more environmental support, and more nursing experience were prone to being more positive in response to the implementation of individualized repositioning frequency. CONCLUSION: The clinical practice status of implementing individualized repositioning frequency among critical care nurses in China is unsatisfactory. Implementation is essential but complex and is influenced by several factors. Theory-based suggestions for improving this situation are provided on the basis of identified barriers.

MiR-155 regulates M2 polarization of hepatitis B virus-infected tumour-associated macrophages which in turn regulates the malignant progression of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) initiated by hepatitis B virus (HBV) infection is a complicated process. MiR-155 can alter the immune microenvironment to affect the host's anti-infective ability. This study investigated the mechanism by which miR-155 affects tumour-associated macrophage (TAM) polarization at a molecular level, thus affecting the malignant progression of HBV+ HCC. MiR-155 and TAM-related cytokine expression were analysed by qRT-PCR. The distribution of TAMs was detected by immunohistochemistry. The effect of the aberrant miR-155 expression on macrophage polarization was examined by flow cytometry. The targeted relationship was verified by dual-luciferase assay, and the protein level of src homology 2 domain-containing inositol polyphosphate 5-phosphatase 1 (SHIP1) was detected by western blot. The proliferation of HCC cells was examined by CCK-8 and colony formation assays. Invasion and migration of HCC cells were detected by transwell assay. In HBV+ HCC tissues, miR-155 was significantly highly expressed and the number of CD206-positive TAM (CD206+ TAM) and CD68-positive TAM (CD68+ TAM) were higher than those in HBV- HCC tissues. In addition, miR-155 overexpression significantly promoted M2-type macrophage polarization, whilst miR-155 silencing expression significantly promoted M1-type macrophage polarization. Besides, the miR-155/SHIP1 axis accelerated HCC cell invasion, proliferation and migration by inducing M2-type macrophage polarization. MiR-155 accelerates HCC cell proliferation, migration and invasion by targeting SHIP1 expression and inducing macrophage M2 polarization. This finding provides new insights into the development of novel therapeutic strategies for combatting HBV+ HCC and a new reference for exploring anti-tumour immunotherapy.

Critical care nurses' knowledge, attitudes, and practices of pressure injury prevention in China: A multicentric cross-sectional survey.

Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen-item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low-level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation.

Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study.

INTRODUCTION: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. METHODS: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. RESULTS: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59-6.38), readmission (OR 1.45; 95% CI 1.25-1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10-5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09-4.01), readmission (OR 1.38; 95% CI 1.21-1.57), and mortality (OR 6.50; 95% CI 4.00-7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. CONCLUSIONS: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

The association between handgrip strength and depression in cancer survivors: a cross-sectional study.

BACKGROUND: The association between handgrip strength and depression in cancer survivors has been unexplored until now. We aim to examine the association between handgrip strength and depression in cancer survivors by using publicly available data (National Health and Nutrition Examination Survey). METHODS: Two waves of data from the National Health and Nutrition Examination Survey, from 2011-2012 and 2013-2014, were extracted and combined to explore this important issue. We extracted maximum patient handgrip strength value (from both hands). The Patient Health Questionnaire (PHQ-9) was used to evaluate depression with a cut-off > = 10 points indicating that patients had depressive symptoms. Other basic characteristics and health-related variables were also collected. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to select potential confounding factors. Multivariable linear or logistic regression models were adopted to explore whether handgrip strength as a continuous variable, or low handgrip strength, was associated with depressive symptoms. RESULTS: There were 876 cancer survivors in our present total sample, with 403 (46.0%) males and 473 females (54.0%). The mean (SD) age of the entire group was 64.67 (13.81) years. The prevalence of depression and low handgrip strength was 12.90% and 16.7%, respectively. The results showed that handgrip strength was negatively associated with depressive symptoms in cancer survivors (OR = 0.95, 95%CI:0.92-0.99; P = 0.024). In addition, after adjusting for age, gender, race; marital status, polypharmacy, sleep disorder, arthritis, congestive heart failure, history of stroke, type of cancer, chronic coronary bronchitis and being overweight, cancer survivors with low handgrip strength had a 2.02-fold risk of depression, compared to those with normal handgrip strength (OR = 2.02,95%CI:1.07-3.81; P = 0.028). CONCLUSIONS: Our present study suggests that low handgrip strength, as a simple and modifiable parameter, is associated with a higher risk of depression in cancer survivors. Therefore, future larger-scale prospective cohort studies are warranted to determine this association.

The association between frailty and mortality among lower limb arthroplasty patients: a systematic review and meta-analysis.

BACKGROUND: Some studies associate frailty and postoperative mortality in hip or knee replacement patients, and others have explored the relationship between the frailty index and changes in postoperative mortality in hip or knee replacement patients, but their findings are not consistent. This meta-analysis and systematic review aimed to pool the results of existing studies to explore whether frailty is an independent risk factor for postoperative mortality in patients with lower limb arthroplasty (including hip or knee arthroplasty). METHODS: On December 15, 2021, we searched the relevant articles from the PubMed, Embase, Medline (via Ovid), China National Knowledge Infrastructure (CNKI) and Wan Fang Med Online databases. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of the articles that met the exclusion and inclusion criteria. R Studio was used to analyze the effect sizes (based on the random model integration) on the extracted data. Meanwhile, potential publication bias and sensibility analysis were performed. RESULTS: We included seven studies, which included a total of 460,594 patients, for quantitative analysis. Overall, frailty increased the risk of mortality in lower limb arthroplasty patients compared to those without frailty, as measured by a pooled risk ratio (RR) of 2.46 (95% confidence interval [CI]: 1.81-3.33). Additionally, subgroup analysis based on population revealed that the pooled RRs for total knee arthroplasty (TKA) patients in three studies and total hip arthroplasty (THA) patients in four studies were 2.61 (95% CI: 2.26-3.02) and 3.18 (95% CI: 1.92-5.28), respectively, for TKA patients in three studies and THA patients in four studies. Additionally, these statistically significant positive associations persisted in subgroup analyses by study design, geographic region, and follow-up period. CONCLUSION: Frailty is an independent risk factor for postoperative mortality in patients undergoing lower limb arthroplasty, according to our findings. This suggests that frailty may be a predictor of preoperative risk stratification for patients with such elective surgery and could alert doctors and nurses of early screening and medical care interventions in patients with such a need for surgery to reduce postoperative mortality in lower limb arthroplasty patients.

The association between the number of teeth and frailty among older nursing home residents: a cross-sectional study of the CLHLS survey.

BACKGROUND: Given that few studies have explored the association between oral health and frailty among older nursing home residents, the purpose of this study was to assess the association between oral health (i.e., the number of teeth and oral behaviors) and frailty in this population using the Chinese Longitudinal Healthy Longevity Survey (CLHLS). METHODS: This was a national cross-sectional study derived from the seventh wave of CLHLS in 2018, consisting of 365 older nursing home residents aged 65 years or older. The frailty index was constructed based on 32 variables consisting of self-rated health status, anxiety, depression, ADL and IADL. Oral health was measured through the number of natural teeth and tooth brushing behavior. Multiple logistic regression was used to identify this association between the number of teeth, oral health behaviors, and frailty. RESULTS: The mean age of this sample was 87.6 (SD = 9.5), with 154 (42.2%) males. The prevalence of frailty and edentulism was 71.2% and 33.4%, respectively. Multiple logistic regression analysis found that the likelihood of frailty decreased with an increased number of teeth, with an OR of 0.94 (95% CI: 0.91-0.98). Compared with participants with edentulism, older adults with 1 to 20 teeth had a lower likelihood of frailty (OR = 0.39, 95% CI: 0.17-0.88); these results were also found in older adults with more than 20 teeth (OR = 0.20, 0.07-0.57). Additionally, older adults who brush their teeth regularly have a lower likelihood of frailty than those who never brush their teeth (OR = 0.37, 95% CI: 0.13-0.99). CONCLUSION: Older nursing home residents who maintain their natural teeth can help lower the risk of frailty, and regular toothbrushing also contributes to decreasing the risk of frailty. Our study emphasizes the importance of oral health, and cohort studies with large-scale samples to address this important issue are warranted in the future.

Gap between risk factors and prevention strategies? A nationwide survey of fall prevention among medical and surgical patients.

AIMS: This study aimed to determine the extent to which nurses report assessing evidence-based falls risk factors and implementing targeted prevention for medical and surgical patients in China. DESIGN: This study was a national online survey. METHODS: The respondents were registered nurses working in medical and surgical units in 662 Chinese hospitals. The data concerning the falls risk factor assessments and targeted interventions implemented by nurses were collected online by the Nursing Management Committee of the Chinese Nursing Association in China in 2019. RESULTS: In total, 68 527 valid questionnaires were returned (95.0%). In medical and surgical units, nurses were most likely to report assessing balance, mobility and strength (81.6%) and orthostatic hypotension (76.4%) in falls patients and least likely to report assessing continence (61.3%) and feet and footwear (55.8%). Ensuring the use of appropriate footwear (79.3%) and managing syncope, dizziness and vertigo (73.8%) were the most common multiple interventions, while managing postural hypotension (48.8%) and cognitive impairment (48.4%) was the least common. Nine falls risk factors with clearly matched multifactorial interventions were identified in medical and surgical units (68.2%-97.1%). CONCLUSIONS: The implementation of multifactorial interventions in medical and surgical wards is inconsistent as reported by nurses in medical and surgical wards. Throughout China, nurses are generally concerned about falls risk factors and prevention for their patients; however, limited attention has been focused on continence, feet and footwear assessment and the management of cognitive impairment. Evidence-based falls prevention should be further tailored to the specific risk factors of each patient. IMPACT: Best practice guidelines for falls prevention in hospitals have been developed and published, and it is important for nurses to use these guidelines to guide practice. Our findings identify that in routine care, healthcare providers and hospitals can prevent falls.

Prevalence of Depressive Symptoms Among Pregnant and Postpartum Women in China During the COVID-19 Pandemic.

OBJECTIVE: According to recent studies, the COVID-19 pandemic has been associated with an increased risk of mental health problems across many subpopulations including pregnant and postnatal women. This study examined the prevalence and correlates of depressive symptoms (depression hereafter) in Chinese pregnant and postpartum women during the COVID-19 pandemic. METHODS: This was a multicenter, cross-sectional study comprising 1309 pregnant and postpartum women across 12 provinces in China during the COVID-19 pandemic. Depression was assessed using the nine-item Patient Health Questionnaire. Univariate analyses and multivariate logistic regression analyses were conducted. RESULTS: The prevalence of depression in pregnant and postpartum women was 27.43% (95% confidence interval [CI] = 25.01%-29.85%). Women who were worried about themselves or their babies being infected with COVID-19 (odds ratio [OR] = 2.562, 95% CI = 1.670-3.929), and those who had delayed regular medical checkups (OR = 2.434, 95% CI = 1.580-3.750) were at higher risk of depression. Compared with those living in central and western parts of China, women living in northern (OR = 0.513, 95% CI = 0.326-0.807) and southeastern parts of China (OR = 0.626, 95% CI = 0.463-0.846) were less likely to have depression. CONCLUSIONS: The COVID-19 pandemic was associated with an increased likelihood of mental health problems among pregnant and postnatal women. Over a quarter of the pregnant and postpartum women in China had depression during the COVID-19 pandemic. Considering the negative health impact of depression, preventive measures, regular mental health screening, and medical checkups are needed with the goal to reduce the risk of depression in this vulnerable population during a pandemic.

An early predictive model of frailty for older inpatients according to nutritional risk: protocol for a cohort study in China.

BACKGROUND: Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information. METHODS: The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up. DISCUSSION: This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis.

BACKGROUND: A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. METHODS: Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle-Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed. RESULTS: Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44-59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66-2.38) and 2.48 (95% CI: 1.78-3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68-4.07) and 2.09 (95% CI: 1.40-3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52-5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66-2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81-2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region. CONCLUSION: Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study.

BACKGROUND: Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients. METHODS: This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes. RESULTS: The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65-75 years, and 26.27% were aged 75-85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076-1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037-1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was - 0.013 (95% CI: - 0.024-- 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65-74 years. CONCLUSIONS: We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682 , registered 09 August 2018.

Chinese orthopaedic nurses' knowledge, attitude and venous thromboembolic prophylactic practices: A multicentric cross-sectional survey.

BACKGROUND: Venous thromboembolism is a severe preventable complication among orthopaedic surgical patients. Integrating therapeutic guidelines into clinical practice can help improve patient safety and reduce the burden of this pathology. Improving the quality of patient care is important for bridging the gap between the prophylaxis for venous thromboembolism and therapeutic guidelines. OBJECTIVES: This study aimed at evaluating the knowledge, attitude, and venous thromboembolism and prophylaxis practices of Chinese orthopaedic nurses to guide quality care improvements. METHODS: The data used in this study are secondary data obtained from a multicentric survey. An anonymous questionnaire was used to measure the attitude and knowledge of venous thromboembolic prophylaxis among orthopaedic nurses. VTE prophylactic practices were extracted from medical records within the electronic case report form immediately after the nurses' investigations. The STROBE statement for observational studies was applied. RESULTS: Results indicated that although 94.0% of the responding nurses had attended training courses in their wards, a majority of them (68.9%) achieved a median knowledge score of 7 points or below (range 0-9). Knowledge regarding the proper use of prophylaxis, identification of risk factors, signs and symptoms for pulmonary embolism was limited. Self-reported attitudes underestimate the relationships between venous thromboembolism and low-quality nursing care. Pharmacological prophylaxis was highly used (90.9%), while the utilisation of mechanical prophylaxis and its proper use was relatively low. CONCLUSIONS: Chinese orthopaedic nurses demonstrated enthusiasm for venous thromboembolism and prophylaxis. Their knowledge needs to be improved, including the proper use of prophylaxis, identification of risk factors, signs and symptoms. Mechanical prophylaxis practice for VTE prevention after THA and TKA surgical procedures is not optimistic. Further studies should analyse the causes from multiple perspectives, including the availability of resources, the knowledge and attitude of doctors, nurses and patients. RELEVANCE TO CLINICAL PRACTICE: The findings from this study can be used to develop and implement interventions for venous thromboembolism after orthopaedic surgery.

Prevalence and associated factors for frailty among elder patients in China: a multicentre cross-sectional study.

BACKGROUND: To date, most previous studies of frailty among hospitalized elderly Chinese patients have been conducted based on small samples, which cannot represent the elderly patient population. The aim of this study was to identify the prevalence of and risk factors for frailty among elderly patients in China. STUDY DESIGN AND SETTING: This cross-sectional study surveyed 9996 elderly patients from 6 tertiary-level hospitals in China. The prevalence of frailty among patients from selected wards was surveyed by trained investigators. A mixed-effects Poisson regression model was used to analyse the factors associated with frailty among elderly patients. RESULTS: The mean age of all subjects was 72.47 ± 5.77 years. The prevalence rate of frailty in this study was 18.02%. After adjustments were made for the confounding effect of the clustering of hospital wards, a mixed-effects Poisson regression model showed that the associated factors of frailty included the following: age (OR: 1.016, 95% CI: 1.012-1.020), BMI < 18.5 (OR: 1.248, 95% CI: 1.171-1.330), female gender (OR: 1.058, 95% CI: 1.004-1.115), ethnic minority (OR: 1.152, 95% CI: 1.073-1.236), admission to hospital by the emergency department (OR: 1.104, 95% CI: 1.030-1.184), transit from another hospital (OR: 1.159, 95% CI: 1.049-1.279), former alcohol use (OR: 1.094, 95% CI: 1.022-1.171), fall history in the past 12 months (OR: 1.257, 95% CI: 1.194-1.323), vision dysfunction (OR: 1.144, 95% CI: 1.080-1.211), cognition impairment (OR: 1.182, 95% CI: 1.130-1.237), sleeping dysfunction (OR: 1.215, 95% CI: 1.215-1.318), urinary dysfunction (OR: 1.175, 95% CI: 1.104-1.251), and defecation dysfunction (OR: 1.286, 95% CI: 1.217-1.358). The results also showed some of the following protective effects: BMI > 28 (OR: 0.897, 95% CI: 0.856-0.940); higher education level, including middle school (OR: 0.915, 95% CI: 0.857, 0.977) and diploma and above (OR: 0.891, 95% CI: 0.821, 0.966); and current alcohol use (OR: 0.869, 95% CI: 0.815, 0.927). CONCLUSION: We identified a relatively high prevalence of frailty among elderly patients, and there are several associated factors among the population derived from this investigation of a large-scale, multicentre, nationally representative Chinese elderly inpatient population. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study.

BACKGROUND: There is still controversy about the relationship between aging and changes in functional ability. This study aims to describe the level of basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL) in different age groups and explore the factors associated with functional disability in Chinese older inpatients. METHODS: This cross-sectional study surveyed 9996 older inpatients aged 65 years and older from six tertiary hospitals in China from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale. A mixed-effect generalized linear model was used to examine the association between functional disability and covariates. RESULTS: The average ADL score was 89.51 ± 19.29 and the mean IADL score 6.76 ± 2.01 for all participants. There was a trend of decreasing scores along with aging, and significant differences between age groups were also observed (P < 0.001). The most affected ADL and IADL was stair climbing and shopping, respectively. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in the past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. Patients from the emergency department or transferred from other hospitals and former alcohol drinkers are at risk of ADL disability. Former smoking is a risk factor for IADL disability, whereas current drinking, higher-level education, and residing in a building without elevators were likely to maintain a better IADL performance. CONCLUSIONS: Functional ability declines with aging, older inpatients are low dependency upon ADL and IADL. There are several associated factors among the participants derived from this investigation of a large-scale, multicenter, nationally representative Chinese older inpatient population. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018.

Utilization of public health care by people with private health insurance: a systematic review and meta-analysis.

BACKGROUND: The objective of this systematic review was to explore the association between private health insurance and health care utilization. METHODS: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases for relevant articles since 2010. Studies were eligible if they described original empirical research on the utilization of public health care by individuals with private health insurance, compared with individuals without private insurance. A pooled measure of association between insurance status with health care utilization was assessed through meta-analysis. RESULTS: Twenty-six articles were included in the final analysis. We found that patients with private insurance did not use more public health care than people without private insurance (P < 0.05). According to the subgroup analysis, people with private insurance were more likely to be hospitalized than people with no insurance (OR 1.67; 95% CI, 1.18 to 2.36). CONCLUSIONS: People with private insurance did not increase their use of health care (outpatient services), compared to those without private insurance. Private health insurance coverage may ease the financial burden on patients and on the public health insurance system.

Hospitalization costs among immobile patients with hemorrhagic or ischemic stroke in China: a multicenter cross-sectional study.

BACKGROUND: In this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs. METHODS: We evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors. RESULTS: In total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS. CONCLUSIONS: We found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.

Intention to leave among newly graduated nurses: A descriptive, multicenter study.

AIMS: To investigate newly graduated Chinese nurses' intention to leave their jobs and to explore the association of intention to leave with nurse characteristics, person-environment fit, and social support. DESIGN: This was a cross-sectional descriptive study. METHODS: Newly graduated nurses (N = 1,313) were recruited from 18 hospitals in six provinces in China, during 2018. An online questionnaire explored intention to leave and related factors, including proactive personality, personal-environment fit, and perceived social support. Chi-squared and multilevel logistic regression analysis were used to examine associations between factors. RESULTS: Among 1,313 newly graduated nurses, 88 (6.7%) reported high-level intention to leave. Nurses working in specialty areas (i.e., outside of medical-surgical wards) and those with higher degree of person-organization fit showed lower intention to leave, whereas those with higher level of education, exposure to negative workplace/life events during the previous year and a proactive personality showed higher intention to leave. CONCLUSION: Among newly graduated Chinese nurses, intention to leave is significant and is influenced by work area, level of education, negative workplace/life events and person-organization fit. The intention to leave is dynamically multifactorial and supportive strategies must be similarly multifaceted to effectively reduce turnover. IMPACT: Little is known about the factors influencing the intention to leave among newly graduated nurses. We found significant intention to leave among new nurses which was negatively associated with work in a specialty area and degree of person-organization fit and positively associated with level of education, exposure to negative workplace/life events and proactive personality. This information adds to our understanding of nurse turnover and will support nurse administrators in the introduction of specific strategies to decrease turnover in this population.