Conectar
Although lung cancer remains the leading cause of cancer deaths in the US, recent advances in early detection and treatment have led to improvements in survival. However, there is a considerable risk of recurrence or second primary lung cancer (SPLC) following curative-intent treatment in patients with early-stage non-small cell lung cancer (NSCLC). Professional societies recommend routine surveillance with CT to optimise the detection of potential recurrence and SPLC at a localised stage. However, no definitive evidence demonstrates the effect of imaging surveillance on survival in patients with NSCLC. To close these research gaps, the Advancing Precision Lung Cancer Surveillance and Outcomes in Diverse Populations (PLuS2) study will leverage real-world electronic health records (EHRs) data to evaluate surveillance outcomes among patients with and without guideline-adherent surveillance. The overarching goal of the PLuS2 study is to assess the long-term effectiveness of surveillance strategies in real-world settings.
PLuS2 is an observational study designed to assemble a cohort of patients with incident pathologically confirmed stage I/II/IIIA NSCLC who have completed curative-intent therapy. Patients undergoing imaging surveillance will be followed from 2012 to 2026 by linking EHRs with tumour registry data in the OneFlorida+ Clinical Research Consortium. Data will be consolidated into a unified repository to achieve three primary aims: (1) Examine the utilisation and determinants of CT imaging surveillance by race/ethnicity and socioeconomic status, (2) Compare clinical endpoints, including recurrence, SPLCs and survival of patients who undergo semiannual versus annual CT imaging and (3) Use the observational data in conjunction with validated microsimulation models to simulate imaging surveillance outcomes within the US population. To our knowledge, this study represents the first attempt to integrate real-world data and microsimulation models to assess the long-term impact and effectiveness of imaging surveillance strategies.
This study involves human participants and was approved by the University of Florida Institutional Review Board (IRB), University of Florida IRB 01, under approval number IRB202300782. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations encompass ensuring the confidentiality of patient information. All disseminated data will be de-identified and summarised.
To identify the barriers and facilitators in the implementation of fertility preservation (FP) shared decision-making (SDM) in oncology care.
Qualitative descriptive study.
Qualitative interviews with 16 female patients with cancer and seven healthcare providers were conducted between July 2022 and April 2024. Data were analyzed using directed content analysis, guided by the implementation science framework.
We identified 22 categories comprising 38 codes as barriers to SDM implementation and 17 categories comprising 26 codes as facilitators. Findings revealed that, at the innovation level, accessibility, feasibility, interdisciplinary collaboration, and quality improvement efforts were decisive in the implementation of FP SDM. At the individual level, healthcare providers' awareness and attitudes towards FP and SDM, as well as patients' knowledge, attitudes, and capabilities in FP SDM, were crucial factors in the implementation of FP SDM. In social, economic, and organizational contexts, support from significant others, social awareness about FP, multidisciplinary care, financial assistance, and educational resources were determinants in implementing FP SDM.
Implementing FP SDM among female patients with cancer necessitates a strategic approach that considers barriers and facilitators. Educating and promoting FP SDM among the public and healthcare providers, combined with incentivizing policies, can enhance individual knowledge and awareness while achieving systemic improvements, facilitating its successful implementation.
This study provides insights into barriers and facilitators and proposes strategic approaches to enhancing FP SDM implementation, contributing to improved quality of life for cancer survivors and advancements in clinical practice.
To canvas the contemporary contextual forces within the Australian residential aged care sector and argue for new research and innovation. There is a pressing need to provide systematised, high-quality and person-centred care to our ageing populations, especially for those who rely on residential care. This paper advances a warrant for establishing a new systematic framework for assessment and management that serves as a foundation for effective person-centred care delivery.
Position paper.
This paper promulgates the current dialogue among key stakeholders of quality residential aged care in Australia, including clinicians, regulatory agencies, researchers and consumers. A desktop review gathered relevant literature spanning research, standards and guidelines regarding current and future challenges in aged care in Australia.
This position paper explores the issues of improving the quality and safety of residential aged care in Australia, including the lingering impact of COVID-19 and incoming reforms. It calls for nurse-led research and innovation to deliver tools to address these challenges.
The paper proposes an appropriate holistic, evidence-based nursing framework to optimise the quality and safety of residential aged care in Australia.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.
A qualitative descriptive study.
The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.
The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.
Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.
The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.
This study was reported in accordance with the COREQ checklist.
No patient or public contribution.
by Jun Sang Yoo, Jae Hyun Choi, Jae Young Park, Jeong Yun Song, Jun Young Chang, Dong-Wha Kang, Sun U. Kwon, Hang Jin Jo, Bum Joon Kim
BackgroundLipohyalinotic degeneration (LD) and branch atheromatous disease (BAD) can contribute to subcortical infarctions in the lenticulostriate artery (LSA) territory. This study aimed to identify the association between the proximal and distal middle cerebral artery (MCA) diameter ratio and the two different pathomechanisms of LSA infarction.
MethodsPatients with acute LSA infarctions categorized as small vessel occlusive disease were included. Demographic and clinical data, along with MCA geometrical variables, were collected. LD and BAD were differentiated based on the length of the infarction diameter and number of axial slices. The proximal/distal M1 diameter ratio was calculated. MCA geometrics between LD and BAD were compared. Independent factors associated with LD were investigated. Computational fluid dynamics (CFD) analysis was used to evaluate hemodynamic parameters.
ResultsA total of 117 patients were included, of whom 64 (54.7%) and 53 (45.3%) were classified as BAD and LD, respectively. LD was associated with hypertension and favorable prognosis. MCA geometric variables revealed that LD had a higher proximal/distal M1 diameter ratio, indicating a potential distinguishing factor. Multivariate analysis confirmed the independent association between LD and the proximal/distal M1 diameter ratio. The proximal/distal M1 diameter ratio also showed a positive correlation with the number of ipsilesional lacunes. CFD analysis showed that the LD model had faster, greater blood influx into LSAs and higher wall shear stress and pressure gradient compared with the BAD model.
ConclusionsThis study suggests MCA geometry, particularly the proximal/distal M1 diameter ratio, may serve as an independent factor for identifying LD.
To systematically synthesise nurses' perspectives on dignified death, providing a culturally informed and comprehensive understanding.
Meta-ethnography.
This study was conducted using Noblit and Hare's approach, which included reciprocal translation, refutational synthesis, and line-of-argument synthesis. Methodological rigour and credibility were evaluated using the Critical Appraisal Skills Program (CASP) checklist. The review included peer-reviewed qualitative studies published in English or Korean that focused on nurses' or nursing students' views on dignified death in end-of-life care.
A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and the Web of Science in August 2023, with an updated search in August 2024. Seventeen qualitative studies published between 2010 and 2024 met the inclusion criteria.
Four interconnected themes emerged: A death that embraces humanity, a death that preserves personal identity, a death that facilitates connection and reconciliation, and a death that affirms acceptance and spiritual serenity. These themes, including eight sub-themes, highlight cultural influences shaping nurses' approaches to dignified death.
The findings emphasise the influence of cultural context in shaping end-of-life care and support the development of culturally sensitive nursing education and guidelines to enhance care quality.
This research provides culturally grounded strategies to improve end-of-life care and strengthen nurses' competencies in delivering holistic support.
This study highlights cultural variations in nurses' approaches to balancing autonomy, family expectations, and spiritual needs, offering practical insights for holistic, patient-centred, and culturally sensitive care.
This review complies with the Equator and improving reporting of meta-ethnography (eMERGe) guidelines.
No patient or public contribution.
To assess telehealth stoma care interventions' impact on stoma adjustment, self-efficacy, anxiety and ostomates' quality of life.
Systematic review and meta-analysis of randomised controlled trials.
Studies published until April 2025 were searched across eight databases—MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, CINAHL, ClinicalTrials.gov and PQDT Global. Randomised controlled trials with individuals aged 18 and older who received telehealth stoma care interventions were included. A meta-analysis was performed using a random-effects model, with the GRADE approach employed to evaluate evidence certainty. This systematic review and meta-analysis complied with the PRISMA guideline and PRISMA 2020 checklist.
Eight studies were included in the meta-analysis. Telehealth interventions significantly improved stoma adjustment (SMD: 1.44, 95% CI: 0.22–2.66) and self-efficacy (MD: 10.23, 95% CI: 3.01–17.44), but did not significantly affect anxiety, while results regarding the effect on quality of life were inconsistent. Three studies showed a high risk of bias, while five showed some concerns. Evidence certainty was moderate for stoma adjustment, self-efficacy and stoma quality of life, and low for anxiety.
Telehealth can enhance stoma adjustment and self-efficacy, thereby improving management. However, the limited and inconsistent findings on anxiety and quality of life outcomes underscore the need for further high-quality research.
This review demonstrates that telehealth stoma care can be vital in improving stoma adjustment and self-efficacy in ostomates.
The PRISMA 2020 checklist.
Not Applicable.
This study aims to assess the impact of a protocol-based video education program on nurses' knowledge of medical device-related pressure injuries prevention, self-efficacy in pressure injury care, and satisfaction with the educational program. This study employed a non-equivalent control group pre-test–post-test design. This study was conducted from September 6, 2024, to September 19, 2024. A total of 62 nurses from the integrated nursing care service wards of a general hospital were recruited and divided into 31 experimental and 31 control groups. The experimental group received a one-week protocol-based video education program, whereas the control group received booklet-based education. Both the experimental and control groups demonstrated statistically significant improvements in medical device-related pressure injuries prevention knowledge after the intervention. The interaction effect between group and time was also significant. Self-efficacy scores increased significantly in both the experimental and control groups, although the interaction effect was not statistically significant. Educational satisfaction showed no significant difference between the two groups. The protocol-based video education program effectively improved nurses' knowledge of medical device-related pressure injuries prevention and demonstrated its potential as a repeatable and accessible learning tool. Future research should focus on longer intervention periods, diverse hospital settings, and the inclusion of clinical outcome data such as actual pressure injury incidence to further validate the program's effectiveness.
ClinicalTrials.gov identifier: KCT0010218.
Valid and reliable measurement of early childhood development (ECD) is critical for monitoring and evaluating ECD-related policies and programmes. Although ECD tools developed in high-income countries may be applicable to low- and middle-income countries (LMICs), directly applying them in LMICs can be problematic without psychometric evidence for new cultures and contexts. Our objective was to systematically appraise available evidence on the psychometric properties of tools used to measure ECD in LMIC.
A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.
MEDLINE, Embase, PubMed, PsycInfo, SciELO and BVS were searched from inception to February 2025.
We included studies that examined the reliability, validity, and measurement invariance of tools assessing ECD in children 0–6 years of age living in LMICs.
Each study was independently screened by two researchers and data extracted by one randomly assigned researcher. Risk of bias was assessed using a checklist developed by the study team assessing bias due to training/administration, selective reporting and missing data. Results were synthesised narratively by country, location, age group at assessment and developmental domain.
A total of 160 articles covering 117 tools met inclusion criteria. Most reported psychometric properties were internal consistency reliability (n=117, 64%), concurrent validity (n=81, 45%), convergent validity (n=74, 41%), test–retest reliability (n=73, 40%) and structural validity (n=72, 40%). Measurement invariance was least commonly reported (n=16, 9%). Most articles came from Brazil, China, India and South Africa. Most psychometric evidence was from urban (n=92, 51%) or urban–rural (n=41, 23%) contexts. Study samples focused on children aged 6–17.9 or 48–59.9 months. The most assessed developmental domains were language (n=111, 61%), motor (n=104, 57%) and cognitive (n=82, 45%). Bias due to missing data was most common.
Psychometric evidence is fragmented, limited and heterogeneous. More rigorous psychometric analyses, especially on measurement invariance, are needed to establish the quality and accuracy of ECD tools for use in LMICs.
CRD42022372305.
Social, emotional and behavioural (SEB) problems are among the most common chronic disabilities affecting children growing up in poverty. They also have implications for children’s school success as they affect essential social-emotional learning skills such as the ability to comply with rules, regulate emotions and get along with others. These skills are first learnt before kindergarten, in the context of a supportive, responsive and consistent parenting relationship. To date, school-based interventions to improve young children’s SEB competence and learning have primarily targeted students and teachers. Yet, parents are central partners in promoting these skills. This study seeks to improve children’s SEB competence and kindergarten readiness by strengthening parenting skills and parent engagement in early childhood education during prekindergarten (PreK). This hybrid type 2 effectiveness-implementation trial will rigorously evaluate the effects of an evidence-based parenting programme, the Chicago Parent Program (CPP), in PreK on children’s SEB competence, kindergarten readiness, chronic school absenteeism and grade retention in urban and rural schools serving students from low-income families in Maryland.
Using a cluster randomised design (n=30 schools, 840 parents; >90% low-income), we will examine the effects of CPP offered universally to PreK parents on parenting skills and parent engagement in children’s education; children’s SEB competence and kindergarten readiness; and chronic absence and grade retention in kindergarten. Schools will be stratified by rural versus urban district, then randomised to CPP or usual practice conditions. Data will be analysed using mixed effects regression models. Using the reach, effectiveness-adoption, implementation, maintenance (RE-AIM) framework and a mixed methods approach, we will assess CPP reach, efficacy, acceptability, adoption, implementation, cost-effectiveness and sustainability when offered in different formats (virtual vs in-person CPP groups) and contexts (urban vs rural). Schools will participate for 2 years with experimental schools offering CPP twice, once in virtual group format and once in an in-person group format (format randomised and counterbalanced). Data will be collected using multiple informants (parents, teachers, district administrative data) and methods (quantitative and qualitative data). Knowledge gained will inform schools in under-resourced urban and rural communities on sustainable, cost-effective strategies for strengthening parent-school connections and improving young children’s SEB competence and academic success.
Ethics approval has been granted by Johns Hopkins University School of Medicine (protocol number 00428221) and the Baltimore City Public Schools (protocol number 2024-013). At the conclusion of the study, results will be summarised and shared with parents, teachers, school principals and district leaders for their perspectives on the outcomes. Final reports will be published in scientific journals and presented at professional meetings.
The multifaceted impact of dementia means that people living with dementia require multidisciplinary care across different services and settings; however, these care transitions pose a risk of fragmented care. Models that improve integration and coordination of care in the community are needed.
This randomised control trial will test the effectiveness and cost effectiveness of a dementia nurse-led intervention to: (1) increase days lived in the community at 12-month follow-up (primary outcome) among people living with dementia and (2) improve quality of life for people living with dementia and their carers, compared with usual care. Participants are recruited from several sources including private and public geriatric medicine clinics, carer support groups and self-referral. People living with dementia and their carers are randomised as a dyad to (1) usual care or (2) dementia nurse-led care-coordination. The dementia nurse will provide care coordination and direct support through a tailored, integrated and patient-centred approach. The needs of people living with dementia will be identified and addressed, with a focus on improving the management of comorbidities, risk reduction and symptoms. Carers will also receive support. The model for people living with dementia will focus on days lived in their community as the outcome variable. Differences between groups in quality of life at 12-month follow-up will be assessed using linear mixed effects regression. Analysis will follow the intention to treat principles. People living with dementia and carers’ data will be analysed separately and collectively for the economic study.
The trial has been approved by the Hunter New England Research Ethics Committee (2023/ETH01221) and the University of Newcastle Ethics Committee (R-2024–0021). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team aims to further implement the intervention as usual care within the participating services and beyond.
The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12624000235505. Registration date: 11 March 2024.
This study aimed to explore communication challenges between parents and healthcare providers in paediatric emergency departments (EDs) and to define the roles and functions of an artificial intelligence (AI)-assisted communication agent that could bridge existing gaps.
A qualitative study using in-depth interviews and affinity diagram methodology to analyse interview data.
A tertiary paediatric ED in South Korea.
11 parents of paediatric patients and 11 ED staff members (physicians, nurses and security personnel).
The study examined parent–provider communication difficulties, emotional responses and situational factors contributing to miscommunication and increased workload for ED staff.
The study identified key emotional factors—fear, anger and sadness—that negatively affect communication between parents and ED staff. Parents experienced frustration due to uncertainty, insufficient information and difficulty navigating the ED process. ED staff faced challenges in managing anxious or demanding parents, resulting in increased workload and communication breakdowns.
An AI-assisted communication agent could help mitigate these challenges by providing timely information, managing non-medical inquiries and supporting both parents and ED staff at critical stages of the ED visit. Implementing such technology has the potential to improve communication and enhance overall patient care in paediatric emergency settings.
To examine the role and impact of carer involvement in rehabilitation for community-dwelling individuals with dementia, focusing on cognitive stimulation therapy, cognitive rehabilitation, cognitive training, cognitive behavioural therapy, and exercise.
A systematic review and synthesis without meta-analysis.
Five electronic databases, reference lists, and citations were searched (2017–2024), targeting primary research that reported results concerning one or more of those five focused rehabilitation interventions for people with dementia and their carers.
Results were synthesised using narrative approaches. The Cochrane Risk of Bias Tool and the Mixed Methods Appraisal Tool were used to appraise the quality of included studies.
Forty-one studies (12 main trials, 22 pilot studies, and 7 sub-studies) were included. While the patterns between carer involvement level and types of rehabilitation were observed, their relationship to intervention effectiveness was unclear. High carer involvement in cognitive stimulation therapy and exercise was associated with improved cognition and quality of life for people with dementia and better health-related quality of life for carers. Pilot studies showed mixed but generally positive trends, with increased depressive symptoms in carers needing further investigation. Qualitative findings highlighted social interaction and improved caregiving knowledge as key enablers to positive experiences, whereas lack of motivation was the main barrier to rehabilitation engagement.
This review identified several patterns between the level of carer involvement and intervention types. However, the mechanism underlying different involvement levels and rehabilitation success remains unclear. More rigorous research is needed to determine the relationship between carer involvement and the effects of rehabilitation interventions on supporting the independence of people with dementia.
This review enhanced the understanding of carers' roles and impacts in supporting dementia rehabilitation and possible links to optimal health outcomes.
Synthesis Without Meta-analysis (SWiM) reporting guideline.
No patient/public contribution.
To determine the effectiveness of nurse-led/involved home-based interventions for older people with COPD and to explore the experiences of older people and nurses with the interventions.
A mixed-methods systematic review following the JBI methodology for mixed-methods systematic reviews.
The search included relevant and peer-reviewed studies published from January 2010 to December 2023 in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, JBI, EMCARE and ProQuest.
English-language reports of nurse-led/involved home-based interventions for people with COPD were included based on authors’ consensus. Three reviewers performed independent quality appraisal using JBI tools. A convergent segregated approach was used for data synthesis and integration.
Seven interventions were identified in two mixed-methods, two qualitative, two quasi-experimental studies, and one secondary analysis from a randomised control trial. The effectiveness of the interventions was measured with various outcomes and was effective to some extent, with reduced hospitalisation, hospitalisation days, hospitalisation cost and all-paid claims. However, the outcomes were not statistically significant, and the effectiveness was inconclusive. While patients appreciated support and resources, some perceived them as a double-edged sword.
Patients preferred more holistic interventions over extended periods. The inconclusive findings and limitations warrant further research with larger sample sizes and comparable measurement tools and outcomes.
This is the first mixed-methods systematic review on the effectiveness of home interventions for people with COPD with a clear definition of ‘nurse-led’. Nurses felt highly valued by patients and other health professionals; however, they reported a lack of support from management. The lack of interventions led by nurses challenges them to lead, deliver and evaluate what matters to people with COPD.
This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Not applicable.
To cross-culturally adapt a framework for person-centred leadership in residential care for older people in Sweden.
This study has an exploratory and descriptive design.
The translation procedure followed a cyclic process of translation into Swedish and back-translation into English by two independent bilingual linguists. An evaluation of conceptual and semantic equivalence and comprehensiveness between the original English version and the translated Swedish version was performed by an expert committee. The translated version of the framework was validated by leaders (n = 34) in residential care, who assessed its relevance through a web form. The adaptation of the framework followed recommended guidelines for cross-cultural adaptation.
The translation procedure resulted in two minor changes related to the wording in two descriptors. The results of the validation procedure showed that the framework is relevant for leaders in Swedish residential care for older people.
The cross-culturally adapted framework is useful and suitable for leaders in Swedish residential care for older people. The framework clarifies the leader's role and identifies leadership attributes and requirements for person-centred leadership in residential care, thereby providing support to leaders by framing person-centred leadership.
The framework can be used as a guide for leadership training and/or development initiatives in residential care. It can be further extended to nursing curriculums, leadership development programs, and organisational performance and development processes. It may also provide a foundation for policy and guidelines by establishing the activities required for leaders to promote person-centredness in the care of older people.
This study followed the STROBE checklist for cross-sectional studies.
There was no patient or public contribution.
Exploratory data analysis involves observing data in graphical formats before making any assumptions. If interesting relationships or patterns among variables are identified, hypotheses are developed for further testing. This study aimed to identify significant differences in the levels of exhaustion, resilience, sleep quality, and sleep hygiene according to the personal characteristics of middle-aged women transitioning into menopause or postmenopause through exploratory data analysis. A total of 200 women aged 44 to 55 years were recruited online in August 2023. Data were collected using valid instruments and analyzed through data visualization, pattern identification in the visualized data, and hypothesis establishment based on the visualized patterns. Hypotheses were tested through the independent-samples t test, analysis of variance, and the Kruskal-Wallis test. A total of 11 patterns and corresponding hypotheses were identified. According to the statistically supported pattern-based hypotheses, middle-aged women who were in their perimenopausal period perceived themselves as unhealthy, had professional occupations, and had the highest level of exhaustion and the lowest levels of resilience, sleep quality, and sleep hygiene. This study demonstrated that data visualization is an efficient way to explore relationships or patterns between data. Data visualization should be considered an informatics solution that can provide insight in the field of healthcare. by Jaeyoung Choi, Esther Park, Hyejeong Park, Danbee Kang, Jeong Hoon Yang, Hyunsoo Kim, Juhee Cho, Joongbum Cho
BackgroundHigh-flow nasal cannula (HFNC) therapy has gained popularity in the pediatric intensive care unit (PICU). However, the nationwide effect of HFNC on mechanical ventilation duration has not been studied.
MethodsWe retrospectively analyzed pediatric patients (28 days to 17 years old) admitted to tertiary ICUs for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. Pre-/post-HFNC periods were defined as the 12 months before and after the application of HFNC in any hospital, respectively, allowing a 6-month transition period. Mechanical ventilation duration and ventilator-free days during these two periods were compared using a multivariable regression model.
ResultsUsing data from 46 hospitals, 4,705 and 4,864 respective pre-/post-HFNC period patients were evaluated. During the post-HFNC period, 14.8% of patients were treated by HFNC, and 67.1% were treated using invasive mechanical ventilation. In adjusted analysis, mechanical ventilation duration was reduced by 0.99 days (confidence interval [CI]: -1.86, -0.12). The duration was significantly reduced by 17.81 days (CI: -35.46, -0.16) among patients whose ventilation duration was longer than 28 days. In subgroup analysis, mechanical ventilation duration was reduced by 1.49 days (CI: -2.78, -0.19) in the overall surgical group and 6.71 days (CI: -11.71, - 1.71) in the neurologic subgroup. Ventilator-free days were increased only in the overall surgical group, by 0.31 days (CI: 0.01, 0.61).
ConclusionsApplication of HFNC to PICU patients could reduce mechanical ventilation duration, especially in patients requiring prolonged mechanical ventilator support or in post-operative patients.
by Daeyun Seo, Seongsoo Lim, Beomkwan Namgoong, Heesung Uhm, Hyeajeong Hong, Nanju Lee, Isong Kim, Seunghun Heo, Ji Hwan Kang, Cheyoun Kim, Hayoung Shin, Jiwoong Her, Min Su Kim
ObjectiveLiver compression (LC) has been proposed to predict fluid responsiveness in human pediatric patients. Because the evaluation of fluid responsiveness through LC depends on the mechanism of increased intra-abdominal pressure (IAP), understanding the impact of LC on IAP, cardiac output (CO), and respiratory parameters is essential. Thus, this study aimed to investigate the effects of LC on these parameters.
MethodsThe present study used six healthy beagles. All dogs were anesthetized with isoflurane and allowed to breathe spontaneously in dorsal recumbency. After instrumentation, LC was performed at four different pressures in a sequential, non-randomized manner: (1) 10 mmHg, approximately half of the minimum value within the range; (2) 22 mmHg, a commonly used pressure within the range; (3) 44 mmHg, twice the pressure of the minimum value within the range; and (4) 60 mmHg, twice the pressure of the maximum value within the range. At each pressure, CO via transthoracic echocardiography, IAP, and cardiorespiratory parameters were measured before, during, and after LC.
ResultsOverall, our results showed that the IAP was significantly increased at all pressures during LC (P Conclusions
This is the first study to evaluate the effects of LC on IAP, CO, and respiratory parameters in healthy, anesthetized, and spontaneously breathing dogs. Our findings indicate that applying LC with a commonly used pressure may have a low risk of inducing intra-abdominal hypertension and related complications. Further studies are required to explore the use of LC in various clinical settings.
To develop deep learning models to predict nursing need proxies among hospitalised patients and compare their predictive efficacy to that of a traditional regression model.
This methodological study employed a cross-sectional secondary data analysis.
This study used de-identified electronic health records data from 20,855 adult patients aged 20 years or older, admitted to the general wards at a tertiary hospital. The models utilised patient information covering the preceding 2 days, comprising vital signs, biomarkers and demographic data. To create nursing need proxies, we identified the six highest-workload nursing tasks. We structured the collected data sequentially to facilitate processing via recurrent neural network (RNN) and long short-term memory (LSTM) algorithms. The STROBE checklist for cross-sectional studies was used for reporting.
Both the RNN and LSTM predicted nursing need proxies more effectively than the traditional regression model. However, upon testing the models using a sample case dataset, we observed a notable reduction in prediction accuracy during periods marked by rapid change.
The RNN and LSTM, which enhanced predictive performance for nursing needs, were developed using iterative learning processes. The RNN and LSTM demonstrated predictive capabilities superior to the traditional multiple regression model for nursing need proxies.
Applying these predictive models in clinical settings where medical care complexity and diversity are increasing could substantially mitigate the uncertainties inherent in decision-making processes.
We used de-identified electronic health record data of 20,855 adult patients about vital signs, biomarkers and nursing activities.
The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross-sectional studies.
Despite widespread adoption of deep learning algorithms in various industries, their application in nursing administration for workload distribution and staffing adequacy remains limited. This study amalgamated deep learning technology to develop a predictive model to proactively forecast nursing need proxies. Our study demonstrates that both the RNN and LSTM models outperform a traditional regression model in predicting nursing need proxies. The proactive application of deep learning methods for nursing need prediction could help facilitate timely detection of changes in patient nursing demands, enabling the effective and safe nursing services.
FreshRSS 