Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed.Identification and speciation of the isolates was conducted by the biochemical tests.Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document.Results: Ninety Candida isolates were isolated from the different clinical samples: urine(43.3%), tracheal aspirate(31.1%), urinary catheter(12.2%), endotracheal tube(7.8%),abdominal drains(3.3%), sputum(2.2%). The incidence of candidiasis caused by nonalbicans Candida(NAC) species(63.3%) was higher than Candida albicans(36.7%).The various NAC species were isolated as: Candida tropicalis(41.1%), Candida glabrata(10%), Candida parapsilosis(6.7%), Candida krusei(3.3%) and Candida kefyr(2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively.Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit

BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)are toxic to the central nervous system.AIM To examine the relationship between the incidence of non-hepatic hyperammonemia(NHH)and the prognosis of patients who were admitted to the intensive care unit(ICU).METHODS This is a prospective,observational and single-center study.A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled.Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored.In addition,factors influencing the prognosis of NHH patients were analyzed.RESULTS A total of 204 patients who met the inclusion criteria were enrolled in this study,including 155 NHH patients and 44 severe-NHH patients.The incidence of NHH and severe-NHH was 75.98% and 21.57%,respectively.Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH.Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients.In addition,the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSION High blood ammonia level is frequent among NHH patients admitted to the ICU,which is related to the clinical characteristics of patients.Furthermore,the level of blood ammonia may be helpful for prognosis prediction.

Level of Stress at Nurses Working in Emergency Clinic and Central Intensive Care: University Clinical Centre of Kosovo

Background: Emergency Clinic (EC) and Central Intensive Care (CIC) are high-stress environments that directly affect the health status of nurses. Methods: The aim of this study was to assess the level of stress at nurses working in the Emergency Clinic and nurses working in the Central Intensive Care. The study included 90 nurses, 45 nurses working in Emergency Clinic and 45 nurses working in Central Intensive Care. The study applied the Emergency Nurse Stress Questionnaire as an instrument to gather the data. This questionnaire was adopted from the Operational Police Stress Questionnaire in order to serve for the function and aim of the present study. Results: Nurses’ cohort-age ranged from 20 to 62 years. The largest proportion of respondents 40 (44.4%) was in the 20 - 30 age group, 58 (64.4%) were married, 60 (66.6%) hold bachelor degree and (33.3%) were with secondary school educational level. In terms of work-related fatigue, significant difference was found in working hours, participants reported that there was a significant difference in fatigue between 12 hours shift nurses (61 ± 10.5) compared to 8 hours nurses (41 ± 23.6) with P < 0.001. Results indicated that a vast majority of participants reported moderate to high levels of stress (81% of participants). There was no significant difference in the level of stress between the two groups of participants. There were also no significant differences compared to their demographic characteristics. Conclusion: These findings emphasize the role of using and assuring adequate strategies for ensuring quality management and finding ways of facilitating the increase in the number of nursing staff in these two departments because workplace overload and fatigue are potential factors that increase nurses’ stress levels.

Prediction of hospital mortality in intensive care unit patients from clinical and laboratory data: A machine learning approach

BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Advancing critical care recovery:The pivotal role of machine learning in early detection of intensive care unit-acquired weakness

This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.

Incidence and Risk Factors of Sub-syndromal Delirium in Patients after Cardiac Surgery

[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.

Opening the doors of the intensive care unit to cancer patients: A current perspective

The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit(ICU) admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied, mainly the number and severity of organic failures, allow us to understand the determinants of the prognosis inside the ICU. However, the availability of intensive care resources is dissimilar by country, and these differences are known to alter the indications for admission to critical care setting. Three to five days of ICU management is warranted before making a final decision(ICU trial) to consider keep down intensive management of critically ill cancer patients. Nowadays, taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified.

Effect of Emergency Care Process Optimization on Rescue Efficiency of Emergency Patients

Objective: This paper discusses the impact of emergency care process optimization on the rescue efficiency of emergency patients. Methods: 102 cases of emergency patients received from January 2017 to February 2018 in our hospital were selected as research objects. According to the order of treatment, they were divided into control group and observation group. The routine nursing process was given to the control group, and the observation group was given an optimized nursing process to compare the rescue efficiency and nursing satisfaction of the two groups. Results: According to the results of the study, the nursing satisfaction of the two groups was compared. Among them, the total satisfaction of the observation group was 49, accounting for 96.07%;the control group was very satisfied with the nursing work, accounting for 82.35%. There was a significant difference in nursing satisfaction between the two groups, which was statistically significant (P<0.05). Comparing the rescue efficiency of the two groups of patients, the observation time, rescue time, infusion time and disease remission time were significantly lower than the control group, the rescue success rate was 94.11%, and the rescue success rate of the control group was 78.43%. The results have statistical significance (P < 0.05). Conclusion: The optimization of emergency nursing process can greatly improve the rescue efficiency of emergency patients, reduce the disability rate and mortality, improve the quality of nursing, and enhance the satisfaction of nursing. It is worthy of clinical promotion practice.

Study on Related Factors of Acute Kidney Injury in Patients under Intensive Care

Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study

BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant:A single-centre retrospective cohort study

BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.

Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

Nursing Diagnoses of the Domain Safety/Protection and Socioeconomic and Clinical Aspects of Critical Patients

Objective: The objective is to correlate the nursing diagnoses of the domain Safety/Protection of NANDA-I in critically ill patients with sociodemographic and clinical data. Method: A cross-sectional study with 86 individuals was conducted, from October 2013 to May 2014 in the Intensive Care Unit of a university hospital in northeastern Brazil, through a formal interview and physical examination. Results: It was possible to identify a total of 20 significant statistical associations, and 15 were clinically justified by the literature, namely: risk for aspiration and reason for admission;impaired dentition and age;risk for peripheral neurovascular dysfunction and sex and comorbidity;skin integrity and comorbidity;risk for impaired skin integrity and gender and reason for admission;impaired tissue integrity and gender and reason for admission;risk for perioperative positioning injury and reason for admission;risk for thermal injury and age and comorbidity;delayed surgical recovery and reason for admission;risk for poisoning and years of schooling;and risk for imbalanced body temperature and age. Conclusions: By understanding the relationship between customers’ answers and the sociodemographic and clinical profile, positive health outcomes can be achieved in particular in the prevention of risks facing vulnerability characteristics, providing greater safety and protection for the critical customer.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Work experience of special workers returning to work after the public health emergency:taking ICU nurses who have been infected with COVID-19 as example

Objective:The occurrence of some public health events inevitably endangers medical personnel,and medical personnel,as a special group,have to resume work on time to treat patients.This coronavirus disease-2019(COVID-19)infection is a good example,and what intensive care unit(ICU)nurses experience as the primary caregivers of critically ill patients after COVID-19 infection is our focus.To explore the work experience of ICU nurses after recovery from COVID-19,and to provide a theoretical basis for the intervention to improve the physical and mental health level and work experience of special workers in public health emergencies.Methods:We conducted an explorative descriptive study using an inductive thematic analysis.Using the maximum differential sampling method,a semi-structured interview was conducted among 13 ICU nurses suffered from COVID-19 in a tertiary grade A hospital in Qingdao,Shandong Province.This study carried on the theme analysis according to the inductive content analysis method and used MAXQDA 2020 Analytics Pro(VERBI Software GmbH,Berlin,Germany)to manage and summarize the interview data.Results:After being infected by the virus,SARS-Coronavirus-2(SARS-CoV-2),the pathogen of COVID-19,the work experience of ICU nurses was extracted from the following 5 themes:(1)Stress and challenge caused by the change of work focus;(2)downsizing,overtime,taking up work with illness,and physical discomfort;(3)dedication and family debt;(4)unknown fear and helplessness;and(5)professional responsibility and sense of benefit.Conclusions:Under the pressure of COVID-19,ICU nurses face multiple pressures and challenges,and their emotions are complex.We suggest that nursing managers should take corresponding measures to alleviate nurses'physical and psychological pressure and improve their work experience.