OBJECTIVE: To construct a longitudinal trajectory model of arterial oxygen tension (PaO₂) within 24 hours after cardiac arrest (CA). METHODS: A retrospective cohort study was conducted. CA patients admitted to the ICU from 2014 to 2015 were selected from the eICU Collaborative Research Database (eICU-CRD). Data about patients' demographic characteristics, history of comorbidities, laboratory test indicators within 24 hours of intensive care unit (ICU) admission [including all PaO₂ data and arterial carbon dioxide tension (PaCO₂)], vasopressor use, and clinical outcomes were extracted from the database. The primary outcome variable was all-cause in-hospital mortality. Group-based trajectory model (GBTM) were built based on the changes in PaO₂ within 24 hours of ICU admission, and patients were grouped according to their initial static PaO₂ values upon ICU admission. Multivariable adjusted Poisson regression analysis was used to compare the in-hospital mortality risk among patients in different PaO₂ dynamic trajectory groups. Sensitivity analyses were performed using multivariable logistic regression and multivariable adjusted Poisson regression without imputation of missing values. RESULTS: A total of 3 866 CA patients were included. Three GBTM trajectory groups were identified based on PaO₂ changes within 24 hours of ICU admission: Group-1 (low level first increased then decreased, 148 cases), Group-2 (sustained low level, 3 040 cases), and Group-3 (first high level then decreased, 678 cases). Significant differences were found among the three groups in age, body weight, maximum serum potassium, maximum PaCO₂, minimum hemoglobin (Hb), vasopressor use, total hospitalization time, ICU stay, and hospital mortality. After incorporating variables with significant differences into the multivariable adjusted Poisson regression model, results showed that compared to Group-2 patients, patients in Group-1 and Group-3 had an increased risk of all-cause in-hospital mortality [Group-1 adjusted relative risk (aRR) = 1.20, 95% confidence interval (95%CI) was 1.02-1.41; Group-3 aRR = 1.11, 95%CI was 1.01-1.24]. Based on initial static PaO₂ values at ICU admission, patients were divided into four groups: PaO₂ < 100 mmHg (1 mmHg = 0.133 kPa; 1 217 cases), PaO₂ 100-200 mmHg (569 cases), PaO₂ 201-300 mmHg (547 cases), and PaO₂ > 300 mmHg (1 082 cases). Multivariable adjusted Poisson regression analysis indicated a significant upward trend in aRR for the latter three groups compared to the PaO₂ < 100 mmHg group. Sensitivity analyses revealed that compared to Group-2, patients in Group-1 and Group-3 had a significantly increased risk of all-cause in-hospital mortality (both P < 0.05). CONCLUSIONS Within 24 hours after return of spontaneous circulation in CA patients, PaO₂ exhibits different dynamic trajectories, and patients with hyperoxia have an increased risk of in-hospital mortality.
Humans ; Retrospective Studies ; Hospital Mortality ; Heart Arrest/blood* ; Prognosis ; Oxygen/blood* ; Intensive Care Units ; Cardiopulmonary Resuscitation ; Male ; Female ; Middle Aged

Objective To investigate the predictive value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating kidneys from donation after brain death (DBD) for the occurrence of delayed graft function (DGF) in recipients. Methods The clinical data of 134 DBD donors and 202 corresponding kidneys and recipients were retrospective analyzed. The recipients were divided into DGF group (n=39) and non-DGF group (n=163) according to the renal function after kidney transplantation. Conventional ultrasound, CEUS parameters, and clinical data were compared between the two groups. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for predicting DGF using CEUS parameters, clinical parameters, and their combination, based on the highest Youden index. The predictive ability of different parameters for DGF was evaluated. Results There were statistically significant differences in cortical peak intensity (PIc), medullary peak intensity (PIm), donor albumin (ALB), serum creatinine (Scr) after admission, and the Na⁺ concentration of recipients between the two groups (all P<0.05). The area under the curve (AUC) for predicting DGF using the combination of CEUS parameters PIc and PIm was 0.711, with an optimal cut-off value of 0.193 and a Youden index of 0.382. The AUC for predicting DGF using the combination of CEUS parameters PIc, PIm and clinical parameters was 0.808, with an optimal cut-off value of 0.191 and a Youden index of 0.517. The sensitivity and specificity were 0.769 and 0.613 for the former, and 0.769 and 0.748 for the latter, respectively. The AUC for predicting DGF using CEUS parameters PIc and PIm combined with clinical parameters was significantly higher than that using CEUS parameters PIc and PIm (P<0.05). Conclusions The CEUS quantitative parameters PIc and PIm have good predictive value in assessing kidneys from DBD donors for DGF in recipients, and the diagnostic efficacy is better when combined with clinical parameters.

Objective:To systematically review the prediction models for extubation failure in critically ill patients undergoing mechanical ventilation, providing a reference for healthcare professionals in selecting appropriate models to identify high-risk populations.Methods:Literature on the construction of prediction models for extubation failure risk in critically ill patients undergoing mechanical ventilation was retrieved from China National Knowledge Infrastructure, Wanfang Database, VIP, SinoMed, PubMed, Web of Science, Embase, and Cochrane Library. The search was limited from database inception to February 2024. Two researchers independently screened the literature and extracted data, using bias risk assessment tools to evaluate the bias risk and applicability of the prediction models.Results:A total of nine studies were included, with the most common predictive factors being mechanical ventilation duration, Glasgow Coma Scale score, cough reflex strength, age, and 24-hour input/output volume. The area under the receiver operating characteristic curve for the models ranged from 0.689 to 0.926, indicating good predictive performance. However, the risk of bias was high, mainly due to small sample sizes, the selection of predictive factors based on univariate analysis, and lack of proper internal validation.Conclusions:Existing prediction models show good predictive performance, but they carry high bias risk. Future studies should improve research design, adhere to model development and reporting guidelines, and develop well-performing, user-friendly prediction models to more accurately identify high-risk populations for extubation failure.

Objective:To systematically review the prediction models for extubation failure in critically ill patients undergoing mechanical ventilation, providing a reference for healthcare professionals in selecting appropriate models to identify high-risk populations.Methods:Literature on the construction of prediction models for extubation failure risk in critically ill patients undergoing mechanical ventilation was retrieved from China National Knowledge Infrastructure, Wanfang Database, VIP, SinoMed, PubMed, Web of Science, Embase, and Cochrane Library. The search was limited from database inception to February 2024. Two researchers independently screened the literature and extracted data, using bias risk assessment tools to evaluate the bias risk and applicability of the prediction models.Results:A total of nine studies were included, with the most common predictive factors being mechanical ventilation duration, Glasgow Coma Scale score, cough reflex strength, age, and 24-hour input/output volume. The area under the receiver operating characteristic curve for the models ranged from 0.689 to 0.926, indicating good predictive performance. However, the risk of bias was high, mainly due to small sample sizes, the selection of predictive factors based on univariate analysis, and lack of proper internal validation.Conclusions:Existing prediction models show good predictive performance, but they carry high bias risk. Future studies should improve research design, adhere to model development and reporting guidelines, and develop well-performing, user-friendly prediction models to more accurately identify high-risk populations for extubation failure.

With reference to the teaching reform of standardized training cases based on organ systems, a teaching case writing team has been established, integrating the teaching experts in basic medicine, clinical medicine, humanities medicine, and other fields. Through collective lesson preparation and discussion, non-fictional comprehensive scenario writing techniques have been used based on organ systems and oriented by competency development, and the teaching cases for postgraduate students were written on the basis of real cases, which lays a solid foundation for the hierarchical and progressive cultivation and improvement of the quality of competency cultivation for postgraduate students through case teaching based on organ systems.

Objective To develop a humanistic care nursing plan for conscious patients in ICU based on narrative nursing theory and to provide a theoretical basis and practical guidance for clinical humanistic care.Methods Literature reviews and qualitative interviews were applied to examine the current situation and needs of humanistic care for critically ill patients at home and abroad.Based on the narrative nursing theory proposed by Jiang and Li,the first draft of humanistic care plan for ICU conscious patients was created based on care procedures by brainstorming among group members.The plan was finalised after two rounds of consultations with nursing specialists using Delphi's method.Results Effective return rate was 100%from both rounds of questionnaires.The expert authority coefficient was 0.917,the Kendall's coefficient of concordance W for the importance of items in the two rounds of inquiries were 0.331 and 0.421,respectively,and the Kendall's coefficient of concordance W for feasibility were 0.328 and 0.349,respectively(P<0.001).The mean scores for the importance of item content were 3.43 to 5.00,and 3.73 to 5.00,with coefficients of variation from 0 to 0.28 and 0 to 0.24,respectively.The mean scores for feasibility were 3.30 to 5.00,and 3.60 to 5.00,with coefficients of variation from 0 to 0.21 and 0 to 0.23,respectively.The finalised humanistic care plan included three first-level items:pre-implementation assessment and preparation,implementation process,and effectiveness evaluation,with a total of 12 secondary items and 31 tertiary items.Conclusion After statistical analysis,it is found that based on narrative nursing theory,the humanistic care nursing plan for conscious patients in ICU developed in this study,is reliable,highly operational,feasible,scientifically sound and practical.

Objective:To explore the effects of aerobic exercise therapy and anaerobic exercise therapy on improving depressive symptoms, sleep quality, and cognitive function in patients with mild and moderate depression.Methods:A prospective study was conducted to collect clinical data from 148 inpatients with mild to moderate depression treated at the Second Affiliated Hospital of Xinxiang Medical College from February 2019 to May 2023 including 74 males and 74 females aged 18 to 60 (40.08±11.03) years. They were randomly assigned the conventional treatment group (group A, 49 cases), the conventional treatment+moderate-intensity aerobic exercise therapy intervention group (group B, 51 cases), and the conventional treatment+moderate intensity anaerobic exercise therapy intervention group (group C, 48 cases). Patients in each group were treated the corresponding intervention for 4 weeks. The 24-item Hamilton Depression Scale (HAMD 24), Pittsburgh Sleep Quality Index (PSQI), and the Montreal Cognitive Assessment (MOCA) were used to score depressive symptoms, sleep quality, and cognitive function, respectively, before and after intervention. Paired sample t-tests were used to compare the changes in scores before and after the intervention. One-way ANOVA was used to analyze and compare the score differences on each scale among the groups. Results:After the intervention, HAMD 24 and PSQI scores in all groups decreased compared with those before the intervention (Group A: HAMD 24 (15.08±4.15) vs (29.33±4.75), PSQI (12.76±2.52) vs (14.88±3.64); Group B: HAMD 24 (12.82±3.83) vs (28.61±5.08), PSQI (11.59±2.26) vs (14.55±4.14); Group C: HAMD 24 (14.44±3.60) vs (29.44±4.98), PSQI (11.40±2.30) vs (15.13±4.62)) (all P<0.001). After the intervention, the MOCA scores in all groups were higher than those before the intervention (Group A: (26.04±2.21) vs (25.92±2.34), t=-2.20, P=0.032; Group B: (26.22±1.59) vs (25.35±1.95), t=-4.45, P<0.001; Group C: (26.10±2.15) vs (25.21±2.13), t=-3.15, P=0.003). After the intervention, the HAMD 24 scores of Group B were lower than those of Group A and Group C ((12.82±3.83) vs (15.08±4.15) vs (14.44±3.60)) (all P<0.05), and the PSQI scores of groups B and C were lower than those of group A ((11.59±2.26) and (11.40±2.30) vs (12.76±2.52)) (all P<0.05). No statistically significant differences in MOCA scores among Group A, Group B, and Group C after the intervention ( P=0.906). Conclusion:Exercise therapy is helpful in improving depressive symptoms and sleep quality in patients with mild to moderate depression, but it does not have a significant advantages in improving cognitive function.

Objective To develop a humanistic care nursing plan for conscious patients in ICU based on narrative nursing theory and to provide a theoretical basis and practical guidance for clinical humanistic care.Methods Literature reviews and qualitative interviews were applied to examine the current situation and needs of humanistic care for critically ill patients at home and abroad.Based on the narrative nursing theory proposed by Jiang and Li,the first draft of humanistic care plan for ICU conscious patients was created based on care procedures by brainstorming among group members.The plan was finalised after two rounds of consultations with nursing specialists using Delphi's method.Results Effective return rate was 100%from both rounds of questionnaires.The expert authority coefficient was 0.917,the Kendall's coefficient of concordance W for the importance of items in the two rounds of inquiries were 0.331 and 0.421,respectively,and the Kendall's coefficient of concordance W for feasibility were 0.328 and 0.349,respectively(P<0.001).The mean scores for the importance of item content were 3.43 to 5.00,and 3.73 to 5.00,with coefficients of variation from 0 to 0.28 and 0 to 0.24,respectively.The mean scores for feasibility were 3.30 to 5.00,and 3.60 to 5.00,with coefficients of variation from 0 to 0.21 and 0 to 0.23,respectively.The finalised humanistic care plan included three first-level items:pre-implementation assessment and preparation,implementation process,and effectiveness evaluation,with a total of 12 secondary items and 31 tertiary items.Conclusion After statistical analysis,it is found that based on narrative nursing theory,the humanistic care nursing plan for conscious patients in ICU developed in this study,is reliable,highly operational,feasible,scientifically sound and practical.

Objective:To explore the effects of aerobic exercise therapy and anaerobic exercise therapy on improving depressive symptoms, sleep quality, and cognitive function in patients with mild and moderate depression.Methods:A prospective study was conducted to collect clinical data from 148 inpatients with mild to moderate depression treated at the Second Affiliated Hospital of Xinxiang Medical College from February 2019 to May 2023 including 74 males and 74 females aged 18 to 60 (40.08±11.03) years. They were randomly assigned the conventional treatment group (group A, 49 cases), the conventional treatment+moderate-intensity aerobic exercise therapy intervention group (group B, 51 cases), and the conventional treatment+moderate intensity anaerobic exercise therapy intervention group (group C, 48 cases). Patients in each group were treated the corresponding intervention for 4 weeks. The 24-item Hamilton Depression Scale (HAMD 24), Pittsburgh Sleep Quality Index (PSQI), and the Montreal Cognitive Assessment (MOCA) were used to score depressive symptoms, sleep quality, and cognitive function, respectively, before and after intervention. Paired sample t-tests were used to compare the changes in scores before and after the intervention. One-way ANOVA was used to analyze and compare the score differences on each scale among the groups. Results:After the intervention, HAMD 24 and PSQI scores in all groups decreased compared with those before the intervention (Group A: HAMD 24 (15.08±4.15) vs (29.33±4.75), PSQI (12.76±2.52) vs (14.88±3.64); Group B: HAMD 24 (12.82±3.83) vs (28.61±5.08), PSQI (11.59±2.26) vs (14.55±4.14); Group C: HAMD 24 (14.44±3.60) vs (29.44±4.98), PSQI (11.40±2.30) vs (15.13±4.62)) (all P<0.001). After the intervention, the MOCA scores in all groups were higher than those before the intervention (Group A: (26.04±2.21) vs (25.92±2.34), t=-2.20, P=0.032; Group B: (26.22±1.59) vs (25.35±1.95), t=-4.45, P<0.001; Group C: (26.10±2.15) vs (25.21±2.13), t=-3.15, P=0.003). After the intervention, the HAMD 24 scores of Group B were lower than those of Group A and Group C ((12.82±3.83) vs (15.08±4.15) vs (14.44±3.60)) (all P<0.05), and the PSQI scores of groups B and C were lower than those of group A ((11.59±2.26) and (11.40±2.30) vs (12.76±2.52)) (all P<0.05). No statistically significant differences in MOCA scores among Group A, Group B, and Group C after the intervention ( P=0.906). Conclusion:Exercise therapy is helpful in improving depressive symptoms and sleep quality in patients with mild to moderate depression, but it does not have a significant advantages in improving cognitive function.

This article summarized the overview of diagnosis related groups (DRGs), the necessity of comprehensively popularizing and applying DRGs in specialized hospitals and general hospitals, the different methods and effects of nursing human resource allocation based on DRGs in specialized hospitals and general hospitals at home and abroad, and analyzed the different challenges and opportunities faced by DRGs in the implementation of human resource allocation in two types of hospitals. According to the types and characteristics of hospitals, this paper put forward some corresponding suggestions and prospects for the future, such as intelligent human resource prediction system and the construction of information sharing platform, so as to provide reference for the comprehensive promotion of DRGs in different types of hospitals in China.