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Background: Ventilator‐associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs) and is a common cause of morbidity and mortality in intensive care patients. Previous studies show that insufficient knowledge and compliance barriers among nurses affect pneumonia. There have been no investigations into intensive care nurses' knowledge and compliance barriers to evidence‐based guidelines (EBGs) for VAP prevention in county‐level hospitals in China. Aim: To explore adult ICU nurses' knowledge and compliance barriers to EBGs for preventing VAP in county‐level hospitals in Hunan Province, China, examine the correlation between knowledge and compliance barriers, and analyse associated factors. Study Design: A cross‐sectional electronic survey was conducted to focus on nurses' knowledge of and compliance barriers to EBGs for preventing VAP. Results: A total of 386 valid questionnaires were collected, with a response rate of 97.47% (386/396 = 97.47%). The median scores for nurses' knowledge (out of 9) and compliance barriers (out of 8) to EBGs for preventing VAP were 7 (interquartile range: 5–8) and 3 (interquartile range: 2–4), respectively. Knowledge was negatively associated with compliance barriers (r = −0.437, p <.01). The results of the multiple linear regression analysis showed that hospital level, age, nurses' attendance at VAP training and years of experience in ICUs were related to the level of knowledge. Nurses' attendance at VAP training, age and years of experience in ICUs were associated with the level of compliance barriers. Conclusions: Intensive care nurses have satisfactory knowledge of EBGs for preventing VAP, but compliance barriers can be reduced. Better knowledge helps reduce the barriers to compliance among nurses. Relevance to Clinical Practice: Nurse managers and nurse educators are suggested to examine nurses' knowledge and compliance barriers to EBGs for preventing VAP, develop personalized training plans, promote continuous education based on the latest EBGs and raise the nurse–patient ratio reasonably. [ABSTRACT FROM AUTHOR]

Background: Medical personnel contact with the patient closely, and their knowledge of vascular catheter-associated infections (VCAIs) is closely related to the prevention of VCAIs. Researchers mainly pay attention to the VCAIs knowledge of doctors and nurses but rarely pay attention to the nursing students in the hospital internship stage. Purpose: To investigate the current situation of knowledge of intern-nursing students in VCAIs, and analyze its influencing factors. Patients and Methods: 843 intern-nursing students were selected from 10 hospitals in five regions of eastern, western, southern, northern, and central China from June 26 to July 31, 2023, using a two-stage random sampling method. A self-designed questionnaire with good reliability and validity was used to investigate their knowledge of VCAIs, and t-test, multiple linear regression analysis, and Welch t-test were used to analyze the collected data by using SPSS Statistics 26.0 (IBM Corp., Armonk, NY). Results: Intern nursing students' mean score of VCAIs knowledge was 48.66 (SD=15.77), with a score below 60 (unqualified) accounting for 75.4%, a score of 60– 79 (qualified) accounting for 19.7%, a score of 80– 89 (good) accounting for 3.6%, and a score of above 90 accounting for 1.3%. Students who attended VCAIs training three or more times had higher scores than those who did not attend training (B: 4.706, p=0.001), knowledge scores of students with a bachelor's degree or above were higher than those with junior college degree or below (B: 8.479, p< 0.001), students who interned in tertiary hospitals had higher scores than those practicing in secondary hospitals (B:12.381, p< 0.001) and scores of students in hospital training were significantly higher than study independently (B:4.116, p=0.007). Conclusion: Intern-nursing students have a relatively low level of knowledge about VCAIs. It is recommended to strengthen clinical systematic and standardized training, improve the knowledge mastery level of intern-nursing students, and enhance their ability to handle VCAIs. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to investigate nurses' willingness and demand for Internet +home care services in different levels of hospitals in China and analyze the influencing factors. Participants and Methods: From October 1 to December 31, 2021, 5714 nurses from 15 hospitals in five regions of China were recruited in this cross-sectional study using a two-stage random sampling method. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for Internet +home care services. χ2 test, Welch t-test, and multiple linear regression analyses were used to analyze the data. Results: Nurses were highly willing to provide Internet +home care services. Statistical differences were found in the willingness to provide Internet +home care services and the preference for service distance, service platform, and single service fee between nurses in different levels of hospitals (both P< 0.05). The willingness to provide "catheter maintenance service" and "rehabilitation nursing service" of nurses in different levels of hospitals were statistically significant (both P< 0.05). Nurses' demand for Internet +home care services increased with the level of their hospital. Multiple linear regression showed that professional title, educational level, monthly family income, and mortgage or car loan influence nurses' demand for Internet +home care services. Conclusion: Nurses' willingness and demand for Internet +home care services vary with the level of their hospitals. It is recommended that government and hospitals regulate the service items, the service distance, single service fee, and other contents according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of the Internet +home care services. [ABSTRACT FROM AUTHOR]

Background: With the aging of China's population, the incidence rate of chronic diseases is rising. At the same time, residents' health awareness is also increasing. Implementing Internet +home care is an inevitable trend in adapting social development. Currently, Internet +home care is in the pilot stage in China, relevant institutional measures are neither standardized nor perfect, and there is no set of quality supervision indicators (QSIs). Purpose: The construction of Internet +home care QSIs in China will provide a theoretical basis for Internet +home care quality supervision. Materials and Methods: The Service-Quality model was used as the theoretical framework, and a literature review, semi-structured interviews, focus group discussions, and Delphi consultations determined the contents of the QSIs and the weight of each indicator. Results: Internet +home care QSIs were constructed and included 5 first-level indicators, 17 secondary indicators, and 69 tertiary indicators. The effective recovery rates of the two rounds of Delphi expert consultation were 100% and 85%, the expert authority coefficients were 0.810 and 0.833, and the Kendall harmony coefficients were 0.189 and 0.125 (P< 0.01). The final set of Internet +home care QSIs was as follows: tangibility (4 secondary and 16 tertiary indicators), reliability (4 secondary and 19 tertiary indicators), guarantee (5 secondary and 20 tertiary indicators), responsiveness (2 secondary and 8 tertiary indicators), and empathy (2 secondary and 6 tertiary indicators). Conclusion: The construction of Internet +home care QSIs based on the SERVQUAL model is scientifically valid, and the indicators are reliable. They provide guidance and reference values for the continuous improvement and promotion of Internet +home care. This work also provides a theoretical basis for researching and developing an Internet +home care quality supervision platform. [ABSTRACT FROM AUTHOR]

Wind energy, as one of the renewable energies with the most potential for development, has been widely concerned by many countries. However, due to the great volatility and uncertainty of natural wind, wind power also fluctuates, seriously affecting the reliability of wind power system and bringing challenges to large-scale grid connection of wind power. Wind speed prediction is very important to ensure the safety and stability of wind power generation system. In this paper, a new wind speed prediction scheme is proposed. First, improved hybrid mode decomposition is used to decompose the wind speed data into the trend part and the fluctuation part, and the noise is decomposed twice. Then wavelet analysis is used to decompose the trend part and the fluctuation part for the third time. The decomposed data are classified. The long- and short-term memory neural network optimized by the improved particle swarm optimization algorithm is used to train the nonlinear sequence and noise sequence, and the autoregressive moving average model is used to train the linear sequence. Finally, the final prediction results were reconstructed. This paper uses this system to predict the wind speed data of China's Changma wind farm and Spain's Sotavento wind farm. By experimenting with the real data from two different wind farms and comparing with other predictive models, we found that (1) by improving the mode number selection in the variational mode decomposition, the characteristics of wind speed data can be better extracted. (2) According to the different characteristics of component data, the combination method is selected to predict modal components, which makes full use of the advantages of different algorithms and has good prediction effect. (3) The optimization algorithm is used to optimize the neural network, which solves the problem of parameter setting when establishing the prediction model. (4) The combination forecasting model proposed in this paper has clear structure and accurate prediction results. The research work in this paper will help to promote the development of wind energy prediction field, help wind farms formulate wind power regulation strategies, and further promote the construction of green energy structure. [ABSTRACT FROM AUTHOR]

Background and Aim: The promotion of peripherally inserted central catheter (PICC) maintenance in primary hospitals can benefit discharged patients with PICCs living in remote areas a lot. Yet, no primary hospitals had introduced PICC maintenance technology in Hunan province, China. The present study aimed to evaluate nurses' attitudes and knowledge of PICC maintenance in primary hospitals in Hunan province, China. Materials and Methods: From November 2018 to January 2019, a total of 560 nurses from 28 community hospitals and 28 township hospitals in 14 cities across Hunan were recruited in the present study. All nurses were registered nurses engaged in clinical work related to intravenous infusion, and their attitudes and knowledge of PICC maintenance were measured by a self-designed questionnaire that was based on literature review and expert consultation. Results: The response rate was 93.6% (560 of 598). Almost all participants could realize the importance and necessity of PICC maintenance. More than 90% of the participants expressed interest in PICC maintenance and showed strong demands for relevant training. However, the nurses' correct response rate of most knowledge items was at a low level (7.14– 57.68%), with only three items exhibiting the correct response rate of 90% or higher. The factors influencing the nurses' PICC maintenance knowledge included their nursing experience, professional title, work setting, and department. Conclusion: Although nurses in primary hospitals had a positive attitude toward PICC maintenance, their knowledge level was unsatisfactory, which might be a barrier to the promotion of PICC maintenance technology in primary hospitals in Hunan province, China. Multiple parties should get involved and take measures to improve the nurses' PICC maintenance knowledge, including the government, nursing associations, large-scale hospitals, and primary hospitals themselves. Besides, new training models and dynamic assessment methods should be explored to improve training effectiveness in the future. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to clarify the short-term quality of life (QoL) of acute leukemia (AL) patients early after stem cell transplantation (SCT) and related predictors of QoL recovery.Methods: We investigated adult AL patients who underwent SCT at the Institute of Hematology and Blood Diseases Hospital after transplantation. Physical/functional and emotional/mental recovery were evaluated using the Short Form 36 (SF-36) questionnaire to identify its trajectory as well as related predictors for the physical component summary (PCS) and mental component summary (MCS). The score was also used to establish a QoL prediction model.Results: A total of 326 AL patients responded to our QoL survey. The results revealed the profile of patient follow-up from 2013 to 2015. Along follow-up after transplantation, there was a significant increase in PCS (p = 0.139) and MCS (p = 0.122). On multivariate regression analysis, apart from follow-up, marriage, financial situation, employment situation, and history of chronic graft-versus-host disease (cGVHD) had clinical significance for both PCS and MCS. A prediction model for patient risk hierarchy estimation was further established. The logistic results revealed that the significant characteristics of patients with high PCS and high MCS were unmarried, without financial burden, reliable on drugs, and with history of acute graft-versus-host disease (aGVHD).Conclusions: This well-established study enabled evaluation of the QoL of AL patients post-HSCT in China. The established prediction model could provide more indications and insights into improvement in quality of life for better medical interventions. [ABSTRACT FROM AUTHOR]

Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. This was a prospective, randomized, controlled, open-label trial. Patients were recruited from 14 medical institutions in China between February and June 2023. In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449–0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039–0.142) in the intervention group and 23.8 % (30/126, 0.167–0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858–0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748–0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311. [ABSTRACT FROM AUTHOR]

• We assessed bacterial community responses to precipitation in biological soil crusts. • Proteobacteria and Actinobacteria were the predominant phyla. • Community composition, but not diversity, responded to precipitation changes. • Microbial biomass carbon altered bacterial community composition. • Composition and soil properties affect soil respiration responses to precipitation. Soil water availability is the critical limitation for soil respiration (R s) and subsequent ecosystem functions in biological soil crusts (BSCs) of arid ecosystems. Thus, uncovering the response mechanism of R s to different precipitation regimes will improve our knowledge of the potential impacts of global climate change on this fragile ecosystem. To investigate the possible effects of altered precipitation regimes on bacterial community composition, soil properties and soil carbon effluxes, we implemented a 3-year field experiment in a desert shrub in northwestern China with manipulative precipitation treatments consisting of natural precipitation, that increased along a precipitation gradient of 5–40 mm during the growing season. Results showed that microbial biomass carbon and nitrogen (MBC and MBN) were significantly increased with increasing rainfall amount but soil organic carbon, total nitrogen, pH and biological thickness were relatively stable. Water addition significantly altered the bacterial community composition but not its diversity (including richness and evenness) by increasing the relative abundances of Actinobacteria and decreasing those of Bacteroidetes and Cyanobacteria. In addition, MBC was the primary driver that altered bacterial community composition. Soil physiochemical properties resulted in approximately 70% variations in R s , whereas soil physicochemical properties and bacterial community composition impacted 10% variations in R s. Our results indicated that bacterial community composition and soil physiochemical properties might be responsible for the responses of R s to rainfall addition in BSCs of desert regions. [ABSTRACT FROM AUTHOR]

• A new hybrid prediction system is proposed to predict wind speed. • Simplex and chaotic mapping optimization cuckoo algorithm are proposed. • An uncertainty prediction model based on Monte Carlo method is proposed. • The energy theory is proposed to optimize the decomposition mode number. • Theories proofs and experiments verify the effectiveness of the model. Wind energy has strong volatility and intermittent. Accurate wind speed prediction can not only improve the safety of the system, but also optimize dispatch and reduce economic losses. However, previous studies tend to ignore the influence of virtual components and lack effective identification of wind speed characteristics and a robust interval prediction scheme, resulting in poor results. To bridge these gaps, this paper proposes an energy theory method to solve the problem of modal over-decomposition. The study also combines effective modal recognition, uses different prediction methods according to modal characteristics and proposes a set of new optimization algorithms to improve nonlinear prediction capabilities. Finally, based on Monte Carlo theory, a set of interval prediction schemes that can adapt to different error characteristics are proposed. Under the verification of wind speed data in Changma, China and Sotavento, Spain. The mean absolute percentage error of wind speed deterministic prediction reaches 4.22% and 5.82%, respectively. The coverage rate of wind speed uncertainty prediction meets different confidence requirements, and the average interval width is still less than 2.5 m/s at 90% confidence. The results show that the forecasting system proposed in this paper is significantly better than all the comparative forecasting schemes, which can reduce the risk of fluctuations and improve the stability and safety of the wind power system. [ABSTRACT FROM AUTHOR]

Evaluating Master of Nursing Specialist (MNS) students' knowledge, attitudes, and practice regarding catheter-related thrombosis (CRT) prevention and treatment is beneficial in developing effective CRT training for them. This study thus aimed to explore their knowledge, attitudes, and practice toward CRT. This was a cross-sectional study that included 1046 MNS students in China. The results revealed that the median scores for the participants' knowledge, attitudes, and practice were 12 (interquartile range: 9-14), 55 (interquartile range: 50-65), and 62 (interquartile range: 51-71), respectively. There was a positive correlation between knowledge and attitudes, as well as attitudes and practice. Age, school level, proactively learning CRT knowledge, gender, enrolment method, participation in clinical practice time, and attendance at CRT training were related to knowledge (p < 0.05). Attendance at CRT training and experience using thrombosis risk assessment forms were related to attitude and practice (p < 0.05). Gender and experience caring for CRT patients were associated with practice (p < 0.05). MNS students have insufficient knowledge of CRT prevention and treatment, and the practice needs to be improved. However, their attitudes are positive., (© 2024 John Wiley & Sons Australia, Ltd.)

Background: The engagement of preschool teachers in their work is pivotal for maintaining teaching quality, ensuring teacher well-being, and fostering children's development. Despite its significance, there is limited knowledge regarding the daily fluctuations in work engagement and the underlying factors influencing it. This study, guided by the Job Demands-Resources model and Affect Event Theory, utilized an experience sampling methodology to investigate the impact of challenge and hindrance stressors on daily work engagement, as well as the mediating role of affect and the moderating effect of mindfulness., Methods: Utilizing an experience sampling method, this study collected data from 220 preschool teachers in Shanghai over five consecutive workdays, conducting surveys once daily. Data analysis was performed using multilevel linear models., Results: The results from multilevel regression indicated that: (1) daily challenge stressors were positively related to work engagement, (2) daily hindrance stressors were negatively related to work engagement, (3) daily positive affect mediated the relationship between challenge stressors and work engagement, (4) daily negative affect mediated the relationship between hindrance stressors and work engagement, and (5) daily mindfulness played a crucial moderating role by alleviating the adverse effects of hindrance stressors on daily negative affect., Conclusions: This study provides valuable insights into the daily experiences of preschool teachers and the factors that influence their work engagement. Understanding the impact of stressors, affect, and mindfulness on work engagement can inform the development of interventions and strategies to improve teacher well-being and work engagement., (© 2024. The Author(s).)

The COVID-19 pandemic has had an inestimable impact worldwide, challenging the daily lives and interactions of children and their families. In 2022, Shanghai implemented a three-month lockdown in response to an acceleration of positive cases during the pandemic period. This restrictive policy provided insight into the impact of the lockdown on children's social adjustment and the role of parent-child conflict during this process. Mothers of preschool-aged children participated in this study and completed the Chinese version of Child-Parent Relationship Scale (CPRS) and the Strengths and Difficulties Questionnaire (SDQ). Using Propensity Score Matching (PSM) method, two matched groups were formed: pre-lockdown group and post-lockdown group, with a total of 574 preschoolers (N = 297 in each group; M age  = 4.36, SD = 0.86) were recruited. The results showed that the lockdown directly impacted children's emotional symptoms. Additionally, the parent-child conflict mediated relationship between the lockdown and children's adjustment. Specifically, parent-child conflict deteriorated children's emotional symptoms, hyperactivity-attention problems, and prosocial behaviors. These findings highlight the significant impact of the severe lockdown on children's social adjustment and the role of parent-child interactions during this period., (© 2024. The Author(s).)

Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services., Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China., Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis., Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >¥10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <¥5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <¥5000 and junior college education or lower, respectively., Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services., (©Jinghui Zhang, Sha Peng, Jianmei Hou, Guiyuan Ma, Yanhui Liu, Yuhua Fan, Lingxia Luo, Zhengkun Shi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.08.2023.)

Accurate monitoring of grassland vegetation dynamics is essential for ecosystem restoration and the implementation of integrated management policies. A lack of information on vegetation changes in the Wulagai River Basin restricts regional development. Therefore, in this study, we integrated remote sensing, meteorological, and field plant community survey data in order to characterize vegetation and ecosystem changes from 1997 to 2018. The residual trend (RESTREND) method was utilized to detect vegetation changes caused by human factors, as well as to evaluate the impact of the management of pastures. Our results reveal that the normalized difference vegetation index (NDVI) of each examined ecosystem type showed an increasing trend, in which anthropogenic impact was the primary driving force of vegetation change. Our field survey confirmed that the meadow steppe ecosystem increased in species diversity and aboveground biomass; however, the typical steppe and riparian wet meadow ecosystems experienced species diversity and biomass degradation, therefore suggesting that an increase in NDVI may not directly reflect ecosystem improvement. Selecting an optimal indicator or indicator system is necessary in order to formulate reasonable grassland management policies for increasing the sustainability of grassland ecosystems.

Biotic mechanisms associated with species diversity are expected to stabilize communities in theoretical and experimental studies but may be difficult to detect in natural communities exposed to large environmental variation. We investigated biotic stability mechanisms in a multi-site study across Inner Mongolian grassland characterized by large spatial variations in species richness and composition and temporal fluctuations in precipitation. We used a new additive-partitioning method to separate species synchrony and population dynamics within communities into different species-abundance groups. Community stability was independent of species richness but was regulated by species synchrony and population dynamics, especially of abundant species. Precipitation fluctuations synchronized population dynamics within communities, reducing their stability. Our results indicate generality of biotic stability mechanisms in natural ecosystems and suggest that for accurate predictions of community stability in changing environments uneven species composition should be considered by partitioning stabilizing mechanisms into different species-abundance groups.

Objectives: The present study aimed to assess the level of knowledge on peripherally inserted central catheter (PICC) maintenance among nurses in China and to analyse the related factors influencing this variable., Design: A cross-sectional survey., Setting: Ninety-one hospitals at three different levels in Hunan Province, China: county hospitals, municipal hospitals and provincial hospitals., Participants: A total of 4110 registered nurses engaged in clinical work related to intravenous infusion., Primary and Secondary Outcome Measures: Nurses' knowledge of PICC maintenance was measured by the score of an anonymous, self-reported questionnaire., Results: The mean score of PICC maintenance among 4110 nurses was 72.86±14.86. 83.5% of the participants exhibited a score of 60 or above, and 34.1% of them exhibited a good grade with a score of 80 or above. The difference in the correct rate among different dimensions was statistically significant (H=17.721, p<0.01). The generalised linear model indicated that the factors influencing the nurses' PICC maintenance knowledge included gender, age, professional title, work setting and previous history of PICC maintenance training., Conclusions: In conclusion, the knowledge of PICC maintenance was at a medium level among nurses in Hunan province, China. Multiple steps should be taken to improve the nurses' PICC maintenance knowledge, including disseminating PICC maintenance knowledge in multiple ways, such as courses, lectures, seminars and new media. Particular attention should be given to populations who responded poorly in this survey, and targeted education for nurses should be distributed based on their performance on specific dimensions, such as the replacement of dressing and needle-free connectors. In addition, the quality of the nurses' practical performance could be measured in the future., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)