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Hyperoxia is very common in critical patients, which causes varying degrees of pathophysiological damage. Hyperoxia is one of the main reasons for increasing mortality, prolonged hospital stay and poor prognosis of critical patients. Therefore, it is critical to carry out the standardized oxygen therapy. In this paper, we discussed the harmful effects of hyperoxemia to critically ill patients by reviewing the effect of hyperoxemia on cardiovascular and cerebrovascular, hyperoxia-induced lung injury, and the association of hyperoxemia with ventilator-associated pneumonia (VAP) and acute renal kidney injury (AKI). Meanwhile, we provided some management suggestions about standardized clinical oxygen therapy, oxygen therapy related research and clinical management of oxygen therapy, aimed at providing reference and research direction for standardizing clinical oxygenation process, reducing the occurrence of hyperoxemia, and making reasonable method for hyperoxemia prevention.

This paper considers the joint design of the Multiphase Shift Key (MPSK) waveform and its mismatched filter to achieve an excellent autocorrelation function. More specifically, a general optimization model that accounts for the minimization of Peak Sidelobe Level (PSL) of autocorrelation in the presence of the SNR, discrete phase, and constant modulus constraints, as well as the filter length requirement, is developed. In order to handle the resultant NP-hard problem, the Primal-dual Type (PDT) algorithm is introduced along with each iteration step required to solve four subproblems with closed-form solutions. Finally, the simulation examples are provided to evaluate the proposed optimization model and the effectiveness iteration procedure. The numerical results highlight that the devised waveform and filter can attain a lower PSL than the other design strategy while possessing low SNR loss.

In this paper, the direction of arrival (DOA) estimation in terms of weak target is addressed under strong mainlobe jamming. Specifically, a sum-difference beam signal model for multiple subarrays is introduced accounting for target echo and mainlobe jamming. For each subarray, the target and jamming signals are separated from the received sum-difference channel signals via blind source separation (BSS) algorithm. Further, monopulse technique is exploited to estimate DOA of weak target by combining all the separated target signals of each subarray. Finally, the effectiveness and performance of the proposed technique are analyzed via numerical simulations. The results show that the introduced procedure is capable of achieving rejection of the mainlobe jamming, while accurately estimating DOAs of target and jamming.

Background Coronavirus disease (COVID-19) has become a pandemic. The knowledge, attitudes, and practices (KAP) of the public play a major role in the prevention and control of infectious diseases. The objective of the present study was to evaluate the KAP of the Chinese public and to assess potential influencing factors related to practices. Methods A cross-sectional online survey was conducted in China in February 2020 via a self-designed questionnaire comprising 33 questions assessing KAP. Results For the 2136 respondents from 30 provinces or municipalities in China, the accurate response rate for the knowledge section ranged from 72.7 to 99.5%, and the average was 91.2%. Regarding attitude section, the percentage of positive attitudes (“strongly agree” and “agree”) ranged from 94.7 to 99.7%, and the average value was 98.0%. The good practices (“always” and “often”) results ranged from 76.1 to 99.5%, and the average value was 96.8%. The independent samples t-test revealed that gender and ethnic differences had no effect on knowledge, attitude or behaviour (P > 0.05). However, knowledge was associated with age (t = 4.842, p p p p p p = 0.017), education level (t = 2.106, p = 0.035), occupation (t = − 4.834, p p p = 0.001), attitude (t = 18.756, p p p = 0.002), and place of residence (t = 3.257, p = 0.001). Conclusions The Chinese public exhibited a good level of knowledge of COVID-19, a positive attitude, and high adherence to good practices. COVID-19-related knowledge, attitudes and practices were affected by age, marital status, education level, occupation, and place of residence to varying degrees. In addition, practices were affected by knowledge and attitudes towards COVID-19.

BackgroundPost-intensive care syndrome (PICS) seriously affects the quality of life of patients and their caregivers. This study systematically evaluates PICS related guidelines and consensuses to provide methodological and strategic guidance for the development and improvement of these guidelines and consensus.MethodsAn Internet search of PICS specific or related guidelines and consensus statements was conducted among academic databases and the websites. The AGREE II was used to evaluate their methodological quality. The themes and contents were evaluated based on the definition of PICS and the “patient-clinical problem-intervention-target” framework.ResultsWe included fourteen guidelines and 10 expert consensuses. The mean AGREE II score for scope and purpose was 86.89% ± 16.12%/ 79.47% ± 11.80%, 55.86% ± 29.17%/16.72% ± 16.39% for stakeholder involvement, 76.35% ± 15.82% /36.09% ±26.05% for rigor of development, 88.03% ± 15.55%/58.84% ± 28.94% for clarity of presentation, 61.79% ± 23.16/32.95% ± 20.91% for applicability, and 66.67% ± 37.96% /28.79% ± 36.54% for editorial independence in Guidelines/Consensus. Most only described a single or series of clinical related issues of PICS; only applicable for critically ill patients with clinical problems of ICUAW, pain, sleep disruption, agitation, and delirium. The interventions included risk assessment, monitoring/diagnosis, prevention, treatment, safety criteria, and home care of one or more symptoms of PICS.ConclusionsOur results suggested that development and improvement of guidelines/consensus should focus on refining the methodology, strengthening quality control, and improving presentation clarity, editorial independence, and applicability. The results may provide new idea for a future guidelines and consensus statements.

This case series examines patients with coronavirus disease 2019 (COVID-19) who were discharged from the hospital and had recurrent positive reverse transcriptase–polymerase chain reaction (RT-PCR) results.

Background: Family clustering has facilitated the transmission of SARS-CoV-2, and the outflows of people from Wuhan to their hometown has become the most important transmission channel in China. The study aimed to investigate the SARS-CoV-2 infection of an entire family, especially children. Methods: This family case study was conducted in General Mountain Hospital, Guizhou Province. In January 2020, we recruited a family of 13 members, including three children and nine adults, at different stages, from admission screening to discharge. We used standardized case report forms to collect clinical data between January 16, 2020 and March 1, 2020. These data included temperature, contact history, incubation period, laboratory test results, imaging results, length of hospital stay, and treatment outcomes. Results: Eight cases had confirmed diagnoses of SARS-CoV-2 infection, including three mild cases (37.5%) and five common cases (62.5%). The child patient had the shortest length of hospital stay and less obvious symptoms. There was no significant difference between the laboratory test results and CT scans. Conclusions: Children are not susceptible to virus infection in their families. Compared with adult patients, pediatric patients have milder symptoms, shorter hospital stays, and lower risk of lung infections. As this cannot confirm whether their nucleic acid amplification tests are negative or positive after discharge, the management and control of discharged patients should therefore be paid additional attention.

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Kidney transplantation is the major treatment for end-stage renal disease (ESRD). However, kidney transplant recipients (KTRs) face severe challenges during the transition period from hospital discharge to home, increasing the risk of early hospital readmission (EHR) and affecting patient safety. Nevertheless, knowledge of effective transitional care for KTRs is limited in China.To evaluate the effectiveness of an innovative transitional care program in improving discharge readiness, transitional care quality, health services utilization and patient satisfaction among KTRs in China.A prospective randomized controlled trial.Patients admitted to undergo kidney transplantation were recruited in a general tertiary hospital in Chengdu, China.A total of 220 eligible patients were recruited and randomly assigned to the intervention and control groups. Participants in the intervention group received a transitional care intervention developed by the research team, including a risk assessment for early readmission, health education from admission to predischarge, individualized discharge planning, and a telephone follow-up once per week for one month and WeChat follow-up postdischarge. The control group received routine care of comparable length and follow-up contact. A trained research assistant collected all patients' baseline data on admission (T0), evaluated the discharge readiness (by the Readiness for Hospital Discharge Scale) on the day of discharge (T1), collected data on transitional care quality (by the Care Transition Measure-15) and patients' satisfaction with transitional care services (by a self-developed patient satisfaction scale) on the 30th day postdischarge (T2), and collected data on hospital readmission, unscheduled outpatient department visits, and emergency room visits on the 30th and 90th days (by a self-developed health services utilization record table) (T3) postdischarge. Intervention effects were analyzed using independent samples t-tests, Wilcoxon-Mann-Whitney U tests, Chi-square tests or Fisher's exact test.Compared with the control group, the intervention group showed significantly better discharge readiness (personal status, P0.001; knowledge, P = 0.010; coping ability, P0.001; expected support, P = 0.007; total score, P0.001), better transitional care quality (importance of preferences, P0.001; management preparation, P0.001; critical understanding, P = 0.003; written and understandable care plan, P = 0.012; total score, P0.001), lower readmission rate at T2 (P = 0.033) and at T3 (P = 0.013), lower emergency room visit rate at T3 (P = 0.014), and better satisfaction with transitional care services (P0.001).This study provides evidence that an innovative transitional care program is effective in promoting KTRs' discharge readiness, transitional care quality, reducing hospital readmission and emergency room visits, and improving their satisfaction with transitional care services.Clinical Trials ChiCTR1800014971.

Earthquakes pose serious threats to the world. Good individual resilience can cope with disaster well, but there were few appropriate assessment tools. The purpose of this study was to develop a new individual earthquake resilience questionnaire and test its reliability and validity. First, we built the framework of the individual earthquake resilience questionnaire based on expert interviews. Then, we established the initial version of questionnaire and used the Delphi method and item selection to modify it by qualitative and quantitative methods. Finally, we built the final version of questionnaire (contained 4 dimensions and 17 items) and tested the reliability and validity. The Cronbach’s α values of the four dimensions were between 0.79 and 0.91, the split-half reliabilities were between 0.85 and 0.93, and the test-retest reliabilities were between 0.72 and 0.80. The item content validity indexes were between 0.87–1, and the average questionnaire content validity index was 0.94. The correlation coefficients between each item and dimension with the total questionnaire ranged from 0.79–0.90 and 0.66–0.79, respectively. We used exploratory factor analysis to identify four common factors with a cumulative variance contribution rate of 74.97%. The questionnaire is a valid and reliable tool to measure individual resilience in the context of earthquake disasters.

Rationale Coronavirus disease 2019 (COVID-19) has emerged as a rapidly spreading communicable disease affecting individuals worldwide. Patients with diabetes are more vulnerable to the disease, and the mortality is higher than in those without diabetes. We reported a severe COVID-19 patient with diabetes and shared our experience with blood glucose management. Patient concerns A 64-year-old female diabetes patient was admitted to the intensive care unit due to productive coughing for 8 days without any obvious cause. The results of blood gas analysis indicated that the partial pressure of oxygen was 84 mm Hg with oxygen 8 L/min, and the oxygenation index was less than 200 mm Hg. In addition, postprandial blood glucose levels were abnormal (29.9 mmol/L). Diagnoses The patient was diagnosed with COVID-19 (severe type) and type 2 diabetes. Interventions Comprehensive interventions including establishing a multidisciplinary team, closely monitoring her blood glucose level, an individualized diabetes diet, early activities, psychological care, etc, were performed to control blood glucose while actively treating COVID-19 infection. Outcomes After the comprehensive measures, the patient's blood glucose level gradually became stable, and the patient was discharged after 20 days of hospitalization. Lessons This case indicated that the comprehensive measures performed by a multidisciplinary team achieved good treatment effects on a COVID-19 patient with diabetes. Targeted treatment and nursing methods should be performed based on patients' actual situations in clinical practice.

Background A novel coronavirus disease that emerged in China in December 2019 (COVID-19) has rapidly spread to all over the world, leading to 823 626 people diagnosed and 40 598 deaths globally as of April 1, 2020. Nurses are providing care to patients with COVID-19 who require hospitalization. To ensure adequate response capacity and to maintain the health of nurses at risk of infection, it is important to analyse the actual work hours and the nurses reported preferred work hours per shift among frontline nurses. Objective To analyse the actual work hours and preferred work hours per shift of nurses reports among frontline nurses fighting the COVID-19 epidemic and to explore the influencing factors on the nurses reported preferred work hours. Design Cross-sectional survey. Settings This study was conducted in 10 designated hospitals providing treatments to patients with COVID-19 in China. Participants Nurses providing care to patients with COVID-19 in designated hospitals in China. Methods A self-designed questionnaire with open-ended questions was used to assess frontline nurses caring for COVID-19 cases in 10 designated hospitals. Quantitative and qualitative methods were used to analyse the actual work hours, the nurses reported preferred work hours and factors influencing nurses reported preferred work hours among the frontline nurses. Results A total of 109 nurses responded to the survey. The actual work hours per shift among frontline nurses were exceeded the nurses reported preferred work hours [Median (interquartile range): 5.00(2.00) h vs 4.00 (2.00)h; Minmum-Maxmum: 4-12 h vs 4-8 h], and 60.55% (66/109) of the nurses regarded 4 h as the preferred number of work hours per shift. Five key themes associated with the influencing factors emerged, including circumstances, personal preventable equipment, the physical and emotional needs of nurse, the safety needs of nurse and work intensity. Conclusions These findings suggest that there is a gap between the actual work hours and the nurses reported preferred work hours among frontline nurses in different units and different posts. The main influencing factors were circumstances, personal preventable equipment, the physical and emotional needs of nurse, the safety needs of nurse and work intensity.

Clinical performance is regarded as a basic and core content of nursing quality. Professional values of nursing students may play an important role in improving clinical performance. Few studies reveal the relationship between professional values, perceived stress and clinical performance. This research has found that professional values play a moderating role in the relationship between perceived stress and clinical performance.To examine the negative association between perceived stress and clinical performance among practice nursing students, and to determine whether professional values plays a moderating role in the relationship between perceived stress and clinical performance among Chinese practice nursing students.A cross-sectional descriptive design has been used.From May to June 2017, a total of 435 Chinese practice nursing students from 4 hospitals filled out the questionnaires. The response rate was 94.57%. Three questionnaires including the Perceived Stress Scale (PSS), Nursing Professional Value Scale-Revised (NPVS-R), and Clinical Performance Scale (CPS). Structural equation modeling was used to deal with the relationships among perceived stress, professional values, and clinical performance.Perceived stress was negatively associated with clinical performance (P 0.01). Professional values significantly affected clinical performance (P 0.01) and moderated the relationship between perceived stress and clinical performance (P 0.01).Perceived stress is negatively related to clinical performance among Chinese practice nursing students, and professional values moderates the relationship between perceived stress and clinical performance, which can form scientific evidence to develop intervention strategies to improve clinical performance.