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Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited.To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses.PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021.Integrative Review.An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence.Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention.Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.

BackgroundThe purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.MethodsThis was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.ResultsUnivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.ConclusionsPICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

AIMS To examine the effectiveness of D-dimer values to be used as an independent diagnostic marker for excluding peripherally inserted central catheter-associated upper extremity deep vein thrombosis and superficial vein thrombosis. DESIGN This was a retrospective case-cohort study. METHODS Records were reviewed for 281 patients who underwent peripherally inserted central catheter insertion between 1 October 2017 and 1 October 2019. According to the modified Wells score after peripherally inserted central catheter insertion, the patients who had low vein thrombosis risk underwent a D-dimer test and colour Doppler ultrasound. RESULTS Among 281 patients, 180 patients (64%, 95% CI: 58.2%-69.4%) had negative D-dimer results and 39 of 180 patients had vein thrombosis despite having a negative D-dimer result, resulting in a failure rate of 21.7% (95% CI: 16.3%-28.3%). The negative predictive value of peripherally inserted central catheter-associated vein thrombosis in the cancer group (80.0%, 95% CI: 73.2%-85.4%) was higher than that of the non-cancer group (60.0%, 95% CI: 35.7%-80.2%). The negative predictive value of peripherally inserted central catheter-associated deep venous thrombosis (84.9%, 95% CI: 78.7%-89.6%) was lower than that of the PICC-associated superficial venous thrombosis (91.0%, 95% CI: 85.4%-94.6%). CONCLUSION The D-dimer levels maybe should not be used as a diagnostic index to rule out peripherally inserted central catheter-associated upper extremity vein thrombosis.

In this paper, we present an improved phase-field-based lattice Boltzmann (LB) method for thermocapillary flows with large density, viscosity, and thermal conductivity ratios. The present method uses three LB models to solve the conservative Allen-Cahn equation, the incompressible Navier-Stokes equations, and the temperature equation. To overcome the difficulty caused by the convection term in solving the convection-diffusion equation for the temperature field, we first rewrite the temperature equation as a diffuse equation where the convection term is regarded as the source term and then construct an improved LB model for the diffusion equation. The macroscopic governing equations can be recovered correctly from the present LB method; moreover, the present LB method is much simpler and more efficient. In order to test the accuracy of this LB method, several numerical examples are considered, including the planar thermal Poiseuille flow of two immiscible fluids, the two-phase thermocapillary flow in a nonuniformly heated channel, and the thermocapillary Marangoni flow of a deformable bubble. It is found that the numerical results obtained from the present LB method are consistent with the theoretical prediction and available numerical data, which indicates that the present LB method is an effective approach for the thermocapillary flows.

Background: With the extensive use of peripherally inserted central catheter (PICC), PICC-associated venous thrombosis (VT) has become one of the most important complications in the hospital. To reduce unnecessary Color Doppler Ultrasound (CDU) or imaging tests, D-dimer values are usually used to exclude VT for patients with low VT risk. There is little evidence for the usefulness of the D-dimer level as an independent diagnostic marker for excluding PICC-associated VT.Aims: To examine the effectiveness of D-dimer values to be used as an independent diagnostic marker for excluding PICC-associated Upper Extremity Venous Thrombosis(UEVT).Methods:Records were reviewed for 281 patients who underwent PICC insertion over the two years period in Xiangya Hospital Central South University.The patients were categorized into the UEVT unlikely group (Results: Among 281 patients, 180 patients (36%, 95%CI:30.6%-41.8%) had negative D-dimer results, 39 of 180 patients had VT despite having a negative D-dimer result, resulting in a failure rate of 21.7% (95% CI: 16.3–28.3%).The NPV of PICC-associated VT in the cancer group (80.0%,95% CI: 73.2–85.4%) was higher than that of the non-cancer group (60.0%,95% CI: 35.7–80.2%). The NPV of PICC-associated DVT(Deep Venous Thrombosis) (84.9%,95% CI: 78.7–89.6%) was lower than that of the PICC-associated SVT(Superficial Venous Thrombosis) (91.0% ,95% CI: 85.4–94.6%).Conclusion: The D-dimer levels maybe should not be used as a diagnostic index to rule out PICC-associated VT to avoid missed diagnosis of PICC-related VT, which may cause adverse consequences.

Background: With the in-depth study of Peripherally Inserted Central venous Catheter (PICC) related venous thrombosis, it is found that the incidence of lower extremity deep venous thrombosis (LEDVT) in patients with PICC in upper extremities is higher than that in patients without PICC . However, there is no explanation for this clinical phenomenon that PICC related venous thrombosis seems to have exceeded the range of PICC travel . The purpose of this study is to elucidate this association between PICC in upper extremities and LEDVT by observing the changes of D-dimer . Methods: This was a retrospective cohort study of adults in Neurology department who underwent Color Doppler ultrasound and D-dimer test between 1 April 2017 to 1 April 2020. We analyzed the related factors of LEDVT and the change of D-dimer value, compared the changes of D-dimer before and after PICC insertion, and evaluated the predictive value of D-dimer in patients with and without PICC. Results: ① It was found that the presence of PICC increased the risk of lower extremity venous thrombosis by 7 times (OR = 7.048 [95% CI: 4.486-11.074]; ②It was found that the presence of PICC promoted the increase of D-dimer value (OR = 5.133 [95% CI: 3.072-8.575]). ③ For patients without LEDVT, the level of D-dimer in patients with PICC was higher than that in patients without PICC (P < 0.05). ④ The level of D-dimer after PICC insertion was significantly higher than that before PICC insertion(P < 0.05). ⑤ In patients with PICC, the AUC value of D-dimer in the diagnosis of LEDVT was 0.657 (95% CI: 0.549-0.765), and the negative predictive value was 82.35%.Conclusion:PICC insertion may increase the level of D-dimer and become an important risk factor of LEDVT; For patients with PICC , D-dimer value is not suitable to rule out LEDVT.

To evaluate residents' knowledge, attitude and behavior towards coronavirus disease 2019 (COVID-19) in Hunan Province, and to explore the factors influencing behaviors.A self-designed questionnaire was used to conduct an online survey for 4 139 Hunan residents. The contents included general population information, residents' knowledge, attitude and practice to COVID-19.Mean scores of knowledge, attitude, and behavior were 29.82±3.16, 6.71±1.12, and 14.93±1.45, respectively. Residents had the highest score of major symptoms of COVID-19 (3.96±0.39), but the lowest was the main transmission routes (3.47±0.89). A total of 22.68% of the residents were very or relatively afraid of the outbreak, but 95.22% of the residents had confidence in defeating COVID-19. In behavior dimension, "handling of suspicious symptoms" had the lowest score (3.58±0.75). The behavior implementation rate of "keep the surfaces of household items clean" (80.50%), "doing more exercise, reasonable diet, working and resting regularly" (84.59%), and "avoid hand contacting with eyes, mouth or nose" (89.51%) were relatively low. Pearson correlation coefficient showed that the knowledge, attitude, and practices score were correlated with each other (knowledge vs behavior:Residents in Hunan Province have a good knowledge, attitude, and behavior to COVID-19. Nevertheless there are still weak links to be improved in all dimensions. It is necessary to strengthen knowledge and behavior of family protection, and care for residents' psychological health, especially persons with low education degree, male and rural residents.

The objective of this study is to explore the relevant risk factors of deep venous thrombosis (DVT) in burn patients. A retrospective analysis was conducted for the medical records of 845 hospitalized burn patients from September 2012 to August 2017. Caprini thrombosis risk assessment scale (CTRAS) was employed for evaluating the risks of DVT. Based upon whether or not DVT occurred, they were divided into non-DVT group (n = 830) and DVT group (n = 15). Among 360 (42.7%) patients with high-risk Caprini scores, only 30 patients received color Doppler examination of lower limb veins, and 15 patients were diagnosed as DVT with a diagnostic rate of 1.8%. Caprini scores of non-DVT and DVT groups were 4.30 ± 2.71 and 9.87 ± 1.46 points, respectively. There was statistically significant difference (P < .05). As revealed by stepwise Logistic regression analysis, age, lower limb burn, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) were independent risk factors for DVT. Burn patients are particularly prone to develop DVT. Age, wound infection, femoral vein catheterization, and long bedriddening time (>40 days) are risk factors. Aggressive preventive measures of DVT should be implemented.

Conjugate heat transfer problems are of great importance in many applications, while the available lattice Boltzmann (LB) models have some limitations in the study of such problems with the heterogeneous media. In this paper, we develop a new LB model for the conjugate heat transfer problems where the evolution equation with a modified equilibrium distribution function and a source term is considered. Through the Chapman–Enksog analysis, the macroscopic temperature equation can be recovered correctly. In order to test the accuracy, efficiency and stability of this LB model, some simple but nontrivial benchmark problems, including the planar thermal Poiseuille flow with two immiscible fluids, the conjugate heat transfer between a stratified heterogeneous medium with variable thermophysical properties, the steady and unsteady-state planer thermal flows with the two immiscible fluids, the steady-state conjugate heat transfer problem with a vertical interface, and the natural convection in a square cavity filled with circular and square rods, are studied. It is found that the results obtained from the present LB model are in good agreement with the analytic solutions or some previous works. In addition, it is also demonstrated that the developed LB model has a second-order convergence rate in space, and is more stable than some previous LB models. Finally, it should be noted that in our work, there is no special treatment to the interface, and the continuity conditions at the interface can be satisfied automatically.

The purpose of the present study was to examine a new protocol involving the spontaneous correction of the misplaced tip of a peripherally inserted central catheter (PICC). Patients with PICCs misplaced in the jugular or contralateral subclavian veins were recruited. All patients underwent chest X-ray (CXR) after 3 days. In addition, those whose PICC tip still was misplaced and received another CXR after 4 days. The functions of the catheters, the subjective feelings of the patients, and local symptoms of the neck and upper anterior chest wall were recorded. Among 866 patients who had PICCs, we observed 22 PICC tips misplaced in the jugular, 3 tips misplaced in the contralateral subclavian vein, and 7 tips misplaced in other locations, which was confirmed by CXR. A total of 22 PICC tips automatically returned to the superior vena cava, which included all 3 tips in the contralateral subclavian vein and 19 tips in the jugular vein. All catheters functioned normally, and the patients had no complaints. In addition, we observed no local symptoms of the neck and upper anterior chest wall. For patients experiencing a PICC misplaced in the jugular and contralateral subclavian veins, there is no need to manually replace. In addition, the function of the catheter can remain normal.

Objective To explore the abilities and barriers of practicing evidence-based nursing (EBN) for burn specialist nurses so as to provide rationales for its clinical training and practice. Methods From January 2016 to March 2016, a cross-sectional survey was conducted with a self-designed questionnaire among burn specialist nurses in Hunan Province. Data analysis was performed with SPSS software (version 20). Results Burn specialist nurses in Hunan Province had diminished EBN abilities. The three procedures of EBN with the lowest score were “summarizing evidence through systematic reviews”, “rigorous evaluations of evidence” and “systematic literature searches”. And the three procedures of “clarifying problems”, “disseminating evidence” and “introducing evidence” scored the highest. The systematic literature retrieval ability of nurses at class III general hospitals was higher than that of class II counterparts (P = 0.001). Thus EBN ability was positively correlated with barriers to practicing EBN, English proficiency, research experiences and educator status. Conclusion Burn specialist nurses at classes III & II general hospitals in Hunan Province had poor EBN abilities. Influencing factors of EBN ability included barriers to practicing EBN, English proficiency, research experiences and educator status. Therefore it is imperative to implement targeted trainings and integrated managements for improved ability of practicing EBN.

To identify the effectiveness of education interventions provided for nurses for clinical alarm response and management.Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating effectiveness for nurse education interventions is limited.Systematic review.A systematic review of experimental studies published in English from 2005-2015 was conducted in four computerised databases (MEDLINE, EMBASE, CINAHL and Scopus). After identification, screening and appraisal using Joanna Briggs Institute instruments, quality research papers were selected, data extraction and analysis followed.Five studies met the inclusion criteria for alarm response and no articles were concerned with clinical alarm education for management. All had different types and methods of interventions and statistical pooling was not possible. Response accuracy, response time and perceptions were consistent when different interventions were adopted. A positive effect was identified when learning about general alarms, single alarms, sequential alarms and medium-level alarms for learning as the primary task. Nurses who were musically trained had a faster and more accurate alarm response. Simulation interventions had a positive effect, but the effect of education provided in the care unit was greater. Overall, clinical alarm awareness was improved through education activities.Nurses are the main users of healthcare alarms and work in complex environments with high numbers of alarms, including nuisance alarms and other factors. Alarm-related adverse events are common. The findings of a small number of experimental studies with diverse evidence included consideration of various factors when formulating education strategies. The factors which influence effectiveness of nurse education are nurse demographics, nurse participants with musical training, workload and characteristics of alarms. Education interventions based in clinical practice settings increase education effectiveness, although simulation can be effective. No study shows any type of intervention results in sustained improvement.There are workload implications in education and the matching of load, number and type of alarms with nurse demographics which should be evaluated. There also needs to be a connection between education and the clinical setting to contribute to clinical alarm awareness for undergraduate nurses and practicing nurses. Education solely supported by employers is insufficient. Patient safety and long-term effects must be further explored.