Nursing Services Research Articles

Developing a quality indicator system for evaluating internet plus home care nursing services based on the SERVQUAL model: a Delphi-analytic hierarchy process study

Background In the context of global population aging and the rapid development of information technology, the demand for Internet Plus Home Care Nursing (Internet+ HCN) services have been on the rise, especially in China. Internet+ HCN services have the potential to maximize existing human resources to counter the shortage of medical healthcare services. However, at present, Internet+ HCN services are difficult to scale due to the lack of standardized service quality governance. Quality indicators for service evaluation of Internet+ HCN services are under-defined. Objective To develop a quality indicator system for evaluating Internet+ HCN services, and to shed theoretical light on assessing mHealth service quality from a user experience perspective. Methods An initial quality indicator system was established based on scenarios related to Internet+ HCN services. The Delphi Method was applied to modify the indicators according to experts’ opinions, and the analytic hierarchy process (AHP) was applied to calculate the indicator weight. Finally, a quality indicator system for evaluating Internet+ HCN services was developed based on the SERVQUAL model. Results Altogether, 17 experts from relevant fields such as nursing education, clinical nursing, health management, and health informatics were consulted through email surveys. The response rates in both rounds of Delphi and the AHP were 100%. The average expert authority coefficients were 0.912 and 0.925 respectively in the two rounds of Delphi. Kendall’s W, indicating variation coefficients, ranged from 0.262 to 0.265. Finally, a quality indicator system for evaluating Internet+ HCN services, comprising five primary indicators and 15 secondary indicators, was developed. Primary indicators and their AHP generated the following weights: assurance (0.245), reliability (0.240), tangibles (0.192), responsiveness (0.190), and empathy (0.132). Conclusions By measuring the services quality gap between user expectations and perceptions, the proposed SERVQUAL model-based quality indicator system shows potential in improving the quality of Internet+ HCN services through the perspective of user experiences.

A neurosurgical nursing training system based on 3D printing models: practice and exploration of precision medicine.

In recent years, the concept of precision medicine has gradually permeated the field of nursing, presenting new challenges for neurosurgical nursing staff. Traditional teaching methods often struggle to adequately convey complex anatomical knowledge and nursing skills, thereby affecting the learning outcomes and clinical decision-making abilities of nurses. As an innovative educational tool, three-dimensional (3D) printing technology has demonstrated significant potential in medical education in recent years. Therefore, this project aims to explore the advantages and feasibility of using 3D printed models as a novel teaching tool in neurosurgical nursing. The study involved 80 nursing personnel who participated in the neurosurgical rotation training at Shaoxing People's Hospital from 2022 to 2023. The control group (40 individuals) used only traditional teaching tools such as textbooks, multimedia courseware, and laboratory equipment for theoretical and practical training based on the curriculum. The experimental group (40 individuals) incorporated a 3D printing model database as an innovative teaching tool on the basis of traditional teaching methods, and used patient-specific 3D printed models for precise nursing training. After the training, both groups were assessed for theoretical and practical abilities, professional values, job satisfaction, and the prognosis of intracranial aneurysm patients they cared for. The experimental group demonstrated superior scores in theoretical and practical abilities, professional values, and job satisfaction compared to the control group. During the training period, patients with intracranial aneurysms receiving precision nursing care from the experimental group showed better quality of life and neurological functional outcomes compared to the control group. The nursing training system based on 3D printing models can enhance the learning efficiency and nursing work satisfaction of nursing personnel. It may have a positive impact on the professional values of nursing personnel, thereby laying a solid foundation for providing high-quality, precise nursing services in the field of neurosurgery in the future.

Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

To explore the effect of nurse-led psychological interventions on diabetes distress, depression, and glycemic control in individuals with type 2 diabetes mellitus (T2DM). Seven databases were systematically searched. Outcome measures were diabetes distress, depression, and hemoglobin A1c (HbA1c) level. RoB 2.0 was used for risk of bias assessment. Data were synthesized using Review Manager 5.4 software. Fourteen studies were included from 2,837 articles. Five studies pooled in the meta-analysis demonstrated reduction in diabetes distress (standard mean difference = -0.36, 95% confidence interval [-0.49, -0.24], p < 0.001), favoring nurse-led psychological interventions over controls. Effects of the interventions on depression and HbA1c level were inconsistent across studies. Nurse-led psychological interventions demonstrated the effect of reducing diabetes distress and some promising benefits for depression and glycemic control. Integrating nurse-led psychological interventions into usual care will be beneficial for individuals with T2DM in the future. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Firearm Injury Prevention and Survivor Interventions: A Scoping Review.

To examine components of firearm injury prevention and survivor response programs, their outcomes, and gaps in this body of research. A total of 100 publications were identified across four databases: PubMed/Medline, PsycInfo, CINAHL, and Scopus. Articles were screened for inclusion in the scoping review and details were extracted into an electronic table for synthesis. A total of 27 articles were included. Education on firearm injury prevention was shown to be feasible and acceptable in health care settings, including emergency departments. Firearm survivor interventions to reduce violent injury recidivism may include peer or mentored support along with case management for coordination of mental health services, vocational training, and other services to address social determinants of health. Other community initiatives to clean up abandoned lots and engage community members in creating safe neighborhoods have been shown to reduce overall gun violence. Multi-level interventions that encompass education on reducing firearm injuries, strategies to improve psychosocial conditions and access to mental health services, as well as meeting the needs of firearm injury survivors, their families, and communities, are needed. Health sector and community partnerships can lead to integrated and sustainable programs to achieve safer neighborhoods and improve psychosocial outcomes for individuals affected by gun violence and impacted communities. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

The Influence of Emotional Intelligence on Psychiatric Nurses' Care Behavior, and the Chain Mediating Role of Compassion Fatigue and Perception of Management.

To investigate psychiatric nurses' emotional intelligence and its effect on care behavior, while also examining the mediating effect of compassion fatigue and perception of management. This cross-sectional study was conducted in several specialized psychiatric hospitals with 360 psychiatric nurses. Self-report surveys were administered, which included the Caring Factor Survey-Caring of Manager, Caring Behaviors Inventory, Compassion Fatigue Short Scale, and Wong Law Emotional Intelligence Scale. Data were analyzed using descriptive, correlation, and path analyses. Mean score for care behavior was 4.78 (SD = 0.83), which was at a moderate level. Compassion fatigue exhibited negative correlations with other variables. Results of mediation effect analysis showed that emotional intelligence directly predicted care behavior (p < 0.001). Emotional intelligence also indirectly affected care behavior through the mediating roles of perception of management and compassion fatigue, and affected care behavior through the chain mediation effect of perception of management and compassion fatigue. Nurse managers should pay attention to the influence of emotional intelligence on care behavior and improve care behavior by strengthening leadership and alleviating compassion fatigue. [Journal of Psychiatric Nursing and Mental Health Services, xx(xx), xx-xx.].

Factors Predicting Posttraumatic Stress and Anxiety in Parents Who Experienced the Great Eastern Anatolian Fault Line Earthquakes: A Community-Based Cross-Sectional Study.

To identify levels and predictors of posttraumatic stress disorder (PTSD) symptomatology and anxiety in parents who experienced the Great Eastern Anatolian Fault Line earthquakes. A cross-sectional and correlational study was conducted from May to September 2023, with 200 parents who experienced earthquakes along the East Anatolian Fault Line. A descriptive information form, the State-Trait Anxiety Inventory (STAI), and Impact of Event Scale-Revised (IES-R) were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data. The earthquakes caused significant distress among parents: 53% experienced unemployment, 85% had damaged homes, 31.1% lost a relative, 82% lacked an emergency kit, and 90% were concerned for their children's safety. Significant predictors of PTSD included loss of a loved one or relative, not having an emergency kit, having a severely damaged or uninhabitable home, having a chronic illness, and being anxious about the earthquake's impact on their child. High anxiety and PTSD levels were prevalent, with a positive correlation between STAI and IES-R scores. Parents were found to have high levels of PTSD symptoms and anxiety. Findings highlight the complex needs of parents in the post-earthquake context, underscoring the critical need for health professionals, including nurses, to provide comprehensive support to individuals who experienced natural disasters. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

A Composite Counternarrative of Discrimination as a Social Determinant of Health: Black College Women's Experiences of Gendered Racism.

Discrimination is a social determinant of health (SDOH) that negatively affects racially minoritized students and patients. Nurses and nurse educators must understand discrimination, including nuanced and intersecting ways that it negatively affects academic and health outcomes. In-depth interviews were conducted with 12 Black women at a primarily White institution in the Southeast United States. The interview guide, informed by critical race and intersectionality theories, explored experiences of gendered racism, particularly in the students' social environments. Narrative analysis was conducted, then a composite counternarrative was composed to portray experiences of gendered racism across multiple levels, including intrapersonal, interpersonal, and institutional. The composite narrative revealed experiences of multi-leveled gendered racial microaggressions that shape the daily lived experiences of Black college women students. Three main themes emerged: Limited Autonomy, Differential Treatment and Differential Assumptions, and Differential Access to Power and Resources. Gendered racism differs from White women's experiences of sexism and Black men's experiences of racism. Institutional efforts to support Black college women must be intentional in addressing the unique ways they experience discrimination in various settings on campus. Nurses' and nurse educators' understanding of gendered racism as a SDOH may ease the hesitancy in addressing health inequities. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Effects of Web-Based Psychotherapeutic Interventions on Depression in Mood Disorders: A Meta-Analysis Study.

To investigate the effects of web-based psychotherapeutic interventions on depression among individuals with mood disorders. For this meta-analysis study, data were obtained from October to December 2023 by searching PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center for articles published in the past 5 years. In the first stage of the search, 12,056 records were obtained. After removing duplicate studies, 4,910 records were considered for title and abstract review. After this evaluation, 139 studies were identified for full-text review. After the review, six studies reporting results on the effectiveness of web-based psychotherapeutic interventions on depression among individuals with mood disorders were ultimately included. Web-based interventions had significant positive effects and provided decreases in depression levels (standardized mean difference = -0.168, 95% confidence interval [-0.315, -0.021]; Z = -2.243; p < 0.05). Web-based interventions for mood disorders may play an effective role in reducing the burden of chronic mental illness and improving patient outcomes. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

The Influence of Nurses Performance, Facilities and Service Quality Towards Patient Satisfaction at the Outpatient Installation of Advent Hospital Bandung

Installation take care road is one of facility House the most sick used by clients or patient and also is access First for every patient For get the care needed , so that very important for House Sick For ensure that every means infrastructure , and also the provision of quality human resources For ensure quality service in maintain satisfaction patient . Research This done For know influence partial and simultaneous from performance nurses , facilities , and quality service to satisfaction patient . Research This is study quantitative descriptive , for describe influence between variable X to Y, which is done against 101 patients take care Road in the House Bandung Adventist Hospital , data inside study This collected use questionnaires that have been tested for validity and reliability, which are then processed use SPSS application , and presented in form table . Found that performance nurse No own influence significant to satisfaction patient with mark significant 0.249, while facilities and quality service own influence significant with mark respectively 0.006 and 0.000. In simultaneous performance nurses , facilities and quality service own influence significant with value 0.000 with 67.9% of satisfaction patient explained by the variables discussed in study this . Satisfaction patient influenced by performance nurses , facilities , and quality service in a way together , because That important for House Sick For Keep going maintain and improve it .

Innovative Regional Services and Heterogeneous Communication Channels: Results from the Nationwide German egePan Project for Pandemic Management.

Background: In the COVID-19 pandemic, novel regional services and communication channels emerged across all sectors of the German healthcare system. To contribute to pandemic preparedness, this study aims to describe newly established services in response to the COVID-19 pandemic from a stakeholder perspective and to examine the interprofessional communication channels, applying a nationwide cross-sectional approach. Methods: A nationwide sample of German healthcare stakeholders comprising general practitioners, associations of statutory health insurance physicians, hospital medical directors, local health departments, rescue coordination centres, medical directors of emergency services, outpatient nursing services, nursing homes, community care access centres, and hospital nursing managers was surveyed. A web-based questionnaire asked for their level of participation in newly implemented regional COVID-19 services and communication channels. Stakeholders' level of recommendation was measured using the Net Promotor Score (NPS), a metric that assesses their satisfaction towards the services surveyed. Results: In total, 1312 healthcare stakeholders participated in the survey. Diagnostic centres (23.0-90.9%), COVID-19 wards in hospitals (40.5-92.1%), emergency medical vehicles designated solely for COVID-19 patients (16.5-68.4%), and crisis intervention teams (11.6-30.6%) exhibited the highest rates of engagement. The services receiving the highest recommendation for future use were COVID-19 focus practices (NPS: 33.4-43.7), COVID-19 wards in hospitals (NPS: 47.6-84.4), transportation of COVID-19 patients exclusively by predefined professional groups (NPS: 12.5-36.4), and newly implemented digitally supported nursing services (NPS: 58.3-100.0). Telephones emerged as the most frequently used communication channel (58.0-96.7%), while email was the primary digital channel (23.7-81.5%). Conclusions: During the COVID-19 pandemic, Germany experienced significant variation in the implementation of pandemic-related services across healthcare sectors, with stakeholders prioritising services built on existing healthcare structures. Developing a proactive digital infrastructure to connect healthcare professionals from different sectors is crucial for better future pandemic management.

Clear Minds: Unravelling Delirium in Older Adults.

With an explosive population growth of older adults, the incidence rates of neuropsychiatric syndromes, particularly delirium, are increasing in the community and hospital settings. Delirium is an acute disturbance in cognition and attention that may signify a serious medical, life-threatening condition and may mimic psychiatric-mental health issues. Although its prevalence rate is lower in the community, delirium affects up to 87% of hospitalized older adults and can cost up to $152 billion each year. Despite its common occurrence, delirium is often undetected in 50% to 60% across all care settings, delaying treatment and resulting in poor patient outcomes, such as increased mortality, prolonged hospital stays, cognitive and functional impairment, decreased quality of life, and institutionalization. The current article addresses strategies to recognize delirium and presents evidence-based approaches and future considerations for delirium management. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 11-18.].

Zuranolone: A Rapidly Acting Oral Neuroactive Steroid Antidepressant for the Treatment of Postpartum Depression.

Severe depression, anxiety, and mood dysregulation during pregnancy and postpartum are risk factors for the safety and health of mother and baby. Current best practice guidelines recommend screening for depressive and anxiety symptoms before and during pregnancy, in addition to the postpartum period. Rapid identification and treatment of depression has the potential to be life-saving and prevent deleterious consequences, including impaired mother-infant bonding, emotional dysregulation, and other developmental problems. The current article reviews the neurobiological mechanisms of postpartum depression and a novel rapidly acting oral pharmacotherapeutic neuroactive steroid, zuranolone. [Journal of Psychosocial Nursing and Mental Health Services, 62(11), 7-10.].

Analysis of Factors Affecting the Inpatient Satisfaction in Integrated Nursing Care Service Wards using a Healthcare Service Survey Database

Purpose : In this study, we aimed to identify factors influencing the inpatient satisfaction in integrated nursing care service wards. Methods : Using data from the 2020 and 2021 healthcare service experience surveys conducted by the Ministry of Health and Welfare, this study analyzed a weighted sample of 416,020 participants using descriptive statistics, pairedt-test, Pearson’s correlation, and multiple linear regression analyses. Results : Inpatient satisfaction in integrated nursing care service wards was most significantly affected by the experiences with nursing services and perceived health status, followed by experiences with doctor services, length of hospitalization, age, experiences with medical institution services, education level, gender, presence of chronic diseases, type of hospital, and occupation. Most significant positive impacts were associated with experiences with nursing and doctor services, especially in general hospitals and high-level facilities, among males and elderly patients ＞ 60 years old. In contrast, high education level, presence of chronic diseases, and unemployment were associated with low inpatient satisfaction. Conclusion : Effective programs and guidelines must be developed and implemented to expand and promote the integrated nursing care and medical services and overall utilization of healthcare institutions, with a special focus on person-centered care.

Effects of Grit, Patient Safety Competence, and Patient Safety Culture on the Patient Safety Nursing Activities of Nurses in Comprehensive Nursing Service Wards

Purpose : In this study, we aimed to assess the impacts of grit, patient safety competence, and patient safety culture on the patient safety nursing activities of nurses in comprehensive nursing service wards. Methods : Here, a self-reported survey of 179 nurses from three tertiary hospitals was performed. Data from 171 valid responses were analyzed using descriptive statistics, independent &lt;i&gt;t&lt;/i&gt;-test, one-way analysis of variance, Pearson’s correlation, and stepwise multiple regression analyses.Results : The key sub-factors influencing the patient safety nursing activities were attitude (&lt;i&gt;β&lt;/i&gt;=.30, &lt;i&gt;p&lt;/i&gt; ＜.001) and skill (&lt;i&gt;β&lt;/i&gt;=.26, &lt;i&gt;p&lt;/i&gt; ＜.001) in the patient safety competence factor and safety environment (&lt;i&gt;β&lt;/i&gt;=.26, &lt;i&gt;p&lt;/i&gt; ＜.001) in the patient safety culture factor. The regression model explained 42.7% of the variance in patient safety nursing activities (F=43.29, &lt;i&gt;p&lt;/i&gt; ＜.001). Conclusion : Overall, these findings highlight the importance of improving the nurse attitude and skills related to patient safety as well as the safety environment in hospitals to enhance the patient safety nursing activities in comprehensive nursing service wards. Targeted educational and training programs should be provided along with organizational support to establish a safe and supportive nursing environment in comprehensive nursing service wards.

In the Context of Integrated Healthcare and Nursing Services, the Study Explores the Production Dilemmas and Optimization of End-of-life Care Services in the Context of Aging Population in Guangxi - based on a Survey of an End-of-life Care Pilot Project i

With the continuous deepening of China's aging population, the number of the elderly has been increasing, and the mortality rate has been rising year by year. At the end of life, people often face psychological fear and physical pain. End-of-life care plays an important role in improving the quality of life of the elderly at the end of life. End-of-life care is an extremely important link in integrated healthcare and nursing services, and it is also an effective measure promoted by the state to cope with aging population. It aims to provide end-of-life care for the elderly in China and ensure the last leg of their life journey. This study takes an end-of-life care pilot project in Guangxi as an example and conducts a field survey on the implementation of end-of-life care services in relevant nursing homes. It also conducts semi-structured interviews with 13 end-of-life care workers and analyzes the data using Nvivo software. The study aims to explore the production dilemmas of end-of-life care services in the context of integrated healthcare and nursing services and propose relevant optimization measures.

Assessment of relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Institutions of North Eastern States of Nigeria

Conflict in health care settings may be effectively managed if nurse managers possess conflict management skills such as reconciliation, listening, and effective communication to bring individuals closer and work together to find fair solutions and meet balanced needs. The study aimed at identifying the relationship between emotional intelligence and conflict resolution among nurse managers at tertiary Health Facilities, in the Northern States of Nigeria. The objectives of the study are to assess the level of emotional intelligence among nurse managers, also to identify the most common types of conflict, determine the causes of conflict, determine the conflict resolution strategies applied by the nurse managers and to identify relationship between emotional intelligence and conflict resolution among nurse managers in tertiary health institutions of North Eastern States. A mixed methods research design (quantitative and qualitative methods) was used. A total of 188 nurse managers and three Head Nursing Services departments formed the sample size. The nurse managers were given structured questionnaires and the Head of the Nursing Services department was interviewed (key informant interview). Three instruments were employed for data collection; Interview Guide, Structured Questionnaire and Participants Demographics Sheet. A simple random sampling technique was used for the study. The obtained data were coded and computed in an SPSS Version 26 and analyzed using percentages, mean and standard deviation for descriptive statistics while the Pearson Correlation Coefficient was used for the inferential statistics. The result of the study revealed that most of the nurse managers have a fair level of emotional intelligence when dealing with conflict among nurse managers. It also revealed that the most common type of conflict among nurses was related to environmental factors. The working environment was the highest cause of conflict among nurses. Social skill strategy was mostly used in conflict resolution. The study revealed that there was no significant relationship between years of experience and conflict resolution r=0.173. Based on the findings the researcher concluded that most of the respondents highly make use of social awareness in the application of emotional intelligence in conflict resolution, most of the causes of conflict among nurses were related to a working environment, and social skills were mostly used in conflict resolution among nurses. Based on the findings of the study, the researcher recommended that other sources of conflict management should be identified for nurse managers to manage conflict, nurse managers should use the skills they have to solve problems and conflict management to be part of a school of nursing curriculum.

Web-Based Nursing Care Documentation for Students to Support Online Learning

Nursing care is the most critical element in nursing services, which aims to improve the patient’s health status. Ineffective and inefficient care documentation can impact the quality of nursing services. However, the increasingly advanced development of technology provides freedom for the health world to improve the quality of patient-centered services. Educational institutions have also used information technology in learning process activities. As prospective health professionals, students must be equipped with competencies to support their performance. In this study, a web-based nursing care information system was developed to assist students in documenting care activities. The website application was designed to increase student competency in nursing documentation activities to provide high-quality nursing services even though learning is online. The waterfall model approach was used in application design. The design stage started with analyzing application requirements, followed by system design and coding. Next, using a Likert-scale questionnaire, a usability test was performed on 15 beta users to assess the functionality of the application. The results showed that the nursing care website application was easy to use and that students felt satisfied. It is hoped that the website application can be made more attractive by including a decisional support system to make it easier for students to enforce nursing diagnoses on patients.

Ready to act? Factors associated with nurses’ desire to work in Primary Health Care in Italy

Abstract Background The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation. Methods A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81). Results In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%). Conclusions A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs. Key messages • Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation. • Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.

Blood urea monitoring in heart failure patients - an important predictor of mortality

Abstract Background Recent ESC position statement regarding worsening renal failure recommends the use of blood urea monitoring of patients with heart failure with reduced ejection fraction (HFrEF). Although both serum creatinine and blood urea nitrogen are markers for renal dysfunction, blood urea nitrogen levels are also affected by reabsorption in the renal tubules, a process modulated by renin-angiotensin-aldosterone activity, sympathetic nervous activity and arginine-vasopressin activity. Thus, neurohormonal activity is reflected in the BUN/creatinine ratio (bUCR) which effectively ‘normalizes’ BUN for the degree of renal dysfunction, as measured by the creatinine level. Previous studies have demonstrated increased mortality at bUCR &amp;gt;100mmol/l. however, most of the prognostic data has come from patients admitted with acute heart failure. The use of bUCR in patients with chronic HFrHF receiving intensive titration of guideline directed medical therapy (GDMT) has not been studied. Purpose To identify the extent of blood urea monitoring in primary care in HFrEF and whether bUCR remains a significant prognostic indicator despite intensive GDMT. Methods We analysed the electronic health records of all patients referred to the Heart Failure Nurse Service (HFNS) in an NHS population approx. 400,000 in 2022. Inclusion criteria consists of patients with symptomatic heart failure NYHA II-IV with echocardiogram demonstrating HFrEF. Patients were segregated into two cohorts, with a urea/creatinine ratio greater or less than 100mmol/l and analysed. Results Data from 338 patients [mean age 72.3 ± 15.6 years; 218 (64.5%) males; 143 (42.3%) ischaemic cardiomyopathy; 141 (41.7%) AF; 49 (14.5%)] were analysed. Of these, 112 (33.1%) had chronic kidney disease (CKD) with eGFR &amp;lt;60 ml/min/1.73m2 at the time of HF diagnosis and 181 (53.6%) had CKD on discharge from the HFNS. During follow-up, 132 (39%) had further admission with HF and 76 (22.5%) died. Sixty-eight (20.1%) patients did not have blood urea checked despite the availability of serum creatinine. While an eGFR &amp;lt; 60 ml/min/1.73m2 at discharge was associated with a twofold increased risk of death (OR 2.4, 95% CI 1.1-5.3, p=0.029), a bUCR &amp;gt; 100mmol/l at discharge was associated with a four-times greater risk of death (OR 4.2, 95% CI 2.2-7.9, p &amp;lt;0.001). Conclusion Blood urea/creatinine ratio is an important predictor of outcome and can be utilised to help identify at-risk patients with HFrEF despite intensive GDMT.Survival from diagnosis bUCR

Best Evidence Summary for Management of Older People With Type 2 Diabetes Mellitus Using 'Internet Plus Nursing Services'.

To evaluate and summarise the evidence for the management of older people with Type 2 diabetes mellitus (T2DM) using 'Internet Plus nursing services (IPNS)'. This study was conducted as an evidence summary, adhering strictly to the evidence summary reporting standards established by Fudan University Center for Evidence-based Nursing. We systematically searched for the best available evidence pertaining to the management of older people with T2DM using the IPNS. The literature types encompassed clinical guidelines, expert consensuses, systematic reviews, evidence summaries and original research studies. In order to gather pertinent information, we conducted a comprehensive search across various databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, PubMed, Web of Science, Yi Maitong Guidelines Network, SinoMed, CNKI, WanFang database, Chinese Biomedical Literature Database and China Science and Technology Journal Database. The search spanned from the inception of each database up to July 2023, ensuring an extensive coverage of relevant resources. After rigorous screening and evaluation, our study ultimately identified 19 articles with high-quality research outcomes. These articles consisted of three guidelines, two expert consensus documents, three systematic reviews and eleven original research studies. Through collaborative and in-depth discussions, we extracted and synthesised 27 pieces of evidence related to the application of the IPNS to enhance the T2DM management for older people. We categorised the evidence into five primary themes: mobile terminal design, team building, health education design, interaction and social support, and information feedback. In designing the IPNS for older people with T2DM, utmost attention should be paid to the intricacies of Internet module development preceded by comprehensive guidance. It is imperative to establish multidisciplinary teams to oversee the curation of patient educational content, ensuring its relevance and effectiveness. Leveraging Internet-based information feedback mechanisms is crucial for fostering peer support, assisting in blood glucose control, enhancing self-management capabilities and ultimately improving overall quality of life. Healthcare professionals are supposed to customise the IPNS for this vulnerable population, taking into account institutional resources and local contextual realities. It is highly recommended that clinical medical personnel worldwide adhere to the evidence-based recommendations for better care of older people with T2DM using the IPNS. No patient or public contribution was incorporated in this study. Our study provides structured ideas for the application of IPNS in T2DM management, provides practicable new ways for IPNS to improve self-management of older people with T2DM, and encourages the provision of Internet-based nursing services based on the needs and characteristics of older people, and jointly solves the challenges of T2DM management in order to enhance the effectiveness of nursing services.