Background: Nursing quality is an integral part of health care quality and one of key performance indicators (KPIs) for health care management. The Plan-Do-Check-Act (PDCA) cycle is a management tool for continuous improvement of a business’s products or processes. It can be applied to standardize nursing management and thus improve the nursing quality and increase the survival rate of patients. This study assessed the value of the PDCA cycle in standardizing nursing management in an intensive care unit (ICU) for patients with severe coronavirus disease 2019 (COVID-19). Methods: The status quo of the ICU was analyzed, and the relevant issues and countermeasures were proposed. The PDCA cycle was applied to standardize the nursing management in the ICU. Results: Nine measures were proposed and applied to improve the management of the COVID-19 ICU: defining the clean or contaminated areas, use of self-designed shoe storage cabinets, defining staff roles and responsibilities, establishing the staffing structure, staff training, placing items at fixed locations, improving shift handover, use of bulletin boards for listing key points, and use of reserved drugs cabinets. The virus contamination awareness, professional skills, awareness of duties and responsibilities, and quality and performance of nursing were remarkably improved 2 weeks after the implementation of the above countermeasures. Conclusions: The PDCA cycle helps to standardize nursing management in COVID-19 ICU by developing and applying effective nursing management approaches.

Background: For a long time, fluid balance monitoring has been one of the most difficult problems in the management of patients with heart failure (HF). There is considerable interest in technology-facilitated fluid balance monitoring. However, little is known about patient acceptance and the use of mobile technology for fluid balance monitoring. Objective: The aim of this study was to develop a mobile app for technology-facilitated fluid balance monitoring and to determine its usability. Methods: A mixed-methods study was conducted in a tertiary hospital in Shanghai, China. A mobile app named I-Self-Care was developed through a best practice implementation project. Patients and nurses both completed the System Usability Scale (SUS, 0– 100) and participated in semistructured interviews. Results: I-Self-Care includes patients’ daily fluid intake and output (I&O), symptoms, hospitalization, and diuretic records. It can automatically calculate food water content and perform real-time analysis of I&O. The average SUS scores were 81.74 (SD 5.44) among 36 patients and 80.80 (SD 13.26) among 28 nurses (scale 0– 100, with 100 being the best usability), which means that I-Self-Care has high usability for both patients and nurses. Semistructured interviews about the usability of the app were conducted with 17 participants. During the interviews, the patients expressed the high ease of use of I-Self-Care, their expectations for a continuously updated database, and improved self-management behaviour. The nurses thought that family support and repeated operation demonstrations were needed for patients to use the app. The nurses also expressed the convenience of this app for nursing work and the information security of patients. Conclusion: With participant feedback, we confirmed the usability of I-Self-Care for fluid balance monitoring in patients with HF. Continuously updated databases, family support, repeated operation demonstrations, and information security are important for HF patients to use I-Self-Care.

Background: Valvular heart disease (VHD) is a leading cause of heart diseases and death, and heart valve replacement (HVR) plays a fundamental role in treating valve disease and improving the function of valves. The lack of continuity of care (CC, also known as transitional care) for postoperative patients after discharge often results in a variety of complications, bringing severe pain to the patients and diminishing their quality of life. Methods: We systematically searched for relevant randomized controlled trials (RCTs) in Cochrane databases, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chongqing VIP, and Wanfang Data. The methodological quality of the included articles was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. The meta-analysis was conducted with RevMan 5.2 software. Results: A total of 14 RCTs (involving 1,825 patients), all in Chinese language, were included in the analysis, including 920 patients in the CC group and 905 patients in the control group (receiving the routine care). Meta-analysis showed that, compared with the control group, the CC group had significantly higher anticoagulation therapy adherence [RR =1.36, 95% CI: (1.25,1.48), P<0.00001], higher awareness of anticoagulation [RR =1.14, 95% CI: (1.09, 1.18), P<0.0001], and lower incidences of anticoagulation complications and adverse events [RR =0.24, 95% CI: (0.17, 0.35), P<0.00001]. In addition, the 5 domains reflecting quality of life including physical domain [MD =2.38, 95% CI: (1.30, 3.46), P<0.0001], psychological domain [MD =2.92, 95% CI: (1.47, 4.37), P<0.0001], levels of independence [MD =4.03, 95% CI: (1.04, 7.01), P=0.008], social relationships [MD=2.56, 95% CI: (1.81, 3.32), P<0.00001], and environment [MD =4.15, 95% CI: (1.16,7.14), P=0.007] were also significantly improved. Discussion: Our results showed CC can effectively improve patients’ anticoagulation therapy adherence and raise their awareness about medications, reduce the incidences of complications and adverse events, and thus improve the patients’ quality of life. However, only a limited number of high-quality RCTs were included in our current analysis, and studies with more rigorous designs are warranted to further validate the impacts of CC on anticoagulation therapy adherence and quality of life after HVR.

Purpose: Individualized anticoagulation therapy is a major challenge for patients after heart valve replacement. Mobile applications assisted by Artificial intelligence (AI) have great potential to meet the individual needs of patients. The study aimed to develop an AI technology-assisted mobile application (app) for anticoagulation management, understand patients’ acceptance of such applications, and determine its feasibility. Methods: After using the mobile application for anticoagulation management for 2 weeks, patients, doctors, and nurses rated its usability using the System Usability Scale (SUS). Additionally, semi-structured interviews were conducted with some patients, doctors, and nurses to gain insights about their thoughts and suggestions regarding the procedure. Results: The study comprised 80 participants, including 38 patients, 18 doctors, and 24 nurses. The average SUS score for patients was 82.37± 5.45; for doctors, it was 84.17± 5.82; and for nurses, it was 81.88± 6.44. This means the patients, physicians, and nurses rated the app highly usable. Semi-structured interviews were conducted on the app’s usability with 18 participants (six nurses, three physicians, and nine patients). The interview results revealed that patients found the application of anticoagulation management simple and convenient, with high expectations for a precise dosage recommendation of anticoagulant drugs. Some patients expressed concerns regarding personal information security. Both doctors and nurses believed that elderly patients needed assistance from young family members to use the app and that it could improve patients’ anticoagulant self-management ability. Some nurses also mentioned that the use of the app brought great convenience for transitional care. Conclusion: This study confirmed the feasibility of using an AI technology-assisted mobile application for anticoagulation management in patients after heart valve replacement. To further develop this application, challenges lie in continuously improving the accuracy of recommended drug doses, obtaining family support, and ensuring information security.

Kinesiophobia, a significant barrier to daily activities, may contribute to adverse outcomes in patients following transcatheter aortic valve replacement (TAVR). This study aimed to assess the prevalence and identify factors associated with kinesiophobia in post-TAVR patients. From January to December 2023, a cross-sectional survey was conducted using a convenience sampling method, involving patients from the cardiology department of a hospital in China. The study utilized several instruments: a general information questionnaire, the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Lubben Social Network Scale-6 (LSNS-6), the Exercise Social Support Scale (ESSS), the Physical Activity Rank Scale (PARS-3) and the Self-Efficacy for Exercise Scale (SEE). Latent profile analysis (LPA) was performed to classify patients into latent subgroups based on their levels of kinesiophobia. Additionally, multivariate logistic regression analysis was employed to identify the influencing factors of kinesiophobia among patients with varying characteristics. This study included a total of 290 participants. Based on the assessment of kinesiophobia, three profile models were identified by LPA: a high-level kinesiophobia group (21 participants, 7.2%), a moderate-level kinesiophobia group (189 participants, 65.2%), and a low-level kinesiophobia group (80 participants, 27.6%). Factors influencing the levels of kinesiophobia across the three latent profiles included education level, aortic stenosis flow type, number of comorbidities, postoperative NYHA cardiac function classification, preoperative physical activity level, social networks, and exercise self-efficacy. Kinesiophobia levels in patients after transcatheter aortic valve replacement exhibit significant heterogeneity, primarily influenced by factors such as education level, aortic stenosis flow type, number of comorbidities, postoperative NYHA cardiac function classification, preoperative physical activity level, social networks, and exercise self-efficacy. In the future, healthcare professionals should identify postoperative patients at risk for kinesiophobia and consider the multifaceted factors affecting this condition. It is essential to encourage and stimulate patients’ thoughts about exercise and to provide targeted intervention strategies to reduce their levels of postoperative kinesiophobia.