Introduction: Frailty is a good predictor of adverse outcomes among older patients, especially those who have undergone surgery. The prevalence of frailty among kidney transplant candidates is higher than the general population. This study aimed to explore the predictive value of frailty on post-transplant adverse outcomes among kidney recipients. Methods: A systematic review was performed for relevant studies until May 20, 2022, using four databases (Embase, Medline, Cochrane, and PsycINFO) for prospective design studies (PROSPERP: CRD42022331022). Random-effect meta-analysis modeling was undertaken in RevMan 5.3 to estimate the predicting value of frailty on adverse outcomes after kidney transplant. Results: This systematic review included 14 studies, eight of which were suitable for meta-analysis. Frailty increased the risk of mortality (pooled hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.48–2.64), surgical complications (risk ratio [RR] 2.14, 95% CI 1.01–4.54), death-censored graft failure (DCGF) (pooled HR 3.31, 95% CI 1.27–8.62), length of stay (LOS) (pooled RR 1.59, 95% CI 1.05–2.39), length of stay ≥2 weeks (pooled odds ratio [OR] 1.72, 95% CI 1.26–2.35). and other common adverse outcomes among kidney transplant recipients. Conclusions: Frailty is associated with adverse outcomes after kidney transplant. This systematic review suggests the importance of assessing frailty among kidney transplant candidates prior to transplantation. Further research focusing on pretransplant assessment combined with frailty is warranted to improve kidney transplant management.

目的 探讨老年糖尿病高危足患者衰弱与足部护理行为的相关性.方法 采用便利抽样法,选取2022年1-6月首都医科大学宣武医院内分泌科、老年医学科收治的220例糖尿病高危足患者为研究对象.采用一般情况调查表、Gavin's糖尿病足危险因素加权值评分工具、中文版衰弱量表及糖尿病患者足部护理行为问卷对患者进行调查.采用Spearman相关性分析探讨老年糖尿病高危足患者衰弱与足部护理行为的相关性.采用多重线性回归分析老年糖尿病高危足患者足部护理行为的影响因素.本研究共发放问卷220份,回收有效问卷210份,问卷有效回收率为95.45％(210/220).结果 210例老年糖尿病高危足患者的足部护理行为问卷标准化得分为(56.65±11.27)分,整体处于中等偏差水平,其中126例(60.00％)患者的护理行为处于较差水平,80例(38.10％)患者处于中等水平.210例老年糖尿病高危足患者衰弱的发生率为27.14％(57/210).相关性分析结果显示,老年糖尿病高危足患者衰弱得分与足部及鞋袜的检查、足部清洁与养护、鞋袜的选择维度得分及足部护理行为问卷总分均呈负相关(P＜0.05).多重线性回归分析结果显示,性别、衰弱程度、足风险分级和居住状况是老年糖尿病高危足患者足部护理行为的影响因素(P＜0.05).结论 老年糖尿病高危足患者的足部护理行为有待提高,其衰弱程度越高,足部护理行为水平越低.医护人员应根据患者特征制订针对性的干预措施,改善或延缓患者的衰弱进程,进而提升其足部护理行为水平,预防糖尿病足的发生.

目的:调查我国二级及以上医疗机构护士的用药安全能力,并分析其影响因素,为提升护士用药安全能力提供参考依据.方法:采用便利抽样法,利用一般资料调查表、护士用药安全能力量表于2023年4月-5月对我国华北、华东、东北、华中、西南、西北、华南地区二级及以上医疗机构的5 193名护士进行横断面调查,并使用多元线性回归分析护士用药安全能力的影响因素.结果:二级及以上医疗机构护士的用药安全能力总分为(161.21±20.78)分,条目均分为(4.48± 0.58)分.6个维度中,影响因素管理维度的条目均分最高,改善用药安全问题维度条目均分最低.多元线性回归分析结果显示,护理工作年限、学历、所在医院等级、职称、日均护理患者数量、所在科室是护士用药安全能力的影响因素(P＜0.05).结论:二级及以上医疗机构护士用药安全能力水平良好,应结合护士的个人特征、所在医院等级、科室类型和护士用药环境等方面,采取适宜的用药安全能力培训方案,重视对改善用药安全问题等方面的培训,进一步提升我国护士的用药安全能力.

Objective:To investigate risk factors for cognitive decline in elderly hospitalised hypertensive patients, develop a risk prediction model and validate it.Methods:By the convenient sampling method, a total of 379 elderly hypertensive patients admitted to Department of Cardiology, Department of Geriatrics (General) and Department of Endocrinology in Xuanwu Hospital of Capital Medical University from April to October 2022 were selected as the study objects. Binomial Logistic regression analysis was used to explore the risk factors of cognitive frailty in elderly hospitalized hypertensive patients and establish a prediction model. Receiver operating characteristic curve (ROC) and Hosmer-Lemeshow goodness of fit test were used to evaluate the prediction effect and calibration degree of the model, and Bootstrap method was used for internal verification.Results:Among 379 elderly hospitalized hypertensive patients, 145 (38.3%) had cognitive frailty. Binomial Logistic regression analysis showed that age, education level, drinking history, daily exercise, use of angiotensin receptor antagonists, Barthel index and nutritional status were the influential factors for cognitive frailty in elderly hospitalized hypertensive patients ( P< 0.05). The area under ROC curve of the prediction model was 0.770 (95% CI: 0.721-0.819, P< 0.001), the sensitivity was 0.607, the specificity was 0.838, and the maximum approximate entry index was 0.445. Hosmer Lemeshow goodness of fit test χ 2=3.581, P=0.893. Internal validation was conducted using the Bootstrap method to resample 1 000 times, and the results showed that the average area under the ROC curve of the prediction model was 0.737 (0.687-0.788) . Conclusions:The risk prediction model for cognitive decline in elderly hospitalized hypertensive patients can predict the risk of cognitive frailty in elderly hospitalized hypertensive patients, which can provide references for medical staff to develop corresponding intervention measures.

Background Diabetic foot is a global threat to public health, as it can lead to infections and amputations and cause significant pain and economic costs for patients. Diabetic foot patients in northern China have more severe local ulcers, worse prognosis, and longer disease duration. Objective This study assessed the foot risk levels and foot care knowledge and behavior status of people with diabetes with different foot risk levels, and investigated the factors that influence the occurrence of high-risk foot in diabetes. Methods This cross-sectional survey included 410 hospitalized people with diabetes. Demographic and disease-related data and foot risk stratification status were collected using investigator-designed questionnaires. Foot care knowledge and behavior questionnaires were also used. Results Among the 410 participants, a total of 367 cases were classified as high-risk feet, among which 135 cases were rated as grade 1, 202 cases grade 2, and 30 cases grade 3. Foot care knowledge surveys revealed low scores in the areas of shoe and sock selection, foot and footwear examination, and management of foot problems. Foot care behavior surveys showed low scores in the areas of foot and footwear examination, management of foot problems, and foot injury risk behavior. One-way ANOVA revealed significant differences in foot care behaviors among patients with different foot risk classifications ( p < 0.05), while no significant differences were observed in foot care knowledge scores. Multivariate logistic regression analysis showed that age, history of cerebrovascular disease, and foot care behavior scores were factors influencing the occurrence of high-risk foot in people with diabetes. Conclusion The results of this study showed a high prevalence of high-risk foot in diabetics; The knowledge and behavior of foot care in diabetics with different foot risk levels were both at a moderately low level; There were differences in foot behavior scores among patients with different foot risk classes, but, counter-intuitively, no significant differences in foot care knowledge. The study found that advanced age, history of cerebrovascular disease, and low foot care behavior scores are risk factors for high-risk foot in diabetes. Therefore, it is necessary to screen patients with diabetes for high-risk feet and implement targeted interventions according to the results.

目的:深入了解糖尿病足病人在疾病进程中对各个不同相关方面所认知的需求及其相互之间的关联影响,为医护人员制定高效的联合干预措施提供依据.方法:采用现象学方法对11例糖尿病足病人进行半结构访谈,运用Colaizzi七步法分析程序进行资料分析.结果:共形成3个类别及6个主题,分别为足部护理知识的需求、疾病自我管理的需求、家庭支持与照顾的需求、专业诊疗护理技术的需求、便利性诊疗护理服务的需求、疾病相关健康教育的需求.结论:糖尿病足病人需求是来自多方面且互相关联的,医护人员应从不同角度出发理解病人需求并重视病人在疾病发展全过程中存在的需求,通过多样化健康教育、开展居家护理服务、构建医院-社区-家庭3方联动的糖尿病足防控模式等措施满足病人需求,进而提高病人体验及生活质量.

护理专业认证可以确定护士实践的资格,保证临床护理质量,同时为护理教育提供参考.文章以美国开业护士认证的发展为主,综述了开业护士认证发展历史、认证机构、认证流程和认证管理的整体框架以及与认证相关研究的发展方向,为我国开业护士认证的发展提供参考.

目的:通过 Meta 分析评价疾病特异性移动健康软件对 2 型糖尿病病人健康管理效果的影响.方法:计算机检索 PubMed、EMbase、the Cochrane Library、CINAHL、万方数据库和中国知网数据库中有关疾病特异性移动健康软件对 2 型糖尿病病人健康管理效果的随机对照试验,检索时限为建库至 2021 年 12 月.经质量评价后,采用 RevMan 5.4 软件进行 Meta分析.结果:共纳入 12篇文献.Meta分析结果显示,基于疾病特异性移动健康应用软件可显著降低 2 型糖尿病病人的糖化血红蛋白[MD=-0.39,95%CI(-0.51,-0.28),Z=6.70,P＜0.00001],提高病人服药依从性.但在改善病人体质指数[MD=-0.08,95%CI(-0.37,0.21),Z=0.52,P=0.60]、总胆固醇水平[SMD=-0.07,95%CI(-0.22,0.08),Z=0.94,P=0.35]、收缩压[MD=2.32,95%CI(-0.22,4.86),P=0.07]及舒张压[MD=0.88,95%CI(-0.71,2.47),P=0.28]方面差异无统计学意义.结论:现有证据表明,疾病特异性移动健康软件可降低病人糖化血红蛋白水平、提升其服药依从性,但在改善病人血压、体质指数及总胆固醇水平上效果不显著,后期需开展更多临床高质量研究进一步验证其临床效果.

This article briefly introduces the roles and characteristics of nurse practitioners abroad and reviews their role and influence in primary health care and puts forward some thoughts on the training of nurse practitioners in China, in order to provide a reference for the training of nurse practitioners in China.