Background/Objectives: We aim to codesign and test a nurse-led, large language model-empowered agent to increase hepatitis B screening and vaccination for inclusion health populations. Methods: This study employs a double diamond model-guided codesign methodology. It includes four phases: (i) Discover: To identify intervention targets, a systematic review was undertaken that synthesized 51 factors influencing hepatitis B screening and vaccination among inclusion health populations. A qualitative study will later be conducted to further elucidate specific cultural barriers in the Chinese context. (ii) Define: To delineate effective intervention designs, two systematic reviews were performed, informing the integration of nurse-led intervention components (e.g., counseling, case management, and care coordination) and adaptation of a large language model to address identified intervention targets. (iii) Develop: To codesign an agent, hepatitis B prevention datasets will be constructed with subsequent model adaptations through fine-tuning and retrieval-augmented generation, as well as collaborations among diverse stakeholders. It will facilitate human-agent interactive consultation, intelligent case management, and care coordination, as well as collaborate with a nurse-led multidisciplinary team to manage hepatitis B screening, vaccination, and care linkage. (iv) Deliver: To evaluate and refine the agent, a mixed-methodology will be adopted, encompassing quantitative evaluation of model response, as well as qualitative evaluation of user experience, technical barriers, and potential benefits. Discussion: This intervention is expected to improve hepatitis B screening and vaccination rates among inclusion health populations, thereby enhancing diagnosis, immunity, and care linkage. It will establish a codesign framework for nursing-specific large language models, broadening the impact of nurses on preventive health equity.

OBJECTIVES:This study aimed to explore barriers precluding hepatitis B virus (HBV) preventive care among the rural population. METHODS:Guided by the National Institute on Minority Health and Health Disparities framework, this qualitative study applied an interpretative phenomenological approach. Participants (n = 34) were recruited from three healthcare settings in southern China from May 2024 to January 2025. Data from semi-structured interviews were analyzed using interpretative phenomenological analysis. RESULTS:Barriers spanned four domains with 11 subthemes. 1) Behavioral: the last-resort paradigm in healthcare utilization, reliance on folk remedies, and intergenerational silence in familial HBV prevention; 2) Physical environment: remote residence from healthcare facilities and compound vulnerabilities in living and working environments; 3) Sociocultural: social marginalization stemming from HBV discrimination, fatalistic resignation towards health, and the myth of the hardy survivor; and 4) Healthcare system: misperceptions, underestimated needs, and access barriers related to labor, mobility, and misaligned healthcare insurance policy. CONCLUSIONS:These barriers perpetuate late HBV diagnosis, low vaccine uptake, and poor treatment adherence among the rural population. This highlights the need for mobile health services to overcome geographic barriers; culturally appropriate interventions to dismantle misinformation, HBV discrimination, and myths; and policies to reduce financial burden and improve insurance coverage, thereby making HBV preventive care accessible for this marginalized group.

PURPOSE:Maintenance hemodialysis (MHD) patients frequently experience psychological distress, including learned helplessness (LH), which impairs self-management and adversely affects health-related quality of life. This study aimed to investigate the latent profiles of LH among MHD patients and to identify the biopsychosocial determinants influencing these profiles. METHOD:A cross-sectional survey was conducted in five hospitals in Guangdong, China, from May to July 2024, enrolling 548 MHD patients. Latent Profile Analysis (LPA) was applied to classify patients into distinct LH subgroups. Chi-square tests and multinomial logistic regression analyses were employed to identify factors influencing LH profiles. RESULTS:LPA identified three distinct LH profiles: High Helplessness-Resigned Group (49.0%), Moderate Helplessness-Adaptive Group (36.4%) and Low Helplessness-Hopeful Group (14.6%). Regression analyses revealed that sex, income, history of kidney transplantation, symptom distress, hope, and family support were significant determinants of LH profiles. Patients with high symptom distress, lower levels of hope, and reduced family support were more likely to belong to the High Helplessness-Resigned Group. CONCLUSIONS:The findings underscore the complex nature of LH in MHD patients and emphasize the importance of symptom management, hope enhancement, and family support in interventions. Tailored psychological and social support strategies may alleviate LH, improving the mental health and quality of life of MHD patients. Future studies should examine the long-term impact of these interventions on patient outcomes.

BACKGROUND:A functional arteriovenous access is crucial for hemodialysis patients. Regular monitoring of vascular access allows for early detection and treatment of complications, which helps the access last longer and improves the effectiveness of dialysis. Clinical guidelines emphasize physical examination as the main way to monitor vascular access. To highlight the importance of physical examination among hemodialysis clinicians, this review investigates its application in AV access assessment. METHODS:We searched the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science, Cochrane Library, Embase, ProQuest, and UpToDate databases from their inception to November 25, 2022, for studies on the physical examination of arteriovenous access. RESULTS:Physical examination exhibits acceptable sensitivity and specificity for detecting AV fistula maturation and stenosis. Quantitative physical examination indicators demonstrate high accuracy in assessing AV fistula stenosis and thrombosis. While widely used to evaluate vascular access function, dialysis practitioners often lack sufficient training and knowledge in physical examination. Therefore, comprehensive training for dialysis professionals in this area is essential. CONCLUSIONS:Several factors hinder the widespread use of physical examination in clinical settings. To optimize AV access care, hemodialysis managers should prioritize the development of standardized physical examination protocols that include quantitative indicators and assessment tools. Furthermore, regular training and competency assessments for dialysis staff are vital. Strengthening practitioners' physical examination proficiency will lead to earlier identification of AV access issues, greater access durability, and improved patient well-being.

BackgroundChronic diseases are a major global health burden, accounting for nearly three-quarters of the deaths worldwide. Large language models (LLMs) are advanced artificial intelligence systems with transformative potential to optimize chronic disease management; however, robust evidence is lacking. ObjectiveThis review aims to synthesize evidence on the feasibility, opportunities, and challenges of LLMs across the disease management spectrum, from prevention to screening, diagnosis, treatment, and long-term care. MethodsFollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, 11 databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, IEEE Xplore, MEDLINE via Ovid, ProQuest Health & Medicine Collection, ScienceDirect, Scopus, Web of Science Core Collection, China National Knowledge Internet, and SinoMed) were searched on April 17, 2024. Intervention and simulation studies that examined LLMs in the management of chronic diseases were included. The methodological quality of the included studies was evaluated using a rating rubric designed for simulation-based research and the risk of bias in nonrandomized studies of interventions tool for quasi-experimental studies. Narrative analysis with descriptive figures was used to synthesize the study findings. Random-effects meta-analyses were conducted to assess the pooled effect estimates of the feasibility of LLMs in chronic disease management. ResultsA total of 20 studies examined general-purpose (n=17) and retrieval-augmented generation-enhanced LLMs (n=3) for the management of chronic diseases, including cancer, cardiovascular diseases, and metabolic disorders. LLMs demonstrated feasibility across the chronic disease management spectrum by generating relevant, comprehensible, and accurate health recommendations (pooled accurate rate 71%, 95% CI 0.59-0.83; I2=88.32%) with retrieval-augmented generation-enhanced LLMs having higher accuracy rates compared to general-purpose LLMs (odds ratio 2.89, 95% CI 1.83-4.58; I2=54.45%). LLMs facilitated equitable information access; increased patient awareness regarding ailments, preventive measures, and treatment options; and promoted self-management behaviors in lifestyle modification and symptom coping. Additionally, LLMs facilitate compassionate emotional support, social connections, and health care resources to improve the health outcomes of chronic diseases. However, LLMs face challenges in addressing privacy, language, and cultural issues; undertaking advanced tasks, including diagnosis, medication, and comorbidity management; and generating personalized regimens with real-time adjustments and multiple modalities. ConclusionsLLMs have demonstrated the potential to transform chronic disease management at the individual, social, and health care levels; however, their direct application in clinical settings is still in its infancy. A multifaceted approach that incorporates robust data security, domain-specific model fine-tuning, multimodal data integration, and wearables is crucial for the evolution of LLMs into invaluable adjuncts for health care professionals to transform chronic disease management. Trial RegistrationPROSPERO CRD42024545412; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024545412

Background/Objectives: We aimed to construct a nomogram model for predicting arteriovenous fistula dysfunction risk and to conduct internal validation. Methods: The clinical data of 335 patients from the 8th Affiliated Hospital of Sun Yat-Sen University, collected from January 2019 to January 2024, were retrospectively analyzed. Among these patients, 103 were assigned to the arteriovenous fistula (AVF) dysfunction group, while 232 were in the non-dysfunction group. In this study, we first identified risk factors for AVF dysfunction using univariate and logistic regression analyses, and then constructed a prediction model by resampling the data. The model's performance was evaluated using the C-index, ROC curve, calibration plot, and decision curve analysis, confirming its strong predictive ability and clinical value. Results: The results indicated that post-dialysis hypotension, abnormal fibrinogen levels, platelet abnormalities, total cholesterol levels, and diabetes mellitus emerged as independent risk factors for AVF dysfunction in MHD patients; however, total protein levels were a protective factor for AVF dysfunction. The model's performance was assessed using the receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow test, and the calibration curve. The ROC curve results demonstrated that the area under the curve (AUC) for the training set was 0.852 (0.799-0.904), while that for the validation set was 0.810 (0.715-0.906), indicating good calibration. The decision curve analysis revealed that the predictive nomogram was clinically useful when the threshold for intervention was set between a 15% and 78% probability of dysfunction. Conclusions: The nomogram prediction model constructed in this study can be used to predict the risk of autogenous arteriovenous fistula dysfunction in hemodialysis patients.

Objective: This study aimed to assess the effect of banana intake during hemodialysis on serum potassium levels in maintenance hemodialysis (MHD) patients. Methods: This study was a single -center, randomized controlled clinical trial conducted from September 15 to December 15, 2021, at a tertiary hospital in southern China. A total of 126 MHD patients were randomly assigned to either the intervention group (n = 64) or the control group (n = 62). Patients in the intervention group consumed approximately 250 g of bananas during hemodialysis, while those in the control group did not consume any food during hemodialysis. Demographic information and hemodialysis-related parameters were collected through case information collection before hemodialysis. Laboratory indicators (such as complete blood count, biochemical indicators, inflammation markers, liver function, kidney function, etc.) were evaluated by collecting pre-hemodialysis blood samples from patients. Serum potassium and blood glucose levels were measured at 2 h and 4 h of hemodialysis, as well as before the next hemodialysis session, and hemodialysis-related complications were recorded. The blood potassium and blood glucose indicators during hemodialysis were compared using repeated measures analysis. Results: A total of 122 MHD patients completed the study (61 in each group). The results showed that there was no significant interaction between group and time on serum potassium levels. However, serum potassium levels in the intervention group were higher than those in the control group at 2 h (3.9 +/- 0.5 mmol/L vs. 3.6 +/- 0.3 mmol/L, P < 0.01) and 4 h (3.5 +/- 0.4 mmol/L vs. 3.3 +/- 0.3 mmol/L, P < 0.01) of hemodialysis. There was no interaction between group and time on blood glucose levels. The incidence of arrhythmias (8.2% vs. 29.5%, P = 0.003) and hypokalemia (52.5% vs. 80.3%, P = 0.002) during hemodialysis was signi ficantly lower in the intervention group compared to the control group. Conclusion: Consuming approximately 250 g of bananas at the start of hemodialysis does not lead to hyperkalemia. It can effectively reduce the incidence of hypokalemia and arrhythmias, and prevent a rapid decline in serum potassium levels during hemodialysis. (c) 2024 The authors. Published by Elsevier B.V. on behalf of the Chinese Nursing Association.

Abstract Background and Aims Research on the association between activity levels and sedentary behaviour with frailty in patients affected by hepatitis B cirrhosis is sparse. This study aimed to explore the association of frailty with activity levels and sedentary behaviours in patients with hepatitis B cirrhosis. Design This cross‐sectional study followed the STROBE checklist. Methods This study was conducted in Guangzhou, China, between August 2021 and October 2022. The frailty condition of patients with hepatitis B cirrhosis was assessed using the liver frailty index (LFI). Their physical activity levels and sedentary time were assessed using the International Questionnaire of Physical Activity. Pearson correlation and binary logistic regression were used to analyse the data. Results Among the 503 patients with hepatitis B cirrhosis in the final analysis, 107 (21.3%) were identified as frail. Frailty was negatively correlated with walking time (r = −0.174, p < 0.001), moderate‐intensity activity time (r = −0.185, p < 0.001), high‐intensity activity time (r = −0.243, p < 0.001) and total activity time (r = −0.256, p < 0.001). Patients with insufficient activity (<150 min/week) and sedentary behaviour (≥420 min/day) were found to have 2.829 times higher risk of frailty than those with sufficient activity (≥150 min/week) and no sedentary behaviour (<420 min/day) (95% CI: 1.380, 5.799). Conclusion Patients with hepatitis B cirrhosis who exhibited frailty demonstrated limited physical activity and engaged in sedentary behaviours. No patient or public contribution Patients with hepatitis B cirrhosis contributed their data to the study.

INTRODUCTION:Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area. METHODS:Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires-the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index-were utilized for data collection through the Questionnaire Star platform. FINDINGS:Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment. DISCUSSION:Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.

As the global population of patients undergoing maintenance hemodialysis continues to grow, more than half are experiencing the psychological distress associated with learned helplessness, a condition potentially linked to adverse outcomes such as depression and suicidal ideation. However, the triggers contributing to learned helplessness in these patients remain poorly understood. This study employs an interpretative phenomenological approach to explore the experiences and triggers of learned helplessness among 26 maintenance hemodialysis patients across five hospitals in China. The analysis of participants’ narratives reveals that learned helplessness in these patients is influenced by a combination of physiological, psychological, and social factors. Physical discomfort and psychological changes contribute to their sense of helplessness. Despite seeking support from family and healthcare providers, their distress often goes unnoticed. Additionally, the social stigma of being perceived as a “special group” further exacerbates their learned helplessness. Based on the findings, the following recommendations are provided to effectively mitigate learned helplessness: Healthcare professionals must reduce symptom burden, provide psychological assessment and support, and assist in rebuilding positive patient cognition. It is also crucial to enhance connections between patients, their families, and social support groups, reduce misunderstandings and stigmatization, and strengthen community support systems.

Background: With approximately one-third of the global population exhibiting serological evidence of exposure, the hepatitis B virus remains a serious public health threat. Elimination of hepatitis B faces enormous challenges, from prevention to diagnosis, treatment, and long-term monitoring. Nurses are pivotal in optimising the hepati-tis B care continuum; however, their contributions have been neglected. Objective: To identify the role of nurses in the elimination of hepatitis B and to synthesise the effectiveness of in-terventions with nursing roles in approaching the elimination target. Design: A systematic review and meta-analysis. Setting(s): Thirteen databases (EMBASE, MEDLINE via OvidSP, Ovid Emcare, Ovid Nursing Database, British Nurs-ing Index, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Web of Science Core Collection, China National Knowledge Internet, SinoMed, and Wanfang Data) were searched from their inception to 6 December 2022. Methods: Interventional studies examining the contribution of nursing roles towards elimination targets were in-cluded. Content analysis was used to extract and map the nursing roles based on the nursing interventions clas-sification system. Random-effects meta-analyses were conducted to examine the effectiveness of the intervention in improving hepatitis B screening, detection, and vaccination rates. Results: The synthesis from 16 studies identified 13 nursing roles that primarily involved (1) health education and counselling for informed patient decision-making regarding hepatitis B prevention, vaccination, screening, and disease monitoring; (2) case management and health promotion to advocate elimination services at multiple levels and enable equitable access among marginalised communities; and (3) running specialist clinics to lead advanced practices in prescribing and carrying diagnostic tests, formulating evidence-based individualised care plans, and coordinating care throughout the disease process. Interventions with these roles achieved pooled hep-atitis B screening and detection rates of 64% (95 % confidence interval [CI] = 0.44, 0.84) and 2 % (95 % CI = 0.00, 0.05), respectively, increased the odds of hepatitis B virus vaccination by 2.61 times (95 % CI = 1.60, 4.28), im-proved immunity rate, and enhanced patient adherence to antiviral treatment and monitoring of liver comorbid-ities. However, their effects on hepatitis B virus DNA-negative conversion rates and hepatocellular carcinoma incidence were not significant. Conclusions: Nurses play multifaceted roles in advocating hepatitis B screening and vaccination, initiating outreach efforts in marginalised communities, and leading advanced practices that effectively contribute to the elimination of hepatitis B. Policymakers should consider how nurses may help the achievement of the elimination target. Registration: PROSPERO (CRD42022380719) registered on December 12, 2022. Tweetable abstract: Nurses raised awareness, initiated outreach efforts, addressed inequalities, and led advanced practices-effectively contributing to eliminating hepatitis B. (c) 2023 Elsevier Ltd. All rights reserved.

Abstract Background Marginalised poor populations, characterised by poverty and social exclusion, suffer disproportionately from hepatitis B virus (HBV) infections and encounter substantial disparities in access to healthcare. This has further exacerbated the global HBV burden and precluded progress towards HBV elimination. This mixed-method systematic review aimed to synthesise their utilisation and influencing factors in HBV healthcare services, including screening, vaccination, treatment, and linkage-to-care. Methods Eleven databases were searched from their inception to May 4, 2023. Quantitative and qualitative studies examining the factors influencing HBV healthcare access among marginalised poor populations were included. A meta-analysis was conducted to synthesise the pooled rates of HBV healthcare utilisation. The factors influencing utilisation were integrated and visualised using a health disparity research framework. Results Twenty-one studies were included involving 13,171 marginalised poor individuals: sex workers, rural migrant workers, irregular immigrants, homeless adults, and underprivileged individuals. Their utilisation of HBV healthcare ranged from 1.5% to 27.5%. Meta-analysis showed that the pooled rate of at least one dose of the HBV vaccine barely reached 37% (95% confidence interval: 0.26‒0.49). Fifty-one influencing factors were identified, with sociocultural factors (n = 19) being the most frequently reported, followed by behavioural (n = 14) and healthcare system factors (n = 11). Socio-cultural barriers included immigration status, prison history, illegal work, and HBV discrimination. Behavioural domain factors, including previous testing for sexually transmitted diseases, residential drug treatment, and problem-solving coping, facilitated HBV healthcare access, whereas hostility coping exerted negative influences. Healthcare system facilitators comprised HBV health literacy, beliefs, and physician recommendations, whereas barriers included service inaccessibility and insurance inadequacies. The biological and physical/built environments were the least studied domains, highlighting that geographical mobility, shelter capacity, and access to humanitarian health centres affect HBV healthcare for marginalised poor populations. Conclusions Marginalised poor populations encounter substantial disparities in accessing HBV healthcare, highlighting the need for a synergistic management approach, including deploying health education initiatives to debunk HBV misperceptions, developing integrated HBV management systems for continuous tracking, conducting tailored community outreach programmes, and establishing a human rights-based policy framework to guarantee the unfettered access of marginalised poor populations to essential HBV services.

目的 了解血液透析护士科室工作氛围与职业倦怠的现状及其相关关系，探讨护士科室工作氛围中引起的职业倦怠因素，初步提出职业倦怠的组织干预措施。方法 采取分层随机整群的抽样方法，选择10 570名血液透析护理人员作为研究对象。调查问卷调查护理人员的一般资料，通过采用马氏人际工作者倦怠量表评价职护士的职业倦怠程度，专业护士工作环境量表评价护士的工作环境现状。利用统计学方法结合职业倦怠量表对血液透析护士产生职业倦怠与科室工作氛围的相关性进行了分析。结果 不同年龄、护龄、血透护龄、职称、职务医院性质、医院级别、发表论文数量、主持或参与科研项目、人际关系与血液透析护士总体的心理状况均有统计学差异。不同科室氛围，护士心理状况不同。结论 随着科室工作氛围越差护士的职业倦怠就越明显。职业倦怠的干预可从改善护士科室氛围入手，可采取提高管理人员素质，改进工作方法定期对护士的工作满意度进行测量和改善，激发护士的内在动机，建立高效的团队合作。

Objective:This study aimed to investigate the impact of integrating medical nursing with targeted functional training interventions on neurological and limb motor function and self-care ability in patients diagnosed with cerebral hemorrhage. Methods:A retrospective cohort study was conducted, including 100 patients diagnosed with cerebral hemorrhage who received interventions at our hospital between January 2020 and June 2022. The patients were divided into two groups: the research group (50 cases) and the reference group (50 cases), based on different intervention methods. The reference group received targeted functional training intervention, while the research group implemented the integration of medical nursing in addition to the reference group intervention. Differences in the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index, Modified Barthel Index (MBI) score, Glasgow Coma Scale (GCS) score, Edinburgh Speech Scale (ESS) score, Fugl-Meyer score, Ability of Daily Living (ADL) score, and efficacy evaluation were observed and compared between the two groups of patients. Results:After nursing, the Fugl-Meyer score and Barthel index score were significantly higher in both groups compared to before nursing, with the research group showing higher scores than the reference group (P < 0.05). There was no significant difference in limb motor function scores between the two groups before nursing (P > 0.05). After the integrated nursing intervention, the NIHSS and ADL scores of both groups were significantly higher than before nursing, with the research group demonstrating higher scores than the reference group (P < 0.05). Conclusions:Integrating medical nursing with targeted functional training interventions has the potential to significantly improve cognitive function, neurological function, and daily activity engagement in patients with cerebral hemorrhage, thereby enhancing their overall quality of life.

Background: Pulmonary hypertension (PH) is common in patients with end-stage renal disease (ESRD). Arteriovenous fistulas (AVF) creation may involve in the pathogenesis of PH. The aim of this study was to explore the impact of PH after AVF creation on the AVF failure rate in maintenance hemodialysis (MHD) patients. Methods: From January 1, 2009, to January 1, 2019, we retrospectively collected data of 578 MHD patients in Guangdong Provincial People's Hospital Blood Purification Center, China. Patients were followed-up until AVF failure or death or May 25, 2020. According to the systolic pulmonary artery pressure (SPAP) within 1 year after the establishment of AVF, the MHD patients were divided into three groups: SPAP <= 35 mmHg, 35 < SPAP < 45 mmHg, SPAP > 45 mmHg. The primary outcome was AVF failure defined as AVF cannot complete hemodialysis. The secondary outcomes were all-cause mortality. Results: A total of 578 patients were analyzed. The average age was 60.66 +/- 15.34 years (58.1% men). Of these, 26.1% of patients were reported PH. The SPAP exhibited a left-skewed nonparametric distribution and the overall SPAP after the creation of AVF was 39.00 (29.00-52.00) mmHg. The median follow-up was 5.8 (5.5-6.3) years. Overall, 12.8% (74/578) patients were reported AVF failure events. There was no significant difference in AVF failure rate among three groups (p = 0.070). A total of 111 (19.2%) died during the follow-up period. Compared with the SPAP <= 35 mmHg group, only the all-cause death rate significantly increased in MHD patients with PH (p < 0.001). Conclusions: The secondary pulmonary hypertension after AVF creation did not increase the risk of AVF failure in MHD patients, but significantly increased the risk of mortality for this portion of the patients. Future larger sample sizes, multi-center, and prospective trials are needed to make sure which type of access will benefit on their survival for MHD patients with SPAP > 35 mmHg.

ObjectiveTo clarify influence of absolute value of ratio of prepump pressure to blood flow rate（|Pa/Qb|） to dysfunction of autogenous arteriovenous fistulas（AVF） and its safety range，and to explore influencing factors of |Pa/Qb|.MethodsClinical information of 490 patients undergoing long⁃term hemodialysis in hemodialysis centers of 3 tertiary grade A hospitals from January 2018 to January 2019 were analyzed retrospectively.Relationship between |Pa/Qb| and AVF dysfunction was evaluated.Influencing factors of |Pa/Qb| were explored.Results85 of 490 patients had AVF dysfunction.Restricted cubic splines revealed U-shaped association between |Pa/Qb| and risk of AVF dysfunction（P<0.001）.When |Pa/Qb| was from 0.30 to 0.52，AVF function was in the safe range.Linear regression analysis showed that |Pa/Qb| was negatively correlated with mean arterial pressure and age，and positively correlated with β2⁃microglobulin concentrations and hemoglobin concentrations（P<0.05）.ConclusionsWhen |Pa/Qb|<0.30 or |Pa/Qb|>0.52，risk of AVF dysfunction is significantly increased，and patient's AVF function should be reassessed.In addition，|Pa/Qb| monitoring can help nurses judge rationality of blood flow rate setting and identify adverse events，prevent further deterioration of AVF function，and prolong life of AVF.

目的 了解我国血液透析护理人力资源配置及影响因素,为血液透析护理人力资源管理提供参考.方法 采用自行设计的调查问卷,对31省/直辖市/自治区1208所医院共4712名血液透析护士进行调查.结果 每10例患者配备护士人数＜1的医院347所(28.7％),每名护士每班次负责机器台数＞5的医院有455所(37.7％).logistic回归分析显示,地区、医院性质、月透析例次、医院等级、每名护士每班次负责机器台数是影响护士配置的主要因素(均P＜0.01);每10例患者配备护士人数、月透析例次是影响每班次护士配置的主要因素(均P＜0.01).结论 我国血液透析护理人力资源配置不足且每班次护理患者数量超标.建议补足护理人力及保证每个治疗班次的护理人力,以减轻护士工作压力,确保患者的透析质量和安全.

目的 探讨老年维持性血液透析患者自体动静脉内瘘(AVF)1年失功率的影响因素.方法 选取2018年7月至2020年5月在广东省人民医院采用前臂AVF做为血管通路的118例维持性透析患者,分为老年组(≥60周岁)和非老年组(<60周岁),运用彩色多普勒超声检查并随访患者AVF失功情况.采用COX比例风险模型进行多因素分析老年患者AVF 1年失功率的影响因素.结果 单因素分析提示AVF 1年失功率与内瘘穿刺部位血流量有关.Kaplan-Meier生存曲线及log-rank检验提示老年组患者AVF 1年通畅率显著低于非老年组,HR(95％CI)=3.612(1.085～12.020),P=0.036.两组分析提示:吻合口直径小于0.35 cm、内瘘穿刺部位血流量小于500 mL/min和桡动脉血流量小于400 mL/min患者AVF 1年通畅率显著降低(P<0.05).COX比例风险模型多因素分析显示内瘘穿刺部位血流量是AVF 1年通畅率的独立影响因素.结论 老年维持性血液透析患者AVF 1年失功率较高,需要密切关注并定期监测其穿刺部位血流量变化.

抗中性粒细胞胞浆抗体(ANCA)相关性血管炎是一组由自身免疫介导的炎症性疾病.本文介绍了1例ANCA相关性血管炎患者接受蛋白A免疫吸附治疗的情况,对其治疗过程及临床疗效进行分析与总结,以期为临床上治疗此病提供参考和借鉴.

目的:明确泵前动脉压与泵控血流速比值的绝对值(|Pa/Qb|)对自体动静脉内瘘(AVF)功能不良的影响及其安全范围,探究|Pa/Qb|的影响因素.方法:回顾性分析2018年1月—2019年1月3所三级甲等医院血液透析中心490例长期血液透析病人临床资料,评估|Pa/Qb|与AVF功能不良的关系,探究|Pa/Qb|的影响因素.结果:490例病人中有85例病人发生AVF功能不良.限制性立方样条显示,|Pa/Qb|与AVF功能不良风险存在U形关联(P<0.001).当|Pa/Qb|为0.30～0.52时,AVF功能处于安全范围.线性回归分析显示,|Pa/Qb|与平均动脉压、年龄呈负相关,与β2微球蛋白浓度、血红蛋白浓度呈正相关(P<0.05).结论:当|Pa/Qb|<0.30或|Pa/Qb|>0.52时,AVF功能不良风险显著增加,应重新评估病人的AVF功能.此外,|Pa/Qb|监测可帮助护士判断泵控血流速设置的合理性以及识别不良事件,防止AVF功能进一步恶化,延长AVF的使用寿命.