Patients with end‑stage kidney disease (ESKD) often struggle to choose among kidney replacement therapy options due to information ambiguity and the complexity of treatment pathways. In nursing, comprehensive, person-centered care has become more popular, placing a strong emphasis on advocacy and the defense of patients’ rights. Discussions about the value of patient-physician collaboration in decision-making, patient involvement strategies, and the nuances of decision-making processes have resulted from this. Currently, there is a steady increase in research on dialysis modality decision-making for patients with end-stage kidney disease (ESKD). However, more comprehensive context-specific conceptual frameworks are still needed to support this research. This study is aim to examine the kidney replacement therapy decision-making process and its influencing factors among patients with ESKD in the nephrology department of a tertiary hospital in China, contributing to a broader shared decision-making paradigm. Twelve patients with ESKD participated in face-to-face interviews using a semi-structured format to facilitate an in-depth understanding of their experiences. The qualitative data from these interviews underwent an inductive thematic analysis to identify underlying themes and patterns. The interview data were coded at three distinct levels using NVIVO 12.0 software, ensuring a thorough and nuanced interpretation. Primary results of analysis of the experiences included three main themes with eight subthemes generated from the data: (1) The precondition: symptom perception (physical and psychological perceptions); (2) The dilemma: information and communication (information dilemma and communication dilemma); (3) The outcome: decision-making behavior (personal, family, social, and therapeutic factors). Patients’ kidney replacement therapy decision‑making process involves three stages: symptom perception as a precondition, dilemmas in information and communication, and multifaceted decision‑making behaviors influenced by personal, familial, social, and therapeutic factors. The results of this study offer a theoretical basis for supporting clinical decision-making practices that align with patients’ experiences and values. To improve information distribution, patient decision aids can be created, and information technology can give broad decision support that matches patients’ values. Not applicable.

Abstract Background Chronic kidney disease (CKD) is a significant public health concern, and patient self-management is an effective approach to manage the condition. Mobile applications have been used as tools to assist in improving patient self-management, but their effectiveness in long-term outpatient follow-up management of patients with CKD remains to be validated. This study aimed to investigate whether using a mobile application combined with traditional outpatient follow-up can improve health outcomes of patients with CKD . Methods This retrospective cohort study recruited CKD patients with stage 1–5 who were not receiving renal replacement therapy from a CKD management center. Two groups were established: the APP + outpatient follow-up group and the traditional outpatient follow-up group. Baseline data was collected from January 2015 to December 2019, followed by a three-year long-term follow-up until December 2022. Laboratory data, all-cause mortality, and renal replacement treatment were then collected and compared between the two groups. Results 5326 patients were included in the study, including 2492 in the APP + outpatient group and 2834 in the traditional outpatient group. After IPTW virtualization matching, the final matched the APP + outpatient group consisted of 2489 cases (IQR, 33–55) and 2850 (IQR, 33–55) in the traditional outpatient group. By the end of the study, it was observed that the laboratory data of Phosphorus, Sodium, Triglyceride, Hemoglobin showed significant improvements, Furthermore the APP + outpatient group demonstrated superior results compared to the traditional outpatient group (P < .05). And it was observed that there were 34 deaths (1.4%) in the APP + outpatient group and 46 deaths (1.6%) in the traditional outpatient group(P = .49). After matching for renal replacement therapy outcomes, the two groups were found to be comparable (95% CI [0.72–1.08], P = .23), with no significant difference. However, it was noted that the traditional outpatient group had a lower incidence of using temporary catheters during initial hemodialysis (95% CI [8.4-29.8%], P < .001). Conclusion The development and application of an app combined with outpatient follow-up management can improve patient health outcomes. However, to ensure optimal preparation for kidney replacement therapy, patients in CKD stages 4–5 may require more frequent traditional outpatient follow-ups, and further develop an information-based decision-making support tool for renal replacement therapy.

IntroductionEuropean Nursing care Pathways (ENP) is a professional care language that utilizes software to map care processes and utilize the data for research purposes, process control, and personnel requirement calculations. However, there is a lack of internationally developed terminology systems and subset specifically designed for the nutritional management of CKD. The aim of this study was to create a subset of the standardized nursing terminology for nutrition management in patients with chronic kidney disease (CKD).Materials and methodsAccording to the guidelines for subset development, four research steps were carried out: (i) Translation of version 3.2 of the ENP (chapter on kidney diseases) and understanding of the framework structure and coding rules of the ENP; (ii) Identification of relevant six-dimensional nursing terms; (iii) Creation of a framework for the subset; (iv) Review and validation by experts.ResultsA subset for CKD nutritional care was created as part of this project, comprising 630 terms, with 17 causal relationships related to nursing diagnoses, 115 symptoms, 31 causes, 34 goals/outcomes, 420 intervention specifications and 13 resources, including newly developed care terms. All terms within the subset have been created using a six-step maintenance procedure and a clinical standard pathway for nutrition management in the SAPIM mode.Implications for nursing practiceThis terminology subset can facilitate standardized care reports in CKD nutrition management, which is used to standardize nursing practice, quantify nursing, services, guidance on care decisions, promoting the exchange and use of CKD nutrition data and serve as a reference for the creation of standardized subset of nursing terminology in China.

Abstract Background: CKD management nurse specialists can effectively delay the progression of CKD by starting from changing patients' lifestyles and improving their self-management ability. Chronic kidney disease management requires more comprehensive theoretical knowledge as well as skills, and therefore there is an urgent need to train a group of multi-skilled specialist nurses. However, there are few specific indicators that can be used to assess the core competencies of these specialist nurses. Therefore, this study aimed to construct a core competency evaluation index system for CKD management specialist nurses through the Delphi expert consultation method. Methods: This study initially constructed a core competency evaluation index system for CKD management nurse specialists through literature review and semi-structured interviews. Two rounds of expert consultation were conducted with 24 experts in different fields from 13 regions of China, including specialist nurses, nursing managers, nursing educators, and clinicians. They rated each item on a Likert scale and suggested modifications. Based on the recommendations of the two rounds of expert consultation and the group discussion, the final evaluation index system was formed. Results: After two rounds of expert consultation, the final evaluation index system of core competence was formed, including three first-level items: professional theoretical knowledge; Clinical practice skills; Professional development competencies,and 16 Level 2 items, corresponding to 64 detailed level items. Conclusions: The establishment of a core competency evaluation index system for CKD management specialist nurses provides a basis for the selection, training, and assessment of specialist nurses. The evaluation index system is comprehensive, reflects the characteristics of the speciality, and provides job descriptions based on core competencies, which can promote the development of chronic kidney disease management.

目的 系统分析终末期肾病患者发生骨折的相关因素.方法 计算机检索中国知网、维普、万方、中国生物医学数据库、PubMed以及EMBASE中自建库以来公开发表的相关文献.由2名研究员独立筛选文献、提取资料、纳入文献质量评价,采用Review Manager 5.3软件进行统计分析.结果 共纳入 19篇文献,合并结果提取 8个相关影响因素,其中 6个危险因素:年龄(OR=1.28,95%CI:1.20～1.37,P＜0.01)、女性(OR=1.93,95%CI:1.51～2.46,P＜0.01)、碱性磷酸酶(OR=1.03,95%CI:1.01～1.05,P=0.008)、甲状旁腺激素(OR=1.07,95%CI:1.04～1.10,P＜0.01)、糖尿病(OR=1.70,95%CI:1.44～2.02,P＜0.01)、透析年限(OR=1.83,95%CI:1.20～2.80,P=0.005);2个保护因素:血清白蛋白(OR=0.81,95%CI:0.69～0.96,P=0.02)和活性维生素D3(OR=0.33,95%CI:0.16～0.67,P=0.002).结论 年龄≥65岁、女性患者、碱性磷酸酶升高、甲状旁腺激素过高或过低、透析年限＞6 年以及合并糖尿病是终末期肾病患者骨折的危险因素,正常的血清白蛋白和活性维生素D3是降低骨折发生的保护因素.

Objective: Exercise, like daily walking, may improve overall health and impede progression of chronic kidney disease (CKD); however, no specific walking dose has been recommended for patients with CKD. We aimed to investigate the association between daily walking steps and health-related quality of life (HRQOL) in adults with CKD. Design and Methods: The walking steps of patients with CKD were extracted from the We Run mobile application. Their average daily walking steps were calculated and subdivided into the low-, middle-, and high-level groups. HRQOL was assessed using the physical component summary (PCS) and mental component summary (MCS) of the MOS 36 Short Form Health Survey (SF-36). Results: A total of 558 adults (50.5%, men) with an average age of 40.2 (+/- 13.8) years were enrolled. The median daily step count was 7,404 steps. The daily walking step count demonstrated an inverse U-shaped relationship with the SF-36 and subscale scores. Partic-ipants with daily walking steps between 7,000 and 12,000 have the highest PCS (68.1 +/- 12.2) and MCS scores (70.0 +/- 19.5). The mul-tiple linear regression model showed that compared with patients with a daily step count of 7,000 to 12,000, patients with a daily step count >12,000 had a significantly lower MCS score (P < .001), while patients with a daily step count <7,000 had significantly lower PCS (P < .001) and MCS scores (P = .034). Moreover, the multivariable logistic regression model showed that patients with a daily step count >12,000 had significantly lower mental health-related quality (odds ratio [OR], 2.188; 95% confidence interval [CI], 1.079-1.439 for low MCS), while those with a daily step count <7,000 had a significantly lower HRQOL than the 7,000 to 12,000 daily step count group (OR, 2.113; 95% CI, 1.203-3.711 for low PCS; OR, 2.099; 95% CI, 1.210-3.643 for low MCS). Conclusions: These findings suggest that daily walking steps between 7,000 and 12,000 are associated with high HRQOL in adults with CKD.

Objective:To systematically evaluate the qualitative research on the clinical practice experience of nursing postgraduates, so as to provide a basis for formulating a standardized and reasonable practice teaching model.Methods:The computer was used to search Cochrane Library, PubMed, Embase, Web of Science, Medline, CNKI, Wanfang, Weipu and China Biology Medicine dics for relevant qualitative researches on clinical practice experience of nursing postgraduates. The search time was from the establishment of the database to February 28, 2020. The 2017 version of the Australian Evidence-based Health Care Center Qualitative Research Quality Evaluation Standard was used to evaluate the quality of the literature. The aggregative synthesis method was used to integrate results of the included literature.Results:A total of 12 studies were included, 40 results were extracted and 7 new categories were formed. Finally, three integrated results were formed, namely, teachers with lower qualifications, lack of management and assessment and status of conflict between practice and scientific research, psychological experience including positive psychological experience and negative psychological experience, and practices suggestions and expectations such as formulating reasonable teaching strategies and strengthening supervision and assessment.Conclusions:Nursing educators should attach importance to the clinical practice experience of postgraduate students, formulate a standard and reasonable practice teaching mode and improve the clinical practice ability of postgraduate students.

目的 系统评价手术前握力锻炼对拟行动静脉内瘘(arteriovenous fistula,AVF)术的慢性肾脏病(chronic kidney disease,CKD)患者前臂血管内径的影响.方法 计算机检索中国生物医学文献数据库、中国知网期刊数据库、维普中文科技期刊数据库、万方期刊数据库、PubMed、Medline、Co-chrane library中已发表的相关文献,检索时限为建库至2021年2月26日.由2名研究员独立筛选文献、提取资料、文献质量评价并进行交叉核对,采用RevMan5.3软件进行Meta分析.结果 共纳入研究12篇,累计样本量343例.Meta分析结果显示:①锻炼后血管内径大于锻炼前血管内径(SMD=1.03,95％ CI:0.62～1.45,P＜0.01).②加压锻炼增加血管内径(SMD=1.31,95％ CI:0.26～2.36,P=0.01),非加压锻炼同样增加血管内经(SMD=0.92,95％ CI:0.49～1.34,P＜0.01).③不同锻炼时间节点血管内径与锻炼前血管内径比较:锻炼第2周(SMD=0.72,95％ CI:0.05～1.38,P=0.03)、第4周(SMD=1.60,95％CI:0.75～2.45,P＜0.01)、第6～8周(S5MD=1.47,95％ CI:0.77～2.18,P＜0.01)血管内径均大于锻炼前血管内径;④锻炼第8周血管内径与锻炼第4周血管内径比较差异无统计学意义(SMD=0.31,95％ CI:-0.43～1.05,P=0.41).结论 手术前握力锻炼可增加拟行AVF手术的CKD患者前臂血管内径,加压锻炼与非加压锻炼均有利于血管内径的增加,可将握力锻炼时间提前到手术前4周或8周.

目的:分析某院慢性肾病管理微信公众号运营现状,为改进今后慢性肾病管理工作提供有力依据.方法:提取2017年9月1日到2017年9月30日“新桥肾内慢性肾病管理中心”微信公众号用户分析、图文分析、消息分析、医患交流情况(留言和在线会话咨询)所有数据,并进行分析.结果:自2015年3月1日建立微信公众号至2017年9月30日累计关注人数4 789人,2017年9月净关注人数(新关注人数-取消关注人数)258人,男性48.4％,女性51.6％;文章被关注程度依次为9月9日重庆市医保政策改革、感冒对肾病的影响、合理休息、饮食指导等;留言和在线咨询人数最多的问题是饮食咨询,其次是专家教授门诊出诊,并列第三的是感冒处理办法和服用糖皮质激素相关问题.结论:微信公众平台能快速有效地传播健康知识和建立与患者沟通交流平台,是对慢性肾病患者实施有效管理的重要方法之一.