Objective To investigate the current situation of the elderly patients with hemodialysis and understand complications and the reasons for death.Methods A total of 52 elderly patients with hemodialysis were selected.The survival quality was measured by SF-36,and the anemia indexes,nutritional indexes and inflammation indexes were measured.The vascular access,complications and death rate were discussed.Results There were 23 patients with anemia,45 patients with malnutrition,and 38 patients with inflammation.14 patients chose intravascular fistula,26 patients chose Cuff catheter,3 patients chose temporary hemodialysis catheter and 9 patients chose Cuff catheter because of failure with intravascular fistula.17 patients dead and the main reasons were lung infection and stoke.The SF-36 score was (85.4 ± 16.5).According to Cox regression analysis,diabetes and hemoglobin were the main factors for the life quality of patients.Conclusion Maintenance hemodialysis can improve the survival time and quality of life in elderly patients with hemodialysis.

Objective To investigate the current situation of the elderly patients with hemodialysis and understand complications and the reasons for death.Methods A total of 52 elderly patients with hemodialysis were selected.The survival quality was measured by SF-36,and the anemia indexes,nutritional indexes and inflammation indexes were measured.The vascular access,complications and death rate were discussed.Results There were 23 patients with anemia,45 patients with malnutrition,and 38 patients with inflammation.14 patients chose intravascular fistula,26 patients chose Cuff catheter,3 patients chose temporary hemodialysis catheter and 9 patients chose Cuff catheter because of failure with intravascular fistula.17 patients dead and the main reasons were lung infection and stoke.The SF-36 score was (85.4 ± 16.5).According to Cox regression analysis,diabetes and hemoglobin were the main factors for the life quality of patients.Conclusion Maintenance hemodialysis can improve the survival time and quality of life in elderly patients with hemodialysis.

Objective:To explore the role of post competency oriented interactive teaching in clinical teaching of blood purification.Methods:A total of 80 interns from the blood purification center of our hospital were selected from May 2019 to August 2020, and they were randomly divided into two groups. The control group ( n=40) were taught by routine clinical teaching, and the observation group ( n=40) was taught by interactive teaching based on the post competency. They were both taught for 3 months. The theoretical and practical assessment results of the two groups after teaching, the post competency before and after the teaching, and the satisfaction with the teaching were compared. SPSS 22.0 was used for t test and chi-square test. Results:The theoretical and practical assessment scores of the observation group after teaching were higher than those of the control group, and the difference was statistically significant (theoretical assessment: t=4.01, P<0.05; practical assessment: t=3.94, P<0.05). There was no statistically significant difference in effective communication ability score ( t=1.31, P=0.193), adaptability and coping ability ( t=1.25, P=0.216), autonomous learning and self-improvement ability ( t=0.93, P=0.356), and management ability score ( t=0.76, P=0.451). After teaching, the competency scores of the above-mentioned positions in the two groups were improved compared with those before teaching, and the scores of the observation group were higher than those of the control group, and the differences were statistically significant (effective communication ability: t=12.60, 6.63, P<0.05; adaptability and coping ability: t=11.21, 6.44, P<0.05; autonomous learning and self-improvement ability: t=10.80, 5.78, P<0.05; management ability score: t= 12.42, 6.79, P<0.05). There were significant differences in the distribution of satisfaction with teaching ( t=6.90, P=0.007) of the two groups of interns, and the total satisfaction rate of the observation group was higher than that of the control group ( t=6.49, P=0.011). Conclusion:The application of post competency oriented interactive teaching in clinical teaching of blood purification internship can not only improve the appraisal results of interns, enhance their post competency, but also improve the teaching satisfaction.

Objective: To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods: The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results: (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95% CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95% CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant (60.6% vs 84.4%, χ²=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95% CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95% CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.

Objective:To analyze the effect of using reflective teaching method based on quality feedback in clinical teaching of hemodialysis.Methods:From January 2019 to May 2020, 76 hemodialysis interns from West China Hospital of Sichuan University were selected and randomly divided into 2 groups. The routine group interns were taught by routine clinical teaching, and the observation group was taught by the reflective teaching based on quality feedback. The teaching time last 3 months. The thinking ability of the two groups before and after teaching and the satisfaction of the interns with the clinical teaching mode were compared. SPSS 22.0 was used for t test and χ2 test. Results:The theoretical and practical assessment scores of the observation group were higher than those of the routine group ( P<0.05). After teaching, the scores of the two groups were all increased in the dimensions of truth-seeking, analytical ability, open thinking, systematic ability, confidence in critical thinking, cognitive maturity and curiosity. And the scores of the above dimensions of the observation group were higher than those of the routine group ( P<0.05). There were significant differences in the satisfaction distribution of the two groups of interns with the clinical teaching mode, and the total satisfaction rate of the observation group was higher than that of the routine group ( P<0.05). Conclusion:The implementation of reflective teaching based on quality feedback in clinical teaching of hemodialysis can improve the teaching effect, enhance the thinking ability of interns, and improve their satisfaction with the clinical teaching model.

Objective To investigate the application of reality cross-sectional assessment ( RCA) in the ability evaluation of young nurses .Methods 32 young nurses, who had worked for 3-10 years, were enrolled in the study.Each month, we randomly selected 10 nurses to finish the RCA.The clinical ability, quality ofcare and patients ’ satisfaction were compared before and after the assessment .Results The score of clinical ability was (80.41 ±10.76) before the application of RCA .After applied the RCA for 6 and 12 month, the scores of clinical ability were (90.78 ±5.71) and (89.25 ±6.36), the difference was significant ( F=15.932,P<0.01).After applied the RCA for 6 and 12 month, the scores of quality of care were (88.03 ±6.05) and (88.22 ±5.98), the difference was significant (F=3.179,P<0.05).The patients’ satisfaction improved from 90.38%to 100.00%, which was significant different (χ2 =18.152,P<0.05).Conclusions RCA combine with practical work can reflect the state of real work of nurses and their true level , which promotes the overall quality of care and clinical practice of working ability .