Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound(hereinafter referred to as the consensus).To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula.Methods We conducted a comprehensive literature review of domestic and international publications,integrated clinical nursing experts' practical experience,and followed evidence-based nursing principles to identify the best available evidence.Through expert panel discussions and 3 rounds of Delphi expert consultation,we systematically revised,refined and improved the initial draft of the consensus,ultimately developing the finalized version.Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100％;the authority coefficient of expert correspondence inquiries was 0.97;the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50.The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127,0.120,and 0.201,respectively(P＜0.05),and the degree of coordination of expert opinions was good and the expert opinions were consistent.The consensus summarized 5 aspects,including relevant terms and definitions,indications for real-time ultrasound-guided arteriovenous fistula puncture,personnel qualifications and training,difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided,and nursing quality control.Conclusion The consensus is scientific,which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

Objective To formulate an expert consensus on the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound(hereinafter referred to as the consensus).To standardize the clinical practice of ultrasound-guided puncture of difficult autologous arteriovenous fistula.Methods We conducted a comprehensive literature review of domestic and international publications,integrated clinical nursing experts' practical experience,and followed evidence-based nursing principles to identify the best available evidence.Through expert panel discussions and 3 rounds of Delphi expert consultation,we systematically revised,refined and improved the initial draft of the consensus,ultimately developing the finalized version.Results The response rates of the 3 rounds of Delphi expert correspondence inquiries were all 100％;the authority coefficient of expert correspondence inquiries was 0.97;the mean importance assignment of the 3 rounds of correspondence inquiries was more than 3.50.The Kendall coordination coefficients of the 3 rounds of expert consultation were 0.127,0.120,and 0.201,respectively(P＜0.05),and the degree of coordination of expert opinions was good and the expert opinions were consistent.The consensus summarized 5 aspects,including relevant terms and definitions,indications for real-time ultrasound-guided arteriovenous fistula puncture,personnel qualifications and training,difficult arteriovenous fistula puncture procedures under real-time ultrasound-guided,and nursing quality control.Conclusion The consensus is scientific,which can provide a basis for hemodialysis practitioners to practice the puncture of difficult arteriovenous fistula under real-time guidance of ultrasound.

Objective:To explore the current status of post management for orthopedic specialist nurses in Beijing, so as to provide reference for formulating orthopedic specialist nurse management systems.Methods:Purposive sampling was used to select 254 orthopedic specialist nurses who participated in the Orthopedic Specialist Nurse Qualification Certification Training Course organized by the Beijing Nursing Association from 2014 to 2020. A survey was conducted using the self-developed Post Management Questionnaire and Job Satisfaction Questionnaire.Results:254 orthopedic specialist nurses came from 46 hospitals in Beijing. 92.9% (236/254) of orthopedic specialist nurses had a bachelor's degree or higher, 69.3% (176/254) of specialist nurses had intermediate or higher professional titles, and hospitals with 67.7% (172/254) of specialist nurses established post management systems or policies. The work of specialist nurses mainly focused on clinical nursing, and also undertook nursing teaching, nursing quality management, organizing nursing rounds, and clinical case nursing. The main factors hindering the development of orthopedic specialist nurses were the heavy workload of clinical affairs, lack of clear job evaluation indicators, and lack of clear career development direction.Conclusions:The post management of orthopedic specialist nurses in Beijing has gradually been carried out, but there is still room for improvement in the implementation of advanced nursing practice activities, assessment and evaluation, and special incentives for specialist nurses. Managers should further establish a sound, scientific, and effective management system, fully leverage the advanced clinical nursing practice role of orthopedic specialist nurses, and promote the scientific application of orthopedic specialist nurses.

Objective:To develop an Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses and test its reliability and validity.Methods:Based on the theory of knowledge, attitude, and practice, a preliminary scale draft was formed through a literature review, three rounds of Delphi expert consultation, and a pre-survey. Using convenience sampling, 311 hemodialysis nurses were selected for a survey from December 2022 to February 2023 for item analysis, exploratory factor analysis and reliability testing. Another survey was conducted on 260 hemodialysis nurses from February to June 2023 for confirmatory factor analysis, convergent validity, and discriminant validity testing.Results:The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses included three subscales and five dimensions, with a total of 33 items. The content validity index at the item level was 0.867 to 1.000, and the content validity index at the scale level was 0.992. After exploratory factor analysis, two, one, and two common factors were extracted from the knowledge, attitude, and practice subscales, with cumulative variance contribution rates of 70.114%, 75.192%, and 67.467%, respectively.Confirmatory:factor analysis showed that the model fitted well. The Cronbach's α coefficients of the three subscales were 0.929 to 0.943, the half reliability coefficients were 0.861 to 0.903, and the retest reliability coefficients were 0.824 to 0.874. Conclusions The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses has good reliability and validity and can be used to evaluate the physical examination ability of hemodialysis nurses for arteriovenous fistula.

Objective:To explore the cognition and behavior of nurses in blood purification centers on the quality of death of patients undergoing maintenance hemodialysis.Methods:The descriptive phenomenological research method was adopted. From August to October 2022, a total of 14 nurses from blood purification centers in three hospitals, namely Beijing Union Medical College Hospital, Beijing Hospital and Beijing Chaoyang Hospital were selected as interview subjects by the purposive sampling method. Semi-structured in-depth interview method was used to collect data, and Colaizzi 7-step analysis method was used to analyze data.Results:The cognition and behavior of nurses in the blood purification center towards the quality of death of maintenance hemodialysis patients were analyzed into four themes, namely factors affecting the quality of death of patients, convenient conditions for nurses to carry out quality of death improvement work, proactive measures taken by nurses to improve the quality of death and obstacles in the process of improving the quality of death of patients.Conclusions:The nurses in the blood purification centers have special characteristics in their feelings about the death of patients with maintenance hemodialysis, and they have certain cognition and judgment about the quality of death of patients. Managers need to pay attention to the relevant needs and suggestions of the nurses in the blood purification centers and provide help and guidance, so as to continuously improve the quality of patient death and achieve the goal of optimal death of patients.

Objective:To summarize the best evidence for non-pharmacological interventions for anxiety and depression in patients receiving maintenance hemodialysis (MHD) .Methods:According to the "6S" evidence hierarchy model, evidence on non-pharmacological interventions for anxiety and depression in patients receiving MHD was systematically searched from top to bottom across databases and websites, including BMJ Best Practice, UpToDate, International Guideline Network, National Institute for Health and Care Excellence (NICE), International Society of Nephrology, Medlive, Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, and China Biology Medicine disc. The search timeframe was from September 1, 2013, to September 1, 2023. Two researchers independently evaluated the quality of the literature, extracted evidence, and summarized recommendations in collaboration with an evidence evaluation group.Results:A total of 18 articles were included, comprising one guideline, two expert consensuses, one clinical decision, one evidence summary, and 13 systematic reviews. A total of 22 best evidence points were summarized in six aspects: screening and assessment, exercise interventions, lifestyle improvements, psychological interventions, other forms of interventions, and personnel and information support.Conclusions:Evidence-based non-pharmacological interventions for anxiety and depression in patients receiving MHD are diverse. The application of evidence should adhere to the principle of individualization, and the combined use of different evidence-based interventions may yield better outcomes.

Objective:To search, review and summarize the best evidence on promoting maturation of autologous arteriovenous fistula (AVF) in patients undergoing maintenance hemodialysis (MHD) .Methods:In accordance with the relevant methods of evidence-based nursing, evidence was retrieved from relevant websites and databases according to the "6S" pyramid model, including clinical decision-making, guidelines, expert consensus, group standards, and systematic reviews. The search time limit was from April 20, 2012 to April 20, 2022. Two investigators assessed the quality of the evidence, and the evidence team extracted and summarized the evidence.Results:A total of 17 articles were included, including 1 clinical decision-making, 6 guidelines, 1 expert consensus, 1 group standard and 8 systematic reviews. Totally 28 best evidences were summarized from 6 aspects: team education, perioperative management, functional exercise, physical therapy, drug application, first puncture timing and scheme.Conclusions:The best evidence provides a reference for medical staff to standardize the management of AVF in MHD patients. It is recommended that medical staff develop individualized plans based on medical conditions, clinical judgment, and patient wishes when applying relevant evidence.

Continuous nursing plays an important role in patients discharged from hospital with peripherally inserted central catheter (PICC) . This article summarizes the current status, models and effect evaluation indicators of continuous nursing for discharged patients with PICC in China, and explores the existing problems and prospects of PICC continuous nursing, so as to provide a reference for medical institutions to effectively implement localized continuous nursing models.

Objective:To evaluate the best preventive measures for hypothermia in patients undergoing hip and knee replacement.Methods:Cochrane Library, PubMed, CINAHL, Embase, Web of Science, CNKI, Wanfang, VIP and Chinese biomedical literature database were searched by computer. Randomized controlled trials on hypothermia prevention measures in hip and knee arthroplasty were searched, and back into the literature references, the retrieval time is from database establishment to December 2019; the two researchers independently conducted literature screening, quality evaluation, and data extraction according to the inclusion exclusion criteria, and used Revman5.3 software for meta-analysis of the included literature.Results:A total of 608 patients were included in 11 literatures. The results of Meta-analysis showed that: in terms of core temperature, the main outcome index, the Forced-air Warming System was superior to the non-Forced-air Warming measure such as electric blanket, electric heating pad and circulating water mattress ( SMD=0.59, 95% CI 0.27-0.92, P=0.0004); in terms of secondary outcome indexes, the Forced-air Warming System was better than the non-Forced-air Warming measure such as electric blanket, electric heating pad and circulating water mattress ( OR=0.28, 95% CI 0.14-0.58, P=0.0006); in terms of thermal comfort, the Forced-air Warming System had no significant effect ( SMD = 0.21, 95% CI-0.56-0.98, P=0.59). Conclusion:Compared with the Forced-air Warming System, the non-Forced-air Warming measure can effectively maintain the core temperature of patients undergoing hip and knee arthroplasty, reduce the occurrence of postoperative chills, but in the aspect of improve thermal comfort of patients is not obvious. However, due to the number of studies and their statistical heterogeneity, large sample and high-quality studies are needed to verify the results of this study.

Objective:To investigate the relationships of rs4658971 polymorphism of disrupted-in-schizophrinia-1 ( DISC1) gene with schizophrenia in children and adolescents and with the brain structure of such patients. Methods:(1) A total of 577 children and adolescents with schizophrenia were recruited from the Inpatient Department of the Second Affiliated Hospital of Xinxiang Medical University from October 2010 to December 2018, and 516 healthy children were selected as the control group.The rs4658971 polymorphism of DISC1 gene was detected by restriction fragment length polymorphism (PCR-RFLP). The differences of DISC1 genotype and allele frequencies between schizophrenia patients and healthy children were compared by Chi-square test.(2)One hundred and eighteen patients with the first-episode schizophrenia whose illness duration was no more than 12 months and 101 healthy children and adolescents were detected by 3.0T magnetic resonance imaging (MRI). The craniocerebral structures of patients with different DISC1 genotypes were analyzed by covariance with age as the covariant. Results:(1) The rs4658971 genotype frequencies(TT 6.6% vs.5.2%, TC 37.4% vs.38.4%, CC 56.0% vs.56.4%, χ2=0.91, P=0.63) and allele frequencies(C 74.70% vs.75.58%, T 25.30% vs.24.42%, χ2=0.23, P=0.63) of DISC1 gene in children and adolescents with schizophrenia were not significantly different from those in the healthy children.(2) Compared with the control group, the transverse diameter of the third ventricle was significantly enlarged in children and adolescent with schizophrenia [(4.68±1.41) mm vs.(4.06±1.36) mm, F=8.534, P=0.004], while the distance between the anterior feet of the lateral ventricle, the width of the caudate nucleus head and the thickness of the hippocampus were significantly reduced [(30.69±2.51) mm vs.(32.02±2.41) mm, (8.17±1.01) mm vs.(9.22±1.14) mm, (8.93±0.97) mm vs.(9.93±1.14) mm], and the differences were statistically significant( F=15.435, 40.201, 44.650, all P<0.001). The covariance analysis (with age as the covariant) showed that there was significant difference in the width of the caudate nucleus head between patients with CC genotype and those with CT+ TT genotype[(8.73±0.85) mm vs.(7.39±0.61) mm, F=41.376, P<0.001]. Conclusions:There are multiple brain structural changes in children and adolescents with first-episode schizophrenia.T allele carriers of DISC1 gene rs4658971 locus may be related to the reduced width of the caudate nucleus head in patients.