Objective:To explore the application effect of transitional care based on Siebens domain management model in patients with atrial fibrillation.Methods:Using the convenient sampling method, a total of 150 atrial fibrillation patients who were admitted to Nanyang Central Hospital from October 2021 to December 2022 were selected as the research objects. Patients were divided into the study group and the control group using the random number table method, with 75 cases in each group. The control group received routine transitional care, while the study group received transitional care based on the Siebens domain management model. The intervention effect was evaluated using Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale.Results:There was no statistically significant difference in scores of Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale of patients between the two groups before intervention ( P>0.05). After intervention, scores of Morisky Medication Adherence Scale and Atrial Fibrillation Self Care Ability Scale of patients in the study group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Transitional care based on Siebens domain management model can improve medication adherence and self-care ability of atrial fibrillation patients.

OBJECTIVE: To analyze the clinical phenotype and genetic characteristics of a patient with Alport syndrome. METHODS: A patient with Alport syndrome who had visited the First Affiliated Hospital of Zhengzhou University in November 2020 was selected as the study subject. Clinical data of the patient were collected. High-throughput sequencing was carried out to detect potential variant of the COL4A3, COL4A4 and COL4A5 genes, and Sanger sequencing was carried out for verification of candidate variants in the family. RESULTS: The main clinical manifestations of the patient included hematuria, proteinuria, and impaired hearing. Audiometric testing suggested symmetrical cochlear sensory neural hearing loss on both sides. Renal biopsy revealed mild mesangial proliferative glomerulonephritis. Genetic testing revealed that the patient has harbored compound heterozygous variants of the COL4A4 gene, namely c.940G>A (p.Gly314Ser) and c.3773G>A (p.Gly1258Asp), which were respectively inherited from her father and mother. Neither variant has been reported before, and were predicted to be pathogenic based on the guidelines from the American College of Medical Genetics and Genomics. CONCLUSION The c.940G>A (p.Gly314Ser) and c.3773G>A (p.Gly1258Asp) compound heterozygous variants of the COL4A4 gene probably underlay the Alport syndrome in this patient. Above finding has enriched the mutational spectrum of the COL4A4 gene.
Female ; Humans ; Nephritis, Hereditary/genetics* ; Hematuria ; Genetic Testing ; Genomics ; Hearing ; Collagen Type IV/genetics*

Objective:To translate and revise the Arteriovenous Fistula Assessment Scale (AVF-AS), test the reliability and validity of the Chinese version of AVF-AS.Methods:The modified Brislin translation model was used to translate, back translate and cross culture adjust AVF-AS, forming the Chinese version of AVF-AS. Using the convenient sampling method, 220 hemodialysis patients from the First Affiliated Hospital of Zhengzhou University were selected for investigation from July to September 2022. Two weeks later, 30 patients were randomly selected for retesting. The valid data were used for project analysis and reliability and validity evaluation.Results:The Chinese version of AVF-AS consisted of 3 factors and 18 items. Consistency level between evaluators was 0.94, the item level content validity index was 0.83-1.00, average scale level content validity index was 0.94, and the calibration validity was 0.68.Three common factors(autogenous arteriovenous fistula blood flow, stenosis and ischemia, puncture location) were extracted from exploratory factors, and the cumulative variance contribution rate was 75.255%. The total scale's Cronbach α was 0.946, the half reliability of each dimension was 0.826 - 0.898, and the test-retest reliability was 0.907.Conclusions:The Chinese version of AVF-AS has good reliability and validity, and can be used as an effective tool to evaluate the autogenous arteriovenous fistula functional status of hemodialysis patients in China.

【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.

Objective:To explore the effect of integrated comprehensive management model in the management of arteriovenous fistula in maintenance hemodialysis (MHD) patients.Methods:From January to December 2020, 174 patients undergoing MHD in the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University were selected as the research object by convenience sampling. According to the random number table method, the patients were divided into the integrated management group and the routine management group, with 87 cases in each group. Patients in the routine management group received routine vascular access nursing after admission. On the basis of routine vascular access nursing, the integrated management group introduced a multidisciplinary vascular access management team to apply it to the access management of MHD patients, and divided the vascular access management into five key links of preoperative assessment, access establishment, access use, access monitoring and access maintenance, and formulated specific measures and content for each link to implemented an integrated comprehensive management model. After three months of intervention, the successful rate of one-time puncture, the use rate of the first dialysis internal fistula, the incidence of associated complications and dialysis tolerance were compared between the two groups.Results:The one-time puncture success rate and the first dialysis internal fistula usage rate in the integrated management group were higher than those in the routine management group, and the differences were statistically significant ( P<0.05) . The overall complication rate in the integrated management group was 6.90% (6/87) , which was lower than 31.03% (27/87) in the routine management group, and the difference was statistically significant (χ 2=16.491, P<0.01) . The scores of the two parts and total scores of the dialysis tolerance in the integrated management group were higher than those in the routine management group, and the difference was statistically significant ( P<0.05) . Conclusions:The integrated comprehensive management model applied in the management of vascular access in MHD patients can increase the one-time puncture success rate of arteriovenous fistula and the use rate of the first dialysis fistula, reduce the incidence of associated complications, and improve patient tolerance.

Objective:To explore the effects of nursing program-based dietary intervention combined with family support in hemodialysis patients.Methods:The clinical data of 180 hemodialysis patients admitted to the First Affiliated Hospital of Zhengzhou University from September 2019 to September 2020 were selected by convenient sampling and retrospectively analyzed. The patients were divided into control group and observation group with 90 cases in each group according to different nursing methods. Patients in the control group received routine dietary care, while patients in the observation group underwent nursing program-based dietary intervention combined with family support on this basis. The nutritional status and dialysis compliance were compared between the two groups at the time of enrollment, 3 months, and 6 months after the intervention.Results:3 and 6 months after the intervention, the levels of body mass index, total protein, albumin, prealbumin, total lymphocyte count, and white blood cell count in the two groups increased, and the observation group was better than the control group, with statistically significant differences ( P<0.05) . At 3 and 6 months after the intervention, the scores of each dimension of compliance in the two groups increased, and the scores of each dimension in the observation group were better than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:Nursing program-based dietary intervention combined with family support can improve the nutritional status and dialysis compliance of hemodialysis patients, which is worth promoting in clinical practice.

Objective:To understand the psychological status and nursing needs of maintenance hemodialysis (MHD) patients and provide reference for clinical targeted nursing.Methods:Using the phenomenological research method, a total of 15 patients with MHD in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by the purposive sampling method, and they were given semi-structured individualized interviews. The Colaizzi 7-step analysis method was used to organize the data, extract the inductive themes and analyze the results.Results:The psychological status of MHD patients was repressed fear, despair and helplessness and acceptance. The nursing needs of MHD patients included disease-related knowledge needs, social support needs and health guidance needs.Conclusions:MHD patients have negative psychology. Medical staff need to understand the psychological status and nursing needs of patients and formulate targeted nursing interventions to meet the actual needs of patients and improve the quality of life of them.

Objective:To explore the effect of family-participated dietary management on dietary compliance behavior and nutritional status in elderly maintenance hemodialysis (MHD) patients.Methods:From July 2019 to December 2020, a total of 120 elderly MHD patients admitted in the First Affiliated Hospital of Zhengzhou University were selected as the research objects, and divided into the experimental group and the control group with 60 cases in each group by random number table method. The control group conducted routine dietary management, and the experimental group received dietary management based on family participation. Six months after intervention, the dietary compliance attitude, dietary compliance behavior and nutritional status were compared between the two groups.Results:Six months after intervention, the scores of social restriction attitude, self-care attitude, acceptance attitude and dietary compliance behavior attitude of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of fluid restriction behavior, potassium intake behavior, self-care compliance, compliance in the face of difficulties, and dietary compliance of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The serum prealbumin (PA) , albumin (ALB) , hemoglobin (Hb) , and transferrin (TRF) of the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Diet management based on family participation can enhance the attitude of dietary compliance, promote the development of dietary compliance behavior, and improve the nutritional status of elderly patients with MHD.

Objective:To explore the effect of nursing intervention based on Donabedian quality theory in blood purification patients undergoing vascular access.Methods:From July 2017 to May 2019, convenience sampling was used to select 120 hemodialysis patients undergoing vascular access who were admitted to the First Affiliated Hospital of Zhengzhou University. All patients were divided into control group and observation group with the method of random number table, with 60 cases in each group. Control group carried routine nursing, and observation group implemented nursing intervention based on Donabedian quality theory, both of which were treated for three months. The composition ratio of vascular access, nutritional status before and after nursing intervention, urea clearance index (Kt/V) and urea decline rate (URR) , incidence of recirculation, and incidence of vascular access complications after nursing intervention were compared between two groups.Results:The proportion of central venous catheter access in observation group (10.00%, 6/60) was lower than that in control group (25.00%, 15/60) , and the difference was statistically significant ( P<0.05) . After intervention, the albumin, hemoglobin, and prealbumin levels of two groups were higher than those before intervention, and the albumin, hemoglobin and prealbumin levels of observation group after intervention were higher than those of control group, and the differences were statistically significant ( P<0.05) . After intervention, post-dialysis Kt/V and URR of observation group were higher than those of control group, and the incidence of recirculation (10.00%, 6/60) was lower than that of control group (21.67%, 13/60) , and the incidence of vascular access complications (5.00%, 3/60) was lower than that of control group (16.67%, 10/61) , and the differences were statistically significant ( P<0.05) . Conclusions:Nursing intervention based on Donabedian quality theory applied to blood purification patients undergoing vascular access can improve the nutritional status and coagulation function of patients, reduce the incidence of complications which is worthy of popularization.

Objective? To explore the effect of staged continuous nursing mode on self-care ability of arteriovenous fistula among hemodialysis patients. Methods? A total of 120 patients with arteriovenous fistula in Blood Purification Center at the First Affiliated Hospital of Zhengzhou University were enrolled in the study by convenience sampling methods from January to December in 2017. Patients were divided into control group and observation group by random numeral table method. The control group received routine nursing and health education. On the basis of these, the observation group was given a phased continuous nursing intervention. The intervention was divided into 3 stages. The Exercise of Self-care Agency Scale (ESCA) was used to evaluate patients before and after the intervention. Complications of arteriovenous fistula were observed and compared in two groups. Results? There was no significant difference in self-concept, knowledge and information seeking, passiveness, motivation, and self-care scores between two groups before intervention. After intervention, the observation group patients' self-concept, knowledge and information seeking, passiveness, motivation, and self-care scores were higher than the control group, and the differences were statistically significant (P＜ 0.05). After intervention, the result of comparing the occurrence of obstruction of internal fistula, thrombosis, infection, and hemorrhage/hematoma in two groups showed that those in control group was higher than observation group with statistical differences (P＜ 0.05). Conclusions? The staged continuous care model improves the self-care ability of arteriovenous fistula among hemodialysis patients, and reduces the occurrence of related complications.