A time-saving method of creating AVF buttonholes: indwelling trocar technique.

AIMS AND OBJECTIVES: This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars. BACKGROUND: Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important. DESIGN: Prospective, observational and cohort study. METHODS: We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines. RESULTS: The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48 ± 0.51 vs. 23.23 ± 3.07, p < .01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94 ± 1.50 vs. 6.03 ± 1.13, p = .002), but there was no significant difference in this result after 1 month (sharp needle group with 4.50 ± 0.94 vs. indwelling trocar group with 4.12 ± 1.19, p = .169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p = .02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p = .102). The difference in arterial pressure and venous pressure between the two groups was not significant (p = .061, p = .222). CONCLUSIONS: Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience. RELEVANCE TO CLINICAL PRACTICE: The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.

Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis.

BACKGROUND: Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies. METHODS: We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software. RESULTS: A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively). CONCLUSIONS: An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.

Integrated management is effective in the prevention and control of COVID-19 in the blood purification center: joint efforts from multiple departments.

BACKGROUND: During the outbreak of new coronavirus pneumonia, many hospitals in China became the designated hospitals for the treatment of new coronavirus pneumonia. The goal was to develop rapid and effective prevention and control methods for blood purification centers. RESEARCH DESIGN AND METHODS: The medical department, hospital department, nursing department, and blood purification center jointly set up a multi-department integrated COVID-19 prevention and control management team to manage the blood purification center. The efforts included the establishment of the continuous renal replacement therapy (CRRT) team for COVID-19, the integrated training and assessment of medical personnel, the integrated education of patients and their families, and the integrated management of the workflow of the hemodialysis room. RESULTS: No infected persons, including medical staff, patients, and their families, have been found in the dialysis center. After multi-departmental integrated training, the theoretical performance of medical staff in our dialysis center has increased from 82.36 ± 8.10 to 95.29 ± 4.95 (p < 0.05), and the unqualified rate dropped from 23.21 to 1.78% (p < 0.05). In addition, the three operational skills evaluation scores have also been significantly improved, from 86.00 ± 4.02, 88.01 ± 6.20, 92.01 ± 2.46 to 95.90 ± 0.30, 97.21 ± 0.87, 96.00 ± 1.00 (p < 0.01), and the passing rate from 80.36 to 100% (p < 0.05). CONCLUSION: Medical staff's knowledge of novel coronavirus pneumonia prevention and control can be improved by multi-sectoral integrated management, and CRRT treatment of COVID-19 patients is effective.