Based On Evidence-based Construction Of Arteriovenous Fistula With Aneurysm In Hemodialysis Patients Mapagement Plan And Application Research

ObjectiveConsidering that all of doctors,nurses and patients need the managements of the patients who suffer from arteriovenous fistulas with aneurysms,we build a management plan for those based on document retrieval,and then make a preliminary empirical study in order to provide a scientific and standardized management program,improve the quality of life of patients with aneurysms and the effect of diagnosis and treatment.Methods1.Using semi-structured interviews,we adopt qualitative research on medical and patient,and get acquainted with the current management situation of arteriovenous fistula patients with aneurysm at present in Zhengzhou City and the demands for management.2.We need to set up a program management team,and systematically search the clinical practice guide and related literature of the management for arteriovenous fistulas with aneurysms at home and abroad,then perform a meta-analysis of the literature.3.According to "JBI evidence classification and evidence recommendation level system(2016)",the above evidence was integrated and analyzed,and combined with the results of qualitative research,the first draft of the management scheme of arteriovenous fistula with aneurysm in hemodialysis patients was constructed.4.We invite relevant experts with certain influence in the same academic field to organize expert meeting,and perfect the above draft,then form the management plan for patients with arteriovenous fistula and aneurysm.5.Based on the above management plan,we adopt similar experimental research methods and take interference for patients with aneurysms,who admitted to the Department of Nephrology of four tertiary hospitals in Zhengzhou in May 2019,we set up control group during the research.Then we evaluate the indexes of those,implementation rate of intervention program by medical staff,mastering rate of knowledge about aneurysm by medical workers,implementation rate of standardized puncture operation by nursing staff,monitoring and evaluation rate of aneurysm reexamination,registration rate of results,reduction rate of tumor,etc.Then input and check the research data by two persons,analyze the data using SPSS20.0 statistical Software.Results1.By a qualitative interview with 12 medical staffs of Nephrology,we sum up weaknesses in such four aspects:insufficient attention,low implementation rate,lack of knowledge and other factors.Through a qualitative interview with 12 patients,we sum up three aspects:knowledge requirements of aneurysm management and maintenance,safety requirement,social support and suggestions.The results of qualitative interviews provide the basis for the next step of evidence-based research.2.Through retrieval of literature by project team members,we have 25 documents in the final summary including 8 clinical practice guidelines,1 expert consensus.4 system assessment,7 randomized controlled trials,3 observational studies and 2 experimental studies.By evaluating and analyzing of the included documents,we get the best evidence for the management of aneurysms in hemodialysis patients.3.On the basis of qualitative interview and research,combined with the evidence of literature,the first draft of management plan for patients suffering from arteriovenous fistula with aneurysm is formed4.By inviting 13 experts from nephrology,blood purification,ultrasound,nutrition and other departments to revise and improve the contents of the plan,we delete 4 items and add 4 items,and obtain the final management plan for patients with arteriovenous fistula and aneurysm.5.Compared with the control group,the implementation rate of the intervention group was increased from 56%to 96.8%,the knowledge of aneurysm management was increased from 10.70 ± 4.85 to 19.85±1.28.the operation implementation rate was increased from 49%to 94.5%,and the tumor reduction rate was increased from 5.6%to 68.4%,which was statistically significant(P<0.05).Conclusion1.Management of hemodialysis patients suffered from arteriovenous fistula with aneurysm is not ideal at present,it's necessary to adopt healthier behaviors for patients with aneurysm,observe the dynamic change of aneurysm and improve the clinical outcome of aneurysm.2.Based on the qualitative interview,evidence-based research and expert meeting,the management scheme of hemodialysis patients suffering from arteriovenous fistula with aneurysm is successfully constructed,which is suitable for the present clinical situation and the needs of patients.3.The application of the management plan for the patients with arteriovenous fistula and aneurysms can effectively improve the following evaluation indexes,such as implementation rate of the intervention plan,operation implementation rate of the nurses,the monitoring and evaluation rate of the aneurysms reexamination,the registration rate of the results,the reduction rate of the aneurysms and others.This will provide the theoretical and practical basis for the clinical doctors and nurses to manage the arteriovenous fistula with aneurysms.