Construction Of Pre-Pregnancy Risk Management Program For Lupus Nephritis Patients

Objectives The research object of this study is female patients with lupus nephritis of childbearing age.The purpose of this study is to investigate the current situation-n of pregnancy risk management in women with lupus nephritis of childbearing age,to find out the problems in pregnancy risk management in LN patients.Then to construction of pre-pregnancy risk management program for LN patients by evidence-based retrieval and Delphi expert consultation.In order to streng-then the pregnancy risk management of LN patients before pregnancy,enhance the awareness of pregnancy risk management of LN patients,improve the proportion of planned pregnancy,reduce or eliminate the risk factors leading to adverse pregnancy outcomes,so as to guide the safe pregnancy of LN patients and reduce the occurrence of adverse pregnancy outcomes.Methods In the first phase of this study,the convenience sampling method was used to select 170 LN patients of childbearing age who attended the lupus nephritis clinic and the chronic kidney disease pregnancy clinic of the National Clinical Research Center of Kidney Diseases,Jinling Hospital from November 2018 to March 2019.A self-made pre-pregnancy risk management questionnaire [including a general information questionnaire and pregnancy risk management "KAP" questionnaire for LN patients of childbearing age] for LN patients of childbearing age was used for field investigation.Taking the tot-al score of "KAP" as the dependent variable,one-way Anova/independent sample t test and multipl e linear regression were used to analyze the influencing factors of pre-pregnancy risk management in LN patients.Then we searched the “BMJ Best Practice,Up To Data,Joanna Briggs Institute(JBI),Guidelines International Network(GIN),National Guideline Clearing house(NGC),National Institute for Health and Care Excellence(NICE),Chinese Guideline Clearinghouse,Cochrane Library,and complementally searched the Pub Med,Embase,CINAHL,and CBM”,to collect relevant“guideline,evidence summary,best practice information(booklet),recommended practice,systemat ic review,and original study”.Two investigators evaluated the quality of the in cluded literature and extracted evidence that met the quality standards.The first draft of management program was established by review of related original studies at home and abroad and group discussion.18 experts from the Nephrology / Women's Reproductive Health field in 7 regions including Chengdu,Nanjing,Shanghai and Suzhou were selected.We distribute the consultation questionnaire through paper or electronic means,and ask experts to rate the importance of each indicator and put forward suggestions for modification.Through 2 rounds of consultation,combined with the opinions of experts on various indicators,the indicators with an index importance score of?3.5and a coefficient of variation of <0.25 are selected.SPSS24.0 software was used for statistical analysis;frequency,mean,and composition ratio were used for statistical description;the expert's authority was expressed based on the expert's judgment basis and familiarity with the consultation content;the degree of coordination of expert opinions used the coefficient of variation and Kendal harmony The coefficient is expressed,and a significance test is performed.P<0.05 is considered statistically significant.The principal component analysis method was used to analyze the weight of each indicator.Results A total of 150 valid questionnaires were obtained.The average KAP score of the patient was 76.35±8.83 points,the average score of the knowledge dimension was 39.22±3.52 points,the average score of the belief dimension was 28.81±5.37 points,and the average score of the behavior dimension was 8.32±1.58 points.The results of t-test or ANOVA showed that there was a significant difference in the total score of pre pregnancy management knowledge among the patients with different education level,current residence,monthly family income,fertility status,whether they intend to have child,who had consulted doctors or received professional guidance(P<0.05).The results of multiple linear regression showed that the total score of the patients who had consulted doctors or received professional guidance was higher,and the total score of the patients who now lived in rural areas or towns,whose education level was junior high school or below,senior high school or technical secondary school and had a child was lower,the difference was statistically significant(P<0.05).Totally 34 articles were selected,including 8 guidelines,4 clinical decisions,2 evidence summary,6 expert consensus,14 systematic reviews.Evaluate and summarize the quality of 20 original documents and retrieved documents Finally 29 items of best evidence were summarized.The management program consisted of 4 first-level items,13 second-level items and 34 third-level items.In the first round of correspondence,18 questio nnaires were distributed and 17 valid questionnaires were recovered,with an effective recovery rate of 94.4%.In the second round of inquiry,17 questionnaires were issued,16 were effectively recovered,and the effective recovery rate was 94.1%.The expert authority scores of two rounds were 0.838?0829.The expert coordination coefficients were 0.348?0.536,significance test result P<0.001.Conclusions At present,LN patients of childbearing age have a lack of comprehensive and in-depth knowledge about pre-pregnancy pregnancy risk management.The implementation rate of pregnancy risk management behaviors such as consulting doctors and using effective contraception measures is low.However,patients generally have strong learning beliefs and are willing to understand disease knowledge and take corresponding actions.The pre-pregnancy risk management plan for LN patients constructed in this study is based on evidence-based search and expert correspondence,which is in line with China's national conditions,and the expert opinions are relatively concentrated and well coordinated,which can provide a basis for interventional research on pre-pregnancy risk management in LN patients.In addition,the balance of factors such as environment,personnel,and time remains when the plan is converted to clinical application.It is recommended that when the plan is applied clinically,a hygienic evaluation should be conducted,taking into full consideration the hospital environment,the conditions of medical staff,the wishes of patients and primary caregivers.