Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

INTEGRATED ANALYSIS APPROACHES TO ROCK MECHANICS PROBLEMS

In order to effectively cope with exponent increase of the complexity faced to the rock mechanics analysis problems and the large incompatibility existing between the information level required to model the rock mass and engineering and our obtainable information level at hand,the integrated approaches with intelligent characters are proposed. Many previous standard methods,such as precedent type analysis,rock classification,analytic method stress-based,basic numerical methods (BEM,FEM,DEM,hybrid),and their extended numerical methods (fully coupled) to be developed,can be selected respectively or integrated accordingly. It is alternative to develop basic/fully integrated system,and internet-based approaches. These novel methods can also be selected or integrated each other or with the standard methods to perform rock mechanics analysis. Some key techniques to develop these alternative methods are discussed. It may focus in future on developing fully integrated systems and internet-based approaches. Developing an environmental,virtual facility/space shall be firstly done for this collaborative research on internet.

Health 3.0—The patient-clinician “arabic spring” in healthcare

A growing number of citizen-patients and clinicians use Communication and Self-Managed Health Technologies (CSMHT) in their relationship. Doing so, they shift from the current paradigm of dependency to a co-responsibility paradigm in healthcare. Facing the runaway utilization of health services, we need to think “outside the box” to unblock the system. A Health 3.0 development model of governance that position patients as primary members of the clinicians’ team is presented to map this institutional transformation. At the practical level, an MD 3.0 relational model and a Citizen-Patient 3.0 behavioral profile are presented.

Identifying behavioral determinants and stage of readiness for performing knee massage among individuals with knee osteoarthritis:An observational study

Objective Patients who experience knee osteoarthritis or chronic knee pain can alleviate their symptoms by performing self-knee massage.Understanding the readiness and types of determinants needed to facilitate self-knee massage is needed to design effective,theory-informed interventions.The primary objective of this study was to apply the transtheoretical model of behavior change to identify how factors,which include the type of knee condition and pain level,predict an individual’s readiness to adopt self-knee massage.The secondary objective employed the capability,opportunity and motivation-behavior(COM-B)model to identify relevant determinants that are predictive of an individual’s readiness to undertake self-knee massage.Methods An observational study design was used to recruit individuals with knee osteoarthritis(n=270)and chronic knee pain(n=130).Participants completed an online survey that assessed the transtheoretical model of behavior change stages,COM-B determinants(capability,opportunity and motivation),along with self-administered massage behavior.Multivariate analysis of covariance and structural equation modeling were used to test the primary and secondary objective,respectively.Results Participants who had knee osteoarthritis scored higher on the action stage compared to those with chronic pain(P=0.003),and those who experienced greater level of pain scored higher in the contemplation(P<0.001)and action phases(P<0.001)of performing knee massage compared to those with milder pain.The COM-B structural equation model revealed self-administered knee massage to be predicted by capability(β=0.31,P=0.004)and motivation(β=0.29,P<0.001),but not opportunity(β=–0.10,P=0.39).Pain level predicted motivation(β=0.27,P<0.001),but not capability(β=0.09,P=0.07)or opportunity(β=0.01,P=0.83).Tests for mediating effects found that determinants of COM-B(motivation and capability)mediate between pain level and self-administered massage behavior(β=0.10,P=0.002).Conclusion Clinicians and researchers can expect that patients diagnosed with knee osteoarthritis or who have chronic knee pain are ready(action stage)or are considering the behavior(contemplation stage)of self-knee massage.Individuals who report having knee osteoarthritis or chronic knee pain should be coached to develop the skills to perform self-knee massage and helped to develop the motivation to carry out the therapy.

Preparation of a questionnaire for disease knowledge-attitude-practice awareness of patients with remitted schizophrenia based on a structural equation model

Background:A relevant questionnaire that evaluates disease awareness of patients with re-mitted schizophrenia is lacking in China.Objective:The purpose of the current study was to develop a questionnaire suitable for eval-uating the disease knowledge-attitude-practice awareness on the part of patients with remitted schizophrenia,thus providing a reliable tool for evaluating patient knowledge of the disease and self-management ability.Methods:To establish a theoretical framework,the literature was reviewed,experts were con-sulted,a semi-structured interview was conducted,and a questionnaire survey was administered to prepare a questionnaire for disease knowledge-attitude-practice awareness on the part of patients with remitted schizophrenia.Results:Exploratory factor analysis showed that the questionnaire consists of four dimen-sions:etiology awareness;risk factor awareness;treatment awareness;and rehabilitation aware-ness.The four dimensions account for 56.6%of the total variability.Confirmatory factor anal-ysis showed that the fitting indices for the structural equation model are as follows:df=1.187;GFI=0.877;AGFI=0.856;and RMSEA=0.030.The total Cronbach a factor for the questionnaire was 0.878.The Cronbach a for each dimension was 0.59-0.81.Conclusion:The questionnaire for disease knowledge-attitude-practice awareness on the part of patients with remitted schizophrenia has better reliability and validity.