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Objective:To compare three nutritional screening tools in predicting dialysis-related pro tein-energy wasting(PEW) among maintenance hemodialysis(MHD) patients and to find a more rapid,accurate,and feasible screening tool.Methods:The nutrtional risk screening 62002 (NRS 2002),7-point subjective global assessment(SGA) and malnutrition inflammation scores (MIS) were compared among 205 MHD patients.Correlations between the serum biochemistry,anthropometry and different screening tools were analyzed,and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results:A total of 31.2％ of HD patients had PEW by ISRNM criteria,whilst using NRS 2002,7-point SGA and MIS,58％,40.8％ and 46.8％ of MHD patients exhibited PEW respectively.The results of three screening tools were closely related to those by serum biochemistry and anthropometry (P ＜ 0.05),but the composite correlation coefficient between the screening tools for PEW and the objective nutritional index commonly used was higher in NRS 2002(r =0.787,P ＜ 0.001) than in 7-Point SGA or MIS.NRS 2002 had higher sensitivity and accuracy values (87.5％ and 59.1％,respectively) in MHD Patients.Conclusion:MIS,7-PointSGA and NRS 2002 are valid tools for nutrition screening of dialysis patients,and NRS 2002 may be the best one.
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Objective To evaluate the use of bioelectrical impedance phase angle (PhA) for predicting protein-energy wasting (PEW) in hemodialysis patients.Methods This cross-sectional study involved 144 patients who were on maintenance hemodialysis (MHD) in the blood purification centers of two tertiary hospitals in Guangzhou,where the body impedance analysis (BIA) was performed after the hemodialysis procedure and the prevalence of protein-energy wasting (PEW) was investigated by the 7-point subjective global assessment (SGA) among.Nutritional indices of the patients with PEW were compared with the well-nourished patients to identify independent variables that can predict PEW and determine the cut-off value of PhA as a predictor.Results The patients with PEW had significantly lower PhA values than the Non-PEWpatients (t =8.68,P=0.00).PhA was positively related with the nutritional indices reflecting function of body proteins or muscles,such as serum albumin (rs=0.25,P=0.00),prealbumin (rs=0.31,P=0.00),free fat mass index (rs=0.25,P=0.00),and mid-arm muscle circumference (rs =O.44,P =O.00).However,the correlations of PhA with fat mass (rs =0.04,P=0.66) and body fat percentage (rs =-0.04,P=0.66) were no statistical significance.Multivariate logistic regression analysis revealed that PhA (OR =4.48,P =0.00) and body mass index (OR =1.59,P =0.00) were independent predictors of PEW,but PhA was more potent than BMI.Receiver operating characteristic curve analysis suggested that the optimum PhA cut-off point for predicting PEW was 4.6.Conclusion PhA can be a useful independent predictor for PEW in hemodialysis patients and its cut-off value is 4.6.
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Objective To evaluate the effect about medication compliance for patients with chronic heart failure in outpatients using nursing intervention model based on Omaha system.Methods 100 patients were randomly divided into observation group(50 patients)and control group(50 patients).The two groups of patients were given routine nursing intervention,the observation group also used the Omaha system to develop care programs on this basis, and was given the implementation about continuity of care.Results On the point of the two or three months after the patients were discharged,the AHFKT -V2 questionnaire scores in the observation group[(17.690 ±1.892)points, (20.900 ±2.052)points]were significantly higher than the control group[(14.080 ±2.374)points,(18.450 ± 1.781)points],the differences were statistically significant (t =-8.488,-6.442,all P <0.05).However,the same as the points after the patients were discharged,Morisky questionnaire scores in the observation group[(1.036 ± 0.780)points,(0.487 ±0.260)points]were significantly lower than the control group[(1.54 ±1.182)points, (0.920 ±0.804)points],the differences were statistically significant(t =3.420,4.965,all P <0.05).Conclusion The use of Omaha system to develop the targeted continuity of care,can improve the patients medication compliance.