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The global prevalence of chronic kidney disease (CKD) has continued to rise over time. Pharmacological therapy is the mainstay of conventional CKD treatment; however, many CKD patients find it difficult to adhere to their medication regimen.
To systematically evaluate and compare the effects of various self-management support strategies for patients with CKD.
We searched PubMed, Embase, The Cochrane Library, Web of Science, and Scopus to identify quasi-randomized and RCTs comparing the effectiveness of different self-management support strategies in CKD patients, The search spanned from database inception to June 24, 2025. Two reviewers independently screened the literature, extracted information, assessed the quality of studies, and we performed analysis using RevMan 5.0 and STATA 14.0 software.
Eighty-one studies were included, examining 10 strategies. Compared to conventional interventions, face-to-face combined tele-guidance, group visits, tele-guidance, and multi-component structured interventions significantly improved patients' self-efficacy. Surface under the cumulative ranking curve (SUCRA) of different self-management support strategies influencing self-efficacy ranked in the top three were face-to-face combined tele-guidance, group visits and tele-guidance. Empowerment interventions, cognitive behavioral therapy (CBT) and tele-guidance enhanced quality of life compared to conventional interventions. The SUCRA for quality of life ranked highest for empowerment, CBT and face-to-face combined tele-guidance. Additionally, we found that these strategies were beneficial in improving patients' blood pressure, IDWG, renal disease knowledge, and self-management.
The study offers evidence on effective self-management support strategies for CKD patients, highlighting face-to-face combined tele-guidance might be the most effective intervention for increasing self-efficacy, while empowerment might be the most effective intervention for increasing quality of life in CKD patients. These findings can help healthcare providers design better programs to improve patient outcomes. However, more high-quality RCTs are needed to confirm findings.
PROSPERO: CRD42024596581
The best evidence on programmed weaning from mechanical ventilation in neurocritical care patients should be gathered, evaluated, and integrated to provide an evidence basis for determining the optimal weaning program for these patients.
According to the ‘6S’ pyramid model of evidence-based practice resources, Chinese and international guideline websites, websites of relevant professional societies, and Chinese and English databases were systematically searched. The databases were searched from the time of establishment to October 2024. Literature screening was subsequently performed according to the inclusion and exclusion criteria. Two researchers independently evaluated the literature quality and extracted and summarised the evidence.
A total of 21 publications were included, including 3 guidelines, 5 expert consensus papers, 1 evidence summary, and 12 systematic reviews. A total of 29 pieces of best evidence in the following 5 aspects were summarised: preweaning preparation and screening, a weaning protocol, extubation assessment, extubation preparation and procedure, and postextubation management.
This study summarises the best evidence for the programmed weaning of neurocritical care patients from mechanical ventilation and provides a basis for clinical medical personnel to standardise this weaning process. Evidence-based application of these strategies should be implemented to verify their clinical efficacy and safety in practice.
Successful weaning is key in the management of neurocritical care patients receiving mechanical ventilation. The establishment of a localised extubation protocol guided by a multidisciplinary team can significantly reduce the extubation failure rate, the duration of mechanical ventilation and the incidence of related complications. However, evidence-based application is needed to verify the efficacy and safety of these strategies in clinical practice.
This evidence review adhered to the evidence review report guidelines formulated by the Evidence-Based Nursing Center of Fudan University. These guidelines cover aspects such as problem establishment, literature search, literature screening, literature evaluation, evidence summary and classification, as well as the formulation of practical suggestions. This evidence summary followed the evidence summary reporting specifications of the Fudan University Center for Evidence-Based Nursing (http://ebn.nursing.fudan.edu.cn) with registration number ES20244849.
This study was based on the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing; the registered name is ‘Summary of the best evidence for weaning from mechanical ventilation in neurocritical care patients’; the registration number is ES20231823
To describe the level of family decision-making self-efficacy and its associated factors among Chinese family members of ICU patients.
Cross-sectional descriptive quantitative study.
Using convenience sampling, 154 ICU patients and their family members from two tertiary hospitals completed a paper-based questionnaire assessing sociodemographic characteristics of patients and their family members, patients' disclosure of preferences to their family members, and family members' decision-making self-efficacy, anxiety and depression, uncertainty of illness, coping and social support. The data were analysed using independent-samples t-tests, one-way analysis of variance, Pearson correlation and multiple linear regression.
The average scores of self-efficacy in treatment, comfort promotion and facing death decision-making were 4.3 (SD = 0.6; range = 1–5), 4.2 (SD = 0.6; range = 1–5) and 3.5 (SD = 0.6; range = 1–5), respectively. Active coping was a predictor of self-efficacy in treatment, comfort-promoting and facing death decision-making. Patients' disclosure of preferences regarding mechanical ventilation, family members' anxiety and illness uncertainty were predictors of self-efficacy in treatment decision-making. Patients' disclosure of preferences regarding expensive medications was a predictor of self-efficacy in comfort-promoting decision-making, and patients' age was a predictor of self-efficacy in facing death decision-making.
Chinese family members of ICU patients reported relatively high self-efficacy in treatment and comfort promotion decision-making but lower self-efficacy in facing death decision-making. Active coping plays a critical role in enhancing decision-making self-efficacy across these three types of decisions. The predictors of decision-making self-efficacy varied according to the specific type of decision.
For Chinese family members of ICU patients, targeted strategies to strengthen their active coping skills are key to enhancing their confidence in making decisions with or for patients. Patients' disclosure of preferences to their family members is helpful for improving family members' confidence in making treatment and comfort promotion decisions. Extra support is especially needed for end-of-life decision-making, particularly when the patient is younger.
This research informs future interventions by highlighting active coping and patients' disclosure of preferences to family members as key factors to strengthen decision-making self-efficacy among Chinese family members of ICU patients. However, family members' decision-making self-efficacy appears to be culturally specific, underscoring the need to design family-centered critical care approaches that are tailored to cultural contexts in other settings. Besides, while our research found a positive association between anxiety and self-efficacy in treatment decision-making, the relationship between them requires further investigation.
STROBE guidelines.
No Patient or Public Contribution.
To investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social-related factors of older adults with different nutritional statuses.
Malnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors.
A cross-sectional study.
From January to April 2023, a cross-sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non-demographic instruments [Short-Form Mini-Nutritional Assessment (MNA-SF), Barthel Index (BI) and Mini-mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross-sectional studies were used in this study (Data S1).
209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment.
Malnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status.
This study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition.
FreshRSS 