Kev Loj Hlob Thiab Kev Ntsuas Ua Ntej Psychometric Ntawm Tus Neeg Laus Mob Raum Kab Mob Rau Tus Kheej Tus Kheej (CKD-SM) Cov Lus Nug

edmund.chen@wecistanche.com

Taw qhia

Ntevmob raum(CKD) cuam tshuam txog kwv yees li 10 feem pua ​​​​ntawm cov neeg laus hauv tebchaws Canada thiab ua rau muaj kev mob hnyav, kev tuag, thiab kev siv cov khoom siv kho mob.1 Tsis ntev los no.mob raumyog ib qho mob ntev uas xav tau kev tswj xyuas tas li; tus naj npawb ntawm cov neeg xav tauraumhloov kho rauraum tsis ua haujlwm(dialysis lossis hloov pauv) nce zuj zus, ua rau cov txiaj ntsig kev noj qab haus huv tsis zoo rau cov neeg mob thiab tus nqi tsis muaj txiaj ntsig rau kev noj qab haus huv.2,3 Kev mob siab rau txo qhov kev pheej hmoo ntawmraum tsis ua haujlwm, CKD kev tswj hwm tau hloov mus rau kev txheeb xyuas ntxov thiab pib ua pov thawj ntawm kev tiv thaiv kev ua ub no, xws li kev tswj hwm tshuaj thiab kev ua neej.4,5 Los ntawm kev cuam tshuam ntxov, feem ntau ua ntej cov neeg mob ntsib ntau yam tsos mob, qhov kev pheej hmoo ntawm kev txhim kho theem kawg.mob raum(ESKD) tuaj yeem txo qis.6,7.Cov neeg mob CKD uas tseem tsis tau muajraumKev hloov kho (KRT) lossis npaj pib KRT feem ntau muaj qee yam tsos mob, thiab yog li ntawd, lawv tsis tshua nyiam koom nrog kev tiv thaiv, xws li kev hloov pauv kev noj haus.1 Yog li ntawd, kev cuam tshuam los txhawb kev tswj tus kheej sai tom qab kuaj mob CKD yog nce zuj zus.8 Txawm hais tias cov kev siv zog no, kev hloov tus cwj pwm tsis tu ncua tuaj yeem nyuaj, thiab feem ntau cov kev cuam tshuam tsis tau raug soj ntsuam nruj heev; Yog li ntawd, nws yog ib qho nyuaj los txiav txim siab seb qhov kev cuam tshuam twg yuav ua tau zoo thiab yog vim li cas.8,9 Compounding qhov no yog qhov tsis muaj cov cuab yeej qhia tus kheej siv tau los ntsuas kev tswj tus kheej cov kev cuam tshuam rau cov neeg mob CKD uas tsis nyob hauv KRT. Cov cuab yeej muaj feem ntau ntsuas cov kev cuam tshuam rau "mob kab mob" feem ntau lossis tsom mus rau theem tom ntej ntawm CKD thaum cov neeg mob tau los ze lossis twb tau txais kev lim ntshav thiab lawv cov kev tswj hwm tus kheej txawv heev (xws li kev tswj fistula ntsig txog kev lim ntshav thiab saib xyuas cov tshuaj poov tshuaj. thiab qib phosphorus).10-18 Tsis tas li ntawd, cov kws kho mob thiab cov kws paub txog cov ntsiab lus tau tsim ntau ntawm cov lus nug uas twb muaj lawm no nrog cov lus nug me me, lossis tsis muaj, cov tswv yim los ntawm cov neeg mob thiab cov neeg saib xyuas, thiab yog li daim ntawv nug yuav tsis cuam tshuam cov neeg mob cov kev xav tau kev tswj tus kheej thiab qhov tseem ceeb. Plaub daim ntawv nug ntsig txog tsim los hais txog CKD kev paub thiab / lossis kev tswj tus kheej, 14,15,19,20 tau siv los ntsuas kev tswj tus kheej hauv CKD. Txawm li cas los xij, cov lus nug no tau tsim thiab siv tau hauv Suav teb thiab Taiwan, uas qhia txog qee qhov kev coj noj coj ua thiab kev txhais lus cov nyom uas yuav txwv tsis pub "kev xav sib npaug" ntawm cov lus nug hauv Canadian cov ntsiab lus.21 Ntxiv mus, ntau qhov tseem ceeb ntawm kev tswj hwm tus kheej tau txheeb xyuas los ntawm cov neeg mob thiab Cov neeg saib xyuas hauv Canada22 tsis tau hais. Yog li ntawd, yuav tsum tau tsim ib daim ntawv nug tus neeg mob uas qhia tshwj xeeb uas ntsuas CKD tus cwj pwm tswj tus kheej hauv Canadian cov ntsiab lus; Cov cuab yeej zoo li no yuav pab tau rau hauv kev ntsuam xyuas ntawm kev tswj tus kheej yav tom ntej thiab cov phiaj xwm kev kawm rau cov pej xeem. Yog li ntawd, peb tau npaj los tsim thiab sim cov lus nug uas tus neeg mob paub txog los ntsuas CKD-kev tswj tus kheej tshwj xeeb hauv cov neeg laus nrog CKD (CKD pawg G2-G5 tsis nyob ntawm KRT).

Ntsiab lus:mob raum mob, kev tswj tus kheej, tus neeg mob tau tshaj tawm cov txiaj ntsig, cov lus nug txhim kho, ua ntej lim ntshav

CISTANCHE yuav txhim kho lub raum / raum mob ntshav qab zib

Cov txheej txheem Daim ntawv nug CKD tswj tus kheej (CKD-SM) tau tsim nyob rau hauv 4 theem (Daim duab 1): (1) kev txheeb xyuas cov khoom; (2) pawg kws tshaj lij kev tshuaj xyuas; (3) pilot test; thiab (4) sim nyob rau hauv ib qho kev tshawb fawb txog kev tswj hwm tus kheej ntawm CKD. Theem 1: Kev Txheeb Xyuas Yam Khoom Lub hom phiaj ntawm theem no yog los tshuaj xyuas cov ntaub ntawv tswj hwm tus kheej thiab sau cov lus nug uas muaj peev xwm rau thawj zaug ntawm pawg kws tshaj lij kev tshuaj xyuas hauv theem 2. Kev tswj tus kheej tau txhais dav dav tias yog ib tus neeg koom nrog hauv kev kho mob. thiab kev kho mob.23,24 Kev tswj tus kheej kuj suav nrog kev ua tau zoo ntawm tus kheej (kev ntseeg ntawm ib tus neeg muaj peev xwm ua) thiab kev saib xyuas tus kheej (lub peev xwm thiab kev ntseeg siab los ua cov dej num uas xav tau kom muaj kev noj qab haus huv zoo).25, 26 Peb tau siv cov qauv kev tswj hwm tus kheej (txhua qhov sib xyaw ua ke ntawm kev paub, kev txawj ntse, thiab kev ntseeg siab uas xav tau los tswj kev mob nkeeg zoo; saib Box 1), tus neeg mob txheeb xyuas qhov tseem ceeb ntawm kev tswj hwm tus kheej tau txheeb xyuas los ntawm Donald thiab al22,27 (kev nkag siab CKD, kev noj haus. , cov tsos mob, tshuaj, kev noj qab haus huv ntawm lub cev thiab lub hlwb, nyiaj txiag, kev mus ncig, kev ua haujlwm, thiab kev kawm), thiab tshuaj xyuas cov lus nug txog kev tswj tus kheej uas twb muaj lawm (Table S1) los qhia txog kev txhim kho daim ntawv nug. Cov ntawv nug txog kev tswj tus kheej/kev ua tau zoo ntawm tus kheej tau raug txheeb xyuas siv ntau txoj hauv kev: MEDLINE thiab National Institutes of Health National Library of Medicine Health Services thiab Sciences Research Resources Instrument search (siv cov lus tshawb fawb txog kev tswj tus kheej, kev saib xyuas tus kheej, kev ua tau zoo ntawm tus kheej,raum) nyob rau lub Ib Hlis 2020.

Peb pawg neeg tshawb fawb (MDS, MD, BRH) rov qab tshuaj xyuas cov khoom muaj peev xwm uas siv cov ntsiab lus kev pab them nqi (Daim duab 2) txhawm rau txheeb xyuas cov ntsiab lus thiab kev sawv cev thiab kom ntseeg tau tias muaj kev sib haum xeeb nrog kev tswj hwm tus kheej theoretical moj khaum thiab cov neeg mob pom qhov tseem ceeb. Peb tau txais kev tawm tswv yim ua ntej hais txog cov ntsiab lus thiab kev sawv cev los ntawm cov kws tshaj lij cov ntsiab lus (3 tus kws kho mob nephrologists thiab tus kws tshawb fawb txog kev noj qab haus huv tshwj xeeb hauv CKD kev tswj hwm tus kheej uas tau koom nrog pawg kws tshaj lij), ua ntej pawg kws tshaj lij tshuaj xyuas hauv theem 2 ntawm txoj kev tshawb no. Thaum lub peev xwm CKD-SM cov lus nug cov khoom raug txheeb xyuas, peb tau xaiv cov lus teb cov lus teb rau daim ntawv nug. Raws li kev coj cwj pwm thiab kev coj cwj pwm, xws li kev paub thiab kev ntseeg siab los tswj CKD, dag ntawm qhov txuas ntxiv, 21 peb tau xaiv txoj kev ntsuas ncaj qha mus txuas ntxiv los sau cov neeg koom nrog cov lus teb raws li 7-point Likert scale xws li "tsis pom zoo" mus rau " pom zoo heev" thiab "tsis muaj kev ntseeg siab heev" rau "kev ntseeg siab heev." Ib qho 7- taw tes ntsuas tau raug xaiv los ua kom zoo dua qhov kev ntseeg siab thaum txo qis cov lus teb.21

Phase 2: Kws muaj kev pab vaj huam sib luag nrog cov khoom khoThe purpose of this phase was to reach a consensus among experts about items and finalize the draft questionnaire for pilot testing with patients. An expert panel, comprising 8 members (including 4  nephrologists, 2 CKD nurses, 1 patient partner, and 1 CKD  self-management researcher), was purposively selected to ensure representation from a variety of clinical roles and prior experience with CKD self-management concepts. The panel was provided with a description of the construct (CKD  self-management), the purpose of the tool (to detect whether patients experience a change in self-management behavior following an intervention), and a draft of the CKD-SM questionnaire items. Each round of review was conducted via an electronic questionnaire using Qualtrics software (Qualtrics,  Provo, Utah). Panel members were asked to rate each item on a 4-point Likert scale ranging from "not relevant" to  "highly relevant" for self-management in early-stage CKD  (defined as patients with CKD categories G2-G5 not on KRT  or preparing for KRT). If a panel member selected "not relevant" or "somewhat relevant" for an item, they were prompted to record a rationale. An open-ended question was also included for panel members to suggest additional items they felt were an important aspect of CKD self-management.  The questionnaire was modified following feedback, including deletion of items scored "not relevant" or "somewhat relevant" by a majority (>50 feem pua ​​​​) ntawm lub vaj huam sib luag thiab ntxiv cov khoom qhia tshiab. Lub vaj huam sib luag ntawm nws tus kheej tau tshuaj xyuas cov lus nug uas tau hloov kho dua mus txog thaum cov ntsiab lus siv tau qhov sib piv (CVR) ntau dua lossis sib npaug rau 0.75 (pom zoo rau cov vaj huam sib luag nrog 7-9 tus ntsuas), qhia tias feem ntau ntawm cov neeg tshuaj xyuas ntseeg tias cov khoom tseem ceeb.21, 31 Cov khoom nrog CVR<0.75 were="" considered="" for="" retention="" if="" their="" removal="" compromised="" an="" important="" content="" domain="" (content="" validity)="" outlined="" in="" the="" content="" coverage="" matrix="" (figure="">

Theem 3: Pilot TestLub hom phiaj ntawm kev sim ntsuas yog txhawm rau ntsuas kev ntseeg tau thiab siv tau nrog cov neeg mob thiab sau cov ntaub ntawv ntawm kev nkag siab, cov lus hais, thiab cov ntsiab lus ntawm kev tswj tus kheej muaj peev xwm ua rau muaj kev txheeb xyuas cov lus nug ntxiv. Daim ntawv nug CKD-SM tau sim sim nrog cov qauv yooj yim ntawm Canadian, cov neeg laus hais lus Askiv nrog CKD (non-dialysis) los ntawm daim ntawv nug hauv hluav taws xob uas tau tshaj tawm los ntawm Interdisciplinary Chronic Disease Collaboration (ICDC; https://cumming.ucalgary.ca/ tshawb fawb/icdc) hauv ib qho tweet ntawm Twitter thaum Lub Plaub Hlis 2020. Cov neeg teb uas tau txheeb xyuas tus kheej tias tau kuaj mob CKD thiab tsis nyob rau hauv kev lim ntshav tau tsim nyog los koom. Cov lus nug tau sau tsis qhia npe siv Qualtrics daim ntawv ntsuam xyuas software (Qualtrics). Peb nrhiav kom suav nrog 30 tus neeg koom nrog hauv kev sim ntsuas; tus qauv loj no tau raug xaiv los ntawm cov kev tshawb fawb zoo sib xws uas qhia tias tus qauv loj ntawm 30 txog 50 yog qhov tsim nyog rau "pretest" ntawm qhov xwm txheej no.32 Ntxiv rau kev ua kom tiav CKD-SM cov lus nug, cov neeg tuaj koom tau nug cov lus qhib-kawg hais txog qhov tseeb. ntawm cov lus nug, kev nkag siab, kev sau ntawv / lo lus paub, yooj yim ntawm cov lus teb, thiab seb puas muaj cov ntsiab lus / cov lus nug uas ploj lawm uas lawv xav tias tseem ceeb rau kev tswj tus kheej hauv CKD. Cov lus nug cov lus teb kev ntseeg tau raug soj ntsuam siv Cronbach qhov kev xeem rau kev sib raug zoo sab hauv (los txiav txim seb cov khoom puas tau ntsuas tib lub tsev). Cronbach tus nqi ntau dua 0.70 tau suav tias yog qhov lees txais.33 Cov lus teb rau cov lus nug qhib tau muab faib ua ke siv cov ntsiab lus piav qhia, cov ntsiab lus sib piv.34

CISTANCHE yuav txhim kho lub raum / raum kab mob

Theem 4: Embed hauv CKD-SM Intervention.Lub hom phiaj ntawm theem no yog sim sim CKD-SM cov lus nug nyob rau hauv kev tshawb fawb txog kev tswj tus kheej thiab sau cov ntaub ntawv psychometric ntsig txog kev ntseeg siab, kev ruaj ntseg, thiab kev teb. Raws li daim ntawv nug CKD-SM tab tom txhim kho, peb tsis tau nrhiav kev ntsuam xyuas kev tswj hwm tus kheej nrog rau daim ntawv nug no (ib qho kev tshawb fawb cais los ntsuas qhov ua tau ntawm kev cuam tshuam tus kheej tau pib thiab luam tawm lwm qhov35); es, qhov kev cuam tshuam tso cai rau lub sijhawm los sau cov ntaub ntawv psychometric ntxiv ntawm qhov ntsuas nws tus kheej. Thaum muaj kev cuam tshuam txog kev tswj tus kheej, cov neeg tuaj koom tau nkag mus rau tus kheej nkag mus rau ib qho khoom siv hluav taws xob tswj tus kheej, KuvLub raumKuv lub vev xaib Kev Noj Qab Haus Huv (www. mykidneysmyhealth.com), rau 8 lub lis piam.35 Lub vev xaib tau tsim nrog cov neeg mob, cov kws tshawb fawb, thiab cov kws kho mob nrog lub hom phiaj los muab CKD kev tswj hwm tus kheej los ntawm kev kawm thiab cov cuab yeej sib tham (xws liraum-Cov npe zaub mov zoo, kev qhia tshuaj tsis yog tshuaj, thiab tshuaj xyuas kev nyuaj siab).36

Daim ntawv nug CKD-SM tau muab ob zaug hauv lub sijhawm preintervention, nyob rau hauv lub hauv paus thiab 1 lub lis piam tom qab (test-retest), thiab postintervention kwv yees li 8 lub lis piam tom qab cov neeg koom tau nkag mus rau lub Web-based txhawb nqa. Txoj kev tshawb no suav nrog cov qauv yooj yim ntawm Canadian, cov neeg laus hais lus Askiv nrog CKD (tsis yog kev lim ntshav) nrhiav online ntawm Twitter thiab lub koom haum Web site (ICDC, Can-SOLVE CKD Network, thiab covLub raum Foundation of  Canada) and through advertisements in 2 nephrology clinics in Alberta from June 2020 to December 2020. Questionnaires were emailed to participants at each time point and completed electronically using Research Electronic Data Capture  (RedCap) 10 data capture software (Vanderbilt University  Medical Center). The analysis included internal consistency reliability (Cronbach α) and test-retest reliability using a 2-way  mixed, absolute effects model (intraclass correlation coefficient [ICC]) to determine whether respondents' scores were stable between administrations prior to the self-management intervention and pre-post test scores (Wilcoxon sign-rank test). Cronbach α and ICC values greater than 0.7 were considered acceptable.33,37 Responsiveness was considered acceptable if preintervention test-retest responses were stable (ICC >0.7) tab sis kev sib koom ua ntej kev cuam tshuam cov lus teb tau sib txawv heev (P Tsawg dua lossis sib npaug rau .05), qhia txog kev ntsuas ntsuas tau ntawm kev tswj tus kheej tom qab kev cuam tshuam. Txoj kev tshawb no tau tshuaj xyuas thiab pom zoo los ntawm University of Calgary Conjoint Research Ethics Board (CHREB), REB20-0153. Kev pom zoo raug sau thiab sau tseg rau txhua tus neeg koom nrog kev kawm (qhov kev tso cai pom zoo tau sau los ua ib feem ntawm cov lus nug tsis qhia npe hauv hluav taws xob rau cov neeg koom nrog kev sim hauv theem 3, thiab kev pom zoo ntawm qhov ncauj tau sau thiab sau tseg rau CKD kev tswj hwm tus kheej kev cuam tshuam kev kawm cov neeg koom hauv theem 4).

Cov txiaj ntsig

Theem 1 thiab 2: Kev txheeb xyuas cov khoom thiab cov kws tshaj lij kev tshuaj xyuasFollowing a review of existing chronic disease self-efficacy questionnaires and patient-identified priorities, 22 potential questionnaire items were drafted for the first round of expert panel review (Table S2). A panel of 8 content experts (including 4 nephrologists, 2 CKD nurses, 1 patient partner, and 1  CKD self-management researcher) reviewed the draft  CKD-SM questionnaire. Two rounds of the review were completed; of the 22 items reviewed in the first round, 13 items were retained. In the second round, 11 items were reviewed and, initially, 10 were retained; following review of the content coverage matrix (Figure 2), the item relating to travel and work was retained to preserve content validity overall.  Of the 24 items retained following expert panel review of the questionnaire, 21 had >85 feem pua ​​kev lees txais (CVR Ntau dua lossis sib npaug rau 0.75) thiab 3 tau txais 75 feem pua ​​(CVR Ntau dua lossis sib npaug rau 0.50). 3 yam khoom nrog CVR<0.75 were="" retained="" to="" preserve="" content="" validity.="" following="" expert="" panel="" review,="" the="" finalized="" questionnaire="" included="" content="" related="" to="" knowledge="" of="" ckd,="" skills/confidence="" to="" engage="" in="" ckd="" self-management,="" blood="" pressure="" targets,=""  laboratory="" measurements,="" nonprescription="" medications,=""  symptoms,="" diet,="" lifestyle="" factors,="" communicating="" needs,="" and="" information-seeking="">

CISTANCHE yuav txhim kho lub raum / raum mob

Theem 3: Pilot Test

Peb caug tus neeg mob nrog CKD los ntawm thoob plaws tebchaws Canada tau koom nrog kev sim ntsuas txij lub Plaub Hlis 2020 txog Lub Tsib Hlis 2020 (Table 1). Kwv yees li ib nrab ntawm cov txiv neej (14/30; 46 feem pua) thiab nruab nrab ntawm 50 thiab 64 xyoo (13/30; 43 feem pua). Kwv yees li 40 feem pua ​​(12/30) muaj kwv yees li glomerular pom tus nqi (eGFR) ntawm<30 ml/min/1.73="" m2="" ;="" the="" remainder="" had="" an="" egfr="" of="" ≥30=""  ml/min/1.73="" m2=""  or="" did="" not="" know="" their="" egfr.="" internal="" consistency="" was="" high="" (cronbach="" α="0.921)." participants="" indicated="" they="" were="" satisfied="" with="" the="" content,="" wording,="" and="" design;="" one="" participant="" indicated="" the="" questionnaire="" was="" "very="" quick="" and="" easy"="" (pt="" 105)="" and="" another="" stated="" they="" "thought="" it="" was="" really="" good.="" it="" is="" progressive,="" one="" question="" leads="" to="" the="" next="" in="" terms="" of="" relevance"="" (pt="" 102)="" (table="" s3).="" a="" common="" comment="" was="" the="" need="" for="" a="" question="" that="" more="" explicitly="" addressed="" mental="" health;="" for="" example,="" one="" participant="" responded,="" "there="" are="" no="" questions="" about="" mental="" health,=""  about="" family="" and="" support="" systems="" as="" ckd="" affects="" the="" whole="" family"="" (pt="" 110)="" and="" another="" asked,="" "why="" is="" everyone="" afraid="" to="" deal="" with="" the="" mental="" health="" issues="" we="" face?"="" (pt="" 129).=""  based="" on="" this="" feedback="" and="" review="" with="" the="" expert="" panel,="" we="" included="" an="" additional="" item="" relating="" to="" mental="" health="" in="" the="" final="" questionnaire:="" "i="" feel="" i="" am="" able="" to="" manage="" my="" mental="" health="" concerns,="" should="" they="" arise"="" (figure="" 2)="" prior="" to="" the="" intervention="" study="" in="" phase="" 4="" (bringing="" the="" total="" number="" of="" questions="" in="" the="" final="" questionnaire="" to="" 25="" items);="" see="" figure=""  s1="" for="" a="" hard="" copy="" version="" of="" the="" final="">

Theem 4: Kev Xeem Embedded hauv CKD-SM Intervention StudyNees nkaum cuaj tus neeg mob los ntawm thoob plaws tebchaws Canada tau koom nrog CKD kev tswj hwm tus kheej txoj kev tshawb fawb txij lub Rau Hli 2020 txog Lub Ob Hlis 2021 (Table 1). Kwv yees li ib nrab ntawm cov txiv neej (15/29; 52 feem pua) thiab nruab nrab ntawm 50 thiab 64 xyoo (11/29; 38 feem pua). Kwv yees li 40 feem pua ​​(11/29) muaj eGFR ntawm<30 ml/="" min/1.73="" m2=""  and="" 60%="" (18/29)="" had="" an="" egfr="" of="" ≥30="" ml/="" min/1.73="" m2=""  or="" did="" not="" know="" their="" egfr.="" internal="" consistency="" reliability="" (cronbach="" α)="" was="" 0.912="" (table="" 2).="" test-retest="" reliability,="" measured="" approximately="" 1="" week="" apart=""  (preintervention)="" using="" icc,="" was="" 0.732="" (95%="" confidence=""  interval,="" 0.686-0.77)="" (p="" <="" .001).="" twenty-two="" paired="" pre/postintervention="" responses,="" measured="" approximately="" 2="" months="" apart="" using="" wilcoxon="" sign-rank="" test,="" demonstrated="" significant="" improvements="" (p="" <="" .05)="" in="" self-management="" for="" 8="" items=""  (table="" 3)="" despite="" stable="" preintervention="" test-retest="" scores;="" no="" significant="" change="" was="" observed="" for="" the="" remaining="" 17="" items.=""  seven="" participants="" lost="" to="" follow-up="" did="" not="" provide="" a="" reason="" for="" nonresponse.="" two="" reminder="" emails="" were="" sent="" to="" these="" participants="" and="" then="" they="" were="" marked="" as="" lost="" to="">

Kev sib tham

Peb tau tsim ib daim ntawv nug CKD-SM rau cov neeg laus nrog CKD pawg G2-G5 tsis nyob rau hauv KRT thiab ua qhov kev ntsuam xyuas kev puas siab puas ntsws ua ntej (xws li kev siv tau, kev ntseeg siab, kev ruaj ntseg, thiab kev teb). Daim ntawv nug CKD-SM tau tsim los ntawm cov kws tshaj lij kev pom zoo, sim sim nrog cov neeg mob, thiab tswj hwm hauv kev kawm ua ntej CKD kev tswj hwm tus kheej. Zuag qhia tag nrho, cov txiaj ntsig tau qhia tias daim ntawv nug CKD-SM tau ua tiav kev ntseeg siab thoob plaws ntau qhov kev tswj hwm, qhia tias CKD-SM cov lus nug tsis tu ncua ntsuas qhov ntev ntawm kev tswj tus kheej. Daim ntawv nug kuj tau tshwm sim kom muaj kev ruaj ntseg nyob rau hauv kev rov qab tswj hwm (thaum tsis muaj kev tswj hwm tus kheej

kev cuam tshuam), tab sis kuj tau teb rau cov kev hloov pauv hauv kev paub txog kev tswj tus kheej muaj peev xwm tom qab kev koom tes hauv kev tswj hwm tus kheej hauv hluav taws xob. Txawm hais tias txoj kev tshawb fawb no tsis tau ntsuas qhov kev tswj hwm tus kheej ncaj qha, cov txiaj ntsig ua ntej los ntawm kev tshawb fawb muaj peev xwm ua tau ua ke nrog daim ntawv nug kev txhim kho no qhia txog kev cuam tshuam txhawb cov neeg mob los tswj CKD, tshwj xeeb yog hais txog kev nrhiav thiab nkag siab cov ntaub ntawv hais txog CKD,raum-cov khoom noj muaj txiaj ntsig, thiab xaiv cov tshuaj uas tsis yog tshuaj.35 CKD cov lus nug txog kev tswj tus kheej tus kheej cov khoom uas pom tau tias kev txhim kho tom qab qhov kev cuam tshuam no cuam tshuam txog kev txhim kho hauv cov cheeb tsam tshwj xeeb, qhia tias daim ntawv nug tau nkag siab txog qhov kev txhim kho tau sau tseg los ntawm cov neeg koom nrog hauv kev tshawb fawb txog kev ua tus kheej. tswj kev cuam tshuam Kev tshawb fawb qhia tias kev tswj tus kheej zoo yuav ua rau qeeb CKD kev nce qib8,9; Txawm li cas los xij, muaj qee qhov kev ntsuas uas muaj los ntsuas tus neeg mob kev tswj hwm tus kheej hauv CKD, tshwj xeeb tshaj yog rau cov tib neeg uas muaj cov theem pib ntawm CKD, ua rau nws nyuaj rau kev txheeb xyuas cov kev tswj hwm tus kheej kom muaj txiaj ntsig zoo rau cov pej xeem no.8,9 Cov kev ntsuas uas twb muaj lawm yuav tsis muaj qhov tshwj xeeb, Kev ntsuas tus kab mob ntev ntev, lossis suav nrog cov lus nug ntsig txog cov tsos mob thiab kev kho mob uas tshwm sim tsuas yog tom qab CKD, xws li kev lim ntshav, kev tswj fistula, thiab saib xyuas cov ntshav phosphorus ntau ntau.10-18 Peb tau txheeb xyuas 3 daim ntawv nug uas twb muaj lawm uas muaj feem cuam tshuam rau CKD kev tswj tus kheej rau cov neeg mob uas tsis yog ntawm KRT.14,15,19 Cov lus nug no tau txais txiaj ntsig zoo rau kev txheeb xyuas cov khoom rau thawj zaug ntawm peb daim ntawv nug CKD-SM. Txawm hais tias cov lus nug tau hais txog ntau yam ntawm cov ntsiab lus uas siv los tsim CKD-SM daim ntawv nug, muaj qee qhov sib txawv ntawm cov lus nug feem ntau cuam tshuam txog tus neeg mob uas tau txheeb xyuas tus kheej tswj hwm tus kheej (xws li kev ntseeg siab xaiv cov tshuaj tsis yog tshuaj, mus ncig, thiab tswj kev puas siab puas ntsws / kev xav. kev noj qab haus huv) thiab tsis muaj "kev xav sib npaug" rau Canadian cov ntsiab lus (cov lus nug no tau tsim thiab siv tau hauv Suav teb thiab Taiwan, thiab qee cov lus nug txhais, xws li "Koj puas paub ntsuas koj cov txiaj ntsig curative" 15 tej zaum yuav tsis meej rau cov neeg tuaj saib). Peb txoj kev tshawb fawb tsim los ntawm cov ntawv nug yav dhau los los ntawm kev sim daws cov qhov khoob no thiab muab cov lus nug txog kev tswj tus kheej rau cov neeg mob CKD uas tsis nyob hauv KRT hauv Canadian cov ntsiab lus.

Daim ntawv nug CKD-SM tau tsim los ntawm kev sib koom ua ke ntawm kev tswj tus kheej txoj kev xav (hais txog cov haujlwm, kev txawj, txheej txheem, thiab kev sib koom ua ke25,28-30) thiab los ntawm kev sab laj nrog pawg kws kho mob thiab cov neeg mob kom ntseeg tau tias cov lus nug xwm txheej zoo sib xws nrog Tam sim no paub txog cov neeg mob cov kev xav tau kev tswj tus kheej hauv CKD thaum ntxov (piv txwv li, nkag siab CKD, noj zaub mov, cov tsos mob, tshuaj, kev noj qab haus huv ntawm lub cev thiab lub hlwb, nyiaj txiag, kev mus ncig, kev ua haujlwm, thiab kev kawm) 22,27 Vim li ntawd , CKD-SM cov lus nug muab ib qho kev ntsuas qhia rau tus neeg mob uas suav nrog cov kev xav tau ntawm lub cev, lub siab xav, thiab kev sib raug zoo ntawm cov neeg mob, ntxiv rau qhov feem ntau xav txog kev kho mob ntsig txog.

CKD kev tswj tus kheej. Raws li tau tshaj tawm los ntawm lwm tus, 8,38,39 pawg kho mob tau lees paub qhov tseem ceeb ntawm kev koom ua ke cov kev xav tau ntawm "tag nrho tus neeg" hauv kev tswj hwm tus kheej. CKD-SM cov ntsiab lus nug yog ib qho kev xav txog cov ntsiab lus ntawm kev tswj tus kheej, nrog rau cov lus nug ntsig txog kev txhawb nqa kev sib raug zoo thiab kev xav, piv txwv li, ntxiv rau cov txiaj ntsig kho mob ntau dua uas siv los ntsuas kev tswj tus kheej, xws li kev saib xyuas ntshav siab thiab kuaj kuaj.

Kev txwvMuaj cov kev txwv uas yuav tsum tau txiav txim siab thaum txhais cov txiaj ntsig ntawm txoj kev tshawb no. Ua ntej, txawm hais tias daim ntawv nug kev txhim kho tau coj los ntawm tus neeg mob ua ntej thiab ua tiav los ntawm cov kws tshaj lij pom zoo, cov qauv loj me me rau txhua qhov kev tshuaj xyuas thiab cov qauv tag nrho yog sib law liag / yooj yim. Nrog rau qhov ntawd hauv siab, Cronbach cov txiaj ntsig tau zoo nyob thoob plaws ntau qhov kev tswj hwm muab kev lees paub tias kev sib haum xeeb sab hauv ntawm daim ntawv nug tau txais. Qhov thib ob, peb cov ntaub ntawv tshuaj xyuas ntawm cov lus nug txog kev tswj tus kheej uas twb muaj lawm tsis yog qhov systematic. Thaum kawg, thaum txoj kev tshawb fawb suav nrog cov neeg mob thoob plaws tebchaws Canada, cov neeg koom nrog ntau yam ntawm CKD qhov hnyav (tsis muaj tus neeg koom nrog KRT, txawm li cas los xij). Peb tau sim txo qhov no hauv qhov kev sim sim los ntawm kev nug cov neeg mob kom xav txog lawv cov kev xav tau thiab kev paub dhau los thaum lawv tau kuaj pom thawj zaug. Raws li daim ntawv nug yog npaj los soj ntsuam CKD kev tswj tus kheej hauv cov neeg mob tsis nyob hauv KRT, kev tshawb fawb txog kev puas siab puas ntsws uas suav nrog cov qauv loj dua thiab los ntawm ntau lub ntsiab lus xav tau.

CISTANCHE yuav txhim kho lub raum / raum tsis ua haujlwm

Xaus  Daim ntawv nug CKD-SM ua tau zoo hauv kev kuaj kev puas siab puas ntsws ua ntej thiab muaj peev xwm ua rau peb nkag siab txog kev tswj tus kheej ntawm cov neeg uas muaj CKD. Daim ntawv nug tuaj yeem pab tau tshwj xeeb hauv cov chaw kho mob raws li qhov ntsuas hauv paus ntawm kev paub txog kev muaj peev xwm los tswj cov yam ntxwv ntawm CKD uas tau txheeb xyuas tias yog ib qho tseem ceeb rau kev tswj hwm tus kheej ntawm CKD, saib xyuas thiab tiv thaiv qhov tsis txaus ntawm kev paub, kev txawj, thiab kev ntseeg siab los tswj CKD , thiab/los yog ntsuas kev tswj tus kheej. Kev ntsuam xyuas psychometric ntxiv hauv cov kev tshawb fawb loj yuav ntxiv dag zog rau peb txoj kev nkag siab txog kev ua tau zoo ntawm daim ntawv nug rau kev ntsuas CKD kev tswj tus kheej; daim ntawv nug yuav raug soj ntsuam ntxiv hauv kev tshawb fawb txog kev tswj hwm tus kheej los ntawm peb pab neeg yav tom ntej.