远程进行腹膜透析培训：结果与家庭培训的比较。
Peritoneal dialysis training performed remotely: results and comparison with Home Training.
机构信息
Department of Nephrology and Dialysis, "Michele E Pietro Ferrero" Hospital-ASLCN2, Strada del Tanaro 7/9, CAP 12060, Verduno, CN, Italy.
出版信息
Clin Exp Nephrol. 2023 Jan;27(1):72-78. doi: 10.1007/s10157-022-02276-z. Epub 2022 Sep 21.
OBJECTIVES
Traditional training (Home Training) in peritoneal dialysis (PD) is based on the physical presence of nurse and patient/caregiver. These "space-time" constraints can influence the training's duration, methodology and results. A remote caregiving system (Videodialysis) in our Center has proved to be effective and safe in remotely guiding patients/caregivers with cognitive/psychological barriers to self-care-PD. Since 08/01/2016, to overcome the limitations of Home Training, Videodialysis has also been used to carry out remote patients/caregivers training (Video Training). Retrospective comparison between Video Training (08/01/2016-05/31/2020) and Home Training (01/01/2014-07/31/2016).
METHODS
Following initial home-visit Video Training is performed via telemedicine from the Center, whereas Home Training is carried out at the patient's home. Only first trainings for all incident PD patients/caregivers were considered. The following patients were excluded: 9 in nursing homes, 13 kept on Videodialysis due to barriers to self-care, 6 uncompleted procedures, 4 other. Total duration, home visits, exchanges/procedures, peritonitis, technique survival were compared between Home Training and Video Training.
RESULTS
46 trainings were considered (median; IQR): 21 Home Training (CAPD/APD: 11/10) in 17 patients (74.3 years (58.8-78.0; assisted PD: 64.7%) and 25 Video Training (CAPD/APD: 8/17) in 21 patients (65.9 years (56.9-76.4) N.S.; assisted PD: 52.4%). Duration (days): Home Training: CAPD 4.0 (4.0-5.5); APD 8.0 (5.3-10.5); Video Training: CAPD 4.5 (3.8-5.0) (N.S.); APD 8.0 (6.0-13.0) (N.S.). Home-visit (number): Home Training: CAPD 9.0 (7.0-10.0); APD 11.0 (7.8-15.5); Video Training: CAPD 2.0 (2.0-3.5) (p < 0.001); APD 5.0 (4.0-6.0) (p < 0.001). Peritonitis (episodes): Home Training: 5 (Follow-up: 471 pts/months); Video Training: 0 (Follow-up 280 pts/months). 2-Year technique survival. Home Training: 56.3%; Video Training: 76.9% (N.S.).
CONCLUSIONS
Video Training is as effective as Home Training, while significantly reducing the number of home visits.
目的
传统的腹膜透析（PD）培训（家庭培训）基于护士和患者/护理人员的实际存在。这些“时空”限制可能会影响培训的持续时间、方法和结果。我们中心的远程护理系统（视频透析）已被证明在远程指导具有自我护理 PD 认知/心理障碍的患者/护理人员方面是有效且安全的。自 2016 年 8 月 1 日起，为了克服家庭培训的局限性，视频透析也被用于进行远程患者/护理人员培训（视频培训）。回顾性比较视频培训（2016 年 8 月 1 日至 2020 年 5 月 31 日）和家庭培训（2014 年 1 月 1 日至 2016 年 7 月 31 日）。
方法
在中心通过远程医疗进行初始家庭访问视频培训，而家庭培训则在患者家中进行。仅考虑所有新出现的 PD 患者/护理人员的第一次培训。排除以下患者：9 名在养老院，13 名因自我护理障碍继续进行视频透析，6 名未完成程序，4 名其他。比较家庭培训和视频培训之间的总持续时间、家访、交流/程序、腹膜炎和技术生存率。
结果
考虑了 46 次培训（中位数；IQR）：21 次家庭培训（持续非卧床腹膜透析/自动化腹膜透析：11/10）在 17 名患者（74.3 岁（58.8-78.0；辅助 PD：64.7%）和 25 次视频培训（持续非卧床腹膜透析/自动化腹膜透析：8/17）在 21 名患者（65.9 岁（56.9-76.4）无统计学差异；辅助 PD：52.4%）。持续时间（天）：家庭培训：持续非卧床腹膜透析 4.0（4.0-5.5）；自动化腹膜透析 8.0（5.3-10.5）；视频培训：持续非卧床腹膜透析 4.5（3.8-5.0）（无统计学差异）；自动化腹膜透析 8.0（6.0-13.0）（无统计学差异）。家访次数：家庭培训：持续非卧床腹膜透析 9.0（7.0-10.0）；自动化腹膜透析 11.0（7.8-15.5）；视频培训：持续非卧床腹膜透析 2.0（2.0-3.5）（p < 0.001）；自动化腹膜透析 5.0（4.0-6.0）（p < 0.001）。腹膜炎（发作）：家庭培训：5 次（随访：471 点/月）；视频培训：0 次（随访：280 点/月）。2 年技术生存率。家庭培训：56.3%；视频培训：76.9%（无统计学差异）。
结论
视频培训与家庭培训一样有效，但显著减少了家访次数。
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