Study On The Development And Validation Of Upper Urinary Tract Damage Risk Management Program In Patients With Neurogenic Bladder

BackgroundUpper Urinary Tract Damage(UUTD)as the most serious complications of Neurogenic Bladder(NGB),often bring to patients with great physical and mental pain and heavy economic burden,the serious influence the patient’s quality of life,and even cause deaths.Therefore,risk management of UUTD is crucial.However,there are few scientific and systematic interventions for the risk of NGB-UUTD.Objectives(1)To summarize the best evidence for risk management program of NGB-UUTD,and provide scientific evidence support for the construction of risk management program of NGB-UUTD.(2)Establish a risk management program of UUTD in patients with NGB,in order to provide guidance for clinical medical staff to scientifically manage patients with NGB.(3)The risk management program of NGB-UUTD will be applied to clinical practice,and its clinical applicability and effectiveness will be discussed.Methods(1)Summary of the best evidence for the risk management of NGB-UUTD.Through the literature review method,we searched domestic and foreign relevant literature on of NGB-UUTD from the establishment of the database to July 2018,included the literature according to the literature quality evaluation criteria and evaluate the evidence in the "JBI Evidence-Based Health Care Center Evidence Grading and Evidence Recommendation Level System(2014)".(2)Construct management program of NGB-UUTD.Use the following 2 methods to form a management program.①Group discussion:through risk factors of UUTD were screened,the best evidence summary and literature review in the previous period,using the group discussion method to initially develop a NGB-UUTD;②Delphi Expert Consultation:Invite 20 experts in related fields to conduct two rounds of review and revision of the preliminary NGB-UUTD by means of purpose sampling.(3)Clinical application of risk management program for NGB-UUTD.By adopting the method of experimental research,patients with NGB were conveniently sampled from three hospitals from December 2018 to November 2019,and patients with high risk of UUTD were screened by combining the risk assessment tool of NGB-UUTD developed in the early stage.The intervention group carried out the intervention according to the management plan constructed in this study,while the control group received routine care.The evaluation indexes included the incidence of upper urinary tract damage,urinary tract infection,residual urine volume,voluntary urination frequency,and urine leakage frequency in both groups.Results(1)Summary of the best evidence for the risk management program of NGB-UUTD.A total of 17 literatures were included,including 2 guidelines,5 systematic evaluations,5 randomized controlled trials,4 quasi-experimental studies and 1 observational study.The best 20 pieces of evidence were finally summarized from four aspects.(2)Construction of the risk management program for NGB-UUTD.Sixteen experts participated in two rounds of expert consultation,and the recoveries of the two rounds of questionnaires were 95.0%and 84.2%,respectively.The authority coefficients are 0.870 and 0.880,respectively.Kendall harmony coefficient was 0.340～0.421(P<0.05).Finally,the risk management program for NGB-UUTD was constructed,including 4 primary indicators,12 secondary indicators and 26 tertiary indicators.(3)Clinical application of the risk management program for NGB-UUTD.The final study included 93 patients at high risk for UUTD.The results showed that the incidence of UUTD in the intervention group was lower than that in the control group,although there was no statistical significance in the follow-up period(P>0.05).After intervention,the incidence of urinary tract infection in the intervention group was significantly lower than that in the control group(P<0.05).The amount of residual urine and the number of urine leakage in the intervention group were less than that in the control group(P<0.05),and the number of spontaneous urination was higher than that in the control group(P<0.05).ConclusionsIn this study,evidence-based nursing research was used to summarize the best evidence of risk management program for NGB-UUTD.On the basis of this,combined with the risk factors of UUTD screened in the previous period.Using the method of group discussion,the NGB-UUTD of risk management plan was initially establishedand,then using Delphi expert consultation method,and finally formed a risk management program of NGB-UUTD,after clinical application,the effectiveness of the preliminary verification,It is worth further clinical promotion.