Objective To investigate the influencing factors and pathways of fluid management adherence and interdialytic weight control in hemodialysis patients based on the health belief model. Methods Using convenience sampling，433 patients receiving hemodialysis were included from 4 hospitals in Guangdong province. The demographic and clinical data questionnaire，Health Belief Scale of Fluid Restriction，and Fluid Intake Adherence Scale were used. The relative-interdialytic weight gain（R-IDWG） was calculated. Results The mean score of patients’ fluid management adherence was 3.08±0.97，indicating a moderate level，with 35.57% of patients exceeding the required R-IDWG standard. Regarding health beliefs，perceived benefits（β=0.161） and self-efficacy（β=0.685） of fluid restriction directly affected fluid adherence；perceived threats of poor fluid restriction indirectly affected fluid management adherence through perceptions of benefits and self-efficacy（β=0.235）；perceived barriers were indirectly and negatively associated with fluid management adherence through self-efficacy（β=-0.246）. Higher fluid management adherence was associated with better control of R-IDWG（β=-0.361）. Regarding the coordinating factors，age，educational level，hemodialysis vintage and diabetes were influential factors of fluid management adherence（|β|：0.050-0.162） and R-IDWG control（|β|：0.049-0.309）. The coefficients（β） of each path were statistically significant（P<0.05）. Conclusion Healthcare providers should comprehensively assess patients’ health beliefs，focus on patients with lower educational levels and diabetes，and identify weakness in their fluid management to achieve the required R-IDWG standard.

Objective To improve the subcutaneous tunnel needle and the method of establishing subcutaneous tunnel for PICC,and to explore its application effect. Methods The improved subcutaneous tunnel needle consists of 3 parts,including needle handle,solid needle core and needle head. The needle head has an arc chamfering structure,which can realize the stable connection between the catheter and the needle head. Patrticipants from a tertiary hospital in Guangdong Province were selected by convenience sampling. 97 tumor patients from November 2019 to January 2021 were allocated into an experimental group,while 115 tumor patients from August 2018 to October 2019 were in the control group. The experimental group received the improved subcutaneous tunnel needle via a 30°~45° degree with venipuncture for PICC catheterization under B-ultrasound,while the control group was treated with Seldinger technique for PICC catheterization under B-ultrasound. The amount of bleeding and the highest pain score,the incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after the operation,the incidence of allergic dermatitis,the incidence of mechanical phlebitis,and the comfort of the patients’ arms at a month after the operation were compared between the 2 groups. Results The amount of bleeding and the highest pain score in the experimental group were higher than those in the control group,and the difference was statistically significant（P<0.001）. The incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after operation and the incidence of allergic dermatitis in the experimental group were lower than those in the control group（P<0.05）,but the incidence of mechanical phlebitis within a month after operation in the 2 groups was not statistically significant（P=0.484）;a month after operation,the arm comfort of the experimental group was higher than that of the control group,and the difference was statistically significant（P<0.001）. Conclusion The improved subcutaneous tunnel needle and subcutaneous tunnel establishment method can reduce the incidence of blood and fluid leakage,catheter prolapse and allergic dermatitis at the puncture point,and improve the postoperative arm comfort of patients,but they could not increase the incidence of mechanical phlebitis.

Objective To compare the differences in unmet Activities of Daily Living（ADL） needs between disabled elderly people living in nursing homes and in families.Methods A total of 258 disabled elderly people from 11 nursing homes and 303 disabled elderly people from 15 communities in Nanjing were recruited. Barthel Index（BI） and Functional Activities Questionnaire（FAQ） were used to screen disabled elderly people from nursing homes and families. Disabled elderly people were then investigated in terms of their unmet ADL needs. Propensity score matching was used to balance the general information of disabled elderly people living in nursing homes and families after using demographic questionnaire,and differences in unmet ADL needs between two groups were explored. Results The total quantity of unmet ADL needs and the quantity of unmet Instrumental Activities of Daily Living（IADL） needs for disabled elderly people in families were significantly less than those in nursing homes（P<0.05）. Significant differences were identified in dressing,toileting,ambulating,walking up and down stairs,financial management,doing housework and cooking（P<0.05）.Conclusion Living in families is superior to living in nursing homes in satisfying ADL needs,nursing homes should take more efficient actions to improve their services.