Impact of a Nurse-Led Chronic Disease Management Intervention Model on Quality of Care and Satisfaction of Maintenance Hemodialysis Patients

Objective:To explore the impact of a nurse-led chronic disease management model on the quality of care and satisfaction of maintenance hemodialysis patients.Methods:72 patients who received maintenance hemodialysis(MHD)from June 2021 to March 2022 were selected to undergo the nurse-led chronic disease management model.The hemodialysis indexes,nutritional status,and the occurrence of adverse events were assessed after 24 weeks of the intervention,and patients’satisfaction was investigated and analyzed.Results:Comparing pre-intervention and after 24 weeks of intervention,urea reduction rate and urea clearance were improved but not statistically different(P>0.05),butβ2-microglobulin was significantly reduced compared with pre-intervention(P<0.05);after 24 weeks of intervention,the effect of decreasing blood calcium,parathyroid hormone,and potassium levels was not obvious(P>0.05),and the level of blood phosphorus decreased significantly compared with pre-intervention(P<0.01),albumin and hemoglobin levels were increased and better than before intervention(P<0.05);after 24 weeks of intervention,the incidence of intradialytic hypotension and hypertension was lower than before intervention(P<0.05),and the total incidence of complications was significantly lower than before intervention(P<0.01);there was no significant difference in the Self-Depression Scale scores after 24 weeks of intervention(P>0.05),and Self-Anxiety Scale scores were significantly lower and better than before intervention(P<0.01).Patient satisfaction was greatly improved,with a statistically significant difference(P<0.05).Conclusion:The chronic disease management intervention model led by specialized nurses is conducive to improving the psychological state and nutritional status of dialysis patients,enhancing the adequacy of dialysis for patients,reducing the incidence of related complications,and ultimately achieving the purpose of improving the quality of life of patients,which has significant clinical value.

The Value of the Wearable Single-lead Remote Monitoring Device with the Scatterplot in Chronic Disease Management

Objective:To study the value of the wearable single-lead remote monitoring device with the scatterplot in chronic disease management.Methods:dmitted into 435 residents accord with the inclusion criteria of 20 primary medical institutions of Yinchuan city,and grouped voluntarily by the implementation schemes were grouped voluntarily according to the implementation schemes.According to one of the three implementation schemes selected,the general practitioner guided the subjects to take on the wearable single-lead remote monitoring device,collecting and uploading the EEG data,then diagnosed and analyzed by the synchronously generated ECG scatterplot,finally,summarized the incidence and the categories,analyzed the differences among these three groups.Results:Among 435 subjects,there were 61 normal patients and 374 arrhythmias with the detection rate of 85.98%;and among the 1672 data collected,there were 606 normal data and 1066 arrhythmia with the detection rate of 63.76%;880 data in total 333 cases with atrial premature beat;442 data in total 215 cases with occasional ventricular premature beat;37 data of 22 cases with frequent atrial beat;65 data of 28 cases with frequent ventricular premature beat;13 data of 6 cases with atrial fibrillation;25 data of 15 cases with excitation conduction disorder;2 data of 2 cases with atrial flutter;31 data of 19 cases with ventricular tachycardia;30 data of 16 cases with conduction block;and 14 data of 8 cases with Para systolic rhythm.comparing the detection rate of arrhythmia in three groups,the difference was not statistically significant(P>0.05).Conclusion:The wearable singlelead remote monitoring device with the scatterplot has high application value in cardiovascular chronic disease management.Its effectively screening,validly diagnosing and detailed classifying are helpful to the early intervention,and the protection of the patients’lives.

Community-based intervention of chronic disease management program in rural areas of Indonesia

Objective:This study evaluates the community-based intervention of chronic disease management(CDM)through the Integrated Non-Communicable Diseases Health Post(Posbindu-NCD)conducted by a community of health workers(CHWs)in Indonesia’s rural areas.Methods:A cohor t retrospective study evaluated 577 par ticipants from Posbindu-NCD in 7 public health centers(PHCs)in 2019.Activities of intervention of CDM for Posbindu-NCD was included,identified risk factors to NCDs,and provided counselling education and other follow-ups based on interviews and measurement results from the five Desk systems that recorded in a medical record as a form of the monthly activity report each the first month,the 6 months,and the 12th month.Results:There were statistically significant differences for alcohol consumed and diabetes mellites(χ^(2)=10.455;P=0.001).There were significant differences on gender(χ^(2)=3.963;P=0.047),on ethnicity(χ^(2)=19.873;P<0.001),and hypertension.In addition,there were also significant differences on ethnicity(χ^(2)=15.307;P<0.001),vegetable consumption(χ^(2)=4.435;P=0.035),physical exercise(χ^(2)=6.328;P=0.012),and the current diseases of hypercholesterolemia of par ticipants.Fur thermore,the survival rate among patients who have overweight,abdominal overweight,hyper tension,diabetes mellitus,and hypercholesterolemia increased among par ticipants who regularly visited Posbindu-NCD compared with the non-regularly one.Conclusions:The CDM program’s community-based intervention through Posbindu-NCD conducted by CHWs improved survival rates in Indonesia’s rural areas.Therefore,this program can be fur ther developed in conducting CDM in the community with the active involvement of CHWs so that the community becomes active regularly in par ticipating in Posbindu-NCD activities in rural areas of Indonesia.

Study on the Management of Chronic Diseases in American and British Community Pharmacy

Objective To provide a reference for promoting the construction of chronic disease management in community pharmacies in China.Methods Literature research and comparative research methods were used to analyze the management of chronic disease carried out by community pharmacies in the United States and the United Kingdom.Results and Conclusion The management of chronic diseases in American and British community pharmacies has formed retail health clinic and online chronic disease mode.It is recommended that Chinese government should issue measures and supporting guidelines for the management of chronic diseases in community pharmacies as soon as possible.Community pharmacies should be encouraged to carry out chronic disease management with the concept of prudent inclusion and gradual progression.Meanwhile,the concentration of drug retail industry should be improved to carry out the systematic construction of chronic disease management and build a standardized chronic disease service process.Besides,community pharmacies should make full use of new technologies such as the Internet,cloud computing and big data,smart wearable devices,and chronic disease management Apps to explore and carry out online professional chronic disease management mode.

Complexity and Management of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is ongoing damage of the kidneys, which affects their ability to filter the blood the way they should. Worldwide CKD is considered as the 16th leading cause of death and affects 8% - 16% of the population. CKD often goes unnoticed and is revealed as an incidental finding. Healthcare providers diagnose the condition as CKD based on persistent abnormal kidney function tests revealing kidney damage markers > 3 months, urine albumin creatinine ratio (UACR) > or equal to 30 mg/g per 24 hours, and GFR < 60 mL/min/1.73m2. In this article, we have discussed chronic kidney disease in terms of kidney physiology, chronic kidney disease pathophysiology, etiology, diagnosis, signs and symptoms, and management.

Health Awareness: A Significant Factor in Chronic Diseases Prevention and Access to Care

Health literacy and awareness are essential strategies in promoting global health and improving access to care. While seen as an essential tool for promoting population health awareness to improve early detection and treatment of chronic diseases, it is yet to be emphasized in most African countries. Health literacy is an essential practice to promote chronic disease prevention and reduce the growing threat to population health. Incidences and mortalities from chronic diseases commonly arise from limited knowledge of the causative risk factors and access to health facilities. Without knowledge about causes, health impacts, and available health services, people continue to indulge in the habits that worsen their health conditions and fail to access care timely. By using health literacy and awareness as a tool for chronic disease prevention, healthcare professionals will develop strategic health awareness programs that fit the socio-demographics of the population they serve. This article explored the significant role health awareness occupies in individual and community health prevention through health promotion and education. It reviewed the concept and dimensions of chronic disease prevention, cultural beliefs and impact on chronic diseases, gaps created by low health literacy, and the significance of health literacy in disease prevention and health promotion. Furthermore, it recommends that health systems and local communities form partnerships to address common and emerging health problems, and health systems should be properly funded.

Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

Moving from death sentence to chronic disease management

In Europe today, HIV/AIDS prevention, treatment and care are needed more than ever. HIV incidence steady in western and central Europe, and dramatically increasing in eastern Europe remains a major challenge to public health in the 21st century. With more than two million people living with HIV/AIDS in the WHO European Region, no country has been spared.

Mobile health technology: a novel tool in chronic disease management

The successful control of chronic diseases mainly depends on how well patients manage their disease conditions with the aid of healthcare providers.Mobile health technology—also known as mHealth—supports healthcare practice by means of mobile devices such as smartphone applications,web-based technologies,telecommunications services,social media,and wearable technology,and is becoming increasingly popular.Many studies have evaluated the utility of mHealth as a tool to improve chronic disease management through monitoring and feedback,educational and lifestyle interventions,clinical decision support,medication adherence,risk screening,and rehabilitation support.The aim of this article is to summarize systematic reviews addressing the effect of mHealth on the outcome of patients with chronic diseases.We describe the current applications of various mHealth approaches,evaluate their effectiveness as well as limitations,and discuss potential challenges in their future development.The evidence to date indicates that none of the existing mHealth technologies are inferior to traditional care.Telehealth and web-based technologies are the most frequently reported interventions,with promising results ranging from alleviation of disease-related symptoms,improvement in medication adherence,and decreased rates of rehospitalization and mortality.The new generation of mHealth devices based on various technologies are likely to provide more efficient and personalized healthcare programs for patients.

Management of Patients with Inflammatory Bowel Disease during the Prevention of COVID-19

Objective: To explore the disease management methods and effects for patients with inflammatory bowel disease (IBD) in the special period of pandemic. Methods: Medical staffs carried out the management of patients with IBD on the inflammatory disease service platform of this center from February to May of 2020 in addition to routine clinical works. Results: None of the nearly 3000 IBD patients who are being followed up at our center were infected with COVID-19. During this period, no patients experienced drug-related serious side effects or disease recurrence that could not be treated in time due to failure to reach the medical staffs. Conclusion: The disease management methods based on IBD platform allow the patients to be properly managed during this special period.

Diabetic Nephropathy and Management

Chronic kidney disease affects people worldwide. Approximately 1 out of 3 adults with diabetes have kidney disease. Among several etiological factors for CKD, diabetes mellitus (DM) and hypertension are the main factors. These factors not only cause CKD but are also responsible for several complications related to CKD. In this article, we have reviewed Diabetic Nephropathy (DN) in terms of etiology, pathophysiology, diagnosis, management, current guidelines for diabetic nephropathy management, and some of the research study findings. Diabetic nephropathy (DN) is the chief factor for end-stage renal disease (ESRD) development across the globe. The primary cause of DN is Diabetes Mellitus, which is an autoimmune lifestyle disorder having several etiological factors. Checking for urine albuminuria, estimated GFR (eGFR), and blood glucose are unswerving tests for DN diagnosis and subsequent monitoring. Controlling hyperglycemia, blood pressure, and proteinuria are critical in stopping the progression of DKD. Clinical practice and evidence-based medicine demonstrated that early diagnosis followed by treatment can prevent or halt DKD progression.

Quality of Diabetes Annual Management in the Internal Medicine Department in Yalgado Ouédraogo Teaching Hospital, Ouagadougou

Introduction: The periodic management of diabetes improves disease’s prognosis. We aimed to evaluate the quality of diabetes annual management and the effectiveness of its treatment in Ouagadougou. Material and Method: It was a cross-sectional and descriptive study, from retrospective records in the internal medicine department, Yalgado Ouédraogo Teaching Hospital (CHU-YO). Diabetic patient’s (15 years old and more) files that were registered between January, 2012 and December, 2016 have been analyzed. Files containing less than 80% data were excluded. Data relating to the baseline characteristics of the patients, the therapeutic education dispensation, the clinical and paraclinical assessment of the initial and annual visits at the first year of patient’s follow-up have been collected. The 2007 diabetes management standards of the French “Haute Autorité de Santé” as well as the biological standards of the same instance have been used. The quantitative variables were expressed as means and standard deviations and qualitative variables were expressed as absolute and relative frequencies. Results: 317 patients, including 218 women (68.77%) were studied. The mean age of women was 51.67 ± 12.46 years, and that of men 55.71 ± 10.63. Diabetes was type 2 in 302 (95.26%) patients. The mean duration since the diagnosis of diabetes was 2.9 years. The completeness rate of therapeutic education at the annual visit was 10.46%. That of the clinical examinations was at best 38.17% and 44.23% for the measurement of weight and blood pressure;otherwise it was less than 5%. About the paraclinical data, apart from the measurement of the fasting blood glucose which completeness rate was 71.61%, that of the others exams were less than 10%. At the annual visit, the mean value of HbA1C was 7.5%, and the target for HbA1C was achieved in 47.90% patients. Conclusion: The quality of diabetes annual management is unsatisfying. A structural improvement and the adaptation of guidelines are needed.

MANAGEMENT OF AE-CB/COPD: A SURVEY OF RESPIRATORY PHYSICIANS IN SOME REGIONS OF CHINA

Objective To investigate the bacteria spectrum isolated from AE-CB/ COPD and the manner of management of AE-CB/COPD in respiratory or internal medicine department in some regions of China. Methods Respiratory physicians received questionnaire at randomization just after they managed a patient presenting to outpatient department with AE-CB/ COPD, on general conditions and symptoms of patients, type of examinations, diagnosis, type of antibiotics used and mode of administration. Results of sputum bacteria culture were followed up. Results Amang the1583 AE-CB/COPD, 63. 04% were male and 35.19% were female. 54.6% of them were older than 60 years. 81.87% of the patients produced sputum. Sputum bacteria culture, chest X-ray and chest CT were carried out to 21.3%, 66. 3% and 11. 1% patients, respectively. 355 strains were isolated from patients whose sputum bacteria culture was positive. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella ca- tarrhalis were the three most isolates. 84. 7% of the 1583 AE-CB/COPD received 1692 times of antibiotic prescribing. The most frequently prescribed antibiotic were B-lactams （51.36% of all antibiotic prescribing）, macrolides （14. 01% ） and quinolones （31.03%）. Much more macrolides were prescribed in the area where mare patients pay the medicines at his own expense than those in the area where more patients share public health service. Conclusion In China, respiratory physicians can reasonably select antibiotics to manage acute exacerbation of chronic bronchitis/ chronic obstructive pulmonary disease in pulmonary outpatient department. Sputum culture is done in part of the patients, but susceptibility tests are missing. One issue revealed by the survey is that the list of prescribing medications laid down by government have great influence on antibiotic use.

Traditional Chinese Practice,A Promising Integrative Intervention for Chronic Non-Infectious Disease Management

The number of people with chronic diseases rises rapidly in recent years worldwide. Except for drug medication, mind-body exercises are indispensable for chronic disease management. Traditional Chinese practice （TCP）, as an integrative intervention, is known as an effective means to keep in good health and fitness, as well as help regulate emotion. This paper introduces the domestic and overseas studies on effectiveness of TCP for chronic diseases, and explores the key action links from three aspects, including functional training of multiple-joint guided by consciousness, relieving psychological risk factors, improving respiratory and digestive function, blood and lymph circulation through respiratory training, and regulation of nerve, metabolic, and immune system. Finally, the authors discussed how to integrate TCP in the chronic disease management, and put forward that the practice methods and evaluation standard should be assessed academically.

STATUS AND CONTROL POLICY OF MAIN CHRONIC DISEASES IN COMMUNITY HEALTH MANAGEMENT BASES IN SHANGHAI AND GUANGDONG

Objective To investigate the current conditions of the main chronic diseases and to make the control policy in community health management base in China. MethodsThe questionnaire consisting of prevalence, awareness rate, management rate, behavior correct rate, control rate, and medicine obey was used to survey the chronic disease condition in 2009. A total of 809 736 residents were randomly selected from Shanghai and Guangdong, China. ResultsThe hypertension prevalence was 17.81%. From sex analysis, the female has higher rate than male in hypertension prevalence, understand rate, management rate, behavior correct rate, control rate, and medicine obey rate. From age analysis, the prevalence, understand rate, management rate, control rate, and medicine obey were increasing along with the age, but behavior correct rate was not in this condition. The diabetes prevalence was 6.92%. To compare with Shanghai and Guangzhou in 5 aspects, the prevalence of chronic diseases was alike. Except lower behavior correct rate in Shanghai, management rate, behavior correct rate, control rate, and medicine obey rate were higher in Shanghai. ConclusionThe government must take main principle in chronic disease control. Base construction of community health management and increase management level of chronic diseases should be enhanced and practitioner's knowledge of chronic disease management should also be enhanced.

Factors influencing Medication Literacy in Chinese Children with Nephrotic Syndrome: insights from the MLS-22 scale

Background:The role of the patient’s medication literacy is crucial in ensuring the efficacy of the treatment for nephrotic syndrome(NS).It is imperative to identify and examine instances of inadequate medication literacy in order to effectively manage NS.This study aimed to detect the low medication literacy in Chinese NS children using the 22-item Medication Literacy Scale(MLS-22)and to further analyze its influencing factors.Methods:This study involved consecutive sampling of 157 Chinese children with NS.Interviewer-led questionnaires were used to collect data.Firstly,the MLS-22 was evaluated for reliability and validity.Secondly,the medication literacy level was assessed,and factors related to low scores were examined using a multivariate logistic regression model.Results:MLS-22 proved reliable and valid for detection at a low level in NS children.The tertile was divided into low-level and medium/high-level medication literacy.It was found that the scores of NS children averaged 13.06.Multivariate logistic regression analysis revealed that parents of children with primary NS and congenital NS had lower medication literacy scores,which were related to parents with less than high school education.Conclusions:Healthcare providers should develop tailored strategies to effectively assist Chinese children with limited medication literacy in managing chronic diseases.

Effect of a traditional Chinese medicine theory-based mobile app on improving symptoms in patients with type 2 diabetes mellitus:A randomized controlled trial

Objective:The aim of this study was to evaluate the effect of the Traditional Chinese Medicine(TCM)theory-based mobile app on improving symptoms in patients with type 2 diabetes mellitus(T2DM)in China.Materials and Methods:A randomized controlled trial was conducted.Ninety-seven patients with T2DM were enrolled and they were randomized into the control group and the experimental group.The control group was given usual diabetes education and follow-up with telephone call,while the experimental group was followed up by using the TCM theory-based mobile app.After 6-month intervention,the diabetic symptom scores,the blood glucose levels,and self-management ability of the two groups were compared.Results:Compared with intervention before,the levels of fasting blood glucose(FBG),2-h postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)decreased in the control group(9.28±3.05 vs.8.26±2.73 mmol/L,12.65±4.18 vs.10.65±3.79 mmol/L,and 8.78%±1.76%vs.7.96%±1.47%,respectively,all P<0.05)and also decreased in the experimental group(8.36±2.64 vs.7.35±2.45 mmol/L,11.50±4.29 vs.9.85±2.71 mmol/L,and 8.64%±2.04%vs.7.29%±1.56%,respectively,all P<0.05)after 6-month intervention,while the summary of diabetes self-care activities(SDSCAs)scale scores after 6-month intervention increased significantly in the control group(35.20±14.68 vs.44.78±10.21,P<0.05)and the experimental group(32.16±13.21 vs.50.37±10.06,P<0.05).After 6-month intervention,the diabetic symptom scores(18.16±2.74 vs.22.18±4.77)and HbA1c(7.29±1.56%vs.7.96%±1.47%)were lower,and SDSCA scale scores(50.37±10.06 vs.44.78±10.21)were higher in the experimental group than the control group(all P<0.05).Conclusion:The mobile app based on TCM theory can effectively improve diabetes-related symptoms in patients with T2DM and help control their blood glucose as well as enhance their self-management ability.

Assessment of Diabetes Outcomes in VA Patients： A Retrospective Study of a Pharmacist-Run CDM Clinic

We evaluated whether pharmacist or primary care management resulted in a larger reduction in mean AlC and which group resulted in a higher number of patients reaching an AlC goal of 7% or lower. This was a single center, retrospective cohort study at the VA Medical Center in Topeka, KS. We included 198 patients with uncontrolled type 2 diabetes （AlC 〉 9%）. Patients with ≥ 1 outpatient pharmacist visit were included in the interventional group, and patients with only primary care visits were included in the control group. A total of 198 patients were included in the study. Pharmacist management reduced the mean AlC by 2.7% （p = 〈 0.05） and primary care decreased the mean AlC by 2.4% （p = 〈 0.05）. A higher percentage of primary care patients reached the AlC goal of ≤ 7% compared to the pharmacy group at 34.3% and 21.5% （p = 0.107）, respectively. The pharmacist managed and primary care managed groups achieved similar reductions in the mean AlC and for the number of patients reaching the AlC goal,

Improving outcomes in patients with heart failure:The contribution of cardiovascular specialist nurses

Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist nurses on long-term health outcomes and patient satisfaction in HF outpatient care.Methods In a year-long observational study from July 2021 to July 2022,230 HF patients at our hospital were divided into an experimental group(n=115)receiving care from cardiovascular specialist nurses and a control group(n=115)managed by general nursing staff.The interventions included comprehensive care such as patient education,medication management,lifestyle guidance,symptom monitoring,and psychological support.The major adverse cardiovascular events(MACEs)and rehospitalization rates were applied as the primary endpoints.Results The experimental group demonstrated significantly fewer MACEs and lower rehospitalization rates compared to the control group(P<0.001).Higher patient satisfaction was observed in the experimental group,with 81.7%reporting high satisfaction vs.53.9%in the control group(P<0.001).Differences in incidence of myocardial infarction and death rates between the groups were not statistically significant.Conclusions The involvement of cardiovascular specialist nurses in HF outpatient care significantly enhances clinical outcomes and patient satisfaction.These nurses play a key role in bridging the transition from hospital to home care,improving adherence to treatment regimens,and reducing healthcare system burdens.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.