Management of chronic heart failure:Role of home echocardiography in monitoring care programs

AIM:To identify a possible role of home echocardiography for monitoring chronic heart failure(CHF)patients.METHODS:We prospectively investigated 118 patients hospitalized during the last year for CHF who could not easily reach the pertaining District Healthcare Center.The patients were followed up with 2 home management programs:one including clinical and electrocardiographic evaluations and also periodic home echocardiographic examinations(group A),the other including clinical and electrocardiographic evaluations only(group B).RESULTS:At the end of the 18-mo follow-up no significant differences were observed between the 2 groups as regards the primary endpoint:rehospitalization occurred in 4 patients of the group A and in 6 patients of the group B;major cardiovascular events occurred in 2 and in 3 patients,respectively.No significant differences were observed with respect to the secondary endpoints:one vascular event appeared in both the groups,3 cardiovascular deaths occurred in group A and 2 in group B.No significant differences were observed between the 2 groups as regards the composite endpoint of death plus hospitalization.CONCLUSION:Home echocardiography for monitoring of CHF patients does not improve the cardiovascular endpoints.In our CHF patients,a low incidence of vascular events was observed.

Study of the Possible Use of a Home-Visit Nursing Interventional Lymphedema Care Program for Secondary Lymphedema in the Elderly at Home

Objective: This study aimed to clarify the possible use of and points to improve a home-visit nursing interventional lymphedema care program (plan) we developed. Methods: The subjects were visiting nurses with at least three years of home-visit nursing experience and experience with lymphedema care for the elderly at home. Semi-structured interviews were conducted, and the collected opinions were aggregated and summarized. Results: Based on interviews with nine subjects, opinions regarding the use of the program, such as “The assessment perspective at the time of introduction helps to grasp the needs for a wide variety of subjects”, and regarding points to improve, such as “It is necessary to set the duration and timing of the section considering the frequency of visits and degree of edema at the time of introduction” and “It is necessary to have a perspective concerning efforts to maintain motivation for care of the elderly and their families”, were aggregated. Discussion: The results of the interviews were generally useful for the structure and development of the program, care methods and content, and interventions for influencing factors. Consideration of setting the timing according to the degree of lymphedema, modification of the program’s development, development of a program that fully considers the degree of edema at the time of introduction and the acceptance of edema among the elderly, and the need to consider the care content that should be given priority were suggested as points for improvement.

Implementation and Evaluation of a Postpartum Care Program for Mothers Raising Infants: A Pilot Study

Background: The aims of this pilot study were to implement and evaluate a postpartum care program for mothers raising children younger than one year to provide physical relaxation, and to reduce mothers’ parenting problems. Methods: A day-service and group-type postpartum care program was implemented with the aim of interacting with peers, promoting local communication, and relaxing mothers. Results: Forty-five pairs of mothers and infants participated in the study. Most of the mothers experienced relaxation, communicated with each other, resolved physical problems, reduced childcare concerns, and developed parenting friends. Conclusions: In addition, feasibility was assured as they were very satisfied with the content of programs such as baby massage and aroma treatment.

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program

Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.

Consideration of the Self-Care Supporting Program Including Simple Exercise for Patients with Early Stages of Secondary Lower-Limb Lymphedema

Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.

Effectiveness of a Self-Foot-Care Educational Program for Prevention of Diabetic Foot Disease

Objective: To verify the effectiveness of a “self-foot-care educational program (SFCEP)” for prevention of type 2 diabetes foot disease. Methods: A single-center, randomized and controlled trial was conducted. Fifty-five patients with type 2 DM, 40 - 75 years of age who were asked to return for a follow-up hospital visit, were allocated to either an SFCEP group (n = 29) or a conventional education program (CEP) group (n = 26). Both of the groups were given foot-care education, monthly for four times in the SFCEP group and in the CEP group one time only by a printed leaflet. The two groups had no statistically significant differences in patient background of the type 2 diabetes history. We evaluated removal rate of skin debris, and the symptoms and conditions of the feet. Results: Between the SFCEP and CEP there were significant differences in removal rate of skin debris (p Conclusion: This study strongly suggests the effectiveness of SFCEP in preventing the occurrence or worsening of diabetic foot diseases.

Preconception Care Health Education for Female Workers of Reproductive Age in Japan Evaluation up to 6 Months after the Program

Objectives: The aim of this study was to implement a health education program for education of preconception care (PCC) for female workers of reproductive age through a seminar and to evaluate the program based on PCC knowledge and awareness and behaviors before the seminar and at 3 and 6 months after the seminar. Methods: A small group health education seminar was implemented using leaflets for 84 female workers of reproductive age, age 20 to 35 years old, and an intervention by group discussion and feedback was provided. Of these participants, 60 (71%) who provided valid survey responses were included in the analysis. The primary outcome indicators were PCC knowledge, PCC awareness and behaviors, and a food frequency questionnaire, and the secondary outcome indicators were self-efficacy and the health awareness and stress management subscales of the Health-Promotion Lifestyle Profile scale. The survey was conducted three times, before the seminar and at 3 and 6 months after the seminar, and the results were compared. Results: The percentage of individuals with PCC knowledge was significantly increased at 3 months after the seminar as compared with before the seminar, and it remained at this level even at 6 months after the seminar. The percentage of individuals with PCC awareness and behaviors was significantly increased for the items actively eat foods containing folic acid, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 3 months after the seminar and for the items eat well-balanced meals, make the mind active, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 6 months after the seminar. Furthermore, the score for the health awareness subscale of the Health-Promotion Lifestyle Profile scale was significantly increased at 6 months after the seminar. Conclusion: The health education program established PCC knowledge at 6 months after the seminar and improved some PCC awareness and behaviors. Therefore, it was suggested that the program would be effective for education of PCC for female workers of reproductive age.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Care of HIV-infected patients in China

Compared with high infection areas of the world, the total HIV infection rate in China is relatively low. Nonetheless, because of China’s vast territory and large population, the potential infection risk must be taken seriously. In the next few years, needle sharing among injection drug users will remain the most common route of transmission for the HIV/ AIDS epidemic in China. Unprotected sex is gradually becoming a major route of transmission. China began to imple- ment HAART in 1999 according to international standards. Prior to 2003, there were only about 150 HIV/AIDS patients were treated with HAART in some clinical trials and about 100 HIV/AIDS patients were treated by private sources. Results of those treatments are the scientific basis for development of the therapeutic strategies in China. In March of 2003, the Chinese government initiated China CARES program. In November of 2003, the Chinese Ministry of Health announced a national policy of free ARV treatment to all HIV+ Chinese citizens who were in poverty and required ARV therapy. There are total of 19,456 HIV/AIDS patients received free ARV drugs to date in 159 regions and 441 towns. Current challenges are how to follow-up and evaluate those patients in the clinical settings. The longer the therapy is postponed, the more side effects and the higher probability of drug resistance are going to occur. It remains unclear, therefore, when HAART regimen should be started in the HIV/AIDS population in China.

Do Community-Based Programs Help to Improve HIV Treatment and Health Outcomes? A Review of the Literature

Increased availability of antiretroviral treatment for HIV makes the goal of universal access attainable. However, in most resource constrained settings where existing health systems are?largely dysfunctional, major barriers to achieving this goal remain. While treatments with antiretroviral drugs (ART) are the focal point of HIV management, it is increasingly recognized that ART alone will not be sufficient to adequately deal with the lifelong consequences of the disease. In addition, the current global economic downturn will continue to impact on funding for HIV care and support, making the search for sustainable solutions more urgent. This article reviews the current evidence base on the impact of community-based programs on HIV/AIDS treatment and general health outcomes, as well as their contribution to ensuring sustained care for HIV-positive people. Our findings suggest that these programs overall have a positive impact on various dimensions of HIV treatment and care, and make a significant contribution to health and HIV outcomes. The authors argue that better use of community platforms for HIV treatment and care programs could be critical for attaining desired goals and should be prioritized at all levels of program design, implementation, and monitoring and evaluation.

基于微信小程序的“校企社”联动社区药学服务模式构建与应用

目的构建基于微信小程序的“校企社”联动社区药学服务模式,提档升级社区药学服务内容和服务方式,提升居民健康生活质量。方法围绕社区居民药学服务需求,整合学校、企业及社区药学资源,打造“药享健康”微信小程序,构建“线上+线下”社区药学服务模式。采用分类随机抽样,随机选取小程序用户为观察组,以线下药学服务结对帮扶社区居民为对照组,围绕用药健康知识掌握合格率、用药依从率、用药行为正确率3个方面进行干预效果比较。结果“药享健康”小程序由“药健康”“药温暖”“药安全”“个人信息”4个模块构成。基于“药享健康”小程序的“校企社”联动社区药学服务模式于2022年7月开始实践应用,小程序现有用户6185人,完成回收过期药品2732次,完成药学服务941次,完成咨询订单3354次。干预后,观察组居民的用药健康知识掌握合格率、用药完全依从率、用药行为正确率分别由干预前的33.53%、20.23%、49.71%提升至76.87%、46.26%、89.80%,且干预后的提升效果均显著优于对照组(P<0.05)。结论该服务模式有效提升了社区药学服务质量,提高了社区居民用药健康意识,促进了居民用药规范化、合理化、安全化。

Snyder希望理论+支持性照护综合护理方案在超声甲状腺结节患者中的应用效果

目的探究Snyder希望理论+支持性照护综合护理方案在超声甲状腺结节患者中的应用效果。方法选择2023年4月至9月北京中医药大学东直门医院80例超声甲状腺结节患者,采用随机数字表法将其分成对照组和观察组,各40例。对照组采用常规护理干预,观察组采用Snyder希望理论+支持性照护综合护理干预,干预时间为2周。比较两组干预前后中文版Herth希望量表(HHI)评分、家庭关怀度指数(APGAR)评分及自我管理能力评分。结果干预后,两组HHI评分高于干预前,且观察组高于对照组(P<0.05)。两组APGAR评分高于干预前,且观察组高于对照组(P<0.05)。两组自我管理能力评分高于干预前,且观察组高于对照组(P<0.05)。结论Snyder希望理论+支持性照护综合护理方案在超声甲状腺结节患者中的应用效果显著,可以提升患者希望水平、家庭功能与自我管理能力,值得在临床推广应用。

CAREFUL NUMERICAL SIMULATION AND ANALYSIS OF MIGRATION-ACCUMULATION OF TANHAI REGION

Numerical simulation of careful parallel arithmetic of oil resources migration-accumulation of Tanhai Region ( three-layer) was done. Careful parallel operator splitting-up implicit iterative scheme, parallel arithmetic program, parallel arithmetic information and alternating-direction mesh subdivision were put forward. Parallel arithmetic and analysis of different CPU combinations were done. This numerical simulation test and the actual conditions are basically coincident. The convergence estimation of the model problem has successfully solved the difficult problem in the fields of permeation fluid mechanics, computational mathematics and petroleum geology.

以患者需求为导向的银屑病延续性护理方案的构建

目的以文献研究为基础,结合银屑病患者需求调查和德尔菲法的专家共识构建适应患者需求的银屑病延续性护理方案。方法采取文献研究法结合问卷调查法对150例银屑病患者进行延续性护理需求调查,基于调查结果讨论形成专家咨询表,通过对16名专家进行2轮咨询,修订并完善构建出银屑病患者的延续性护理方案。结果文献研究法从延续性护理的实施人员、具体内容、方式、频率、服务对象五个方面进行证据总结形成条目池,共纳入文献6篇,包括指南3篇、随机对照试验1篇、类试验1篇和专家共识1篇。延续性护理服务需求问卷调查希望形式主要集中在通过电话、短信随访、微信、QQ等互联网交流等方式,需求集中在用药、病情咨询、皮肤护理等方面指导。发放了16份有效问卷,两轮咨询共15位专家提出建议,Cr为0.85~1.00,平均为0.89;各条目CVj<0.25。最终构建出5个一级指标,27个二级指标及62个三级指标的银屑病患者延续性护理方案。结论基于患者需求的文献研究结合专家函询论证后构建的银屑病患者延续性护理方案有利于银屑病患者延续性护理措施的落地。

基于眼科联盟下专科护士培训方案指标体系的构建

目的:构建眼科联盟下专科护士培训方案的指标体系。方法:采用文献研究和半结构化访谈法初步构建培训方案,结合临床实践经验形成指标体系初稿,运用Delphi法对30名专家进行2轮问卷咨询,形成最终的专科护士培训方案指标体系。结果:两轮问卷有效回收率分别为96.7%、86.2%,专家熟悉系数为0.86,判断依据系数为0.98,专家权威系数0.92,肯德尔协调系数为0.21,本次函询专家较可靠,专家意见基本一致。最终确立的方案包括3个一级指标、12个二级指标、73个三级指标,其重要性评分为4.16~5.00,变异系数为0.00~0.16。结论:研究结果具有可靠性、现实性和针对性,形成的指标体系对眼科联盟下专科护士规范化培训的开展有指导作用。

“十三五”期间广州市不同结核病防治管理模式实施效果评价

目的:评价广州市现存结核病管理模式的实施效果,为不断完善结核病防治服务体系提供依据和实例。方法:从广州市结核病监测信息报告管理系统和广州市“十三五”结核病防治规划终期评估报告中搜集2016-2020年广州市4种结核病防治管理模式(慢病管理模式、“三位一体”模式、综合医院管理模式和委托服务模式)下的结核病疫情资料,计算不同模式下的肺结核患者登记率、病原学阳性率、治疗成功率、管理率和规范管理率等,并进行实施效果的成本-效用分析。结果:2016-2020年,广州市肺结核年均总登记率为51.78/10万(46 228/89 280 200),4种模式年均登记率由高及低依次为委托服务模式[74.37/10万(10 522/14 148 900)]、“三位一体”模式[50.17/10万(11 349/22 619 500)]、慢病管理模式[47.37/10万(14 588/30 793 700)]和综合医院管理模式[44.98/10万(9769/21 718 100)],差异有统计学意义(χ^(2)=222.422,P<0.001)。总病原学阳性率为49.33%(22 806/46 228),以慢病管理模式为最高[50.98%(7437/14 588)],委托服务模式为最低[48.07%(5058/10 522)];总治疗成功率为93.26%(43 113/46 228),以综合医院管理模式为最高[95.73%(9352/9769)],“三位一体”模式为最低[90.30%(10 248/11 349)];总规范管理率为89.08%(13 254/14 879),以委托服务模式为最高[95.40%(2573/2697)],“三位一体”模式为最低[82.69%(3100/3749)];差异均有统计学意义(χ^(2)=27.302,P<0.001;χ^(2)=306.666,P<0.001;χ^(2)=294.272,P<0.001)。总人均投入0.86元(76 477 200/89 280 200),挽回1个伤残调整生命年(DALY)损失需要投入的费用以“三位一体”模式为最高[188.20元(20 326 600/108 003.67)],综合医院管理模式为最低[153.77元(15 155 800/98 560.73)]。结论:“十三五”期间广州市4种结核病防治管理模式各有其优势及不足,未来仍需结合各区需求导向,从政府部门、系统到人才建设,积极采取措施,完善其现存结核病防治服务体系中的不足,以进一步提升患者登记率、病原学阳性率和总规范管理率。