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By reviewing the concept of disease management and disease managers, the admission qualification of disease managers, the role and specific work of disease managers in chronic disease management, this paper aims to provide a theoretical basis for disease managers to develop in a deeper and higher direction in chronic disease management, and to further improve the value of nurses themselves and the direction of specialty development.
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Objective To investigate the value of contrast -enhanced ultrasound combined with serum homocysteine in determining the stability of atherosclerotic plaques.Methods 96 cases with cerebrovascular disease accompanied by carotid atherosclerotic plaques were selected.All patients were taken ultrasonography and contrast -enhanced ultrasound.Semi -quantitative grading was used for plaque according to the reinforced.The serum homocys-teine levels were detected.Results A total of 146 plaques of 96 cases were found out.Hard plaques were 13(8.9%),soft plaques were 71(48.6%)and mixed plaques were 62(42.5%).All cases were divided into three groups according to the plaque ultrasound contrast semiquantitative grading.24 cases were in Ⅰ grade group,46 cases were in Ⅱ grade group,26 cases were in Ⅲ grade group.The differences of serum homocysteine levels among the three groups were statistically significant(F =59.942,P <0.05),pairwise compared,the differences were statistically significant(t =16.837,20.682 and 15.416,all P <0.05).Pearson linear correlation analysis showed that contrast -enhanced ultrasound plaque classifications were positively correlated with serum homocysteine levels(r =0.709,P =0.000).Conclusion Contrast -enhanced ultrasound could accurately assess the neovascularization in the plaque. Semi -quantitative grading of ultrasound contrast are positively correlated with serum homocysteine levels.Combined the two could provides scientific basis for early and accurate prediction the stability of plaque.
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Objective To investigate the ultrasonic performance of carotid atherosclerotic plaque and the correlation between microvessel density in plaque .Methods 87 cases of patients undergoing carotid artery plaque dissection were selected .113 plaques were found .All patients were taken carotid color Doppler sonography test and analysis of the plaque .The maximum thickness of plaques was taken HE stained ,and the vessel density in the plaque was counted .The correlation with sonographic performance of plaques was analyzed .Results The maximum plaque thicknesses in hard plaque ,soft plaque and mixed plaque were (0.49 ±0.05)mm,(0.36 ±0.08)mm and (0.39 ± 0.10)mm,respectively,and cross-sectional area stenosis rates were (88.32 ±6.51)%,(68.92 ±12.05)% and (71.95 ±13.04)%,respectively,the differences were statistically significant (F=16.329,23.723,all Pmixed plaques>hard plaque,the differences were statistically significant (t=6.579 and 9.392,all P<0.05).Pearson cor-relation analysis showed that the maximum plaque thickness and cross -sectional area stenosis rate in soft plaque were positive correlation between microvascular density values (r=0.372,P=0.011;r=0.438,P=0.000).Conclusion Color Doppler ultrasound examination might indirectly reflect microvessel densities in carotid artery plaque .It could be used preliminary assessment of vulnerability of carotid artery plaque .
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Objective To explore the effect of modified type B lynch uterine suture combined with calcium in the prevention and treatment for uterine atony postpartum hemorrhage.Methods 63 pregnant women with postpartum hemorrhage risk factors which would be underwent cesarean delivery were randomly divided into the study group (32 cases) and the control group (31 cases).The study group was given intravenous calcium gluconate (10ml) 10 min before the operation,and modified type B lynch uterine suture in the operation.The control group was only given the same dose of oxytocin of the study group.Results The amount of bleeding intraoperation and 24h after the operation was (182.6 ± 47.7) ml and (214.1 ± 63.8) ml,respectively,the time of intraoperative uterine contractions was (3.8 ± 1.3)min,the degree of hemoglobin decreased 24h after the operation was (9.2 ±2.0) min in the study group,which were less than those of the control group(t =7.26,2.97,2.39,4.01,all P ＜ 0.05).There was no statistically significant difference in puerperal morbidity and neonatal asphyxia between the two groups (all P ＞ 0.05).Conclusion The modified type B lynch uterine suture combined with calcium could effectively prevent and treat uterine atony postpartum hemorrhage,and could not increase the rate of neonatal asphyxia and puerperal morbidity.