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Objective:To investigate the effect of hospital-community-family transitional rehabilitation care model on patients with brain trauma and explore an economic, effective, all-sided rehabilitation approach.Methods:A total of 82 in-patients with brain trauma were recruited from January 2018 to June 2019 in Shanghai Yang Zhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center). The participants were allocated into 2 groups based on randomized digital tables. Forty patients in the observation group received the hospital-community-family transitional rehabilitation care, and forty-two patients in the control group received routine rehabilitation care. All the participants completed assessments with the Fugl-Meyer Assessment Scale (FMA), the Barthel Index for the Activities of Daily Living (BI) and the Hamilton Anxiety Scale (HAMA) before the intervention, at discharge, 1 month, 4 months, 6 months and 10 months after discharge, respectively.Results:Before the intervention, no statistical significance was identified in the total scores of FMA, BI and HAMA between the two groups ( P>0.05). Compared to the control group, the total scores of FMA, BI and HAMA in the observation group were significantly improved at the discharge, 1 month, 4 months, 6 months and 10 months after discharge, respectively ( t values were -13.82 - 10.28, all P<0.05). Significant differences were observed in the level of FMA, BI and HAMA between the two groups across 6 time points ( Ftime×group=20.34, 18.34, 19.55, Ftime=183.24, 184.30, 179.09, Fgroup=28.86, 32.19, 26.63, all P<0.05). Conclusions:The hospital-community-family transitional rehabilitation care model which is based on medical consortium effectively improved traumatic brain-injured patients′motor function, the level of activities of daily living, and patients′anxiety. In addition, the model also improved the quality of medical services.
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Objective:To explore the effect of hospital-community-family trinity linkage home visiting on quality of life of convalescent patients with traumatic brain injury.Methods:A total of 100 convalescence patients with traumatic brain injury admitted to Shanghai Yangzhi Rehabilitation Hospital from January 2019 to January 2020 were selected as the research objects, and randomly divided into the intervention group ( n=51) and the control group ( n=49) by random number table method. The control group received routine rehabilitation nursing guidance. Patients in the intervention group were treated with hospital-community-family triple linkage family visit for nursing intervention for 10 months. The Medical Outcomes Study 36-Item Short-Form (SF-36), General Self-Efficacy Scale (GSES) and Exercise of Self Care Agency Scale (ESCA) were used to compare the quality of life of 2 groups before intervention, 1, 4, 6, 8 and 10 months after intervention. Results:After 6 months of the intervention, eight dimensions of SF-36 such as physiological function, role-physical, body pain, general health, vitality, social function, role-emotional, and mental health scored 29.61 ± 9.21, 38.73 ± 14.42, 41.96 ± 8.25, 38.63 ± 8.43, 50.10 ± 8.03, 42.40 ± 18.28, 43.14 ± 15.34, 38.31 ± 8.88 in the intervention group, and 35.92 ± 8.02, 52.04 ± 14.29, 50.00 ± 11.90, 47.76 ± 9.08, 56.12 ± 7.66, 56.99 ± 19.40, 55.10 ± 16.03, 44.96 ± 7.73 in the control group. The difference between two groups showed significant difference ( t values were -5.21--3.81, all P<0.05). The GSES scores and ESCA scores after 1,4,6,8,10 months of the intervention showed an distinct advantage in the intervention group than the control group ( t values were -20.99-11.55, all P<0.05). Conclusions:The hospital-community-family trinity linkage home visiting could improve the quality of life, self-efficacy, and self-care ability of patients with traumatic brain injury, and promote their rehabilitation effect when they returned to family and society.
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Objective:To explore the application effects of the Doctor-nurse-therapist integrated Model on the patients with brain injury in the rehabilitation period.Methods:A total of 60 patients with brain injury from January 2016 to October 2017 were selected as the control group underwent interventions based on traditional treatment model involving medical treatment, nursing and rehabilitation, and then 56 patients with brain injury from January 2018 to October 2019 were aselected as the experimental group followed Doctor-Nurse-Therapist integrated model for rehabilitation treatment. All subjects were recruited from inpatients hospitalized in the Forth Department of Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center). The differences of motor function, activities of daily life (ADLs), anxiety and depression scores between the two groups were compared.Results:After 6 weeks of interventions, the scores of motor function were 80.27±18.20 and 67.32±19.71, and ADLs scores were 73.14±19.18 and 64.59±20.33 for the experimental group and the control group, respectively. The differences of the motor function and ADLs scores showed statistical significance between the experimental group and the control group ( t values were 3.491, 2.105, P<0.05). The anxiety and depression scores were 44.68±12.29 and 42.61±17.95 in the experimental group, while 52.25±12.95 and 50.84±18.14 in the control group, respectively. Statistical significance was found according to differences of anxiety and depression scores between the experimental group and the control group ( t values were 2.965,-2.236, P<0.05). Conclusions:Under the integrated model, doctors, nurses and therapists can evaluate, discuss, formulate and implement the flow scheme of the model, which can significantly improve the motor function and daily life ability of patients with brain injury in the rehabilitation period as well as anxiety, depression and the quality of medical services, and reduce the burden of family and society.
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Objective To explore the effects of swallow-feeding management in patients with dysphagia after traumatic brain injury (TBI). Methods By convenient sampling, 53 TBI patients from the Forth Department of Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center) from January 2016 to December received a conventional rehabilitation program as the control group. 52 TBI patients from January 2017 to December were recruited into the observation group, while they received the swallow-feeding training and rehabilitation nursing intervention in comparison with the conventional rehabilitation program received in the above control group. The therapeutic effects were evaluated in the two groups through comparing swallowing function pre and post the 30-days interventions, respectively. Results Before intervention the swallowing function of the observation group was graded as grade I (0 example), grade Ⅱ (16 examples), grade Ⅲ (14 examples), grade Ⅳ (14 examples) and grade Ⅴ (8 examples) respectively, while the swallowing function of the control group was graded as gradeⅠ(0 example), gradeⅡ(11 examples), grade Ⅲ(13 examples), gradeⅣ (18 examples) and grade Ⅴ (11 examples) respectively before intervention. The difference in the degrees of the swallowing function had no statistical significance between the control group and the observation group before interventions (Z=-1.268, P=0.205). After intervention the swallowing function of the observation group was graded as grade Ⅰ (20 example), grade Ⅱ (19 examples), grade Ⅲ (10 examples), grade Ⅳ (2 examples) and grade Ⅴ (8 examples) respectively. Meanwhile the swallowing function of the control group was graded as grade Ⅰ (8 example), grade Ⅱ (19 examples), grade Ⅲ (13 examples), grade Ⅳ(10 examples) and grade Ⅴ(3 examples) respectively after intervention. Hence, The difference in the degrees of the swallowing function had statistical significance between the observation group (Z=-6.222, P＜0.01) and control group (Z=-5.892, P＜0.01) pre and post interventions. Moreover, the improvement of swallowing function in the observation group was larger than that of the control group and the difference in the degree of the swallowing function have statistics significance between the two groups (Z=-3.265, P＜0.01). The food intake of the two groups were observed for 30 days, and the results revealed that there were 1 502 cases and 808 cases in respiratory aspiration in the control group and observation group respectively. It can be seen that the incident rate of respiratory aspiration was significantly lower in the observation group than that of the control group (χ2=52.567, P=0.047). Conclusion The Swallow-feeding management can improve the swallowing function, effectively reduce the incidence of respiratory aspiration and also enhance the quality of life in TBI patients.
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Objective To explore the value of microRNA in differential diagnosis of tuberculous ascites and cancerous ascites.Methods From January 2011 to October 2013,31 patients with ascites were enrolled in this study,19 cases of whom had cancerous ascites (two cases of ovarian cancer,three cases of liver cancer,one case of bile duct carcinoma,five cases of gastric cancer,three cases of pancreatic cancer,four cases of colon cancer and one case of peritoneal mesothelioma) and 12 cases had tuberculous ascites.Ascites was collected for microRNA microarray detection,and the possible differential expressed microRNA was screened.The results of microarray were confirmed by TaqMan stem-loop real-time polymerase chain reaction (PCR) method.The t test,receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were performed for statistical analysis.Results The results of microRNA expression profiles indicated that there were differences between tuberculous ascites and cancerous ascites.The findings of TaqMan real-time PCR showed the expression of microRNA-21 in cancerous ascites was 39.3±11.6,which was much higher than that of tuberculous ascites (12.6 ±4.1),and the difference was statistically significant (t=4.921,P＜0.05).The expression of microRNA-134 in cancerous ascites was 68.2±20.4,which was lower than that of tuberculous ascites (210.2±37.2),and the difference was statistically significant (t =3.430,P ＜ 0.05).The AUC of microRNA-21 and microRNA-134 in differential diagnosis of tuberculous ascites and cancerous ascites was 0.882 (95 ％ CI 0.816-0.917) and 0.877 (95％ CI 0.782-0.901).The AUC of combined microRNA-21 and microRNA-134 in differential diagnosis of tuberculous ascites and cancerous ascites was 0.915 (95％ CI 0.863-0.967).Conclusions There are differences in microRNA expression profiles between tuberculous ascites and cancerous ascites.The detection of microRNA-21 and microRNA-134 expression in ascites is of great importance in differential diagnosis.