Análisis comparativo de la Iniciativa Global para el Asma y las guías sudamericanas para el diagnóstico, manejo y prevención del asma en pacientes pediátricos

Fundamento: el asma es una enfermedad inflamatoria crónica con una alta prevalencia en Sudamérica, por lo que requiere un diagnóstico adecuado, manejo óptimo y medidas de prevención respaldados por evidencia científica constantemente actualizada. Objetivo: realizar un análisis comparativo entre la Iniciativa Global para el Asma y las guías sudamericanas para el diagnóstico, manejo y prevención del asma en pacientes pediátricos. Métodos: estudio de tipo observacional descriptivo que compara la guía Iniciativa Global para el Asma del año 2023 con guías nacionales de los países sudamericanos Colombia, Argentina, Chile, Uruguay, Venezuela y Perú, en los siguientes parámetros: recomendaciones diagnósticas, recomendaciones en el manejo y estrategias de prevención. Resultados: se encontraron diferencias en las recomendaciones de prevención y educación en las guías analizadas, mientras que la Iniciativa Global para el Asma y algunas guías sudamericanas mencionan medidas de prevención, otras guías no las mencionan o tienen información limitada al respecto. En los exámenes auxiliares, todas las guías mencionan la realización de espirometría para evaluar la función pulmonar, pero existen diferencias con la inclusión de otros exámenes, como el test de alergia o la medición de óxido nítrico exhalado. Conclusiones: se requiere una mayor estandarización y actualización de las guías sudamericanas para garantizar un manejo adecuado y consistente del asma en la región.

Foundation: Asthma is a chronic inflammatory disease with a high prevalence in South America, which requires proper diagnosis, optimal management and prevention measures supported by constantly updated scientific evidence. Objective: to carry out a comparative analysis between the Global Initiative for Asthma and the South American guidelines for the diagnosis, management and prevention of asthma in pediatric patients. Methods: descriptive observational study that compares the 2023 Global Initiative for Asthma guideline with national guidelines from the South American countries Colombia, Argentina, Chile, Uruguay, Venezuela and Peru, in the following parameters: diagnostic recommendations, management recommendations and prevention strategies. Results: differences were found in prevention and education recommendations in the guides analyzed, while the Global Initiative for Asthma and some South American guides mention prevention measures, other guides do not mention them or have limited information in this regard. In auxiliary tests, all guidelines mention performing spirometry to evaluate lung function, but there are differences with the inclusion of other tests, such as the allergy test or the measurement of exhaled nitric oxide. Conclusions: Greater standardization and updating of South American guidelines is required to guarantee adequate and consistent management of asthma in the region.

Practical Approach to Care Kit: Innovation for nurses' clinical practice in HIV management / Practical Approach to Care Kit: inovação para a clínica do enfermeiro no manejo do HIV / Practical Approach to Care Kit: innovación para la clínica de enfermería en el manejo del VIH

Abstract Objective: to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care. Method: an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding. Results: the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices. Conclusion: The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.

Resumo Objetivo: analisar a utilização do Practical Approach to Care Kit como uma tecnologia adotada na prática clínica dos enfermeiros no manejo do HIV na Atenção Primária à Saúde. Método: pesquisa exploratória e descritiva, ancorada no referencial metodológico da Teoria Fundamentada nos Dados Construtivista. A definição dos participantes foi realizada por amostragem inicial, com 12 enfermeiros, e amostragem teórica, com cinco gestores, totalizando 17 participantes. Os dados foram coletados por entrevistas intensivas e análise documental, e foram analisados em duas etapas: 1) codificação inicial; e 2) codificação focalizada. Resultados: os profissionais identificaram o Practical Approach to Care Kit como uma inovação tecnológica que contribuiu para a ampliação da prática clínica e empoderamento do enfermeiro no manejo clínico da infecção por HIV. Também destacaram sua importância como ferramenta para orientação das diferentes responsabilidades e atribuições no compartilhamento do cuidado, contribuindo para a prestação de práticas baseadas em evidências. Conclusão: o Practical Approach to Care Kit é uma inovação tecnológica que transformou a prática clínica do enfermeiro no manejo do HIV, ampliando seu escopo de atividades na realização do diagnóstico, avaliação da condição de saúde e aconselhamento, avaliação da adesão ao tratamento, efeitos adversos e prescrição de exames, medicamentos e imunobiológicos.

Resumen Objetivo: analizar el uso del Practical Approach to Care Kit como tecnología adoptada en la práctica clínica de los enfermeros en el manejo del VIH en la Atención Primaria de la Salud. Método: investigación exploratoria y descriptiva, basada en el marco metodológico de la Teoría Fundamentada en los Datos Constructivistas. La definición de los participantes fue realizada por muestreo inicial, con 12 enfermeros, y muestreo teórico, con cinco gestores, fueron 17 participantes en total. Los datos fueron recolectados a través de entrevistas intensivas y análisis de documentos, y fueron analizados en dos etapas: 1) codificación inicial; y 2) codificación enfocada. Resultados: los profesionales identificaron el Practical Approach to Care Kit como una innovación tecnológica que contribuyó a la expansión de la práctica clínica y al empoderamiento de los enfermeros en el manejo clínico de la infección por VIH. También destacaron su importancia como herramienta para orientar las diferentes responsabilidades y obligaciones en la distribución de la atención de los pacientes, contribuyendo a la prestación de prácticas basadas en evidencia. Conclusión: el Practical Approach to Care Kit es una innovación tecnológica que ha transformado la práctica clínica de los enfermeros en el manejo del VIH, ampliando su radio de acción para la realización del diagnóstico, evaluación del estado de salud y asesoramiento, evaluación de la adherencia al tratamiento, efectos adversos y prescripción de exámenes, medicamentos e inmunobiológicos.

Comparación: acetaminofén vs ibuprofeno para el tratamiento de los síntomas en pacientes con infección por SARS-CoV-2 / Comparação: paracetamol vs ibuprofeno para o tratamento de sintomas em pacientes com infecção por SARS-CoV-2 / Comparison: acetaminophen vs ibuprofen for the treatment of symptoms in patients with SARS-CoV-2 infection

La propagación del COVID-19 fue expedita y tras varios informes la eficacia de algunos medicamentos antiinflamatorios no esteroideos, como el ibuprofeno, estuvo bajo sospecha. Mientas que el paracetamol (acetaminofén) se sugirió como una alternativa segura y recomendable para el manejo temprano y domiciliario del dolor y fiebre en pacientes. Objetivo. Comparar el uso del acetaminofén vs ibuprofeno para tratamiento de los síntomas en pacientes con infección por SARS-COV-2". Metodología. La investigación es una revisión sistemática, donde, se analizaron artículos científicos publicados en revistas vinculadas a áreas de salud, disponibles en buscadores y plataformas digitales tales, como Scienedirect, Pubmed, Elsevier y Springer Link. Las búsquedas se realizaron utilizando las palabras claves previamente definidas. Conclusión. El uso del ibuprofeno ha estado en duda desde sus inicios, en pacientes con COVID-19. Sin embargo, ningún estudio afirma asociar el uso del mismo con aumentos importantes en estadía hospitalaria, ingresos en UCI, necesidad de ventilación mecánica, ni mortalidad. Sin embargo, el acetaminofén ha sido utilizado desde un principio, su uso no estuvo en duda, pero los hallazgos recientes parecen indicar que no es tan eficaz como se pensaba en un principio. Siendo bastante inferior en la comparación directa con el ibuprofeno.

The spread of COVID-19 was expeditious and after several reports the efficacy of some non-steroidal anti-inflammatory drugs, such as ibuprofen, was under suspicion. While paracetamol (acetaminophen) was suggested as a safe and recommended alternative for early and home management of pain and fever in patients. Objective. To compare the use of acetaminophen vs ibuprofen for symptom management in patients with SARS-COV-2 infection". Methodology. The research is a systematic review, where scientific articles published in journals related to health areas, available in search engines and digital platforms such as Scienedirect, Pubmed, Elsevier and Springer Link, were analyzed. Searches were performed using previously defined keywords. Conclusion. The use of ibuprofen has been in question since its inception in patients with COVID-19. However, no study claims to associate its use with significant increases in hospital stay, ICU admissions, need for mechanical ventilation, or mortality. However, acetaminophen has been used from the beginning, its use was not in doubt, but recent findings seem to indicate that it is not as effective as originally thought. It is quite inferior in direct comparison with ibuprofen.

A disseminação da COVID-19 foi rápida e, após vários relatos, a eficácia de alguns anti-inflamatórios não esteroides, como o ibuprofeno, ficou sob suspeita. Já o paracetamol (acetaminofeno) foi sugerido como uma alternativa segura e recomendada para o tratamento precoce e domiciliar da dor e da febre nos pacientes. Objetivo. Comparar o uso de acetaminofeno versus ibuprofeno para o controle dos sintomas em pacientes com infecção por SARS-COV-2". Metodologia. A pesquisa é uma revisão sistemática, onde foram analisados artigos científicos publicados em periódicos relacionados às áreas de saúde, disponíveis em sites de busca e plataformas digitais como Scienedirect, Pubmed, Elsevier, e Springer Link. As buscas foram realizadas por meio de palavras-chave previamente definidas. Conclusões. O uso do ibuprofeno tem sido questionado desde sua criação em pacientes com COVID-19. No entanto, nenhum estudo afirma associar seu uso a aumentos significativos na permanência hospitalar, internações em UTI, necessidade de ventilação mecânica ou mortalidade. No entanto, o acetaminofeno tem sido usado desde o início, seu uso não foi questionado, mas descobertas recentes parecem indicar que ele não é tão eficaz quanto se pensava originalmente. Ele é muito inferior em comparação direta com o ibuprofeno.

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease / Recomendações da Sociedade Brasileira de Pneumologia e Tisiologia para o manejo da doença pulmonar pós-tuberculose

ABSTRACT Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

RESUMO Historicamente, todos os esforços contra a tuberculose concentraram-se no diagnóstico rápido e no tratamento efetivo para quebrar a cadeia de transmissão do Mycobacterium tuberculosis. No entanto, nos últimos anos, têm sido encontradas mais e mais evidências sobre as dramáticas consequências da condição definida como doença pulmonar pós-tuberculose (DPPT). Aproximadamente um terço dos pacientes que sobrevivem à tuberculose pulmonar enfrenta morbidades consideráveis e persistentes, incluindo comprometimento respiratório, desafios psicossociais e redução da qualidade de vida relacionada à saúde após o término do tratamento. Diante da importante carga global e local da tuberculose, bem como da carga estimada da DPPT, considerou-se urgente o desenvolvimento de um documento de consenso por uma sociedade científica brasileira - a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - para a prevenção e manejo dessa condição, a fim de alocar recursos de forma adequada para e nos serviços de tuberculose e servir de guia para os profissionais de saúde. Uma equipe de onze pneumologistas e um metodologista foi criada pela SBPT para revisar as evidências atuais sobre a DPPT e desenvolver recomendações adaptadas ao contexto brasileiro. O painel de especialistas selecionou os temas com base nas evidências atuais e diretrizes internacionais. Durante a primeira fase, três membros do painel redigiram as recomendações, que foram divididas em três seções: definição e prevalência de DPPT, avaliação da DPPT e manejo da DPPT. Na segunda fase, todos os membros do painel analisaram, discutiram e revisaram as recomendações até chegar a um consenso. O documento foi aprovado formalmente pela SBPT em sessão especial organizada durante o Congresso Anual da SBPT de 2023.

Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study

SUMMARY OBJECTIVE: This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS: This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS: Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO2/FiO2<300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION: After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.

Exploring cost drivers for improving disease management: the case of type 2 diabetes at a tertiary hospital in Burundi, Africa

Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco using the interrupted time-series analysis. The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2= -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). The effect of thecovid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Construction of a logical model of the line of care for people with chronic kidney disease / Construção de modelo lógico da linha de cuidado da pessoa com doença renal crônica

ABSTRACT OBJECTIVE To build and validate a logical model of the line of care for people with chronic kidney disease. METHODS This is a descriptive study with a qualitative approach, with documentary research and analysis of primary data collected in interviews with key informants, carried out from May to September 2019, in the Guarani Aquifer Health Region, belonging to the Regional Health Department 13. Based on the theoretical framework proposed by McLaughlin and Jordan, five stages were followed: collection of relevant information; description of the problem and context; defining the elements of the logical model; construction and validation. RESULTS The logical model was organized into three care dimensions - primary health care, specialized care and high complexity care - composed of structure, process and result components. CONCLUSION The constructed logical model has the potential to contribute to the assessment of the line of care for people with chronic kidney disease, in order to achieve better results in the management of this disease, something that favors both the patient and the health system.

RESUMO OBJETIVO Construir e validar um modelo lógico da linha de cuidado da pessoa com doença renal crônica. MÉTODOS Trata-se de um estudo de caráter descritivo e com abordagem qualitativa, sendo feitas pesquisa documental e análise de dados primários coletados em entrevistas com informantes-chave, realizadas de maio a setembro de 2019, na Região de Saúde do Aquífero Guarani, pertencente ao Departamento Regional de Saúde 13. A partir do referencial teórico proposto por McLaughlin e Jordan, foram seguidas cinco etapas: a coleta de informações relevantes; a descrição do problema e do contexto; a definição dos elementos do modelo lógico; e a construção e validação. RESULTADOS O modelo lógico foi organizado em três dimensões assistenciais - atenção primária à saúde, atenção especializada e atenção de alta complexidade - compostas pelos componentes de estrutura, processo e resultado. CONCLUSÃO O modelo lógico construído tem potencial para contribuir com a avaliação da linha de cuidado da pessoa com doença renal crônica, ao visar o alcance de melhores resultados no manejo dessa doença, o que favorece tanto o seu portador quanto o sistema de saúde.

Qihuang Yishen Granules （芪黄益肾颗粒） Combined with Chronic Disease Management of Traditional Chinese Medicine for Diabetic Kidney Disease Patients with Deficiency of both Qi and Yin：A Clinical Observation / 中医杂志

ObjectiveTo observe the effectiveness and safety of Qihuang Yishen Granules （芪黄益肾颗粒） combined with traditional Chinese medicine （TCM） chronic disease management on patients with diabetic kidney disease with deficiency qi and yin. MethodsTotally 140 patients diagnosed as diabetic kidney diseases with deficiency of both qi and yin were randomly divided into control group and trial group，with 70 cases in each group. Patients in the control group were treated with symptomatic treatment and routine chronic disease management. Patients in the trial group added Qihuang Yishen Granules and chronic disease management with TCM characteristics on the basis of symptomatic treatment. The course of treatment in both groups lasted for 6 months. The changes of laboratory indexes and chronic disease management level scores of the two groups of patients before treatment and after 3 and 6 months of treatment were compared， and their correlation were analyzed.The laboratory indexes of urinary protein and renal function related indicators such as 24-hour urinary protein quantification （24 hUTP）， serum creatinine （Scr）， blood urea nitrogen （BUN）， and estimated glomerular filtration rate （eGFR）， and control compliance rate， as well as blood glucose and lipid related indicators such as glycosylated hemoglobin （HbA1c）， low-density lipoprotein cholesterol （LDL-C）， triglyceride （TG） and control compliance rate were observed. The chronic disease management level scores included exercise，cognitive symptom management practice，communication with doctors， self-efficacy of symptom management，self-efficacy of disease commonness management. ResultsFinally，67 cases in the control group and 68 cases in the trial group completed the study. Compared with the group before treatment， the trial group had lower 24 hUTP and Scr， higher exercise score， total self-management score and all self-efficacy scale scores， higher TG at 3 months of treatment； at 6 months of treatment， the trial group had lower 24 hUTP， higher eGFR， and higher self-management scores and self-efficacy scale scores of all chronic diseases （P＜0.05）， and the control group had higher self-management total score （P＜0.05）. After 6 months of treatment， the trial group had lower 24 hUTP， Scr， LDL-C， and TG， higher eGFR， higher compliance rate of 24 hUTP， eGFR， LDL-C， and TG， and higher scores for all chronic disease management indexes compared with the control group （P＜0.05）. In terms of the correlation between laboratory indicators and chronic disease management level scores：there was a statistically significant difference in the correlation between 24hUTP and exercise，symptom management self-efficacy，and self-efficacy of disease commonness management （P＜0.05 or P＜0.01），all of which were negatively correlated. There was a statistically significant difference in the correlation between Scr and symptom management self-efficacy and self-efficacy of disease commonness management （P＜0.01），both of which were negatively correlated. There was a statistically significant difference in the correlation between eGFR and symptom management self-efficacy and self-efficacy of disease commonness management （P＜0.01），both of which were positively correlated. ConclusionQihuang Yishen Granules combined with chronic disease management of TCM can improve the level of proteinuria，renal function and lipid metabolism in patients with diabetic kidney disease with deficiency of both qi and yin，thus delaying the progress of diabetic kidney disease and also improve the level of chronic disease management of patients.

Research progress of hydroxychloroquine retinopathy / 中华眼底病杂志

Hydroxychloroquine is widely used in a variety of autoimmune diseases. However, long-term use of hydroxychloroquine can cause severe retinopathy, which has a complex pathogenic mechanism and diverse clinical manifestations, mainly manifested as photoreceptor and retinal pigment epithelial damage and irreversible vision loss. Identifying damage before retinitis pigment epithelium lesions preserve central vision, so early detection is crucial to slow disease progression and reduce vision loss. The development of multimodal imaging technology and the issuance of the latest treatment guidelines provide a powerful tool for the early screening and treatment of hydroxychloroquine retinopathy. Proficient in the latest guidelines for the treatment of hydroxychloroquine can better guide clinicians to do a good job in disease screening and management, recommend risks, safe dosages and appropriate screening procedures to patients and strengthen the prevention of hydroxychloroquine retinopathy, which will help save the vision of more patients and reduce the waste of medical resources.

Chronic disease management approaches for fundus disease to be explored and established / 中华眼底病杂志

Chronic disease is a major threat to human health. Fundus disease has become a major ophthalmic disease affecting daily life. Although great breakthroughs have been made in the treatment, compared with other chronic disease management, the management of patients with fundus disease is still in its infancy. To strengthen the management exploration of patients with fundus diseases, establish a management model of fundus diseases and strive to improve patients' awareness of fundus diseases and adherence to treatment and follow-up are the great challenges at present. All ophthalmic centers should strengthen patient education, establish a regional cooperation network, support the construction of grassroots medical capacity, cultivate talents, enhance training, promote the standardized treatment of fundus diseases, standardize fundus imaging inspection and diagnosis, and promote the homogeneous construction of diagnosis and treatment of chronic fundus diseases. We will accelerate the construction of a hierarchical diagnosis and treatment system and the ability to link consultation and referral. Through systematic management and intervention of fundus diseases, a large number of patients with fundus diseases will receive early screening, diagnosis, standardized continuous treatment and systematic management, and improve the quality of life of patients with fundus diseases.

Pay attention to the whole process management of diabetic retinopathy / 中华眼底病杂志

Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it is a key ocular fundus disease that needs to be paid attention to in the next five years according to the "14th Five-Year" Plan for Eye Health. Promoting the systematic management of DR and constructing the chronic disease management system are the key to the next step of national eye health work. It is necessary to further improve the management mode of the whole course of DR patients with chronic eye disease through the joint action of medical security system at all levels, including strengthening supporting policies of primary medical institutions, optimizing medical service mode and process, strengthening scientific education to improve patients' and doctors' disease cognition, and updating authoritative Chinese DR guidelines to standardize diagnosis and treatment. It is hoped that the low vision and blindness caused by DR in China can be greatly reduced after the implementation of the "14th Five-Year" Plan for Eye Health.

Effects of hierarchical management based on medical alliances on patency of arteriovenous graft in hemodialysis patients / 中华肾脏病杂志

Objective:To investigate the impacts of hierarchical management based on medical alliance on the patency of arteriovenous graft (AVG),and provide a basis for further exploration of optimal AVG management.Methods:In this retrospective cohort study, clinical and follow-up data of patients with AVG established in the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2021 were analyzed. Patients were divided into medical alliance group and non-medical alliance group according to whether they were under hierarchical management model, and the patency rate of AVGs and the incidence of clinical events were compared between the two groups.Results:A total of 328 AVGs were included in this study, which were from 151 hemodialysis centers, including 189 AVGs (57.6%) from 72 centers in medical alliance group, and 139 AVGs (42.4%) from 79 centers in non-medical alliance group. The age of the patients was (55.57±11.80) years, among whom 130 (39.6%) were males and 126 (38.4%) were diabetic. The follow-up time of AVGs in this cohort was 15.5 (9.5, 26.2) months, with 15.4 (9.8, 25.2) months in medical alliance group and 15.5 (9.2, 27.3) months in non-medical alliance group. The incidence of thrombosis or occlusion (0.328 times/patient-year), graft dissection (0.007 times/patient-year), graft infection (0.030 times/patient-year), and catheter utilization (0.043 times/patient-year) in the medical alliance group were lower than those in the non-medical alliance group (0.589 times/patient-year, 0.040 times/patient-year, 0.054 times/patient-year and 0.147 times/patient-year, respectively), and there was no significant difference in clinic follow-up rates between the two group (1.91 times/patient-year vs. 1.94 times/patient-year). The median primary patency time was 17.4 (95% CI 11.3-23.5) months, the median primary assisted patency time was 32.6 (95% CI 25.0-40.2) months, and the median secondary patency time was 47.9 (95% CI 40.0-55.8) months in the medical alliance group, compared with 12.3 (95% CI 9.4-15.2) months, 19.4 (95% CI 14.3-24.5) months, and 34.6 (95% CI 29.3-39.9) months in the non-medical alliance group, respectively. Primary patency were significantly higher in the medical alliance group (77.4%, 62.2%, 39.9%, and 26.6%) than those in the non-medical alliance group (71.1%, 50.1%, 30.6%, and 13.4%) at 6, 12, 24, and 36 months (Log-rank test, χ2=4.504, P=0.034). Primary assisted patency were significantly higher in the medical alliance group (90.9%, 84.3%, 67.1%, and 46.1%) than those in the non-medical alliance group (89.2%, 75.7%, 42.0%, and 16.6%) at 6, 12, 24, and 36 months (Log-rank test, χ2=10.655, P=0.001). Secondary patency were significantly higher in the medical alliance group (96.8%, 91.8%, 84.2%, and 74.0%) than those in the non-medical alliance group (89.9%, 85.8%, 69.3%, and 47.5%) at 6, 12, 24, and 36 months (Log-rank test, χ2=11.634, P=0.001). Multivariate Cox regression analysis showed that it was a protective factor for primary patency ( HR=0.708, 95% CI 0.512-0.980, P=0.037), primary assisted patency ( HR=0.506, 95% CI 0.342-0.749, P=0.001) and secondary patency ( HR=0.432, 95% CI 0.261-0.716, P=0.001) under the medical alliance model. Conclusion:The hierarchical management based on medical alliances can improve the patency of AVGs and reduce the incidence of clinical events.

Research progress on risk factors for radiologically isolated syndrome conversion and its clinical management / 中华神经科杂志

Radiologically isolated syndrome (RIS) is considered as an imaging marker of the prodromal stage of multiple sclerosis (MS), and approximately one-third of patients might convert to clinically isolated syndrome or clinically definite multiple sclerosis within 5 years after diagnosis. Although it still remains inconclusive whether or not disease-modifying therapies for RIS need to be initiated, effective identification of prognostic factors for conversion would be of great benefit for early screening of high-risk patients and subsequent clinical precision management. Combined with the latest research progress at home and abroad, this review summarizes the prognostic factors for conversion of RIS to MS from the aspects of demographic characteristics, clinical presentations, imaging manifestations, cerebrospinal fluid and ophthalmological examinations. Given that disease-modifying therapies for RIS are still in clinical research stage and there are no definite recommendations to date, this article expounds the research progress on clinical monitoring, therapeutics and prevention of disease progression, which aims to provide neurologists with reference suggestions on clinical management of RIS.

Effect of COVID-19 epidemic on management of diabetic patients / 中华全科医师杂志

The outbreak of COVID-19 as an acute communicable disease has also changed the epidemiological status of diabetes mellitus and other noncommunicable chronic diseases. During the COVID-19 epidemic period, it was observed that there were increased morbidity of diabetes, difficulties in blood sugar control and increased acute complications for diabetic patients. This may be attributed to lifestyle changes during the epidemics, such as the reduced exercise time and increased sedentary time, more snacks and sugary food intake, as well as anxiety and depression. However, it is not known the long-term impact of COVID-19 epidemic on the management of diabetic patients, so it is necessary to closely monitor the exposed diabetic patients in the future.

Development and application of clinical assessment tools for cholinergic urticaria / 中华皮肤科杂志

This review comprehensively summarizes clinical assessment tools which have been developed and validated for cholinergic urticaria (CholU) , involving diagnosis and severity assessment of CholU, assessment of patients′ quality of life, and assessment of disease control. The application methods and status of relevant tools in clinical practice are introduced in detail.

Research advances on the correlation between frailty and chronic pain in the elderly / 中华老年医学杂志

Frailty is currently one of the hot research topics in geriatric medicine.With decreased physiological reserve of multiple systems and reduced anti-stress ability as its main manifestations, frailty results in a range of adverse outcomes.On the other hand, chronic pain is a common clinical syndrome that threatens physical and mental health of the elderly.The relationship between frailty and chronic pain is receiving increasing attention because both of them are important risk factors for impaired quality of life of elderly individuals.In this review, we summarize the correlation between frailty and chronic pain, and its possible underlying mechanisms, in order to provide new ideas for frailty identification and intervention and effective chronic pain management.

Whole-course management strategy of HIV infections / 中华临床感染病杂志

The global efforts aimed at preventing and controlling HIV infections have made remarkable progress. With the continuous accumulation of clinical evidence and the development of antiviral drugs, the treatment of HIV/AIDS has entered an era of chronic disease management. However, it has also brought about many challenges. Currently, some areas in prevention, control and management of HIV infection need to be further improved, and the long-term management model currently in use need to be further refined in China. The comprehensive whole-course management mode for HIV/AIDS, which is proved as effective and efficient means, should be widely recognized and vigorously promoted in order to provide reference and assistance for the clinical management of HIV infection in China.

Health benefits of integrating physical activity with chronic disease management in community-dwelling older adults: a scoping review / 中国康复理论与实践

ObjectiveTo construct a health intervention model for community-dwelling older adults with chronic diseases based on the International Classification of Diseases, Eleventh Revision (ICD-11) and the International Classification of Functioning, Disability and Health (ICF), and to analyze the health outcomes of three types of intervention models that integrate physical activity and chronic disease management. MethodsA scoping review was conducted by searching CNKI, Web of Science, PubMed and EBSCO databases for literature on community-based management of chronic diseases, physical activity, exercise rehabilitation, physical activity prescription intervention and related health outcomes up to May, 2023. ResultsEight studies from four countries were included, involving 568 randomized controlled trials and 4 359 participants aged 50 to 72. The studies were published mainly between 2017 and 2022. Community-based health intervention models for older adults with chronic diseases were categorized into three types: community health service models (chronic disease management and exercise rehabilitation), community physical activity models (prevention and health promotion) and mixed models (a combination of these two models). The community health service model focused on chronic disease management in the community, integrating community sports, and involving physical activity intervention, health education, dietary intervention, monitoring and motivation intervention, and care coordination, for six to 24 months, with the intervention attribute of rehabilitation and health promotion. The personnel involved doctors, nurses, dietitians, pharmacists, social workers and primary healthcare clinicians. The community physical activity model focused on design and implementation physical activity intervention for chronic disease in the community environment, providing relevant physical activity advice and guidance, and personalized reinforcement and support. The physical activities included walking, cycling, warm-up exercises, cardiopulmonary fitness, muscle strength and balance training, coordination and stretching exercises, Taijiquan, Yoga, Qigong, and water sports; ten to 150 minutes a time, low to vigorous, for eight to twelve months, with the intervention attribute of prevention and health promotion. The personnel involved clinical staff, primary healthcare staff, exercise intervention experts and consultants, doctors, nurses, social workers and certified exercise coaches. The mixed model involved a chronic disease prevention and management plan, including physical activity counseling, lifestyle intervention related to physical activity, personalized health guidance and exercise program design, for six to twelve months, with the intervention attribute of prevention, rehabilitation and health promotion. The personnel involved sports coaches and retired professional athletes, dietitians, nurses, personal trainers, general practitioners, occupational therapists and physiotherapists. The main health outcomes involved body function-related indicators, such as control of weight, blood pressure, waist circumference, systolic blood pressure, triglyceride and high-density lipoprotein cholesterol levels, to reduce cardiovascular risk; relief of arthritis and herpes zoster pain, improvement in cognitive function and depressive symptoms. In terms of activity-related outcomes, the physical fitness improved, involving agility and dynamic balance, flexibility, muscle strength, and aerobic endurance; while the amount of physical activity increased, as well as the time spent on mild, moderate and vigorous exercise or leisure activities; the risk of fall reduced, the level of daily physical activity improved, and the self-efficacy and level of social participation increased. ConclusionThe community-based physical activity and health services models for older adults with chronic diseases may be classified as community health service model, community physical activity model and mixed model. A comprehensive intervention integrating physical activity and community health services can improve the health status, control the symptoms of chronic diseases, improve physical and mental functions, and increase the level of physical activity and quality of life for older adults with chronic diseases. The mixed model is a hybrid model that incorporates physical activity into community health services, which can provide comprehensive health interventions to make better health and health-related benefits.

Research progress in prevention and disease management of osteoporotic fractures / 上海预防医学

Osteoporotic fracture is the most major complication of osteoporosis. It is a significant global public health problem which continues to bring serious family and social burden. In order to improve the prevention and treatment of osteoporotic fractures， many countries have carried out new ways of fracture prevention and management， and achieved some results. Prevention mainly aims at those at high risk of fracture， and includes new health education on fracture and the promotion of fall prevention measures. For management， the "Fracture liaison services" mode is mainly applied to the fracture patients， with refined patient management to deal with the fractures that have occurred. This article summarizes the global prevalence of osteoporotic fractures， risk factors， and the current research progress in fracture prevention and management in China and the West.

Current status and suggestions of home pharmacy services under the background of aging / 药学实践杂志

Objective To explore how to further improve the quality of home pharmacy services under the background of aging. Methods The development history of home pharmacy service in our country in recent years was summarized, and the current status and limitations of home-based pharmacy service were analyzed. Results Our country's home-based pharmacy service has gradually matured and standardized from the early stage of independent exploration in various regions, but its quality improvement is still restricted by multiple bottlenecks. It is recommended to increase the popularity of pharmacy services, broaden the promotion channels for rational drug use, and optimize the allocation of pharmacists. etc. to be improved. Conclusion It is of great significance to improve the quality of home-based pharmacy services for home-based patients in the community, and it requires the joint efforts of multiple parties to improve it.