Heart failure with Normal and Reduced Ejection Fraction – Assessment and Shared Care Management

@#Non-alcoholic fatty liver disease (NAFLD) has become the commonest chronic liver disease in the world. Overall improvement in public health, active screening of blood products, and universal vaccination of hepatitis B have led to a drop in incidence of hepatitis B and C worldwide. NAFLD is strongly associated with metabolic syndrome. With the rise in overweight status and obesity worldwide, it is not surprising that NAFLD is on the rise. Diagnosis of NAFLD requires confirmation of fatty infiltration in liver, as well as liver damage such as elevated liver enzymes and presence of fibrosis. Currently, the best treatment for NAFLD is weight loss, and the proven method would be dieting with regular exercises. Vitamin E and pioglitazoles are promising medications for treating NAFLD, but each medication has their shortcomings. Until more studies are conducted, lifestyle modification remains the only reliable way to treat NAFLD. Family physicians ought to look out for cardiovascular diseases, as well as being vigilant in cancer screening, as NAFLD is associated with higher risks of ischemic heart disease and cancer.

Effect of the shared care-based diabetes management among patients with type 2 diabetes / 中国实用护理杂志

Objective To explore the effect of shared care model on diabetes management among patients with type 2 diabetes mellitus (T2DM), therefore, to establish a more efficient education and management model for patients with T2DM. Methods Through convenient sampling, a total of 210 patients with T2DM were recruited from the outpatient clinic of the endocrinology center at Luhe Hospital, Capital Medical University, Beijing, from August to October, 2017. Patients were equally divided into two groups (n=105/group): intervention group and control group.The intervention group completed 103 cases and the control group 100 cases.The intervention group adopted the shared care education model, while the control group followed the conventional education management model. The follow up time of the intervention group was 12 months. The levels of glycosylated hemoglobin (HbA1c), Body Mass Index (BMI) and diabetes self-management behaviors were collected at baseline and at 12-months and compared between two groups. Measurement data were examined by t-test and rank-sum test; Count data were examined by chi square test, P<0.05 was thought to be statistically significant. Results At 12-month following the implementation of the management models, the HbAlc and BMI of the intervention group were (6.47 ± 0.66)%, (22.28 ± 2.41) kg/㎡, and those of the control group were (6.90 ± 0.61)%, (23.49 ± 1.59) kg/㎡, respectively. There were significant differences between the two groups (t=-4.63, 0.00, P<0.01). The intervention group had healthy diet, exercise, self-blood sugar monitoring, blood sugar monitoring in compliance with doctor's advice, self-foot examination and medication scores of (6.08 ± 1.34), (6.06 ± 1.59), (5.18 ± 2.00), (5.28 ± 1.99), (4.64 ± 2.54), (6.80 ± 0.55) respectively, while the control group had (5.43 ± 1.71), (5.46 ± 1.89), (4.27 ± 1.64), (4.23 ± 1.64), (3.57 ± 2.74), (5.30 ± 2.68) respectively. There were significant differences between the two groups (t=-4.03--2.73, P < 0.05). Conclusion Compared with the traditional education and management model, the shared care model with a multi-disciplinary approach is more patient-centered, and could provide systematic, standardized and personalized management for patients with T2DM and showed greater improvement in diabetes management.

Heart failure with normal and reduced ejection fraction - assessment and shared care management

@#Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders. HF due to left ventricular dysfunction is categorized into HF with reduced ejection fraction (with Left Ventricular Ejection Fraction (LVEF) ≤50 percent, known as HFrEF; also referred to as systolic HF) and HF with preserved ejection fraction (with LVEF >50 percent; known as HFpEF; also referred to as diastolic HF.1 A reduced LVEF in systolic heart failure is a powerful predictor of mortality. As many as 40 -50 percent of patients with heart failure have diastolic heart failure with preserved left ventricular function. Overall, there is no difference in survival between diastolic and systolic heart failure that cannot be attributed to ejection fraction. Patients with diastolic heart failure are more likely to be women, to be older, and to have hypertension, atrial fibrillation, and left ventricular hypertrophy, but no history of coronary artery disease.2,3 The pathogenesis of diastolic dysfunction involves abnormalities of active ventricular relaxation and passive ventricular compliance, which lead to ventricular stiffness and higher diastolic pressures. These pressures are transmitted through atrial and pulmonary venous systems, reducing lung compliance. A combination of decreased lung compliance and cardiac output leads to symptoms.

Effect of the shared care-based diabetes management among patients with type 2 diabetes / 中国实用护理杂志

Objective@#To explore the effect of shared care model on diabetes management among patients with type 2 diabetes mellitus (T2DM), therefore, to establish a more efficient education and management model for patients with T2DM.@*Methods@#Through convenient sampling, a total of 210 patients with T2DM were recruited from the outpatient clinic of the endocrinology center at Luhe Hospital, Capital Medical University, Beijing, from August to October, 2017. Patients were equally divided into two groups (n=105/group): intervention group and control group.The intervention group completed 103 cases and the control group 100 cases.The intervention group adopted the shared care education model, while the control group followed the conventional education management model. The follow up time of the intervention group was 12 months. The levels of glycosylated hemoglobin (HbA1c), Body Mass Index (BMI) and diabetes self-management behaviors were collected at baseline and at 12-months and compared between two groups. Measurement data were examined by t-test and rank-sum test; Count data were examined by chi square test, P<0.05 was thought to be statistically significant.@*Results@#At 12-month following the implementation of the management models, the HbAlc and BMI of the intervention group were (6.47 ± 0.66)%, (22.28 ± 2.41) kg/m2, and those of the control group were (6.90 ± 0.61)%, (23.49 ± 1.59) kg/m2, respectively. There were significant differences between the two groups (t=-4.63, 0.00, P< 0.01). The intervention group had healthy diet, exercise, self-blood sugar monitoring, blood sugar monitoring in compliance with doctor's advice, self-foot examination and medication scores of (6.08 ± 1.34), (6.06 ± 1.59), (5.18 ± 2.00), (5.28 ± 1.99), (4.64 ± 2.54), (6.80 ± 0.55) respectively, while the control group had (5.43 ± 1.71), (5.46 ± 1.89), (4.27 ± 1.64), (4.23 ± 1.64), (3.57 ± 2.74), (5.30 ± 2.68) respectively. There were significant differences between the two groups (t=-4.03--2.73, P<0.05).@*Conclusion@#Compared with the traditional education and management model, the shared care model with a multi-disciplinary approach is more patient-centered, and could provide systematic, standardized and personalized management for patients with T2DM and showed greater improvement in diabetes management.

Approach To Symmetrical Polyarthritis with Focus on Rheumatoid Arthritis

Symmetrical polyarthritis is not uncommon as a presenting clinical problem in the primary care setting. The ability to differentiate inflammatory from non-inflammatory, articular from peri-articular joint pain will help the Family Physician (FP) to further narrow the diagnosis of joint pain, and provide early referral and effective treatment when necessary. Integrating clinical reasoning with the concept of likelihood ratios in the process of diagnosis, FPs can also easily differentiate the various diagnoses of symmetrical polyarthritis, including rheumatoid arthritis (RA). There is also increasing evidence that shared care of patients with rheumatoid arthritis can be done successfully and safely between FPs and rheumatologists.

One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

Apoio matricial: um caminho para a integração saúde mental e atenção primária / Matrix support: a way to mental health and primary health care integration

O ensaio aborda a integração da saúde mental na Atenção Primária à Saúde por meio do apoio matricial. Traz os diferentes aspectos da inserção da saúde mental na atenção primária e os fatores que atuam como barreiras ao processo. Discute os achados de pesquisas nacionais e internacionais sobre a temática e os elementos comuns à descentralização em saúde mental. Os resultados permitem inferir que a supervisão e o suporte de especialistas, a sistematicidade dos encontros, a longitudinalidade, a capacitação de profissionais generalistas e especialistas, os cuidados coordenados em rede e os recursos invisíveis desempenham um papel central para a integração saúde mental e atenção primária.

This essay tackles the integration of mental health in Primary Health Care through the matrix support. It brings the different aspects of integration of mental health insertion into primary care and the factors that act as barriers to the process. It discusses the findings of national and international researches about the theme and the common elements to decentralization in mental health. The results allow us to infer that the supervision and the support of experts, the systematic nature of the meetings, the longitudinality, the enablement of both generalist and expert professionals, the coordinated cares in network and the invisible resources perform a central role for the integration of mental health and primary care.