Improvement of long-term risks of cardiovascular events associated with community-based disease management in Chinese patients of the Xinjiang autonomous region of China.

BACKGROUND: A recent community-based disease management (CBDM) pilot study reported a 20.5% prevalence of hypertension and a 0.5 and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV: CHD and stroke) events is unknown. The objective of the study was to understand the long-term impact of CBDM interventions on CV risk factors using disease-model simulation based on a single-arm experimental study. METHODS: A discrete event simulation was developed to evaluate the impact of CBDM on the long-term CV risk among patients with hypertension, in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on time to CV events (CHD and strokes), which are estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM study. The simulation estimated the number of CV events over patients' lifetimes. RESULTS: During a 2-year follow up, the CBDM led to an average reduction of 8.73 mmHg in SBP from baseline, and a 42% reduction in smoking. The discrete event simulation showed that, in the control group, the model estimated incidence rates of 276, 1789, and 616 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. The impact of CBDM on SBP translated into reductions of 8, 28, and 23% in CHD, stroke, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related deaths were reduced by 12, 30, and 26%, respectively. CONCLUSIONS: The implementation of CBDM in China's Xinjiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.

Application of naso-jejunal tube in patients with severe craniocerebral injury: a comparative study on timing of enteral nutrition / 中国实用护理杂志

Objective To discuss the appropriate timing of providing enteral nutrition through nasojejunal tube for patients with severe craniocerebral injury.Methods 126 cases of patients were divided into 3 groups randomly,providing enteral nutrition through naso-jejunal tube for the first group,the second group and the third group within 12～24 hours,48 hours later and 72 hours later after injury respectively.The nutrition situation of 3 groups was recorded 6 hours later,48 hours later,on the 5th day and the 10th day,including indicators such as total serum protein,blood albumin,serum creatinine,etc and complication cases of diarrhea,hemorrhage of digestive tract,palirrhea,aspiration,inhalation pneumonia and so on within 2 weeks after injury.Results In terms of indicators of albumin,creatinine 48 hours after injury and total protein,albumin and creatinine on the 5th day and 10th day,the first group were better than the second and third group,there were statistic differences between the three groups.Complication comparison within 2 weeks after injury:the difference of palirrhea cases among the three groups was significant,the third group had a higher ratio than the first and second group.And there was no statistic difference in the other indicators like diarrhea,hemorrhage of digestive tract,aspiration and inhalation pneumonia.Conclusions It is high time that patients with simple severe craniocerebral injury are provided with enteral nutrition through naso-jejunal tube within 12 to 24 hours,which can improve patients nutrition situation without the increase of the complications.

Feasibility study in collecting blood specimen of cancer patients through PICC / 中国实用护理杂志

Objective To study the influence of collecting blood specimen of cancer patients through PICC on blood test result and catheter-related complication,and discuss the path and feasibility of collecting blood through PICC.Methods Adopting clinical self-contrast experiment,collecting blood specimens of 100 patients at one side through PICC (the observation group)and by ordinary method at the other side of limbs (the control group),comparing the test differences of blood routine,blood biochemistry,and coagulation function,etc.between the two groups.The incidence of catheter-related complication was also observed a week after collecting blood through PICC.Results There was no statistic difference between the two groups in terms of test results.No case of catheter-related complication in a week after collecting blood occurred in the observation group.Conclusions The method of collecting blood specimen through PICC is accurate,safe and feasible,the key point is to implement scientific and standard collecting path and entry-qualification of operators strictly.

Influence of health education pathway on detaining time of thoracic drainage tube / 中国实用护理杂志

Objective To discuss the influence of health education pathway on detaining time of thoracic drainage tube and standardize the nursing procedure for postoperative patients.Methods Forty five patients after thoracotomy from March to December in 2006 were set as the control group.Fifty patients of the same kind from January to September in 2007 were named the test group.The control group received conventional nursing education.The test group received health education on the day of operation,the first,second,third and fourth day after operation from specified nurses according to health education pathway.The contents included psychological nursing,pain management,respiratory function and physical training and enhancement of drainage efficacy.The average indwelling time of thoracic drainage tube was recorded.Results The average indwelling time of thoracic drainage tube in the test group and the control group was(74.40±8.88)h and(91.68±10.08)h respectively,which showed statistical difference,P＜0.01.Conclusions Application of health education pathway effectively shortened indwelling time of thoracic drainage tube as well as reduced pain and medical costs of patients.

Perioperative nursing of patients with primary venous reflux disease of lower extremity / 中国实用护理杂志

Objective To discuss the perioperative nursing experience of patients with primary venous reflux disease(PVRD)of lower extremity undergoing external valvuloplasty of superficial femoral vein.Methods Patients(146 cases)with PVRD of lower extremity were given psychological nursing,observation of postoperative complications and rehabilitation exercise instruction.Results Five limbs appeared short lymphatic seepage and other limbs recovered completely.No thrombus Was seen.Venous claudication,swelling and pain disappeared in 90.4% patients.Limbs symptom alleviated in 9.6% patients.All varicos evein disappeared.The function of deep vein valve recovered in 92% patients by color doppler ultra sonoscope re-examination.Conclusions General evaluation before operation,good perioperative psycho logical nursing and attention to the complication and rehabilitation exercise instruction are significant for reduction of postoperative complication and improvement of success rate of operation.

Influence of self-management education on the health status of patients with gastric carcinoma during chemotherapy / 中国实用护理杂志

Objective To analyze the method of self-management education on the health status of patients with gastric carcinoma during chemotherapy. Methods Patients with gastric carcinoma (60 cases) were divided into the test group and the control group with 30 cases in each group. The two groups both received chemotherapy of complete cycle and general health education. The test group adopted self-management education based upon the above treatment, including collective education, group discussion and individual instruction. The treatment effect was appraised and compared by senior primary nurses. Results The recent total effective rate of chemotherapy in the test group was 76.7%, which was higher than that of the control group (50.0%). The level of life quality of the test group was also better than that of the control group (P<0.05). Conclusion Patients-centered self-management education could improve the health status of patients with gastric carcinoma during chemotherapy.