Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events in patients with diabetes and overt nephropathy: a meta-analysis of randomised controlled trials.

OBJECTIVE: The efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing cardiovascular outcomes in patients with diabetes and overt nephropathy is still a controversial issue. METHODS: We systematically searched MEDLINE, Embase and Cochrane Library for randomised controlled trials. RESULTS: Thirteen trials containing 4638 patients with diabetes and overt nephropathy were included. Compared with controls, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment did not reduce the risk of cardiovascular events (odds ratio 0.94, 95% confidence interval 0.86 to 1.03, P=0.18; I2=0.0%, P=0.75). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy reduced the odds of heart failure events by 29% (0.71, 0.61 to 0.83, P<0.001; I2=0%, P=0.78). The results indicated no significant differences between the two treatment regimens with regard to the frequency of MI (0.95, 0.76 to 1.19, P=0.64), stroke (1.20, 0.83 to 1.74, P=0.32), cardiovascular death (1.26, 0.96 to 1.65, P=0.09) and all-cause mortality (0.98, 0.86 to 1.12, P=0.73). Among all kinds of adverse effects, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy increased the incidence of hyperkalemia (2.26, 1.42 to 3.61, P=0.001). CONCLUSION: This study demonstrated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers did not reduce cardiovascular events in patients with diabetes and overt nephropathy.

The discussion of application of key contact point in the high-quality nursing care demonstration project / 中国实用护理杂志

Objective To apply the theory of key contact point to the high-quality nursing care demonstration project in order to raise the satisfaction rate of hospitalized patients. Methods To investigate the key contact point from 142 hospitalized patients and 124 their family members by means of questionnaire, then to analyze the related items and find out the key contact point that affects the satisfaction rate, finally take proper nursing strategy. Results The whole diathesis of nursing staff was improved obviously, the awareness of service enhanced and nursing quality improved continuously the satisfaction rate of the hospitalized patients also increased. Conclusions Applying the theory of key contact point to the high-quality nursing care demonstration project can improve the satisfaction rate of hospitalized patients.