AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a tota...AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.展开更多
Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and...Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.展开更多
Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital...Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital from September 2019 to August 2020 were selected as the research objects.The 69 patients were divided into study group(35 cases)and control group(34 cases).The compliance behavior,quality of life and nursing satisfaction of pulmonary tuberculosis patients were studied and analyzed.Results:The compliance rate of the control group was 82.35%,and that of the study group was 97.14%;The quality of life in the control group was[61.32±7.66],which was significantly lower than that in the study group[71.12±7.23];The satisfaction rate of the study group was 97.14%,which was significantly higher than 73.53%of the control group.Conclusion:In the treatment of tuberculosis patients,the use of case management nursing service can effectively improve the quality of life of patients,improve the compliance behavior of patients,and improve the treatment effect of patients,which is worthy of promotion.展开更多
Objective:To objectively assess the impact of case management on patients with myocardial infarction or unstable angina.Methods:PubMed,EMBASE,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNK...Objective:To objectively assess the impact of case management on patients with myocardial infarction or unstable angina.Methods:PubMed,EMBASE,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNKI),and Chinese Biomedical Literature Database were searched for relevant randomized controlled trials(RCTs)published through February 2015.The quality of eligible studies was independently assessed by two investigators.The primary outcome assessed from included studies was all-cause mortality,with total cholesterol,systolic and diastolic blood pressures,smoking cessation rates and cost-effectiveness as secondary outcomes.The pooled effect sizes were expressed as relative risk,odds risk,and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using Cochrane Q and determined with an I2 statistic.Results:After the initial search,a total of four studies divided into six RCTs that included 1293 participants met the inclusion criteria and were analyzed.The results of meta-and descriptive analyses failed to identify any significant differences in all-cause mortality during the follow-up period of up to 36 months.Furthermore,a definitive conclusion for remaining indicators could not be drawn due to limited evidence.Conclusion:Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care.Additional,prospective RCTs of high quality and large scale are warranted to verify these results.展开更多
Background: Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requi...Background: Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requires the incorporation of information pertaining to patient evaluation, treatment planning, referrals, and follow-up care to ensure that payment for services is received and that care is ongoing and comprehensive. The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin(Hb Aic), systolic blood pressure(SBP), diastolic blood pressure(DBP), and low-density lipoprotein(LDL). Methods: Databases including Pub Med, Embase, Web of Science, the Cochrane Library, the China Na-tional Knowledge Infrastructure(CNKI), VIP, Wan Fang and the Chinese Biomedical Literature Database(CBM) were searched for randomized controlled trials(RCTs) dating as late as Jan, 2015. Reference sections of the included studies were also searched.Results: Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported Hb Aic as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. The pooled results indicated that statistically significant improvements in Hb Aic(MD =-0.35, 95% Cl(-0.68,-0.02), P = 0.04) and LDL levels(MD =-2.49, 95% C/(-4.04,-0.93), P = 0.002) were associated with the case management group compared with control group; however, no statistically significant differences in DBP(MD =-0.08, 95% CJ(-0,68, 0,52),P = 0.8) and SBP(MD =-0.96, 95% CJ(-5,77, 3,84),P = 0,69) were observed.Conclusions: Case management was effective in improving Hb Aic and LDL levels in patients with type 2 diabetes mellitus. Although no statistically significant differences in DBP and SBP between the case management group and the control group were observed, further research is required to draw a conclusion about the effect of managed care on these outcomes. Based on this meta-analysis of clinical trials, we conclude that case management offers an effective clinical method for the treatment of type 2 diabetes.展开更多
<strong>Background</strong>: The aim at this study is to establish the effectiveness of case management (CM) compared to care as usual (CAU) in patients with schizophrenia. <strong>Methods</strong...<strong>Background</strong>: The aim at this study is to establish the effectiveness of case management (CM) compared to care as usual (CAU) in patients with schizophrenia. <strong>Methods</strong>: 128 patients with schizophrenia were recruited from the community of Haidian District (Beijing, China), 68 patients in the CM group and 60 patients in the CAU group. Efficacy and safety information were assessed at one year follow-up. The relapse rate was similar in both groups after 12 months followed up (7% and 5%). The withdraw rate was significant lower in CM group compared with CAU group (10% and 36%). <strong>Results</strong>: There is no significant difference in PANSS, PSP and SSMI score between 2 groups at each visit. Between endpoint and baseline, there is a significant improvement on PANSS negative score and PSP in patients treated with CM, while CAU group was not significantly changed. <strong>Conclusions</strong>: There is a possible effectiveness of CM group of improving negative symptoms and social function in schizophrenia clients.展开更多
Diabetes is the world’s third largest threat to people’s health. In China, the incidence of diabetes is on the rise, the cure rate of diabetes is low, patients with complications are more, and diabetes patients brin...Diabetes is the world’s third largest threat to people’s health. In China, the incidence of diabetes is on the rise, the cure rate of diabetes is low, patients with complications are more, and diabetes patients bring a heavy economic burden to the family and society. <span "="">Compared with developed countries, China still has a big gap in terms of diabetes care, education and management, and even less long-term follow-up of diabetes education and management results. Therefore, the management of diabetic patients should not only stay in the intervention during hospitalization, but also extend to the outside of the hospital. Only by implementing the whole-process nursing case management integrating hospitalization</span>-family/community-outpatient, can diabetic patients better control blood glucose, delay or prevent the occurrence of chronic complications, and improve their quality of life. The nursing work method of case management is adopted to carry out personalized assessment for diabetes patients, design the process of initial outpatient consultation, content and process of follow-up consultation for nurses, and implement personalized guidance. The diabetic complications should be screened regularly, diabetes management should be standardized, self-care ability and behavior compliance of treatment and nursing of diabetic patients should be improved, and comprehensive whole-process nursing management should be provided for every diabetic patient, so as to improve the quality of life of patients and truly benefit diabetic patients.展开更多
Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management i...Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.展开更多
BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical ...BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.展开更多
Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present s...Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present study aimed to assess the capacity of HF for integrating intestinal schistosomiasis case management into their routine activities.In addition,the current capacity for HF-based STH case management was evaluated.Methods:A random cluster survey was carried out in July 2014,in 65 HF located in Schistosoma mansoni and STH endemic areas.Data were collected by semi-quantitative questionnaires.Staff with different functions at the HF were interviewed(managers,care providers,heads of laboratory and pharmacy and data clerks).Data pertaining to knowledge of intestinal schistosomiasis and STH symptoms,human and material resources and availability and costs of diagnostic tests and treatment were collected.Findings:Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis(abdominal pain 43.1%,bloody diarrhoea 13.9%and bloody stool 7.7%).Few staff members(15.7%)received higher education,and less than 10%were trained in-job on intestinal schistosomiasis case management.Clinical guidelines and laboratory protocols for intestinal schistosomiasis diagnosis and treatment were available in one third of the HF.Diagnosis was performed by direct smear only.Praziquantel was not available in any of the HF.The results for STH were similar,except that major symptoms were more known and cited(abdominal pain 69.2%and diarrhoea 60%).Clinical guidelines were available in 61.5%of HF,and albendazole or mebendazole was available in all HF.Conclusions:The current capacity of HF for intestinal schistosomiasis and STH detection and management is inadequate.Treatment was not available for schistosomiasis.These issues need to be addressed to create an enabling environment for successful integration of intestinal schistosomiasis and STH case management into HF routine activities in Burundi for better control of these diseases.展开更多
The ongoing coronavirus disease 2019(COVID-19)pandemic has put a strain on health systems globally.Although Africa is the least affected region to date,it has the weakest health systems and an exponential rise in case...The ongoing coronavirus disease 2019(COVID-19)pandemic has put a strain on health systems globally.Although Africa is the least affected region to date,it has the weakest health systems and an exponential rise in cases as has been observed in other regions,is bound to overwhelm its health systems.Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic.The World Health Organization(WHO)recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility;however,where this is not possible due to the health system capacity,patients can be isolated in re-purposed facilities or at home.An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases,given the already limited health infrastructure and health workforce,and the risk of nosocomial transmission.Use of repurposed facilities requires additional resources,including health workers.Home isolation,on the other hand,would be a challenge given the poor housing,overcrowding,inadequate access to water and sanitation,and stigma related to infectious disease that is prevalent in many African societies.Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited.These unique cultural,social,economic and developmental differences on the continent,call for a tailored approach to COVID-19 case management strategies.This article proposes three broad case management strategies based on the transmission scenarios defined by WHO,and the criteria and package of care for each option,for consideration by policy makers and governments in African countries.Moving forward,African countries should generate local evidence to guide the development of realistic home-grown strategies,protocol and equipment for the management of COVID-19 cases on the continent.展开更多
<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>&l...<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Benin republic is a sub-Saharan African country endemic to malaria caused by </span><i><span style="font-family:Verdana;">Plasmodium falciparum</span></i><span style="font-family:Verdana;">. To reduce the death rate due to this scourge, it is essential to ensure quality care, especially for children under five years who are the most vulnerable. The main objective of this study is to assess the quality of severe malaria case management in patients under five years.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Methods</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Descriptive and analytical cross-sectional stud</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> performed in health facilities in Cotonou city, the economic capital of Benin Republic. Study sample included 205 suspected cases of severe malaria among children aged under five years, in four health facilities. In each of hospitals, all children under five years with severe malaria presumption were enrolled in the study. Quality was assessed through five components: diagnosis, treatment, </span><a name="_Hlk44629869"></a><span style="font-family:Verdana;">patient monitoring, counselling/advice, and patient’s follow-up. Base</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">d</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> on the Benin Republic’s malaria case management standard protocol, the assessment criteria of each component were defined.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Results</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The sex ratio was 1.25 boys to a girl. The median of hospitalisation duration was 3 days with first quartile (Q1) = 2 and third quartile (Q3) = 5. Among 205 severe malaria cases included, 157 (76.59%) were not managed in accordance with the requirements of the national protocol of malaria case management. The different components of cases management are not all implemented during the care of patients.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Conclusion</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">There is a need for training to health workers on implementation of severe malaria in children under 5 years protocol. Also, there is a need for investigation about factors associated with malaria protocol implementation.</span></span></span>展开更多
Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor...Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor nutrition, thus affecting the prognosis. This study aims to introduce a typical case to explore the whole-course</span><span style="font-family:""> </span><span style="font-family:Verdana;">(started at admission and ended 5 years after surgery)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and Multidisciplinary Teams (MDTs)</span><span style="font-family:""> </span><span style="font-family:Verdana;">(comprising physician, primary nurse, case manager, nutrition liaison and nutrition specialist nurse)</span><span style="font-family:""> </span><span style="font-family:Verdana;">nutritional management mode of breast cancer patients. The patient successfully completed the scheduled treatment by implementing the whole-course and multidisciplinary nutrition management. The mode can prospectively and dynamically estimate the changes </span><span style="font-family:Verdana;">in</span><span style="font-family:Verdana;"> patients’ nutritional status, and provide timely nutritional intervention to promote patient outcomes.展开更多
BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%...BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.展开更多
Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants...Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants with chronic conditions. The objective was to identify the degree of implementation of work related measures in medical rehabilitation and the extent of RTW outcomes. Methods: 5883 insurants were considered. Severe Restriction of Work Ability (SRWA), Work-related Medical Rehabilitation (WMR), and Case Management (CM) were examined for 2008 and 2012. An Index of Employment status (IoE) was used in a logistic regression. Results: Utilization of WMR raised from 12.3% in 2008 to 66.1% in 2012. The proportion of insurants with SRWA and WMR grew from 8% up to 40.1%. In 2008, 14.7% of insurants with SRWA received WMR;in 2012, it grew to 76.6%. On the other hand, in 2012 26% got WMR without SRWA and 12.2% had SRWA and got no WMR. CM was not conducted in 2008 but reached 20.2% in 2012. Across all indications, WMR resulted in positive RTW as measured by IoE: OR = 0.75 (KI-95%: 0.67 - 0.86). Conclusion: WMR was successfully implemented according to the German guideline. There is a need to optimize the linkage between SRWA and WMR and CM to provide need-based care.展开更多
Background This study aims to analyze and summarize the postoperative nursing care of a patient with pregnancy complicated by aortic dissection who achieved"four preservations"(preserving the fetus’life,the...Background This study aims to analyze and summarize the postoperative nursing care of a patient with pregnancy complicated by aortic dissection who achieved"four preservations"(preserving the fetus’life,the newborn’s life,the pregnant woman’s uterus,and the pregnant woman’s aortic valve)in our hospital,in order to explore nursing methods for such patients,summarize clinical experience,and guide clinical practice.Methods Our hospital treated a case of pregnancy complicated by aortic dissection in May 2022.After admission,the patient underwent major vascular surgery and developed chylothorax postoperatively.A nutritionist was consulted to calculate the patient’s nutritional needs and develop a daily meal plan.The nurse guided the patient to complete the required food intake.The patient underwent both major vascular surgery and cesarean section;finding a balance between anticoagulation and bleeding was essential.A group discussion was organized,with daily blood tests performed to maintain the patient’s INR between 1.8-2.5.How to initiate early postoperative activity for a pregnant patient after major vascular surgery has not been reported in the literature.The hospital’s cardiac rehabilitation doctors and nurses developed an exercise plan for the patient,and the nurse assisted the patient in gradually completing the program.The patient simultaneously faced the dual roles of a mother caring for a newborn and a patient recovering from aortic dissection surgery,enduring immense psychological pressure.To facilitate role transition and stress relief,a psychiatrist assessed the patient and provided psychological guidance and medication treatment based on the assessment results.The nurse was responsible for monitoring,evaluating,and recording the patient’s progress.Results The patient successfully underwent concurrent major vascular replacement surgery and cesarean section,ensuring a safe childbirth for the mother and a successful delivery for the baby.The surgery also preserved the patient’s aortic valve,eliminating the need for lifelong anticoagulant use,significantly improving the patient’s postoperative quality of life and reducing economic and psychological burdens.A uterine balloon was used intraoperatively and for seven days postoperatively to compress the uterus and stop bleeding,successfully preserving the patient’s uterus.This case represents the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dissection.The patient recovered smoothly postoperatively,with no related complications and currently leads a healthy life.Conclusion Based on the patient’s condition and pregnancy status,strengthening multidisciplinary collaboration,adopting the most appropriate surgical approach,and providing personalized nutritional care,anticoagulation care,rehabilitation exercises,and psychological and social support can shorten the hospital stay and promote the patient’s early recovery.Pregnancy complicated by aortic dissection is relatively rare in clinical practice.This case is the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dissection.By analyzing the nursing care of this case,we comprehensively explored various aspects of postoperative care for the patient,summarized clinical experience,and aimed to guide clinical practice.展开更多
The knowledge about factors contributing to remission among individuals with schizophrenia is still missing. Studies show that the number of individuals’ reaching remission is varying among psychiatric outpatient car...The knowledge about factors contributing to remission among individuals with schizophrenia is still missing. Studies show that the number of individuals’ reaching remission is varying among psychiatric outpatient care centres. Therefore, the purpose was to investigate case managers (CM) perception of care interventions promoting remission. Semi-structured interviews were conducted with CM (n = 12) and data were analysed with qualitative content analysis. The results show that CM needs to possess competence, master assessment structure and process. These key-points appear to be of crucial importance for a successful promotion of remission among individuals with schizophrenia.展开更多
Throughout the world, infrastructure to support cities is critical to support sustainable and responsible economic development. This can include new infrastructure projects in the case of growing areas. It can also in...Throughout the world, infrastructure to support cities is critical to support sustainable and responsible economic development. This can include new infrastructure projects in the case of growing areas. It can also include the renewal and upgrading of existing infrastructure in areas that have been inhabited and already developed. Infrastructure includes roads, bridges and transportation systems; power grids and energy service;internet and telecommunications; and water and sewer services. This development can be part of a system of systems, in which government, industries, and universities can contribute knowledge, skills, and abilities. This paper will investigate the strategic project management taken by one university to provide an academic experience that will prepare engineering students to address several of the Grand Engineering Challenges of the 21 st Century, as identified by the US National Academy of Engineering.The challenges relating to energy, water, information, and urban infrastructure can be approached using the functions of teaching, research, and service. By approaching the challenges strategically, resources of faculty time, student effort and laboratory facilities can be leveraged to achieve greater results. This case study will describe the efforts and results to date and identify opportunities for future growth.展开更多
Background:Trichomoniasis,a sexually transmitted disease(STD),is caused by Trichomonas vaginalis in both men and women.Screening of trichomoniasis is problematic in resource challenged settings as currently available,...Background:Trichomoniasis,a sexually transmitted disease(STD),is caused by Trichomonas vaginalis in both men and women.Screening of trichomoniasis is problematic in resource challenged settings as currently available,inexpensive diagnostic methods are of low sensitivity and/or specificity.In India,National AIDS Control organization(NACO)recommended syndromic case management(SCM)for treatment.The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis.Methods:Patients visiting Department of Obstetrics&Gynecology,Vardhman Mahavir Medical College and Safdarjung Hospital,New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM.Based on SCM,patients(n=820)were treated with antibiotics using pre-packed STI/RTI kits(sexually transmitted infection/reproductive tract infection;procured by National AIDS Control/State AIDS Control Society(NACO/SACS),Ministry of Health and Family Welfare,Govt of India.)under National AIDS Control Programme(NACP III)for syndromic case management(SCM).Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR.Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB,gyrA and orf1 gene specific primers for diagnosis of T.vaginalis(TV),Chlamydia trachomatis(CT)and Neisseria gonorrhoeae(NG)respectively.Results:Out of 6000 patients who visited OPD,820(14%)female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely,TV,CT,NG and Candida or for co-infection.On the basis of signs&symptoms and NACO guidelines,the following distribution of various infections was observed:TV(46%),CT(20%),coinfection with TV and CT(12%),coinfection with CT and NG(11%),coinfection with TV,CT and Candida(7%)and coinfection with TV and NG(2%).Others were infected with NG alone(1%),coinfected with TV and Candida(0.4%)and 0.3%were coinfected with CT,NG and Candida.Based on PCR method,110(17%)women tested positive for one or more of these three pathogens while 524(83%)women were negative for any of these three pathogens but could be positive for other STIs not tested in this study.Since all the patients(634)were given antibiotics,we estimate that the over-treatment was 85%while 524(83%)patients were also misdiagnosed by SCM.Conclusions:The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance.The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner.展开更多
基金Supported by the Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.YNZD2201903)the Scientific Research Foundation of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.KYQD20180306)the Nursing Project of the Eye Hospital of Wenzhou Medical University(No.YNHL2201908).
文摘AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
文摘Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.
基金Medical science research key project plan of Hebei health and Family Planning Commission in 2018.Subject name:Evaluation of application effect of case management model in newly treated smear positive pulmonary tuberculosis patients,Question number:20180720.
文摘Objective:To explore the effect of case management nursing service on compliance behavior and quality of life of patients with pulmonary tuberculosis.Methods:69 cases of pulmonary tuberculosis patients in our hospital from September 2019 to August 2020 were selected as the research objects.The 69 patients were divided into study group(35 cases)and control group(34 cases).The compliance behavior,quality of life and nursing satisfaction of pulmonary tuberculosis patients were studied and analyzed.Results:The compliance rate of the control group was 82.35%,and that of the study group was 97.14%;The quality of life in the control group was[61.32±7.66],which was significantly lower than that in the study group[71.12±7.23];The satisfaction rate of the study group was 97.14%,which was significantly higher than 73.53%of the control group.Conclusion:In the treatment of tuberculosis patients,the use of case management nursing service can effectively improve the quality of life of patients,improve the compliance behavior of patients,and improve the treatment effect of patients,which is worthy of promotion.
文摘Objective:To objectively assess the impact of case management on patients with myocardial infarction or unstable angina.Methods:PubMed,EMBASE,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNKI),and Chinese Biomedical Literature Database were searched for relevant randomized controlled trials(RCTs)published through February 2015.The quality of eligible studies was independently assessed by two investigators.The primary outcome assessed from included studies was all-cause mortality,with total cholesterol,systolic and diastolic blood pressures,smoking cessation rates and cost-effectiveness as secondary outcomes.The pooled effect sizes were expressed as relative risk,odds risk,and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using Cochrane Q and determined with an I2 statistic.Results:After the initial search,a total of four studies divided into six RCTs that included 1293 participants met the inclusion criteria and were analyzed.The results of meta-and descriptive analyses failed to identify any significant differences in all-cause mortality during the follow-up period of up to 36 months.Furthermore,a definitive conclusion for remaining indicators could not be drawn due to limited evidence.Conclusion:Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care.Additional,prospective RCTs of high quality and large scale are warranted to verify these results.
文摘Background: Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requires the incorporation of information pertaining to patient evaluation, treatment planning, referrals, and follow-up care to ensure that payment for services is received and that care is ongoing and comprehensive. The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin(Hb Aic), systolic blood pressure(SBP), diastolic blood pressure(DBP), and low-density lipoprotein(LDL). Methods: Databases including Pub Med, Embase, Web of Science, the Cochrane Library, the China Na-tional Knowledge Infrastructure(CNKI), VIP, Wan Fang and the Chinese Biomedical Literature Database(CBM) were searched for randomized controlled trials(RCTs) dating as late as Jan, 2015. Reference sections of the included studies were also searched.Results: Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported Hb Aic as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. The pooled results indicated that statistically significant improvements in Hb Aic(MD =-0.35, 95% Cl(-0.68,-0.02), P = 0.04) and LDL levels(MD =-2.49, 95% C/(-4.04,-0.93), P = 0.002) were associated with the case management group compared with control group; however, no statistically significant differences in DBP(MD =-0.08, 95% CJ(-0,68, 0,52),P = 0.8) and SBP(MD =-0.96, 95% CJ(-5,77, 3,84),P = 0,69) were observed.Conclusions: Case management was effective in improving Hb Aic and LDL levels in patients with type 2 diabetes mellitus. Although no statistically significant differences in DBP and SBP between the case management group and the control group were observed, further research is required to draw a conclusion about the effect of managed care on these outcomes. Based on this meta-analysis of clinical trials, we conclude that case management offers an effective clinical method for the treatment of type 2 diabetes.
文摘<strong>Background</strong>: The aim at this study is to establish the effectiveness of case management (CM) compared to care as usual (CAU) in patients with schizophrenia. <strong>Methods</strong>: 128 patients with schizophrenia were recruited from the community of Haidian District (Beijing, China), 68 patients in the CM group and 60 patients in the CAU group. Efficacy and safety information were assessed at one year follow-up. The relapse rate was similar in both groups after 12 months followed up (7% and 5%). The withdraw rate was significant lower in CM group compared with CAU group (10% and 36%). <strong>Results</strong>: There is no significant difference in PANSS, PSP and SSMI score between 2 groups at each visit. Between endpoint and baseline, there is a significant improvement on PANSS negative score and PSP in patients treated with CM, while CAU group was not significantly changed. <strong>Conclusions</strong>: There is a possible effectiveness of CM group of improving negative symptoms and social function in schizophrenia clients.
文摘Diabetes is the world’s third largest threat to people’s health. In China, the incidence of diabetes is on the rise, the cure rate of diabetes is low, patients with complications are more, and diabetes patients bring a heavy economic burden to the family and society. <span "="">Compared with developed countries, China still has a big gap in terms of diabetes care, education and management, and even less long-term follow-up of diabetes education and management results. Therefore, the management of diabetic patients should not only stay in the intervention during hospitalization, but also extend to the outside of the hospital. Only by implementing the whole-process nursing case management integrating hospitalization</span>-family/community-outpatient, can diabetic patients better control blood glucose, delay or prevent the occurrence of chronic complications, and improve their quality of life. The nursing work method of case management is adopted to carry out personalized assessment for diabetes patients, design the process of initial outpatient consultation, content and process of follow-up consultation for nurses, and implement personalized guidance. The diabetic complications should be screened regularly, diabetes management should be standardized, self-care ability and behavior compliance of treatment and nursing of diabetic patients should be improved, and comprehensive whole-process nursing management should be provided for every diabetic patient, so as to improve the quality of life of patients and truly benefit diabetic patients.
文摘Despite many attempts to evaluate the effectiveness of case management for frail older people, systematic reviews including experimental designs show inconsistent results. Starting from the view that case management is a complex intervention occurring in multilayered realities, we conducted a realist evaluation of case management in Belgium, where this type of intervention is new. Realist approaches are particularly well suited to evaluate complex interventions as they seek to investigate iteratively the literature and empirical data to uncover mid-range theories underpinning the intervention under study. As such, realist evaluations are works in progress which provide tools to describe how, why and for whom an intervention is supposed to work. In this paper, we describe two mid-range theories that can explain why case management can help frail older people to remain at home, through the lens of capacity and social support.
基金This study protocol was approved by the General Hospital of the Yangtze River Shipping,and all the families have voluntarily participated in the study and have signed informed consent forms.
文摘BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.
基金The Schistosomiasis Control Initiative(SCI)/Imperial College and VLIR-UOS funded this study。
文摘Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present study aimed to assess the capacity of HF for integrating intestinal schistosomiasis case management into their routine activities.In addition,the current capacity for HF-based STH case management was evaluated.Methods:A random cluster survey was carried out in July 2014,in 65 HF located in Schistosoma mansoni and STH endemic areas.Data were collected by semi-quantitative questionnaires.Staff with different functions at the HF were interviewed(managers,care providers,heads of laboratory and pharmacy and data clerks).Data pertaining to knowledge of intestinal schistosomiasis and STH symptoms,human and material resources and availability and costs of diagnostic tests and treatment were collected.Findings:Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis(abdominal pain 43.1%,bloody diarrhoea 13.9%and bloody stool 7.7%).Few staff members(15.7%)received higher education,and less than 10%were trained in-job on intestinal schistosomiasis case management.Clinical guidelines and laboratory protocols for intestinal schistosomiasis diagnosis and treatment were available in one third of the HF.Diagnosis was performed by direct smear only.Praziquantel was not available in any of the HF.The results for STH were similar,except that major symptoms were more known and cited(abdominal pain 69.2%and diarrhoea 60%).Clinical guidelines were available in 61.5%of HF,and albendazole or mebendazole was available in all HF.Conclusions:The current capacity of HF for intestinal schistosomiasis and STH detection and management is inadequate.Treatment was not available for schistosomiasis.These issues need to be addressed to create an enabling environment for successful integration of intestinal schistosomiasis and STH case management into HF routine activities in Burundi for better control of these diseases.
文摘The ongoing coronavirus disease 2019(COVID-19)pandemic has put a strain on health systems globally.Although Africa is the least affected region to date,it has the weakest health systems and an exponential rise in cases as has been observed in other regions,is bound to overwhelm its health systems.Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic.The World Health Organization(WHO)recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility;however,where this is not possible due to the health system capacity,patients can be isolated in re-purposed facilities or at home.An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases,given the already limited health infrastructure and health workforce,and the risk of nosocomial transmission.Use of repurposed facilities requires additional resources,including health workers.Home isolation,on the other hand,would be a challenge given the poor housing,overcrowding,inadequate access to water and sanitation,and stigma related to infectious disease that is prevalent in many African societies.Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited.These unique cultural,social,economic and developmental differences on the continent,call for a tailored approach to COVID-19 case management strategies.This article proposes three broad case management strategies based on the transmission scenarios defined by WHO,and the criteria and package of care for each option,for consideration by policy makers and governments in African countries.Moving forward,African countries should generate local evidence to guide the development of realistic home-grown strategies,protocol and equipment for the management of COVID-19 cases on the continent.
文摘<strong>Background</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">Benin republic is a sub-Saharan African country endemic to malaria caused by </span><i><span style="font-family:Verdana;">Plasmodium falciparum</span></i><span style="font-family:Verdana;">. To reduce the death rate due to this scourge, it is essential to ensure quality care, especially for children under five years who are the most vulnerable. The main objective of this study is to assess the quality of severe malaria case management in patients under five years.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Methods</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Descriptive and analytical cross-sectional stud</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> w</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> performed in health facilities in Cotonou city, the economic capital of Benin Republic. Study sample included 205 suspected cases of severe malaria among children aged under five years, in four health facilities. In each of hospitals, all children under five years with severe malaria presumption were enrolled in the study. Quality was assessed through five components: diagnosis, treatment, </span><a name="_Hlk44629869"></a><span style="font-family:Verdana;">patient monitoring, counselling/advice, and patient’s follow-up. Base</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">d</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> on the Benin Republic’s malaria case management standard protocol, the assessment criteria of each component were defined.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Results</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The sex ratio was 1.25 boys to a girl. The median of hospitalisation duration was 3 days with first quartile (Q1) = 2 and third quartile (Q3) = 5. Among 205 severe malaria cases included, 157 (76.59%) were not managed in accordance with the requirements of the national protocol of malaria case management. The different components of cases management are not all implemented during the care of patients.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"><strong>Conclusion</strong><strong></strong></span></b></span></span><strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;"></span></b></span></span></strong><span><span><b><span style="font-family:;" "=""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">There is a need for training to health workers on implementation of severe malaria in children under 5 years protocol. Also, there is a need for investigation about factors associated with malaria protocol implementation.</span></span></span>
文摘Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor nutrition, thus affecting the prognosis. This study aims to introduce a typical case to explore the whole-course</span><span style="font-family:""> </span><span style="font-family:Verdana;">(started at admission and ended 5 years after surgery)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and Multidisciplinary Teams (MDTs)</span><span style="font-family:""> </span><span style="font-family:Verdana;">(comprising physician, primary nurse, case manager, nutrition liaison and nutrition specialist nurse)</span><span style="font-family:""> </span><span style="font-family:Verdana;">nutritional management mode of breast cancer patients. The patient successfully completed the scheduled treatment by implementing the whole-course and multidisciplinary nutrition management. The mode can prospectively and dynamically estimate the changes </span><span style="font-family:Verdana;">in</span><span style="font-family:Verdana;"> patients’ nutritional status, and provide timely nutritional intervention to promote patient outcomes.
文摘BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.
文摘Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants with chronic conditions. The objective was to identify the degree of implementation of work related measures in medical rehabilitation and the extent of RTW outcomes. Methods: 5883 insurants were considered. Severe Restriction of Work Ability (SRWA), Work-related Medical Rehabilitation (WMR), and Case Management (CM) were examined for 2008 and 2012. An Index of Employment status (IoE) was used in a logistic regression. Results: Utilization of WMR raised from 12.3% in 2008 to 66.1% in 2012. The proportion of insurants with SRWA and WMR grew from 8% up to 40.1%. In 2008, 14.7% of insurants with SRWA received WMR;in 2012, it grew to 76.6%. On the other hand, in 2012 26% got WMR without SRWA and 12.2% had SRWA and got no WMR. CM was not conducted in 2008 but reached 20.2% in 2012. Across all indications, WMR resulted in positive RTW as measured by IoE: OR = 0.75 (KI-95%: 0.67 - 0.86). Conclusion: WMR was successfully implemented according to the German guideline. There is a need to optimize the linkage between SRWA and WMR and CM to provide need-based care.
文摘Background This study aims to analyze and summarize the postoperative nursing care of a patient with pregnancy complicated by aortic dissection who achieved"four preservations"(preserving the fetus’life,the newborn’s life,the pregnant woman’s uterus,and the pregnant woman’s aortic valve)in our hospital,in order to explore nursing methods for such patients,summarize clinical experience,and guide clinical practice.Methods Our hospital treated a case of pregnancy complicated by aortic dissection in May 2022.After admission,the patient underwent major vascular surgery and developed chylothorax postoperatively.A nutritionist was consulted to calculate the patient’s nutritional needs and develop a daily meal plan.The nurse guided the patient to complete the required food intake.The patient underwent both major vascular surgery and cesarean section;finding a balance between anticoagulation and bleeding was essential.A group discussion was organized,with daily blood tests performed to maintain the patient’s INR between 1.8-2.5.How to initiate early postoperative activity for a pregnant patient after major vascular surgery has not been reported in the literature.The hospital’s cardiac rehabilitation doctors and nurses developed an exercise plan for the patient,and the nurse assisted the patient in gradually completing the program.The patient simultaneously faced the dual roles of a mother caring for a newborn and a patient recovering from aortic dissection surgery,enduring immense psychological pressure.To facilitate role transition and stress relief,a psychiatrist assessed the patient and provided psychological guidance and medication treatment based on the assessment results.The nurse was responsible for monitoring,evaluating,and recording the patient’s progress.Results The patient successfully underwent concurrent major vascular replacement surgery and cesarean section,ensuring a safe childbirth for the mother and a successful delivery for the baby.The surgery also preserved the patient’s aortic valve,eliminating the need for lifelong anticoagulant use,significantly improving the patient’s postoperative quality of life and reducing economic and psychological burdens.A uterine balloon was used intraoperatively and for seven days postoperatively to compress the uterus and stop bleeding,successfully preserving the patient’s uterus.This case represents the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dissection.The patient recovered smoothly postoperatively,with no related complications and currently leads a healthy life.Conclusion Based on the patient’s condition and pregnancy status,strengthening multidisciplinary collaboration,adopting the most appropriate surgical approach,and providing personalized nutritional care,anticoagulation care,rehabilitation exercises,and psychological and social support can shorten the hospital stay and promote the patient’s early recovery.Pregnancy complicated by aortic dissection is relatively rare in clinical practice.This case is the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dissection.By analyzing the nursing care of this case,we comprehensively explored various aspects of postoperative care for the patient,summarized clinical experience,and aimed to guide clinical practice.
基金financial support from the Fyrbodal Research and Development Council,Region Vastra Gotaland and the Department of Research and Development,the NU-Hospital Organization,Trollhattan,Sweden.
文摘The knowledge about factors contributing to remission among individuals with schizophrenia is still missing. Studies show that the number of individuals’ reaching remission is varying among psychiatric outpatient care centres. Therefore, the purpose was to investigate case managers (CM) perception of care interventions promoting remission. Semi-structured interviews were conducted with CM (n = 12) and data were analysed with qualitative content analysis. The results show that CM needs to possess competence, master assessment structure and process. These key-points appear to be of crucial importance for a successful promotion of remission among individuals with schizophrenia.
文摘Throughout the world, infrastructure to support cities is critical to support sustainable and responsible economic development. This can include new infrastructure projects in the case of growing areas. It can also include the renewal and upgrading of existing infrastructure in areas that have been inhabited and already developed. Infrastructure includes roads, bridges and transportation systems; power grids and energy service;internet and telecommunications; and water and sewer services. This development can be part of a system of systems, in which government, industries, and universities can contribute knowledge, skills, and abilities. This paper will investigate the strategic project management taken by one university to provide an academic experience that will prepare engineering students to address several of the Grand Engineering Challenges of the 21 st Century, as identified by the US National Academy of Engineering.The challenges relating to energy, water, information, and urban infrastructure can be approached using the functions of teaching, research, and service. By approaching the challenges strategically, resources of faculty time, student effort and laboratory facilities can be leveraged to achieve greater results. This case study will describe the efforts and results to date and identify opportunities for future growth.
基金supported by funds from University of Delhi(DST-PURSE grant 2011–2013)to DS.supported by grants from Indian.Indian Council of Medical Research(ICMR),Government of India,to DS and PM.
文摘Background:Trichomoniasis,a sexually transmitted disease(STD),is caused by Trichomonas vaginalis in both men and women.Screening of trichomoniasis is problematic in resource challenged settings as currently available,inexpensive diagnostic methods are of low sensitivity and/or specificity.In India,National AIDS Control organization(NACO)recommended syndromic case management(SCM)for treatment.The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis.Methods:Patients visiting Department of Obstetrics&Gynecology,Vardhman Mahavir Medical College and Safdarjung Hospital,New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM.Based on SCM,patients(n=820)were treated with antibiotics using pre-packed STI/RTI kits(sexually transmitted infection/reproductive tract infection;procured by National AIDS Control/State AIDS Control Society(NACO/SACS),Ministry of Health and Family Welfare,Govt of India.)under National AIDS Control Programme(NACP III)for syndromic case management(SCM).Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR.Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB,gyrA and orf1 gene specific primers for diagnosis of T.vaginalis(TV),Chlamydia trachomatis(CT)and Neisseria gonorrhoeae(NG)respectively.Results:Out of 6000 patients who visited OPD,820(14%)female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely,TV,CT,NG and Candida or for co-infection.On the basis of signs&symptoms and NACO guidelines,the following distribution of various infections was observed:TV(46%),CT(20%),coinfection with TV and CT(12%),coinfection with CT and NG(11%),coinfection with TV,CT and Candida(7%)and coinfection with TV and NG(2%).Others were infected with NG alone(1%),coinfected with TV and Candida(0.4%)and 0.3%were coinfected with CT,NG and Candida.Based on PCR method,110(17%)women tested positive for one or more of these three pathogens while 524(83%)women were negative for any of these three pathogens but could be positive for other STIs not tested in this study.Since all the patients(634)were given antibiotics,we estimate that the over-treatment was 85%while 524(83%)patients were also misdiagnosed by SCM.Conclusions:The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance.The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner.
