‘An end has a start’1

Abstract

Background: Disease management programmes (DMPs) improve quality of care for patients with heart failure (HF). However, only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction (HFPEF). Objective: To estimate the impact of a structured, nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF. Methods: Single blinded randomized clinical trial with an intervention over six months and a follow-up during 12 additional months. In the control group, the patients (n = 41) were managed according to Russian national guidelines. Patients in the intervention group (n = 44) received education on individual lifestyle changes and modifications of cardiovascular disease (CVD) risk factors, home-based exercise training and weekly nurse consultations in addition to usual care. Results: Six months after their inclusion, patients in the intervention group significantly improved body mass index, waist circumference, six-min walk test distance, total cholesterol, low-density lipoprotein, left ventricular end-diastolic volume index, quality of life and level of anxiety. After 18 months, there were 11 deaths (25%) or hospitalizations in the intervention group and 12 (29%) in the control group (P = 0.134). Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up: the hazard ratio was 0.47 (95% CI: 0.17–1.28; P = 0.197). After 18 months, this was 0.85 (0.42–1.73; P = 0.658).

Conclusion: This primary care based DMP for patients with HFPEF improved the patients’ emotional status and quality of life, positively influenced body weight, functional capacity and lipid profile, and attenuated heart remodelling.     

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

Background: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established.

Objective: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF.

Methods: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed.

Results: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001–1.04), and (OR: 1.09, 95% CI: 1.03–1.15), respectively.

Conclusion: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode.     

枯草杆菌屎肠球菌二联活菌制剂对急性肝衰竭大鼠肠道微生态失调的调节作用

目的:探讨枯草杆菌屎肠球菌二联活菌制剂(商品名:美常安)对急性肝衰竭(AHF)大鼠肠道微生态失调的调节作用。方法:用D-氨基半乳糖(D-gal)1.2 g/kg腹腔注射制成AHF模型。将实验动物分为对照组、模型组、治疗组,分别检测肠道菌群变化和内毒素含量。结果:经过美常安治疗2周后,大鼠肠道内有益菌含量明显上升,有害菌含量下降,肠道菌群比例恢复正常,血中内毒素含量降低。结论:美常安通过对AHF大鼠肠道微生态失调的直接调节作用,间接的起到了保肝护肝的作用,对于AHF疾病的本身也起到了积极的治疗作用。     

浅析城市环卫道路保洁车专用机构的传动方式

从技术及使用方面对现有国产环卫道路保洁车的专用机构传动进行了分析,得出采用全液压传动方式是环卫道路保洁车动力传递的最佳选择,并阐述了其先进性和适用性。     

A-N两班制排班模式在医院优质服务病区的应用效果

目的探讨A-N两班制排班模式在优质病区的运用,使有限的护理人力达到更优化的组合,来提高护理质量和护士排班的满意度。方法将创优病区普外科采用APN排班模式的阶段为对照组,采用改革后A-N两班制排班模式的阶段(即A代表上午班,上班时间8:00～16:30;N代表夜班,双人上班,上班时间16:30～次日08:00,其中22:00～次日02:00时间段可休息1人,02:00～06:00时间段可休息1人)为实验组,评价两组实施前后的护理质量、病人满意度、护士对排班的满意度等效果。结果实施A-N两班制排班模式后创优病区的护理质量、病人满意度、护士排班的满意度明显高于APN连续性排班模式病区(p<0.05,差异有统计学意义)。结论 A-N两班制排班模式能满足当下护士的需要,值得基层医院优质服务病区在排班方面借鉴。     

浅谈技术进步对医院建筑设计的影响

随着医疗和信息技术的迅猛发展,医院建筑设计也随之改变。文章论述了智能化系统的运用、医院管理模式的变化对医院建筑设计的影响,建议建筑师将医院整体的物流、人流进行有序组织与优化,为就诊患者和医务人员提供良好的就医和工作环境。