Objective To explore the influence of case management on short-term intensive insulin therapy effect,including treatment compliance,safety and glucose metabolic index in newly diagnosed type 2 diabetic patients in outpatient clinic. Methods A total of 100 newly diagnosed type 2 diabetic patients in outpatient clinic were enrolled in this study and randomly divided into 2 groups:intervention group (n=52)and control group (Con,n = 48 ). The intervention group received standard insulin injection case management provided by a team composed of doctors and nurse case manager. The control group received routine insulin injection education in outpatient. Attitudes and compliance of insulin treatment,incidence of hypoglycemia,fasting blood glucose (FBG) and glycated haemoglobin A1c (HbA1 c ) were compared between the two groups at baseline and after 3 months follow up. Results After intervention,the total score and scores by dimension of insulin treatment attitude were higher in intervention group than in Con group[(76.30 ± 4.06 )vs (60.53 ± 3.18 )score,P < 0.01 ]. Insulin treatment compliance was better in intervention group than in Con group (82.7％ vs 64.6％,P < 0.05 ). The hypoglycemia incidence was lower in intervention group than in Con group (19.2％ vs 31.3％,P >0.05),although without statistical difference. FBG and HbA1 c were all lower in intervention group than in Con group [(6.79 ± 1.41 )vs (7.51±1.15)mmol/L,(6.62±0.69)％ vs (7.15±0.75)％,P <0.05]. Conclusion Case management could effectively improve the insulin treatment attitude and compliance,and then optimize glycemic control innewly diagnosed type 2 diabetic patients treated with short-term intensive insulin therapy in outpatient clinic.

Objective To observe the effect and safety of ambroxol combined with antibiotic in treatment the elderly diabetic patients complicated with pneumonia.Methods 86 elderly diabetic patients with pneumonia were selected and divided into observation group and control group according to different treatment options.All the patients were given oxygen,suction,nutrition therapy,postural drainage and basic treatment for diabetes.Cefoperazone sulbactam was given in control group,5.0g dissolved in 150 ml saline,1 time/d.Ambroxol hydrochloride injection was added in observation group,40mg/kg dissolved in 150 ml saline,1 time/d.Body temperature,sputum,leukocyte and chest X-ray were observed and recorded,and the recovery time was recorded.Results 37 cases were cured,6 cases improved in observation group,and the total effective rate was 100.00％.28 cases were cured,12 cases improved in control group,and the total effective rate was 93.02％.The effective rate of the observation group was higher than the control group(P ＜0.05).The incidence rate of adverse reactions in observation group was 6.98％,while 4.65％ in control group,and there was no statistical difference between the two groups (P ＞ 0.05).Conclusion Ambroxol hydrochloride added to antibiotic routine therapy in treatment the elderly diabetic patients complicated with pneumonia couldimprove the cure rate and shorten the healing time.It was worthy of clinical application.

This paper analyzes the explore the factors influencing the TCM clinical pathway using the fishbone dragram. We found that the main impacting factors of TCM clinical pathway were government policy factors, hospital management factors and personal factors. It was suggested to promote Chinese medicine clinical pathway pilot job, not only need to cooperate with the administrative departments of health and medical institutions, also need to strengthen the change of the idea of both doctors and patients.

Objective To set up care service quality evaluation indicators and establish weight coefficient for assessment of elderly institution in Chongqing.Methods SEVQUAL Model was used as the theoretical guidance,through Delphi expert inquiry,analytic hierarchy process (AHP),the weight of each indicator in five grades and consistency check was calculated.Results The care serv ice quality evaluation indicators contained five first-grade indexes and twenty second-grade indexes.The first-grade indexes included tangibles,reliability,responsiveness,assurance,empathy,respectively.The results of the consisten-cy check of the single grade sorts had a satisfying consistency(CR＜0.10).Conclusions The scientific meth-ods and comprehensive indicators were applied to the construction of care service quality e-valuation indicators for elderly institution in Chongqing.In some degree,this construction of indicators may improve quality of care service and provide useful reference evidence for quality assessment in elderly in-stitution.

Objective To investigate the recognition of graded nursing and its influencing factors among nursing assistants in elder homes.Methods A questionnaire survey was conducted on 116 nursing assistants.Results The nursing assistants showed insufficient recognition of graded nursing,there were significant differences in role cognition,operation and practice training,salary,and the nursing workload,there were no significant differences in working years and educational levels.Conclusions The recognition of graded nursing was insufficient.It is suggested to increase the role cognition education,enhance the theory and practice training,provide higher salaries and allocate workload reasonably to ensure the implementation of graded nursing and increase the satisfaction level of the elderly.

Objective To observe the efficacy and safety of butyiphthalide and nimodipine in the treatment of vascular dementia (VAD).Methods Eighty cases with VAD were randomly divided into the treatment group (40 cases) and the control group (40 cases).The control group were given 30 mg nimodipine for three times a day ;The treatment group was given additionally three times a day of 0.2 g butyiphthalide for 12 consecutive weeks.The Mini-Mental State Examination (MMSE),Clinical Dementia Rating (CDR),and Activities of Daily Living (ADL) scores were used for the assessment of cognitive function.The assessments were done before and after treatment.The adverse effects were also recorded.Results In the treatment and the control groups,the MMSE,CDR and ADL scores (MMSE:23.17 ± 1.89,19.43 ± 2.04; CDR:1.06 ± 0.11,1.21 ±0.50;ADL:40.11 ±5.10,41.22 ±4.80) after treatment were significantly improved than those (MMSE:16.54 ± 1.98,16.28 ± 2.11 ; CDR:1.78 ± 0.25,1.75 ± 0.31 ; ADL:47.45 ± 5.22,46.75 ± 5.31) (MMSE:t =2.42,P ＜0.05,t =2.34,P ＜0.05 ;CDR:t =1.67,P ＜ 0.05,t =1.54,P ＜0.05 ;ADL:t =6.73,P ＜0.05,t =5.24,P ＜ 0.05) before treatment.After 12 weeks of treatment,the MMSE,CDR and ADL scores in the butyiphthalide group were significantly improved than that in the control group (t =1.85,1.84,5.91,respectively; P ＜ 0.05).No serious adverse events were recorded during the treatment.Conclusion Butyiphthalide and nimodipine can prominently improve,better than nimodipine alone,the cognitive function of patients with vascular dementia.Moreover,its security and tolerability are good.

Objective To investigate the effect of dichloroacetate on the expression of Kv1.5 in a rat model of pulmonary arterial hypertension (PAH) .Methods Thirty-two male SD rats weighing 200-250 g were randomly divided into 4 groups ( n = 8 each): normal control group (group C), dichloroacetate control group (group D),PAH group, and PAH + dichloroacetate group (group PD). PAH was induced by left lung resection combined with subcutaneous injection of monocrotaline 60 mg/kg in PAH and PD groups. In group PD, dichloroacetate 80 mg/kg was given through a gastric tube into stomach once a day for 28 consecutive days after monocrotaline injection,while the equal volume of normal saline was given instead of dichloroacetate in group PAH. Group D only received dichloroacetate 80 mg/kg through a gastric tube into stomach once a day for 28 consecutive days. Pulmonary arterial pressure (PAP) was measured at day 28 after monocrotaline injection. The rats were then sacrificed and lung tissues were removed to calculate the percentage of thickness of the tunica media of pulmonary artery and right venicular hypertrophy index and to determine the proliferating cell nuclear antigen (PCNA) and Kv1.5 protein expression (by Western blot) and Kv1.5 mRNA expression (by RT-PCR).Results Compared with group C, the PAP,percentage of thickness of the tunica media, right ventricular hypertrophy index were significantly increased, Kv1.5 mRNA and protein expression was down-regulated and PCNA expression was up-regulated in groups PAH and PD ( P ＜ 0.05). Compared with group PAH, the PAP, percentage of thickness of the tunica media, right ventricular hypertrophy index were significantly decreased, Kv1.5 mRNA and protein expression was up-regulated and PCNA expression was down-regulated in group PD (P ＜ 0.05). There was no significant difference in the indexes mentioned above between group C and group D ( P ＞ 0.05). Conclusion Dichloroacetat alleviates PAH through upregulating Kv1.5 expression in lung tissues and inhibiting pulmonary vascular remodeling in rats.

Objective To realize the characteristics of clinical distribution of multidrug-resistant organisms (MDRO)in a hospital,and take specific measures for the prevention and control of infection.Methods Surveillance data of 891 MDR isolates detected in a hospital between January 1 and December 31,2012 were analyzed retrospec-tively.Results Of 891 MDR isolates,extended-spectrumβ-lactamase (ESBL)-producing Escherichiacoli ranked first(342,38.39% ),followed by ESBL-producing Klebsiellapneumoniae(195,21.89% ),MDRAcinetobacterbau-mannii(185,20.76% ),methicillin-resistantStaphylococcusaureus(138,15.49% ),MDRPseudomonasaeruginosa (27,3.03% ),ESBL-producingProteusmirabilis(2,0.22% ),and ESBL-producing Klebsiellaoxytoca(2,0.22% );Bacteria mainly concentrated on general intensive care unit(ICU)(163,18.29% ),department of neurology(136, 15.26% ),general surgery(103,11.56% ),neurosurgery(85,9.54% ),and respiratory diseases department(71, 7.97% ).The most common bacteria isolated from sputum was MDR Acinetobacterbaumannii(242,50.63% ),and mainly concentrated on general ICU;the most common bacteria isolated from urine was ESBL-producing Escherich-iacoli(141 ,80.57% ),mainly concentrated on the departments of neurology and urology. Conclusion MDRO infec-tion in this hospital mainly concentrate on lower respiratory tract and urinary system. Monitor on high-risk depart-ments and vulnerable patients should be intensified,targeted preventive measures should be stressed to curb MDRO infection and spread.

The morbidity and mortality of heart failure (HF) were gradually incrcased,around 2％-3％ of the population suffered from HF.As a biomarker,NT-proBNP has been shown to be widely used in the diagnosis of HF patients.NT-proBNP lever is affected by many factors,especially the age,age-specific NT-proBNP lever is very important in diagnosis of elderly HF patients.

Objective To investigate the acaroid mite pollution in houses in Huaibei area,Anhui province and to prevent allergic diseases caused by acaroid mites. Methods The samples of acaroid mites were collected from the houses,hotels and undergraduate dormitories,then the acaroid mites were separated,classed and counted. Results Fifteen kinds of acaroid mites were detected from the samples,belonging to 5 families,11 genera. The analysis showed that average density of acaroid mites in the common houses ranked the first,32.5. The values of the species richness index R was 1.36,the species diversity index was 2.16,the species evenness index was 0.9. Conclution The density of acaroid mites in the common houses is higher in Huaibei area and the effective measure should be taken to control the acaroid mites.