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.

Accidents, Occupational ; Acetic Anhydrides ; Adult ; Blast Injuries ; complications ; therapy ; Burns, Inhalation ; etiology ; therapy ; Humans ; Lung Injury ; etiology ; therapy ; Male ; Middle Aged

The essence of twirling reinforcing-reducing method is discussed to provide theoretical guidance for clinical application of reinforcing-reducing method. Through retrospection on historical literature of twirling reinforcing-reducing method, records and explanatory notes are thoroughly explored. Several existing opinions are analyzed and explained for instance twirling method has connection with circulation direction of channels; twirling method is subdivided into right and left, male and female, hand and foot; twriling method is related to quantity of stimulus and operation time; twriling method belongs to spiral motion and so on. As a result, it is found that the key of twirling reinforcing-reducing method is the posture of needle-holding hand that defines three-dimensional motion. If twirling method is subdivided into right and left, male and female, hand and foot and so on, steric effects of lifting-thrusting movement that come along with twirling method could be ignored at the same time. It is that the essence of twirling reinforcing-reducing method is close to the principle of lifting-thrusting reinforcing-reducing method, enriching effect with slow insertion and fast withdrawal of needle while reducing effect with fast insertion and slow withdrawal, which is recorded in Miraculous Pivot: Nine needle and Twelve Yuan. With this principle as guide, manipulation could be avoided to become a mere formality and illusory metaphysics during clinical application of twirling reinforcing-reducing method.
Acupuncture Therapy ; history ; instrumentation ; methods ; China ; History, Ancient ; Humans ; Medicine in Literature ; Needles ; history

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 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 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 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.

BACKGROUND:Latest researches suggest that delayed endothelial repair in drug-eluting stents may cause thrombosis and coronary occlusion.Therefore,a novel kind of drug stent,which is characterized by satisfactory anti-proliferative action as well as inhibitive effects on thrombosis,needs to be developed.OBJECTIVE:To summarize the recent research progress and clinical applications of drug-eluting stents (DES) and to seek the direction of new developments.RETRIEVE STRATEGY:The retrieve staffs were the research personnel for this paper.A computer-based online search was conducted in PUBMED for English language publications containing the key words of "drug eluting stents,percutaneous coronary intervention,coronary disease" from January 2002 to April 2007.Relevant data were also searched in international conference reports on the Internet between January 2005 and June 2007.The number of total retrieved Iiteratures was 15.Inclusion criteria:①reports about drug stents;②reports on research progress in the field of drug stents;③reports on the clinical application of drug stents.Exclusion criteria:low relevance and duplicated articles.LITERATURE EVALUATION:There were 264 articles about research and clinical applications of DES.Of those,42 literatures and 5 conference reports with high relevance and timeliness were included in this report.DATA SYNTHESIS:An ideal DES is comprised of a platform,a drug carrier vehicle and a pharmaceutical compound in harmony with each other.Given the ongoing development of DES materials and drugs,more effective DESs are introduced in the clinical practice.Recently,clinical data on DES encourage the interventional cardiologist to use DES in more challenging coronary lesions,such as chronic total occlusions,complex lesions and multivessel lesions.However,concern that DES may be associated with a risk of late thrombotic events arose,suggesting an imbalance between safety and efficacy of DES.Therefore,novel strategies including bioabsorbable stents,and stents coated with pro-healing agents are promising.CONCLUSION:The development of DES is a breakthrough in interventional cardiology that bring great benefit to patients with coronary disease,especially for restenosis and revascularization.Nevertheless,more endeavour will be necessary to create DES with high efficacy as well as low risk.