Background: Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting (CABG). However, medication adherence after CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG. Methods: The Measurement and Improvement Studies of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1:1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage medication adherence in the intervention group through a health self-management program initiated during hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac educational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization. Discussion: Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model for outpatient health self-management that could be translated to various chronic diseases and widely disseminated across resource-limited settings. Trial Registration https://clinicaltrials.gov (NCT02432469).
Coronary Artery Bypass ; methods ; Humans ; Medication Adherence ; Myocardial Infarction ; prevention & control ; Secondary Prevention ; methods ; Smartphone ; Stroke ; prevention & control

BACKGROUNDLong-term use of antiplatelet agents, statins, beta-blockers and angiotensin-converting enzyme inhibitors are proven therapies for secondary prevention in acute coronary syndrome. However, little is known of physicians' opinion about their use in China.

METHODSIn 2010, standard questionnaires were posted to chief cardiologists in 1397 geographically diverse and representative sample of tertiary and secondary hospitals in China, collecting information about their opinions on the recommended treatments for acute coronary syndrome.

RESULTSA total of 1009 (72%) cardiologists responded with a valid questionnaire. Of them, 77% reported routine use of all the four main secondary preventive treatments, with little difference between secondary and tertiary hospitals (75% vs. 79%, P = 0.16). Of the cardiologists reporting routine or selective use of aspirin, beta-blockers, statins and angiotensin-converting enzyme inhibitors, 94%, 85%, 73% and 86% would recommend indefinite use respectively. For all the 4 treatments combined, only 63.5% reported indefinite use at the same time, with no significant difference between secondary and tertiary hospitals (62% vs. 65%, P = 0.17), nor between hospitals with or without fast track for primary percutaneous coronary intervention (66% vs. 61%, P = 0.50).

CONCLUSIONSAlthough Chinese cardiologists seem well informed about the value of main secondary preventive treatments for acute coronary syndrome, there is still gap in their understanding of the need for combined and prolonged use of these treatments.

Acute Coronary Syndrome ; prevention & control ; China ; Coronary Disease ; prevention & control ; Humans ; Physicians ; statistics & numerical data ; Secondary Prevention ; methods ; Surveys and Questionnaires

BACKGROUND: Stroke is the number one cause of adulthood disability in Korea. Rehabilitation after stroke can minimize functional disability, enhance recovery toward independence, and optimize community reintegration. The inter-departmental stroke meeting (IDSM) is a potential method to improve rehabilitation outcomes in patients with stroke. We aimed to analyze the effect of IDSM on rehabilitation after acute ischemic stroke management. METHODS: Medical records of 753 patients with acute ischemic stroke admitted to the neurology department of our medical center between January and December 2014 were reviewed retrospectively. In May 2014, weekly IDSMs were initiated. All physicians responsible for the patient's care reviewed patient treatment, methods of secondary prevention, and future rehabilitation plans. RESULTS: The transfer rate significantly increased after initiation of IDSM (phase 2, 3) and the length of stay (LOS) before transfer to the rehabilitation department decreased significantly from 9.68 ± 8.50 days to 5.75 ± 2.12 days. There was a reduction in the total LOS from 52 ± 28.57 days to 35 ± 27.21 days after IDSMs were introduced. In non-transferred patients also, the total LOS reduced significantly. The transfer rate increased significantly and the LOS before transfer to the rehabilitation department decreased significantly after implementation of IDSM in a subgroup of patients with moderate to severe stroke. CONCLUSION: The introduction of IDSM was significantly correlated with improvements in transfer rates and reduction of LOS in hospital. This finding shows that IDSMs are an important intervention to improve therapeutic progress and outcomes for patients with stroke.
Cerebrovascular Disorders ; Humans ; Korea ; Length of Stay ; Medical Records ; Methods ; Neurology ; Rehabilitation* ; Retrospective Studies ; Secondary Prevention ; Stroke*

BACKGROUNDThe present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly taking aspirin.

METHODSThe patients in this group were all stroke survivors who have formerly been diagnosed with a cerebral infarction or transient ischemic attack (TIA) in our hospital. We investigated their use of aspirin over a three-year period following their hospitalization. According to the patients' aspirin usage, they were divided into treatment and non-treatment groups. In addition, the reasons for not taking or irregularly taking aspirin were analyzed in the two groups.

RESULTSA total of 1240 patients were studied, including 367 (29.60%) in the treatment group and 873 (70.40%) cases in the non-treatment group. In addition, 201 (16.20%) cases in the treatment group had been regularly taking aspirin (50 - 325 mg of aspirin daily) for 1 to 3 years or longer. The results demonstrated that the main reasons for not taking aspirin in this study were related to patients' concerns regarding the side effects of taking aspirin (46.45%), as well as the doctors' inadequacy in informing their patients to take aspirin (38.71%). The major reasons for patients to irregularly take aspirin were that the doctors did not notify the length of aspirin usage to their patients (41.57%), and that doctors did not prescribe aspirin upon the patients' follow-up visit (26.51%).

CONCLUSIONThe most effective way to increase patient's compliance for aspirin consumption is to promote the guidelines for stroke treatment and to relay these advances in stroke therapy to the patient.

Aged ; Aspirin ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Patient Compliance ; Retrospective Studies ; Secondary Prevention ; methods ; Stroke ; prevention & control ; psychology

OBJECTIVE: To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding. METHODS: A total of 23 Chinese medical centers participated in this trial. Adult patients with a history of ischemic stroke were randomly assigned in a 1:1 ratio using a block design to receive either Naoxintong Capsule (1.2 g orally, twice a day) or placebo in addition to standard care. The primary endpoint was recurrence of ischemic stroke within 2 years. Secondary outcomes included myocardial infarction, death due to recurrent ischemic stroke, and all-cause mortality. The safety of drugs was monitored. Results were analyzed using the intention-to-treat principle. RESULTS: A total of 2,200 patients were enrolled from March 2015 to March 2016, of whom 143 and 158 in the Naoxintong and placebo groups were lost to follow-up, respectively. Compared with the placebo group, the recurrence rate of ischemic stroke within 2 years was significantly lower in the Naoxintong group [6.5% vs. 9.5%, hazard ratio (HR): 0.665, 95% confidence interval (CI): 0.492-0.899, P=0.008]. The two groups showed no significant differences in the secondary outcomes and safety, including rates of severe hemorrhage, cerebral hemorrhage and subarachnoid hemorrhage (P>0.05). CONCLUSION The combination of Naoxintong Capsule with standard care reduced the 2-year stroke recurrence rate in patients with ischemic stroke without increasing the risk of severe hemorrhage in high-risk patients. (Trial registration No. NCT02334969).
Adult ; Humans ; Secondary Prevention/methods* ; Ischemic Stroke ; Stroke/prevention & control* ; Cerebral Hemorrhage/complications* ; Double-Blind Method ; Platelet Aggregation Inhibitors

Female ; Hepatitis B, Chronic ; prevention & control ; surgery ; therapy ; Humans ; Immunotherapy ; Liver Cirrhosis ; surgery ; Liver Transplantation ; Male ; Postoperative Complications ; prevention & control ; Preoperative Care ; methods ; Secondary Prevention

OBJECTIVETo investigate the clinical effect of mild warming moxibustion (MWM) on acupoints Shenque (RN8) and Guanyuan (RN4) for treatment of recurrent respiratory tract infection (RRTI) in children with cerebral palsy (CP).

METHODSSixty-four CP patients with RRTI were randomly and equally assigned to two groups, all received conventional rehabilitation treatment, but in acute infection stage, MWM was applied on the treated group, and intravenous dripping of immunoglobulin was given to the control group, all for 3 months. The frequency of RRTI attacking (Fre), the mean cough alleviating time (T-CA) and rale disappearing time (T-RA) during infection, as well as the serum levels of immune globulins during the post-treatment 1-year follow-up period were observed.

RESULTSThe effectiveness in the treated group was better than that in the control group, showing in aspects of Fre (2.38 +/- 0.64 times vs. 6.50 +/- 0.84 times), T-CA (3.92 +/- 1.32 days vs. 6.48 +/- 2.18 days) and T-RA (4.66 +/- 1.82 days vs. 7.64 +/- 1.44 days), significant difference was shown between groups (P < 0.01). The serum levels of IgG, IgM and IgA all raised in both two groups (P < 0.05), comparison of immunoglobulin levels between groups showed that they were lower immediately after treatment, but higher at the end of the 1-year follow-up in the treated group than those in the control group.

CONCLUSIONMWM on acupoints Shengue and Guanyuan has a better and long-term clinical effect for treatment of RRTI in children with CP.

Acupuncture Points ; Cerebral Palsy ; complications ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Moxibustion ; methods ; Respiratory Tract Infections ; complications ; drug therapy ; prevention & control ; Secondary Prevention

AIMTo report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases.

METHODSFrom May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old (average 11.62 +/- 7.18 years) with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases.

RESULTSThe buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture.

CONCLUSIONInlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.

Adolescent ; Adult ; Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Male ; Mouth Mucosa ; transplantation ; Secondary Prevention ; Transplants ; Treatment Outcome ; Urethra ; surgery ; Urethral Stricture ; prevention & control ; Urinary Fistula ; prevention & control ; Urologic Surgical Procedures, Male ; adverse effects ; methods

OBJECTIVETo discuss the effects of criteria in controlling the risk factors on secondary prevention of brain vessel disease.

METHODSAmong 631 cases who had been examined at our hospital on brain vessel disease for longer than 1 year, 123 cases were chosen as treatment group which received criterion therapy to control their risk factors while the rest cases were under antitheses group. The two groups were compared on the 1 year recrudesce rate thereafter.

RESULTSThe 1 year recrudesce rate of the treatment group showed better than the antitheses group (P = 0.005 < 0.05), as the benefit mostly from the control of risk factors, such as blood pressure (P = 0.005), blood sugar (P = 0.038). There was active effect of criterion therapy in controlling the risk factors.

CONCLUSIONThere was active effect of criterion therapy in controlling the risk factors as high blood pressure, high blood sugar and high blood fat etc. Healthy life style would help the recurrence of brain vessel disease, which should be highlighted in the secondary prevention of brain vessel disease.

Adult ; Aged ; Aged, 80 and over ; Blood Glucose ; Brain Diseases ; epidemiology ; etiology ; prevention & control ; Brain Ischemia ; epidemiology ; etiology ; prevention & control ; Diabetes Complications ; Female ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Risk Factors ; Secondary Prevention ; methods

OBJECTIVE: To investigate the influence of endoscopic variceal ligation (EVL) on liver function and analyze the risk factors of rebleeding after EVL. METHODS: A total of 137 cirrhotic patients with esophageal varices who received EVL were retrospectively analyzed, and divided into group A, B, and C according to the Child-Pugh scores of liver function. We compared the liver function 1 week preoperatively and postoperatively. The patients were further divided into a rebleeding group and a non-rebleeding group after the EVL, and risk factors about rebleeding were analyzed. RESULTS: There was no significant difference on ALT, AST, T-Bil, and D-Bil either preoperatively or postoperatively in group A, B, and C (P>0.05). Thirteen patients (9.49%) rebled after the EVL. The course of disease, liver function, prothrombin time, and mass ascites were the risk factors of rebleeding. CONCLUSION EVL has no obvious effect on liver function, and the course of disease, liver function, prothrombin time and mass ascites are risk factors of rebleeding after EVL.
Adult ; Endoscopy ; methods ; Esophageal and Gastric Varices ; etiology ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; surgery ; Humans ; Ligation ; methods ; Liver ; physiopathology ; Liver Cirrhosis ; complications ; etiology ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Recurrence ; Risk Factors ; Secondary Prevention