Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To study the influencing factors of nursing dependence in patients with moderate to severe dementia.Methods:Eighty-seven patients with moderate to severe dementia were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University. The demographics of each patient were recorded. The Chinese version of the Nursing Dependence Scale (CDS) was evaluated. The simple mental state test (MMSE), severe cognitive impairment series (SIB-S), and 6-minute walk test score (6MWT) for each patient. Mobility Test Score (TUG), US Cornell Depression Table Score (CSDD), Apathy Score (AES-10)were recorded. Demographic variables, MMSE, 6MWT, TUG, CSDD,AES-10, SIB-S as an independent variable, CDS as a dependent variable, multivariate linear logistic regression was analyzed.Results:The median comorbidities were 2, 6MWT, TUG, MMSE, SIB-S, CSDD, AES-10 score was (208.54±74.02) m and (24.56±11.83), (12.67±5.47), (40.85±7.54), (7.92±4.48), (25.28±7.23) points, which were independent factors with statistically significant impact on the care dependency scale ( B value was -0.67-0.67, P < 0.05 or 0.01). Conclusions:Patients with moderate to severe dementia have more comorbidities, lower physical endurance and increased dependence on depression.

Objective:To investigate the risk factors of elderly, sports cognitive risk syndrome falling, repeated falls and fractures after falls.Methods:A total of 3 552 people were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from April 2015 to April 2016. The demographics of each selected individual were recorded. The selected individuals were assessed by MMSE for the presence of Subjective Cognitive Complaint (SCC), and the pace was used to assess whether there was slow walking and whether there was MCR (SCC + slow walking). All individuals were divided into MCR group and non-MCR group according to the evaluation results. The non-MCR group was subdivided into SCC subgroup, slow speed walking subgroup and healthy subgroup. Baseline variables were compared between the two groups, and demographics between subgroups, subgroups, and MCR groups were compared. Follow-up was followed every 4 months for a total of 2 years. The number of people who fell during the follow-up period, repeated falls, and fractures were recorded. With all demographics and SCC, walking at a slower pace, MCR was an independent variable, with a fall during follow-up, repeated falls and post-fall fractures as dependent variables, and a COX proportional hazard regression model of independent and dependent variables.Results:The proportions of the MCR group in higher education, depression, the use of crutches were 10.2% (36/352), 22.4% (79/352), 44.9% (158/352), the BMI, number of medications in the MCR group were (27.0 ± 4.3) kg/m 2, (6.8±3.2), the proportions of non-MCR group in higher education, depression, using crutches ratio were 22.9% (732/3 200), 12.8% (409/3 200), 22.8% (729 /3 200), the BMI, number of medications of non-MCR group were (24.8 ± 3.8) kg/m 2, (5.2 ± 3.1), the two groups showed statistical significant difference( χ2 values were 29.93, 3.45, 24.98, t values were 12.34, 82.71, P<0.05). The proportions of higher education, depression and crutches were 18.9% (289/1531), 13.2% (202 /1531) and 22.5% (344/1531) in SCC subgroup. The difference between MCR group and SCC subgroup was statistically significant ( χ2 values were 14.99, 19.28, 73.56, P<0.05). The higher education level of the slow walking group was 16.6% (34/205), which was significantly different from that of the MCR group ( χ2 value was 4.77, P<0.05). The proportions of higher education level, arthritis, depression and crutches in the healthy subgroup were 27.9% (409/1 464), 12.9 (190/1 464), 11.2% (164/1 464) and 19.7% (288/1 464), while that in the SCC subgroup were 18.9% (289/1 531), 16.2 (248/1 531), 13.2% (202/1 531) and 22.5% (344/1 531), and that in the slow walking subgroup were 16.6% (34/205), 21.5% (44/205), 20.9 (43/205) and 47.3% (97/205). There were significant differences among the three subgroups ( χ2 values were 13.08-78.28, P<0.05). BMI and number of drugs in healthy subgroups were (23.4±4.4) kg/m 2 and (4.7±2.8) , SCC group was (25.2±4.3) kg/m 2 and (5.1±2.9) kinds, and slow walking subgroup were (25.1±3.8) kg/m 2 and (6.7±3.1) kinds. The differences among the three subgroups were statistically significant ( t values were 2.68,7.21, P<0.05). The risks of falling, repeated falling and fracture after falling in MCR patients were 1.22, 1.47 and 2.54 ( P<0.05). Conclusions:Age, MCR is a high risk factor for falls in the elderly, repeated falls and fractures after falls. In clinical care, MCR needs to be evaluated and attention should be payed to the elderly.

Objective:To investigate serum levels of 25-hydroxyvitamin D [25-(OH)D3], the vitamin D receptor(VDR), LL-37, cytokines such as interleukin 6(IL-6)and tumor necrosis factor-α(TNF-α)in elderly and non-elderly patients with pulmonary tuberculosis, and to study the correlation between serum vitamin D levels and clinical characteristics.Methods:A total of 56 elderly patients and 56 non-elderly patients with active pulmonary tuberculosis admitted to Chengdu Public Health Clinical Center from January 2019 to March 2019 were enrolled.The levels of 25-(OH)D3, VDR, LL-37, IL-6 and TNF-α were detected by ELISA and compared between the two groups.Clinical data such as the number of T lymphocytes, lesions and cavities in bilateral lung fields and extra-pulmonary tuberculosis were collected.Results:There were significant differences in serum vitamin D levels [(28.94±12.88)nmol/L vs.(34.47±12.78)nmol/L, t=3.650, P=0.025], while levels of VDR, LL-37, IL-6 and TNF-α(all P>0.05)were similar between the elderly and non-elderly groups.Besides, patients in the elderly group were associated with significantly lower levels of CD4 + T lymphocytes [(295.71±153.83)×10 6/L vs.(421.25±206.00)×10 6/L]and CD8 + T lymphocyte count [159.5(101.0, 239.0)×10 6/L vs.261.5(187.0, 409.0)×10 6/L]than those in the nonelderly group(all P=0.000). Also, there were more severe pulmonary tuberculosis cases in the elderly group than the non-elderly group [(51/56, 91.1%) vs.(28/56, 50.0%), χ2=22.730, P=0.000]. The serum level of 25-(OH)D3 was positively correlated with CD4 + T cell count in elderly patients( r=0.190, P< 0.05). Conclusions:Elderly patients with pulmonary tuberculosis have a high proportion of severe tuberculosis and reduced serum levels of vitamin D, CD4 + T cell count and CD8 + T cell count, compared with non-elderly patients.Attention should be paid to vitamin D levels and their potential impact on disease progression in elderly patients with active tuberculosis.

Objective: To investigate the effect of pre-stroke dependence and pre-stroke combined dementia on the outcome of 3 months after stroke in patients aged more than 65 years. Methods: This study was a retrospective cohort study. A total of 966 patients with acute stroke were enrolled in the Department of Neurology, the First Affiliated Hospital of China Medical University from March 2015 to March 2018, including 168 patients diagnosed with dementia before acute stroke for the dementia group, and the remaining 798 people were treated as the non-dementia group. The demographic differences between the two groups at admission were compared. With the death and independence as the dependent variable within 3 months after the diagnosis of acute stroke, the independent risk of admission and the presence of dementia were used as covariates to make a COX proportional hazard assessment. Results: There was significant difference in the number of medications, consistently taken with warfarin, pre-stroke independence, admission status between the dementia group and the non-dementia group (U=3.42, χ²=4.52, 8.96, 8.76, P<0.01). There was no significant difference in the number of deaths between the two groups during admission (χ²=0.96, P>0.05). There was significant difference in the number of deaths within 3 months after discharge and dependence within 3 months after stroke between the two groups (χ²=5.69, 6.94, P < 0.01). Patients with pre-stroke dementia died during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.00, 1.32, 2.56 compared with those who were completely independent before admission; mild dependence before admission patients who died before the stroke were completely dead during hospitalization and died within 3 months after discharge, the risk of moderate-to-severe dependence within 3 months after discharge was 1.42, 1.86, 2.73, respectively. Patients who were moderately dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.68, 2.42, respectively. Patients who were heavily dependent before admission were more likely to die from hospitalization than those who were completely independent before stroke, the risk of death within 3 months after discharge was 1.89, 3.24, respectively. Conclusions Pre-stroke dementia and activity disorder lead to a high risk of death and high disability within 3 months after stroke.

Objective: To study the causes and influencing factors of no seeking medical treatment among pneumoconiosis patients. Methods: Using stratified sampling method and typical survey method, we carried out the questionnaire survey in nine provinces in China including the east, the medium and the western region using a questionnaire on the seeking medical behavior pf pneumoconiosis patients and the influencing factors. The subjects include occupational pneumoconiosis cases and clinically diagnosed cases and the response rate is 94.3 percent. The data was entered twice with epidate3.1 and error detection and statistical analysis was completed with SPSS 20.0. Chi-square test was used for univariate analysis, and multivariate logistic regression was used for multivariate analysis. Results: One thousand and thirty-seven subjects were investigated with average age 55.9±11.2 years. Seventy percent of them were silicosis and 21.9 percent were coal worker’s pneumoconiosis with 67.5 percent of them residing permanently in the countryside, and 37.9 percent of their education background were primary school culture and 33.1 percent of them had junior high school culture. Thirty two point six percent of respondents had no personal income with a median monthly income of 1 200 yuan. Four hundred and thirty four of subjects hadn't seek medical treatment since they got the pneumoconiosis accounting for 41.9 percent with three hundred and thirty seven of them hospitalized directly. The reasons of no seeking medical treatment for the respondents mainly include the self-induction symptoms lighter, the high cost of treatment and cannot claiming the payment of the medical expenses, buying drugs in drugstore, thinking that no medicine can cure pneumoconiosis or no effect, complex procedures, too far away from medical institutions, no unaccompanied, needing a long time or no time, communication disorders, etc. accounting for 44.4 percent, 24.6 percent, 10.9 percent, 9.1 percent, 6.9 percent, 4.4percent, 3.2 percent, 2.9 percent, 1.9 percent, 1.5 percent, respectively. The results of multivariate analysis showed the main characteristics of subjects with restrictions to the outpatient health service utilization are as follows: demographic sociological indicators such as registered permanent residence area is western (OR_western=2.18, 95%CI:1.38-3.43) , more than seventy five years old (OR_{over 75}=6.82, 95%CI:2.04-22.9) , unemployment, temporary or permanent employment (OR _unemployment=1.90, 95%CI:1.17-3.08; OR_{temporary employment}=3.11, 95%CI:1.57-6.14; OR_{permanent employment}=2.10, 95%CI:1.18-3.74) , self-rated health score of 50 or above (OR_{self-rated-70}=2.04, 95%CI:1.18-3.51; OR_{self-rated-90}=3.00, 95%CI:1.97-5.37; OR_{self-rated 90}=2.95, 95%CI:1.74-8.07) ; with increase to the outpatient health service utilization are breath with difficulty (OR=0.57, 95%CI:0.41-0.78) , emphysema (OR=0.48, 95%CI:0.26-0.90) , hospitalized with pneumo-coniosis (OR=0.12, 95%CI:0.07-0.20) . Conclusion Pneumoconiosis patients no covered by injury insurance should be orderly included in the basic medical security system, and be given the medical treatment actively; It should be strengthened the health management for the pneumoconiosis patients and correctly guided the utilization of medical services.

Objective To study the impact of integrated nursing process in intravenous thrombolysis in patients with cerebral infarction in superacute period.Methods A total of 31 intravenous thrombolysis patients from January to December 2015 were as experimental group given integrated nursing process and 31 cases from May to December 2014 were as control group given conventional nursing,thrombolysis patients' behavioral life quality by NIHSS,dementia by MMSE and depression by CES-D before and after thrombolysis were compared.Results There was no significant different in experimental group and control group in NIHSS score,MMSE score and CES-D scores before thrombolysis;while there was statistically significance between the two groups in NIHSS scores after thrombolysis in 24 hours,in 15 days or in one month(P ＜0.05).There was no statistically significance between the two groups in MMSE scores after thrombolysis in 24 hours (P ＞ 0.05),but was statistically significant in 15 days after thrombolysis and one month (P ＜ 0.01).There was statistically significant difference between the two groups in CES-D scores in 24 hours,15 days and 1 month after thrombolysis (P ＜ 0.05).Conclusion Quality of care for the patients with acute cerebral infarction thrombolysis associates with their behavioral life quality,dementia and depression.Integrated nursing process improves their behavioral life quality,and relieves dementia and depression of patients with acute cerebral infarction thrombolysis.

Objective To study the impact of integrated nursing process in intravenous thrombolysis in patients with cerebral infarction in superacute period.Methods A total of 31 intravenous thrombolysis patients from January to December 2015 were as experimental group given integrated nursing process and 31 cases from May to December 2014 were as control group given conventional nursing,thrombolysis patients' behavioral life quality by NIHSS,dementia by MMSE and depression by CES-D before and after thrombolysis were compared.Results There was no significant different in experimental group and control group in NIHSS score,MMSE score and CES-D scores before thrombolysis;while there was statistically significance between the two groups in NIHSS scores after thrombolysis in 24 hours,in 15 days or in one month(P ＜0.05).There was no statistically significance between the two groups in MMSE scores after thrombolysis in 24 hours (P ＞ 0.05),but was statistically significant in 15 days after thrombolysis and one month (P ＜ 0.01).There was statistically significant difference between the two groups in CES-D scores in 24 hours,15 days and 1 month after thrombolysis (P ＜ 0.05).Conclusion Quality of care for the patients with acute cerebral infarction thrombolysis associates with their behavioral life quality,dementia and depression.Integrated nursing process improves their behavioral life quality,and relieves dementia and depression of patients with acute cerebral infarction thrombolysis.