Objective? To evaluate the effects of different forms of self-management education on glycosylated hemoglobin (HbA1c) in diabetic patients. Methods? The related clinical randomized controlled trials (RCTs) were retrieved in China National Knowledge Infrastructure (CNKI), VIP, WanFang data and Chinese Biomedical Database (CBM) (key words:diabetes/ self-management/ health education/behavior/ psychology) and in Embase, PubMed, Cochrane (key words:of intervention/ knowledge/ behavior/psychological/ diabetes/ DSME) from building the database to June 2018 as well as in related journals by hand. Then, we evaluated the quality of literature and carried out data analysis with the RevMan5.0. Results? Finally, a total of 16 literatures (evaluating the effects of self-management education in diabetic patients with the outcome indexes of HbA1c) were included with 9 of them in the subgroup of behavior intervention, 4 in the subgroup of elementary knowledge cognitive intervention and 3 in the subgroup of mental intervention. Besides, 3 literatures with the level A and 13 with the level B. Meta-analysis showed that the HbA1c of the subgroup of behavior intervention was with WMD=-0.78, 95%CI (-1.14, -0.41)(P＜ 0.05), HbA1c of the subgroup of elementary knowledge cognitive intervention was with WMD=-0.55, 95%CI (-1.06, -0.04)(P＜ 0.05) and HbA1c of the subgroup of mental intervention was with WMD=-0.55, 95%CI (-1.24, 0.15)(P＞ 0.05). Conclusions? Behavior intervention and elementary knowledge cognitive intervention all have positive effects on HbA1c of diabetic patients. However, whether mental intervention has effects on patients＇ HbA1c has not gotten a final conclusion. We should implement comprehensive self-management education for diabetic patients from many aspects including behavior, cognition and psychology to achieve an ideal effect.

Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median (P₂₅, P₇₅) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance (P<0.001). The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% (95%CI 59.7%-65.9%), 59.5% (95%CI 56.5%-62.4%) and 56.6% (95%CI 53.6%-59.6%) respectively, and the difference was statistically significant (P<0.001). Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95%CI 20.6%-29.6%), 17.0% (95%CI 12.6%-21.1%) and 11.9% (95%CI 8.4%-15.7%) respectively, and the difference was statistically significant (P<0.001). There were significant changes (P<0.05) in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant (P<0.001). Conclusion Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system

Objective: To investigate the situation of work engagement among nurses in tertiary level 1st general hospitals and evaluated potential associations between psychological contract, psychological capital, and work Engagement. Methods: A cross-sectional descriptive study design was used. 320 nurses from three tertiary level 1st general hospitals in Jinan was included. Data were gathered with Utrecht Work Engagement Scale (UWES-9) , Psychological Capital Questionnaire, and Psychological Contract Questionnaire. Possible predictors of work engagement were analyzed using ANOVA and multivariate linear regression models with SPSS 20.0. Results: A total of 320 questionnaires were enrolled and 282 questionnaires were returned, with a response rate of 88.1%. The total mean (SD) score was 3.79 (0.91) for work engagement, 3.66 (0.72) for psychological contract and 4.39 (0.63) for psychological capital. One-way analysis of variance and post-hoc analysis showed that there was significant difference in work engagement among nurses of different gender (P<0.05) , education level (P<0.05) , department (P<0.01) and professional title (P<0.05) . Pearson correlation analysis showed that psychological contract positively associated with work engagement (r=0.253, P<0.01) and psychological capital (r=0.198, P<0.01) , and psychological capital positively associated with work engagement (r=0.575, P<0.01) . Results of multiple hierarchical regression analysis showed that work department, gender, educational background, professional title, hope, optimism and team obligation predicted work engagement and they accounted for 42.8% of the variance in work engagement. Conclusion The work engagement of nurses is at a medium level. Work engagement of nurses is influenced by gender, professional title, educational level and department; Both psychological contract and psychological capital of nurses positively correlated with work engagement.

Objective: To explore the evaluation of joint injury by HEAD-US-C (Hemophilic Early Arthropathy Detection with UltraSound in China, HEAD-US-C) in patients with moderate or severe hemophilia A treated with prophylaxis vs on-demand. Methods: The patients from June 2015 to July 2017 with moderate or severe hemophilia A were examined by ultrasound imaging of the elbows, knees and ankles; Meanwhile the HEAD-US-C ultrasound assessment scale and hemophilia joint health score scale 2.1 (HJHS2.1) were used to score the joint status. The correlation between the HEAD-US-C and HJHS score was performed in prophylaxis group and on-demand group patients, respectively. Results: A total of 925 cases of joint ultrasonography were conducted in 70 patients with moderate or severe hemophilia A. Among patients with moderate hemophilia, the median (IQR) of HEAD-US-C score and HJHS score in on-demand group were significantly higher than those in the prophylaxis group[1 (0, 6) vs 0.5 (0, 3) , z=0.177, P=0.046],[2 (0, 4) vs 2 (0, 3) z=0.375, P=0.007], even though there was no significant difference of the median (IQR) number of annualized target joints bleeding episodes between on-demand and prophylaxis groups[1 (0, 7) vs 1 (0, 5) , z=1.271, P=0.137]. Unlike in moderate cases, on-demand treatment group had more annualized target joints bleeding episodes than prophylaxis group among patients with severe hemophilia[3 (0, 8) vs 2 (0, 8) , z=0.780 P=0.037]. The prophylaxis group compared favorably with on-demand therapy group in terms of HEAD-US-C score[1 (0, 6) vs 4 (0, 7) , z=2.189, P=0.008], and HJHS score[2 (0, 5) , 4 (1, 6) , z=3646, P<0.001]for the severe hemophilia patients. The positive correlation between HEAD-US-C score and HJHS score was identified (P<0.05) , whether on-demand treatment or prophylaxis groups. The correlation coefficient between HEAD-US-C score and HJHS score in on-demand treatment and prophylaxis groups were 0.739 (95% CI 0.708-0.708) , 0.865 (95% CI 0.848-0.848) respectively, and 95% CI didn’t overlap (P<0.05) , indicating that the correlation coefficient in prophylaxis group had stronger correlation than that in on-demand group. Conclusions Clinical effects of prophylaxis were significantly better than those of on-demand treatment in patients with moderate or se-vere haemophilia A. HEAD-US-C scoring system could effectively evaluate joints damage in hemophilia A patients treated with on-demand or prophylaxis, companied by significantly positive correlation with HJHS clinical evaluation system, and provided objective index for clinical effect assessment.

Objective To investigate the effect of home-based motor imagery training on the lower extremity motor function,balance ability and activities of daily living in post-stroke patients. Methods Fifty-six stroke survivors were divided into the control group and the intervention group by random number table method.All the patients got the conventional nursing, rehabilitation booklets and the video tapes which contained physical therapy and occupational therapy. Furthermore, the patients in the intervention group received 6 weeks motor imagery (MI) therapy through an instant messaging client (Tencent QQ), three times a week, 30mins per time. The outcomes were measured before discharge (T0), immediately after the intervention (T1), and 6 weeks (T2) after the intervention using the Fugl-Meyer Motor Assessment Scale (FMA), Berg Balance Scale (BBS), Barthel Index (BI). Results At baseline, the scores of FMA、BBS、BI in the intervention group were (15.12 ± 4.19), (24.50 ± 2.72), (54.04 ± 17.44) points, while in the control group were (14.23 ± 3.67), (23.92 ± 2.82), (49.46 ± 15.09) points. There were no differences on any scale between the two groups at baseline (t=0.810, 0.750, 1.012, P>0.05). At 6 weeks,the scores of FMA, BB, BI in the control group were (14.81 ± 3.50), (29.31 ± 2.43), (50.77 ± 14.47) points, and were significantly lower than (17.38 ± 4.10), (37.38 ± 4.30), (74.62 ± 11.22) pointsin the interventiongroup (t=2.438, 8.326, 6.641, P<0.05 or 0.01). At 12 weeks, the scores of FMA, BB, BI in the control group were (15.54±3.44), (32.35±1.98), (59.08±13.85) points, and were significantly lower than (18.58±4.19), (41.19±3.96), (86.54± 9.88) points in the intervention group (t=2.858, 10.189, 8.233, P<0.01). A main effect of intervention (F=4.158, 63.716, 30.379, P < 0.05) and an interactive effect of time and intervention (F=47.941, 61.029, 29.685, P=0.000) were observed in the model of FMA, BBS, BI using ANOVA of repeated measures. The factors were compared with each other and the difference was statistically significant (P=0.000). Conclusions The home-based MI training can improve the lower extremity motor function, balance ability and activities of daily living in patients with stroke.

Objective To investigate the differences in the curative effects between traditional telephone follow-up and medical care combined with WeChat and medical mobile app in adult epilepsy patients with anxiety and depression,analyze the influence factors for the differences from following five aspects: medication compliance, anxiety and depression,quality of life of patients, knowledge of diseases and related behavior correction,satisfaction rate of patients to follow-up and patients' hospital readmission rate. Methods A total of 100 adult epilepsy patients with anxiety and depression in our department from February 2015 to October 2015 were investigated in the study. The patients were divided into observation group and control group by admission order alternates (50 respectively). Patients in control group received traditional telephone follow-up,while patients in observation group were managed using WeChat and medical mobile APP. Medication compliance,anxiety and depression,quality of life of patients,knowledge of diseases and related behavior correction, satisfaction rate of patients to follow-up and number of patients' hospital readmission were compared between two groups at intake time and after 6 months' follow-up. Results Among 100 epilepsy patients, 14 patients were lost and 86 patients were followed up for 6 months. At 6 months' post discharge, medication compliance of patients in observation group was significantly higher than that in control group (P<0.05). The scores of SAS and SDS in observation group were lower than those in control group, with statistically significant difference (P<0.05). The score of QOLIT-31 in observation group was significantly higher than that in control group (P<0.05). Patients in observation group performed better than patients in control group in diet habit correction, knowledge of training methods, as well as in satisfaction to follow-up and rate of patients' hospital readmission. The differences were statistically significant (P<0.05). Conclusions Medical care combined with WeChat and medical mobile APP in adult epilepsy patients with anxiety and depression can improve patients' medication compliance, relieve patients' anxiety and depression, increase quality of life of patients, enhance patients' knowledge of disease and behavior correction and raise the rate of patients' hospital readmission and satisfaction to follow-up.

Objective To systematically evaluate the effectiveness of diabetes self-management education through telemedicine on glycosylated hemoglobin (HbA1c). Methods Randomized clinical trials (RCTs) that assessed the effectiveness of remote diabetes self-management education in patients with diabetes were systematically reviewed using multiple electronic databases. The searching time was from database establishment to May 2015. These articles were analyzed after evaluation of their quality. Results Eight RCTs were included involving 2 047 patients.The results of Meta-analysis showed the effectiveness of remote DMSE on reduction of HbA1c of patients with type 2 diabetes was more significant than that of the control group [WMD=-0.50,95%CI (-0.88,-0.12),P < 0.05],while failing to support the effectiveness of remote DMSE on patients with type 1 diabetes [WMD=0.62, 95%CI(-0.19,1.43), P>0.05]. Conclusions Remote DMSE is effective to improve the glycemic control in patients with type 2 diabetes,while the effect on patients with type 1 diabetes is still not certain. Large-scale and multi-centered RCTs are needed to confirm its effectiveness.

Self-efficacy is the extent or strength of one′s belief in one′s own ability to complete tasks and reach goals. Self-efficacy affects every area of human endeavor. By determining the beliefs a person holds regarding his or her power to affect situations, it strongly influences both the power a person actually has to face challenges competently and the choices a person is most likely to make. In this paper, the factors affecting self-efficacy, the effects of self-efficacy, the application range and interventions of self-efficacy in clinical disease management are reviewed. It has great significance in the improvement of ability of disease management,disease prognosis and quality of life by lifting the self-efficacy.

Objective To investigate the influence of a multifaceted stroke telehome-care (THC) on extremities function, activities of daily living (ADL) and quality of life in stroke patients with hemiplegia. Methods A total of 52 stroke survivors in department of neurology were randomized to the THC intervention or usual care. The patients in the control group received conventional care, while those in the intervention group were additionally given a THC program over 3 months. The THC intervention includes motor imagery and adaptive strategies. Data collection was undertaken using the Fugl-Meyer Motor Assessment Scale (FMA), the Barthel Index (BI), the Stroke Impact Scale (SIS) at baseline, 3 months, and 6 months. Results At baseline, the scores of FMA, BI, and SIS in the intervention group were 53.62 ± 23.52, 54.04 ± 17.44, 179.96 ± 28.51, and while the scores of the control group were 50.96 ± 19.52, 49.46 ± 15.09, 169.23 ± 28.48. There were no pre-existing differences on any scale between the two groups (t=0.443, 1.012, 1.358, P > 0.05). At 3 months, the scores of FMA, BI, SIS in the control group were 53.54 ± 17.45, 50.77 ± 14.47, 76.19 ± 27.78, and were significantly lower than 78.38 ± 12.54, 74.62 ± 11.22, 228.54±22.63 in the THC group (t=5.895, 6.641, 7.449,P<0.01). At 6 months, the scores of FMA, BI, SIS in the control group were 57.88±17.89, 59.08±13.85, 183.92±26.56, and were significantly lower than 90.58 ± 9.60, 86.54 ± 9.88, 252.19 ± 20.10 in the THC group (t=8.211, 8.233, 10.451, P < 0.01). Conclusions A telehome-care program that provide distance training and education of disabled persons resulted in greater improvements in physical functioning, ADL and quality of life.

Objective To investigate the status of anxiety,depression and self-efficacy, social support among patients with severe burns and analyze their correlation. Methods Eighty-four patients with severe burns were selected by convenience sampling. They were evaluated by Hospital Anxiety and Depression scale (HADS), General Self-efficacy Scale (GSES) and Social Support Assessment Scale (SSAS) and the correlation of two scales was analyzed. Results The anxiety score was 6.62 ± 3.98, depression score was 7.63 ± 4.36, self-efficacy score was 20.94 ± 4.96 and the social support score was 41.40±6.47;Self-efficacy was negatively correlated with the anxiety (r=-0.356, P<0.05) and depression (r=-0.362, P<0.05). Social support was also negatively correlated with the anxiety (r=-0.305, P<0.05) and depression (r=-0.320, P<0.05). Conclusions There is a medium level of anxiety and depression among patients with severe burns. Psychological interventions via increasing the self- efficacy are suggested for the patients with severe burns in the future.