Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge tran...Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.展开更多
Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admit...Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.展开更多
Chronic heart failure(CHF)is a pathological state in which the cardiac ejection fraction is insufficient to meet an individual's metabolic needs owing to changes in the cardiac structure or function.Various etiolo...Chronic heart failure(CHF)is a pathological state in which the cardiac ejection fraction is insufficient to meet an individual's metabolic needs owing to changes in the cardiac structure or function.Various etiologies such as myocardial infarction and inflammation are implicated,and the main symptoms are dyspnea,lower limb edema,fatigue,and discomfort during rest or exercise.CHF is the primary outcome of cardiovascular disease,and the increasing morbidity and mortality rates highlight the significant risks of this condition.According to traditional Chinese medicine,the pathogenesis of CHF is deficiency of heart qi and heart yang,which predominantly affects the heart,but may also impede the function of other zang-organs such as the spleen and kidney,and aggravate the symptoms of heart failure.With technological advancements and enhanced awareness of health conditions and disease prevention,China has promoted traditional medicine practices such as medicine and food homology(MFH),which has received increasing attention in recent years.This concept stipulates that certain medicines and foods have the same origin;ergo,these foods have medicinal properties,with many being used in the pre-vention and treatment of CHF.However,the efficacy and safety of MHF substances have yet to be determined,and there is no consensus regarding the development of disease prevention and treatment strategies.This article therefore reviews the current evidence for MFH in the prevention and treatment of CHF by summarizing the therapeutic potential of this practice and discussing treatment strategies and aims to improve the understanding of Chinese medicine and food homologous substances in the treatment of this condition,as well as highlight the current literature and avenues for future research.展开更多
There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between ...There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.展开更多
Objective: To implement the whole-process capacity management model led by specialist nurses, improve the capacity management behavior of medical staff, and build a standardized, standardized and operable CHF capacity...Objective: To implement the whole-process capacity management model led by specialist nurses, improve the capacity management behavior of medical staff, and build a standardized, standardized and operable CHF capacity management system. Methods: According to the evidence pyramid principle and search strategy, 2 evidence-based nursing backbone completed literature search in both Chinese and English, and finally included 7 literatures. Results: Around the three key links of capacity assessment, monitoring and management, stakeholders were invited to evaluate each evidence according to the FAME principle, that is, the feasibility, suitability, effectiveness and clinical significance of evidence. Finally, 11 best evidences were obtained and 5 clinical review indicators of the cost project were transformed. This study formulated the competence management plan for CHF patients based on the current situation, established competence load evaluation criteria for CHF patients, and determined the target “dry weight” value for CHF patients. Conclusion: The whole-course volume management model of CHF patients guided by specialist nurses should be established and applied and promoted in the “heart failure Center Alliance unit”, so as to improve the capacity management ability of medical staff for CHF patients, enhance the self-management ability of CHF patients, improve the capacity management behavior and health outcomes, and effectively reduce the hospitalization rate and mortality rate of CHF patients in the region.展开更多
BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investig...BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
Dear Editor,The primary objective of the letter is to emphasize the importance of personalized management of arterial blood pressure(ABP)in the context of off-pump coronary artery bypass grafting(CABG)surgery.Coronary...Dear Editor,The primary objective of the letter is to emphasize the importance of personalized management of arterial blood pressure(ABP)in the context of off-pump coronary artery bypass grafting(CABG)surgery.Coronary artery disease,a leading global cause of mortality,necessitates a substantial number of cardiac surgeries,with approximately 400,000 CABG operations conducted annually in the United States.Postoperative heart failure(HF)is a common occurrence after CABG surgery,with readmission rates within 30 d due to HF ranging from 12% to 16%.展开更多
Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morb...Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.展开更多
BACKGROUND Epidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%,the number of people affected is more than 4 million,and the 5-year survival rate is even lower than that of ...BACKGROUND Epidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%,the number of people affected is more than 4 million,and the 5-year survival rate is even lower than that of malignant tumors.AIM To determine the impact of WeChat platform-based health management on severe chronic heart failure patients’health and self-management efficacy.METHODS A total of 120 patients suffering from chronic heart failure with cardiac function grade III-IV,under the classification of the New York Heart Association,were admitted to our hospital in May 2017.In January 2020,they were divided into two groups:A control group(with routine nursing intervention)and an observation group(with WeChat platform-based health management intervention).Changes in cardiac function,6-min walking distance(6MWD),high-sensitivity cardiac troponin(hs-cTnT),and N-terminal pro B-type natriuretic peptide(NT-proBNP)were detected in both groups.The Self-Care Ability Scale(ESCA)score,Minnesota Living with Heart Failure Questionnaire score,and compliance score were used to evaluate self-management ability,quality of life,and compliance of the two groups.During a follow-up period of 12 mo,the occurrence of cardiovascular adverse events in both the groups was counted.RESULTS The left ventricular ejection fraction,stroke output,and 6MWD increased,and the hs-cTnT and NT-proBNP decreased in both the groups,as compared to those before the intervention.Further,cardiac function during the 6MWD,hs-cTnT,and NT-proBNP improved significantly in the observation group after intervention(P<0.05).The scores of self-care responsibility,self-concept,self-care skills,and selfcare health knowledge in the observation group were higher than those of the control group before intervention,and their ESCA scores were significantly improved after intervention(P<0.05).The Minnesota heart failure quality of life(LiHFe)scores of physical restriction,disease symptoms,psychological emotion,social relations,and other items were decreased compared to those of the control group before intervention,and the LiHFe scores of the observation group were significantly improved compared to those of the control group(P<0.05).With intervention,the compliance scores of rational diet,regular medication,healthy behavior,and timely reexamination were increased,thereby leading to the compliance scores of the observation group being significantly improved compared to those of the control group(P<0.05).During the 12 mo follow-up,the incidence rates of acute myocardial infarction and cardiogenic rehospitalization in the observation group were lower than those of the control group,and the hospitalization time in the observation group was shorter than that of the control group,but there was no significant difference between the two groups(P>0.05).CONCLUSION WeChat platform-based health management can improve the self-care ability and compliance of patients with severe chronic heart failure,improve the cardiac function and related indexes,reduce the occurrence of cardiovascular adverse events,and enable the avoidance of rehospitalization.展开更多
BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the inc...BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.展开更多
Objective： To standardize pain management in the anesthesia recovery period and improve the effects of analgesia on acute postoperative pain. Methods： Using healthcare failure mode and effect analysis （HFMEA）, we ...Objective： To standardize pain management in the anesthesia recovery period and improve the effects of analgesia on acute postoperative pain. Methods： Using healthcare failure mode and effect analysis （HFMEA）, we analyzed the primary cause of patients＇ pain and subsequently determined the process and risk priority number （RPN）. Results： Actions were taken to improve patients＇ pain. After using HFMEA, the experimental group＇s visual analog scale （VAS） scores were lower than those of the control group at 1 h and at discharge from the post-anesthetic intensive care unit （PAICU）. The differences were statistically significant （P 〈 0.05）. Conclusions： The application of failure mode and effect analysis can relieve pain and improve the quality of nursing.展开更多
Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated wi...Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated with late nephrology case management and to describe the evolution of patients depending on the time of care nephrology. Material and Methods: It was a 5-year prospective study, observational type, going from January 1st, 2010 to December 31th, 2014. We studied all the patients hospitalized with chronic renal failure with dialysis or not and we excluded the patients hospitalized for acute renal failure. Results: The study population includes 307 men (53.4%) and 268 women (46.6%) with a sex ratio of 1.14. Age population ranged between 15 and 85 years old with a mean of 44.4 ± 16.20 years old. Their profession was distributed as follows: 220 housewives (38.3%), 181 workers (31.5%), 104 civil servants (18.1%), 56 students (9.7%) and 14 unemployed (2.4%). Patients came from all regions of the country: Conakry: 389 patients (67.6%);Lower Guinea: 82 (14.3%);Middle-Guinea: 57 (9.9%);Upper Guinea: 31 (5.4%);Guinea Forest Region: 16 (2.8%). In this study population, 48 patients were admitted in emergency (8.3%);105 were scheduled (18.3%) and 422 were referred to the nephrology department (73.4%). Reasons for the emergency admission were acute pulmonary edema in 21 patients (43.7%), decompensated anemia in 13 patients (27.1%), loss of consciousness in 9 patients (18.7%) and malignant hypertension in 5 patients (10.4%). The reference patterns was uremic syndrome in 312 patients (54.3%), followed by high blood pressure in 247 patients (42.9%), an edematous syndrome in 234 patients (40.7%), oligoanuria in 222 patients (38.6%), morphological abnormalities on the renal ultrasound in 4 patients (0.7%). The functional symptoms were vomiting in 379 patients (65.9%), followed by dyspnea in 290 patients (50.4%), headaches in 287 patients (49.9%). Among them, 121 patients could handle alone, 431 were borne by their families and 23 were indigent;181 patients had consulted before 1 month of the beginning of the signs, 238 between 1 and 2 months and 156 after 2 months;48 were admitted in emergency, 105 were programmed by the Nephrology Department and 422 were referred to the other health structures of the country. Conclusion: Several factors contributed to the delay in treatment, among which: the low socioeconomic level, the delay of the reference of the patients, the long distance of the regions, the lack of Nephrology units in the country.展开更多
It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) the...It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to revisit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short- and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.展开更多
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rat...Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.展开更多
The objective of this study is to investigate a network failure problem with a significant path, emerging from the context of crisis management, such as in the case of natural disasters. For a given tree with m failed...The objective of this study is to investigate a network failure problem with a significant path, emerging from the context of crisis management, such as in the case of natural disasters. For a given tree with m failed edges, we assume that we have sufficient resources to recover k edges of the m edges. Each node has a positive weight. In this situation, we consider which k edges should be fixed in order to maximize the sum of the weights of the nodes reachable from the significant path. In this paper, we formulate such a problem as a combinatorial problem. Further, we show that a part of our problem may be solved by translating it into the terms of the so-called tree knapsack problem.展开更多
Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharma...Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharmacists of the Franche-Comte region (France) and patients of the Franche-Comté Heart Association. Method: Two questionnaires were drawn up and sent to pharmacists and patients. Results: The 118 pharmacists participating in this survey (36.9%) felt that they had a role to play in dispensing drugs (100.0%), educating patients about their treatment (83.1%), informing patients about the importance of observance (81.4%) and over- the-counter drugs (58.5%), distributing heart failure brochures (51.7%) and providing medical equipment (44.9%). On the other hand, only a third of them thought that they should inform patients about their illness and give advice by phone. On the whole, knowledge level is good for disease, drug therapy, contraindicated drugs, medical supervision and hygieno-dietetic management, but intermediate or poor for alert signs of decompensation, essential vaccinations and patient associations. University training in this area during formal pharmacy studies is considered either “insufficient” or “very insufficient” in 56.9% of cases. Although more than 99% of the pharmacists think that additional training is needed, only 33.1% had actually benefited from such training. Of the 96 patients (48.0%) who completed the questionnaire, 92.6% are faithful to their pharmacist. They contact him more about drug therapy than about their disease, or information related to treatments. Roles attributed to their pharmacist are mainly related to drug therapy explanation and information concerning over-the-counter drugs. Therapeutic education is known to 40.6% of interrogated patients. Among these patients, two-thirds depend on their pharmacist and feel that he is capable of providing the necessary education. Moreover, 46.2% of patients had received some form of therapeutic education from their pharmacist. Pharmacists believe that they are able to assume this role in 67.8% of cases. Conclusion: In spite of biases, this study allowed us to assess the expectations of heart failure patients with regard to the pharmaceutical management of their disease, thus clarifying the indispensable contribution that pharmacists make in the management of this disease.展开更多
Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these...Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.展开更多
Background: Renal failure (RF) is a frequent complication during multiple myeloma (MM) and sometimes reveals the disease. The median survival of MM patients with RF is shorter than that of patients with myeloma withou...Background: Renal failure (RF) is a frequent complication during multiple myeloma (MM) and sometimes reveals the disease. The median survival of MM patients with RF is shorter than that of patients with myeloma without renal involvement. Although patient survival has been prolonged with the new therapies, the median survival does not exceed five to seven years. Few data on this subject are available in sub-Saharan Africa. Objectives: To describe the therapeutic management and evolution of MM with RF in a developing country like Togo. Method: This was a retrospective descriptive and analytical study which took place over a period of ten years (2010-2019) and included the records of patients with MM according to the 2009 and/or 2014 IMWG criteria, hospitalized or followed up in the nephrology and rheumatology departments of the CHU-SO with a GFR Results: During the study period, 78 patients with MM had renal failure (55.7%). Therapeutically, hygienic and dietary measures were dictated in 84.6% of cases (68 patients). Rehydration was performed in 38 cases (48.7%);alkalinization of urine in 10 cases (12.8%);use of antibiotics in 36 cases (46.2%), NSAIDs in 51 cases (65.4%);use of biphosphonates in 36 cases (46.6%). Surgical immobilization by screw-plate osteosynthesis was performed in 02 patients. Nephrologically, 8 patients underwent ESRD. The different chemotherapy protocols used were Melphalan-Prednisone in 70% of cases, Melphalan-Cyclophosphamide-Prednisone in 26.7% of cases and Cyclophosphamide-Prednisone in 3.3%. The median overall survival was 8 months. The median survival was 13 months in patients who recovered from renal failure versus 2 months in those who did not recover from renal failure (p = 0.0030). Of the 78 patients in our series, 22 patients had died (28.2%). Conclusion: Despite renal failure, the Alexanian protocol and biphosphonates are still widely used in combination with symptomatic treatment with significant results.展开更多
Heart failure (HF) is a clinical syndrome due to structural and/or functional cardiac anomalies, accompanied by elevated natriuretic peptide levels and/or cardiogenic pulmonary or systemic congestion;severely compromi...Heart failure (HF) is a clinical syndrome due to structural and/or functional cardiac anomalies, accompanied by elevated natriuretic peptide levels and/or cardiogenic pulmonary or systemic congestion;severely compromising patients’ health, performance and quality of life. The advancement of novel treatment and their endorsement by international medical and scientific societies have shifted the treatment of HF with reduced ejection fraction (HFrEF) towards quadruple therapy: an angiotensin receptor-neprilysin inhibitor or an angiotensin-converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium/glucose co-transporter-2 inhibitor (SGLT2i). This paper reviews the available literature on state-of-the-art diagnostic and therapeutic advances in HFrEF, discusses landmark trials that shifted the paradigm towards quadruple therapy in HFrEF, visits the potential challenges in Lebanon and globally, proposes an algorithm for treatment introduction and sequencing in HFrEF and highlights clinical considerations for HFrEF management and patient education and follow-up. This practical guidance could serve cardiologists and other medical specialists in identifying clinical signs of HFrEF, diagnosing patients, referring them or prescribing the components of quadruple therapy, and offering medical advice and follow-up. We highlight the role of SGLT2is in HF management and their effectiveness in reducing rates of hospitalization for HF as well as cardiovascular deaths, with satisfactory safety profile.展开更多
文摘Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.
文摘Objective: This study focuses on the clinical observation of the impact of different treatment methods for gestational heart failure on delivery outcomes. Method: A total of 160 pregnant women with heart failure admitted to our hospital between October 2020 and October 2021 were selected as the study subjects. They were categorized based on delivery mode, delivery timing, heart failure control time, and cardiac function status. The delivery outcomes of the different groups were then compared. Result: In terms of delivery methods, the rate of neonatal asphyxia was higher following vaginal delivery than cesarean section. Regarding delivery timing, the neonatal mortality rate was lower for cesarean sections performed at 32-36 + 6 weeks compared to those conducted at 37-39 + 6 weeks. With respect to heart failure control time, the rates of neonatal asphyxia and pulmonary hyaline membrane disease were lower in the ≤ 48- hour group than in the > 48-hour group. From the perspective of cardiac function status, patients with cardiac function I- II exhibited relatively lower rates of neonatal asphyxia and perinatal mortality compared to those with cardiac function III-IV. The observed differences were statistically significant (P < 0.05). Conclusion: For patients with gestational heart failure, cesarean section is the recommended mode of delivery, with the optimal timing being between 32 and 36+6 weeks of pregnancy. During cesarean section, the timing of delivery should be carefully selected based on the mother’s cardiac function status.
基金supported by National Natural Science Foundation of China(82274082 and 82204943),Beijing“high-grade,precision and advanced”Project,Beijing Key Laboratory for Basic and Development Research on Chinese Medicine.
文摘Chronic heart failure(CHF)is a pathological state in which the cardiac ejection fraction is insufficient to meet an individual's metabolic needs owing to changes in the cardiac structure or function.Various etiologies such as myocardial infarction and inflammation are implicated,and the main symptoms are dyspnea,lower limb edema,fatigue,and discomfort during rest or exercise.CHF is the primary outcome of cardiovascular disease,and the increasing morbidity and mortality rates highlight the significant risks of this condition.According to traditional Chinese medicine,the pathogenesis of CHF is deficiency of heart qi and heart yang,which predominantly affects the heart,but may also impede the function of other zang-organs such as the spleen and kidney,and aggravate the symptoms of heart failure.With technological advancements and enhanced awareness of health conditions and disease prevention,China has promoted traditional medicine practices such as medicine and food homology(MFH),which has received increasing attention in recent years.This concept stipulates that certain medicines and foods have the same origin;ergo,these foods have medicinal properties,with many being used in the pre-vention and treatment of CHF.However,the efficacy and safety of MHF substances have yet to be determined,and there is no consensus regarding the development of disease prevention and treatment strategies.This article therefore reviews the current evidence for MFH in the prevention and treatment of CHF by summarizing the therapeutic potential of this practice and discussing treatment strategies and aims to improve the understanding of Chinese medicine and food homologous substances in the treatment of this condition,as well as highlight the current literature and avenues for future research.
文摘There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.
文摘Objective: To implement the whole-process capacity management model led by specialist nurses, improve the capacity management behavior of medical staff, and build a standardized, standardized and operable CHF capacity management system. Methods: According to the evidence pyramid principle and search strategy, 2 evidence-based nursing backbone completed literature search in both Chinese and English, and finally included 7 literatures. Results: Around the three key links of capacity assessment, monitoring and management, stakeholders were invited to evaluate each evidence according to the FAME principle, that is, the feasibility, suitability, effectiveness and clinical significance of evidence. Finally, 11 best evidences were obtained and 5 clinical review indicators of the cost project were transformed. This study formulated the competence management plan for CHF patients based on the current situation, established competence load evaluation criteria for CHF patients, and determined the target “dry weight” value for CHF patients. Conclusion: The whole-course volume management model of CHF patients guided by specialist nurses should be established and applied and promoted in the “heart failure Center Alliance unit”, so as to improve the capacity management ability of medical staff for CHF patients, enhance the self-management ability of CHF patients, improve the capacity management behavior and health outcomes, and effectively reduce the hospitalization rate and mortality rate of CHF patients in the region.
文摘BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
基金supported by the National Key Technologies Research and Development Program(2021YFF1200602)the National Science Fund for Excellent Overseas Scholars(0401260011)+1 种基金the National Defense Science and Technology Innovation Fund of Chinese Academy of Sciences(c02022088)Tianjin Science and Technology Program(20JCZDJC00810).
文摘Dear Editor,The primary objective of the letter is to emphasize the importance of personalized management of arterial blood pressure(ABP)in the context of off-pump coronary artery bypass grafting(CABG)surgery.Coronary artery disease,a leading global cause of mortality,necessitates a substantial number of cardiac surgeries,with approximately 400,000 CABG operations conducted annually in the United States.Postoperative heart failure(HF)is a common occurrence after CABG surgery,with readmission rates within 30 d due to HF ranging from 12% to 16%.
文摘Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
文摘BACKGROUND Epidemiological studies have found that the prevalence of chronic heart failure in China is 0.9%,the number of people affected is more than 4 million,and the 5-year survival rate is even lower than that of malignant tumors.AIM To determine the impact of WeChat platform-based health management on severe chronic heart failure patients’health and self-management efficacy.METHODS A total of 120 patients suffering from chronic heart failure with cardiac function grade III-IV,under the classification of the New York Heart Association,were admitted to our hospital in May 2017.In January 2020,they were divided into two groups:A control group(with routine nursing intervention)and an observation group(with WeChat platform-based health management intervention).Changes in cardiac function,6-min walking distance(6MWD),high-sensitivity cardiac troponin(hs-cTnT),and N-terminal pro B-type natriuretic peptide(NT-proBNP)were detected in both groups.The Self-Care Ability Scale(ESCA)score,Minnesota Living with Heart Failure Questionnaire score,and compliance score were used to evaluate self-management ability,quality of life,and compliance of the two groups.During a follow-up period of 12 mo,the occurrence of cardiovascular adverse events in both the groups was counted.RESULTS The left ventricular ejection fraction,stroke output,and 6MWD increased,and the hs-cTnT and NT-proBNP decreased in both the groups,as compared to those before the intervention.Further,cardiac function during the 6MWD,hs-cTnT,and NT-proBNP improved significantly in the observation group after intervention(P<0.05).The scores of self-care responsibility,self-concept,self-care skills,and selfcare health knowledge in the observation group were higher than those of the control group before intervention,and their ESCA scores were significantly improved after intervention(P<0.05).The Minnesota heart failure quality of life(LiHFe)scores of physical restriction,disease symptoms,psychological emotion,social relations,and other items were decreased compared to those of the control group before intervention,and the LiHFe scores of the observation group were significantly improved compared to those of the control group(P<0.05).With intervention,the compliance scores of rational diet,regular medication,healthy behavior,and timely reexamination were increased,thereby leading to the compliance scores of the observation group being significantly improved compared to those of the control group(P<0.05).During the 12 mo follow-up,the incidence rates of acute myocardial infarction and cardiogenic rehospitalization in the observation group were lower than those of the control group,and the hospitalization time in the observation group was shorter than that of the control group,but there was no significant difference between the two groups(P>0.05).CONCLUSION WeChat platform-based health management can improve the self-care ability and compliance of patients with severe chronic heart failure,improve the cardiac function and related indexes,reduce the occurrence of cardiovascular adverse events,and enable the avoidance of rehospitalization.
基金Supported by Basic Research on Medical and Health Application of the People's Livelihood Science and Technology Project of Suzhou Science and Technology Bureau,No.SYS2020102.
文摘BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.
文摘Objective： To standardize pain management in the anesthesia recovery period and improve the effects of analgesia on acute postoperative pain. Methods： Using healthcare failure mode and effect analysis （HFMEA）, we analyzed the primary cause of patients＇ pain and subsequently determined the process and risk priority number （RPN）. Results： Actions were taken to improve patients＇ pain. After using HFMEA, the experimental group＇s visual analog scale （VAS） scores were lower than those of the control group at 1 h and at discharge from the post-anesthetic intensive care unit （PAICU）. The differences were statistically significant （P 〈 0.05）. Conclusions： The application of failure mode and effect analysis can relieve pain and improve the quality of nursing.
文摘Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated with late nephrology case management and to describe the evolution of patients depending on the time of care nephrology. Material and Methods: It was a 5-year prospective study, observational type, going from January 1st, 2010 to December 31th, 2014. We studied all the patients hospitalized with chronic renal failure with dialysis or not and we excluded the patients hospitalized for acute renal failure. Results: The study population includes 307 men (53.4%) and 268 women (46.6%) with a sex ratio of 1.14. Age population ranged between 15 and 85 years old with a mean of 44.4 ± 16.20 years old. Their profession was distributed as follows: 220 housewives (38.3%), 181 workers (31.5%), 104 civil servants (18.1%), 56 students (9.7%) and 14 unemployed (2.4%). Patients came from all regions of the country: Conakry: 389 patients (67.6%);Lower Guinea: 82 (14.3%);Middle-Guinea: 57 (9.9%);Upper Guinea: 31 (5.4%);Guinea Forest Region: 16 (2.8%). In this study population, 48 patients were admitted in emergency (8.3%);105 were scheduled (18.3%) and 422 were referred to the nephrology department (73.4%). Reasons for the emergency admission were acute pulmonary edema in 21 patients (43.7%), decompensated anemia in 13 patients (27.1%), loss of consciousness in 9 patients (18.7%) and malignant hypertension in 5 patients (10.4%). The reference patterns was uremic syndrome in 312 patients (54.3%), followed by high blood pressure in 247 patients (42.9%), an edematous syndrome in 234 patients (40.7%), oligoanuria in 222 patients (38.6%), morphological abnormalities on the renal ultrasound in 4 patients (0.7%). The functional symptoms were vomiting in 379 patients (65.9%), followed by dyspnea in 290 patients (50.4%), headaches in 287 patients (49.9%). Among them, 121 patients could handle alone, 431 were borne by their families and 23 were indigent;181 patients had consulted before 1 month of the beginning of the signs, 238 between 1 and 2 months and 156 after 2 months;48 were admitted in emergency, 105 were programmed by the Nephrology Department and 422 were referred to the other health structures of the country. Conclusion: Several factors contributed to the delay in treatment, among which: the low socioeconomic level, the delay of the reference of the patients, the long distance of the regions, the lack of Nephrology units in the country.
文摘It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to revisit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short- and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.
文摘Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
文摘The objective of this study is to investigate a network failure problem with a significant path, emerging from the context of crisis management, such as in the case of natural disasters. For a given tree with m failed edges, we assume that we have sufficient resources to recover k edges of the m edges. Each node has a positive weight. In this situation, we consider which k edges should be fixed in order to maximize the sum of the weights of the nodes reachable from the significant path. In this paper, we formulate such a problem as a combinatorial problem. Further, we show that a part of our problem may be solved by translating it into the terms of the so-called tree knapsack problem.
文摘Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharmacists of the Franche-Comte region (France) and patients of the Franche-Comté Heart Association. Method: Two questionnaires were drawn up and sent to pharmacists and patients. Results: The 118 pharmacists participating in this survey (36.9%) felt that they had a role to play in dispensing drugs (100.0%), educating patients about their treatment (83.1%), informing patients about the importance of observance (81.4%) and over- the-counter drugs (58.5%), distributing heart failure brochures (51.7%) and providing medical equipment (44.9%). On the other hand, only a third of them thought that they should inform patients about their illness and give advice by phone. On the whole, knowledge level is good for disease, drug therapy, contraindicated drugs, medical supervision and hygieno-dietetic management, but intermediate or poor for alert signs of decompensation, essential vaccinations and patient associations. University training in this area during formal pharmacy studies is considered either “insufficient” or “very insufficient” in 56.9% of cases. Although more than 99% of the pharmacists think that additional training is needed, only 33.1% had actually benefited from such training. Of the 96 patients (48.0%) who completed the questionnaire, 92.6% are faithful to their pharmacist. They contact him more about drug therapy than about their disease, or information related to treatments. Roles attributed to their pharmacist are mainly related to drug therapy explanation and information concerning over-the-counter drugs. Therapeutic education is known to 40.6% of interrogated patients. Among these patients, two-thirds depend on their pharmacist and feel that he is capable of providing the necessary education. Moreover, 46.2% of patients had received some form of therapeutic education from their pharmacist. Pharmacists believe that they are able to assume this role in 67.8% of cases. Conclusion: In spite of biases, this study allowed us to assess the expectations of heart failure patients with regard to the pharmaceutical management of their disease, thus clarifying the indispensable contribution that pharmacists make in the management of this disease.
文摘Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants;average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.
文摘Background: Renal failure (RF) is a frequent complication during multiple myeloma (MM) and sometimes reveals the disease. The median survival of MM patients with RF is shorter than that of patients with myeloma without renal involvement. Although patient survival has been prolonged with the new therapies, the median survival does not exceed five to seven years. Few data on this subject are available in sub-Saharan Africa. Objectives: To describe the therapeutic management and evolution of MM with RF in a developing country like Togo. Method: This was a retrospective descriptive and analytical study which took place over a period of ten years (2010-2019) and included the records of patients with MM according to the 2009 and/or 2014 IMWG criteria, hospitalized or followed up in the nephrology and rheumatology departments of the CHU-SO with a GFR Results: During the study period, 78 patients with MM had renal failure (55.7%). Therapeutically, hygienic and dietary measures were dictated in 84.6% of cases (68 patients). Rehydration was performed in 38 cases (48.7%);alkalinization of urine in 10 cases (12.8%);use of antibiotics in 36 cases (46.2%), NSAIDs in 51 cases (65.4%);use of biphosphonates in 36 cases (46.6%). Surgical immobilization by screw-plate osteosynthesis was performed in 02 patients. Nephrologically, 8 patients underwent ESRD. The different chemotherapy protocols used were Melphalan-Prednisone in 70% of cases, Melphalan-Cyclophosphamide-Prednisone in 26.7% of cases and Cyclophosphamide-Prednisone in 3.3%. The median overall survival was 8 months. The median survival was 13 months in patients who recovered from renal failure versus 2 months in those who did not recover from renal failure (p = 0.0030). Of the 78 patients in our series, 22 patients had died (28.2%). Conclusion: Despite renal failure, the Alexanian protocol and biphosphonates are still widely used in combination with symptomatic treatment with significant results.
文摘Heart failure (HF) is a clinical syndrome due to structural and/or functional cardiac anomalies, accompanied by elevated natriuretic peptide levels and/or cardiogenic pulmonary or systemic congestion;severely compromising patients’ health, performance and quality of life. The advancement of novel treatment and their endorsement by international medical and scientific societies have shifted the treatment of HF with reduced ejection fraction (HFrEF) towards quadruple therapy: an angiotensin receptor-neprilysin inhibitor or an angiotensin-converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium/glucose co-transporter-2 inhibitor (SGLT2i). This paper reviews the available literature on state-of-the-art diagnostic and therapeutic advances in HFrEF, discusses landmark trials that shifted the paradigm towards quadruple therapy in HFrEF, visits the potential challenges in Lebanon and globally, proposes an algorithm for treatment introduction and sequencing in HFrEF and highlights clinical considerations for HFrEF management and patient education and follow-up. This practical guidance could serve cardiologists and other medical specialists in identifying clinical signs of HFrEF, diagnosing patients, referring them or prescribing the components of quadruple therapy, and offering medical advice and follow-up. We highlight the role of SGLT2is in HF management and their effectiveness in reducing rates of hospitalization for HF as well as cardiovascular deaths, with satisfactory safety profile.
