Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it is a key ocular fundus disease that needs to be paid attention to in the next five years according to the "14th Five-Year" Plan for Eye Health. Promoting the systematic management of DR and constructing the chronic disease management system are the key to the next step of national eye health work. It is necessary to further improve the management mode of the whole course of DR patients with chronic eye disease through the joint action of medical security system at all levels, including strengthening supporting policies of primary medical institutions, optimizing medical service mode and process, strengthening scientific education to improve patients' and doctors' disease cognition, and updating authoritative Chinese DR guidelines to standardize diagnosis and treatment. It is hoped that the low vision and blindness caused by DR in China can be greatly reduced after the implementation of the "14th Five-Year" Plan for Eye Health.
ObjectiveTo systematically review the efficacy of discharge preparation service in elderly patients with chronic diseases.MethodsCNKI, WanFang Data, VIP, Web of Science, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect randomized controlled trails (RCTs) on the discharge preparation service for elderly patients with chronic diseases from January, 2000 to January, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs, involving 884 patients were included. The results of meta-analysis showed that: after the hospitalization preparation service, the incidence of acute complication (RR=0.38, 95%CI 0.15 to 0.98, P=0.04), patient compliance behavior (SMD=0.54, 95% CI 0.25 to 0.83, P=0.000 3), exercise capacity (SMD=2.65, 95%CI 0.25 to 5.04, P=0.03), and nursing satisfaction (SMD=0.71, 95%CI 0.10 to 1.33, P=0.02) significantly improved. However, there were no significant differences in emergency hospital admission for acute complications (RR=0.25, 95%CI 0.06 to 1.11, P=0.07), self-care ability (SMD=2.18, 95%CI ?1.02 to 5.38, P=0.18), activity of daily living (ADL) (SMD=0.56, 95%CI ?0.47 to 1.59, P=0.28).ConclusionsThe current evidence shows that after implementation of the discharge preparation service, the incidence of acute complication, compliance behavior, exercise ability, and service satisfaction of the elderly patients with chronic diseases are significantly improved. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
ObjectiveUse information technology to establish an “Internet+” chronic disease management model to provide patients with a full process, seamless, and convenient services. Explore a new model of “Internet+” chronic disease management and care services in the region. Methods Patients with chronic diseases treated in Mianyang Central Hospital from May 2018 to April 2019 were selected. The patients were randomly divided into intervention group and control group according to the single and even number at the end of hospitalization number. The control group adopted the traditional chronic disease management mode, and the intervention group adopted the “Internet+” chronic disease management mode based on the patients’ needs. And select the nursing experts who provide “Internet+” online nursing services. Compared with the effective management before and after the implementation of “Internet+” chronic disease management, the number of patients with chronic diseases, clinical outcome indicators, the number of health education readings, the number of Internet nursing services, and the sense of professional benefit of nurses and other indicators, etc. Results A total of 143 patients were included, including 78 in the control group and 65 in the intervention group. A total of 28 nursing experts were investigated. The effective management rate of patients with chronic diseases was 78.7%. The WeChat public account “Slow Disease Window” has read nearly 90 000 person-times, and the Internet Hospital “Nursing Professional Online” has nearly 2 000 online nursing services. After participating in “Internet+” chronic disease management, the disease activity and functional status of chronic disease patients were significantly improved (P<0.05). Nursing professionals have a strong sense of professional benefits (P<0.05). Conclusions With the development of “Internet+” chronic disease management, a new mode of chronic disease management was explored to promote the management of chronic disease more convenient and efficient, so that the health education work can be homogenized, the clinical outcome of the patients was effectively improved. At the same time the career planning of nursing staff can be broadened.
Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence, low awareness, poor prognosis, and high medical costs. Effective follow-up management can facilitate timely adjustment of the treatment of the CKD patients and delay the disease progression. The application of internet of things (IoT) technology in dynamic monitoring and telemedicine is helpful for the self-management of patients with chronic diseases, and can provide convenient, intelligent, and humanized medical and health services. In the future, with the rapid growth of demands of CKD management and innovations in information technology, new medical IoT industry will accelerate the intelligent development of CKD management. Multi-disciplinary and multi-industrial collaboration should be promoted to solve current challenges, such as evaluation of actual effectiveness, the system design and construction, and the accessibility of intelligent healthcare services, to ensure that IoT products can improve clinical outcomes, reduce medical expenditure, and lower disease burden.
Patients with chronic diseases usually face severe challenges during their transition from hospital to home, such as poor discharge preparation, the increased incidence of medical errors, insufficient self-care capability, and poor participation in healthcare decision, which can result in increased readmission and poor patient safety. This paper reviews the definition of transitional care, single-element transitional care intervention strategy, and multiple-element transitional care intervention strategy, in order to provide new insights into the development of effective and safe transitional care strategies in China.
This paper introduces the background and research design (including site of investigation, study population, baseline survey and follow-up monitoring), which belongs to the Precision Medicine Project of the National Key Research and Development Program of China.
The new coming era has brought great challenge to present health service model, and the development of new science and technology had improved the reconstruction of medical system and model. With the guidance of evidence-based management and participation of model technology, this paper provides an explanation of the new health service model containing new health management, clinical medicine, chronic disease management and elder care which cover the whole life cycle, so as to implement the " Health China” strategy and develop a whole life cycle health service system for all residents with necessary, high quality, and affordable prevention, treatment, rehabilitation and health promotion.
The 14th Five-Year Plan for National Health explicitly proposes elevating the comprehensive prevention and control strategy for chronic diseases to the national strategy, aiming to address the growing demand for long-term management and individualized treatment of chronic diseases. In this context, the adaptive treatment strategy (ATS), as an innovative treatment model, offers new ideas and methods for the management and treatment of chronic diseases through its flexible, personalized, and scientific characteristics. To construct ATS, the sequential multiple assignment randomized trial (SMART) has emerged as a research method for multi-stage randomized controlled trials. The SMART design has been widely used in international clinical research, but there is a lack of systematic reports and studies in China. This paper first introduces the basic principles of ATS and SMART design, and then focuses on two key elements of the SMART design: re-randomization and intermediate outcomes. Based on these two elements, four major types of SMART designs are summarized, including: (1) SMART designs in which the intermediate outcome corresponds to a single re-randomization scheme (the classical type), (2) SMART designs in which no intermediate outcome is embedded, (3) SMART designs in which the intermediate outcome corresponds to a different re-randomization scheme, and (4) SMART designs in which the intermediate outcome and the previous interventions jointly determine the re-randomization. These different types of SMART designs are appropriate for solving different types of scientific problems. Using specific examples, this paper also analyzes the conditions under which SMART designs are applicable in clinical trials and predicts that the mainstream analysis methods for SMART designs in the future will combine frequentist statistics and Bayesian statistics. It is expected that the introduction and analysis in this paper will provide valuable references for researchers and promote the widespread application and innovative development of SMART design in the field of chronic disease prevention, control, and treatment strategies in China.
ObjectiveTo analyze the health examination results of hospital retirees, understand their health status and provide the evidence for health management.
MethodsThe data were collected from our 1 089 hospital retirees (51-96 years old) who received health examination in West China Hospital of Sichuan University from January to December 2013, including 345 males and 744 females, with a mean age of 70 years. The data were analyzed by SPSS 16.0 software.
ResultsHypertension, dyslipidemia and diabetes were the three chronic diseases with the highest detectable rate, and the rate was respectively 49.49%, 44.90% and 31.04%. The detectable rate of hypertension was not significantly different between male and female. The rate of dyslipidemia in females was higher than that in males. The rate of diabetes in males was higher than that in females. The detectable rate of hypertension and diabetes increased with the increase of age. The detectable rate of dyslipidemia had no significant relationship with age.
ConclusionThe health condition of retirees cannot be neglected. We need to strengthen the health management for the retirees.
Exercise intervention is an important non-pharmacological intervention for various diseases, and establishing precise exercise load assessment techniques can improve the quality of exercise intervention and the efficiency of disease prevention and control. Based on data collection from wearable devices, this study conducts nonlinear optimization and empirical verification of the original "Fitness-Fatigue Model". By constructing a time-varying attenuation function and specific coefficients, this study develops an optimized mathematical model that reflects the nonlinear characteristics of training responses. Thirteen participants underwent 12 weeks of moderate-intensity continuous cycling, three times per week. For each training session, external load (actual work done) and internal load (heart rate variability index) data were collected for each individual to conduct a performance comparison between the optimized model and the original model. The results show that the optimized model demonstrates a significantly improved overall goodness of fit and superior predictive ability. In summary, the findings of this study can support dynamic adjustments to participants' training programs and aid in the prevention and control of chronic diseases.
