Reducing the incidence of stroke-associated pneumonia: an evidence-based practice.

BACKGROUND: Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). AIM: The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. METHODS: The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. RESULTS: A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. CONCLUSIONS: Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.

Impact of the systematic use of the volume-viscosity swallow test in patients with acute ischaemic stroke: a retrospective study.

BACKGROUND: Dysphagia is common after stroke. Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Early detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. The aim of the study was to assess the impact of the systematic administration of the volume-viscosity swallow test (V-VST) in patients with acute ischaemic stroke. METHODS: This was a retrospective observational study that enrolled patients with acute ischaemic stroke in two consecutive time periods: pre-V-VST, when the 30-mL water-swallowing test (WST) was systematically administered, and V-VST, when all patients underwent the WST and the V-VST test was systematically administered if the patient failed the WST. RESULTS: Two hundred and 42 patients were enrolled. The mean age of the participants was 68.8 ± 10.88 years, 61.2% were male, and the median National Institutes of Health Stroke Scale score was 3 (IQR, 1-6). A total of 147 patients were enrolled during the pre-V-VST period and 95 were enrolled during the V-VST period. There was a significant difference in the occurrence of SAP (21.8% vs. 10.5%, p = 0.024) and the rate of nasogastric tube feeding (25.9% vs. 14.7%, p = 0.040) between the two groups, and no differences were found in the length of hospital stay (p = 0.277) or the total cost of hospitalization (p = 0.846). CONCLUSIONS: The V-VST was a better clinical screening tool, and it can also provide detailed suggestions regarding dietary modifications to prevent aspiration and SAP.

Factors influencing health behaviour, blood pressure control, and disability in hypertensive ischaemic stroke patients after a comprehensive reminder intervention.

AIMS: To test prospective pathways of a Comprehensive Reminder System based on the Health Belief Model (CRS-HBM), stroke knowledge, health belief in health behaviour, blood pressure (BP) control, and disability in hypertensive ischaemic stroke patients at 6-month postdischarge. DESIGN: A nested cohort study design. METHODS: Data were derived from a randomized controlled trial evaluating the effects of the intervention (N = 174, performed during February 2015 - March 2016). Data were collected by questionnaires and analysed in structural equation modelling in Mplus software. RESULTS: The proposed model provided a good fit to the data. This model accounted for 51.5% of the variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. The CRS-HBM had: (a) direct positive effect (ß = .391, p < .001) and indirect positive effects (ß = .186, p = .002) on health behaviour; (b) direct positive effect (ß = .356, p < .001) and indirect positive effects (ß = .183, p = .009) on BP control; and (c) indirect negative effect (ß = -.146, p = .008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief. CONCLUSIONS: The CRS-HBM can not only directly but also indirectly improve patients' health behaviours by improving their health knowledge or health belief. Better health behaviour can improve patients' BP control and reduce disability. Therefore, nurses need to pay more attention to not only patients' health knowledge but also their health belief when providing education. IMPACT: The CRS-HBM intervention accounted for 51.5% of variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. This research can help nurses improve health education strategies in postdischarge and community contexts to achieve better health results.

Glucose screening within six months postpartum among Chinese mothers with a history of gestational diabetes mellitus: a prospective cohort study.

BACKGROUND: Gestational diabetes mellitus (GDM) is a risk factor for diabetes mellitus. The 75-g, 2-h oral glucose tolerance test is recommended for mothers with a history of GDM to screen for diabetes in the postnatal period. The aim of this study was to investigate the rate of glucose screening within 6 months postpartum among Chinese mothers with a history of GDM, and to identify its predictors. METHODS: A prospective cohort study was conducted in a regional teaching hospital in Guangzhou, China, between July 2016 and June 2017. The participants were Chinese mothers (n = 237) who were diagnosed with GDM, were aged 18 years or older with no serious physical or mental disease and had not been diagnosed with type 1 or type 2 diabetes prior to their pregnancy. The revised Chinese version of the Champion's Health Belief Model Scale and social-demographic and perinatal characteristics factors were collected and used to predict postpartum glucose screening (yes or no). Adjust odds ratio (AOR) and 95% confidence interval (95% CI) were calculated. RESULTS: The mean age of the 237 mothers was 32.70 years (range from 22 to 44). Almost half of the mothers (45.6%) were college graduates or higher. Chinese mothers reported a high level of perceived benefits, self-efficacy, and health motivation towards postpartum glucose screening, with a mean score above 3.5. Chinese mothers were more likely to undertake postpartum glucose screening if they were a first-time mother [AOR 2.618 (95% CI: 1.398-4.901)], had a high perceived susceptibility score [AOR 2.173 (95% CI: 1.076-4.389)], a high perceived seriousness score [AOR 1.988 (95%CI: 1.020-3.875)] and high perceived benefits score [AOR 2.978 (95%CI: 1.540-5.759)]. CONCLUSION: The results of this study will lead to better identification of mothers with a history of GDM who may not screen for postpartum glucose abnormality. Health care professionals should be cognizant of issues that may affect postpartum glucose screening among mothers with a history of GDM, including parity, perceived susceptibility, perceived seriousness and perceived benefits.

[Effect of Jian'erle Granule on Thl7/Treg Imbalance of Asthma Mice].

Objective To observe the levels of Th17 associated inflammatory factor IL-17 and Treg associated inflammatory factor IL-10 in serum and bronchoalveolar lavage fluid (BALF) of bronchial asthma mice, and to explore the mechanism of Jian'erle Granule (JG) for preventing and treating asth- ma. Methods Totally 40 Balb/c mice were divided into 4 groups according to random digit table, i.e., the normal control group, the asthma group, the post-excitation asthma group, the JG +asthma group, 10 in each group. Asthma model was established by 1% ovalbumin (OVA) (grade V) solution sensitization and excitation after intraperitoneal injection of antigen suspension in all groups except the normal control group. JG (0. 36 g/mL) was administrated to mice in the JG +asthma group after modeling. Equal volume of normal saline was administrated to mice in the rest 3 groups. All medication lasted for 14 successive days. After medication mice in the JG +asthma group and the asthma group were excited with 1% OVA (grade I) again for 40 min by atomization inhalation. Lung inflammation was examined by HE staining. Levels of IL-10 and IL-17 in BALF and serum were measured by ELISA. Results Bronchial structure in lung tissue was normal in mice of the normal control group, with no inflammatory infiltration seen. Mucosal epithelial cells of bronchial wall were injured in the asthma group and the post-excitation asthma group, with inflammatory infiltration seen. Inflammation around bronchus and blood vessels was obviously attenuated in the JG+asthma group. Compared with the normal control group,the IL-17 level in serum and BALF significantly increased, IL-10 level significantly decreased in the asthma group (P <0.01). Compared with the asthma group, IL-17 level in serum and BALF increased and IL-10 level in serum and BALF decreased in the post-excitation asthma group (P <0.01). Compared with the asthma group, the IL-17 level in serum and BALF significantly decreased, IL-10 level significantly increased in the JG +asth- ma group (P <0. 01). Compared with the post-excitation.asthma group,the IL-17 level in serun and BALF significantly decreased and IL-10 level in serum and BALF significantly increased in the JG + asthma group (P <0. 01). Conclusion The mechanism for JG preventing and treating asthma might be correla- ted with regulating Th17/Treg cytokine balance in serum and BALF.

Relationship between frailty and long-term care needs in Chinese community-dwelling older adults: a cross-sectional study.

OBJECTIVES: Our study aimed to investigate the relationship between the severity of frailty and the long-term care (LTC) needs of older adults from Chinese communities. DESIGN: A cross-sectional study. SETTING: Three Chinese community health centres. All data were collected by trained researchers through face-to-face collection. PARTICIPANTS: We surveyed a total of 540 older residents who aged 60 or older from community in Guangzhou, China. MEASURES: The Chinese version of the Tilburg frailty indicator was used to assess the frailty status of participants. LTC needs was evaluated by Integrated Home Care Services Questionnaire. Using non-adjusted and multivariate adjusted logistic regression analysis to evaluate frailty and LTC needs, then smoothed plots, threshold effect analysis and P for trend were used to further investigate the relationship between them. RESULTS: The prevalence of frailty was 45.2% among the 540 older adults enrolled (aged 70.4±8.3 years; 65.7% females). 27% had higher LTC needs, which increased to 65.1% for individuals with frailty. Logistic regression analysis showed that frailty was strongly associated with LTC needs (OR 3.06, 95% CI 2.06 to 4.55, p<0.01). In the multivariate model, after adjusting for demographic characteristics, economic situation, activities of daily living and comorbidities, frailty remained significantly associated with LTC needs (OR 2.32, 95% CI 1.39 to 3.88, p<0.01). The smoothed plots showed a nearly linear relationship between frailty and LTC needs. Threshold effect analysis showed that every point increase in frailty, the score of LTC needs increased 1.3 points. The IQR to regroup individuals with frailty. Compared with the first quartile (scores ≤2), the incidence of LTC needs increased with the frailty status (p value for trend <0.01). CONCLUSION: There is a linear relationship between frailty and LTC needs. With the increasing degree of frailty, the LTC needs of older adults dramatically increases.

N-(4-Chloro-2-nitro-phen-yl)-5-methyl-isoxazole-4-carboxamide.

In the title compound, C(11)H(8)ClN(3)O(4), the dihedral angle between benzene and isoxazole rings is 9.92 (1) °. The nitro group is almost coplanar with the benzene ring with an O-N-C-C torsion angle of 8.4 (3)°. The mol-ecular conformation is stabilized by an intra-molecular N-H⋯O hydrogen bond, closing a six-membered ring.

Trapping the lead ion in multi-components aqueous solution by natural clinoptilolite.

To study whether natural clinoptilolite could selectively capture Pb(2+) ion in the aqueous solution containing salt and glycine as well as nitrosamines, the natural zeolite was utilized in the complex solution with pH value of 1.2 in comparison with other porous materials such as zeolite NaZSM-5 and activated carbon. Clinoptilolite exhibited the highest capability in adsorbing Pb(2+) ion in the solution at 37 degrees C, achieving the capacity of 7 mg/g, two times more than that by other zeolites and six times over that by activated carbon, and the adsorption equilibrium could be achieved within 2h. The impacts of solid-liquid ratio, initial concentration of Pb(2+) and the competition of other metal ions or volatile nitrosamines on the adsorption were examined, and the change in Gibbs energy for the ion-exchanged of Pb(2+) ion by clinoptilolite was discussed, through which the ion-exchange process was proven to be spontaneous. Moreover, both the selectivity of clinoptilolite toward Pb(2+) ion in complex solution and the venial toxicity of clinoptilolite on the viability of RAW264.7 cells were investigated in this article.