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.

[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.