Study on the Nursing Effect of Diabetes Health Education Nursing Methods Applied to Diabetes Patients in the Endocrinology Department

The aim of this study was to explore the nursing effect of diabetes education and nursing methods applied to diabetic patients in the endocrinology department. From October 2019 to October 2020, 90 patients with diabetes who were admitted to the Department of Endocrinology in our hospital were selected as the research objects, and the medical records of all patients were retrospectively analyzed. The patients were randomly divided into two groups, 45 patients who were given regular care as the control group and 45 patients who were given the diabetes health education care model as the experimental group. Routine care was given to patients in the routine group; that is, we paid attention to the patients’ diet, medication, and blood glucose levels. The experimental group patients were given diabetes health education guidance. The nursing effect, blood sugar level, disease awareness level, occurrence of complications, and compliance of the two groups of patients were evaluated. In this study, diabetes health education was given to the experimental group of patients. The conditions of this group of patients were significantly better than those of the basic group using conventional nursing methods. Therefore, the application of diabetes health education is very effective. The recovery from the disease has positive significance.

Direct Costs of Healthcare for Children with Type 1 Diabetes Using a CGM System: A Health Economic Analysis of the VIDIKI Telemedicine Study in a German Setting

Aims The Virtual Diabetes Outpatient Clinic for Children and Adolescents (VIDIKI) study was a 6-month quasi-randomized, multicentre study followed by an extension phase to evaluate the effects of monthly video consultations in addition to regular care. A health economic analysis was conducted to assess the direct costs. Methods The cost data of 240 study participants (1–16 years of age) with type 1 diabetes who were already using a continuous glucose monitoring system were collected in the first 6 months of the study. The intervention group (IG) received monthly video consultations plus regular care, and the waiting control group (WG) received only regular care. Cost data were collected for a comparable anonymized group of children from the participating health insurance companies during the 6-month period before the study started (aggregated data group [AG]). Results Cost data were analysed for the AG (N=840) 6 months before study initiation and those for the study participants (N=225/240). Hospital treatment was the highest cost category in the AG. There was a cost shift and cost increase in the IG and WG, whereby diabetes supplies were the highest cost category. The mean direct diabetes-associated 6-month costs were € 4,702 (IG) and € 4,936 (WG). Conclusion The cost development within the cost collection period over two years possibly reflects the switch to higher-priced medical supplies. Video consultation as an add-on service resulted in a small but nonsignificant reduction in the overall costs.

Relationship between care model and disease activity states and health-related quality of life in systemic lupus erythematosus patients

Objective To assess whether the care model (comprehensive vs regular) has any impact on the clinical outcomes of systemic lupus erythematosus patients. Methods Between August 2019 and January 2020, we evaluated SLE patients being cared for at two Peruvian hospitals to define the impact of care model on disease activity state and health-related quality of life (HRQoL). Disease activity was ascertained with the SLEDAI-2K and the Physician Global Assessment (PGA) which allows to define Lupus Low Disease Activity State (LLDAS) and Remission. HRQoL was measured with the LupusQoL. The association between care model and disease activity (Remission and LLDAS) state was examined using a binary logistic regression model. The association with HRQoL was examined with a linear regression model. All multivariable analyses were adjusted for possible confounders. Results 266 SLE patients were included, 227 from the comprehensive care model and 39 from the regular care model. The regular care model was associated with a lower probability of achieving remission (OR 0.381; CI: 95% 0.163–0.887) and LLDAS (OR 0.363; CI: 95% 0.157–0.835). Regular care was associated with a better HRQoL in two domains (pain and emotional health). We found no association between the care model and the other HRQoL domains. Conclusion A comprehensive care model was associated with the probability of achieving remission and LLDAS but had no apparent impact on the patients’ HRQoL.

Parkinson’s patients situation during the SARS CoV-2 pandemic and their interest in telemedicine A cross-sectional study

Background During the SARS CoV-2 pandemic, telemedicine experienced an enormous boom. Also, for Parkinson’s patients there are upcoming alternatives to regular care. Objective The aim of the present study was to interview Parkinson’s patients under the impression of the first lockdown in Germany about their health care situation, but especially about the use of and attitudes towards videotherapy and -consultation. Methods Northern German members of the German Parkinson Association were mailed a 16-item questionnaire including demographic questions on a one-time basis. The voluntary participants answered regarding their health care situation during the first German SARS CoV-2 lockdown, as well as attitudes towards videotherapy/-consultations. Results The 332 (of 974 questionnaires) responding evaluated their care situation predominantly (58.7%) unchanged during lockdown. There was hardly any previous experience in the areas of videotherapy and -consultations (15.4% and 3%, respectively), but at the same time mostly imaginability of implementation (54.2% and 56%, respectively) and the belief that they could motivate themselves to do so (51.8%). A total of 69% welcomed technical support for the implementation of videotherapy. Conclusion In principle, there seems to be both, a need and an interest in telematics in healthcare such as videotherapy and video consultations, even if further barriers such as technical implementation need to be addressed. An expansion of telemedical services and infrastructure seems desirable not only in the pandemic situation, but also in the long term against the backdrop of demographic change, especially in an area like Schleswig-Holstein. Further studies are needed.

Long-term ocular damage after recovery from COVID-19: lack of evidence at three months

Importance A small number of COVID-19 patients has been reported to suffer from acute keratoconjunctivitis. In very rare cases, acute inflammatory retinal vein occlusion, papillophlebitis or retinopathy have been observed. Objective To determine possible long-term effects on the eye, especially on the retina, in patients who had suffered from COVID-19 at least 3 months after recovery. Design Prospective cross-sectional study. Setting Hospital of the Ludwig Maximilians University, Munich. Participants Patients who had been tested positive for SARS-CoV-2 or for anti-SARS-CoV-2 IgG serum antibodies in the Hospital of the Ludwig Maximilians University, Munich between May and September. Methods Patients who had tested positive were either hospitalized or discharged into home quarantine via the emergency room. Three months after recovery, they were invited to participate voluntarily for this study during their follow-up in our clinic. A complete ophthalmological exam including functional and imaging end points (including optical coherence tomography (OCT), OCT angiography) was performed. Main outcomes and measures Visual acuity, slit lamp, bio microscopy and fundoscopy, multimodal imaging findings. Results In total, 21 patients were examined. The mean age (SD) of the patients was 48.7 (18.3) years. Of these, 14 (66.6%) were hospitalized and 7 (33.3) were discharged home. Two hospitalized patients (9.5%) received invasive ventilation. During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. Ophthalmological examination of the previously hospitalized group took place 111.4 (23.2) days after recovery and discharge from the hospital, while non-hospitalized patients were examined after mean 123.4 (44.7) days. All patients showed normal findings for anterior and posterior segment of both eyes. OCT and OCT-A showed no evidence of retinal damage, or vascular or microvascular events. Conclusion and relevance This study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3 months after recovery from COVID-19, without previous eye involvement. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence.

Reducing Aspiration Pneumonia Risk for Older People: Effect of Evidence-Based Oral Care

Poor oral health increases the risk of aspiration pneumonia for older people. This is due primarily to six pathogens found in the mouth: five bacteria and one fungus. With a cohort of older people who were dependent on others for their oral care, we analyzed the load and type of bacteria and fungi from swabs of cheek, gum, and tongue mucosa. There were no significant differences between the three sites for load of bacteria (H (2) = .89; p = .64); there were significant differences between the sites for type of bacteria (F (2,78) = 11.97; p <.001) with the tongue showing the greatest diversity. There were no significant differences between the three sites for load (H (2) = 2.94; p = .23) or type (F (2,77) = .46; p = .63) of fungi. We then investigated the effect of regular compared to evidence-based oral care over a six-week period, and whether evidence-based oral care could significantly reduce the absolute count of the six oral pathogens specifically related to aspiration pneumonia. Participants self-selected into Regular Care (n = 10) and Evidence-based Care (n = 17) Groups. Evidence-based oral care resulted in significant decreases (p = .02 to p < .001) in the load of four potentially pathogenic bacterial species, including E. coli, gut-based bacteria, and in an increased load of Lactobacillus reuteri, a host-protective normal flora in the mouth, compared to baseline. There were no significant differences between groups for the abundance and type of fungi.

Building a Mobile Stroke Unit Based on 5G Technology – A Study Protocol

Background: In-time treatment of acute stroke is critical to saving people’s lives and improving the quality of post-stroke life. A mobile stroke unit (MSU) with fifth-generation (5G) mobile networks strengthens the interaction of patient information and healthcare resources, thereby reducing response times and improving thrombolysis results. However, clinical evidence of better outcomes compared to regular care is still lacking.Method and Design: In this randomized controlled trial, 484 patients with acute stroke are allocated into the MSU and regular care groups. We establish medical records for each patient and conduct a follow-up of 90 days. The primary outcomes are functional results as defined by utility-weighted modified Rankin Scale (uw-mRS) 90 days after the incidence occurred, whereas secondary outcomes include the alarm to CT scan completed time, the alarm to treatment decision time, the alarm to thrombolytic time, quality of life, and symptomatic intracranial hemorrhage combined with NIHSS score as well as cost-effectiveness.Discussion: This study establishes an innovative MSU (based on 5G) to manage acute stroke, comparing its clinical and economic outcomes to regular care and informing decision-makers of the effectiveness of the stroke emergency system.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx?proj=63874], identifier [ChiCTR2000039695].

Outcomes in patients with a first episode of chest pain undergoing early coronary CT imaging

ObjectivesTo investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics.MethodsPatients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care.ResultsMean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively).ConclusionsIn a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality.

The Effectiveness of Telemedical Monitoring Program DiabCare Tirol for Patients with Gestational Diabetes Mellitus

The aim of this paper was to evaluate the effect of telemedical care of gestational diabetes mellitus (GDM) patients with the digital treatment pathway model DiabCare Tirol. Methods: 27 courses of patients with GDM, who were telemonitored through the integrated care program DiabCare Tirol in a diabetes outpatient clinic in Tyrol, Austria during the COVID-19 pandemic in 2020, were analyzed. In addition, randomized controlled trials (RCTs) on telemedicine interventions for GDM were researched, and their results were used for comparison with this disease management method. The patient outcome analysis was used to examine the effects of the integrated care program involving telemonitoring support and compared them to the results of RCTs in which participants were randomly assigned to one of two groups, either mobile monitored or standard treatment group. Results: The feasibility of the digital treatment pathway model was confirmed in practice, as the trend analysis of the 27 GDM patients involved showed significantly improved glycaemic control. Results of RCT studies tend to support the findings of DiabCare Tirol. Conclusion: Benefits of telemonitoring with integrated care to support conventional therapy cannot be dismissed, especially in times of the pandemic. Continuous outcome research with larger patient numbers will be necessary to confirm the effectiveness of telemonitoring in a regular care setting.

System of providing cancer care in the Netherlands during COVID-19 pandemic: assessing the consequences of the first wave

The COVID-19 pandemic has had a huge impact on healthcare systems in many countries around the world, including the cancer care system in the Netherlands. During the first smart lockdown, the number of consultations by family physicians (general practitioners) decreased by 70%, and the number of referrals of patients to specialized centers (hospitals) decreased by 75 %. Since the 9th week of 2020, in which the first case of COVID-19 in the Netherlands was confirmed, there has been a marked decrease in the number of diagnosed oncological diseases. When compared with the first weeks of 2020, the number of diagnoses at the peak of the pandemic decreased by 20-4 0%. 20th week and onwards saw the recovery of the diagnostic system, although the number of detected cases of cancer remained low. Screening programs for breast, colon and cervical cancer have been suspended at 12th week of 2020. Further clinical studies are needed to identify the real effects of the pandemic on long-term outcomes (survival and quality of life) in cancer patients. It is important to remove unnecessary barriers for patients to seek care in primary health care and to ensure continued regular care during the pandemic.