Effect of ERAS Combined with Comfortable Nursing on Quality of Life and Complications in Femoral Neck Fractures of the Aged People

Objective. To explore the effect of enhanced recovery after surgery (ERAS) combined with comfortable nursing on the quality of life and complications of elderly patients with femoral neck fracture (FNF). Methods. From May 2019 to May 2020, 80 senile FNF patients who admitted to our hospital were treated by total hip arthroplasty (THA). All patients were randomly divided upon admission into a control group (CG) with usual care and a study group (RG) with ERAS combined with comfort care of 40 patients each. The postoperative efficacy was assessed by Harris score of hip joint function, and the psychology was evaluated by self-rating anxiety scale (SAS). The SF-36 score of quality of life, the time of catheter removal, the time of getting out of bed, the hospital stays, the satisfaction of nursing, and the Barthel score of self-care ability were compared between the two groups before and after nursing, and the incidence of postoperative complications was also evaluated. Results. Compared with the CG, the SF-36 score of quality of life and Barthel score of self-care ability in the RG were dramatically higher, while the SAS score of anxiety was dramatically lower. Besides, the time of catheter removal, the time of getting out of bed, and the hospital stays in the RG were dramatically lower ( P < 0.05). Furthermore, the nursing satisfaction and postoperative efficacy of patients in the RG were obviously higher (both P < 0.05), while the incidence of complications in the RG was obviously lower ( P < 0.05). Conclusion. ERAS combined with comfortable nursing can improve the hip joint function, quality of life, and self-care ability scores of senile FNF patients; relieve the anxiety in patients; and reduce the incidence of postoperative complications, which is valuable to be applied extensively.

The Clinical Efficacy of Clopidogrel Bisulfate Tablets Combined with Olmesartan Medoxomil for Ischemic Stroke with Hypertension and the Effect of Angiotensin II Type 1 Receptor Level on Prognosis

Background. Ischemic stroke combined with hypertension can increase risks of stroke recurrence and death. Aim. The aim of this study is to investigate the clinical efficacy of clopidogrel bisulfate tablets combined with olmesartan medoxomil in the treatment of ischemic stroke patients with hypertension and the effect of angiotensin II type 1 receptor (AT1R) level on prognosis. Methods. Ninety ischemic stroke patients with hypertension were chosen for continuous treatment with clopidogrel bisulfate tablets and olmesartan medoxomil for 12 months. The Modified Edinburgh Scandinavian Stroke Scale (MESSS) score, Brunnstrom score, Barthel score, death, recurrence, and progression of cerebrovascular residual lesions were observed and recorded during the treatment period. According to the plasma AT1R expression of the patients before treatment, the patients were divided into a high-AT1R group and low-AT1R group. Then, survival analysis was performed. Results. Compared with pretreatment, the MESSS scores of the patients at the first, second, third, sixth, ninth, and twelfth months after treatment were reduced ( p < 0.01 ) while the Brunnstrom score and Barthel score were prominently boosted ( p < 0.01 ). Compared with the low-AT1R group, patients in the high-AT1R group had higher rates of stroke recurrence and progression of residual cerebrovascular lesions ( p < 0.05 ). Conclusion. Clopidogrel bisulfate tablets combined with olmesartan medoxomil has prominent clinical effects in the treatment of ischemic stroke patients with hypertension, evidently improving the prognosis. In addition, the level of AT1R may be a vital factor affecting the prognosis.

Infective endocarditis after transcatheter aortic valve implantation

Introduction Infective endocarditis (IE) is a potentially serious complication in patients with prosthetic heart valves. The objective of this study is to analyze and describe the incidence, baseline characteristics, risks factors and in-hospital evolution in IE after Transcatheter Aortic Valve Implantation (IE-TAVI). Methods All the TAVI implanted in our center since the beginning of the program have been included consecutively. Patients with a confirmed diagnosis of IE according to the “ESC Guidelines for the management of infective endocarditis” are identified and analyzed. Results 331 TAVI have been implanted in our center from June 2009 to February 2021. IE-TAVI incidence in our series is 2.7% (n=9 cases). In baseline analysis, we observed that insulin dependent diabetes mellitus, Barthel Score and Pulmonary systolic pressure &gt;50mmHg are significantly associated with the appearance of IE-TAVI (TABLE 1). The most frequently microorganism is Enterococcus faecalis (44.4%; n=4) followed by Staphylococcus aureus (22.2%; n=2), Coagulase-negative staphylococci (22.2%; n=2) and Streptococcus viridans (11.1%; n=1). 77.8% of IE-TAVI (n=7) are Nosocomial IE or non-nosocomial healthcare-associated IE. 2 of them have been related to implantation (1 Enterococcus faecalis and 1 Coagulase-negative staphylococci) and 5 have been related to other interventions (2 after gastroscopy, 1 after percutaneous vascular intervention, 1 hemodialysis catheter infection and 2 unknown focus). 44.4% of IE-TAVI (n=4) were confirmed after performing Positron Emission Tomography (PET) scan. 3 cases (33.3%) were diagnosed with the initial Transthoracic Echocardiogram (TTE) and 2 cases (22.2%) were diagnosed after performing a Transesophageal Echocardiogram (TEE) (TABLE 2) 4 patients had an indication for surgery according to the ESC Guidelines (3 for persistent bacteremia and 1 for severe aortic regurgitation), but all were ruled out due to high surgical risk. Hospital mortality was 44.4% (n=4). The main predictor of hospital mortality was having an indication for surgery (p=0.028), which was present in 3 of the 4 deaths. The other death was due to digestive bleeding during hospitalization. Conclusions IE-TAVI is a serious disease with high in-hospital mortality. Insulin dependent diabetes mellitus, Barthel Score and Pulmonary systolic pressure &gt;50mmHg are risk factors for IE-TAVI. PET-scan is the imaging test of choice when there were no echocardiographic findings. The main predictor of mortality is having an indication for surgery according to the ESC Guidelines. FUNDunding Acknowledgement Type of funding sources: None.

Effect of Transcranial Direct Current Stimulation Plus Early Rehabilitation Therapy on Cerebral Cognitive Function, Hemodynamics and Life Qualityin Patients

With the implementation of Health China strategy, rehabilitation medicine, as an important branch of medicine, plays an increasingly important role in China’s health. Objective: This paper aims to inquire into the effects of transcranial direct current stimulation (TDCS) plus early rehabilitation therapy on cerebral cognitive function, hemodynamics and quality of life (QOL) in patients with cerebral infarction (CI). Methods: One hundred and eight Clpatients treated in our hospital were randomized into the observation group (OG; n=63) for TDCS plus early rehabilitation therapy and the control group (CG; n=45) for early rehabilitation therapy alone. The changes of hemodynamic index before and after treatment were observed. The eurological deficit [neurological deficit score (NDS)] and cognitive impairment [mini-mental state examination (MMSE)], as well as activity of daily living (ADL; Barthel score) and motor function [Fugl Meyer assessment (FMA)] were compared between the two series. The assessment of neurological function recovery of patients in the two cohors was performed by the National Institutes of Health Stroke Scale (NIHSS). The therapeutic effect of the two groups was compared, as well as the post-treatment QOL referring to the questionnaire of QOL of patients with acute CI. Results: The post-treatment hemodynamic indexes increased in both OG and CG, and the increase was more profound in OG (p<0.05). After treatment, the NDS score in OG was lower while the MMSE score was higher as compared to CG (p<0.05). The Barthel score and the FMA score increased in both groups after treatment, with higher scores in OG (p<0.05). The NIHSS score of both groups decreased post treatment, and the score was lower in OG (p<0.05). OG presented with notably higher total effective rate (p=0.028) and superior QOL than CG (p<0.05). Conclusions: TDCS plus early rehabilitation therapy is effective for patients with early CI, which can enormously improve the neurological function, hemodynamics, activity ability and QOL of patients.

Assessment of functional recovery after cranioplasty

Background: Cranioplasty is done after decompressive craniectomy surgeries either for cosmetic reasons or to afford protection against the development of the syndrome of the trephined which is deterioration after cranial decompression procedures. The aim of the study was to study functional recovery after cranioplasty based on improvement of Barthel activities of daily living (ADL) score.Methods: This was a prospective study done over 6 months period, December 2020 to May 2021. The functional recovery following cranioplasty was assessed based on improvement in Barthel ADL score. Pre-operative and post-operative Barthel ADL score after 3 months after cranioplasty of patients are found out. The change in Barthel score is analyzed and significance found out using paired t test.Results: In this study, 62 patients were included. 42 patients had improvement of ADL score. 14 patients had no change and 6 patients had worsening of score. After cranioplasty, ADL score has improved and it was statistically significant (p<0.001). Also, patients with low level of dependency (level 1, 2 and 3) have decreased in number and patients with higher levels of dependency (level 4 and 5) have increased in number after the surgery, suggesting that there is shift of patients from lower level of dependency to higher levels.Conclusions: Cranioplasty seems to offer patients clear benefits in terms of neurological improvement in many cognitive domains as well as in quality of life. Hence, cranioplasty advocated for functional/neurological recovery rather than cosmetic reasons.

Application and effect evaluation of nursing quality target management in free flap transplantation for hand injury

To explore application and effect of nursing quality target management in free flap transplantation for hand injury. 140 patients with free skin flap transplantation for hand injury admitted to the hand and foot surgery ward of the hospital from January 2017 to December 2019 were selected as the research objects. They were randomly divided into observation group and control group. There were 70 patients in each group, and both groups of patients received microscopic free flap transplantation. The observation group adopted traditional nursing mode and nursing quality target management mode to carry out nursing, while the control group adopted traditional nursing mode to carry out nursing. The treatment compliance, skin flap survival, occurrence of vascular crisis, occurrence of complications, VAS and Barthel comparison score of the two groups were compared. The treatment compliance of patients in the observation group was significantly higher than that in the control group (P < 0.05). The survival rate of skin flap in the observation group was higher than that in the control group (P < 0.05). The incidence of vascular crisis in the observation group was lower than that in the control group (P < 0.05). The postoperative pain in the observation group was better than that in the control group (P < 0.05). There was no significant difference in Barthel score between the observation group and the control group at admission (P > 0.05), but the improvement range of Barthel score in the observation group was higher than that in the control group at discharge (P < 0.05), The satisfaction of patients in the observation group to nurses was higher than that in the control group (p < 0.05). The application of nursing quality target management can improve the treatment compliance of patients, improve the survival rate of free skin flap transplantation for hand injury, reduce the incidence of vascular crisis within 48 hours after operation, reduce the occurrence of postoperative complications, relieve the pain of patients, improve self-care ability and ensure the quality of life.

Comparison of 12-cm versus 6-cm long peripheral catheters in patients with difficult intravenous access (DIVA)

Background: Long peripheral catheter is 6–15 cm long vascular device. The aim of the study was to compare the frequency of complications of two types of long peripheral catheters with different length inserted in DIVA patients. Methods: Under ultrasound navigation 2.7F 6.4 cm or 4Fr 12 cm long peripheral catheter was inserted. Complications of both long peripheral catheters were prospectively observed and their relationship to the patient’s age, gender, selected vein, number of punctures and Barthel score system was evaluated. Results: Ninety-three 12 cm and fifty-five 6.4 cm long peripheral catheters were inserted. Median of dwelling time was 8 days for 6.4 cm and 9 days for 12 cm long peripheral catheter. There were 17 (26%) complications in 6.4 cm (38/1000 catheter days) and 15 (16%) in 12 cm catheter (17/1000 catheter days), p = 0.04. The complications of both peripheral catheters were not associated with the age of patients, gender, number of punctures and selected vein for insertion. Unlike 12 cm catheter, the complications of 6.4 cm long peripheral catheter were significantly associated with the result of Barthel scoring system ( p = 0.003). Conclusion: The frequency of complications was more common with 6,4 cm than with 12 cm catheter.

Medical and economic consequences of perioperative complications in older hip fracture patients

Summary Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. Purpose Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. Methods A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. Results Complications that required surgical revision/treatment (type III) were associated with an increased 6 months’ mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. Conclusions The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.

The expression of cerebrospinal fluid pentraxin-3 in patients with hemorrhagic stroke

Background: There exists brain tissue inflammation and endothelial function damage in stroke. Method: We investigated serum and cerebrospinal fluid (CSF) levels of PTX3, HSP70, VEGF, IL-6, CRP in patients with stroke, this study was conducted on 85 standard stroke patients during 2015-2016, include ischemic stroke (IS) group (52 cases) and hemorrhagic stroke (HS) group (33 cases). The patients without inflammatory and neurological disease were the control group (20 cases). The levels of PTX3, HSP70, VEGF, IL-6 and CRP in serum on the 1th, 5th and 14th day after admission were measured and compared them with that in cerebrospinal fluid, NIHSS and Barthel score were also performed for assessing patients with HS. The results showed that the serum levels of PTX3, HSP70, VEGF, IL-6, CRP with HS were higher than that with IS patients (P<0.001, P=0.16, P=0.08, P=0.12, P<0.001, respectively), and PTX3 level began to fall after 14th day (P=0.015). The cerebrospinal fluid of PTX3, HSP70,VEGF and IL-6 levels in patients with HS were higher than that of normal control group (P=0.002, P=0.003, P<0.001, P<0.001, respectively). The levels of PTX, HSP70, IL-6 in cerebrospinal fluid were higher than that in the serum (P=0.026, P<0.001, P<0.001, respectively), and VEGF, CRP instead (P=0.011, P<0.001, respectively). The level of PTX3 in cerebrospinal fluid was positively correlated with IL-6 in patients with HS (P<0.001), PTX3 and IL-6 in patients with HS were positively correlated with patients' NIHSS score (P=0.007, P<0.001, respectively), and negatively correlated with Barthel index score (P=0.023, P<0.001, respectively). Inflammation and endothelial damage were more severe in patients with HS. The levels of PTX3 and IL-6 in cerebrospinal fluid could assess the severity, progression, and prognosis of HS. PTX3 may be a potential biomarker in HS, it could provide potent basis for doctors to select appropriate treatment measures as soon as possible.

The efficiency of combining modified acupuncture and motor relearning method on post-stroke patients

Background and Objectives: Combining modern medicine and traditional medicine in the rehabilitation of post-stroke motor deficit has shown interesting results. Many studies on modified acupuncture, a combination of modern and traditional techniques, have proven its effectiveness in motor rehabilitation in post-stroke patients. Furthermore, the effectiveness of the motor relearning method in the treatment of post-stroke paralysis has been elucidated. Therefore, our study aims to determine whether the combination between modified acupuncture and motor relearning method can improve treatment outcomes. Method: Multicenter randomized controlled trial (Traditional Medicine Hospital of Ho Chi Minh City, General Hospital of Soc Trang Province, and People Military Hospital of Soc Trang Province) from July 2014 to July 2015. 66 post-stroke patients were divided into two groups: The control group received modified acupuncture combined with Bobath method and the trial group received modified acupuncture combined with motor relearning method. After six weeks, patients were evaluated according to the Barthel score, the 10-hole test, and the ability to walk. Results: The trial group showed better results than the control group. There was a significant difference between the two groups in the Barthel score and the ability to walk, excluding the 10-hole test. After treatment, 77.42% of patients in the trial group showed improvement compared to only 51.61% in the control group (P < 0.05). Conclusion: The combination of modified acupuncture and motor relearning method is more effective than the combination of modified acupuncture and Bobath method in the rehabilitation of motor deficit after stroke.