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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.A nested cohort study design.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.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 (β = .391, p .001) and indirect positive effects (β = .186, p = .002) on health behaviour; (b) direct positive effect (β = .356, p .001) and indirect positive effects (β = .183, p = .009) on BP control; and (c) indirect negative effect (β = -.146, p = .008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief.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.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.目的: 检验高血压缺血性脑卒中患者出院后6个月的基于健康信念模式的综合提醒系统(CRS-HBM)、脑卒中知识、健康行为方面健康信念、血压(BP)控制和残疾的前瞻性路径。 设计: 采用巢式队列研究设计。 方法: 数据来源于一项评估干预效果的随机对照试验(N=174,于2015年2月至2016年3月开展)。通过问卷调查收集数据,并在Mplus软件中进行结构方程建模分析。 结果: 所建模型与数据拟合良好。出院后6个月,该模型占健康行为变化的51.5%,血压控制的34.1%,改良的Rankin量表评分的5.7%。基于健康信念模式的综合提醒系统:对健康行为有(a)直接积极影响(β= .391,p.001)和间接积极影响(β= .186,p = .002);对血压控制有(b)直接积极影响(β= .356,p.001)和间接积极影响(β= .183,p = .009);对残疾有(c)间接负面影响(β= −.146,p = .008)。女性性别与更好的健康行为有关。高等教育对脑卒中知识和健康信念的预测水平较高。 结论: 基于健康信念模式的综合提醒系统可通过提高患者的健康知识或健康信念,直接或间接地改善患者的健康行为。良好的健康行为有助于改善患者的血压控制,降低残疾发生率。因此,护士在进行健康教育时,不仅要多多关注患者的健康知识,更要重视病人的健康信念。 影响: 出院后6个月,基于健康信念模式的综合提醒系统干预占健康行为变化的51.5%,血压控制的34.1%,改良的Rankin量表得分的5.7%。本项研究可帮助护士在患者出院后及社区环境中改进健康教育策略,以取得更好的健康结果。.

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.

The evidence for the effect of remote ischemic postconditioning(RIpostC) on autonomic function in patients with acute ischemic stroke(AIS) is lacking and the neural mechanism underlying the protection of RIpostC remains speculative. This trial was aimed to evaluated the efficiency of RIpostC on autonomic function in AIS patients.One hundred and six AIS patients were included in this prospective, randomized, placebo-controlled trial. Patients in intervention group (n = 57) received 4 cycles of alternating inflation (cuff inflation to 200 mmHg) and deflation for 5 min on healthy upper arm once a day for 30 days. The control group underwent a sham inflation and deflation cycles. Autonomic function was evaluated by heart rate variability (HRV).All HRV parameters except for the ratio of low frequency to high frequency (P = 0.101) increased significantly with time (P0.001) in the two groups. The value of standard deviation of all normal R-R intervals(SDNN) and high frequency at day7 and day30 and the value of the percent of difference between adjacent normal R-R intervals (pNN50) at day 30 in RIpostC group was significantly higher than that of the sham-RIpostC group(P0.05). A significant time-by-group interaction was observed in SDNN、pNN50、and high frequency over time between two groups (P0.05).30-day RIpostC could improve autonomic function in AIS patients through the enhancement of the total autonomic nerve activity and vagus nerve activity. The mechanism of RIpostC mediating autonomic function needs to be further investigated.