1. Precautions for XIMC internal medicine inpatients receiving physical examinations: (NOTE TO FRANK – THESE CLINICAL GUIDELINES SHOULD BE EVALUATED BY UPMC’S CLINICAL DEPARTMENTS TO VALIDATE THE CLINICAL CONTENT AND APPROVE THE CLINICAL INSTRUCTIONS, MY REVIEW IS ONLY FOR EDITORIAL PURPOSES)

XIMC inpatients receiving physical examinations will receive personalized care and guidance from the physician, who will prescribe customized examination services, provide guidance for treatment and rehabilitation, and carry out follow-up visits according to the needs of the patients.

Routine physical examination for XIMC patients is generally completed in 2-3 days.

Patients who need physical examination immediately on the day of admission are required to fast from 20:00 the day before admission (a light diet with an appropriate amount is recommended for dinner); and no water is allowed from 22:00. Patients should moderate their diet for several days before examination. Do not take too much food that is greasy or difficult to digest, alcoholic beverages or drugs that have an impairment on the hepatic and renal function should be avoided. The patients will be admitted to the hospital from 8:00 a.m. to 9:00 a.m.

Patients with a history of hypertension and diabetes should take their drugs as usual, but drink a little amount of water.

Patients with a history of surgery or disease should bring all of their relevant medical records and data.

Patients who are pregnant or plan to conceive in the near future should tell the doctor about it, and should not receive X-ray examination. Female patients should schedule their examinations to avoid menstruation, and urinate completely before gynecological examinations (ultrasonography). They should not take urine samples for gynecological examination during their menstrual period, but receive the examinations after their menstrual period.

 

2. Precautions for XIMC internal medicine inpatients receiving gastrointestinaloscopy:

1) Preparation for colonoscopy (avoid scheduling the examination to occur during the patient’s menstrual period; discontinue the use of aspirin for a week prior to the examination if endoscopy is required):

a) Have a semi-liquid diet without residue (noodles, porridge, bread, or some fruits, but not vegetables) 2 days before examination.

b. Have a liquid diet (milk, soybean milk or all kinds of soup, and egg custard for the lunch) the day before examination

c) Patients who will receive examinations in the morning should take drugs at 21:00 the day before examination, and those patients who will receive examinations in the afternoon should start to take drugs at 9:00 a.m. on the day of examination, and drink all the colon-clearing medicines within half an hour (it is recommended to walk about and massage the abdomen clockwise during drug administration so as to accelerate defecation and relieve abdominal distention). It is forbidden to eat any food after drug administration.

2) Preparation for gastroscopy (painless gastroscopy)

a) Have a diet that is easy to be digested the day before examination, drink milk or soybean milk or eat porridge before 8:00 a.m. on the day of examination, and do not eat anything after 8:00 a.m

b) A painless gastroscopy requires family members to accompany the patient on the day of the examination.

c) Have a warm or cold diet 2 hours after anesthesia.

3) The results of gastrointestinal endoscopy can be obtained within 30 minutes of the examination, excluding the biopsy results.

 

3. Education about diabetes:

Diabetes is a chronic life-long disease. Currently, there is no cure for it. However, it is also a controllable disease. Good self-management and treatment can effectively prevent diabetic complications, and thus the life span and quality of life of patients are not affected.

[Education about diet]

The goal of the treatment with diabetic diet is to recover and maintain the optimal control of blood glucose levels: fasting: 4.4-6.1 mmol/L, non-fasting: 4.4-8.0 mmol/L, and glycated hemoglobin: <6.5%.

The diabetic diet is a healthy diet suitable for everyone. It does not include any food that absolutely cannot be eaten for the patients. Principles of dietary treatment: keep a balanced diet with well-proportioned meat and vegetables as well as coarse food and refined grain; eat at a regular time and in a fixed quantity; have a bland diet to reduce fat; avoid eating too much; make the diet as rich as possible; eat more foods rich in cellulose; take food carefully and slowly, etc. It is not recommended to eat a lot of porridge, but a small amount of porridge with dry foods. It had better be taken along with foods containing protein, such as eggs, milk and steamed meat dumpling.

Patients with diabetes should quit smoking and limit their drinking.

Estimation of diabetic diets: It is determined based on the physical activity of the patients. Inpatients are estimated on the basis of rest. They should have at least three meals a day, including 200-250g staple food, more than 500g fresh vegetables, a cup of milk, an egg, about 100g meat diet, 50-100g bean products, 2-3 tablespoons of oil and 6g salt. (Please carry out education according to the patient's actual condition. For example, patients with renal disease should have a high-quality and low-protein diet, and patients with gout should not take seafood, alcohol, animal offal, beans, etc.).

[Treatment of diabetes with exercises]

The treatment of diabetes with exercises adheres to the three principles: do aerobic exercise, keep persistent and act within one's capability.

Patients with diabetes should choose aerobic exercise and avoid anaerobic exercise while taking exercise. Patients with diabetes should do exercise reasonably rather than doing a lot of exercise blindly or taking a little exercise which has no effect on the health. They should keep doing exercise frequently for at least 3 times a week. The duration of each exercise should be not less than 20-30 min, but not more than 1 hour, including pre-exercise preparation and post-exercise recovery.

 

4. Coronary heart disease

Coronary heart disease (full name is coronary atherosclerotic heart disease) is also known as coronary atherosclerosis, myocardial ischemia, heart disease and so on. Coronary heart disease is the most common heart disease. The heart is mainly composed of myocardium, while the coronary artery is responsible for supplying blood to the myocardium.

[Risk factors]

1. Age: The risk of arterial injury and stenosis is increased with age.

2. Gender: The risk of coronary heart disease in males is generally larger than that in females, but the risk is increased significantly in postmenopausal women.

3. Family history: The risk of coronary heart disease is relatively high for people with the family history of coronary heart disease, especially when parents suffer from coronary heart disease in an early age (<60 years old).

4. Smoking: Nicotine can cause vasoconstriction, and carbon monoxide will destroy the vascular intima, making them more prone to atherosclerosis. The incidence of myocardial infarction in females who smoke at least 20 cigarettes every day is 6 times than that in females who do not smoke. The incidence in males who smoke is 3 times than that in males who do not smoke.

5. Hypertension: Uncontrolled high blood pressure can lead to coronary sclerosis and thickening of the arteries, reducing blood flow to the blood vessels.

6. High cholesterol: Excessive high cholesterol in blood can increase the risk of forming atherosclerotic plaque. High cholesterol may be caused by increased low-density lipoprotein (LDLs) or insufficient high-density lipoprotein (HDLs), the former of which is a 'bad' cholesterol and the latter one is a 'good' cholesterol.

7. Diabetes: Diabetes can significantly increase the risk of coronary heart disease.

8. Obesity: Weight gain is often associated with other risk factors, such as hypertension, hyperlipidemia and diabetes.

9. Lack of physical activity: Lack of exercise is associated with coronary heart disease and can affect other risk factors.

10. Great mental stress: Prolonged mental stress can damage arteries and exacerbate other risk factors of coronary heart disease.

Some risk factors of coronary heart disease are inter-related and often exist in multiple ways. For example, obesity can cause diabetes and hypertension. The combination of a variety of risk factors will further increase the risk of coronary heart disease. For example, metabolic syndrome is a syndrome that includes hypertension, high triglycerides, high level of insulin, and increased lumbar fat. Such patients have a significantly increased risk of coronary heart disease.

[Consequences] Coronary heart disease can lead to:

1. Chest pain (angina): Coronary stenosis will result in insufficient myocardial blood supply, and chest pain (angina), shortness of breath or other symptoms especially during physical activity.

2. Myocardial infarction: If the cholesterol plaque ruptures, it will promote platelet aggregation and make your coronary arteries blocked completely, thus causing an acute myocardial infarction. The long-term lack of blood supply to the myocardium may cause irreversible damage as a result of myocardial infarction. The extent of myocardial damage partially depends on whether you can receive treatment as soon as possible after myocardial infarction.

3. Heart failure: Your heart will become weak and fail to provide enough blood to meet your body's needs if there is a chronic lack of oxygen and nutrients in some parts of your heart due to a decrease in blood flow, or if you once suffered from myocardial infarction. This condition is known as heart failure.

4. Arrhythmia: Insufficient blood supply to the heart or damaged heart tissue can affect electrical pulse of your heart, thus causing arrhythmia. 

[Preparation before treatment]

1. During treatment, the doctor may ask you to receive necessary blood examinations, such as lipids, blood glucose, liver function and kidney function, all of which should be conducted on an empty stomach. Therefore, you need to stop food and water intake 8 hours before treatment, and avoid overeating for 3 days before the examination.

2. Please record your symptoms in detail to avoid any omission while visiting the doctor, including symptoms that may seem irrelevant to heart disease.

3. You also need to provide some key personal information, such as your family history of illness, especially the histories of heart disease, stroke, hypertension and diabetes of your parents and your brothers and sisters, as well as whether you have mental stress or have any recent change in your lifestyle.

4. Keep a detailed record of the medicines you are currently taking, including traditional Chinese medicines and nutritional and vitamin supplements.

5. If you have medical records of treatments or diagnostics provided by other hospitals, please bring them with you, including the test results, ECG and all imaging examination information.

6. If you feel it may be difficult to see a doctor here by yourself, you had better ask your families or friends to come with you/

7. Record the questions you may want to ask your doctor and bring them with you.

Please prepare in advance to communicate with your doctor during your visit. If you have any questions to ask, please prepare them in the order of importance to you.. For patients with coronary heart disease, the following questions may be of concern to you:

1. What is the cause of my symptoms?

2. Are there any other causes for these symptoms?

3. What examinations are needed for me?

4. What is the best plan for diagnosis and treatment?

5. In addition to the described plan, are there any other options available?

6. I also have other health problems. How can I deal with them at the same time?

7. Is there any contraindications for treatment that I should pay attention to?

8. How much will the treatment or examination cost? Can I use the medical insurance to help pay for the cost?

9. Are there any similar drugs that can be used to replace the medicines you prescribed?

10. Can you recommend some health information or websites to me?

If you have any question about the doctor's treatment at the time of your visit, prepare in advance of the visit to ask them.

 

Questions your doctor may ask you during your visit.

Your doctor may ask you some questions. If you have prepared in advance, you can save some time in asking your doctor about your concerns. Doctors often ask the following questions:

1. When did the symptoms start to occur?

2. Is your symptom persistent or occasional?

3. How serious are your symptoms?

4. What can make your symptoms aggravated?

5. What can relieve your symptoms?

 

What can you do while preparing for the visit

You should start to follow a healthy lifestyle as early as possible, such as quitting smoking, eating healthy food and doing more exercise. These are the first lines for preventing coronary heart disease and its complications, including myocardial infarction and stroke. 

[Lifestyle]

The change in lifestyle may help to prevent or delay the progression of coronary heart disease.

1. Quit smoking: Smoking is the main risk factor for coronary heart disease. Nicotine will make your blood vessels shrink, and increase the burden on your heart; carbon monoxide will reduce the content of oxygen in your blood, and destroy the inner wall of blood vessels. Smoking cessation is the best way to reduce your risk of coronary heart disease.

2. Control blood pressure: You need to pay attention to your blood pressure. If your blood pressure is higher than normal or if you have a history of heart disease, your doctor will advise you to measure your blood pressure more frequently. The optimal level of blood pressure is systolic blood pressure <120 mmHg and diastolic blood pressure <80mmHg.

3. Check blood lipids: You need to check your blood lipids regularly (at least once every 5 years) from the age of 20. If your test results are out of the regulated range, your doctor may suggest you receive examinations more frequently.

4. Control diabetes: If you have diabetes, strict control of blood glucose helps to reduce the risk of coronary heart disease.

5. Do more exercise: Doing exercise can help you maintain a healthy weight, control diabetes, high cholesterol, hypertension and other risk factors of coronary heart disease. If your doctor thinks you can do some exercise, you should try your best to do 30 to 60 minutes of aerobic exercise daily for at least 5 days a week.

6. Have a healthy diet: A healthy diet should be based on fruits, vegetables and whole grains with low saturated fat, low cholesterol and low sodium. This can help you control your weight, blood pressure and cholesterol. It is also beneficial to eat fish once or twice a week.

7. Control your weight: Excessive body weight will increase the risk of coronary heart disease. Weight loss is especially important for person with an oversize waist (> 85 cm for males and > 80 cm for females) because people of this size are more likely to develop diabetes and heart disease.

8. Relieve stress: You should try your best to relieve stress. Learn to relieve stress through simple methods such as relaxing your muscles and taking a deep breath. Backpacking is also a great idea.

In addition to keep a healthy lifestyle, remember the importance of regular physical examination. The main risk factors for coronary heart disease are high cholesterol, hypertension and diabetes. Coronary hear disease does not show symptoms in the early stage. Early detection and treatment of these diseases can make you have a healthy heart. Coronary and other cardiovascular diseases increase the risk of influenza complications, so you should consult your doctor about the need for an annual injection of influenza vaccine.

5. Upper respiratory tract infection

Upper respiratory tract infection (URTI for short) is also known as common cold. It is a general term for acute inflammation in the nose, pharynx or throat. In a broad sense, URTI is not a disease but a group of diseases, including common cold, viral pharyngitis, laryngitis, herpes angina, pharyngoconjunctival fever and bacterial pharyngeal tonsillitis. In a narrow sense, it is also called as common cold which is the most common acute respiratory infectious disease. It is self-limited but has relatively high incidence. Adults suffer from common cold 2-4 times a year, while children have a higher incidence rate, that is, 6-8 times a year. The common cold occurs throughout the year, but more frequently in spring and winter.

[Precautions] 

1. Environment and rest: Maintain good indoor ventilation at a suitable temperature and humidity. The patients should have more rest.

2. Diet: Provide the patients with a bland diet with high calorie and rich vitamin that is easy to be digested, and encourage the patient to drink enough water every day, avoid irritating food, and quit smoking and drinking.

3. Prevention of cross-infection: Pay attention to segregate the patient and reduce contact with the patient to avoid cross-infection. The patient should not cough or sneeze in the direction of others. The tableware, spittoon and other tools used by the patient should be disinfected regularly.  Use of disposable appliances and tableware with proper disposal is recommended.

4. Psychological guidance: Eliminate tension, keep an optimistic attitude, cooperate with the treatment actively, change unhealthy lifestyles consciously, and establish good habits.

 

6.COPD

Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by persistent airflow limitation. The progressive development of airflow limitation is associated with an increased chronic inflammatory response to toxic particles or gases in the airways and lungs.

[Prevention] 

1. Quit smoking: Smoking is the main risk factor leading to COPD. It is difficult to achieve good results by drug therapy alone without the elimination of the cause. Therefore, the key measure to prevent the occurrence and development of COPD is to quit smoking.

Reduce the inhalation of occupational dust and chemical substances, and ensure work protection for people engaged in exposure to occupational dust, such as staff for coal mines, metal mines, cotton textile industry, chemical industry and some mechanical processing.

2. Reduce indoor air pollution: Avoid burning biofuels, such as cooking with firewood, indoor heating and passive smoking, in a poorly ventilated space.

3. Prevent and treat respiratory infections: Prevent and actively treat upper respiratory tract infections.  Receive an  injection of influenza vaccine in autumn or winter; avoid going to crowded places; keep the indoor air fresh; treat the upper respiratory tract infection actively.

4. Take more exercise: Choose the exercise that is suitable for you according to your own condition, such as walking, jogging, swimming, climbing stairs, mountain climbing, shadowboxing, dancing and lifting a few pounds of heavy things with the hands (exhale while lifting up).

5. Exercise respiratory function: one of the important goals in the treatment of patients with COPD is to maintain good lung function. Only by maintaining good lung function can patients have better mobility and good quality of life. Therefore, respiratory function exercise is of great importance. Patients can exercise lung function through yoga breathing exercise, respiratory exercise, deep and slow abdominal resistance breathing exercise, singing, whistling, fluting and so on.

6. Cold-endurance exercise: Reduced cold endurance can lead to recurrent upper respiratory tract infections in COPD patients, so cold tolerance is also important for patients with COPD. The patient can exercise the cold endurance by washing his/her face with cold water from summer, carrying out outdoor activities every day, etc.

[Treatment] Treat with drugs and oxygen

1. Bronchodilators. These drugs help to expand the airway and make breathing easier. Bronchodilators are divided into short-acting (effective for 6 to 9 hours) or long-lasting (effective for 24 hours) reagents. Most bronchodilators require inhalation for taking effect immediately. Take a quick-acting inhalant with you whenever you're away from home.

2. Corticosteroids. These drugs can reduce airway inflammation.

3. Take drugs strictly according to the doctor's advice. Please consult a professional doctor quickly if you experience a problem with the medicine.

4. Treatment with oxygen can dramatically increase the amount of oxygen in the blood and helps you to breathe easier. Long-term domiciliary oxygen therapy can improve the survival rate for the patient. It is recommended that patients purchase an oxygen generator and inhale oxygen using the nasal prong method. Use the flow recommended by the doctor [in general, the patient should use a low flow (2L/min), and the time of oxygen inhaling should be not less than 15 h/d]. Do not change the flow without the permission of the doctor. Ask the patients to pay attention to 'Four Preventions': fire, shock, oil and heat prevention. Meanwhile, the distilled water in the humidified container should be changed every day, and the nasal tube should be changed every week.

 

7. Hypertension

Human blood pressure is not constant, but fluctuates within a certain range throughout the day. It is even more dangerous in hypertensive patients who have markedly increased blood pressure and in those who are old with poor vascular wall elasticity or an injury (such as atherosclerosis).

1. When you are lifting or carrying heavy objects, your blood pressure can be significantly increased, the systolic blood pressure can be increased by 6.7-13.3kPa (50-100mmHg) or even higher, but when you stop lifting or carrying, the blood pressure should quickly return to normal.

2. When you are angry, extremely fearful or stressed out: your blood pressure can be elevated dramatically, the systolic blood pressure can be increased by 2.6-10.7kPa (20-80mmHg) or even higher, and the diastolic blood pressure can also be elevated.

3. When you are experiencing extreme excitement including ecstasy and laughter: your blood pressure can also be elevated dramatically. The degree of increase in blood pressure is similar to that of extreme mental stress.

4. When you are defecating, especially when you are suffering from constipation: the blood pressure may be significantly increased, the systolic blood pressure can be increased by 4.0-9.3kPa (30-70mmHg) or even higher, and the diastolic blood pressure can be increased by 1.3-4.0kPa (10-30mmHg) or even higher when you defecate for a long time or when you defecate too hard.

5. When you are coughing, especially when you are coughing paroxysmal and violently: your blood pressure can be elevated suddenly. The degree of increase in blood pressure is proportional to the severity of coughing. The increase in systolic blood pressure can be up to about 8.0kPa (60mmHg).

6. When you talk continuously and loudly (giving a lecture or a lesson): your blood pressure will be elevated dramatically with the degree similar to that of extreme excitement when you shout or debate emotionally.

7. Drink a lot of spirit (excessive drinking): the blood pressure of some people may be increased dramatically and suddenly for a short time, which is the main cause of excessive drinking-induced cerebral stroke.

[Drug therapy for hypertension and precautions]

1. Remember to follow your doctor advice to receive re-examination of serum potassium regularly during the administration of diuretics, because diuretics can cause hypokalemia, and may even become life threatening in severe cases.

2. Get familiar with the contraindications of each drug.

3. Patients who take antihypertensive drugs for a long time should pay attention to prevent falling. When they need to stand up from sitting or lying, they should do it slowly. In case of discomfort while walking, they should sit down or go to bed with the aid of others. Do not discontinue the drugs suddenly. Even if the blood pressure is too low, you should reduce the dose gradually under the guidance of the doctor. 'Three Preventions' for drug administration: Prevention of withdrawal syndrome: Some people stop taking drugs without permission when the blood pressure return to normal after administration of antihypertensive drugs, but the blood pressure is increased several days later, and symptoms such as sweating, headache, insomnia and excitability are observed, which are described as withdrawal syndroms. Almost all antihypertensive drugs are likely to induce such adverse reactions. Prevention of hypotension: If you take antihypertensive drugs improperly (like excessive administration), symptoms such as sudden drop in blood pressure, increased pulse rate, dizziness, and even transient loss of consciousness may occur, which is known as hypotension syndrome. Prevention of nocturnal syndrome: According to the rule of biological clock, human blood pressure shows a 'two high and one low' phenomenon throughout the day. It will drop naturally after sleeping, and excessively low blood pressure will result in brain ischemia, thus inducing ischemic stroke. You should follow the doctor's advice rather than act on your own.