1. Introduction

According to 2014 data of the National Bureau of Statistics, the population ≥aged 60 years in China has reached 177 million people, accounting for about 13.32% of the total population, indicating that the country has entered an aging stage.1 At the same time, diabetes is a common chronic disease in the elderly and its incidence is increasing annually. With age, calcium activity decreases, increasing the risk of fracture, especially of the femur neck, tibia,or ulna. Due to decreased physical function in patients with diabetes, bone fracture trauma can aggravate the condition and the risk of complications in this population.Compared to young patients, the recovery period following fracture is extended, seriously affecting the quality of life.2,3 In addition, patients who experience disease education during their hospitalization remember only 60% of the knowledge upon discharge, which further decreases over time, resulting in reduced compliance with doctor’s instructions. Therefore, targeted measures are necessary for these patients to improve their quality of life.4 At present, the change in the biomedical model has resulted in a change in the mode of health education from traditional teaching to patient-centered education.5 A menu-style volunteer service model of health education in Tai’an city provides volunteer service through an activities menu.The menu-style volunteer service refers to having certain professional volunteers collect information and present it in a volume, which is distributed to communities, villages,and towns, to allow residents to provide services such as volunteers to hotels/institutions that order these services.6,7 Through four steps, namely, preparing dishes, ordering,sending food, and tasting, as well as assessment of the condition of the object of study, the model aims to manage,evaluate, and improve the health education system; finally,a standardized voluntary service system is formed.8,9 This study, carried out from September 2016 to February 2017,assessed the effects of the implementation of a voluntary health education system in community elderly diabetes patients with fracture and provides an ethical review.

近年来，随着土木行业的新材料、新技术、新工艺、新方法的不断涌现，行业规范需要高校的课程设置和选用教材应跟上社会需求，但很多高校使用的经典教材虽然一版再版，但在规范调整、行业动态、新方法、新技术应用等方面未跟上社会发展步伐，教学内容和教学课程体系滞后于行业发展，教师也未能根据行业发展更新教学内容，导致学生的知识体系和能力不能满足当前的工程实践要求。

2. Materials and methods

2.1 Study subjects

This study used convenience sampling to select 59 cases of elderly patients with fracture and diabetes mellitus,who attended the Department of Orthopedic Surgery in a hospital of Tai’an City from September 2016 to February 2017. The patients ranged in age from 60 years to 86 years, with an average age of 77.5 years. Among them, there were six cases of fibular fracture, 11 cases of tibial fracture, nine cases of femoral fracture, 27 cases of radius fracture, and 12 cases of ulnar fracture. The history of diabetes ranged from 17 years to 1 year, and the patients’ fasting blood glucose concentrations ranged from 8.3 to 16.4 mmol/L. Among them, 37 cases had a history of diabetes and 12 cases were diagnosed with diabetes after hospitalization.

Finally, the patients were divided into experimental(33 cases) and control (26 cases) groups: foreign patients and patients for whom community nursing observation was not convenient were included in the control group,and patients residing in the city and patients for whom community nursing was convenient were included in the experimental group. There was no significant difference between the two groups in terms of age, sex, disease severity, and educational level (P ＞ 0.05).

2.2 Nursing interventions

The nurses administered anti-inflammatory, oral hypoglycemic drugs, or insulin injections to the 59 patients after surgery, helped reduce local edema, provided diet guidance and early functional rehabilitation exercises,and established personal health registration forms.

(1) the “delivery” process, which used a variety of ways to provide volunteer education that allowed patients with diabetes in the community to participate actively in the nursing process of the disease; through the study of related knowledge,patients were better able to understand the importance of diet, exercise, medication compliance, and blood glucose monitoring;

2.2.1 Control group: routine hospital health education On the day of discharge, health-care-related education was provided, to inform the patient of hospital procedures and matters requiring attention, by a responsible nurse according to the patient’s condition and operational situation of the hospital.

(1) Blood glucose control: patients were informed of the correct use of hypoglycemic drugs according to the doctor’s instructions, the need to regularly monitor blood sugar levels, and the adverse reactions to and countermeasures for hypoglycemic drugs.

(4) Psychological guidance: psychological health education was provided to patients and their families in order to increase their confidence in overcoming the disease.

(2) Diet guidance and incision care: because of the peculiarity of the diabetes diet, the importance of proper nutrition and the need to monitor blood glucose were emphasized. In addition, patients were informed and trained regarding the normal and abnormal conditions, treatments for wound healing, and how to prevent bedsores, deep vein thrombosis, pulmonary infection, and other complications. Finally, the patients were informed about the stitches and postoperative follow-up routine.

(3) A doctor–patient contact card was issued because patients with diabetes have poor peripheral circulation, which may lead to an extended period of time for functional recovery. It is easy to address patient problems by establishing an effective relationship between the nurse and the patient.

传统的成本管理过分强调“省”和“节流”，努力追求成本最小化，结果使成本管理仅仅限制在生产领域当中，这种方式把直接材料、直接人工，和制造费用当作减少成本费用的主要技巧，因此成本管理陷入了一个简单的循环，成本的减少并不能够提供最终的决策所需要的有效信息，无法准确的表现出整个经营活动过程，更不能具体的表现出每一个环节的成本信息。反而更多的关注点放在了生产过程中的节省，这样造成了在过程当中核算的比较多，但是前期的预测和准备较少，成本管理效果非常弱。

2.2.2 Experimental group: routine hospital health education and menu-based health education

In addition to the routine care provided to the control group, the observation group was also offered a voluntary health education menu, according to the Tai’an municipal civilization office guidelines, which was developed to meet the living needs of the community residents and improve their quality of life, as follows:

(4) “Food dishes”: based on the information obtained from evaluations of the effect of health education in patients – provided by community health records and regular telephone follow-up,the menu consultation service for patients, and volunteer opinions and suggestions – additional guidance and education to help patient understanding were prepared for the future.

(3) “Send food”: the implementation of the health education process mainly included two parts,

(2) Patients with disease-related service requirements could “Order” consultations in two ways:

更有一个企业借助电商模式积极地拥抱终端市场，他们组建自己的互联网服务平台，甚至“割肉”舍弃部分原有渠道，下沉终端，与有实力的种植平台对接、合作，将产品、技术、服务有效结合形成合力。这种合作模式，在我国当下的农村市场中极具生命力和活力。正如全国农业技术服务中心首席专家高祥照所言：“服务是农资行业永恒的主题，只不过随着农业新形势的发展，服务的内容和方式在发生变化。重新构架服务模式需要整个行业付诸实践和努力。”

(a) based on their needs and the menu information, patients could directly telephone a consultation doctor;

The dysfunction and annoyance indexes of the control and experimental groups before and after intervention are shown in Table 3.

(1) The “meal preparation service” team consisted of members of four departments, including orthopedics specialists (two chief physicians and two residents),two diabetes specialists (two physicians), one psychologist, one public nutritionist, four nurse specialists (two from the Department of Orthopedics and two diabetes specialist nurses who earned the title after system specialist training), and two community health service center members of the medical staff.The titles and expertise of the 14 medical personnel were included in a booklet issued to the patients;the community health workers were responsible for answering patient questions and collecting basic information from patient records, including name,address, age, clinical diagnosis, surgery date, time to discharge, and contact information.

生活当中对于小学生来说是不缺乏美好的事物的，但是可能会缺少发现美好事物的眼睛。在写作过程当中，如果缺少了发现美的能力，可能他在写作过程当中表现出来的内容就是比较枯燥和乏味的，缺少了对学习和生活的体会。在一个相同的环境当中，善于发现美的同学可能看见的是鲜花争相开放，春天万物复苏的气息，而不善于发现的可能就发现不了美丽的景色。老师在生活中应该给学生以指导，让他们对于美能够有自己的主观的判断，在审美的基础上建立起属于自己的空间，描绘出美好的事物。

(a) volunteers who directly responded to patient phone calls;

(b) volunteers who provided community health education seminars. Before the lecture,community medical staff reported on patient questions and requests that suggested inadequate education. Five days in advance, the community nursing staff distributed a poster to the community publicity column and telephoned to inform the patients in the experimental group of the upcoming lecture. The volunteers used a variety of educational methods and topics, such as displaying the food model, enabling patients to correct ingestion methods on how much food there is in order to have an intuitive understanding, and providing a practical demonstration of insulin, among other lessons. At the end of each lecture, the patients’ knowledge was assessed through a question-and-answer form and the patient was asked to share his/her own nursing experience.

2005 年春，昭通至待补公路动工，全长600米的牛栏江大桥应运而生。2013年，昭通至会泽高速公路又拉开了施工序幕，新的牛栏江特大桥成为一道独特的风景。如今站在牛栏江边，两座牛栏江大桥犹如江底的两道彩虹，高高地挂在“江底三桥”的上空。

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2.3 Evaluation methods

(1) Treatment compliance: diabetes treatment adherence was assessed based on the scale proposed by Chen10 in 2007, according to Li and Cai,11 who developed the diabetes compliance questionnaire; after repeated revision and expert consultation, the content validity was 0.83, the test–retest reliability was 0.86,and Cronbach’s alpha was 0.86. A total of five dimensions and 20 entries were used to evaluate patient compliance with medication,reasonable diet, regular exercise, blood glucose tests, and regular follow-up. Each item was scored as follows: regularly (one point),occasionally (two points), and never (three points). The total score ranges from 20 to 60 points, with a higher score indicating better compliance.

(2) Blood glucose and lipid levels: these measures included levels of fasting plasma glucose (FPG),2-hour postprandial plasma sugar (2hPG), glycosylated hemoglobin (HbA1c), total cholesterol(TC), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C).

(3) Short musculoskeletal function assessment(SMFA)12: the English version of the tool was developed by the University of Minnesota, while the Chinese version was developed by Wang13 in 2015. The questionnaire includes disability and annoyance indexes, with two subscales containing 34 and 12 entries, respectively.The scores of the two standardized subscales contain a total of 100 points, with a higher total score indicating a greater degree of dysfunction. All three indexes were measured at the beginning and 6 months after the intervention, respectively.

2.4 Statistical methods

The data were recorded in a Microsoft Excel spreadsheet and analyzed using IBM SPSS Statistics for Windows, version 20.0. Data were expressed as average± standard deviation (M ± SD), and the differences between the two groups were assessed using the twosample t-test (α = 0.05).

采用SPSS 13.0统计软件对肿瘤治疗前后肺体积、肿瘤体积及剂量对比行t检验，计量资料使用来表示，肺剂量体积直方图参数与靶区相关性分析采用Person法，P<0.05为差异有统计学意义。

3. Results

3.1 Treatment compliance before and after intervention

The patient compliance in terms of medication, reasonable diet, regular exercise, blood glucose monitoring, and regular follow-up improved significantly in the experimental group compared to those in the control group (P ＜ 0.05). Analysis of blood glucose and lipid levels revealed significant changes in FPG,2hPG, TG, HDL-C, and LDL-C levels in the experimental group (P ＜ 0.05), while the changes in HbA1c and TC did not change significantly between groups(P ＞ 0.05) (Tables 1 and 2).

3.2 Comparison of blood glucose and blood lipid levels before and after the intervention

Table 2 shows the changes in blood glucose and lipid levels before and after intervention in the control and experimental groups.

由表2可以看出，存在亚健康状况的学生中，胃、大肠存在问题的人很多，无规律和不科学的饮食习惯都会造成胃和大肠的能量不均衡[8].由表2也可以看出,肝和肺存在问题的学生也比较多，抽烟、喝酒等都会造成肝和肺的能量不平衡.由此可见，不良的生活习惯是造成大学生亚健康状况的一个重要原因.大学生，以年轻力壮作为资本，不知道引起体力和精力透支的无规律的起居和饮食将会付出沉重的代价，造成亚健康状态，甚至引发多种疾病.不良的生活习惯主要有：

3.3 Comparisons of dysfunction and annoyance indexes

(b) patients could inform the community health care staff the name of the specialist and the knowledge they wanted to know, and experts from the community health care would schedule a health education lecture.

4. Discussion

4.1 Menu-based voluntary health education can improve patient compliance

Research has shown that behavior change can be used to measure the success of diabetes education programs.14,15 In this study, the effects of the application of a menu-based volunteer health education in community patients with diabetes on compliance are shown in Table 1. Patient compliance was significantly higher after the intervention(P ＜ 0.05). The reasons for this finding may be the following:

Table 1. Patient compliance before and after the intervention (M ± SD, n = 59)

Notes: #Intragroup comparison, P ＜ 0.05; ＊intragroup comparison, P ™ 0.01; M = mean value; SD = standard deviation.

Control group Experimental group Before intervention Items intervention t P Before intervention After After intervention t P Medication compliance 8.15 ± 1.38 8.08 ± 1.41 0.40 0.07 8.06 ± 1.17 8.61 ± 1.62 –2.25 0.032#Reasonable diet 7.69 ± 1.19 7.88 ± 1.18 –1.55 0.13 7.55 ± 1.06 9.00 ± 1.80 –4.11 0.000＊Regular exercise 7.85 ± 0.97 8.15 ± 1.41 –1.03 0.31 7.76 ± 1.12 8.70 ± 1.68 –2.70 0.011#Blood glucose monitoring 7.50 ± 1.27 7.77 ± 1.45 –1.77 0.09 7.21 ± 1.19 8.61 ± 1.71 –4.21 0.000＊Periodic inspection 7.11 ± 1.14 7.34 ± 1.05 –1.81 0.08 7.09 ± 1.21 8.21 ± 1.50 –3.77 0.01＊

Table 2. Blood glucose and blood lipid changes (M ± SD, n = 59)

Notes: #Intragroup comparison, P ＜ 0.05; ＊intragroup comparison, P ＜= 0.01; 2hPG = 2-hour postprandial plasma sugar; FPG = fasting plasma glucose; HbA1c = g lycosylated hemoglobin; HDL-C = high-density lipoprotein-cholesterol; LHDL-C = low-density lipoprotein-cholesterol; M = mean value; SD = standard deviation; TC = total cholesterol; TG = triglyceride.

Items Control group Experience group Before intervention After intervention t P Before intervention After intervention t P FPG 8.88 ± 1.56 8.38 ± 1.12 1.443 0.161 8.96 ± 0.99 8.29 ± 0.61 3.747 0.001＊2hPG 13.97 ± 2.10 13.39 ± 2.48 1.81 0.083 13.51 ± 2.08 12.95 ± 2.37 2.18 0.037#HbA1c 8.315 ± 0.59 8.18 ± 0.62 2.023 0.054 8.45 ± 0.60 8.30 ± 0.59 1.964 0.058 TC 4.52 ± 0.33 4.44 ± 0.29 1.899 0.069 4.59 ± 0.36 4.52 ± 0.33 2.01 0.053 TG 1.63 ± 0.27 1.57 ± 0.17 1.509 0.144 1.68 ± 0.30 1.57 ± 0.15 2.212 0.034#HDL-C 0.83 ± 0.29 0.91 ± 0.38 1.443 0.161 0.81 ± 0.26 0.92 ± 0.34 2.517 0.017#LDL-C 3.81 ± 0.38 3.69 ± 0.35 1.995 0.057 3.72 ± 0.41 3.59 ± 0.39 2.62 0.013#

Table 3. Comparisons of dysfunction and annoyance indexes (M ± SD, n = 59)

Notes: #Intragroup comparison, P ＜ 0.05; ＊Intragroup comparison, P ＜= 0.01; M = mean value; SD = standard deviation.

Control group Items intervention After intervention t P Before intervention After intervention t P Experimental group Before Disability index 67.42 ± 7.12 65.5 ± 5.98 1.995 0.057 69.36 ± 6.82 66.69 ± 7.12 2.153 0.039#Annoyance index 70.11 ± 6.92 67.81 ± 7.19 1.806 0.083 70.58 ± 7.65 66.09 ± 7.54 2.799 0.009＊

不少学者还从具体的方面做了实证研究。母语对二语习得的语法方面会有影响，国内学者以及国外学者都研究了母语对二语习得语法方面的影响，研究结果都说明了母语知识的正向迁移在外语学习中的作用，母语知识有助于外语的学习。

(2) the “send food” process, in which diabetes specialist nurses regularly telephoned for follow-up assessments to better understand the patients’condition and supervise the patients’ adoption of healthy behaviors.well as reduce the economic burden on the family and save valuable medical resources, which are conducive to the development of social security system and health improvement.16 Therefore, comprehensive hospitals and community medical institutions should work together in order to establish the continuity of the medical system.However, the establishment of this method to improve the long-term care of the elderly patients will require government participation, increased investment, improved community facilities, and increased medical staff ratios in order to offer education for elderly patients for disease treatment and prevention. The present study had several limitations, including the limited implementation time and patient conditions, as well as the fact that the patient menu-based health education service is a volunteerbased activity; whether the findings of the present study can be applied to other community patients with chronic diseases requires further research.

由图1可知，采用XRF法测定PVC中Cl含量的准确性要高于氧弹法和艾士卡法，其测定结果为55.7%，接近理论值56.8%。而氧弹法和艾士卡法测出的Cl含量分别为30.49%和25.52%，与理论计算的Cl含量偏差较大。

4.2 Menu-based voluntary health education can improve blood sugar and blood lipid levels

Table 2 shows that the voluntary service menu health education intervention reduced the FPG, 2hPG, TG,and LDL-C levels and increased HDL-C level (P ＜ 0.05),which may be related to health education that improved compliance, modified poor habits, and encouraged a reasonable diet and regular exercise. The HbA1c and TC levels tended to decrease, but the difference was not significant (P ＞ 0.05), which might be related to the short intervention period.

4.3 Intervention can promote the recovery of patients’ function and improve their mental health

Table 3 shows that the menu service for nursing health education promoted the functional recovery of patients(P ＜ 0.05), facilitated fracture recovery to progress to isotonic and isometric exercise, and increased patient confidence to overcome the disease (P ＜ 0.05) in the experimental group, compared to the control group, in order to improve patient mental health.

5. Conclusions

The implementation of a menu service for patient health education following hospital discharge can provide more comprehensive and more specific health guidance,which may promote functional recovery, improve mental health, and improve the quality of life of patients, as

Conflicts of interest

All contributing authors declare no conflicts of interest.

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