Status of Patients Using Antihypertensive Drugs After Intervention Table 3.17: Percentage of Patients Using Antihypertensive Drugs After Intervention

Car body electrical practice - 8 zt2i3t4l5ee zt2a3gs zt2a3ge zc2o3n4t5e6n7ts If the voltage is out of specification, replace the wire or connector. If the voltage is within specification, install the front fog light relay and follow step 5. Step 5 Check the front fog light switch - Remove the D4 connector of the fog light switch - Use a multimeter to measure the resistance of the front fog light switch. Measurement location Condition Standard D4-3 (BFG) -D4-4 (LFG) Light switchFront Fog OFF >10kΩ D4-3 (BFG) -D4-4 (LFG) Front fog light switchON <1 Ω - Standard resistor D4 connector is located on the combination switch assembly. If the resistance is out of specification, replace the combination switch (the fog light switch is located in the combination switch). If the resistance is within specification, follow step 6. Step 6 Check wiring and connectors (front fog light relay-light selector switch) - Disconnect connector D4 of the combination switch assembly - Use a voltmeter to measure the voltage value of jack D4 on the wire side. Measurement location Control modecontrol Standard D4-3 (BFG) - (-) AQ TAIL 11 to 14 V D4 connector for the wiring of the combination switch assembly If the voltage does not meet the standard, replace the wire or connector. If the voltage is within standard, there may have been an error in the previous measurements. Step 7 Check the front fog lights - Remove the front fog light electrical connector. - Supply battery voltage to the fog lamp terminals Jack 8, B9 of front fog lamp on the electrical side blind first. Power supply location Terms and Conditions Battery positive terminal - Terminal 2Battery negative terminal - Terminal 1 Fog lightsbefore morning - If the light does not come on, replace the bulb. If the light is on, re-plug the jack and continue to step 8. Step 8 Check wiring and connectors (relay and front fog lights) - Disconnect the B8 and B9 connectors of the front fog lights. - Use a voltmeter to measure voltage at the following locations: Measurement location Switch location Terms and Conditions B8-2 - (-) AQ Electric lock ON TAIL size switchFog switch ON 11 to 14 V B9-2 - (-) AQ Electric lock ONTAIL size switch Fog switch ON 11 to 14 V B8 and B9 connectors on the front fog lamp wiring side Voltage is not up to standard, repair or replace the jack. If up to standard, there may have been an error in the measurement process. 2.2.4. Procedure for removing, installing and adjusting fog lights 1. Procedure for removing - Remove the front inner ear pads Use a screwdriver to remove the 3 screws and remove the front part of the front inner ear liner -Remove the fog light assembly + Disconnect the connector. + Use a screwdriver to remove 3 screws to remove the fog light cover 2. Installation sequence -Rotate the fog lamp bulb in the direction indicated by the arrow as shown in the figure and remove the fog lamp from the fog lamp assembly. -Rotate the fog light bulb in the direction indicated by the arrow as shown in the figure and install the light into the fog light assembly. - Use a screwdriver to install the fog light cover -Install the electrical connector Attention: Be careful not to damage the plastic thread on the lamp assembly. - Install the front inner ear pads Use a screwdriver to install the front inner bumper with 3 screws. 3. Prepare the vehicle to adjust the fog light convergence. Prepare the vehicle: - Make sure there is no damage or deformation to the vehicle body around the fog lights. - Add fuel to the fuel tank - Add oil to standard level. - Add engine coolant to standard level. - Inflate the tire to standard pressure. - Place spare tire, tools and jack in original design position - Do not leave any load in the luggage compartment. - Let a person weighing about 75 kg sit in the driver's seat. 4. Prepare to check the fog light convergence a/ Prepare the vehicle status as follows: - Place the car in a dark enough place to see the lines. The lines are the dividing line, below which the light from the fog lights can be seen but above which it cannot. - Place the car perpendicular to the wall. - Keep a distance of 7.62 m between the center of the fog lamp and the wall. - Park the car on level ground. - Press the car down a few times to stabilize the suspension. Note: A distance of approximately 7.62 m is required between the vehicle (fog lamp center) and the wall to adjust the convergence correctly. If the distance of 7.62 m cannot be achieved, set the correct distance of 3 m to check and adjust the fog lamp convergence. (Since the target area varies with the distance, please follow the instructions as shown in the figure.) b/ Prepare a piece of thick white paper about 2 m high and 4 m wide to use as a screen. c/ Draw a vertical line through the center of the screen (line V). d/ Set the screen as shown in the picture. Note: - Keep the screen perpendicular to the ground. - Align the V line on the screen with the center of the vehicle. e/Draw the reference lines (H, V LH and V RH lines) on the screen as shown in the figure.HINT: Mark the center of the fog lamp on the screen. If the center mark cannot be seen on the fog lamp, use the center of the fog lamp or the manufacturer's name mark on the fog lamp as the center mark. H line (fog light height): Draw a line across the screen so that it passes through the center mark. Line H should be at the same height as the center mark of the fog light bulb. Line V LH, V RH (center mark position of left fog lamp LH and right fog lamp RH): Draw two lines so that they intersect line H at the center marks. 5. Check the fog light convergence a/ Cover the fog lamp or remove the connector of the other side fog lamp to prevent light from the unchecked fog lamp from affecting the fog lamp convergence test. b/ Start the engine. c/ Turn on the fog lights and make sure that the dividing line is outside the standard area as shown in the drawing. 6. Adjust the fog light convergence Use a screwdriver to adjust the fog light to the standard area by turning the toe adjustment screw. Note: If the screw is adjusted too far, loosen it and then tighten it again, so that the last rotation of the light adjustment screw is clockwise. 3. Self-study questions 1. Describe the operating principle of the lighting system with automatic headlight function 2. Describe the operating principle of the lighting system with the function of rotating headlights when turning 3. Draw diagram and connect lighting system on Hyundai Porter car 4. Draw diagram and connect lighting system on Honda Accord 1992 5. Draw the lighting circuit on a 1993 Toyota Lexus LESSON 3 MAINTENANCE AND REPAIR OF SIGNAL SYSTEM I. IMPLEMENTATION GOAL After completing this lesson, students will be able to: - Distinguish between types of signals on cars - Correctly describe common symptoms and suspected areas causing damage. - Connecting signal circuits ensures technical requirements - Disassemble, install, check, maintain and repair the signal system to ensure technical requirements. - Ensure safety in work and industrial hygiene II. LESSON CONTENT 1. General description The signal system equipped on cars aims to create signals to notify other vehicles participating in traffic about the vehicle's operating status such as: stopping, parking, braking, reversing, turning... Signals are used either by light such as headlamps, brake lights, turn signals….. or by sound such as horns, reverse music…. Just like the lighting system. A signal system circuit usually consists of: battery, fuse, wire, relay, electrical load and control switch. Only some switches of the signal system are on the combination switch. The switches of other signals are usually located in different locations such as in the gearbox or brake pedal…… 2. Maintenance and repair 2.1. Turn signals and hazard lights The installation location of the turn signal is shown in Figure 3.1. The turn signal control switch is located in the combination switch under the steering wheel. Turning this switch to the right or left will make the turn signal turn right or left. The hazard light switch is used when the vehicle has a problem while participating in traffic. When the hazard light switch is turned on, all the turn signals on the vehicle will light up at a certain frequency. The hazard light switch is usually placed separately from the turn signal switch (some old cars integrate the hazard and turn signal switches on the same combination switch cluster). Figure 3.1 Turn signal switch Figure 3.2 Hazard switch The part that generates the flashing frequency for the lights is called a turn signal relay. The turn signal relay usually has 3 terminals: B (positive power supply); E (negative power supply); L (providing the turn signal switch to distribute to the lamp) 2.1.1. Circuit diagram To generate the frequency for the turn signal, a turn signal relay is used in the turn signal circuit. The current from the turn signal relay will be sent to the turn signal switch assembly to distribute the current to the turn signal lights for the driver's purpose. Figure 3.3. Schematic diagram of a turn signal circuit without a hazard switch 1. Battery; 2. Electric lock; 3. Turn signal relay; 4. Turn signal switch; 5. Turn signal lamp; 6. Turn signal lamp; 7. Hazard switch Figure 3.4 Schematic diagram of turn signal circuit with hazard switch 1. Battery; 2. Combination switch cluster; 3. Turn signal; 4. Turn signal light; 5. Turn signal relay Today's cars no longer use three-pin turn signal relays (B, L, E) but use eight-pin turn signal relays (figure 3.5) (pin number 8 is used for hazard lights). For this type, the current supplying the turn signal lights is supplied directly from the turn signal relay to the lights. div.maincontent .p { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; margin:0pt; } div.maincontent p { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; margin:0pt; } div.maincontent .s1 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 13pt; } div.maincontent .s2 { color: black; font-family:"Times New Roman", serif; font-style: italic; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s3 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s4 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 13pt; } div.maincontent .s5 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 13pt; vertical-align: 1pt; } div.maincontent .s6 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 11pt; } div.maincontent .s7 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; vertical-align: -9pt; } div.maincontent .s8 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 11pt; } div.maincontent .s9 { color: #008000; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s10 { color: black; font-family:"Times New Roman", serif; font-style: italic; font-weight: normal; te
Qos Assurance Methods for Multimedia Communications zt2i3t4l5ee zt2a3gs zt2a3ge zc2o3n4t5e6n7ts low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter. EF PHBs can be implemented if the output port's bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the router's service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port. This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation. PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values. Figure 2.10 Example of EF installation Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ. Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets. 2.2.4.2 Assured Forwarding (AF) PHB PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels. Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance. PHB Class PHB Subclass Package type DSCP AF4 AF41 Short 100010 AF42 Medium 100100 AF43 High 100110 AF3 AF31 Short 011010 AF32 Medium 011100 AF33 High 011110 AF2 AF21 Short 010010 AF22 Medium 010100 AF23 High 010110 AF1 AF11 Short 001010 AF12 Medium 001100 AF13 High 001110 Table 2.8 AF DSCPs The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped. When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels. In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards. 2.2.5.Example of Differentiated Services We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions: Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped. Figure 2.12 DiffServ Example Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a router's per-hop behavior is based only on the packet's marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability. Chapter Conclusion Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model. DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy. Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc. In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being "frozen", or many packets being dropped, seriously affecting service quality. Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion. 3.1. DropTail method DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped. Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages: − Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially. − Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended, Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed. − Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the router's buffer, this method is very expensive and ineffective. − No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy. The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers. In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management. 3.2. Random elimination method – RED 3.2.1 Overview RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet. The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router. Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways: − Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes. − Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet). Figure 3. 1 RED algorithm The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols. To achieve the above goals, RED gateways must do the following: − The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to. − The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network. − An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connection's shared bandwidth at the gateway. − Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows). 3.2.2 Algorithm This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5] For each packet arrival Caculate the average queue size avg If minth ≤ avg < maxth div.maincontent .s1 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 15pt; } div.maincontent .s2 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: bold; text-decoration: none; font-size: 15pt; } div.maincontent .p { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; margin:0pt; } div.maincontent p { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; margin:0pt; } div.maincontent .s3 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: bold; text-decoration: none; font-size: 14pt; } div.maincontent .s4 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s5 { color: black; font-family:"Times New Roman", serif; font-style: italic; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s6 { color: black; font-family:"Times New Roman", serif; font-style: italic; font-weight: bold; text-decoration: none; font-size: 14pt; } div.maincontent .s7 { color: black; font-family:Wingdings; font-style: normal; font-weight: normal; text-decoration: none; font-size: 14pt; } div.maincontent .s8 { color: black; font-family:Arial, sans-serif; font-style: italic; font-weight: bold; text-decoration: none; font-size: 15pt; } div.maincontent .s9 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: bold; text-decoration: none; font-size: 14pt; } div.maincontent .s10 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 9pt; vertical-align: 6pt; } div.maincontent .s11 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 13pt; } div.maincontent .s12 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-decoration: none; font-size: 10pt; } div.maincontent .s13 { color: black; font-family:"Times New Roman", serif; font-style: normal; font-weight: normal; text-d

3.3.2. Current status of patients using antihypertensive drugs after intervention Table 3.17: Percentage of patients using antihypertensive drugs after intervention

Practice

Target group		Total
Proof	Intervention	Total
Use medicine	Quantity	70	117	187
Use medicine	Proportion	46.4%	77.5%	61.9%
p < 0.05
Be reminded take medicines	Quantity	8	74	82
Be reminded take medicines	Proportion	5.3%	49.3%	27.2%
p < 0.05
Total		151 (100%)	151 (100%)	302 (100%)

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After the intervention, regarding the use of antihypertensive drugs, 61.9% of the patients in the study sample were using them, of which 46.4% were in the control group and 77.5% in the intervention group. The rate of drug use in the intervention group was statistically higher than that in the control group.

Regarding medication reminders after the intervention, although the group reminder solution was no longer supported before the 2-month evaluation period, in the intervention group, up to 49.3% of patients were still reminded to take medication in the past week while in the control group only 5.3% of patients were reminded. The rate in the intervention group was statistically higher than that in the control group.

3.3.3. Status of treatment compliance after intervention

Table 3.18: Morisky score distribution of patients after intervention (n = 182)

Morisky Point

Proof	Intervention	Shared
0	0	25	25
1	22	51	73
2	4	10	14
3	9	15	24
4	9	4	13

8	1	9
6	7	5	12
7	10	1	11
8	1	0	1
Total	70	112	182

Table 3.20: Distribution of compliance status according to Morisky scale after CT

Compliance level

treatment

Control group		Intervention group		Shared
n	%	n	%	n	%
Good	0	0	25	16.6	25	8.3
Medium	26	17.2	61	40.4	87	28.8
Non-compliance	125	82.8	65	43.0	190	62.9
Total	151	100.0	151	100.0	302	100.0
χ 2 = 58.0 p < 0.05

According to the Morisky scale, after the intervention, in the control group, no patient achieved good treatment compliance; 26 patients had average compliance (17.2%) and up to 82.8% of patients did not comply with treatment. Meanwhile, in the intervention group, up to 16.6% of patients had good treatment compliance and 40.4% of patients had average compliance. The difference after the intervention between the control group and the intervention group was statistically significant.

If we calculate according to 2 levels including compliance (good and average) and non-compliance (remaining) according to the concept used in the study, we have:

Table 3.21: Patient compliance rate after intervention

Treatment adherence rate

Target group		Total
Proof	Intervention	Total
Quantity	26	86	112
Proportion	17.2%	57.0%	37.1%
Total	151 (100%)	151 (100%)	302 (100%)
p < 0.05

On average, in the study sample, after intervention, 37.1% of patients adhered to treatment and 62.9% did not adhere to treatment. Of which, the adherence rate in the control group was 17.2%, lower than that in the intervention group at 57.0%. The difference between the control group and the intervention group was statistically significant.

To explain this when analyzing the qualitative results, in-depth interviews showed that when patients are reminded to take their medication, they will be aware that taking their medication is very important. Receiving reminders and encouragement from those around them also makes patients more committed to the treatment process. Patients also believe that the Interpretation Board is a good support for patients, helping them understand the meaning of the measured values as well as marking them:

PVS Patient Nam, 76 years old, Dong Co commune:

“… When I first came back from the hospital, my wife and I reminded me to take my medicine. After a while, I got used to it and when my son went to work far away, no one reminded me. I told them that my friends who were in the same situation as me often came over to encourage me…and if they reminded me to take my medicine, I wouldn’t forget and I would see that this treatment was important…so I had to continue taking it. I knew that the disease was still there …”

PVS BS Tien Hai District Medical Center:

“… There is this thing that patients write down, I can see it just by looking at it. If they bring it to me and I find the medicine is not suitable, I can easily change it. But old patients always remember and forget, they say it is high, but when asked how much it is, how can I say it? Sometimes, when I ask about any medicine, they say it feels comfortable, so I just prescribe it, …‖

Group discussions with health station staff showed that the station really liked the use of the Interpretation Board for patients to record and monitor blood pressure indexes over time and wanted a program to support patients to use this board widely at home:

TLN Tay Giang commune :

“… It's not that the elders don't know, but if you bring this table, one elder will tell another, and people will understand everything, and one person will tell another, and people who have never measured before may also want to measure to compare…‖

3.4. Evaluation of intervention results

3.4.1. Changes in knowledge and skills in blood pressure measurement before and after intervention

95%

68%

71%

59%

61%

54%

38%

36%

Control Group - Knowledge

Intervention Group - Knowledge

Control group -

Skill

Intervention Group - Skills

100%

90%

80%

70%

60%

50%

40%

30%

20%

Before CT After CT

Figure 3.1: Changes in knowledge and skills in self-monitoring BP after CT

After the intervention, the proportion of patients with correct knowledge about BP monitoring in the intervention group increased from 68.2% to 94.6% and the proportion with correct blood pressure measurement skills increased from 53.6% to 71.2% while these two proportions also increased slightly in the control group.

Analyzing the change from no knowledge to knowledge about self-monitoring blood pressure before and after the intervention, we have the distribution according to the following table:

Table 3.22: Distribution of patients with knowledge status change on self-monitoring of blood pressure Before and After CT

After intervention
Have knowledge	No knowledge	Shared
Before intervention	Proof	Have knowledge	89	0	89
	Proof	No knowledge	3 (4.8%)	59	62 (100%)
	p > 0.05 (Mc-Nemar test)
	Intervention	Have knowledge	103	0	103
	Intervention	No knowledge	38 (82.6%)	8	46 (100%)
	p < 0.05 (Mc-Nemar test)
	Shared	Have knowledge	192	0	192
	Shared	No knowledge	41 (38%)	67	108 (100%)
	p < 0.05 (Mc-Nemar test)

After the intervention, in the control group, 3 patients, equivalent to 4.8% of the group without knowledge before the intervention, changed their status from having no knowledge about self-monitoring of blood pressure to having knowledge about self-monitoring of blood pressure. However, the change from having no knowledge to having knowledge in the control group was not statistically significant. Meanwhile, in the intervention group, after the intervention period, 38 patients, equivalent to 82.6% of patients who had no correct knowledge about self-monitoring of blood pressure, changed to having correct knowledge. And the change in the intervention group was statistically significant. Thus, it can be seen that the intervention really brought about an improvement in the patients' knowledge about self-monitoring of blood pressure.

On the other hand, when analyzing the change in patients' correct blood pressure measurement skills before and after the intervention in both groups, we have:

Table 3.23: Distribution of patients who changed status from not knowing how to measure BP to knowing how to measure BP correctly

After intervention
Already know how to measure	Unknown	Shared
Before intervention	Proof	Already know how to measure	46	7	53
	Proof	Unknown	11 (11.5%)	85	96 (100%)
	p > 0.05 (Mc-Nemar test)
	Can card	Already know how to measure	59	18	77
	Can card	Unknown	45 (65.2%)	24	69 (100%)
	p < 0.05 (Mc-Nemar test)
	Shared	Already know how to measure	105	25	130
	Shared	Unknown	56 (33.9%)	109	165 (100%)
	p < 0.05 (Mc-Nemar test)

After the intervention, in the control group, 11 patients, accounting for 11.5%, changed from not knowing how to measure blood pressure themselves to having the skills to measure blood pressure themselves. However, the change in the control group was not statistically significant. In the intervention group, after the intervention period, 45 patients, equivalent to 65.2% of the patients who did not know how to measure blood pressure before the intervention, knew how to measure blood pressure correctly after the intervention. And the change in the intervention group was statistically significant. Thus, it can be seen that the intervention really helped improve the patients' skills to measure blood pressure correctly.

3.4.2. Changes in blood pressure measurement practices before and after intervention

87.9%

87.4%

62.2%

54.9%

51.0%

28.0%

13.9%

24.5%

100%

Control group -

Measure blood pressure

Intervention group

- Measure BP

Control group -

Record index

Intervention group

- Record index

90%

80%

70%

60%

50%

40%

30%

20%

10%

Before CT After CT

Figure 3.2: Percentage of patients who self-monitored BP and recorded pre- and post-CT readings

Comparing the results achieved in increasing self-monitoring of blood pressure with the intervention target, we see that after the intervention, this rate increased by 37.4% in the group of patients receiving the intervention while in the control group, this rate only increased slightly at 7.3%. Thus, the intervention program achieved higher than the set target of increasing the rate of regular self-monitoring of blood pressure.

Analyzing the changes of the 2 groups before and after the intervention in improving the practice of self-monitoring BP at home and recording the index, we have the following tables:

Table 3.24: Distribution of patients who changed from not measuring blood pressure at home to self-monitoring blood pressure at home before and after intervention

After intervention
Practice measuring	No practice measurement	Shared
Before intervention	Proof	Practice measure	76	7	83
	Proof	No practice measurement	18 (26.5%)	15	68 (100%)
	p < 0.05 (Mc-Nemar test)
	Intervention	Practice measure	68	9	77
	Intervention	No practice measurement	64 (86.5%)	10	74 (100%)
	p < 0.05 (Mc-Nemar test)
	Shared	Practice measure	144	16	160
	Shared	No practice measurement	82 (57.7%)	60	142 (100%)
	p < 0.05 (Mc-Nemar test)

After the intervention, in the control group, 18 patients (26.5%) changed their status from not practicing blood pressure monitoring to practicing blood pressure monitoring. The change in the control group was statistically significant. In the intervention group, after the intervention period, 64 patients, equivalent to 86.5% of the patients who had not practiced before the intervention, changed to the status of practicing blood pressure monitoring after the intervention. And the change in the intervention group was statistically significant. The above results show that after the intervention, patients had significant improvements in increasing their practice of self-monitoring blood pressure. However, it is not really certain whether it was due to the intervention alone or a change over time and other errors because the study was short-term, patients were interviewed many times, leading to spontaneous changes in

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