The effect of subcutaneous injection duration on patients receiving low-molecular-weight heparin:Evidence from a systematic review

To assess the effect of the injection duration of subcutaneous low-molecular-weight heparin(LMWH)on pain and bruising in patients.Randomized controlled trials and quasiexperimental studies were searched for in four electronic databases.The pooled effect size was expressed as relative risk(RR)andmeandifference(MD)with95%confidence intervals(CI)for dichotomous and continuous data.Cochrane Q and p value were used to assess heterogeneity and the I2 statistic was adopted to quantify the level.Finally,eight studies involving a total of 532 participants met our inclusion criteria.The slow(30 second)injection was associated with a reduction in pain intensity and duration,and lower bruising occurrence at 48-72 hours and 48 hours post injection.The bruising area was also smaller at 48 hours and 60 hours post injection.Nodifferenceswere identified betweenthe slowand fast(10 second)injectionin bruising area and bruising occurrence at 24 hours and 60 hours post injection.With present evidences,slow injection of LMWH is beneficial to the patient's well being,but further studies to identify the feasibility and standardization of the technique is recommended.

Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in China's Mainland

The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.

Jinhuang powder for the treatment of diabetic foot ulcers:an updated metaanalysis with power analysis and trial sequential analysis

Background:Traditional Chinese Medicines(TCM)had been indicated to benefit for the chronic non-infectious diseases,such as cancers,hypertension,primary dysmenorrheal,etc.Although randomized controlled trials(RCTs)had been conducted,there was still the controversy on the efficacy of Jinhuang powder for diabetic foot ulcers(DFUs).Objective:This systematic review aimed to objectively evaluate the potential of Jinhuang powder for DFUs.Methods:Seven databases(CNKI,Chongqing VIP,Wanfang database,CBM,the Cochrane Library,PubMed and Web of Science)were searched to retrieve RCTs up to December,2016;and the relevant references of the eligible studies were screened.According to the eligible criteria,the literature was screened;data were extracted;and then the methodological quality was assessed.The meta-analysis,power analysis and trial sequential analysis(TSA)were performed by using Meta analyst software(version beta 3.13),Stata 12.0,Power and Precision statistical software package(Biostat)and TSA software(version0.9),respectively.Results:Finally,three RCTs with 198 participants were included.The results of meta-analysis showed that there were statistically significant differences between groups in(1)the cure rate(RR,1.25;95%CI.1.10to1.41;P=0.00)and(2)the wound healing time(SMD,-3.404;95%CI,-5.821 to -0.987;P=0.00).Three trials presented more than 80% power with 0.05α-errors in both outcomes and the power of two meta-analyses to pool different outcomes presented more than 95%.The TSA showed that the summary results were certain.Conclusion:The external application with Jinhuang powder was an effective and cost-effective therapy for DFUs.The power analysis and TSA showed that the efficacy of Jinhuang powder dressing for the treatment of DFUs is conclusive.

Early enteral nutrition supplemented with probiotics improved the clinical outcomesin patients with severe head injury： protocol for a meta-analysis of randomizedcontrolled trials

Objective： The aim of this systematic review of randomized controlled trials （RCTs） is to determine the effects of earlyenteral nutrition supplemented with probiotics on clinical outcomes in patients with SHI.Methods and analysis： A systematic search will be carried out in PubMed, Cochrane Central Register of ControlledTrials （CENTRAL）, China National Knowledge Infrastructure （CNKI）, WanFang database, and Chinese BiomedicalLiterature （CBM） in order to identify the randomized controlled trials （RCTs） investigated the potential of early enteralnutrition supplemented with probiotics on patients with severe head injury, as well as we will also manually check thebibliographies of eligible studies and topic-related reviews. We will assign two investigators to independently search allpotential citations, extracted data, and appraised risk of bias accordingly, and then STATA software version 12.0 will beused to statistically analyze all data.Ethics and dissemination： The ethics approval and patient written informed consent will not be required because allanalyses in the present study will be performed based on data from published studies. We will submit our systematicreview to a peer-reviewed scientific journal for publication.

Case management does not decrease mortality of patients with myocardial infarction or unstable angina:Evidence from a systematic review

Objective:To objectively assess the impact of case management on patients with myocardial infarction or unstable angina.Methods:PubMed,EMBASE,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNKI),and Chinese Biomedical Literature Database were searched for relevant randomized controlled trials(RCTs)published through February 2015.The quality of eligible studies was independently assessed by two investigators.The primary outcome assessed from included studies was all-cause mortality,with total cholesterol,systolic and diastolic blood pressures,smoking cessation rates and cost-effectiveness as secondary outcomes.The pooled effect sizes were expressed as relative risk,odds risk,and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using Cochrane Q and determined with an I2 statistic.Results:After the initial search,a total of four studies divided into six RCTs that included 1293 participants met the inclusion criteria and were analyzed.The results of meta-and descriptive analyses failed to identify any significant differences in all-cause mortality during the follow-up period of up to 36 months.Furthermore,a definitive conclusion for remaining indicators could not be drawn due to limited evidence.Conclusion:Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care.Additional,prospective RCTs of high quality and large scale are warranted to verify these results.

Effects of honey dressing for the treatment of DFUs: A systematic review

Background:Honey dressing has been applied to clinical practice for many types of disease for centuries.Many researchers have studied the effects of honey dressing for the treatment of DFUs(diabetic foot ulcers),and no systematic review has considered effects of honey dressing on DFUs.A systematic review performed to objectively evaluate the effectiveness of honey dressing in the treatment of DFUs.Methods:We include all original studies found for the key words honey and diabetic foot ulcers.Mean effect sizes and confidence intervals are pooled from study effect sizes according to standard methods,and these are considered for various common types of honey dressing interventions separately.Results:A total of 4 RCTs involving 258 participants were included,and 3 trails involving 228 participants met the quantitative analysis and 1 study involving 30 participants met qualitative analysis.Results of meta and descriptive analyses showed that total treatment time,Mean purge time of ulcers,ratio of purging germ,healed area of ulcers in honey dressing group are better than that of control group,respectively,and with statistically significant differences.Conclusions:Honey dressing was superior of traditional dressing for treatment of DFUs.Due to limitations in the quantity of published studies,this conclusion has yet to be carried out in large,multicenter study to validate.

Effect of case management on patients with type 2 diabetes mellitus: a meta-analysis

Background： Case management is a term used to describe the activities performed by a physician or other health care professional to ensure the coordination of medical services required by a patient. Managed care requires the incorporation of information pertaining to patient evaluation, treatment planning, referrals, and follow-up care to ensure that payment for services is received and that care is ongoing and comprehensive. The objective of this review was to assess the efficacy of case management in patients with type 2 diabetes mellitus with respect to outcomes such as glycosylated hemoglobin （HbA1c）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and low-density lipoprotein （LDL）. Methods： Databases including PubMed, Embase, Web of Science, the Cochrane Library, the China Na- tional Knowledge Infrastructure （CNKI）, VIP, Wan Fang and the Chinese Biomedical Literature Database （CBM） were searched for randomized controlled trials （RCTs） dating as late as Jan, 2015, Reference sections of the included studies were also searched. Results： Twelve studies, involving 11 RCTs that evaluated a total of 4000 patients, were included in this analysis. Two of the 12 studies evaluated the same RCT. Seven of the 12 studies reported HbAlc as an outcome, and three trials reported changes in SBP, DBP and LDL levels as outcomes. The pooled results indicated that statistically significant improvements in HbAlc （MD = -0.35, 95% CI （-0.68, -0,02）, P = 0.04） and LDL levels （MD = -2,49, 95% CI （-4.04, -0.93）, P - 0.002） were associated with the case management group compared with control group; however, no statistically significant differences in DBP （MD = -0.08, 95% CI （-0.68, 0.52）, P = 0.8） and SBP （MD = -0.96, 95% CI （ 5.77, 3.84）, P = 0.69） were observed. Conclusions： Case management was effective in improving HbA1c and LDL levels in patients with type 2 diabetes mellitus. Although no statistically significant differences in DBP and SBP between the case management group and the control group were observed, further research is required to draw a conclusion about the effect of managed care on these outcomes. Based on this meta-analysis of clinical trials, we conclude that case management offers an effective clinical method for the treatment of type 2 diabetes.

Application of Home Health Nursing Abroad:A Literature Review

Currently, with advancesin medical science, the average lifespan of citizens is gradually in- creasing worldwide, resulting in the emergence of an aging society. Aged patients are especially prone to suffering from various chronic diseases, and many elderly patients select to receive home-based care. Thus, professional care in elderly patients＇ homes is needed, which also represents a mark of social development. Today, home health nursing is widely applied, including nursing of post labor mothers and their infants, and osteoporosis patients, among others. The aim of the present study was to explore the home health nursing model and its applicable range, as well as existing problems and the impact of the model in the domestic settings.