Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers:A systematic review and meta-analysis

BACKGROUND The definition of diabetic foot syndrome(DFS)varies depending on the location and resources.Few classifications are available according to the indication.DF ulcers and vitamin D deficiency are common diseases among patients with diabetes.Previous literature has shown an association between DF ulcer(DFU)and vitamin D deficiency.However,the available meta-0analysis was limited by substantial bias.AIM To investigate the association between DFUs and vitamin D levels.METHODS We searched PubMed,MEDLINE,and Cochrane Library,EBSCO,and Google Scholar for studies comparing vitamin D levels and DF.The keywords DFU,DFS,diabetic septic foot,vitamin D level,25-hydroxy vitamin D,vitamin D status,and vitamin D deficiency were used.The search engine was set for articles published during the period from inception to October 2022.A predetermined table was used to collect the study information.RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts[odds ratio(OR):-5.77;95%confidence interval(CI):-7.87 to-3.66;χ2 was 84.62,mean difference,9;I2 for heterogeneity,89%;P<0.001 and P for overall effect<0.001].The results remained robust for hospitalized patients(OR:-6.3295%CI:-11.66 to-0.97;χ2 was 19.39;mean difference,2;I2 for heterogeneity,90%;P=0.02).CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs.Further larger randomized controlled trials are needed.

Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes

PURPOSE: Diabetic patients with severe diabetic neuropathy often have hypoesthesia and numbness. This study evaluated foot self-care behavior according to severity of diabetic neuropathy. METHODS: We used a hand-held nerve conduction test device DPN check (HDN-1000, Omron) to evaluate severity of diabetic neuropathy. Foot self-care was evaluated using the Japanese SDSCA (the Summary of Diabetes Self-Care Activities measure). Foot self-care comprised visual inspection, washing, wiping interdigital areas, and checking shoes, and was scored according to the number of days self-care which was performed in the previous week. RESULTS: The study evaluated 103 diabetic patients (age: 65.7 years, diabetes duration: 13.9 years, HbA1c: 7.3%). Total scores (out of 28 points) for self-care behavior according to neuropathy severity were 11.8 (Normal: n = 54), 10.6 (Mild: n = 27), 13.3 (Moderate: n = 17), and 10.8 (Severe: n = 5). Foot self-care scores were low in all groups, with particularly low scores in those with severe neuropathy. However, no statistically significant differences were observed. CONCLUSIONS: Foot self-care is essential in diabetes because lesions are more likely to occur in severe neuropathy. Living alone and the presence of recurrent foot lesions are associated with poor survival prognosis. Accordingly, foot-care intervention must take neuropathy severity and lifestyle factors into account. The severity of diabetic neuropathy must be determined and foot-care intervention should take lifestyle factors into account.

Effects of Health Education with Problem-Based Learning Approaches on the Knowledge, Attitude, Practice and Coping Skills of Women with High-Risk Pregnancies in Plateau Areas

Objective: Given the unique cultural background, way of life, and physical environment of the Tibetan Plateau, this study aims to investigate the effects of health education using problem-based learning (PBL) approaches on the knowledge, attitude, practice, and coping skills of women with high-risk pregnancies in this region. Methods: 76 high-risk pregnancy cases were enrolled at Tibet’s Linzhi People’s Hospital between September 2023 and April 2024. 30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education. 46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches. Two groups’ performance on their health knowledge, attitude, practice and coping skills before and after interventions were evaluated, and patient satisfaction were measured at the end of the study. Results: There was no statistical significance (P P P Conclusions: Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge, attitude and practice and healthier coping skills. Also, it can improve patient sanctification.

Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3 - 4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3 - 4 patients were performed in our department for Rutherford category 2 - 6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3 - 12 days) whereas the 30-day mortality rate in this homogeneous “high-risk” group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking ((p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/(p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC “C” and “D” lesions (p = 0.360 and (p = 0.0394), the stent number ((n = 3) and length (>6 cm) ((p = 0.0039 and (p = 0.0003) and the initial ABI scoring ((p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA “high risk” patients, owning low invasiveness, reproducibility and acceptable patency in return to punctual postoperative surveillance.

Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

人文关怀护理对糖尿病足患者焦虑抑郁情绪效果观察

目的运用人文关怀护理干预缓解糖尿病足患者焦虑抑郁情绪。方法选取于2022年1月—2023年4月医院收治的糖尿病足患者100例为研究对象,随机分组为对照组和观察组,各50例。对照组接受常规治疗和护理,观察组在对照组基础上增加人文关怀护理。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估患者焦虑抑郁情绪。结果干预后,两组SAS和SDS量表评分均较干预前下降,且观察组SAS和SDS量表评分低于对照组,差异有统计学意义(P<0.01)。结论人文关怀护理能有效改善糖尿病足患者焦虑抑郁情绪,增强积极应对方式,从而有利于改善生活质量。

中医调护法联合延续护理干预对糖尿病足高危患者足部护理知识及自我管理能力的影响

目的 探讨应用中医调护法联合延续护理干预对糖尿病足高危患者足部护理知识、自我管理能力的影响。方法 选取2021年1月-2023年2月本院收治的糖尿病足高危患者80例为研究对象,遵循随机数表法分成实验组(n=40)、对照组(n=40)。对照组患者应用常规护理,实验组患者在常规护理的基础上,给予患者加用中医调护法联合延续护理干预。比较两组患者的足部护理知识得分、干预前后患者自我管理能力得分变化。结果 实验组患者在干预后的足部护理知识得分各项均高于对照组,差异有统计学意义(P<0.05);在干预后患者自我管理能力的各方面得分相比干预前提高,而实验组分值高于对照组,差异有统计学意义(P<0.05)。结论 针对糖尿病足高危者,应用中医调护法联合延续护理干预,能显著提高患者足部护理知识掌握情况,此外也可提高患者自我管理能力。

The Effectiveness of Concept Mapping as an Educational Nursing Intervention Strategy to Handle Diabetic Foot: Integrative Review

Introduction: Concept map is used as a teaching strategy, where nursing uses this method often to learn more effectively and to be able to apply knowledge when working with diabetic patients. Objective: The aim of this review is to examine all the published articles related to the effectiveness of concept mapping as an educational nursing intervention strategy to handle diabetic foot from 2010-2019. Methodology: Integrative review design in reviewing pertaining literature. Key words related to research were used, database obtained from Cochrane library, MEDLINE, PubMed, Science Direct, Cumulative Index Nursing and Allied Health Literature (CINAHL), ProQuest and Ovid databases were searched, covering the period 2010 to 2019. Other Studies were included if they were related to the effectiveness of concept mapping as an educational nursing intervention strategy to handle diabetic foot. Results: Reveled that concept mapping is a very crucial education tool for both nurses and patients. It is used by nurses to teach diabetic patients how to prevent diabetic foot ulcer, as well as to understand how to organize information and understand the facts. Conclusion: This review confirmed that there are growing confirming literatures about the application of concept maps as an effective nursing strategy. It that can be used by nurses and other health care professionals, to maintain healthy feet and prevent further complications such as bruises, cuts and sores.

Effectiveness of a Self-Foot-Care Educational Program for Prevention of Diabetic Foot Disease

Objective: To verify the effectiveness of a “self-foot-care educational program (SFCEP)” for prevention of type 2 diabetes foot disease. Methods: A single-center, randomized and controlled trial was conducted. Fifty-five patients with type 2 DM, 40 - 75 years of age who were asked to return for a follow-up hospital visit, were allocated to either an SFCEP group (n = 29) or a conventional education program (CEP) group (n = 26). Both of the groups were given foot-care education, monthly for four times in the SFCEP group and in the CEP group one time only by a printed leaflet. The two groups had no statistically significant differences in patient background of the type 2 diabetes history. We evaluated removal rate of skin debris, and the symptoms and conditions of the feet. Results: Between the SFCEP and CEP there were significant differences in removal rate of skin debris (p Conclusion: This study strongly suggests the effectiveness of SFCEP in preventing the occurrence or worsening of diabetic foot diseases.

Adjuvant Treatment for High-Risk Operable Prostate Cancer

Patients who have undergone a radical prostatectomy may have to face high risks of recurrence. The risk of recurrence is elevated due to probable occult metastatic disease at the time of diagnosis. A rationale for using multimodal approach in order to minimize the chance of disease recurrence and to improve the survival of high risk patients is emerging from preclinical and clinical studies. New molecular and genetics assays, may help to select patients most likely to benefit from these approaches. In this review, we will especially discuss the potential benefits of adjuvant therapy after radical prostatectomy. This paper presents the identification of these high-risk patients;the explanation of an adjuvant treatment of residual disease after a radical prostatectomy;the clinical studies with adjuvant androgen deprivation, radiotherapy and/or chemotherapy and the microarrays analysis. This review highlights the importance of these new adjuvant treatments that aims at targeting the factor which triggers metastatic disease following a radical

糖尿病足病人自我管理支持需求的质性研究

目的:深入了解糖尿病足病人在疾病进程中对各个不同相关方面所认知的需求及其相互之间的关联影响,为医护人员制定高效的联合干预措施提供依据。方法:采用现象学方法对11例糖尿病足病人进行半结构访谈,运用Colaizzi七步法分析程序进行资料分析。结果:共形成3个类别及6个主题,分别为足部护理知识的需求、疾病自我管理的需求、家庭支持与照顾的需求、专业诊疗护理技术的需求、便利性诊疗护理服务的需求、疾病相关健康教育的需求。结论:糖尿病足病人需求是来自多方面且互相关联的,医护人员应从不同角度出发理解病人需求并重视病人在疾病发展全过程中存在的需求,通过多样化健康教育、开展居家护理服务、构建医院-社区-家庭3方联动的糖尿病足防控模式等措施满足病人需求,进而提高病人体验及生活质量。

中药足浴联合耳穴压豆治疗老年失眠30例

目的探讨中药足浴联合耳穴压豆治疗老年患者失眠的临床效果。方法将60例住院失眠的老年患者随机分为治疗组和对照组各30例,对照组给予常规药物治疗,治疗组给予中药足浴联合耳穴压豆治疗,观察2组失眠老年患者的临床疗效。结果治疗组总有效率为93.33%(28/30),显著高于对照组的76.67%(23/30),差异具有统计学意义(P<0.05)。结论中药足浴联合耳穴压豆治疗老年患者失眠的效果显著,不良反应小,能更好地改善老年人的睡眠质量,值得进一步探讨。

Does orthotics use improve comfort,speed,and injury rate during running?A randomised control trial

BACKGROUND Running is a hugely popular sport.Unfortunately,running-related injury(RRI)rates are high,particularly amongst amateur and recreational runners.Finding ways to reduce RRI rates and maximise comfort and performance for runners is important.Evidence regarding whether orthotics can successfully improve these parameters is limited and contradicting.Further research is required to provide runners with clearer guidance on the usefulness of orthotics.AIM To investigate the effect of Aetrex Orthotics on comfort,speed and RRI rates during recreational running.METHODS One hundred and six recreational runners were recruited on a voluntary basis via running clubs and social media pages and randomised into either the intervention or control group.Participants in the intervention group ran with Aetrex L700 Speed Orthotics inserted in their usual running shoes,whilst participants in the control group ran in their usual running shoes with no orthotics.The study ran for an 8-wk period.Participants provided data relating to running comfort,distance,and time during weeks 3-6.Participants provided data relating to any RRIs they sustained during all 8 wks.Running distance and time were used to calculate running speed in miles per hour(mph).For each outcome variable,95%confidence intervals and P values were calculated to assess the statistical significance between the groups.For comfort and speed data,univariate multi-level analysis was performed,and for outcome variables with significant between group differences,multi-level multivariate analysis was performed to evaluate any confounding effects of gender and age.RESULTS Ninety-four participants were included in the final analysis(drop-out rate=11%).Comfort and speed from 940 runs and 978 injury data reports were analysed.Participants who ran with orthotics reported,on average,speeds 0.30 mph faster(P=0.20)and comfort scores 1.27 points higher(P≤0.001)than participants who ran with no orthotics.They were also 2.22 times less likely to sustain an injury(P=0.08)than participants who ran with no orthotics.However,findings were only significant for comfort and not for speed or injury rates.Age and gender were found to be significant predictors of comfort.However,the improvements in comfort reported by participants who ran with orthotics were still significant after adjusting for age and gender.CONCLUSION This study found orthotics to improve comfort and speed and prevent RRIs whilst running.However,these findings were only statistically significant for comfort.

看图对话互动式健康教育对老年糖尿病患者足部自我护理行为的影响

目的:探讨看图对话互动式健康教育模式对老年糖尿病患者足部自我护理行为的影响.方法:选择2020年1月至2021年1月在本院就诊的120例老年糖尿病患者为研究对象,将其随机分为试验组(n=60)和对照组(n=60).试验组在采用传统的健康教育方式基础上增加"糖尿病足部护理"看图对话工具开展互动式健康教育,对照组仅采用传统的健康教育方式.比较两组干预前、后血糖控制情况、低血糖发生率及足部自我护理行为的变化.结果:干预3个月后,试验组患者的空腹血糖、餐后2h血糖、糖化血红蛋白水平均低于对照组,低血糖发生率低于对照组,足部自我护理行为方面明显优于对照组,差异均有统计学意义(P<0.05).结论:开展看图对话互动式健康教育,临床效果良好,不仅能帮助老年糖尿病患者更好地控制血糖水平,降低低血糖发生率,还能助其建立健康的足部自我护理行为,延缓或避免糖尿病足的发生.

收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术的应用

目的:探讨收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术应用的效果。方法:择期行足部手术的老年患者69例,以随机数字表法分为3组:蛛网膜下腔阻滞联合大腿止血带组(C组)、蛛网膜下腔阻滞联合踝部止血带组(SA组)及收肌管及腘窝坐骨神经阻滞联合踝部止血带组(NA组)。比较3组麻醉后30 min内平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)变化峰值,松止血带后1、3、5、10、15 min时MAP及HR变化;术后排尿、排气时间及24 h恢复质量(quality of recovery,QoR)-15评分;麻醉及术野止血效果、间羟胺用量、首次自控镇痛(patient-controlled analgesia,PCA)时间、术后48 h内舒芬太尼用量及不良反应等情况。结果:纳入患者69例,64例完成研究。与C组及SA组比较,NA组麻醉后30 min内MAP及HR变化峰值明显减小,术后排尿、排气时间显著缩短,24 h QoR-15评分更高;麻醉起效较慢、阻滞范围小,间羟胺用量更少,首次PCA时间显著延长,术后12、24及48 h舒芬太尼累积用量减少,差异有统计学意义(P<0.05)。与C组比较,SA组及NA组松止血带后MAP、HR波动幅度明显减小,间羟胺用量更少;术后止血带区域皮肤水泡和疼痛发生率更低,差异有统计学意义(P<0.05)。3组其余指标差异无统计学意义(P>0.05)。结论:收肌管及腘窝坐骨神经阻滞联合踝部止血带应用于老年足部手术,血流动力学稳定,恢复速度快,效果良好,不良反应少。

多功能护理充气垫在制动或不能活动患者中的应用效果

目的探讨多功能护理充气垫在制动或不能活动患者中的应用效果。方法选取2022年9月至2023年2月广东省人民医院赣州医院神经外科收治的60例因创伤、手术或各种病理情况而需制动或不能活动患者作为研究对象,按照计算机随机数法分为对照组(30例)与观察组(30例)。对照组采用常规药物预防护理,观察组应用研发的多功能护理充气垫预防护理。比较两组的腿部功能情况、静脉血栓和足下垂发生率、生活质量综合评定问卷(GQOL-74)评分、满意度得分、住院时间、住院费用、早期活动时间。结果两组患者的静脉血栓、足下垂发生率比较,差异无统计学意义(P>0.05)。观察组的GQOL-74评分、满意度得分均高于对照组,差异有统计学意义(P<0.05)。观察组的早期活动时间、住院时间均短于对照组,住院费用低于对照组,差异有统计学意义(P<0.05)。结论采用多功能护理气垫应用在因创伤、手术或各种病理情况而需制动或部分制动的患者护理中,可降低静脉血栓、足下垂发生率,促进患者康复,提高长期生存质量。

老年糖尿病足溃疡住院患者营养现状调查及因素分析研究

目的探讨老年糖尿病足溃疡(diabetic foot ulcer,DFU)住院患者的营养现状并分析其影响因素。方法选取2022年7月—2023年7月收治于贵州中医药大学第二附属医院内分泌科老年DFU住院患者136例为研究对象,收集患者一般资料,通过营养风险筛查量表(Nutritional Risk Screening 2002,NRS2002)判断其营养情况,NRS2002<3分(40例)为无风险组,NRS2002≥3分(96例)为风险组,对两组患者资料进行比较分析。结果136例研究对象中,96例患者(70.58%)存在营养风险。单因素分析结果显示,两组患者的年龄、病程、足溃疡感染情况、Wagner分级、葡萄糖化血红蛋白(glycated hemoglobin,HbA1c)、C反应蛋白(C-reaction protein,CRP)情况比较,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄、病程、足溃疡感染、Wagner分级、HbA1c、CRP均是影响老年DFU住院患者营养状况的危险因素(P<0.05)。结论老年DFU住院患者存在一定的营养风险,年龄、病程、足部溃疡感染情况、Wagner分级、C反应蛋白因素可增加患者的营养风险。因此,医护工作者应重视住院患者的营养筛查、评估,及时将精准化医学营养治疗方案与慢病治疗相结合,提高患者的生活质量。

2型糖尿病合并足部感染患者运用湿性换药护理的效果分析

目的探讨2型糖尿病合并足部感染患者运用湿性换药护理的效果。方法选取2021年1月—2022年1月临沂河东医院收治的2型糖尿病合并足部感染患者80例,采用双盲随机法分为两组。对照组给予常规换药护理,观察组实施湿性换药护理。比较两组护理前后不良情绪监测指标、生存质量评分、满意度、换药频率、伤口愈合时间、换药疼痛评分、瘢痕发生率。结果观察组不良情绪监测指标低于对照组,生存质量评分高于对照组,满意度高于对照组,换药频率、换药疼痛评分低于对照组,伤口愈合时间短于对照组,瘢痕发生率低于对照组,差异有统计学意义(P<0.05)。结论2型糖尿病合并足部感染患者实施湿性换药护理效果确切,可缓解疼痛,缓解不良情绪,减少换药频次,缩短愈合时间,减少瘢痕形成,改善患者生活质量,提高满意度。

糖尿病患者足部风险筛查现状及影响因素分析

目的:分析糖尿病患者足部风险筛查现状及影响因素。方法:选取2020年1月—2022年12月成都市温江区人民医院收治的糖尿病患者240例为研究对象,通过问卷调查的形式了解足部风险筛查的具体情况,分析患者进行风险筛查的影响因素。结果:在参与调查的糖尿病患者中,54.24%的患者属于糖尿病足的高危人群,能够主动参与风险筛查的患者占比15.25%。多因素Logistic回归分析发现,家庭人均月收入、糖尿病足高危人群及筛查必要性认知、文化程度是足部风险筛查的影响因素(P<0.05)。结论:从整体来看,糖尿病患者主动参与足部风险筛查的意愿不高,在对其进行干预的时候要重点关注家庭收入较低、尚未存在高危风险及对糖尿病足风险筛查认知不到位、文化程度较低的患者群体。

Clinical features and prognostic analysis of high-risk acute promyelocytic leukemia patients

<正>Objective To investigate the clinical features and outcomes of high-risk acute promyelocytic leukemia(APL)patients.Methods A retrospective analysis was conducted to compare the clinical characteristics and prognosis of 118 high-risk APL patients(WBC≥10×10~9/L)and 234 low and intermedia-risk patients(WBC<10×10~9/L)from January 2003 to April 2015。