Search

Elderly patients with type 2 diabetes mellitus often face the problems of multimorbidity and multiple medications, and these conditions often lead to irrational or inappropriate medication use, significantly affecting patient outcomes and quality of life, making early and effective medication decisions particularly important. As an important supplement to medication support information, decision support tools, including electronic health record-based systems, mobile applications, online health platforms, etc., provide personalized, evidence-based medical information to help patients understand medication regimens, assist patients and healthcare professionals in making more rational medication decisions, enhance the appropriateness and safety of medication, and reduce the risk of drug interactions, thereby improving the overall treatment of patients and reducing the risk of drug interactions. The application of medication management in elderly patients with type 2 diabetes mellitus has made significant progress, thus improving the overall outcome and quality of life of patients. This article summarizes the current situation of medication use in elderly patients with type 2 diabetes mellitus, the influencing factors, types, application methods and their roles of decision aids, aiming to provide reference for the development of medication decision aids for this population in China.

Background Patient decision aids (PDAs) are essential tools to assist patients in the process of shared-decision making. However, their effects have been reported to be inconsistent in shared-decision making in the diagnosis and treatment of colorectal cancer. Objective To assess the core factors in the development of PADs supporting decision-making in colorectal cancer diagnosis and treatment, and their application effects using a systematic review. Methods In February 2022, randomized controlled trials (RCTs) on PDAs supporting decision-making in colorectal cancer care were searched in databases including PubMed, Web of Science, CIHNAL, Cochrane Library, EmBase, PsycINFO, JBI, Scopus, CNKI, WanFang, CQVIP and SinoMed from inception to January, 2022. Two researchers performed literature screening and data extraction separately. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials (5.1.0) was used to assess the risk of bias. A descriptive analysis was conducted to describe the core factors used in the development of PDAs and to summarize the effect of PDAs. Results A total of 11 RCTs were included, involving PDAs for supporting decision-making in colorectal cancer screening, systemic therapy and supportive care for advanced colorectal cancer, chemotherapy for metastatic colorectal cancer, and genetic testing for hereditary nonpolyposis colorectal cancer. The quality was moderate on the whole. Specifically, the quality of one RCT was rated as level A and that of the other 10 was level B. The analysis found that: (1) currently, the development of PDAs for supporting decision-making in colorectal cancer is mainly under the guidance of the quality criteria framework published by the International Patient Decision Aids Standards Collaboration, and the core content of the tool include providing information about options, balanced presentation of options, clarifying and expressing values; (2) The use of PDAs increased patient knowledge (six RCTs) , reduced patient decisional conflicts (eight RCTs) and promoted informed choice (two RCTs) . Conclusion The use of PDAs has proven to be effective in improving patient decision-making behavior and results in colorectal cancer. Although the evidence is still insufficient, they have broad prospect in clinical practice. In the future, the PDAs that are applicable to Chinese patients in different stages of colorectal cancer can be developed with the support of foreign theoretical achievements about decision-making and in accordance with the conditions of Chinese population, and the application effects of them need to be assessed further.

Aims: To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association. Background: There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational‐level solutions to prevent it. Methods: A cross‐sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire‐Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis. Results: A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate. Conclusion: The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses. Impact: This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB. Patient or Public Contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Stress-induced hyperglycaemia ( SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy ( CIIT) tends to induce hypoglycaemia and glucose variability. Aims This study investigated the clinical effects of a blood glycaemic control optimization programme ( BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. Design This study is a randomized, controlled, prospective clinical observation. Methods Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. Results Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly ( p = 0·000). The high glycaemic index ( p = 0·000), incidence of hypoglycaemia ( p = 0·011), and other adverse events as well as the incidence of abdominal infection ( p = 0·026), incision infection ( p = 0·044), and lung infection ( p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. Conclusion BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. Relevance to clinical practice This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. [ABSTRACT FROM AUTHOR]

Purpose: Eriodictyol is an active flavonoid present in several vegetables and fruits. Eriodictyol-bearing plants have long been used in folk medicine used to treat different human disorders. It has been reported to exhibit the anticancer, antioxidative and antiinflammatory properties. The current research study was designed to explore the anticancer potential of eriodictyol against CNE1 nasopharyngeal cancer (NP) cells. Additionally, its effects of targeting MEK/ERK signalling pathway, autophagy, cell migration and invasion were also examined., Methods: MTT assay was applied for viability measurements, and clonogenic potency measurements were made by clonogenic assay. Autophagy was monitored by transmission electron microscopy (TEM). Cell migration capability was examined by wound healing assay, and transwell chambers assay was used for estimation of cell invasion. Western blotting assay was performed to examine protein expression levels., Results: The results indicated the proliferation rate of CNE1 cells was reduced in eriodictyol dose-dependently. Cell colonies were also observed to be minimised after eriodictyol exposure. The underlying mechanism of antiproliferative effects of eriodictyol in the current research was found to be autophagy-mediated as suggested by TEM and increased expressions of pro-autophagy proteins. Cell migration and invasion was significantly suppressed by eriodictyol in CNE1 cells. Finally, western blotting assay indicated that eriodictyol blocked MEK/ERK signalling pathway dose-dependently. In conclusion, the results of the currently performed investigation indicated that eriodictyol is a potential anticancer agent against CNE1 nasopharyngeal cancer., Conclusions: Therefore, this molecule may prove a leading agent in nasopharyngeal cancer treatment provided further in vitro and in vivo investigations are performed.

Objective: To investigate the curative effect of bronchoalveolar lavage with fiberoptic bronchoscopy combined with vibration sputum drainage in the treatment of severe pneumonia patients undergoing mechanical ventilation (MV)., Methods: A prospective randomized controlled trial was conducted. 286 severe pneumonia patients undergoing MV admitted to intensive care unit (ICU) of Hunan People's Hospital from January 2014 to July 2016 were enrolled, and they were divided into control group and observation group according to random number table, with 143 patients in each group. Patients in both groups received sensitive antibiotics for anti-infection, etiological treatment, and calefacient and humidifying treatment. The patients in the control group received bronchoalveolar lavage with fiberoptic bronchoscopy, and those in the observation group received bronchoalveolar lavage combined with vibration sputum drainage. The parameters of respiratory function and inflammation before and after treatment, curative effect, and prognosis were compared between the two groups., Results: (1) There were no significant differences in respiratory function parameters between the two groups before treatment, 2 hours after treatment, the parameters were improved in both groups. Moreover, oxygenation index (PaO 2 /FiO 2 ) in observation group was significantly higher than that of control group [mmHg (1 mmHg = 0.133 kPa): 379.1±20.2 vs. 351.8±24.7], and arterial partial pressure of carbon dioxide (PaCO 2 ) and airway resistance (Raw) were significantly lower than those of the control group [PaCO 2 (mmHg): 36.5±5.8 vs. 45.3±6.9, Raw (cmH 2 O, 1 cmH 2 O = 0.098 kPa): 12.9±0.6 vs. 13.1±0.8, all P < 0.01]. (2) There were no significant differences in inflammation parameters between the two groups before treatment, 24 hours after intervention, which were significantly decreased in both groups. Moreover, white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in the observation group were significantly lower than those of the control group [WBC (×10 9 /L): 8.2±1.7 vs. 12.8±3.7, PCT (μg/L): 15.4±2.4 vs. 21.8±3.1, CRP (mg/L): 37.1±6.1 vs. 67.2±7.2, all P < 0.01]. (3) Compared with the control group, the treatment efficiency of observation group was improved [95.1% (136/143) vs. 87.4% (125/143)], the quantity of sputum excretion was increased (mL: 49.2±12.5 vs. 36.9±11.0), duration of MV and length of ICU stay were significantly shortened (days: 6.4±3.6 vs. 9.4±2.1, 8.6±5.7 vs. 12.4±4.6, both P < 0.01), however, there was no significantly statistical difference in 28-day mortality between control group and observation group [2.8% (4/143) vs. 2.1% (3/143), P > 0.05]., Conclusions: Compared with bronchoalveolar lavage with fiberoptic bronchoscopy alone, the treatment of bronchoalveolar lavage combined with vibration sputum drainage is more effective in sputum excretion for severe pneumonia patients undergoing MV, which could improve the respiratory function, reduce infection, shorten the duration of MV and the length of ICU stay, and improve the recovery.