[Holistic Person-Centered Care for Individuals With Type 2 Diabetes Mellitus].

In 2022, the American Diabetes Association and the European Association for the Study of Diabetes emphasized that type 2 diabetes care is a person-centered holistic care concept. This article summarizes the concepts of holistic care for individuals with type 2 diabetes and proposes a complete model of the six-layer whole-person care circle for individuals with type 2 diabetes. This model treats individuals with type 2 diabetes as the core of care and adopts their specific needs, preferences, and values to design individualized care plans. The overall goal of care is to maintain quality of life and to avoid or delay complications. Management methods must be holistic. Based on people and comprehensive considerations, six circles of care are listed. The first layer is caregivers, taking into account the influence of the family and the community on the individual. The second layer is multi-professional and multi-disciplinary team care, which provides support to individuals with diabetes. The third layer emphasizes the need for the following thirteen principles in diabetes care: monitoring and screening for complications, behavior modification for healthy habits, monitoring and continuous assessment, reducing the risk of hypoglycemia, effective implementation and care organization, considering underlying physiological conditions, avoiding therapeutic inertia, considering social determinants of health, psychological factors, structured diabetes education, language proficiency, shared decision-making, and considering regional healthcare institutions and related resources. The fourth layer is the decision cycle of care, which applies the principles of care and conducts continuous and dynamic case management based on the decision cycle. The fifth layer is the healthcare network through which health providers provide hospital, long-term care, and primary clinics/ primary network care referrals based on the needs of individual with diabetes. The sixth layer leverages the chronic care model to construct a supportive healthcare system comprising organizational support, clinical information systems, delivery system design, decision support, self-management support, and community resources. This proposed model may provide a reference for constructing healthcare systems to care for patients with type 2 diabetes.

Effects of scar massage on burn scars: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: This study explored the physical and psychological effects of scar massage on burn patients. BACKGROUND: Hypertrophic scar development is highly prevalent following burn injuries. Scar massage may have physical and psychological effects, although evidence of its effectiveness for burn scar improvement remains inconsistent. DESIGN: A systematic review and meta-analysis of randomised controlled trials and quasi-experimental trials. METHODS: This study was conducted following the Centre of Reviews and Dissemination guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PubMed, EMBASE, and Chinese Electronic Periodical Services were searched for studies published between January 1990 and February 2022. Quality was assessed using the Joanna Briggs Institute (JBI) Appraisal Checklist. The final recommendation strength was assessed according to the JBI recommendation rating. A meta-analysis was performed using Review Manager Version 5.4 software with a random-effect model. RESULTS: Seven studies (420 participants) investigating scar massage for burn patients were included. The scar massage sessions lasted 5-30 min and were delivered by massage therapists 1-3 times a week for 12 weeks. Overall, scar massage decreased pain levels (standardised mean difference [SMD]: -2.39; 95% confidence interval [CI]: -3.96 to -0.83), improved scar thickness (mean difference: -0.05; 95% CI: -0.1 to -0.0), reduced pruritus (SMD: -1.89; 95% CI: -2.95 to -0.82) and reduced anxiety (SMD: -1.52; 95% CI: -2.73 to -0.32), but no significant effect on depression(SMD: -0.92; 95% CI:-2.28 to 0.44). CONCLUSIONS: The meta-effects of scar massage among burn patients are significantly improved scar formation and reduced pruritus and anxiety. Providing scar massage is feasible and effective for burn patients. Future research should evaluate its long-term effects. RELEVANCE TO CLINICAL PRACTICE: Scar massage is relatively convenient and effective in preventing and alleviating hypertrophic burn scarring. Further research can provide detailed suggestions for effective scar massage implementation.

Meta-analysis of randomized controlled trials of the efficacy of propolis mouthwash in cancer therapy-induced oral mucositis.

PURPOSE: This meta-analysis aimed to evaluate the efficacy and safety of propolis mouthwash in cancer patients with therapy-induced oral mucositis. METHODS: This was a systematic review of randomized control trails (RCTs). We searched ten electronic databases for studies published prior to April 06, 2017. The included RCTs were published in English and Chinese. The Jadad score was used to evaluate the quality of the articles identified. Two reviewers independently evaluated each of the studies. The data were entered into Review Manager (RevMan) 5.3 software and checked for accuracy. Outcome incidence analysis was performed using odds ratios (ORs). RESULTS: Of the 352 articles identified, five potentially relevant articles met our inclusion criteria. These 5 RCTs included a total of 209 participants. The Jadad score for methodological quality was 3.60 ± 0.55. No obvious publication bias was noted. The incidence of severe oral mucositis was significantly lower in the propolis group than in the control group (OR = 0.35, p = 0. 003). The corresponding 95% confidence interval (CI) was 0.18 to 0.70. Between-study heterogeneity was low (I2 = 0.000, p = 0.45). No side effects were reported. CONCLUSIONS: Propolis mouthwash is effective and safe in the treatment of severe oral mucositis. To maintain propolis safety, propolis usage should occur under the supervision of medical staff and health professionals. Future multi-center studies and a clinical protocol are needed to confirm the current findings regarding the efficacy and safety of propolis mouthwash.

Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial.

AIMS AND OBJECTIVES: To determine the efficacy of swaddling and heel warming on pain response in neonates following heel stick. BACKGROUND: Swaddling has been suggested to reduce pain response in neonates during heel stick. Heel warming is also often performed for drawing blood easily before heel stick. However, the efficacy of both on pain response is unclear. DESIGN: A randomised controlled study was used. METHODS: Twenty-five neonates were randomly assigned to each of the control, swaddling and heel-warming groups. Heart rate, oxygen saturation Neonatal Infant Pain Scale and duration of crying were used to assess pain reactivity and pain recovery. A greater heart rate and Neonatal Infant Pain Scale increase, or oxygen saturation decrease, indicated higher pain reactivity. A longer duration of heart rate and oxygen saturation changes after heel stick back to baseline indicated a longer pain recovery. RESULTS: The decrease in oxygen saturation in swaddling group was significantly greater than that in heel-warming group. The increase in the Neonatal Infant Pain Scale in control group was significantly higher than that in swaddling group. The heart rate recovery time in control group and swaddling group was significantly longer than that in heel-warming group. The oxygen saturation recovery time in control group was significantly longer than that in heel-warming group. The duration of crying in control group was significantly longer than those in swaddling group and heel-warming group. CONCLUSION: Both swaddling and heel warming decreased the pain response of neonates during heel stick. Heel warming resulted in a lower pain response than did swaddling for neonates, particularly in terms of pain recovery. RELEVANCE TO CLINICAL PRACTICE: Heel warming could become a routine practice to decrease the pain response of neonates during heel stick.

Efficacy of five-element gymnastics in glucose and lipid control in Taiwanese patients with type 2 diabetes.

The purpose of this quasi-experimental study was to determine the efficacy of Five-Element Gymnastics (FEG) in controlling glycosylated hemoglobin (HbA1C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) at the 8th and the 16th weeks of intervention for patients with type 2 diabetes in Taiwan. FEG consolidates several traditional Chinese exercises including Qigong, Xiang Gong, and martial arts with gymnastics. The experimental group (n = 31) practiced FEG at home for 16 weeks. The control group (n = 35) maintained usual activities. FEG was associated with decrease of HbA1C, TG, and LDL-C levels at the 8th week and continuous decrease of HbA1C through the 16th week. FEG could be an exercise choice for patients with type 2 diabetes.

[Caregiving burden and associated factors among caregivers of terminally ill gastrointestinal cancer patients].

BACKGROUND: Heavy caregiving burdens can harm the physical and mental health of primary caregivers and reduce patient care quality. Understanding caregiving burden and its associated factors among primary caregivers of terminally ill patients with gastrointestinal cancer can help improve holistic terminal healthcare quality. PURPOSE: The authors explore in this paper the relationship between caregiving burden and terminally ill gastrointestinal cancer patient disease characteristics, demographic backgrounds, level of social support, self-care efficacy, fear of death and self-perceived symptom distress in both patients and primary caregivers. METHODS: This was a cross-sectional, descriptive, and correlational study that used convenience sampling and structured questionnaires. Data were collected from 178 family caregivers of terminally ill patients with gastrointestinal cancer in the Tainan and Chiayi areas of Southern Taiwan. RESULTS: The caregiving burden of caregivers of terminally ill gastrointestinal cancer patients in hospice homecare was significantly higher than that of those recruited from outpatient departments. Caregiving burden for liver and pancreatic cancer patients was significantly higher than for colorectal cancer patients. The caregiving burden of spousal caregivers was significantly higher than that of lineal blood relatives. The caregiving burden of caregivers with worse self-perceived health status was significantly higher than that of those with better self-perceived health status. The most important explanatory factors of caregiving burden among primary caregivers terminally ill gastrointestinal cancer patients were (in descending order) social support, self-perceived symptom distress in patient, self-perceived health status, location of study subject recruitment, fear of death, and relationship with patient; these factors explained 63.8% of the total variation. Social support was the most important explanatory factor, explaining 37.2% of total variance. CONCLUSIONS: We recommend that terminal health care teams better assess the social support given primary caregivers of terminally ill gastrointestinal cancer patients, that assistance be provided to caregivers with less social support, that caregiver life-and-death education be improved, and that primary caregivers be taught how to accept and positively handle the death of the loved one in their care. More attention should be paid to controlling symptoms of terminal stage cancer patients in order to reduce caregiver self-perceived symptom distress. Evaluation of caregiving burden is especially important for those primary caregivers who are hospice homecare workers, spouses, and of lower self-perceived health status.