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Purpose: This study aimed to investigate the impact of acupuncture on Diabetic peripheral neuropathy (DPN) symptoms among individuals with diabetic neuropathy. Methods: In a single-blind, randomized trial conducted between 2019 and 2020, 60 patients diagnosed with diabetic neuropathy were enrolled. These participants were randomly assigned to either the intervention or control group. The intervention group received real acupuncture alongside routine treatment once a week for seven sessions, each lasting 20 min. Meanwhile, the control group received sham acupuncture as an adjunct to their routine treatment, following the same schedule. To evaluate treatment efficacy, the study assessed primary outcomes, such as pain intensity measured using the Visual Analogue Scale (VAS). Secondary outcomes included evaluating fatigue severity and diabetic peripheral neuropathy (DPN) side effects, measured using the multidimensional fatigue inventory (MFI-20) and a standard questionnaire after each session. Results: No statistically significant differences in pain and fatigue scores were observed between the two groups throughout all visits, even after adjusting for baseline characteristics, age, sex, type of diabetes, discopathy, and carpal tunnel syndrome parameters (P > 0.05). The findings did not provide strong evidence supporting a significant effect of real acupuncture compared to sham acupuncture on pain and fatigue values (P = 0.267 and 0.634, respectively). However, the 95% confidence interval for pain scores (-0.35, 1.28) was inconclusive, encompassing effect sizes favoring sham acupuncture. Conclusion: Findings suggest that using acupuncture as an adjunctive therapy alongside routine treatment may not lead to a significant reduction in the symptoms of peripheral neuropathy and fatigue severity among individuals with diabetic neuropathy. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01314-1.
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INTRODUCTION AND IMPORTANCE: While acute colonic ischemia is frequently observed in the elderly, rectal ischemia is a rare occurrence. We presented a case of transmural rectosigmoid ischemia in a patient who had not undergone any significant interventions and had no underlying diseases. Conservative treatment methods were unsuccessful, and surgical resection was necessary to prevent the development of gangrene or sepsis. CASE PRESENTATION: Upon arrival at our health center, a 69-year-old man reported experiencing left lower quadrant pain and rectorrhagia. The CT scan revealed thickening in the sigmoid and rectum. Subsequent colonoscopy revealed circumferential ulcers, severe edema, erythema, discoloration, and ulcerative mucosa in both the rectum and sigmoid. Due to persistent severe rectorrhagia and worsening pathologic parameters, another colonoscopy was performed three days later. CLINICAL DISCUSSION: Initially, conservative treatments were administered, but as the tenderness worsened, surgical exploration of the abdomen was necessary. During the procedure, a large ischemia from the sigmoid to the rectal dentate line was observed, and the lesion was resected. A stapler was then inserted into the rectum, followed by the use of the Hartman pouch method to deviate the tract. Finally, colectomy, sigmoidectomy, and rectal resection were performed. CONCLUSION: Due to the worsening pathological condition of our patient, surgical resection was necessary. It is important to note that rectosigmoid ischemia, although rare, can develop without a known underlying cause. Therefore, it is crucial to consider and evaluate potential causes beyond the most common ones. Furthermore, any pain or rectorragia should be assessed immediately.
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BACKGROUND: Nurses' influence on health policy protects the quality of care by access to required recourses and opportunities. This is a new and important concept for nursing; however, research studies on policy influence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents. The aim of this paper is to clarify the concept of nurses' policy influence and to propose the definition of this concept, considering the context of Iran. MATERIALS AND METHODS: The eight stages of Walker and Avant approach was used to guide this concept analysis. Various databases and internet engines were searched to find all related information about the concept. Textbooks were also searched manually. English language literature reports published between 1990 and 2012 were reviewed. RESULTS: Based on the analysis undertaken, nurses' policy influence is nurses' ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses' job environment and increases patient outcomes. This is a dynamic process situated on a spectrum and is accompanied with nurses' knowledge, competency, power, and advocacy, and also their ability to change. CONCLUSIONS: Nurses have individual views on health care issues and influence health care policies in different ways. With a common understanding of nurses' policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients' outcomes.