Death in the life cycle is the final farewell. Palliative care can relieve symptoms, strengthen comfort care, and improve the quality of life at the end of the life of the elderly, patients with malignant diseases and other groups. With the development of the economy, the aging population and the changing needs of various social groups, there are obstacles and difficulties in the practice of palliative care, such as the poor public awareness of palliative care, the lack of palliative care service agencies, the shortage of professional personnel, and deficient law and regulation support. Policies and laws and regulations support defects. This article starts from the necessity of the development of palliative care, analyzes the factors that affect the practice of palliative care, and puts forward countermeasures for the development of palliative care.

Objective To systematically review the effects of hospital-community integrated management mode in diabetes mellitus. Methods To comprehensively search the database including CNKI, Taiwan Airiti library, WanFang Data, WeiPu Data and PubMed, we manually searched the relevant references of literature for the RCTs on hospital-community integrated management mode in diabetes mellitus, and Meta-analysis was used by software Revman 5. 2, and making descriptive analysis of the outcomes which could not be merged. Results A total of 15 RCTs were included involving 3 in English and 12 in Chinese, and 7 studies with high-quality and 8 of them with low-quality. According to the 11 evaluation focused outcomes indexes, the result of Meta-analysis showed that compared with conventional management, the hospital-community integration mode could effectively improve patients′ biochemical indicators such as glycated hemoglobin (HbA1c)[MD= -0. 39, 95%CI(-0. 56, -0. 22),P<0. 001], fasting plasma glucose[MD=-0. 75, 95%CI (-1. 16, -0. 33),P<0. 001], triglycerides[MD= -0. 36, 95%CI ( -0. 63, -0. 10), P=0.007], high-density lipoprotein (HDL-C)[MD =0. 09, 95%CI (0. 04, 0. 14), P <0. 001], low density lipoprotein (LDL-C)[MD= -0. 15, 95%CI (-0. 23, -0. 06),P=0. 001], but there was no effect on total cholesterol[MD= -0. 27, 95%CI (-0. 58, 0. 03),P=0. 080]. At the same time, the descriptive analysis presented that the model could improve patients′ awareness rate of diabetes health knowledge and promote the correct behavior of medication and regular exercise, in addition it could increase the score of life quality and reduce medical expenses. Conclusions Diabetes hospital-community integrated management can effectively improve the level of blood glucose and blood lipids, reduce the occurrence and development of related complications and provide a reliable basis for the management of diabetic patients. There is a positive impact to improve the patients′ behavior and quality of life, but it requires more randomized controlled studies to be analyzed and verified.

Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.