Objective:To analyze the practical experiences and challenges faced by nurses in community-based elderly care institutions in the management of insulin therapy for elderly patients with diabetes.Methods:This qualitative study employed purpose sampling to recruit nurses from two community-based elderly care institutions in Beijing from June to October 2023. Semi-structured interviews were conducted focusing on their experiences and challenges in insulin use for elderly patients with type 2 diabetes. All interviews were audio-recorded and transcribed into text. Framework analysis was used to analyze the interview data.Results:A total of 15 nurses participated in the interviews, all of whom were female with work experience ranging from 4 to 12 years. The analysis revealed three main themes and 2-3 subthemes under each theme. Theme 1 patients′ experiences with insulin injection: concerns about adverse reactions such as hypoglycemia, obesity, and injection pain; attention to insulin dosage, blood glucose levels, dietary management, and weight control. Theme 2 nurses′ practices and challenges in insulin management: communication and emotional support; trust-building between nurses and elderly patients; impact of insufficient human resources. Theme 3 nurses′ experiences with diabetes knowledge education and training: motivation for training; adaptation of training content, format and frequency to local conditions; implementation and significance of health education.Conclusions:The management of elderly people with diabetes in community-based elderly care institutions presents significant challenges. It is essential to provide personalized insulin management support, emotional support, and psychological counseling for elderly diabetic patients. Additionally, nurses require access to relevant diabetes knowledge education and training to enhance their ability of effective care.

Objective:To analyze the practical experiences and challenges faced by nurses in community-based elderly care institutions in the management of insulin therapy for elderly patients with diabetes.Methods:This qualitative study employed purpose sampling to recruit nurses from two community-based elderly care institutions in Beijing from June to October 2023. Semi-structured interviews were conducted focusing on their experiences and challenges in insulin use for elderly patients with type 2 diabetes. All interviews were audio-recorded and transcribed into text. Framework analysis was used to analyze the interview data.Results:A total of 15 nurses participated in the interviews, all of whom were female with work experience ranging from 4 to 12 years. The analysis revealed three main themes and 2-3 subthemes under each theme. Theme 1 patients′ experiences with insulin injection: concerns about adverse reactions such as hypoglycemia, obesity, and injection pain; attention to insulin dosage, blood glucose levels, dietary management, and weight control. Theme 2 nurses′ practices and challenges in insulin management: communication and emotional support; trust-building between nurses and elderly patients; impact of insufficient human resources. Theme 3 nurses′ experiences with diabetes knowledge education and training: motivation for training; adaptation of training content, format and frequency to local conditions; implementation and significance of health education.Conclusions:The management of elderly people with diabetes in community-based elderly care institutions presents significant challenges. It is essential to provide personalized insulin management support, emotional support, and psychological counseling for elderly diabetic patients. Additionally, nurses require access to relevant diabetes knowledge education and training to enhance their ability of effective care.

Objective To investigate the risk factors of abnormal circadian rhythm of blood pres-sure in patients with Stanford type B aortic dissection. Methods Case information of 204 patients with Stanford type B aortic dissection admitted to vascular surgery department of the Second Xiangya hospital of Central South University from January 2016 to December 2018 were retrospectively analyzed. According to patients'blood pressure rhythm during hospitalization, patients were divided into normal blood pressure cir-cadian rhythm group (127 cases) and abnormal blood pressure circadian rhythm group (77 cases). Demo-graphic information, ambulatory blood pressure monitoring results, comorbilities and medication treatment of the two groups were compared by using multivariate logistics regression analysis. Results The difference of the ambulatory blood pressure monitoring results{average night systolic blood pressure [(112. 90 ± 10. 00) mmHg vs (128. 15 ± 15. 20) mmHg], average night diastolic blood pressure [(66. 40 ± 7. 91) mmHg vs (76. 10 ± 7. 97) mmHg]}, comorbilities hyperlipidemia, renal failure, obstructive sleep apnea hypopnea syndrome, smoking and the medication treatment ( analgesics, hypnotics and intravenous antihypertensive medicine) were statistically significant (P<0. 05);multivariate logistic regression analysis showed that ob-structive sleep apnea hypopnea syndrome and renal failure were independent risk factors of abnormal blood pressure rhythm in Stanford type B aortic dissection patients. While analgesics, hypnotics and intravenous antihypertensive medicine were protective factors. Conclusions The risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection are renal failure and obstructive sleep apnea hypopnea syndrome. Protective factors were the usage of analgesics, hypnotics and intravenous antihypertensive medicine.

Aortic dissection is a life-threatening cardiovascular condition. The elevated blood pressure plays an important role in the development and the formation of aortic dissection, thus treatment of aortic dissection requires the management of blood pressure control. In this paper, we reported the current situation and summarized the influencing factors of blood pressure management in the treatment of patients with aortic dissection. Suggestions were provided to improve the management of blood pressure control and to support the future research in China.

Objective To investigate the clinical predictive value of rheumatoid factor (RF), anti-keratin antibodies (AKA), anti-cyclic citrullinated peptide (anti-CCP) antibody and anti-perinuclear factor (APF) in the transition from undifferentiated arthritis (UA) to rheumatoid arthritis (RA), and to analyze the clinical relevant factors. Methods 271 patients with UA who were followed up for a year were enrolled into the investigation. RF was measured by the rate scatting immunity method. APF and AKA were detected by immuniofluorescence method(IFA). Anti-CCP was measured by ELISA. Erythrocyte sedimentation rate (ESR) was analyzed by Wilcoxon method. The duration of morning stiffness, the numbers of swelling and tender joints, tender joints involved and DAS28 score were recorded and analyzed. Results 99% patients who had four-antibody-positive finally convetted from UA to RA. The conversation rate for those who had two or more than two antibody-positive was 83.0% and 65.9% respectively. The sensitivity and specificity of RF and anti-CCP antibody-positive in those who converted from UA to RA was 77.8% and 80.5% respectively. The percentage of polyarticular swelling in antibody-negative, one-antibody-positive, two-antibody-positive, three-antibody- positive and four-antibody-positive was 48%, 57%, 59%, 70% and 70% respectively. Meanwhile, the percentage of multi-small-joint involvement was 71%, 71%, 72%, 76% and 83% respectively. The proportion of elbow involvement in antibody-negative patients was 72%, which was the highest among all joint area involvement. The conversion differences of the group with more than 3 swelling joints or more than 3 small joints involvement ranked the first and second in frequency. Conclusion The combined detection of these autoantibodies could increase the specificity of early diagnosis of RA. The more positive antibodies present, the more likely the concersion form UA to RA. The sensitivity and specificity of RF and anti-CCP-positive is high, so the latter is expected to become one of the diagnostic criteria. The polyarticular swelling and multi-small-joint involvement are valuable in predicting the transformation from UA to RA.