Objective To explore the correlation between glycemic control and complexity of drug treatment regimens in elderly patients with type 2 diabetes mellitus.Methods A retrospective,cross-sectional study was conducted to collect the elderly patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology at the Geriatric Hospital of Nanjing Medical University from June 2022 to December 2024.The clinical characteristics and medication compliance of the patients were recorded through pharmaceutical consultations.The medication regimen complexity index(MRCI)and diabetes-specific medication regimen complexity index(D-MRCI)were calculated for each patient.Patients were divided into the target-achieving group and the non-target-achieving group based on whether their blood glucose met the criteria.Univariate analysis and multivariate Logistic regression analysis were used to identify the factors associated with adequate blood glucose control.Results A total of 152 patients were included,123(80.9%)had poorer glycemic control,31.6%exhibited good medication adherence,and 76.3%demonstrated good adherence to diabetes medications.The mean total MRCI score was(25.90±8.63),while the median D-MRCI score was 9.00(5.25,11.75),with 44.7%of patients classified as having high D-MRCI scores(D-MRCI>9).The results of Spearman correlation analysis indicated that the number of medications used by patients was highly correlated with the MRCI score(r=0.899,P<0.001),while the number of diabetes medications used was highly correlated with the D-MRCI score(r=0.705,P<0.001).Univariate analysis results revealed that high complexity diabetes medication regimen,duration of diabetes,the number of types of antidiabetic drugs,and the number of injectable antidiabetic medications were associated with glycemic control(P≤0.05).Multivariate analysis results showed that,high diabetes medication complexity was an independent risk factor for inadequate blood glucose control[OR=4.119,95%CI(1.121,15.139),P=0.033].Conclusion Higher D-MRCI(>9)was associated with poorer glycemic control.Simplifying medication regimens and optimizing medication management strategies may improve patient outcomes.

Objective To retrieve,evaluate and summarise the best evidence on screening and management of psychological distress in patients who had ostomy for colorectal cancer.Methods Literatures on psychological distress screening and management in patients undergoing colorectal cancer ostomy were systematically searched across various websites and databases of home and abroad from inception to 20th June,2024 including Cochrane Library,PubMed,Embase,CINAHL,Web of Science,CNKI,Wangfang,VIP,UpToDate,National Guideline Clearing-house,National Comprehensive Cancer Network,the National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,the International Guideline Collaboration Network,Wound,Ostomy and Continence Nurses Society,World Council of Enterostomal Therapists,Medlive,Chinese Nursing Association.The search aimed to identify evidence on psychological distress screening and management in patients with colorectal cancer and stomas,including guidelines,evidence summaries,expert consensuses,systematic reviews,and Meta-analyses.The search was limited to articles published from the inception of each database to 20th June,2024.The searched literature included guidelines,evidence summary,expert consensus,systematic review,meta-analysis,etc..Two researchers independently evaluated the quality of literature and extracted evidences,as well as checked and integrated the evidences together with a panel of evidence-based research experts.Results A total of 14 articles were included,comprising four guidelines,one expert consensus,two evidence summaries,four meta-analyses and three systematic reviews.The articles encompassed 7 dimensions with a total of 18 pieces of evidence,including one in screening timing,one in screening tools,3 in screening content,3 in drug intervention,3 in self-management,5 in psychological support and 2 in health education.Conclusion The evidence summarised in this study on the screening and management of psychological distress in patients who had ostomy for colorectal cancer is scientifically comprehensive.It provides an evidence-based basis for medical staff in prevention and management of psychological distress in patients.It is necessary to formulate a scientific management plan in clinical practice,according to the specific requirements of departments,the patients and their family members.

Objective:To explore the effect of multiple modified process management intervention on cardiac func-tion,psychological state,stress level,sleep quality and adverse events in patients with severe coronary atherosclerot-ic heart disease(CHD).Methods:This randomized controlled study enrolled 130 severe CHD patients who were treated in Affiliated Beijing Shijitan Hospital of Capital Medical University between January 2020 and May 2023.Patients were randomly divided into control group(n=65)and intervention group(n=65).Patients in the control group were treated with routine management intervention,while those in the intervention group were given addi-tional multiple modified process management interventions.Both groups were intervened for 4 weeks.Cardiac func-tion,levels of norepinephrine(NE)and cortisol(COR),scores of Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),General Comfort Questionnaire(GCQ),Pittsburgh Sleep Quality Index(PSQI),and the incidence of adverse events during intervention were compared between the two groups.Results:Compared to those in control group after intervention,patients in intervention group had significant higher left ventricular ejection fraction(LVEF)[(57.81±2.15)％vs.(50.11±2.99)％]and GCQ score[(95.88±5.37)points vs.(75.81±6.67)points](P＜0.001 all),and significant lower left ventricular end-diastolic volume(LVEDV)[(109.81±5.37)ml vs.(129.26±5.17)ml],left ventricular end-systolic volume(LVESV)[(50.85±3.08)ml vs.(66.02±3.77)ml],levels of NE[(61.56±5.49)pg/ml vs.(69.86±5.03)pg/ml],COR[(85.63±5.19)ng/ml vs.(92.28±6.57)ng/ml],scores of SAS[(30.06±5.19)points vs.(49.51±5.85)points],SDS[(31.86±4.51)points vs.(40.00±5.10)points]and PSQI[(8.72±1.58)points vs.(13.89±2.40)points],and incidence of ad-verse events(4.69％vs.23.44％)(P＜0.01 all).Conclusion:The multiple modified process management interven-tion may improve the cardiac function,adverse psychological state,stress level,sleep quality and reduce the inci-dence of adverse events in patients with severe CHD.

Objective To determine the effects of heated iodophor disinfection on intraoperative body temperature and bleeding in elderly patients undergoing radical mastectomy.Methods A total of 78 elderly patients who underwent unilateral radical mastectomy in Suqian Hospital of Jiangsu Provincial People's Hospital from September 2022 to August 2024 were selected as the study subjects,and they were randomly divided into the control group and the observation group,with 39 cases in each group.The control group and the observation group were disinfected with iodophor at temperature of 23℃and heated to 37℃before surgery,respectively.The qualified skin disinfection,incision infection,body temperature,adverse reactions during the recovery period,intraoperative bleeding volume,postoperative drainage bleeding volume,and hemoglobin levels of patients of the two groups were compared.Results There was no statistically significant difference in the qualified rate of skin disinfection or incision infection rate between of patients the two groups(P>0.05).At 30 minutes after disinfection,60 minutes after disinfection,and at the end of surgery,the body temperature of patients in the observation group was significantly higher than that in the control group(P<0.05).The incidences of intraoperative hypothermia,delayed awakening,and shivering reaction of patients in the observation group were significantly lower than those in the control group(P<0.05).The intraoperative bleeding volume and postoperative drainage bleeding volume of patients in the observation group were significantly lower than those in the control group(P<0.05).The hemoglobin level 3 days after surgery of patients in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Compared with the routine use of 23℃iodophor to disinfect the skin of elderly patients undergoing radical mastectomy,the use of iodophor heated to 37℃does not affect the disinfection effect and incision infection,and the incidence of intraoperative hypothermia in patients is lower,which is conducive to reduce the amount of intraoperative bleeding and the incidence of adverse reactions during the recovery period.

Objective:To investigate the surgical techniques and clinical efficacy of arthroscopic-assisted posterior malleolus reduction for the management of ankle fracture-dislocation.Methods:A retrospective analysis was performed on the clinical data of 27 patients who underwent arthroscopy-assisted posterior malleolar reduction via the posterior approach for the surgical management of ankle fracture-dislocation at the Third Affiliated Hospital of Nanjing Medical University (Changzhou No.2 People's Hospital) between January 2022 and June 2023. The cohort comprised 17 males and 10 females, with a mean age of 43.67±9.56 years (range, 25-63 years). Based on the Bartonícek and Rammelt classification, there were 15 type II cases, 9 type III cases, and 3 type IV cases. The operation time, posterior ankle arthroscopy duration, and postoperative complications, such as neurovascular injury, wound infection, or skin necrosis, were recorded. X-ray and 3D CT imaging were utilized to assess joint surface reduction quality, tibiofibular matching and fracture healing status. The ankle plantarflexion, dorsiflexion and hallux flexion contractures were recorded at the last follow-up. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Olerud-Molander ankle score (OMAS), while pain was evaluated using the visual analogue scale (VAS).Results:All 27 patients were followed up postoperatively, with a mean follow-up duration of 14.30±1.38 months (range, 12-18 months). Postoperatively, one patient experienced wound exudation, while another developed intermuscular venous thrombosis in the calf. No cases of neurovascular injury, wound infection, skin necrosis, or hallux flexion contracture occurred, and no reduction loss was observed. The mean operation time was 96.11±11.55 min (range, 80-120 min), and the posterior ankle arthroscopy duration was 35.74±5.67 min (range, 30-45 min). Postoperative X-ray evaluations demonstrated no loss of fracture reduction, and all fractures achieved bony union. The mean fracture healing time was 3.78±0.75 months (range, 3-5 months). Postoperative CT evaluations showed no joint surface malalignment, and distal tibiofibular matching was satisfactory. At the final follow-up, mean ankle plantarflexion was 46.74°±4.73° (range, 33°-50°), and dorsiflexion was 20.96°±3.29° (range, 14°-26°). There was no hallux flexion contracture occurred. The mean AOFAS ankle-hindfoot score was 92.11±7.19 (range, 74-100), with 20 excellent, 5 good, and 2 fair, yielding an excellent-good rate of 93%. The mean OMAS score was 94.44±7.25 (range, 75-100), comprising 20 excellent and 7 good results, yielding an excellent-good rate of 100%. The mean VAS score was 0.70±0.95 (range, 0-3).Conclusion:Arthroscopy-assisted posterior malleolar reduction in ankle fracture-dislocation surgery provides optimal soft tissue protection and ensures precise fracture reduction and fixation.

Objective:To investigate the surgical techniques and clinical efficacy of arthroscopic-assisted posterior malleolus reduction for the management of ankle fracture-dislocation.Methods:A retrospective analysis was performed on the clinical data of 27 patients who underwent arthroscopy-assisted posterior malleolar reduction via the posterior approach for the surgical management of ankle fracture-dislocation at the Third Affiliated Hospital of Nanjing Medical University (Changzhou No.2 People's Hospital) between January 2022 and June 2023. The cohort comprised 17 males and 10 females, with a mean age of 43.67±9.56 years (range, 25-63 years). Based on the Bartonícek and Rammelt classification, there were 15 type II cases, 9 type III cases, and 3 type IV cases. The operation time, posterior ankle arthroscopy duration, and postoperative complications, such as neurovascular injury, wound infection, or skin necrosis, were recorded. X-ray and 3D CT imaging were utilized to assess joint surface reduction quality, tibiofibular matching and fracture healing status. The ankle plantarflexion, dorsiflexion and hallux flexion contractures were recorded at the last follow-up. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Olerud-Molander ankle score (OMAS), while pain was evaluated using the visual analogue scale (VAS).Results:All 27 patients were followed up postoperatively, with a mean follow-up duration of 14.30±1.38 months (range, 12-18 months). Postoperatively, one patient experienced wound exudation, while another developed intermuscular venous thrombosis in the calf. No cases of neurovascular injury, wound infection, skin necrosis, or hallux flexion contracture occurred, and no reduction loss was observed. The mean operation time was 96.11±11.55 min (range, 80-120 min), and the posterior ankle arthroscopy duration was 35.74±5.67 min (range, 30-45 min). Postoperative X-ray evaluations demonstrated no loss of fracture reduction, and all fractures achieved bony union. The mean fracture healing time was 3.78±0.75 months (range, 3-5 months). Postoperative CT evaluations showed no joint surface malalignment, and distal tibiofibular matching was satisfactory. At the final follow-up, mean ankle plantarflexion was 46.74°±4.73° (range, 33°-50°), and dorsiflexion was 20.96°±3.29° (range, 14°-26°). There was no hallux flexion contracture occurred. The mean AOFAS ankle-hindfoot score was 92.11±7.19 (range, 74-100), with 20 excellent, 5 good, and 2 fair, yielding an excellent-good rate of 93%. The mean OMAS score was 94.44±7.25 (range, 75-100), comprising 20 excellent and 7 good results, yielding an excellent-good rate of 100%. The mean VAS score was 0.70±0.95 (range, 0-3).Conclusion:Arthroscopy-assisted posterior malleolar reduction in ankle fracture-dislocation surgery provides optimal soft tissue protection and ensures precise fracture reduction and fixation.

Organizational and institutional management plays a pivotal role in the pharmaceutical management of medi-cal institutions.Strengthening management in this area significantly enhances the quality of medical services and promotes the standardization,refinement,and scientific management of hospitals at all levels and types.To achieve homogenization in organiza-tional and institutional management,the Pharmaceutical Specialized Committee,Chinese Hospital Association compilation team adhered to principles of scientific,universality,instructiveness,and operability.After in-depth problem sorting,extensive opinion collection,and rigorous expert deliberation,we have formulated the first domestic group standard for regulating the organizational and institutional systems of pharmaceutical management in medical institutions.This article aims to detail the process of formula-ting this standard and to provide an in-depth analysis of its content,hoping to offer valuable advice and guidance for the construc-tion of organizational and institutional management in pharmaceutical affairs for medical institutions of all levels and types.

Aim To explore the predictive value of stress hyperglycemia ratio(SHR)for in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods This study constituted a retrospective investigation that collected 995 patients diagnosed with acute STEMI at Suining Central Hospital from June 2019 to July 2023.Comparisons of baseline data were conducted using t-test,Mann-Whitney U test and chi-square test;Logistic regression was used to analyze the association between SHR and the risk of in-hospital mortality and mechanical complications in acute STEMI patients;Restricted cubic spline analysis based on the Logistic re-gression model was utilized to explore non-linear relationship between SHR and the risk of in-hospital mortality and mechan-ical complications;ROC curve was used to evaluate the diagnostic efficacy of SHR;Subgroup analysis was used to assess the predictive efficacy of SHR in each subgroup.Results Patients with high SHR had a significantly higher cardiovas-cular mortality(P=0.007).High SHR was an independent risk factor for in-hospital all-cause mortality(Model 1:OR=3.085,95％ CI:1.719～5.538,P＜0.001;Model 2:OR=2.738,95％ CI:1.4439～5.132,P=0.002),cardiovascular mortality(Model 1:OR=3.406,95％ CI:1.869～6.228,P＜0.001;Model 2:OR=3.053,95％ CI:1.595～5.817,P＜0.001),ventricular aneurysm(Model 1:OR=3.203,95％CI:1.665～6.069,P＜0.001;Model2:OR=3.93,95％CI:1.785～8.663,P＜0.001),cardiac rupture(Model 1:OR=2.461,95％ CI:1.389～4.312,P=0.002;Model 2:OR=2.302,95％ CI:1.214～4.274,P=0.009)and composite endpoint(Model 1:OR=3.719,95％ CI:2.226～6.332,P＜0.001;Model 2:OR=2.919,95％ CI:1.576～5.405,P＜0.001)in patients with acute STEMI.SHR was positively correlated in a linear relationship with the risk of in-hospital all-cause mortality(P for non-linearity=0.250),cardiovascular mortality(P for non-linearity=0.129),ventricular aneurysm(P for non-linearity=0.588),cardiac rupture(P for non-linearity=0.787)and composite endpoint(P for non-linearity=0.399).The SHR had excellent diagnostic efficacy for in-hospital all-cause mortality(AUC=0.694),cardiovascular mortality(AUC=0.697),ventricular aneurysm(AUC=0.706),cardiac rupture(AUC=0.667)and composite endpoint(AUC=0.730),meanwhile SHR predicted efficacy consistently across subgroups.Conclusions High SHR is an independent risk factor for in-hospital all-cause mortality,cardiovascular mortality and cardiac mechanical complications in patients with a-cute STEMI.SHR holds significant predictive value for the prognosis of patients with STEMI.

Objective To determine the effects of heated iodophor disinfection on intraoperative body temperature and bleeding in elderly patients undergoing radical mastectomy.Methods A total of 78 elderly patients who underwent unilateral radical mastectomy in Suqian Hospital of Jiangsu Provincial People's Hospital from September 2022 to August 2024 were selected as the study subjects,and they were randomly divided into the control group and the observation group,with 39 cases in each group.The control group and the observation group were disinfected with iodophor at temperature of 23℃and heated to 37℃before surgery,respectively.The qualified skin disinfection,incision infection,body temperature,adverse reactions during the recovery period,intraoperative bleeding volume,postoperative drainage bleeding volume,and hemoglobin levels of patients of the two groups were compared.Results There was no statistically significant difference in the qualified rate of skin disinfection or incision infection rate between of patients the two groups(P>0.05).At 30 minutes after disinfection,60 minutes after disinfection,and at the end of surgery,the body temperature of patients in the observation group was significantly higher than that in the control group(P<0.05).The incidences of intraoperative hypothermia,delayed awakening,and shivering reaction of patients in the observation group were significantly lower than those in the control group(P<0.05).The intraoperative bleeding volume and postoperative drainage bleeding volume of patients in the observation group were significantly lower than those in the control group(P<0.05).The hemoglobin level 3 days after surgery of patients in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Compared with the routine use of 23℃iodophor to disinfect the skin of elderly patients undergoing radical mastectomy,the use of iodophor heated to 37℃does not affect the disinfection effect and incision infection,and the incidence of intraoperative hypothermia in patients is lower,which is conducive to reduce the amount of intraoperative bleeding and the incidence of adverse reactions during the recovery period.

Objective:To investigate the feasibility of flight fatigue being detected via photoplethysmography (PPG) and regional cerebral oxygen saturation (rScO 2) in order to address the challenges posed by flight fatigue during prolonged or multiple consecutive flights. Methods:A total of 16 healthy male volunteers were enrolled. A wireless cerebral oximetry monitor headband was employed to collect PPG and rScO 2 data from the forehead while a multi-lead physiological data acquisition system was used concurrently to record three-lead electrocardiograms (ECGs). After 18 h of sleep deprivation, each volunteer performed a flight-simulating task, which was divided into 4 stages: the baseline period (T1), relaxation period (T2), early fatigue period (T3) and severe fatigue period (T4). Five-minute data was collected from each stage for analysis using AcqKnowledge 6.0. Heart rate (HR) and 3 HR variability (HRV) metrics, namely standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and low frequency to high frequency power ratio (LF/HF), were computed independently from both ECG and PPG traces. The mean rScO 2 value for each stage was used to represent the cerebral oxygen saturation during that stage. The intra-class correlation coefficient (ICC) was employed to assess the consistency of the measurements, and the differences in HR and HRV indicators of the volunteers in the 4 stages of the experiment were analyzed. Results:The HR measured by ECG and PPG was highly consistent across the 4 stages among the 14 volunteers ( ICC=0.951, 0.963, 0.962, 0.963, P=0.013, 0.011, 0.021, 0.015), so were SDNN, RMSSD and LF/HF values ( ICC=0.935-0.983, all P<0.05). HR values calculated with either method showed significant differences across the 4 stages in the 14 volunteers ( F=21.63, 20.52, P=0.007, 0.008). HR gradually declined from T1 to T4, and was significantly lower at T4 than at T1 ( P=0.011, 0.009). There were significant differences in SDNN ( F=22.31, 24.26, P=0.006, 0.003), RMSSD ( F=22.30, 22.26, P=0.006, 0.006), and LF/HF ( F=20.37, 25.13, P=0.009, 0.002) across the 4 stages among the 14 volunteers. SDNN and RMSSD kept increasing as fatigue was intensified, while LF/HF decreased correspondingly. Statistically significant differences were found in SDNN, RMSSD and LF/HF values between T4 and T1 (all P<0.01). rScO 2 measured during the flight-simulating trial also differed significantly across the 4 stages ( F=21.39, P=0.007). rScO? at both T3 and T4 was significantly lower than at T1 ( P=0.009, 0.007). Conclusions:PPG can replace ECG for monitoring HR and HRV indicators under flight fatigue. Furthermore, the combination of PPG with rScO 2 monitoring allows for earlier detection of flight fatigue. This study is expected to offer a user-friendly and non-invasive approach to management of pilot fatigue.