Objective:To investigate the impact of phototherapy on lipohypertrophy (LH) induced by insulin injections.Methods:Ninety-nine diabetes patients with LH who were admitted to the Endocrinology Department of the First Affiliated Hospital of Nanjing Medical University between April 2021 and February 2022 were selected as the study subjects. The length, width, and depth of each LH were measured, and the maximum LH, total LH, and average LH of the long, wide, and deep diameters were collected for all patients. SPSS 26.0 software was used to randomly allocate the subjects to the experimental group (50 cases) and the control group (49 cases). The control group received routine nursing care and avoided insulin injections at the LH site, while the experimental group received phototherapy based on the control group measures, twice a day, for 20 minutes each time for each LH site. Two independent sample t-tests, Mann-Whitney U tests, paired t-tests, and Wilcoxon signed-rank tests were used to compare the intergroup and intragroup differences in the length, depth, and width of the maximal LH, total LH, and average LH in the two groups before and after intervention. Results:There were 3 patients lost to follow-up in the experimental group and 2 patients in the control group, respectively, and 47 patients were included in both groups. After intervention, the length, depth, and width of the maximum LH, total LH, and average LH were all smaller in both the experimental and control groups than before intervention (all P<0.05). After intervention, the depth of the maximum LH and average LH were smaller in the experimental group than in the control group (both P<0.05). Compared with the control group, the percentage changes in the length and depth of the maximum LH, the length, depth, and width of total LH, and the length, depth, and width of average LH before and after intervention were greater in the experimental group (all P<0.05). Conclusions:Avoiding insulin injections at the LH site during hospitalization is beneficial for the regression of LH in diabetes patients. Phototherapy can further reduce LH by stopping insulin injection at the LH site.

Objective:To summarize the best evidence for nutrition management of type 2 diabetes mellitus (T2DM) , so as to provide a reference for formulating nutrition management plans.Methods:According to the "6S" evidence model, evidence-based guidelines, expert consensus, and systematic reviews on nutrition management for T2DM were systematically searched and screened in professional group websites, clinical practice guideline websites and databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱwas used to assess the methodological quality of the guideline. Quality evaluation of systematic reviews and expert consensus was conducted according to the appraisal system of the Australian Joanna Briggs Institute (JBI) Evidence-based Health Care Center. The recommended items with the same or similar content were synthesized according to the principle of evidence synthesis, and group discussion was carried out on evidence of conflicting conclusions. The recommendations for nutrition management of T2DM suitable for our national conditions were selected.Results:A total of 5 399 domestic and foreign articles were searched, and 19 articles were finally included, including 8 guidelines, 1 expert consensus, and 10 systematic reviews. The quality evaluation results of 1 guideline were grade A, and 7 guidelines were grade B, and the results of systematic review and expert consensus evaluation were both recommended. According to the principle of evidence synthesis, the recommendations were synthesized, including 5 aspects, namely nutrition management methods, nutrition screening and assessment, energy requirements, macronutrient intake, and micronutrient intake, with a total of 29 pieces of best evidence.Conclusions:Evidence on nutrition management of adults with T2DM is extensive but limited. Macronutrients have similar recommendations. However, there is still a lack of high-quality evidence for micronutrients, especially in terms of whether routine micronutrient supplementation is necessary and the specific intake. Extensive practical exploration and scientific research are needed to enrich the relevant evidence in the field of T2DM.

目的 探讨糖尿病足风险评分结果与患者代谢指标及踝臂指数(ABI)的相关性.方法 选取2020年2-12月在南京医科大学第一附属医院内分泌科住院的糖尿病患者410例,根据Gavin's足危险因素加权值积分法评分结果将其分为低风险组(A组,n=225)、中风险组(B组,n=174)和高风险组(C组,n=11).比较3组的血脂指标[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、肾功能指标[尿微量白蛋白(MAU)、尿肌酐(UCr)及MAU/UCr]、双下肢ABI及血糖、胰岛功能指标[糖耐量试验(OGTT)0、60、120 min血糖、胰岛素(Insul)及C肽、血糖曲线下面积(AUCGLU)、胰岛素曲线下面积(AUCInsul)及C肽曲线下面积(AUCCP)],采用Spearman秩相关分析,分析指标与Gavin's足危险因素加权值积分法评分的关系.结果 C组的LDL-C明显高于A、B组,B组则明显高于A组,C组的双下肢ABI明显低于A、B组,B组则明显低于A组,差异均有统计学意义(P<0.05),3组患者的其他血脂指标、肾功能指标及血糖胰岛功能指标比较,差异均无统计学意义(P>0.05).Spearman秩相关分析显示,LDL-C与糖尿病足风险评分呈正相关,双下肢ABI与Gavin's足危险因素加权值积分法评分呈负相关(P<0.05).结论 糖尿病足风险评分与患者的LDL-C及双下肢ABI密切相关,应重视对糖尿病患者相关指标的监测与调控.

Objective:To compile Participation Intention of Nurses on Internet plus Nursing Service Scale and conduct reliability and validity tests.Methods:Based on the theory of planned behavior, literature review and semi-structured interview were used to form the item pool of the scale. Through expert consultation, project analysis, the scale items were screened, and Participation Intention of Nurses on Internet plus Nursing Service Scale was initially formed. The convenient sampling method was adopted to select 825 nurses from6 hospitals in Jiangsu Province (2 ClassⅢ hospitals, 2 ClassⅡ hospitals and 2 ClassⅠ hospitals) from October to December 2020 to conduct a formal survey to test the validity of the questionnaire.Results:The Participation Intention of Nurses on Internet plus Nursing Service Scale included 3 subscales (participating behavioral attitude, subjective behavioral norms and perceived behavioral control) , 8 dimensions and 17 items. The Cronbach 's α coefficient of the total scale was 0.927, and the test-retest reliability coefficient was 0.805.The correlation coefficient between nurses ' willingness to participate in "Internet plus Nursing Service Scale" and participating behavior was 0.743 ( P<0.01) . Factor analysis extracted 8 common factors, and the cumulative variance contribution rate was 72.33%. Conclusions:The Participation Intention of Nurses on Internet plus Nursing Service Scale has good reliability and validity, which can be used to evaluate the "Internet plus Nursing Service" participation behavior willingness of nurses.

Objective:To explore the clinical application of high-frequency ultrasound in the screening of lipohypertrophy (LH).Methods:This was a cross-section study. A total of 548 diabetic patients who received insulin injection more than six months were recruited from November 2016 to September 2020 in the First Affiliated Hospital of Nanjing Medical University. Clinical data and insulin injection duration of patients were collected, the patients were examined through visual and palpation and ultrasound. The t-test, nonparametric test or Chi square test was used to compare the count data between groups. Results:Of the 548 patients, 418 patients were found to have LH detected by clinical examination, 478 patients by ultrasound, 390 patients both by clinical examination and ultrasound. The detectable rate of LH by high-frequency ultrasound was higher than that by the clinical examination [76.3% (418/548) vs. 87.2% (478/548), χ2=59.998, P<0.01]. Compared with those detected by ultrasound only, the mean depth, median length, median width and median area of LH detected both by clinical examination and ultrasound examination were higher, with a statistically significant difference in the width diameter ( P<0.05). The imaging features of LH included three types ( hyperechoic, isoechoic, hypoechoic) and five subtypes. Among them, the most common type was hyperechoic type, which had no blood flow, no capsule, and uniform mass with unclear boundary, accounting for 65.9% (315/478). Compared with LH detected by high-ultrasound only, the mean deep diameter, length diameter, width diameter and area of LH detected both by clinical examination and ultrasound examination were all increased, and the difference of width diameter was statistically significant [8.67 (7.66, 13.21) mm vs. 13.47 (8.70, 18.22) mm, Z=-2.135, P<0.05]. Conclusion:In addition to the traditional clinical examination (visualization and palpation), high-frequency ultrasound can be used as an important supplement to the examination of insulin injection site in diabatic patients.

To evaluate the impact of the depth of lipohypertrophy on glycemic control in diabetic patients, 498 diabetic patients were recruited from July 2017 to July 2020 in the First Affiliated Hospital of Nanjing Medical University. Their demographic and clinical data were collected. Lipohypertrophy was assessed with ultrasound. 85.1%(424/498) of patients had lipohypertrophy. The average depth of lipohypertrophy was(5.62±2.49) mm. Compared with HbA 1C≤7%, patients with HbA 1C>7% had significantly higher proportion of lipohypertrophy with depth >5 mm(69.7% vs 81.3%, P<0.05). After adjusting potential confounders, the level of HbA 1C in patients with the depth of lipohypertrophy>5 mm was still significantly higher than those with the depth of lipohypertrophy≤5 mm( OR=1.716, 95% CI 1.104-2.668, P<0.05). The depth of lipohypertrophy may be an independent risk factor for suboptimal HbA 1C. However, prospective studies are still needed to confirm.

Objective:To systematically sort out the research context of home-visiting nurses, and explore research hotspots and development trends in this field, so as to provide reference and ideas for follow-up research.Methods:We retrieved literature on home-visiting nurses included in PubMed from January 1, 2010 to August 1, 2020. The year of publication, journal, country, first author, and high-frequency subject terms were counted. BICOMB and gCLUTO were used to perform cluster analysis and visual analysis of subject terms.Results:A total of 1 223 articles were included, and 35 high-frequency subject terms were extracted. Through cluster analysis, four research hotspots were obtained, namely palliative care and chronic disease management, maternal and child nursing, perinatal health promotion nursing services, home-visiting nurse role function play and nurse-patient relationship, the role of home-visiting nurses in primary health care and in reducing patient hospitalization and readmission.Conclusions:The research results of home-visiting nurses continue to increase, and the topics are increasingly diversified. However, the field of home-visiting nurse research in my country is limited. We can learn from foreign experience and rely on the rapid development of "Internet + Nursing Service" to improve the connotation and quality of home care services.

目的:调查1型糖尿病（T1DM）患者胰岛素注射相关皮下脂肪增生（LH）的发生率，并分析其与多维度自我管理的关系。方法:采用便利抽样法选取2017年7月至2020年8月于南京医科大学第一附属医院内分泌科门诊、住院和参加夏令营、冬令营等教育活动的持续胰岛素注射时长≥6个月的T1DM患者139例，采用高频超声筛查LH，同时运用胰岛素注射相关自我管理行为评定量表（DBRS）进行问卷调查。采用Pearson相关分析法分析T1DM患者自我管理行为各维度与LH的相关性，二元logistic回归分析法探究患者LH发生的影响因素。结果:139例患者中，111例（79.9%）发现LH。Pearson相关分析结果显示，T1DM患者胰岛素注射相关糖尿病行为总评分及自我管理行为调整、血糖监测与控制、日常基础管理和胰岛素注射管理4个维度评分与LH的发生均呈负相关（ r值分别为－0.681、-0.546、-0.473、-0.580、-0.616，均 P<0.01）。二元logistic回归分析结果显示，DBRS中的自我行为调整维度（OR=0.116，95% CI 0.034~0.163）、血糖监测与控制维度（OR 0.096，95%CI 0.026~0.122）、胰岛素注射管理维度（OR 0.324，95%CI 0.004~0.852）是患者LH发生的影响因素。 结论:T1DM患者LH发生率较高，其发生与多维度自我管理行为相关，重点改善患者胰岛素注射技术的同时，推动患者胰岛素注射自我管理行为的全面提升是有效预防LH发生的重要保障。

目的 引入马斯特里赫特临床教学问卷(the Maastricht Clinical Teaching Questionnaire,MCTQ),并进行跨文化调适,形成中文版MCTQ,并进行信、效度检验.方法 对英文版MCTQ进行翻译、回译及文化调适,形成中文版MCTQ.选取426名护理实习生作为研究对象采用中文版MCTQ问卷进行调查,其中30名学生在2周后进行重测,邀请8名专家对中文版MCTQ进行内容效度评价,以评价该问卷的信度及效度.结果 中文版MCTQ探索性因子分子提取4个公因子,包括建模、辅导、表达探索、学习环境.量表的Cronbach'sα系数为0.912,重测信度为0.862,内容效度为0.960.结论 中文版MCTQ问卷有严谨的理论基础,在中国文化背景下具有较高的信度和效度,可作为护理实习生反馈评价临床教学质量的有效工具.