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      The Efficacy of Targeted Perioperative Management for Diabetic Patients with Traumatic Calcaneal Fractures

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          Abstract

          Objective

          To assess the efficacy of targeted perioperative management for diabetic patients with traumatic calcaneal fractures.

          Methods

          Between April 2020 and December 2020, 100 diabetic patients with traumatic calcaneal fractures treated in our institution satisfying the inclusion criteria were enrolled and assigned to receive either conventional treatment with surgery or plaster fixation (observation group) or targeted treatment with surgery or plaster fixation (experimental group) via the random number table method, with 50 patients in each group. All eligible patients were followed up for 1 year postoperatively. Outcome measures included length of hospital stay, recovery time, fracture healing, duration of postoperative wound drainage, complication rate, blood glucose, and treatment satisfaction. The Maryland score was used for the assessment of foot function.

          Results

          The duration of postoperative wound drainage, length of hospital stay, and recovery time in the experimental group (3.63 ± 1.04 d, 12.13 ± 3.77 d, and 111.22 ± 16.24 d) were significantly shorter than those in the observation group (5.71 ± 2.34 d, 15.28 ± 4.42 d, 123.10 ± 22.82 d) ( P < 0.01). The experimental group obtained a markedly higher complete healing rate versus the observation group ( P < 0.001). A significantly lower complication rate was observed in the experimental group than in the observation group ( P < 0.05). The Maryland scores results were dichotomized into good (≥75 points) and poor (<75 points). The experimental group showed significantly higher Maryland scores good rate and treatment satisfaction versus the observation group ( P < 0.01). The experimental group patients were associated with better postoperative fasting glucose and 2 h postprandial glucose versus those in the observation group ( P < 0.05).

          Conclusion

          Targeted treatment in the perioperative management of diabetic patients with traumatic calcaneal fractures significantly promotes the recovery of patients, reduces the incidence of complications, increases treatment satisfaction, and ameliorates the doctor-patient relationship.

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          Most cited references22

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          Multifactorial intervention has a significant effect on diabetic kidney disease in patients with type 2 diabetes

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            The impact of the COVID‐19 pandemic on people with diabetes and diabetes services: A pan‐European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium

            Abstract Aim To describe diabetes nurses' perspectives on the impact of the COVID‐19 pandemic on people with diabetes and diabetes services across Europe. Methods An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. Results Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID‐19 pandemic had impacted ‘a lot’ on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased ‘a lot’: anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty‐seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self‐management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID‐19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. Conclusion The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID‐19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID‐19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.
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              Postoperative diabetes insipidus: how to define and grade this complication?

              Purpose Although transient diabetes insipidus (DI) is the most common complication of pituitary surgery, there is no consensus on its definition. Polyuria is the most overt symptoms of DI, but can also reflect several physiological adaptive mechanisms in the postoperative phase. These may be difficult to distinguish from and might coincide with DI. The difficulty to distinguish DI from other causes of postoperative polyuria might explain the high variation in incidence rates. This limits interpretation of outcomes, in particular complication rates between centers, and may lead to unnecessary treatment. Aim of this review is to determine a pathophysiologically sound and practical definition of DI for uniform outcome evaluations and treatment recommendations. Methods This study incorporates actual data and the experience of our center and combines this with a review of literature on pathophysiological mechanisms and definitions used in clinical studies reporting of postoperative DI. Results The occurrence of excessive thirst and/or hyperosmolality or hypernatremia are the best indicators to discriminate between pathophysiological symptoms and signs of DI and other causes. Urine osmolality distinguishes DI from osmotic diuresis. Conclusions To improve reliability and comparability we propose the following definition for postoperative DI: polyuria (urine production > 300 ml/hour for 3 h) accompanied by a urine specific gravity (USG)   300 mosmol/kg, or serum sodium > 145 mmol/L. To prevent unnecessary treatment with desmopressin, we present an algorithm for the diagnosis and treatment of postoperative DI.
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                Author and article information

                Contributors
                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi
                1741-427X
                1741-4288
                2022
                28 June 2022
                28 June 2022
                : 2022
                : 1294416
                Affiliations
                Department of Hand and Foot Surgery, Jinan Zhangqiu District People's Hospital, Jinan, China
                Author notes

                Academic Editor: Xiaonan Xi

                Author information
                https://orcid.org/0000-0002-1077-3678
                Article
                10.1155/2022/1294416
                9256409
                a37a10d0-3042-4c13-8b49-15dfadf790a2
                Copyright © 2022 Sibin Hao et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 March 2022
                : 12 May 2022
                : 18 May 2022
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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