Background Diabetes is a common chronic disease that requires a long‐term regimen. However, the management of diabetes by telenursing is limited and inconclusive. Objectives To determine the effectiveness of telenursing on control in diabetes. We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs). Methods We searched electronic databases, including PubMed, Embase, Web of Science and Cochrane Library. Studies comparing telenursing with usual care in diabetes patients were included. Results A total of 17 randomized controlled trials were identified. Glycated hemoglobin (HbA1c) dates were pooled using a random effects meta‐analysis method, followed by subgroup analyses to examine heterogeneity. The meta‐analysis showed that the use of telenursing (vs. usual care) was associated with a significant reduction in HbA1c levels compared to usual care, with a pooled 0.68% (95% CI: 0.33–1.03, p = 0.0001; I2 = 95%). For the secondary outcome, the SMD of body mass index (BMI) was −0.25% (95% CI: −0.81 to 0.32%, p = 0.39), with no statistically significant change; the fasting blood sugar (FBS) SMD was −0.19% (95% CI: 0.20 to 1.01, p = 0.003), with a statistically significant change; the total cholesterol (TC) SMD was −0.09% (95% CI: −0.03 to 0.21, p = 0.12), with no statistically significant change. Conclusions Telenursing, as a useful tool for patient education and behavioral interventions, can help diabetes patients to improve their glycemic control. However, more studies on up‐to‐date and cost‐effective technologies are needed.
Objective: Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. Methods: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. Results: In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. Conclusions: The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.
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