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Guerin RM, O'Toole E, Daly B. The Will Reconsidered: Hard Choices in Living Organ Donation. Narrat Inq Bioeth 2018; 8:179-186. [PMID: 30220701 DOI: 10.1353/nib.2018.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the following article, we illustrate an interview between a living donor advocate and a potential living organ donor in which the donor faced a hard choice: the reasons to donate and the reasons not to donate were equally persuasive. In the discussion that follows, we analyze the act of willing, what differentiates coercion and willing, and how the case study highlights a different, but by no means rare, instance in which donors feel paralyzed by the choice at hand. In such cases, we suspect that donor advocates either do not approve the potential donor for transplantation or simply remain neutral. But we think that this approach benefits neither the donor nor the recipient. We conclude this study with recommendations for living donor advocates, providing questions that might solicit donors' deeper values and suggesting that in these situations donors may benefit from additional time for reflection.
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Clough S, Burke M, Daly B, Scambler S. The impact of pre-radiotherapy dental extractions on head and neck cancer patients: a qualitative study. Br Dent J 2018; 225:28-32. [DOI: 10.1038/sj.bdj.2018.442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/09/2022]
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Lavrentaki A, Subramanian A, Thomas GN, Valsamakis G, Toulis K, Daly B, Mastorakos G, Tahrani A, Nirantharakumar K. Gestational Diabetes Mellitus is associated with increased risk of Non-Alcoholic Fatty Liver Disease: A population-based cohort study. ENDOCRINE ABSTRACTS 2018. [DOI: 10.1530/endoabs.56.gp92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Faulks D, Dougall A, Ting G, Ari T, Nunn J, Friedman C, John J, Daly B, Roger-Leroi V, Newton JT. Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e278-e290. [PMID: 28940883 DOI: 10.1111/eje.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION These results are positive, and the scales now need to be validated in the field. CONCLUSIONS It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.
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Hetland B, Hickman R, McAndrew N, Daly B. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses. AACN Adv Crit Care 2018; 28:160-170. [PMID: 28592476 DOI: 10.4037/aacnacc2017118] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.
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Keohane DM, McGillivary NA, Daly B. Physical activity levels and perceived barriers to exercise participation in Irish General Practitioners and General Practice trainees. IRISH MEDICAL JOURNAL 2018; 111:690. [PMID: 29952439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physical activity is a pillar stone of health promotion and primary care is perfectly poised to disseminate this message. Primary care however, often fails in this regard, missing an opportunity to promote a simple intervention that is effective, free and easily accessible. This study aimed to determine physical activity levels in Irish General Practitioners and General Practice Trainees in addition to describing the barriers to exercise that exist amongst this cohort. This cross-sectional study of Irish General Practice trainers and trainees captured a categorical record of physical activity as well as a qualitative measure of the perceived barriers to exercise. Only 49% (n=107) of those studied engaged in health enhancing physical activity while 20% (n=44) were completely inactive. Sixty percent (n=131) demonstrated excessively sedentary behaviour. The greatest barriers to exercise were time expenditure and exhaustion. General practitioners and trainees are more likely to engage with promoting physical activity as a health intervention if its benefits are clearly demonstrable in their own lives. This established trend of inactivity needs to be reversed if physicians wish to realise significant health benefits in their own lives and achieve substantial change in the health behaviours of their patients.
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Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J, Keerthy D, Jolly K, Saravanan P, Nirantharakumar K. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLoS Med 2018; 15:e1002488. [PMID: 29337985 PMCID: PMC5770032 DOI: 10.1371/journal.pmed.1002488] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/11/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease. METHODS AND FINDINGS We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31-26.34) and hypertension (IRR = 1.85; 95% CI 1.59-2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37-5.66), and for cerebrovascular disease 0.95 (95% CI 0.51-1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease. CONCLUSIONS Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.
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Daly B, Thompsell A, Sharpling J, Rooney YM, Hillman L, Wanyonyi KL, White S, Gallagher JE. Evidence summary: the relationship between oral health and dementia. Br Dent J 2017; 223:846-853. [DOI: 10.1038/sj.bdj.2017.992] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/29/2022]
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Bolster F, Ali Z, Daly B. The “pseudo-CT myelogram sign”: an aid to the diagnosis of underlying brain stem and spinal cord trauma in the presence of major craniocervical region injury on post-mortem CT. Clin Radiol 2017; 72:1085.e11-1085.e15. [DOI: 10.1016/j.crad.2017.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/01/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
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Munoz-Largacha J, Rao S, Daly B, Litle V, Suzuki K. P1.05-013 Induction Chemoradiation Is Associated with Improved Survival in Resected Non-Pancoast Lung Cancer with Chest Wall Invasion. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dougall A, Hayes M, Daly B. A systematic review of the use of local analgesia in medically compromised children and adolescents. Eur Arch Paediatr Dent 2017; 18:331-343. [DOI: 10.1007/s40368-017-0304-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022]
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Daly B, Tian CJL, Scragg RKR. Effect of nurse-led randomised control trials on cardiovascular risk factors and HbA1c in diabetes patients: A meta-analysis. Diabetes Res Clin Pract 2017; 131:187-199. [PMID: 28756133 DOI: 10.1016/j.diabres.2017.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/23/2017] [Accepted: 07/07/2017] [Indexed: 12/31/2022]
Abstract
A systematic review and meta-analysis identified 42 randomised control trials comparing a nurse-led intervention with 'usual care' to quantify their effect on glycated haemoglobin (HbA1c) and major cardiovascular risk factors in diabetes patients. All relevant databases were systematically searched for publications to February 2016: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE and Cumulative Index to Nursing & Allied Health Literature (CINAHL). The 42 trials recruited 9955 diabetes patients (5022 randomised to intervention and 4933 to 'usual care'). For patients receiving the nurse-led intervention, compared with 'usual care', there were small but significant mean reductions for HbA1c [-0.28%; 95% CI -0.38%, -0.18%; p-value<0.0001, n=6920] and serum triglyceride levels [-0.27mmol/L; 95% CI -0.49, -0.06; p=0.01, n=1169], and a greater proportion of patients stopped smoking [risk ratio=2.70; 95% CI 1.35, 5.43; p=0.005, n=1890 patients]. Mean reductions for systolic [-1.84mmHg; 95% CI -3.97, -0.10; p=0.06, 4241 patients] and diastolic [-0.95mmHg; 95% CI -2.15, -0.25; p=0.12, 3811 patients] blood pressures trended towards significance. There were no significant mean reductions for body mass index or serum cholesterol. Nurse-led interventions produced greater improvements than 'usual care' for HbA1c, serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management.
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Asimakopoulou K, Rhodes G, Daly B. Risk communication in the dental practice. Br Dent J 2017; 220:77-80. [PMID: 26794113 DOI: 10.1038/sj.bdj.2016.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/09/2022]
Abstract
The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.
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Daly B, Raiman I, Goodson J. Screening for diabetes in pregnancy in a regional area with a high Māori population. THE NEW ZEALAND MEDICAL JOURNAL 2017; 130:25-31. [PMID: 28207722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIMS To identify and document factors associated with screening for diabetes in pregnancy in a regional area with a high Māori population in New Zealand. METHODS An audit was undertaken of routine hospital data collected from all 656 women who gave birth, between June and December in 2013 and 2014, in two Mid-North Island hospitals in the Bay of Plenty region. RESULTS Of the 656 woman who gave birth during these periods, only 416 (63%) were screened for diabetes in pregnancy, including 390 (60%) for gestational diabetes mellitus later in pregnancy. After controlling for age, screening was less common in Māori (56%) compared with European women (76%). After adjusting for ethnicity, women aged 35-40 years were more likely to be screened compared with women aged 25-29 years (77% versus 61%; p=0.02). Screening was associated with longer hospital stays following birth, with screened women more likely to stay >5 days than <1 day, compared with unscreened women (84% versus 56%; p<0.0001). Screening was significantly higher in 2014 than 2013 (68% versus 58%; p=0.008). CONCLUSIONS Greater effort is required to increase screening, especially for Māori women who have increased risk of type 2 diabetes and gestational diabetes mellitus and of poorer outcomes.
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Daly B, Young S, Marla R, Riddell L, Junkin R, Weidenhammer N, Dolan J, Kinsella J, Zhang R. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth 2017; 29:57-63. [DOI: 10.1016/j.ijoa.2016.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/24/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
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Al Khamis S, Asimakopoulou K, Newton J, Daly B. Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women. JDR Clin Trans Res 2016; 1:211-217. [DOI: 10.1177/2380084416665075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women’s understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists’ purported incorrect beliefs about providing dental treatment to pregnant women and the women’s lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women. Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.
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Hsiao CP, Daly B, Saligan LN. The Etiology and management of radiotherapy-induced fatigue. ACTA ACUST UNITED AC 2016; 1:323-328. [PMID: 29651466 DOI: 10.1080/23809000.2016.1191948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fatigue is one of the most common side-effects accompanying radiotherapy, but arguably the least understood. Radiotherapy-induced fatigue (RIF) is a clinical subtype of cancer treatment-related fatigue. It is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living, and is not relieved by adequate rest or sleep. RIF is one of the early side-effects and long-lasting for cancer patients treated with localized radiation. Although the underlying mechanisms of fatigue have been studied in several disease conditions, the etiology, mechanisms, and risk factors of RIF remain elusive, and this symptom remains poorly managed. The purpose of this paper is to review and discuss recent articles that defined, proposed biologic underpinnings and mechanisms to explain the pathobiology of RIF, as well as articles that proposed interventions to manage RIF. Understanding the mechanisms of RIF can describe promising pathways to identify at-risk individuals and identify potential therapeutic targets to alleviate and prevent RIF using a multimodal, multidisciplinary approach.
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Moore S, Shiers D, Daly B, Mitchell AJ, Gaughran F. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132:109-21. [PMID: 25958971 DOI: 10.1111/acps.12431] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side-effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical health conditions, including cancer, fractures and complications of surgery. We set out to examine the literature on disparities in medical and dental care experienced by people with schizophrenia and suggest possible approaches to improving health. METHOD This narrative review used a targeted literature search to identify the literature on physical health disparities in schizophrenia. RESULTS There is evidence of inequitable access to and/or uptake of physical and dental health care by those with schizophrenia. CONCLUSION The goal was to reduce the mortality gap through equity of access to all levels of health care, including acute care, long-term condition management, preventative medicine and health promotion. We suggest solutions to promote health, wellbeing and longevity in this population, prioritising identification of and intervention for risk factors for premature morbidity and mortality. Shared approaches are vital, while joint education of clinicians will help break down the artificial mind-body divide.
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Ciro RE, Gokhale S, Daly B. Author response. Neurology 2015; 84:1910-1911. [PMID: 26131460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Pullicino PM, Ramos-Estebanez C, Gokhale S, Daly B, Schor NF. Clinical and ethical judgment: A profound dilemma. Neurology 2015; 84:1910. [DOI: 10.1212/01.wnl.0000465425.64165.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Daly B, Arroll B, Kenealy T, Sheridan N, Scragg R. Management of diabetes by primary health care nurses in Auckland, New Zealand. J Prim Health Care 2015; 7:42-49. [PMID: 25770715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.
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Daly B, Arroll B, Kenealy T, Sheridan N, Scragg R. Management of diabetes by primary health care nurses in Auckland, New Zealand. J Prim Health Care 2015. [DOI: 10.1071/hc15042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM: To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS: Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS: Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION: Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes. KEYWORDS: Blood glucose; diabetes mellitus type 1; diabetes mellitus type 2; nurses; primary health care; risk management
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Douglas S, Daly B, Rowbottom J, Hejal R, O’Toole E. 394. Crit Care Med 2014. [DOI: 10.1097/01.ccm.0000457891.66845.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daly B, Kenealy T, Arroll B, Sheridan N, Scragg R. Do primary health care nurses address cardiovascular risk in diabetes patients? Diabetes Res Clin Pract 2014; 106:212-20. [PMID: 25271111 DOI: 10.1016/j.diabres.2014.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 08/15/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
Abstract
AIMS To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. METHODS Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. RESULTS The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001). CONCLUSIONS Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.
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Daly B, Gokhale S, Ramos-Estebanez C. Clinical and ethical judgment: a profound dilemma. Neurology 2014; 83:1369-71. [PMID: 25288696 PMCID: PMC4189099 DOI: 10.1212/wnl.0000000000000875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/08/2014] [Indexed: 11/15/2022] Open
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