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Gucciardi E, Demelo M, Lee RN, Grace SL. Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes. ETHNICITY & HEALTH 2007; 12:163-87. [PMID: 17364900 DOI: 10.1080/13557850601002148] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period. DESIGN The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence. RESULTS Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months. CONCLUSIONS Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Victoria St, Toronto, Ontario, Canada.
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202
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Affiliation(s)
- Peter G F Swift
- Childrens Hospital, Leicester Royal Infirmary, Leicester, UK.
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203
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KNIGHTS S, TAPSELL L. Dietetic practice in type 2 diabetes: An ethnographic study of Australian dietitians. Nutr Diet 2007. [DOI: 10.1111/j.1747-0080.2007.00114.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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204
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Ko SH, Song KH, Kim SR, Lee JM, Kim JS, Shin JH, Cho YK, Park YM, Jeong JH, Yoon KH, Cha BY, Son HY, Ahn YB. Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Diabet Med 2007; 24:55-62. [PMID: 17227325 DOI: 10.1111/j.1464-5491.2007.02013.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Patient education is a very important part of diabetes care. However, until now, little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes (SIDEP) for people with Type 2 diabetes mellitus. METHODS People with Type 2 diabetes (n = 547) hospitalized from December 1999 to December 2000 were randomly assigned to two groups. Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education. After discharge, all patients were monitored regularly. Laboratory data were obtained, and adherence to self-care behaviour was determined on a five-point scale by questionnaires completed annually. RESULTS Of the patients who completed the SIDEP, 160 (73.1%) were followed up for more than 4 years. The mean HbA(1c) (7.9 +/- 1.2 vs. 8.7 +/- 1.6%; P < 0.05) and the frequency of hospitalization related to diabetes per patient per year (0.3 +/- 0.6 vs. 0.8 +/- 0.9; P < 0.05) was significantly lower in the SIDEP group than in the control group. The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years (P < 0.05). People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c) at follow-up. CONCLUSIONS A well-designed, intensive patient education programme is necessary for people with diabetes. However, regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control, especially in insulin-treated patients.
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Affiliation(s)
- S-H Ko
- Department of Inteernal Medicine, The Catholic University of Korea, Seoul, South Korea
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205
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Gallegos EC, Ovalle-Berúmen F, Gomez-Meza MV. Metabolic Control of Adults With Type 2 Diabetes Mellitus Through Education and Counseling. J Nurs Scholarsh 2006; 38:344-51. [PMID: 17181082 DOI: 10.1111/j.1547-5069.2006.00125.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the efficacy of a controlled nursing intervention focused on education and counseling to improve metabolic control of adults diagnosed with diabetes mellitus type 2 in (DMT2) ambulatory care. DESIGN A quasi-experimental design with repeated measures was selected. A sample of 45 subjects participated, of which 25 were in the experimental group, and 20 in the comparison group. Measures were taken at 0, 3, 6, 9, and 12 months, including glycosylated hemoglobin (HbAlc), psychosocial, and clinical variables. FINDINGS Results showed a significant decrease in HbAlc in the experimental group, as well as positive effects of self-care agency, adaptation, and barriers to treatment (plus one interaction) on the HbA1c levels and on the scores of self-care actions. CONCLUSIONS The counseling and educational model applied in the intervention was effective to improve the metabolic control of diabetic patients in the experimental group. Self-care agency, adaptation, and barriers were predictors of self-care measures and level of HbA1c.
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Affiliation(s)
- Esther C Gallegos
- University of Nuevo Leon, School of Nursing, Gonzalitos 1500 Nte., Mitras Centro, Monterrey, N.L. Mexico, USA.
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206
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Abstract
Trata-se de um estudo de caso único com o objetivo de refletir sobre o trabalho multiprofissional com grupo de diabéticos na implementação do Serviço de Medicina Preventiva-SEMPRE. A coleta de dados foi realizada através de consulta a documentação interna e de observação direta e participante realizada pelo pesquisador durante as atividades realizadas com adultos e crianças diabéticas. A reflexão ocorreu de acordo com a formação inicial de um grupo: encaminhamento, seleção e grupamento. Esta forma de trabalho permitiu maior eficiência e menor custo-efetividade nos programas educativos, sendo necessário o investimento na educação continuada da equipe multiprofissional. Para tanto, é preciso desencadear o processo de cooperação interna e a disponibilização do saber de cada elemento da equipe de saúde.
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Affiliation(s)
- Carla Regina de Souza Teixeira
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP
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Abstract
Group education is increasingly being advocated in place of the traditional one to one approach in health care. Using the example of diabetes, this article describes why group education is effective, and outlines a process that can help shape a group education programme. Identifying the purpose of a programme, understanding how people learn, and behaviour change techniques, all help the educator identify what are the important elements to include. Planning the process of a programme to enhance its success, and developing an evaluation strategy to measure success, are also included.
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Barkauskas VH, Schafer P, Sebastian JG, Pohl JM, Benkert R, Nagelkerk J, Stanhope M, Vonderheid SC, Tanner CL. Clients Served and Services Provided by Academic Nurse-Managed Centers. J Prof Nurs 2006; 22:331-8. [DOI: 10.1016/j.profnurs.2006.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Indexed: 11/30/2022]
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Leeman J. Interventions to improve diabetes self-management: utility and relevance for practice. DIABETES EDUCATOR 2006; 32:571-83. [PMID: 16873595 DOI: 10.1177/0145721706290833] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to review publications of research on diabetes self-management interventions and assess whether the interventions are relevant for practice. METHODS A content analysis was performed on research reports published between 1993 and 2004 of interventions designed to improve patients' diabetes self-management. Information was abstracted relevant to the intervention's generalizability to other settings and its compatibility and feasibility in practice. RESULTS Publications included only limited information relevant to an intervention's generalizability across populations and settings. Many of the interventions tested were not designed to be compatible with the realities of current practice or to be delivered in the settings in which most diabetes care is provided. Many of the interventions were very complex, requiring multiple delivery modes and contacts, proactive scheduling, and coordination across disciplines. CONCLUSIONS In view of the prevalence of diabetes, it is critical that effective self-management interventions be adopted and implemented. Interventions need to be designed so that their findings have greater relevance and utility for practice and can be generalized across practice settings.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, CB#7460, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.
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Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabet Med 2006; 23:944-54. [PMID: 16922700 DOI: 10.1111/j.1464-5491.2006.01906.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To develop a patient-centred, group-based self-management programme (X-PERT), based on theories of empowerment and discovery learning, and to assess the effectiveness of the programme on clinical, lifestyle and psychosocial outcomes. METHODS Adults with Type 2 diabetes (n = 314), living in Burnley, Pendle or Rossendale, Lancashire, UK were randomized to either individual appointments (control group) (n = 157) or the X-PERT Programme (n = 157). X-PERT patients were invited to attend six 2-h group sessions of self-management education. Outcomes were assessed at baseline, 4 and 14 months. RESULTS One hundred and forty-nine participants (95%) attended the X-PERT Programme, with 128 (82%) attending four or more sessions. By 14 months the X-PERT group compared with the control group showed significant improvements in the mean HbA1c (- 0.6% vs. + 0.1%, repeated measures anova, P < 0.001). The number needed to treat (NNT) for preventing diabetes medication increase was 4 [95% confidence interval (CI) 3, 7] and NNT for reducing diabetes medication was 7 (95% CI 5, 11). Statistically significant improvements were also shown in the X-PERT patients compared with the control patients for body weight, body mass index (BMI), waist circumference, total cholesterol, self-empowerment, diabetes knowledge, physical activity levels, foot care, fruit and vegetable intake, enjoyment of food and treatment satisfaction. CONCLUSIONS Participation in the X-PERT Programme by adults with Type 2 diabetes was shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, body weight, BMI and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, enjoyment of food, knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction.
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Affiliation(s)
- T A Deakin
- Nutrition & Dietetic Department, Burnley, Pendle & Rossendale Primary Care Trust, East Lancashire, UK.
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213
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Stallwood L. Relationship between caregiver knowledge and socioeconomic factors on glycemic outcomes of young children with diabetes. J SPEC PEDIATR NURS 2006; 11:158-65. [PMID: 16774526 DOI: 10.1111/j.1744-6155.2006.00062.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To describe the relationship between caregiver diabetes knowledge and socioeconomic factors on glycemic outcomes of young children with type 1 diabetes. DESIGN AND METHODS Seventy-three caregivers of children less than 9 years of age were conveniently sampled and completed the Michigan Diabetes Research and Training Center Diabetes Knowledge Test and a demographic questionnaire. RESULTS Higher caregiver knowledge was associated with lower hemoglobin A1c (HbA1c) levels, higher income levels, and being married. Thirty-three (44%) children had HbA1c levels within the target range. PRACTICE IMPLICATIONS Perform ongoing knowledge assessments and educational interventions related to deficits, with a special focus on families in lower socioeconomic situations.
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Affiliation(s)
- Lynda Stallwood
- University of Colorado at Denver and Health Sciences Center, School of Nursing, Denver, CO, USA.
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Smaldone A, Lin S, Ganda OP, Caballero AE, McMurrich S, Weinger K, Hannagan K. Should group education classes be separated by type of diabetes? Diabetes Care 2006; 29:1656-8. [PMID: 16801595 PMCID: PMC1584305 DOI: 10.2337/dc06-0356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Arlene Smaldone
- From the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts
- From the Harvard Medical School, Boston, Massachusetts
| | - Susan Lin
- From the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts
| | - Om P. Ganda
- From the Harvard Medical School, Boston, Massachusetts
- From the Section on Clinical Research, Joslin Diabetes Center, Boston, Massachusetts
| | - A. Enrique Caballero
- From the Harvard Medical School, Boston, Massachusetts
- From the Section on Clinical Research, Joslin Diabetes Center, Boston, Massachusetts
| | - Sheila McMurrich
- From the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts
| | - Katie Weinger
- From the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts
- From the Harvard Medical School, Boston, Massachusetts
| | - Keri Hannagan
- From the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts
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215
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Massey Z, Rising SS, Ickovics J. CenteringPregnancy group prenatal care: Promoting relationship-centered care. J Obstet Gynecol Neonatal Nurs 2006; 35:286-94. [PMID: 16620257 DOI: 10.1111/j.1552-6909.2006.00040.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CenteringPregnancy is an innovative model of group prenatal care that has been implemented at more than 100 prenatal care sites since 1995. CenteringPregnancy provides group prenatal care that is relationship centered, nurturing and transforming relationships among women, their families, and health care professionals. Complete prenatal care is provided in a group setting. Prenatal assessment, education, and support occur in a facilitative environment. The model offers effective and efficient care that is sustainable and can enhance the health of women, their families, health care providers, and communities.
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Affiliation(s)
- Zohar Massey
- Yale School of Public Health, New Haven, CT 06510, USA.
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216
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Leeman J, Jackson B, Sandelowski M. An Evaluation of How Well Research Reports Facilitate the Use of Findings in Practice. J Nurs Scholarsh 2006; 38:171-7. [PMID: 16773922 DOI: 10.1111/j.1547-5069.2006.00096.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze how research is reported in journal publications as a potential barrier to use of research findings in practice. DESIGN Content analysis of 46 reports of diabetes self-management interventions published between 1993 and 2004. METHODS Data were extracted from the publications using a coding scheme based on concepts from Rogers' theory of the diffusion of innovations. FINDINGS Authors provided only some of the information potential users need to progress through Roger's stages of adopting an intervention and implementing it in practice. Authors provided only limited information on the target population; frequency, number, and duration of patient contacts; expertise and training required to deliver the intervention; intervention protocol; and the process of adapting and implementing interventions in practice settings. CONCLUSIONS To close the gap between research and practice, authors should offer more information to help readers decide whether and how to adopt and implement interventions.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.
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217
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Bergenstal RM. Treatment models from the International Diabetes Center: advancing from oral agents to insulin therapy in type 2 diabetes. Endocr Pract 2006; 12 Suppl 1:98-104. [PMID: 16627391 DOI: 10.4158/ep.12.s1.98] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To discuss treatment models used at the International Diabetes Center (IDC) and present strategies for transitioning patients with type 2 diabetes from orally administered medications to insulin therapy. METHODS The experiences of the IDC in developing and improving patient care and educational programs are reviewed. In addition, clinical outcomes and economic results are highlighted. RESULTS In the management of chronic conditions such as diabetes, the patient is a crucial member of the health-care team. Therefore, patients must understand and endorse treatment goals. Key components of the patient-centered IDC treatment model are group instruction focused on behavioral change, worksite education and coaching programs, and treatment algorithms to help clinicians identify treatment priorities and initiate appropriate therapeutic strategies, including early and more effective use of insulin therapy. CONCLUSION The IDC patient-centered team model aimed at helping patients live well with diabetes has been shown to improve achievement of glycemic, lipid, and blood pressure goals, and it is economically viable. One approach to helping more patients with type 2 diabetes reach glycemic targets is for clinicians to become more comfortable with, and therefore more aggressive in, initiating and adjusting insulin therapy.
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Affiliation(s)
- Richard M Bergenstal
- International Diabetes Center, Park Nicollet Institute, Minneapolis, Minnesota, USA
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Sanz-Cuesta T, Del Cura-González MI, Azcoaga-Lorenzo A, González-González AI, Tello-Bernabé ME, Rodríguez-Gabriel G, Artola-Méndez S, Girbés-Fontana M, López A. [Systematic review of group educational interventions in type-2 diabetes patients]. Aten Primaria 2006; 36:573-5. [PMID: 16507293 PMCID: PMC7684478 DOI: 10.1016/s0212-6567(05)70569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the effect of group educational interventions in type-2 diabetes patients. To analyse what kind of group intervention has the best long-term effects. DESIGN Systematic review. DATA SOURCES Review of electronic data bases: CENTRAL, MEDLINE, EMBASE, CINAHL, and PASCAL, and of the bibliographic references of the studies selected. Contacts with experts to locate non-published articles. Selection of studies. Randomised clinical studies with controls and quasi-experimental studies that evaluate group education interventions aimed at type-2 diabetes patients over 18 years old. These interventions were of any length and in any context, and their target was to improve quality of life, self-control, or metabolic control. The comparison group included individual educational interventions and non-interventions. VARIABLES RESULT: Quality of life, self-control, and diabetes control (HbA1c, cholesterol, triglycerides, blood pressure, and smoking). REVIEW METHODS Trial selection by 3 groups with 3 researchers in each, who independently reviewed headings, abstracts and key words of all the identified trials to decide on their eligibility. The quality of trials was evaluated by the criteria defined by the Cochrane Metabolic and Endocrine Disorders Group. Researchers assessed the articles independently; and discrepancies were resolved by discussion and consensus.
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Affiliation(s)
- T Sanz-Cuesta
- Gerencia Atención Primaria Area 9, Servicio Madrileño de Salud, Madrid, Spain.
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220
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Suhonen R, Nenonen H, Laukka A, Välimäki M. Patients' informational needs and information received do not correspond in hospital. J Clin Nurs 2006; 14:1167-76. [PMID: 16238762 DOI: 10.1111/j.1365-2702.2005.01233.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study describes and compares the information patients want with the information they receive and examines whether this varies between patients. BACKGROUND Patient information during hospitalization has received increasing attention. Previous studies, however, have identified problems of inadequate or insufficient information from a patient's point of view. DESIGN Descriptive, survey design with questionnaires. METHODS The categorical data were collected by specifically designed questionnaires from adult patients (n = 928) on discharge from one Finnish hospital. The data were analysed statistically using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis, McNemar and Wilcoxon Signed Ranks tests). RESULTS Patients attached great importance to information on illness and treatment, and information in this area was provided quite satisfactorily. Less importance was attached to information regarding patient's daily management of illness, such as aftercare, prognosis and patients' rights and less information was reportedly provided. Female gender was systematically associated with attaching greater importance to information and to better evaluations of informational areas. CONCLUSIONS Patients informational needs and the information received from staff did not correspond. The findings confirm the importance of nurses' roles in assessing patients' informational needs to tailor and provide explicit and relevant information to satisfy patients' informational needs. RELEVANCE TO CLINICAL PRACTICE More emphasis should be put on developing methods to ascertain patients' informational needs, to evaluate the content of information and to develop tailored information packages for different patients. This can be done by empowering and helping patients to access and understand relevant and appropriate information, for example, by Web-based information systems.
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Lebovitz HE, Austin MM, Blonde L, Davidson JA, Del Prato S, Gavin JR, Handelsman Y, Jellinger PS, Levy P, Riddle MC, Roberts VL, Siminerio LM. Ace/Aace Consensus Conference on The Implementation of Outpatient Management of Diabetes Mellitus: Consensus Conference Recommendations. Endocr Pract 2006; 12 Suppl 1:6-12. [PMID: 16627372 DOI: 10.4158/ep.12.s1.6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Torres HC, Virginia A H, Schall VT. [Validation of Diabetes Mellitus Knowledge (DKN-A) and Attitude (ATT-19) Questionnaires]. Rev Saude Publica 2005; 39:906-11. [PMID: 16341399 DOI: 10.1590/s0034-89102005000600006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To present the cross-cultural adaptation of the Diabetes Knowledge Scale and Attitudes Questionnaires targeted to evaluate Brazilian Diabetes Mellitus patients. METHODS These questionnaires underwent the following steps: presentation, translation, back translation, semantic and idiomatic assessments, cultural and conceptual similarities and a pilot test. They were administered in two opportunities a month apart in a sample of 61 Diabetes Mellitus type-2 patients from a university hospital. The study design included a test-retest reliability of the answers, which were analyzed and estimated by means of the Kappa coefficient. RESULTS The findings suggested an adequacy of the instruments to the Portuguese language and Brazilian cultural identity. The Kappa coefficient in the reliability analysis showed levels of concordance from moderate to high (0.44 to 0.69) for most questions. CONCLUSIONS The questionnaires proved to be of very easy understanding for the studied subjects and reliable and valid for use in the evaluation of diabetes educational programs in the reality of Brazil.
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Affiliation(s)
- Heloisa C Torres
- Departamento de Enfermagem Aplicada, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Garrett N, Hageman CM, Sibley SD, Davern M, Berger M, Brunzell C, Malecha K, Richards SW. The effectiveness of an interactive small group diabetes intervention in improving knowledge, feeling of control, and behavior. Health Promot Pract 2005; 6:320-8. [PMID: 16020626 DOI: 10.1177/1524839903260846] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study is to evaluate the effectiveness of a small group intervention in improving knowledge, feeling of control, and behaviors related to self-management of diabetes. The intervention includes educational content on diabetes self-management as well as discussion of attitudes, feelings, and motivations about living with diabetes. The authors randomized volunteers into an intervention group that participated in the small-group learning activity and a control group that received a diabetes self-care book. A survey was conducted by telephone before and after each intervention and the difference in change over time between the groups was assessed for each outcome. Compared to the control group, participants in the small-group activity reported significant changes on all three outcomes adjusting for demographic differences between the groups. Because facilitating the learning session does not require clinically trained personnel, this type of intervention could broaden the resources available to people with diabetes.
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225
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Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions to enhance medication adherence. Cochrane Database Syst Rev 2005:CD000011. [PMID: 16235271 DOI: 10.1002/14651858.cd000011.pub2] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. OBJECTIVES To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. SEARCH STRATEGY Computerized searches were updated to September 2004 without language restriction in MEDLINE, EMBASE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA), PsycINFO and SOCIOFILE. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of original and review articles on the topic. SELECTION CRITERIA Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS Study design features, interventions and controls, and results were extracted by one reviewer and confirmed by at least one other reviewer. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. MAIN RESULTS For short-term treatments, four of nine interventions reported in eight RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient compliance, but did not enhance the clinical outcome. For long-term treatments, 26 of 58 interventions reported in 49 RCTs were associated with improvements in adherence, but only 18 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Six studies showed that telling patients about adverse effects of treatment did not affect their adherence. AUTHORS' CONCLUSIONS Improving short-term adherence is relatively successful with a variety of simple interventions. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
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Affiliation(s)
- R B Haynes
- McMaster University Medical Centre, Clinical Epidemiology and Biostatistics, HSC Room 2C10b, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5.
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Stern E, Benbassat CA, Goldfracht M. Impact of a two-arm educational program for improving diabetes care in primary care centres. Int J Clin Pract 2005; 59:1126-30. [PMID: 16178977 DOI: 10.1111/j.1368-5031.2005.00643.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Improvement of the quality of diabetes care is essential for reducing diabetes complications. Nevertheless, compliance with diabetes clinical practice recommendations is inadequate in primary care. The aim of this study was to assess the impact of diabetes education, when directed simultaneously to both diabetes care providers and patients, on the frequency of performance of relevant laboratory tests and improvement of metabolic control. A three-step educational program was applied at 45 community clinics of a health-managed organisation comprising 175 health care providers and 16,275 diabetic patients. At the end of a 2-year period, the proportion of diabetic patients with HbA1c tested at least once a year rose from 60 to 85%. The percentage of patients with HbA1c <7% rose from 38 to 50%, whereas the percentage with HbA1c >8.5% decreased from 27 to 19%. The number of patients visiting an eye clinic at least once yearly rose from 55 to 65% and of those undergoing microalbumin testing from 27 to 37%. There was a 20% increase in the number of patients with low-density lipoprotein cholesterol measurements. Our study demonstrates the efficacy of diabetes education when directed simultaneously to health care providers and diabetic patients. The improvement in quality of care induced by such intervention can translate into better metabolic control and, ultimately, the prevention of diabetes complications.
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Affiliation(s)
- E Stern
- General Health Services, Tel Aviv, Israel.
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227
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Jenhani M, Gaha K, Nabouli R, Ghedira A, Ben Abdelaziz A. Effectiveness of patient education on glycemic control in insulin treated patients in general practice. DIABETES & METABOLISM 2005; 31:376-81. [PMID: 16369200 DOI: 10.1016/s1262-3636(07)70207-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the effectiveness of a patient education program on diabetes control. METHODS A pre-test post-test pre experimental study was performed with 87 insulin treated diabetic patients followed in the chronic disease unit of Kelibia district (Nabeul, Tunisia). Subjects received education in 6 monthly sessions. Outcome measures included glycated haemoglobin (HbA1c), anxiety level according to the Hamilton scale and Body Mass Index. Changes were assessed after the 6 month program. RESULTS HbA1c decreased from 8.8% +/- 1.23 to 7,6 +/- 1.43 (P<10-6) with an increase in the prevalence of satisfactory HbA1c (< or = 8%) from 33% to 61.2% (P<0,001). The prevalence of severe anxiety decreased by about a third (P < 0,001). CONCLUSION Education led to an improvement in diabetes control in insulin treated diabetic patients. More attention should be paid to such strategies in general practice.
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Affiliation(s)
- M Jenhani
- District Hospital of Kelibia, Nabeul, Tunisia
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228
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Keers JC, Groen H, Sluiter WJ, Bouma J, Links TP. Cost and benefits of a multidisciplinary intensive diabetes education programme. J Eval Clin Pract 2005; 11:293-303. [PMID: 15869559 DOI: 10.1111/j.1365-2753.2005.00536.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the cost and benefits of an intensive diabetes education programme for patients with prolonged self-management problems and to determine the inclusion criteria for optimal outcomes. METHODS Sixty-one participants of a multidisciplinary intensive diabetes education programme (MIDEP) were measured before they started the intervention (T0), and at 1-year follow-up (T1). Data on glycaemic control (HbA1c), diabetes-related distress (PAID) and costs were obtained. Changes over time were analysed and means at T0 and T1 were compared to a reference group of 230 non-referred consecutive outpatients. The number needed to treat (NNT), that is, the number of patients to be treated to achieve one successful case, was calculated for different baseline values of HbA1c and PAID to determine optimal inclusion criteria. RESULTS Diabetes-related costs decreased significantly and participants improved significantly in HbA1c and diabetes-related distress following MIDEP. HbA1c and distress reached the levels of the reference group. The T1 costs remained higher than in the reference group, but the reduction in costs outweighed the intervention costs. Including patients with baseline HbA1c>or=8.0% and/or PAID scores>or=40 would improve the NNT to achieve clinically relevant outcomes, while 76% of the patients matched these inclusion criteria. CONCLUSIONS MIDEP is effective in improving glycaemic control and diabetes-related distress for patients with prolonged self-management difficulties. Besides the immediate reduction in costs found in the present study, improved glycaemic control may reduce future costs of diabetic complications. Stricter inclusion criteria with respect to HbA1c and PAID scores may further improve the programme's efficiency.
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Affiliation(s)
- J C Keers
- Northern Centre for Healthcare Research, University of Groningen, the Netherlands.
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229
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Deakin T, McShane CE, Cade JE, Williams RDRR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005:CD003417. [PMID: 15846663 DOI: 10.1002/14651858.cd003417.pub2] [Citation(s) in RCA: 426] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear. OBJECTIVES To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes. SEARCH STRATEGY Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field. Date of last search was February 2003. SELECTION CRITERIA Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner. MAIN RESULTS Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication. AUTHORS' CONCLUSIONS Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.
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Affiliation(s)
- T Deakin
- Department of Nutrition & Dietetics, Burnley, Pendle & Rossendlae Primary Care Trust, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, UK, BB10 2PQ.
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230
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Abstract
TOPIC Peer coaching for diabetes support. purpose. To see if peer coaching assists a person with diabetes make the correct diet and activity choices. SOURCES OF INFORMATION Journal articles, Internet. CONCLUSIONS Peer support is helpful for people who are struggling to cope with diabetes. If peer support is offered, a structured follow-up program needs to be in place.
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232
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Kotani K, Sakane N. Effects of a self-help group for diabetes care in long-term patients with type 2 diabetes mellitus: an experience in a Japanese rural community. Aust J Rural Health 2004; 12:251-2. [PMID: 15615577 DOI: 10.1111/j.1440-1854.2004.00626.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Tottori University, Yonago83-8503, Japan.
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Abstract
An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.
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Affiliation(s)
- Stanton Newman
- Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, London, UK.
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234
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Franz MJ. Is weight loss the best lifestyle intervention for type 2 diabetes? Curr Diab Rep 2004; 4:361-3. [PMID: 15461901 DOI: 10.1007/s11892-004-0038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Adolfsson ET, Smide B, Gregeby E, Fernström L, Wikblad K. Implementing empowerment group education in diabetes. PATIENT EDUCATION AND COUNSELING 2004; 53:319-24. [PMID: 15186870 DOI: 10.1016/j.pec.2003.07.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2002] [Revised: 06/21/2003] [Accepted: 07/06/2003] [Indexed: 05/21/2023]
Abstract
The overall aim was to gain insight into and understand how physicians and nurses view the implementation of empowerment group education (EGE) in diabetes. Prior to the study the physicians and nurses attended a 2-day empowerment workshop. Further, they had implemented the empowerment approach in two groups of patients with type II diabetes. Three to 9 months later they (five physicians and 11 nurses from six family practices) participated in focus group interviews to evaluate the implementation of the EGE. The interviews were audio-taped, transcribed and analysed using the constant comparative method. The main result showed a conflict in roles. The physicians and nurses knew their role in the traditional approach but not with respect to the empowerment approach, which they needed to grow into. At the same time as they started a new way of working, their role had changed from being an expert to being a facilitator. As experts they felt secure; as facilitators they needed support in their educational process. To implement EGE they required support both from the family practice and from a supervisor in direct connection with the EGE.
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Affiliation(s)
- Eva Thors Adolfsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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236
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Affiliation(s)
- John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto and Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Helde G, Brodtkorb E, Bråthen G, Bovim G. An easily performed group education programme for patients with uncontrolled epilepsy--a pilot study. Seizure 2003; 12:497-501. [PMID: 12967579 DOI: 10.1016/s1059-1311(03)00050-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The factual knowledge of epilepsy is often insufficient among patients with this disorder. Compliance problems due to ignorance are common, and counselling is extremely important. We have developed a simple 1-day, low-cost group education programme for patients with epilepsy, intended to be suitable in routine care. The programme aims to help patients to achieve an improved understanding of the disorder and was carried out for a total of 54 consecutive patients with at least one seizure during the last year. This hospital-based 6-hour interactive course is organised by an epilepsy nurse and contains the following elements: basic knowledge about epilepsy, living with epilepsy, visit to the EEG lab, social security system and medical treatment. It was evaluated by means of a semi-structured interview and was found generally useful by all the participants. Sixty-five percent considered the sharing of experience with other patients to be the most valuable element. The ideal group size was found to be six to eight. Heterogeneity concerning age, sex and competence seemed to increase the interaction within the groups. This pilot study indicates that group education may be a useful approach in the clinic.
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Affiliation(s)
- Grethe Helde
- Department of Neuroscience, Section of Neurology, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Ziemer DC, Berkowitz KJ, Panayioto RM, El-Kebbi IM, Musey VC, Anderson LA, Wanko NS, Fowke ML, Brazier CW, Dunbar VG, Slocum W, Bacha GM, Gallina DL, Cook CB, Phillips LS. A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes. Diabetes Care 2003; 26:1719-24. [PMID: 12766100 DOI: 10.2337/diacare.26.6.1719] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA(1c) levels in urban African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires. RESULTS At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA(1c) (9.4%). Improvements in glycemic control over 6 months were significant (P < 0.0001) but similar in both groups: HbA(1c) decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches. CONCLUSIONS Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.
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Affiliation(s)
- David C Ziemer
- Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Miller CD, Barnes CS, Phillips LS, Ziemer DC, Gallina DL, Cook CB, Maryman SD, El-Kebbi IM. Rapid A1c availability improves clinical decision-making in an urban primary care clinic. Diabetes Care 2003; 26:1158-63. [PMID: 12663590 DOI: 10.2337/diacare.26.4.1158] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Failure to meet goals for glycemic control in primary care settings may be due in part to lack of information critical to guide intensification of therapy. Our objective is to determine whether rapid-turnaround A1c availability would improve intensification of diabetes therapy and reduce A1c levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS In this prospective controlled trial, A1c was determined on capillary glucose samples and made available to providers, either during ("rapid") or after ("routine") the patient visit. Frequency of intensification of pharmacological diabetes therapy in inadequately controlled patients and A1c levels were assessed at baseline and after follow-up. RESULTS We recruited 597 subjects. Patients were 79% female and 96% African American, with average age of 61 years, duration of diabetes 10 years, BMI 33 kg/m(2), and A1c 8.5%. The rapid and routine groups had similar clinical demographics. Rapid A1c availability resulted in more frequent intensification of therapy when A1c was >/=7.0% at the baseline visit (51 vs. 32% of patients, P = 0.01), particularly when A1c was >8.0% and/or random glucose was in the 8.4-14.4 mmol/l range (151-250 mg/dl). In 275 patients with two follow-up visits, A1c fell significantly in the rapid group (from 8.4 to 8.1%, P = 0.04) but not in the routine group (from 8.1 to 8.0%, P = 0.31). CONCLUSIONS Availability of rapid A1c measurements increased the frequency of intensification of therapy and lowered A1c levels in patients with type 2 diabetes in an urban neighborhood health center.
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242
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Koev DJ, Tankova TI, Kozlovski PG. Effect of structured group education on glycemic control and hypoglycemia in insulin-treated patients. Diabetes Care 2003; 26:251. [PMID: 12502698 DOI: 10.2337/diacare.26.1.251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Current literature in diabetes. Diabetes Metab Res Rev 2002; 18:245-52. [PMID: 12112943 DOI: 10.1002/dmrr.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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