1
|
Abd-El mohsen SA, Mohamed Shehata AA. Evaluating the effect of health education program on outcomes of type I diabetic patients: A randomized controlled study. Saudi J Biol Sci 2020; 27:2869-2875. [PMID: 33100841 PMCID: PMC7569108 DOI: 10.1016/j.sjbs.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background; findings from the meta-analysis have shown that patients present improvements in glycaemic control, and in the prevention and control of the acute and chronic complications, when they receive effective treatment, self-management support and regular monitoring. The present study aimed to evaluate the effect of implementing a health education program on outcomes of type I diabetic patients. Quasi-experimental study design was used to fulfill the aim of the study. The study was conducted in the outpatient diabetic clinic at Asyut University Hospital; 60 adult male and female patients who attended the outpatient diabetic clinic were included. Two tools were used in this study; structured interviewing questionnaire with three parts; part one: demographic patient variables, part two: patient's medical data and part three: patient's knowledge regarding diabetes, the second tool is evaluation of type I diabetic patients' outcomes (pre/post). Results revealed that the highest percentage of the studied samples were in the age group 18 to less than 30 years, 90.0% of the study group and 83.4% of the control group were having a family history of diabetes, a statistically significant difference was found in the study group patients pre and post application of the program regarding insulin injection and glycemic control. Conclusion: this study demonstrated the effectiveness of health education program implementation on the outcomes of type I diabetic patients in terms of improved knowledge and practicing exercise, teeth care, feet care and on glycemic control.
Collapse
Affiliation(s)
- Sahar A. Abd-El mohsen
- Department of Nursing Sciences, College of Applied Medical Sciences in Wadi Alddawasir, Prince Sattam bin Abdulaziz University, Postal code: 18616, Saudi Arabia
| | - Azhar A. Mohamed Shehata
- Department of Nursing Sciences, College of Applied Medical Sciences in Wadi Alddawasir, Prince Sattam bin Abdulaziz University, Postal code: 18616, Saudi Arabia
- Department of Community Health Nursing, Faculty of Nursing, Zagazig University, Egypt
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW The goal of this review is to summarize information about insulin dosing software and calculators used as computerized decision support systems or electronic glucose management systems (eGMS). These are used for hospitalized, insulin-treated patients with diabetes. We describe the advantages and disadvantages and the rationale for their use. RECENT FINDINGS We compared commercially available insulin dosing software, namely, Glucommander™, EndoTool®, GlucoStabilizer®, and GlucoTab®, in addition to computerized order entry systems that are available in electronic health records. The common feature among these eGMS is their ability to limit occurrences of hypoglycemia while achieving and maintaining patients at target blood glucose level. More research needs to be done examining the efficacy of eGMS in disease-specific states and their benefits and utility in preventing adverse outcomes. Their long-term benefits to health care systems are beginning to emerge in cost-saving benefits and prevention of readmissions.
Collapse
Affiliation(s)
- Jagdeesh Ullal
- Center for Diabetes and Endocrinology, Division of Endocrinology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Joseph A Aloi
- Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
3
|
Horton WB, Law S, Darji M, Conaway MR, Akbashev MY, Kubiak NT, Kirby JL, Thigpen SC. A MULTICENTER STUDY EVALUATING PERCEPTIONS AND KNOWLEDGE OF INPATIENT GLYCEMIC CONTROL AMONG RESIDENT PHYSICIANS: ANALYZING THEMES TO INFORM AND IMPROVE CARE. Endocr Pract 2019; 25:1295-1303. [PMID: 31412227 DOI: 10.4158/ep-2019-0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In this descriptive study, we evaluated perceptions and knowledge of inpatient glycemic control among resident physicians. Methods: We performed this study at four academic medical centers: the University of Mississippi Medical Center, University of Virginia Health System, University of Louisville Health Sciences Center, and Emory University. We designed a questionnaire, and Institutional Review Board approval was granted at each institution prior to study initiation. We then administered the questionnaire to Internal Medicine and Medicine-Pediatric resident physicians. Results: A total of 246 of 438 (56.2%) eligible resident physicians completed the Inpatient Glycemic Control Questionnaire (IGCQ). Most respondents (85.4%) reported feeling comfortable treating and managing inpatient hyperglycemia, and a majority (66.3%) agreed they had received adequate education. Despite self-reported comfort with knowledge, only 51.2% of respondents could identify appropriate glycemic targets in critically ill patients. Only 45.5% correctly identified appropriate inpatient random glycemic target values in noncritically ill patients, and only 34.1% of respondents knew appropriate preprandial glycemic targets in noncritically ill patients. A small majority (54.1%) were able to identify the correct fingerstick glucose value that defines hypoglycemia. System issues were the most commonly cited barrier to successful inpatient glycemic control. Conclusion: Most respondents reported feeling comfortable managing inpatient hyperglycemia but had difficulty identifying appropriate inpatient glycemic target values. Future interventions could utilize the IGCQ as a pre- and postassessment tool and focus on early resident education along with improving system environments to aid in successful inpatient glycemic control. Abbreviations: DM = diabetes mellitus; Emory = Emory University Healthcare; IGC = inpatient glycemic control; IGCQ = Inpatient Glycemic Control Questionnaire; IRB = Institutional Review Board; PGY = postgraduate year; UMMC = University of Mississippi Medical Center; UVA = University of Virginia Health System; UL = University of Louisville Health Sciences Center.
Collapse
|
4
|
Horton WB, Law S, Darji M, Conaway MR, Kubiak NT, Kirby JL, Thigpen SC. Construction and preliminary evaluation of the inpatient glycemic control questionnaire (IGCQ): a survey tool assessing perceptions and knowledge of resident physicians. BMC MEDICAL EDUCATION 2019; 19:228. [PMID: 31234836 PMCID: PMC6591905 DOI: 10.1186/s12909-019-1657-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Uncontrolled hyperglycemia in hospitalized patients, with or without diabetes mellitus, is associated with many adverse outcomes. Resident physicians are the primary managers of inpatient glycemic control (IGC) in many academic and community medical centers; however, no validated survey tools related to their perceptions and knowledge of IGC are currently available. As identification of common barriers to successful IGC amongst resident physicians may help foster better educational interventions (ultimately leading to improvements in IGC and patient care), we sought to construct and preliminarily evaluate such a survey tool. METHODS We developed the IGC questionnaire (IGCQ) by using previously published but unvalidated survey tools related to physician perspectives on inpatient glycemic control as a framework. We administered the IGCQ to a cohort of resident physicians from the University of Mississippi Medical Center, University of Louisville, Emory University, and the University of Virginia. We then used classical test theory and Rasch Partial Credit Model analyses to preliminarily evaluate and revise the IGCQ. The final survey tool contains 16 total items and three answer-choice categories for most items. RESULTS Two hundred forty-six of 438 (56.2%) eligible resident physicians completed the IGCQ during various phases of development. CONCLUSIONS We constructed and preliminarily evaluated the IGCQ, a survey tool that may be useful for future research into resident physician perceptions and knowledge of IGC. Future studies could seek to externally validate the IGCQ and then utilize the survey tool in pre- and post-intervention assessments.
Collapse
Affiliation(s)
- William B. Horton
- Divsion of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA USA
| | - Sidney Law
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Monika Darji
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Mark R. Conaway
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA USA
| | - Nancy T. Kubiak
- Division of General Internal Medicine, Palliative Medicine, and Medical Education, Department of Medicine, University of Louisville, Louisville, KY USA
| | - Jennifer L. Kirby
- Divsion of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA USA
| | - S. Calvin Thigpen
- Division of General Internal Medicine and Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, MS USA
| |
Collapse
|
5
|
Torres HDC, Pace AE, Chaves FF, Velasquez-Melendez G, Reis IA. Evaluation of the effects of a diabetes educational program: a randomized clinical trial. Rev Saude Publica 2018; 52:8. [PMID: 29412378 PMCID: PMC5802646 DOI: 10.11606/s1518-8787.2018052007132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS The educational program model developed was effective to improve the glycemic control of the intervention group participants.
Collapse
Affiliation(s)
- Heloísa de Carvalho Torres
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Aplicada. Belo Horizonte, MG, Brasil
| | - Ana Emília Pace
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Departamento de Enfermagem Geral e Especializada. Ribeirão Preto, SP, Brasil
| | - Fernanda Figueredo Chaves
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Programa de Pós-Graduação em Enfermagem. Belo Horizonte, MG, Brasil
| | - Gustavo Velasquez-Melendez
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| |
Collapse
|
6
|
Rushakoff RJ, Rushakoff JA, Kornberg Z, MacMaster HW, Shah AD. Remote Monitoring and Consultation of Inpatient Populations with Diabetes. Curr Diab Rep 2017; 17:70. [PMID: 28726156 DOI: 10.1007/s11892-017-0896-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Inpatient hyperglycemia is common and is linked to increased morbidity and mortality. We review current and innovative ways diabetes specialists consult in the management of inpatient diabetes. RECENT FINDINGS With electronic medical records (EMRs), remote monitoring and intervention may improve the management of inpatient hyperglycemia. Automated reports allow monitoring of glucose levels and allow diabetes teams to intervene through formal or remote consultation. Following a 2-year transition of our complex paper-based insulin order sets to be EMR based, we leveraged this change by developing new daily glycemic reports and a virtual glucose management service (vGMS). Based on a daily report identifying patients with two or more glucoses over 225 mg/dl and/or a glucose <70 mg/dl in the past 24 h, a vGMS note with management recommendations was placed in the chart. Following the introduction of the vGMS, the proportion of hyperglycemic patients decreased 39% from a baseline of 6.5 per 100 patient-days to 4.0 per 100 patient-days The hypoglycemia proportion decreased by 36%. Ninety-nine percent of surveyed medical and surgical residents said the vGMS was both important and helpful.
Collapse
Affiliation(s)
- Robert J Rushakoff
- Division of Endocrinology and Metabolism, University of California, San Francisco, 2200 Post St., Suite C-430, San Francisco, CA, 94115, USA.
| | - Joshua A Rushakoff
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary Kornberg
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Arti D Shah
- Division of Endocrinology and Metabolism, University of California, San Francisco, San Francisco, CA, USA
- Division of Endocrinology and Metabolism, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
7
|
Challenges of Inpatient Glycemic Control. J Nurs Care Qual 2017; 32:267-271. [PMID: 28323688 DOI: 10.1097/ncq.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hyperglycemia occurs in more than 30% of hospitalized patients. The condition has been associated with higher mortality and poor outcomes. Systems to effectively treat dysglycemia have been put into place, although many focus on critical care areas. The purpose of this article is to provide an overview of the challenges for glycemic control in non-critical care areas. Standardized order sets, critical pathways, professional education, and collaborative systems can support improved control.
Collapse
|