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Zhu Y, Zhang H, Xi Y, Zhu H, Lu Y, Luo X, Tang Z, Lei H. The Implication of Diabetes-Specialized Nurses in Aiming for the Better Treatment and Management of Patients with Diabetes Mellitus: A Brief Narrative Review. Diabetes Ther 2024; 15:917-927. [PMID: 38472627 PMCID: PMC11043239 DOI: 10.1007/s13300-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Diabetes mellitus (DM) is regarded as one of the most critical public health challenges of the 21st century. It has evolved into a burgeoning epidemic since the last century, and today ranks among the major causes of mortality worldwide. Diabetes specialist nurses (DSNs) are central to good patient care and outcomes including confident self-care management. Evidence shows that DSNs are cost-effective, improve clinical outcomes, and reduce length of stay in hospital. In this brief narrative review, we aim to describe the roles of DSNs and their contribution in the treatment and management of patients with DM. This narrative review describes the importance of DSNs in healthcare practice, in the inpatient and outpatient departments, in the pediatrics department, in managing diabetic foot ulcers, in the treatment and management of gestational diabetes, in prescribing medications for DM and in diabetes self-management education on glycosylated hemoglobin, and cardiovascular risk factors. To conclude, DSNs have a crucial role in the treatment and management of patients with DM and its complications. DSNs have a great impact on diabetes therapy, and hence implementation of DSNs and nurse-led diabetic clinics might be beneficial for the health care system. Finally, having DSNs might significantly contribute to good healthcare practice and support. Even though DSNs are not available in several regions around the globe, and even though this post is still new to several health care institutions, the presence of DSNs recognized and certified by the various healthcare systems would be very useful.
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Affiliation(s)
- Yefang Zhu
- Department of Rehabilitation Medicine, Huzhou Shushan Geriatric Hospital First Ward, Huzhou, 313000, Zhejiang, People's Republic of China
| | - Hongmei Zhang
- Department of Endocrinology, Ezhou Central Hospital, Hubei, 436000, Ezhou, People's Republic of China
| | - Ying Xi
- The Outpatient Department, The First People's Hospital of Longquanyi District, Chengdu, West China Longquan Hospital, Sichuan University, Sichuan, 610100, People's Republic of China
| | - Hongli Zhu
- Department of Health Management, The First People's Hospital of Longquanyi District, Chengdu, West China Longquan Hospital, Sichuan University, Sichuan, 610100, People's Republic of China
| | - Yan Lu
- The Outpatient Department, The First People's Hospital of Longquanyi District, Chengdu, West China Longquan Hospital, Sichuan University, Sichuan, 610100, People's Republic of China
| | - Xue Luo
- Department of Neurosurgery, The First People's Hospital of Longquanyi District, Chengdu, West China Longquan Hospital, Sichuan University, Sichuan, 610100, People's Republic of China
| | - Zhangui Tang
- Department of Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hong Lei
- Department of Health Management, The First People's Hospital of Longquanyi District, Chengdu, West China Longquan Hospital, Sichuan University, Sichuan, 610100, People's Republic of China.
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Gregory JW, Townson J, Channon S, Cohen D, Longo M, Davies J, Harman N, Hood K, Pickles T, Playle R, Randell T, Robling M, Touray M, Trevelyan N, Warner J, Lowes L. Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial. BMJ Open 2019; 9:e032317. [PMID: 31796486 PMCID: PMC6924753 DOI: 10.1136/bmjopen-2019-032317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis. DESIGN A multicentre randomised controlled trial (January 2008/October 2013). SETTING Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. INTERVENTION Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care. MAIN OUTCOME MEASURES Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources. RESULTS 203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms. CONCLUSIONS There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes. TRIAL REGISTRATION NUMBER ISRCTN78114042.
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Affiliation(s)
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, Cardiff University, School of Medicine, Cardiff, UK
| | - Justin Davies
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Harman
- University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tabitha Randell
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Morro Touray
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Nicola Trevelyan
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Justin Warner
- Department of Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Vissarion B, Malliarou M, Theofilou P, Zyga S. Improvement of Diabetic Patients Nursing Care by the Development of Educational Programs. Health Psychol Res 2014; 2:931. [PMID: 26973922 PMCID: PMC4768559 DOI: 10.4081/hpr.2014.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 11/23/2022] Open
Abstract
Diabetes is a major health problem with many social and economic consequences in general population. The importance of education in the diabetic patient and his family, led to the development of diabetes clinical nurse specialist. The role of diabetes clinical nurse specialist is essential and crucial to the hospitals and the community, in order to form a relationship with the diabetic patient and his/her family. In this way health is promoted to the maximum extent possible. In conclusion educational programs help patients with diabetes to obtain information about their condition and improve their self-care skills.
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Affiliation(s)
| | - Maria Malliarou
- Nursing Department, 404 General Military Hospital, Technological Institution of Larisa , Thessaly, Greece
| | - Paraskevi Theofilou
- Department of Kinesiology, Centre for Research and Technology, Health and Quality of Life Research Group , Trikala, Thessaly, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese , Sparta, Lakonia, Greece
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4
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O'Hagan M, Harvey JN. Glycemic control in children with type 1 diabetes in wales: influence of the pediatric diabetes specialist nurse. Diabetes Care 2010; 33:1724-6. [PMID: 20435792 PMCID: PMC2909049 DOI: 10.2337/dc09-2304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether glycemic control is improving in diabetic children in Wales and to identify factors associated with improvement. RESEARCH DESIGN AND METHODS Data were collected in 2001 and 2006. RESULTS Over time A1C was reduced from 9.08 +/- 1.66 to 8.88 +/- 1.63% (P = 0.012). There were differences among centers (P < 0.001) and differential changes over time (interaction P < 0.001). Since 2001 five centers had appointed a pediatric diabetes specialist nurse (PDSN). A1C improved in these centers from 9.59 +/- 1.88 to 8.72 +/- 1.61% (P < 0.001). Glycemic control was worse in children aged >10 years compared with younger patients (P < 0.001). Improvement occurred in those aged >10 years. Age (P = 0.003) and insulin dose (P < 0.001) were positively and independently associated with A1C. Thus, any influence of PDSNs was not achieved through increased insulin prescription. CONCLUSIONS Improvement in glycemic control has occurred. Worse control is associated with greater prescribed insulin dose in older children. Appointment of PDSNs was associated with improved glycemic control among adolescents.
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Affiliation(s)
- Malachy O'Hagan
- Department of Pediatrics, Bro Morgannwg NHS Trust, Swansea, U.K
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5
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Weitzel D, Pfeffer U, Dost A, Herbst A, Knerr I, Holl R, Herbstc A, Knerr I, Holl R. Initial insulin therapy in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2010; 11:159-65. [PMID: 19708907 DOI: 10.1111/j.1399-5448.2009.00562.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study was to define parameters that influence the initial insulin dosage in young subjects with type 1 diabetes regarding the amount of daily insulin, the ratios of basal and prandial insulin, and the insulin/carbohydrate ratios. STUDY DESIGN We used a computer-based registry (with prospectively collected data) in Germany and Austria, a software for the management and data documentation of diabetic patients (DPV), to analyze the initial insulin therapy in 2247 children with newly diagnosed type 1 diabetes to identify factors that influence diabetes therapy within the first 10 d. RESULTS For both genders, glucosylated hemoglobin A1c (HbA1c), blood pH at diabetes onset, and pubertal status are the major factors determining the initial insulin dosage calculated as the amount of daily insulin per kilogram body weight (kg), the basal and prandial insulin dose per kilogram, and day and the insulin/carbohydrate ratios for meals. The frequency of hypoglycemia correlated with increasing quotient of applied to calculated insulin dosage. CONCLUSION The predictive factors of insulin requirement may exert beneficial effects on the assessment and adjustment of insulin therapy in young diabetic subjects at disease onset. On the basis of a multiple, linear regression, we suggest a formula to calculate the initial insulin therapy.
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Affiliation(s)
- Dieter Weitzel
- German Clinic for Diagnostic, Children's and Adolescent's Outpatient Centre, Wiesbaden, Germany
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6
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Lowes L, Davis R. A UK wide survey of insulin initiation in children with type 1 diabetes and nurses’ perceptions of associated decision-making. J Clin Nurs 2009; 18:1287-94. [DOI: 10.1111/j.1365-2702.2008.02705.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Davis RE, Lowes L, Cradock S, Dromgoole P, Mcdowell J. Insulin initiation among adults and children with diabetes in the United Kingdom. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdi.937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Type 1 diabetes is one of the most common chronic childhood disorders, occurring with increasing frequency. Diabetes management involves the child and family learning how to inject insulin and monitor blood glucose, and adhere to a diet containing healthy food choices. Medical interventions necessary to stabilise newly diagnosed diabetes depend upon the clinical condition of the child at presentation. Hospital admission is necessary if intravenous therapy is required to correct dehydration, electrolyte imbalance, and ketoacidosis, with progression to oral fluids and subcutaneous insulin administration as the child's condition improves. If the child is mildly to moderately symptomatic and clinically well, subcutaneous insulin and oral diet and fluids may be begun from the time of diagnosis, and stabilisation at diagnosis does not necessarily require hospital admission. This article reviews the evidence concerning hospital or home based treatment at diagnosis for children with type 1 diabetes. The Cardiff approach to home management is briefly described, and the benefits and disadvantages of different approaches to initial management are discussed.
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Affiliation(s)
- L Lowes
- Nursing, Health and Social Care Research Centre, Wales, College of Medicine, Cardiff University, Cardiff, Wales, UK.
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9
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Lowes L, Lyne P, Gregory JW. Childhood diabetes: parents' experience of home management and the first year following diagnosis. Diabet Med 2004; 21:531-8. [PMID: 15154935 DOI: 10.1111/j.1464-5491.2004.01193.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To explore parents' experience of having a child diagnosed with Type 1 diabetes, managed at home, and their first year following diagnosis. METHODS A qualitative, longitudinal study based on 40 in-depth interviews with parents of 20 children with newly diagnosed Type 1 diabetes managed at home from diagnosis in South Wales. RESULTS Many parents were alarmed by the speed of diagnosis following the gradual progress of their child's symptoms. The provision of timely, adequate information was important to all parents. Although five parents had initial concerns about going home, all parents were subsequently pleased their children had not been hospitalized. Home management enabled parents to integrate diabetes management into the family's normal lifestyle from diagnosis. Professional support, particularly accessible telephone advice, was valued by and reassured parents. Parents experienced a loss of spontaneity, a continuing fear of hypoglycaemia and did not want their child to feel different to other children. Acutely aware of the seriousness of diabetes, they did their utmost to achieve optimal glycaemic control but felt that diabetes could not 'dominate' if they were to lead a 'normal' life. CONCLUSIONS The experience of parents in this study suggests that parents of children with newly diagnosed diabetes are able to cope successfully when given the opportunity to start treatment at home. Therefore, if children with diabetes are clinically well at diagnosis, this study supports home management as a system of care from the parents' point of view. These findings are relevant to clinicians, policy makers and health service managers involved in planning and providing paediatric diabetes care.
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Affiliation(s)
- L Lowes
- Nursing, Health and Social Care Research Centre, University of Wales College of Medicine, Cardiff, UK.
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10
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Gage H, Hampson S, Skinner TC, Hart J, Storey L, Foxcroft D, Kimber A, Cradock S, McEvilly EA. Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness. PATIENT EDUCATION AND COUNSELING 2004; 53:333-346. [PMID: 15186872 DOI: 10.1016/j.pec.2003.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2002] [Revised: 04/20/2003] [Accepted: 06/09/2003] [Indexed: 05/24/2023]
Abstract
Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure.
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Affiliation(s)
- Heather Gage
- Department of Economics, University of Surrey, Guildford GU2 7XH, UK.
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11
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Balkrishnan R, Manuel J, Clarke J, Carroll CL, Housman TS, Fleischer AB. Effects of an episode of specialist care on the impact of childhood atopic dermatitis on the child's family. J Pediatr Health Care 2003; 17:184-9. [PMID: 12847428 DOI: 10.1067/mph.2003.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although some preliminary work has examined the impact of atopic dermatitis (AD) on families, no empirical work has examined changes in the impact on families dealing with AD over time. An exploratory analysis of change in impact on families dealing with AD before and after an episode of medical care in a physician office setting was conducted. METHOD Baseline and follow-up surveys were completed by 35 parent caregivers before and 1 month after a dermatologist visit for the child at an academic medical center. RESULTS In the postcare survey, there was a 43% reduction in the Dermatitis Family Impact Questionnaire (DFI) scores (P <.01) compared with baseline. Significant differences were also observed in other parent caregiver-reported characteristics. The significant change in parent caregiver characteristic associated with the decreased DFI score was the increased satisfaction with the medical care related to the child's treatment (P <.01). DISCUSSION These data reveal that there is a strong decrease in impact on a family associated with an episode of specialist care for children with AD. The importance of pediatric health care professionals in decreasing the impact of AD on families needs further exploration.
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Affiliation(s)
- Rajesh Balkrishnan
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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12
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Barton DM, Baskar V, Kamalakannan D, Buch HN, Gone K, Wilson E, Anderson J, Abdu TAM. An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital. Diabet Med 2003; 20:394-8. [PMID: 12752489 DOI: 10.1046/j.1464-5491.2003.00947.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To assess the process of clinical care and outcomes of young patients with diabetes attending clinics at a large district general hospital. METHODS Retrospective analysis of data obtained from 106 case notes of patients aged 12-22 years attending the paediatric, combined adolescent or adult diabetes clinics between 1998 and 2000. The frequency of follow-up, rate of admission, glycaemic control, systolic blood pressure, weight change and screening for complications were assessed. RESULTS The mean attendance rate was 78%. The admission rate was 91 admissions per 1000 patient years. Overall, the mean HbA1c was 9.1% with only 15% of paediatric and adolescent patients having mean HbA1c<or= 8.0%. Mean systolic blood pressure was 124 mmHg. There was a significant increase in obesity with mean weight for height at diagnosis increasing from 89% to 111% after 7 years of diabetes. Mean daily insulin dose was 1.51 U per kg body weight and decreased with increasing age. Screening for complications and associated conditions was variable: 91% for retinopathy, 86% for foot problems, 64% for thyroid dysfunction, 22% for coeliac disease and 10% for microalbuminuria. The overall rate of retinopathy was low at 4% of those screened. CONCLUSIONS Providing satisfactory care for young people with diabetes remains a difficult challenge. Although the complication rate observed was low in this group, the most important issues are the need for improvement in glycaemic control, weight gain and high drop-out rate.
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Affiliation(s)
- D M Barton
- Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
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Kapellen TM, Heim K, Nietzschmann U, Galler A, Raile K, Kiess W. Changes in pediatric diabetes care throughout a 30-yr period at one institution for pediatric diabetology in Germany. Pediatr Diabetes 2002; 3:70-3. [PMID: 15016159 DOI: 10.1034/j.1399-5448.2002.30202.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The objective of the present study was to investigate putative changes in pediatric diabetes care at one institution between 1969 and 1998. METHODS A structured questionnaire was used to analyze all medical records from the Hospital for Children and Adolescents of the University of Leipzig, Germany, from 1969 to 1998, in order to review the number of cases of type 1 diabetes mellitus and the length of hospital stay of children with diabetes during the 30-yr period. RESULTS Between 1969 and 1998, 441 children and adolescents (211 boys and 230 girls) with newly diagnosed diabetes mellitus type 1 were treated at the Hospital for Children and Adolescents in Leipzig. The number of patients newly diagnosed increased from 55 between 1969 and 1973 to 105 between 1994 and 1998 (p < 0.0003). The initial therapy and diabetes education were carried out in an in-patient setting. The average duration of hospital stay was 36 d in the years 1969-73, and 17 d in the years 1994-98 (p < 0.0002). This reduction of time spent in hospital was achieved by establishing structured training courses and exact planning of treatment in relation to the degree of illness at presentation. CONCLUSION The number of patients with type 1 diabetes mellitus receiving care in this single institution between the years 1969 and 1998 has increased continuously. With the help of quality-assured structured training courses in a clinic for pediatric diabetes care, a dramatic reduction of the duration of hospital stay was achieved.
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Affiliation(s)
- Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Pediatric Endocrinology and Diabetology, Leipzig, Germany.
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Hjelm K, Nyberg P, Apelqvist J. Determinants of ambulatory care in a defined adult Swedish diabetic population. Diabetes Res Clin Pract 2002; 56:49-61. [PMID: 11879721 DOI: 10.1016/s0168-8227(01)00351-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIMS To investigate factors associated with health care utilisation in ambulatory diabetes care in relation to complications attributable to diabetes mellitus in an adult diabetic population. METHODS A cross-sectional study; standardised interview, physical examination, and an evaluation of medical records, comprising all known diabetic subjects living in six primary health care districts in southern Sweden (N = 1861, aged > 25 years; 90.1% participation). RESULTS People managed by specialists (17.2%) had more complications related to diabetes and were more often treated with insulin. Persons managed in health care centres with a diabetes nurse specialist used insulin more often, used self-monitoring of blood glucose (SMBG) more regularly, lived on their own, and used meals on wheels and Community Care Alarm Service more frequently than those managed in other health centres. Multiple logistic regression analysis showed high utilisation of office visits to physicians ( > 5 visits) to be mainly associated with the presence of a foot ulcer (OR (95% CI) 2.1 (1.4-3.3)), congestive heart failure (1.6 (1.1-2.3)), and cardio-cerebrovascular disease (1.4 (1.1-1.9)). High utilisation of visits to other care-givers ( > 4 visits) was related to current or previous foot ulcers (2.4 (1.5-3.7) and 2.1 (1.2-3.5)), meals on wheels (1.9 (1.2-3.0)), and treatment with insulin (1.6 (1.2-2.1)). CONCLUSIONS High utilisation of ambulatory diabetes care was mainly associated with health status and complications related to diabetes, particularly diabetic foot ulcers. Organisational factors such as managed care with access to a diabetes nurse specialist in a health care centre was related to increased use of self-monitoring of blood glucose and insulin treatment. Visits to other care-givers were associated with access to social welfare. In diabetes care, activities to promote health and prevent complications need to be stressed.
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Affiliation(s)
- Katarina Hjelm
- Department of Community Health Sciences Malmö, University of Lund, Sweden.
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15
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Llahana SV, Poulton BC, Coates VE. The paediatric diabetes specialist nurse and diabetes education in childhood. J Adv Nurs 2001; 33:296-306. [PMID: 11251716 DOI: 10.1046/j.1365-2648.2001.01665.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS OF THE STUDY The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process. DESIGN AND METHODS A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%). FINDINGS The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education. CONCLUSIONS The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.
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Affiliation(s)
- S V Llahana
- School of Health Sciences, University of Ulster, UK.
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Ferris TG, Dougherty D, Blumenthal D, Perrin JM. A report card on quality improvement for children's health care. Pediatrics 2001; 107:143-55. [PMID: 11134448 DOI: 10.1542/peds.107.1.143] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Improving the quality of health care is a national priority. Nonetheless, no systematic effort has assessed the status of quality improvement (QI) initiatives for children or reviewed past research in child health care QI. This assessment is necessary to establish priorities for QI programs and research. METHODS To assess the status of QI initiatives and research, we reviewed the literature and interviewed experts experienced in QI for child health services. We defined QI as activities intended to close the gap between desired processes and outcomes of care and what is actually delivered. We classified reports published between 1985 and 1997 by publication characteristics, study design, clinical problem addressed, site of intervention, the QI method(s) used, and explicit association with a continuous quality improvement program. RESULTS We reviewed 68 reports meeting our definition of QI. More than half (48) were published after 1994. The reviewed reports included controlled evaluations in 36% of all identified interventions, and 3% of the reports were associated with continuous quality improvement. QI methods demonstrating some effectiveness included reminder systems for office-based preventive services and inpatient pathways for complex care. Reportedly successful QI initiatives more commonly described improvement in administrative measures such as rate of hospitalization or length of stay rather than functional status or quality of life. Interviews found that barriers to QI for children were similar to those for adults, but were compounded by difficulties in measuring child health outcomes, limited resources among public organizations and small provider groups, and relative lack of competition for pediatric tertiary care providers. Research and dissemination of QI for children were seen as less well developed than for adults. CONCLUSIONS Attempts to improve the quality of child health services have been increasing, and the evidence we reviewed suggests that it is possible to improve the quality of care for children. Nonetheless, numerous gaps remain in the understanding of QI for children, and widespread improvement in the quality of health services for children faces significant barriers.
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Affiliation(s)
- T G Ferris
- Institute for Health Policy, Boston, Massachusetts, USA.
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Lowes L, Lyne P. Your child has diabetes: hospital or home at diagnosis? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2000; 9:542-8. [PMID: 11904888 DOI: 10.12968/bjon.2000.9.9.6288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Historically, children with diabetes have been hospitalized at diagnosis, but increasingly, newly diagnosed children are being cared for entirely at home. The management of this chronic condition usually involves the whole family, with children often taking responsibility for much of their own care. However, this article focuses specifically on the needs of parents, forming part of an extensive literature review informing a study exploring parents' experience of home management and coping over the first year with childhood diabetes. A search of the literature revealed a scarcity of evidence overall about hospitalization or home management from a parental perspective, and none in relation to childhood diabetes. This article provides a critical appraisal of the appropriateness of these two approaches to care for parents of children with newly diagnosed diabetes. First, a brief introduction to home management in childhood diabetes is followed by an examination of the small amount of research found about home management and hospitalization from the point of view of parents. Then, the possible benefits and disadvantages of both approaches are discussed and subsequently scrutinized in the context of childhood diabetes. Finally, preliminary conclusions are drawn and suggestions made for the direction of future research in this area.
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Affiliation(s)
- L Lowes
- Department of Child Health, University Hospital of Wales
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Smith E, Alexander V, Booker C, McCowan C, Ogston S, Mukhopadhyay S. Effect of hospital asthma nurse appointment on inpatient asthma care. Respir Med 2000; 94:82-6. [PMID: 10714484 DOI: 10.1053/rmed.1999.0676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While asthma nurses are funded by many health authorities within the U.K. National Health Service, for the improvement of clinical management in both inpatient and outpatient settings in secondary care, the effect of asthma nurse appointment on acute asthma care in hospitalized children has been inadequately studied. Here, we test the hypothesis that the employment of a full-time hospital asthma nurse improves quality of care for children admitted to hospital with acute asthma. Prospective in design, the study compares analyses of indicators of good clinical practice for hospitalized asthmatic children (2-16 yrs) before and after the appointment of a hospital asthma nurse. Both management [oxygen saturation check (35/106 vs. 111/126, P<0.05)] and discharge planning [self management plan/asthma education (17/106 vs. 49/126, P<0.05), follow-up arrangements with general practice (8/106 vs. 25/126, P<0.05)] improved. There was, however, no significant change in oral steroid administration, peak flow check, inhaler technique assessment, inhaled drug prophylaxis or arrangements for hospital follow-up at discharge. Employment of a hospital-based children's asthma nurse leads to significant improvement in aspects of routine in-patient asthma management. However, other important areas of in-patient asthma care did not improve following nurse-led interventions. A clearer evidence base may improve compliance with asthma management guidelines, and could make the role of hospital asthma nurse more effective.
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Affiliation(s)
- E Smith
- Department of Child Health, University of Dundee, Ninewells Hospital and Medical School, Scotland, UK
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