Evaluation of Swiss guidelines for the indication for hysterectomy in relation to patient outcome

Equipping School Health Personnel for Diabetes Care with a Competency Framework and Pilot Education Program

BACKGROUND

Schools struggle to support health needs of students with diabetes due to limited funding/resources. A competency framework can help individual schools clarify the knowledge and skills required for school-based diabetes care within their unique context, and inform the development of standardized diabetes education for health staff.

METHODS

A consensus-building technique, known as the Delphi method, was used to create a competency framework for diabetes care at school with a panel of 37 stakeholders. A continuing education program based on the resultant framework was developed and pilot-tested with school nurses. Pretest and post-test scores on knowledge, perceived competence, and self-efficacy were compared to evaluate the effectiveness of the program.

RESULTS

Consensus was obtained for a total of 70 competencies: 22 competencies for health aids, 36 additional competencies for school nurses, and 12 additional competencies for diabetes resource nurses. Thirty school nurses completed the continuing education program and demonstrated significant improvement in diabetes knowledge, self-efficacy, and competence in pathophysiology and diabetes care tasks (p < .01 for all).

CONCLUSIONS

Developing a consensus framework is an excellent starting place for stakeholders to identify the skills and knowledge required for various school personnel and to ensure that all school health staff members receive adequate diabetes education.

Evidence for overuse of medical services around the world

Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.