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To become an expert within a week: Children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education - A qualitative interview study. J Pediatr Nurs 2022; 67:e24-e30. [PMID: 36307293 DOI: 10.1016/j.pedn.2022.10.004] [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: 01/29/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education during hospitalisation. DESIGN AND METHODS A qualitative interpretive design was applied. Semi-structured interviews with 15 children and their parent(s) were conducted. Data were analysed via thematic analysis. RESULTS The analysis revealed three themes: To be diagnosed with diabetes turns one's world upside down; It is positive to meet friendly and helpful healthcare professionals; and Diabetes education is overwhelming but required. CONCLUSIONS To be hospitalised and receive a diabetes diagnosis is overwhelming. The family must learn, in a short time, the basic skills to manage the condition. While learning, the child may fluctuate between being active and passive. In this vulnerable situation, it is positive to meet helpful healthcare professionals. Children find the motivation to learn, as they want to self-manage and be independent. All necessary education is given, but often the families would like to be more actively involved in the teaching. Sometimes, the teaching is also very compressed. PRACTICE IMPLICATIONS It is important to be aware of the vulnerable situation of the family and to adjust education to the fluctuations of the child. Teaching should be simplified and broken down stepwise, using pictures, artefacts, etc., to support the learning. More involvement may make education even more engaging and interesting. It has to be considered whether the education can be compressed into too short a time, making it difficult to transfer to the everyday lives of the families.
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Neyra Marklund I, Rullander AC, Lindberg K, Ringnér A. Initial Education for Families with Children Diagnosed with Type 1 Diabetes: Consensus from Experts in a Delphi Study. Compr Child Adolesc Nurs 2022. [DOI: 10.1080/24694193.2022.2033351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Isabel Neyra Marklund
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Anna-Clara Rullander
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Karolina Lindberg
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Anders Ringnér
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
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Thompson D, Leach M, Smith C, Fereday J, May E. How nurses and other health professionals use learning principles in parent education practice: A scoping review of the literature. Heliyon 2020; 6:e03564. [PMID: 32211543 PMCID: PMC7082510 DOI: 10.1016/j.heliyon.2020.e03564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/21/2019] [Accepted: 01/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background Health Professionals (HPs) play an important role in supporting parents to care for their children, by facilitating parents' knowledge and skills development through parent education. This is achieved through teaching, whereby planned strategies, based on principles of how people learn, enable learning. Despite Learning Principles being the fundamental tenets of the learning process, how HPs perceive and use Learning Principles in their practice is neglected in the healthcare literature. Objective To identify, describe and map the existing literature on nurses' and HPs' perceptions and use of Learning Principles in parent education practice. Method A scoping review was performed using the Joanna Briggs Institute approach. A comprehensive search of 10 databases and the grey literature was undertaken between March and June 2017 to identify pertinent English-language publications. The search was limited to literature published between 1998 and 2017. Following a screening and inclusion criteria eligibility check, 89 articles were selected for inclusion. Results HPs' perceptions of Learning Principles were diverse, somewhat disorganised, divergent in meaning and implicit. This was until the Dimensions of Learning construct was applied to guide the analyses and mapping. This revealed that HPs, of whom 60.7% were nurses, used Learning Principles in parent education, but only referred to them in the context of Adult Learning. Enablers to HPs using Learning Principles included shared partnerships between parents and HPs, while barriers included parents' health beliefs, psychological issues and organisational assumptions about learning. Evaluation of parents' learning also represented implicit use of Learning Principles by HPs. Conclusion This scoping review is the first to examine HPs' perceptions and use of Learning Principles within parent education practice. The findings reveal a significant gap in this body of knowledge. The paucity of studies containing any explicit descriptions of Learning Principles strongly supports the need for further exploration and codification of Learning Principles, through qualitative methods, whereby a deeper understanding of what is happening in healthcare practice can be established.
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Affiliation(s)
- Deryn Thompson
- University of South Australia, North Terrace, Adelaide, 5000, Australia
| | | | | | - Jennifer Fereday
- Women's and Children's Health Network, University of South Australia, Australia
| | - Esther May
- University of South Australia, Dean Academic and Clinical Education, Health Sciences, Australia
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Nilsson G, Hansson K, Tiberg I, Hallström I. How dislocation and professional anxiety influence readiness for change during the implementation of hospital-based home care for children newly diagnosed with diabetes - an ethnographic analysis of the logic of workplace change. BMC Health Serv Res 2018; 18:61. [PMID: 29382386 PMCID: PMC5791731 DOI: 10.1186/s12913-018-2861-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background In 2013–14, the evidence based care model Hospital-based Home Care for children newly diagnosed with diabetes was implemented at a large paediatric diabetes care facility in the south of Sweden. The first step of the implementation was to promote readiness for change among the professionals within the diabetes team through regular meetings. The aim was to analyse the implicit facilitators and barriers evident on a cultural micro level in discussions during the course of these meetings. What conceptions, ideals and identities might complicate, or facilitate, implementation? Methods A case study was conducted during the implementation process. This article draw on ethnographic observations carried out at team meetings (n = 6) during the introductory element of implementation. From a discourse theoretical perspective, the verbal negotiations during these meetings were analysed. Results Three aspects were significant in order to understand the dislocation during this element of implementation: an epistemological disagreement that challenged the function of information within care practice; a paradoxical understanding of the time-knowledge intersection; and expressions of professional anxiety. More concretely, the professionals exhibited an unwillingness to give up the opportunity to provide structured, age-independent information; a resistance against allowing early discharge; and a professional identity formed both by altruistic concern and occupational guardiancy. The findings suggest the necessity of increased awareness of the conceptions and ideals that constitute the basis of a certain professional practice; a deeper understanding of the cultural meaning that influences care practice within a specific logic in order to predict in what way these ideals might be challenged by the implemented evidence. Conclusions Our main contribution is the argument that the implemented evidence in itself needs to be examined and problematized from a cultural analytical perspective before initiation in order to be able to actively counter negative connotations and resistance.
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Affiliation(s)
- Gabriella Nilsson
- Department of Arts and Cultural Sciences, Division of Ethnology, Lund University, Box 192, 221 00, Lund, Sweden.
| | - Kristofer Hansson
- Department of Arts and Cultural Sciences, Division of Ethnology, Lund University, Box 192, 221 00, Lund, Sweden
| | - Irén Tiberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Stefanowicz A, Mysliwiec M, Adamkiewicz-Drozynska E. Parental knowledge and metabolic control of children and young adults with type 1 diabetes. Arch Med Sci 2018; 14:52-59. [PMID: 29379532 PMCID: PMC5778408 DOI: 10.5114/aoms.2015.53832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The authors aimed to answer the following questions: 1) What level of knowledge of type 1 diabetes do the parents of children and young adults with this disease have? 2) Will this level of knowledge increase after 1 year of observation? 3) Does improving the knowledge of young adults and their parents result in better metabolic control of the patients? MATERIAL AND METHODS This study included 227 patients between the ages of 5 and 20 years with type 1 diabetes. The research was conducted from March 2009 to June 2011. The following two time points were examined: the beginning of the study (test 1a) and one year later (test 1b). The knowledge levels of the patients and parents were obtained using a survey and a knowledge test. RESULTS Comparison of the results from the two study time points showed that the respondents had a significantly higher level of knowledge after 1 year (p = 0.001). The comparison of glycated hemoglobin levels between the two time points in patients with type 1 diabetes revealed that the levels were significantly higher at test 1b compared to test 1a (p = 0.0005). CONCLUSIONS The parents of children and young adults with type 1 diabetes demonstrate a satisfactory level of theoretical knowledge of therapeutic conduct and self-monitoring principles. The test 1b results demonstrated a higher level of theoretical knowledge in all respondents and poorer metabolic control. Poorer metabolic control in some patients suggests that metabolic control in type 1 diabetes depends on factors other than education. Further research is necessary to determine these additional factors.
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Affiliation(s)
- Anna Stefanowicz
- Advanced Registered Nurse Practitioner, Department of General Nursing, Chair of Nursing, Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
- Chair and Clinics of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Malgorzata Mysliwiec
- Chair and Clinics of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
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Biru M, Lundqvist P, Molla M, Jerene D, Hallström I. Surviving Overwhelming Challenges: Family Caregivers' Lived Experience of Caring for a Child Diagnosed with HIV and Enrolled in Antiretroviral Treatment in Ethiopia. ACTA ACUST UNITED AC 2015; 38:282-99. [PMID: 26375615 DOI: 10.3109/01460862.2015.1079278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Family caregivers play a critical role in caring for children living with HIV, however, there is little knowledge about their experiences. The aim of this study was to illuminate the family caregivers' lived experiences of caring for a child when he or she has been diagnosed with HIV and enrolled to antiretroviral treatment. Qualitative interviews with 21 family caregivers of 21 children diagnosed with HIV were analyzed using an inductive design with a hermeneutic phenomenological approach. The caregivers' experience were articulated in 5 subthemes under the main theme of "Surviving overwhelming challenges": "Committed care-giving," "Breaking the family life," "Caring burdens," "Confronting conflicts," and "Living with worry." Despite the difficult situation the family caregivers experienced with extensive worry, caring burdens, and disrupted family and social networks, they were committed caregivers. They were empowered by their belief in God but also by their strong belief in the child's treatment and support from healthcare workers. The healthcare system needs to consider possible ways to support the family caregivers during child's HIV diagnosis and treatment initiation as part of a continuum of care.
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Affiliation(s)
- Mulatu Biru
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - Pia Lundqvist
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - Mitikie Molla
- b School of Public Health, Addis Ababa University , Ethiopia , and
| | - Degu Jerene
- c HEAL TB project, Management Sciences for Health , Ethiopia
| | - Inger Hallström
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
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Pennafort VPDS, Silva ANS, Queiroz MVO. The perception of nurses regarding educational practices for children with diabetes in hospital care. Rev Gaucha Enferm 2014; 35:130-6. [DOI: 10.1590/1983-1447.2014.03.43313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to describe the perception of nurses regarding educational practices conducted with children with diabetes in a hospital unit. It is a descriptive qualitative study, conducted in an inpatient unit of a public hospital in Fortaleza, state of Ceará, Brazil, between January and February of 2013, with six nurses. Data were collected by means of semi-structured interviews and submitted to content analysis, from which two categories emerged: role of nurses and staff in caring for the child with diabetes: the necessary intersection; and health education directed at the child with diabetes and family members in the hospital context. Nursing professionals acknowledged educational activities as part of an interdisciplinary care strategy which must occur since the moment the child is admitted. However, they displayed a reductionist view, centered on insulin therapy and changes of habit, which indicates the need for more creative approaches, capable of enhancing learning aspects and minimizing the gaps which prevent the disease from being managed appropriately.
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Jönsson L, Lundqvist P, Tiberg I, Hallström I. Type 1 diabetes - impact on children and parents at diagnosis and 1 year subsequent to the child's diagnosis. Scand J Caring Sci 2014; 29:126-35. [DOI: 10.1111/scs.12140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lisbeth Jönsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Pia Lundqvist
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Irén Tiberg
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Inger Hallström
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
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Wigert H, Wikström E. Organizing person-centred care in paediatric diabetes: multidisciplinary teams, long-term relationships and adequate documentation. BMC Res Notes 2014; 7:72. [PMID: 24490659 PMCID: PMC3913792 DOI: 10.1186/1756-0500-7-72] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/31/2014] [Indexed: 12/30/2022] Open
Abstract
Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12–18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes. Methods Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team’s experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care. Results Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation. Conclusion Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented.
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Affiliation(s)
- Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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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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Jönsson L, Hallström I, Lundqvist A. "The logic of care" - parents' perceptions of the educational process when a child is newly diagnosed with type 1 diabetes. BMC Pediatr 2012; 12:165. [PMID: 23083125 PMCID: PMC3489565 DOI: 10.1186/1471-2431-12-165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 10/17/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The number of new cases of type 1 diabetes mellitus (T1DM) has increased substantially in recent years and it is now one of the most common long-term endocrine disorders in childhood. In Sweden the child and family are hospitalised in accordance with the national guidelines for one to two weeks at diagnosis. The purpose of this study was to describe parents' perceptions of the educational process when their child is newly diagnosed with T1DM. METHODS Qualitative interviews were performed in the south western part of Sweden with ten mothers and eight fathers of children, diagnosed with T1DM, at three to six months after they had received the diagnosis. The interviews were analysed using deductive content analysis and Mol's philosophical theory. RESULTS The results show that almost all parents had experienced the educational process as being satisfactory. However, most parents felt that the teaching needed to be adapted to the individual families and to help them to learn to live with diabetes in their everyday lives. Rather than merely teaching according to a fixed schedule and cramming knowledge, the education should be parent-centered and provide time for grief and shock. There should also be a greater emphasis on why certain things should be done rather than on what should be done. The routines learned at the hospital made the efforts to be good parents managing the child's disease, and continuing to lead a normal family life, a difficult task. CONCLUSIONS In order to optimize the educational process for families with children newly diagnosed with T1DM an increased focus on the families' perceptions might be helpful in that this could lead to further revelations of the educational process thus making it more understandable for the family members involved.
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Affiliation(s)
- Lisbeth Jönsson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anita Lundqvist
- Department of Health Sciences, Lund University, Lund, Sweden
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In-hospital survival skills training for type 1 diabetes: perceptions of children and parents. MCN Am J Matern Child Nurs 2012; 37:88-94. [PMID: 22357069 DOI: 10.1097/nmc.0b013e318244febc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE When a child is diagnosed with type 1 diabetes, parents and/or children must gain significant knowledge and learn specific skills to maintain health. Children in the United States who experience diabetic ketoacidosis (DKA) at the time of diagnosis typically spend 3 days in the hospital learning these life-saving skills. The purpose of this study was to gain knowledge concerning children's and parents' perceptions of this hospitalization period and of the initial education and support received from nurses. STUDY DESIGN AND METHODS The study used qualitative descriptive methods. A child interview guide and written parent survey were used to elicit children's and parents' perceptions. Two outside experts reviewed these tools. Twenty children aged 8 to 15 years along with 25 parents participated. Reductionistic and constructionistic steps were used to analyze the qualitative data. RESULTS During this hospitalization, children were most disturbed by the invasiveness of the required interventions while parents reported significant emotional distress related to the diagnosis. Children and parents alike felt the Survival Skills Training they received was effective. Education involving demonstration and return demonstration, supervision of skill performance, positive feedback from nurses about skill performance, and reassurance for long-term quality of life were nurse behaviors found to be helpful. CLINICAL IMPLICATIONS Implications for care include age-appropriate information in a variety of formats, minimizing the invasive nature of the treatment, providing opportunities for demonstration/return demonstration of skills, providing positive support and reassurance, and delivering concentrated instruction related to carbohydrate counting.
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