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Uludağ E, Kaşikçi M. Motivational Interviewing With Pender's Health Promotions Model: Diabetics Self-Management Behavior. Nurs Sci Q 2024; 37:255-265. [PMID: 38836477 DOI: 10.1177/08943184241247011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The purpose of the study was to determine the effects of motivational interviewing as based on Pender's health promotion model (HPM) on diabetes self-management behavior among individuals with Type 2 diabetes. Apart from their routine care, the individuals in the intervention group were given a 30-45-minute motivational interview based on Pender's HPM once a week for three months. Statistically significant differences were determined between the groups in the total score of the scales and its sub-dimensions (p < .05). The intervention applied in the present study can be used as an effective and easy method through which to develop and maintain diabetes self-management behaviors.
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Affiliation(s)
- Elanur Uludağ
- Assistant Professor, Department of Nursing, Erzurum Technical University Faculty of Health Sciences, Erzurum, Turkey
| | - Magfiret Kaşikçi
- Professor, Department of Nursing, Ataturk University Faculty of Nursing, Erzurum, Turkey
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2
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Theivasigamani K, Palaniappan S. An Overview of Pharmaceutical Care in Type II Diabetes Mellitus Patients: Current Position and Prospects. Curr Diabetes Rev 2024; 20:e050523216588. [PMID: 37151063 DOI: 10.2174/1573399819666230505123428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 05/09/2023]
Abstract
Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review.
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Affiliation(s)
- Kumutha Theivasigamani
- Research Scholar, Karpagam Academy of Higher Education, Coimbatore, India
- Nandha College of Pharmacy, Erode, India
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3
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Gomille-Hahn L, Grammes J, Lehnart J, Binz C, Koehn S, Kubiak T, Benecke A. Reduktion von diabetesbezogenem Distress bei Typ-1- und Typ-2-Diabetes durch eine kognitiv-verhaltenstherapeutische Gruppenintervention. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1928-9691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungDas Stresserleben durch die Erkrankung Diabetes mellitus stellt für einen Großteil der betroffenen Personen oft eine deutliche Belastung dar, die sich negativ auf das Diabetes-Selbstmanagement und damit auf die Gesundheit der Betroffenen auswirken kann. Das Ziel der vorliegenden Studie war die Evaluation einer diabetesspezifischen kognitiv-verhaltenstherapeutischen Gruppentherapie zur Reduktion des Stresserlebens, bestehend aus sechs Sitzungen für Personen mit Typ-1- oder Typ-2-Diabetes. Vermittelt wurden Techniken zur Stressbewältigung, wie Achtsamkeit und Entspannungsübungen, sowie kognitive Techniken, die auf den Alltag mit der Diabeteserkrankung und damit verbundene Gedanken und Emotionen der Teilnehmenden bezogen waren. Von 52 Personen (51,9% mit Typ-1-Diabetes, 61,5% weiblich, Alter MW= 50,4 Jahre) lagen nach Studienteilnahme Fragebögen vor. Eine signifikante Verbesserung konnte im Problem Areas In Diabetes Questionnaire (Δ6.24 [95%-KI: 1.85–10.62], p=.006), dem Perceived Stress Survey (Δ2.93 [95%-KI: 1.59–4.26], p=.000) und der Diabetes Acceptance Scale (Δ5.5 [95%-KI: 9.07–1.93], p=.003) erreicht werden. Diese erwies sich auch im Follow-Up nach sechs Monaten als stabil. Der selbstberichtete HbA1c-Wert reduzierte sich im Befragungszeitraum bei der Teilstichprobe von N= 40, von der die Daten verfügbar waren, ebenfalls signifikant (Δ0.73 [95%-KI: 0.015–1.452], p=.046). Das Gruppentherapieprogramm zur Stressreduktion kann als eine niedrigschwellige, psychotherapeutische Interventionen zur Reduktion diabetesbezogener Belastungen angesehen werden. Es könnte ein hilfreiches primär- und sekundärpräventives Angebot für stressbelastete Menschen mit Diabetes in der Standardversorgung darstellen.
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Affiliation(s)
- Lara Gomille-Hahn
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Jennifer Grammes
- Gesundheitspsychologie, Johannes Gutenberg-Universität, Mainz, Germany
- c/o IDT, Arbeitsgemeinschaft Diabetes und Technologie der Deutschen Diabetes Gesellschaft, Ulm, Germany
| | - Judith Lehnart
- Soziale Arbeit und Sozialwissenschaften, Katholische Hochschule Mainz, Mainz, Germany
| | - Christine Binz
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Sandra Koehn
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Thomas Kubiak
- Gesundheitspsychologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical Activity and Nutrition Interventions for Type 1 Diabetes: A Meta-analysis. Pediatrics 2022; 150:188758. [PMID: 35953465 DOI: 10.1542/peds.2022-056540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current evidence is lacking on physical activity and nutrition-based interventions focusing on the management of type 1 diabetes mellitus (T1DM) and health-related quality of life among children. To assess the effects of physical activity interventions and nutrition-based interventions for children with T1DM. METHODS Data sources include the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, CINAHL through January 2022. Study selection includes randomized controlled trials of children aged 18 years and below with T1DM comparing either a physical activity intervention, a nutrition-based intervention, or hybrid physical activity and nutrition-based intervention with placebo or no-treatment control. Data were pooled using a random-effects model. Primary outcomes were hemoglobin A1c (HbA1c), and health-related quality of life. RESULTS Eighteen trials were included. Physical activity compared with the no-treatment group showed a lack of effect on HbA1c (mean difference = -0.58, 95% confidence interval -1.20 to 0.05; P value = .07). Nutrition-based intervention compared with no-treatment control for HbA1c level revealed a lack of effect (mean difference = -0.61, 95% confidence interval -1.48 to 0.26; P value = .17). Limitations include paucity of studies and low quality of evidence caused by the risk of bias. CONCLUSIONS Despite the lack of significant evidence, the generally favorable results highlight the potential of such interventions in enhancing glycemic control and health-related quality of life. Additionally, promising results from a single physical activity-nutrition-based hybrid intervention in terms of glycemic control indicate the plausible effectiveness of a mixed intervention.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies.,National University Health System, Singapore
| | | | - Evelyn C Law
- Departments of Pediatrics.,National University Health System, Singapore.,Translational Neuroscience Program, Agency for Science, Technology, and Research, Singapore Institute for Clinical Sciences, Singapore
| | - John C M Wong
- Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Bloor LE, Jendrusina AA, Rexer K. Broad and Adaptive Integrated Health Psychology Services: Engaging BIPOC Veterans in VA Healthcare. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09906-4. [PMID: 35978152 PMCID: PMC9385418 DOI: 10.1007/s10880-022-09906-4] [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] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
Clinical health psychologists provide adaptive, evidenced-based interventions that incorporate behavioral medicine and behavioral health strategies, with the potential to integrate broadly across the medical system. Veterans Affairs (VA) healthcare strives to meet the needs of an increasingly diverse patient population with complex behavioral health needs. This conceptual paper describes an example of health psychology at one VA healthcare system, with a focus on adaptive and culturally responsive services reaching Black, Indigenous and People of Color/Veterans of Color (BIPOC). The clinical health psychology services and cases described aim to reach Veterans who may not participate in, or benefit as fully from, traditional disease self-management or mental health services. The authors offer recommendations, to secure the value and sustainability of these integrated health psychology services, and hopefully contribute to addressing healthcare inequities.
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Affiliation(s)
- Lindsey E Bloor
- Department of Psychiatry, VA Ann Arbor Healthcare System, Michigan Medicine, Ann Arbor, MI, 48105, USA.
| | - Alexander A Jendrusina
- Department of Psychiatry, VA Ann Arbor Healthcare System, Michigan Medicine, Ann Arbor, MI, 48105, USA
| | - Kyle Rexer
- Department of Psychiatry, VA Ann Arbor Healthcare System, Michigan Medicine, Ann Arbor, MI, 48105, USA
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Tang P, Lee M. Exploring the Necessity of Psychological Rounds and Psychological Interventions in General Hospitals in the Post-COVID-19 Period. Front Psychol 2022; 13:916776. [PMID: 35898988 PMCID: PMC9309204 DOI: 10.3389/fpsyg.2022.916776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the necessity of psychological rounds and psychological intervention in the post-COVID-19 period in a general hospital. Methods Based on the current pandemic influence on Chinese people's psychology, the medical experience, and environment were analyzed, and the feasibility of psychological evaluation and intervention were appraised with the psychological changes that might be brought by the medical behaviors, especially for surgical operations. Results Nowadays, the pandemic is under full control in China, although the pandemic is rampant abroad. In China, the "Normalized pandemic prevention" phase has begun. In the post-COVID-19 period, the prolonged pandemic has made numerous people pessimistic, angry, and other negative emotions. Several general hospitals are facing huge influences: under the influence of anxiety, such as "higher hospital-acquired infection rate," the patient attendance rate is reduced, and the hospital income is sharply reduced. Doctor-patient conflicts are more likely to occur during the medical procedures, affecting the medical experience, and reducing the rate of re-visit and referral. Conclusion After analyzing a series of "endogenous" and "exogenous" factors of medical procedures in a general hospital in the post-pandemic period, it suggests that anxiety and depression caused by uncertainties in the medical procedures may be more obvious. Also, it is necessary to pay attention to the psychological status of patients and carry out psychological rounds and psychological interventions in general hospitals. The service quality can be improved, the medical experience can be ameliorated, and it can help general hospitals to turn "crisis" into "opportunity," which also brings better development.
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Affiliation(s)
- PeiXi Tang
- Department of Sleeping Disorders and Neurosis, Brain Hospital of Hunan Province (The Second People’s Hospital of Hunan Province), College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - MaoSheng Lee
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
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7
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Zhu X, Lee M, Chew EAL, Goh LJ, Dong L, Bartlam B. "When nothing happens, nobody is afraid!" beliefs and perceptions around self-care and health-seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care. Int Wound J 2021; 18:850-861. [PMID: 33955156 PMCID: PMC8613372 DOI: 10.1111/iwj.13587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Self-management and self-care are the cornerstone of diabetes care and an essential part of successfully preventing or delaying diabetes complications. Yet, despite being armed with the required information and guidance for self-management, self-care and adherence to foot self-care recommendations and compliance to medication among patients with diabetic foot ulcer and diabetic lower extremity amputations remain low and suboptimal. This study reveals in-depth account of nine such patients' beliefs and perceptions around their illness, their self-care, and their health-seeking behaviours. Patients living with diabetic lower extremity amputation displayed profound lack of knowledge of self-care of diabetes and foot and passive health-related behaviours. The overarching sense that "when nothing happens, nobody is afraid," points to a lack of motivation in taking charge of one's own health, whether this is with reference to treatment or care adherence, following recommended self-care advice, or seeking timely treatment. The Health Beliefs Model provides the theoretical framework for probing into the factors for the participants' suboptimal self-care and passive health-seeking behaviours. Two themes emerged from data analysis: profound knowledge deficit and passive health-related behaviours. The beliefs and perceptions around self-care and health-seeking behaviours for patients with lower extremity amputation are interpreted as the "ignorant self" with passive health-seeking behaviours. Patients with diabetes and diabetic foot diseases may benefit from personalized education, motivational interviewing, and family support.
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Affiliation(s)
- Xiaoli Zhu
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Mary Lee
- Health Outcomes and Medical Education ResearchNational Healthcare GroupSingapore
| | - Evelyn AL Chew
- Clinical Research UnitNational Healthcare Group PolyclinicsSingapore
| | - Ling Jia Goh
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Lijuan Dong
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
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The effect of the motivational interview program on coping and adaptation of patients with type 2 diabetes: An action research study. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.930592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Rafie Z, Vakilian K, Zamanian M, Eghbali H. The Effect of Solution-Oriented Counseling on Coping Strategies in Mental Health Issues in Women with Gestational Diabetes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:983-991. [PMID: 33559816 DOI: 10.1007/s10488-021-01111-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the effectiveness of solution-oriented intervention in patients with gestational diabetes, stress and anxiety on using coping strategies. This study was a randomized clinical trial with a control group. The population consisted of 56 diabetic women under treatment with insulin, who obtained higher score in one of the psychological disorders using DASS-21 (Depression, anxiety, stress scale). The participants were randomly assigned in two interventional (n = 28) and control (n = 28) groups after signing the written informed consent forms. The solution-oriented interventional program was conducted in six 60-min sessions for 6 weeks. Immediately after the final session and 6-8 weeks after the first session of the intervention, both groups completed coping inventory for stressful situations. The analytical statistic of t-test, chi-square, and variance analysis with repeated measurements using SPSS were used to analyze the data. solution-oriented counseling increased the problem-solving coping strategy in the intervention group (P = 0.001); the scores obtained by the subjects in the interventional group after adjusting the score before the intervention increased 2.68 units immediately after the intervention, which was not statistically significant (p-value = 0.44). However, it increased 11.5 scores six weeks after the intervention, which was statistically significant (P = 0.00). But, emotional and avoidance coping strategies were not significantly different between the two groups. This technique can be easily trained to all clients, and since it is focused on finding various solutions for psychological problems by clients, it can be used to reduce stress and anxiety in other chronic diseases as well.IRCT code: The code of this clinical trial study is IRCT20200202046339N1.
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Affiliation(s)
- Zahra Rafie
- School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Katayon Vakilian
- Department of Midwifery, School of Medicine, Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Basij Square, Sardasht Region, Peyambare-Azam Bliding, Arak, Iran.
| | - Maryam Zamanian
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Hosein Eghbali
- Clinical Psychology, Semnan Azad University, Semnan, Iran
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10
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical activity interventions and nutrition-based interventions for children and adolescents with type 1 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd013858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Evelyn C Law
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
- Translational Neuroscience Programme; Agency for Science, Technology and Research Singapore Institute for Clinical Sciences; Singapore Singapore
| | - John CM Wong
- Department of Psychological Medicine; Yong Loo Lin School of Medicine, National University of Singapore; Singapore Singapore
| | - Kah Yin Loke
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Wilson Wai San Tam
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
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11
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Moulson H, Sanders S, Coppin S, Meyrick J. What psychosocial interventions work to reduce hospital admissions in people with diabetes and elevated HbA 1c : a systematic review of the evidence. Diabet Med 2020; 37:1280-1290. [PMID: 32443172 DOI: 10.1111/dme.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes is a chronic condition that can lead to devastating complications if not managed effectively. Individuals with elevated HbA1c are at higher risk of developing complications resulting in diabetes-related hospital admissions, an additional pressure and expense for healthcare systems. AIM To systematically review evidence of the effectiveness of psychosocial interventions among individuals with elevated HbA1c , as indicated by hospital admissions. METHODS Electronic databases (MEDLINE, PsychINFO, CINAHL, AMED, Embase and Scopus) were used to identify studies systematically. Studies were screened against eligibility criteria and included if they evaluated the effectiveness of a psychosocial intervention on diabetes-related hospital admissions in individuals with elevated HbA1c . Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, and a narrative synthesis was conducted. RESULTS Of 15 362 studies, five were included in the review. Psychosocial interventions were found to significantly reduce diabetes-related hospital admissions in four of these studies and interventions involving psychotherapy in particular were found to reduce admissions. The methodological quality of studies ranged from weak to moderate, due to lack of blinding, weak study design and issues with withdrawals and drop-outs. CONCLUSIONS Psychosocial interventions may reduce diabetes-related hospital admissions in individuals with elevated HbA1c ; however, due to variability in methodological rigour, the conclusion remains tentative. Further research targeting this group, particularly within the adult population, is recommended. (PROSPERO registration number: CRD42019133456).
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Affiliation(s)
- H Moulson
- Department of Psychology, University of West England, Bristol, UK
| | - S Sanders
- Department of Psychology, University of West England, Bristol, UK
| | - S Coppin
- Department of Psychology, University of West England, Bristol, UK
| | - J Meyrick
- Department of Psychology, University of West England, Bristol, UK
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Corbett C, Jolley J, Barson E, Wraight P, Perrin B, Fisher C. Cognition and Understanding of Neuropathy of Inpatients Admitted to a Specialized Tertiary Diabetic Foot Unit With Diabetes-Related Foot Ulcers. INT J LOW EXTR WOUND 2019; 18:294-300. [PMID: 31307246 DOI: 10.1177/1534734619862085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated cognitive functioning and understanding of peripheral neuropathy in a cohort of individuals with diabetes-related foot ulcers requiring hospitalization. The aim was to examine the association between cognition, understanding of peripheral neuropathy, and diabetic health variables. Thirty inpatients referred to the Diabetic Foot Unit Clinical Psychology service, at the Royal Melbourne hospital, were assessed using the Montreal Cognitive Assessment (MoCA) and the Patient Interpretation of Neuropathy (PIN) questionnaire. Relevant demographic and medical information was collected. In this predominantly middle-aged, male cohort, the average MoCA score (22.37, SD = 3.65) fell below the general population age-matched mean, and a quarter of the MoCA patient scores were consistent with those seen in early dementia samples (<20). There appeared to be several misperceptions regarding peripheral neuropathy, less accurate attributions of blame to self or practitioners, and more accurate attributions of control of ulcer management to practitioners. Correlation analysis indicated that individuals with stronger MoCA scores tended to provide more accurate answers on the Acute Foot Ulcer Onset PIN scale. Individuals with diabetes-related foot ulcers requiring hospitalization demonstrate reduced cognitive functioning and this may affect their understanding of peripheral neuropathy, particularly information regarding foot ulcer onset. Routine screening of cognitive functioning in this cohort may be useful so that health education and care management can be adjusted according to individual patients' cognitive capabilities.
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Affiliation(s)
- Claire Corbett
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jane Jolley
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Paul Wraight
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Byron Perrin
- La Trobe University, Bendigo, Victoria, Australia
| | - Caroline Fisher
- The Royal Melbourne Hospital, Parkville, Victoria, Australia.,The Melbourne Clinic, Richmond, Victoria, Australia
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Abstract
Dietary advice is fundamental to the management of diabetes. Although ideally such advice should be delivered by a state-registered dietitian, it is more usually delivered by other health professionals. The primary focus for those with type 1 diabetes is carbohydrate counting and insulin adjustment and for the majority of people with type 2 diabetes, weight management is key. Patient-centred care is emphasised for the delivery of dietary advice. It is widely recognised that knowledge alone is not sufficient to induce behaviour change and practical approaches to a variety of behavioural interventions are discussed.
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Affiliation(s)
- Pamela A Dyson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
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14
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Subrata SA, Phuphaibul R. A nursing metaparadigm perspective of diabetic foot ulcer care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S38-S50. [PMID: 30925236 DOI: 10.12968/bjon.2019.28.6.s38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.
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Affiliation(s)
- Sumarno Adi Subrata
- PhD Candidate, Doctor of Philosophy Program in Nursing, International and Collaborative with Foreign University Program, Mahidol University, Thailand; and Nursing Lecturer, Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
| | - Rutja Phuphaibul
- Professor of Nursing, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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15
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Prom MC. Facing Diabetes: A Guide for Psychiatric Providers. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Sina M, Graffy J, Simmons D. Associations between barriers to self-care and diabetes complications among patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 141:126-131. [PMID: 29689320 DOI: 10.1016/j.diabres.2018.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
AIMS To determine which barriers to care are associated with type 2 diabetes complications in an area in rural East England. METHODS 3649 individuals with type 2 diabetes from 62 general practices were contacted via postal invitation which included a 33 item Barriers-to-Diabetes-Care Survey. Barriers were grouped into five priori major categories: educational, physical, psychological, psychosocial, and systems. The associations of reported barriers, both individually and as a group, with self-reported complications were assessed using logistic regression. RESULTS 39.5% of participants had self-reported diabetes complications. Physical health barriers (OR = 3.3; 95%CI: 2.7, 4.0), systems barriers (OR = 1.6; 95%CI: 1.3, 2.0) and psychological barriers (OR = 1.3 (95%CI: 1.1, 1.5) were associated with diabetes complications. In subcategories, presence of comorbidities (OR = 4.8; 95%CI: 3.9, 5.9), financial difficulties (OR = 1.7; 95%CI: 1.3, 2.1), absence of services (OR = 2.0; 95%CI: 1.4, 3.0), feeling others should bear more financial responsibility for their care (OR = 1.6 (95%CI: 1.1, 2.1), no access to diabetes service (OR = 1.3; 95%CI: 1.1, 1.5), feeling worried about their diabetes (OR = 1.5; 95%CI: 1.2, 2.0) and lack of readiness to exercise (OR = 1.4; 95%CI: 1.2, 1.7) were associated with diabetes complications. CONCLUSIONS Barriers to self-care are significantly more common among those with, than those without, diabetes complications. Systematic identification and management of different barriers to self-care could help personalise care for those with diabetes related complications.
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Affiliation(s)
- Maryam Sina
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Jonathan Graffy
- Primary Care Unit, Dept of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, United Kingdom
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
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17
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Tsai CY, Li IC, Lai FC. Substantial effects of empowerment case management on physical health of type 2 diabetic patients. J Clin Nurs 2018; 27:1632-1640. [PMID: 29194837 DOI: 10.1111/jocn.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effects of empowerment case management on the physical health of patients with type 2 diabetes. BACKGROUND Diabetes is a global health issue. Case management is often used on diabetes management at various levels. Empowerment has been used for chronic situation management, but its effects have not been widely studied in diabetic populations. DESIGN Purposive sampling was used to recruit 125 participants with type 2 diabetes aged 18 years or older from a regional teaching hospital in Taiwan. METHODS Empowerment case management was applied for 42 participants, while the other 83 received normal case management. Survey items included demographics, preprandial (AC) and postprandial (PC) blood sugar levels, glycated haemoglobin (HbA1C), systolic and diastolic blood pressure, total cholesterol, and the presence or absence of acute and chronic complications. Descriptive statistics and a generalised estimating equation were used to analyse the model's effects on the two groups. RESULTS The PC blood sugar levels of patients receiving empowerment case management declined at 3 months (B = -34.26, p < .01), and this decrease was maintained at 6 months (B = -83.66, p < .001). As of 6 months after starting the intervention, patients receiving empowerment case management enjoyed better physical health. These patients' AC blood sugar levels (B = -50.16, p < .001), HbA1C (B = -0.98, p < .001), systolic blood pressure (B = -8.24, p < .001), diastolic blood pressure (B = -5.73, p < .01) and total cholesterol (B = -13.74, p < .05) all experienced a continuous drop and were controlled well, and no diabetes-related acute or chronic complications were observed either. Patients with type 2 diabetes who received empowerment case management managed their physical health better. Moreover, its greatest effect was that patients were able to form exercise groups and continue to maintain their health. CONCLUSIONS Empowerment case management was shown to have a substantial effect on the physical health and self-care of patients with diabetes, thus making it a suitable intervention tool for managing diabetes cases. RELEVANCE TO CLINICAL PRACTICE The study results showed that empowerment case management is suitable for managing diabetes cases. It has a substantial effect on the maintenance of physical health, occurrence of complications and effectiveness of self-care among patients with diabetes. For better care outcomes, empowerment case management should be integrated into the guidelines of diabetes management.
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Affiliation(s)
- Chin-Yun Tsai
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.,New Taipei City Hospital, New Taipei City, Taiwan
| | - I-Chuan Li
- Institute of Community Health Care, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Chih Lai
- College of Nursing, Taipei Medical University, Taipei, Taiwan
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18
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Wasag DR, Gregory JW, Dayan C, Harvey JN. Excess all-cause mortality before age 30 in childhood onset type 1 diabetes: data from the Brecon Group Cohort in Wales. Arch Dis Child 2018; 103:44-48. [PMID: 28860211 DOI: 10.1136/archdischild-2016-312581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term outcomes in young people with type 1 diabetes continue to be of interest, and may help evaluate the effects of changes to the clinical care of children that have occurred in recent decades. AIMS To identify mortality and its causes before age 30 years in patients developing type 1 diabetes before age 15 years. METHODS Since 1995, paediatricians in Wales have compiled a prospective register of incident cases of type 1 diabetes occurring before age 15 years in Wales (the Brecon Cohort). Their subsequent mortality rates were compared with mortality in the general populations of Wales and England using the patient-years exposure method. Causes of death were ascertained from death certificates and from clinicians. RESULTS The standardised mortality ratio for young people with type 1 diabetes in Wales was 2.91 with no clear evidence of improvement or worsening of mortality risk over time. Most deaths occurred between ages 15 and 30 years although at a slightly younger age than in the general population. There were more deaths with increasing age at diagnosis of diabetes. Ketoacidosis remains the most common cause of death before age 30 years. Hypoglycaemia was difficult to ascertain with certainty but also caused some deaths. In this age group, chronic complications of diabetes were not a cause of mortality. CONCLUSIONS Despite the developments in clinical care in recent years, the mortality risk for people developing type 1 diabetes in childhood remains high in young adult life before the onset of chronic complications.
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Affiliation(s)
- Diana R Wasag
- Diabetes Research Group, Wrexham Academic Unit, Bangor University, Wrexham, UK
| | - John W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Colin Dayan
- Department of Experimental and Molecular Medicine, Cardiff University, Cardiff, UK
| | - John N Harvey
- Diabetes Research Group, Wrexham Academic Unit, Bangor University, Wrexham, UK
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19
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Deeb A, Akle M, Al Ozairi A, Cameron F. Common Issues Seen in Paediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management. J Diabetes Res 2018; 2018:1684175. [PMID: 29682577 PMCID: PMC5848057 DOI: 10.1155/2018/1684175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/14/2017] [Accepted: 01/11/2018] [Indexed: 01/17/2023] Open
Abstract
Diabetes is a chronic disease and its management is associated with multiple challenges. This is particularly the case in children and adolescents. Factors that contribute to difficulties in managing diabetes in youth include psychological characteristics, family dynamics, and social behavior. The purpose of this article is to highlight some psychological issues in children and adolescents with diabetes. We aim to present selected case scenarios encountered by health professionals and to provide tips on strategies for managing psychological aspect of diabetes. We tackle the psychological issues related to diabetes under four main categories: maladaptive disorders, eating disorders, family psychopathology, and family dysfunction. Psychotherapy and psychoanalysis are useful modalities in diabetes management. The psychological intervention is aimed at supporting patients and families to reach a balance between a normal family routine and a good glycemic control. We demonstrate unique requirements in coordinating care for children and adolescents with diabetes and highlight the importance of encouraging a positive behavior. Managing diabetes in children and adolescents needs to be in the form of a collaborative work between health care professionals, children and adolescents, and their families. Caring, supportive family backed up by experienced multidisciplinary team is the best approach to prevent psychological difficulties.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Abdulla Al Ozairi
- Medical & Surgical Psychiatry, Kuwait University, Kuwait City, Kuwait
| | - Fergus Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia
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20
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Saha S, Riemenschneider H, Müller G, Levin-Zamir D, Van den Broucke S, Schwarz PEH. Comparative analysis of diabetes self-management education programs in the European Union Member States. Prim Care Diabetes 2017; 11:529-537. [PMID: 28663021 DOI: 10.1016/j.pcd.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups.
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Affiliation(s)
- Sarama Saha
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Henna Riemenschneider
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Diane Levin-Zamir
- Clalit Health Services, University of Haifa School of Public Health, Israel
| | | | - Peter E H Schwarz
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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21
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Gallardo-Rincón H, Saucedo-Martínez R, Mujica-Rosales R, Lee EM, Israel A, Torres-Beltran B, Quijano-González Ú, Atkinson ER, Kuri-Morales P, Tapia-Conyer R. Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model. Diabetes Metab Syndr Obes 2017; 10:443-455. [PMID: 29089779 PMCID: PMC5655124 DOI: 10.2147/dmso.s137891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient "educational chain". In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. METHODS A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. RESULTS Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities - including owning and using a glucometer and belonging to a disease support group - saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63-68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous "links" of the educational chain. CONCLUSION Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD's, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.
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Affiliation(s)
| | - Rodrigo Saucedo-Martínez
- Fundación Carlos Slim, Mexico City, Mexico
- Correspondence: Rodrigo Saucedo-Martínez, Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City 11520, Mexico, Tel +52 55 5506 2853, Email
| | | | - Evan M Lee
- Lilly Global Health, Eli Lilly and Company, Vernier, Switzerland
| | - Amy Israel
- Lilly Global Health, Eli Lilly and Company, Vernier, Switzerland
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22
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Snowdon-Carr V. Using psychological approaches for working with obesity and type 2 diabetes. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Abualula NA, Jacobsen KH, Milligan RA, Rodan MF, Conn VS. Evaluating Diabetes Educational Interventions With a Skill Development Component in Adolescents With Type 1 Diabetes: A Systematic Review Focusing on Quality of Life. DIABETES EDUCATOR 2016; 42:515-28. [PMID: 27402637 DOI: 10.1177/0145721716658356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Adolescents with type 1 diabetes mellitus (T1DM) may have reduced quality of life (QOL) when compared with their peers. This systematic review evaluated the effectiveness of diabetes self-management education (DSME) interventions with a skills development component on the QOL of adolescents with T1DM. METHODS Six databases were systematically searched for studies on the QOL outcomes of DSME interventions for adolescents with T1DM. Fourteen studies published between 1994 and 2014 met the inclusion criteria. RESULTS Of the 14 studies, only 4 had significant QOL outcomes for the intervention participants. Successful DSME interventions had indirect behavioral skills foci or a combination of indirect and direct behavioral skills foci and a duration ≥2 months. CONCLUSION This review provides evidence that educational interventions with an indirect behavioral skills development that facilitates diabetes management may improve QOL among adolescents with T1DM. Structured interventions targeting adolescents' QOL are needed to determine which are most effective in improving QOL. Adolescents with T1DM should be routinely screened and monitored for low QOL and referred to QOL-improving interventions.
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Affiliation(s)
- Nada A Abualula
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan),College of Nursing, Taibah University, Madina, Saudi Arabia (Ms Abualula)
| | - Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Renee A Milligan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Margaret F Rodan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA (Dr Conn)
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24
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Yee LM, McGuire JM, Taylor SM, Niznik CM, Simon MA. Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:170-80.e1. [PMID: 26706027 DOI: 10.1016/j.jneb.2015.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. DESIGN Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. SETTING Urban academic medical center. PARTICIPANTS Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. PHENOMENON OF INTEREST Social and environmental barriers to nutrition therapy for diabetes management during pregnancy. ANALYSIS Qualitative analysis of interview data using electronic coding software was performed using theme analysis. RESULTS Participants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. CONCLUSIONS AND IMPLICATIONS Pregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy.
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Affiliation(s)
- Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Jamie M McGuire
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shaneah M Taylor
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte M Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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25
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[Management of alcohol use disorders in ambulatory care: Which follow-up and for how long?]. Encephale 2016; 42:67-73. [PMID: 26796554 DOI: 10.1016/j.encep.2015.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alcohol consumption with its addictive potential may lead to physical and psychological dependence as well as systemic toxicity all of which have serious detrimental health outcomes in terms of morbimortality. Despite the harmful potential of alcohol use disorders, the disease is often not properly managed, especially in ambulatory care. Psychiatric and general practitioners in ambulatory care are first in line to detect and manage patients with excessive alcohol consumption. However, this is still often regarded as an acute medical condition and its management is generally considered only over the short-term. On the contrary, alcohol dependence has been defined as a primary chronic disease of the brain reward, motivation, memory and related circuitry, involving the signalling pathway of neurotransmitters such as dopamine, opioid peptides, and gamma-aminobutyric acid. Thus, it should be regarded in terms of long-term management as are other chronic diseases. OBJECTIVE To propose a standard pathway for the management of alcohol dependence in ambulatory care in terms of duration of treatment and follow-up. METHODS Given the lack of official recommendations from health authorities which may help ambulatory care physicians in long-term management of patients with alcohol dependence, we performed a review and analysis of the most recent literature regarding the long-term management of other chronic diseases (diabetes, bipolar disorders, and depression) drawing a parallel with alcohol dependence. RESULTS Alcohol dependence shares many characteristics with other chronic diseases, including a prolonged duration, intermittent acute and chronic exacerbations, and need for prolonged and often-lifelong care. In all cases, this requires sustained psychosocial changes from the patient. Patient motivation is also a major issue and should always be taken into consideration by psychiatric and general practitioners in ambulatory care. In chronic diseases, such as diabetes, bipolar disorders, or depression, psychosocial and motivational interventions have been effective to improve the patient's emotional functioning and to prevent or delay relapses. Such interventions help patients to accept their disease and to promote long-term therapeutic plans based on treatment adherence, behavioural changes, self-management and self-efficacy. The management of alcohol-dependence in ambulatory care should be addressed similarly. Therapeutic monitoring may be initiated to manage alcohol use disorders, including alcohol dependence, especially when the patient is unwilling or unready for alcohol withdrawal (i.e. using the strategy of reduction of alcohol consumption, which is considered a possible intermediate step toward abstinence). CONCLUSION Alcohol dependence needs long-term medical supervision, and the therapeutic success depends on the initiation of sustained monitoring at the time of diagnosis (initiating phase with several consultations over 2-4 weeks) with psychosocial and motivational interventions in order to address all the patient uncertainties, to involve him/her in a proactive disease management plan, and to insure adherence to treatment, behavioural changes and new lifestyle. A close monitoring (once a month during the first 6 months) during a consolidation phase is necessary. Finally, a regular monitoring should be maintained overtime after 6-12 months in order to insure that the patient maintains a minimal consumption during the first year, to consolidate the patient's motivation, to abstain in at risk situations, and to maintain a controlled consumption or abstinence.
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Joshi A, Arutagi V, Nahar N, Tiwari S, Singh D, Sethia S. Diabetes ongoing sustainable care and treatment (DOST): A strategy for informational deliverance through visual dynamic modules sustained by near peer mentoring. J Family Med Prim Care 2016; 5:270-275. [PMID: 27843826 PMCID: PMC5084546 DOI: 10.4103/2249-4863.192363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The informational continuity for a diabetic patient is of paramount importance. This study on a pilot basis explores the process utility of structured educational modular sessions grounded on the principle of near-peer mentoring. Methodology: Visual modules were prepared for diabetic patients. These modules were instituted to 25 diabetic patients in logical sequences. In the next phase, 4 persons of these 25 patients were designated as diabetic-diabetes ongoing sustainable care and treatment (DOST). Each diabetic-DOST was clubbed with two patients for modular session and informational deliverance during the next 7 days. Process analysis was performed with “proxy-indicators,” namely, monthly glycemic status, knowledge assessment scores, and quality of life. Data were analyzed by interval estimates and through nonparametric analysis. Results: Nonparametric analysis indicated a significant improvement in glycemic status in terms with fasting blood sugar (W = 78 z = 3.04, P = 0.002), 2 h-postprandial blood sugar (W = 54, z = 2.01, P = 0.035), and in knowledge score (χ2 = 19.53, df = 3; P = 0.0002). Quality of life score showed significant improvement in 2 out of 7 domains, namely, satisfaction with treatment ([difference in mean score = 1.40 [1.94 to 0.85]) and symptom botherness (difference in mean score = 0.98 [1.3–0.65]). Conclusion: Because of inherent methodological limitations and innate biases, at this juncture no conclusive statement can be drawn. Although, primitive process evidences indicate the promising role of the diabetic-DOST strategy.
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Affiliation(s)
- Ankur Joshi
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Nitin Nahar
- Department of Medicine, GMC, Bhopal, Madhya Pradesh, India
| | - Sharad Tiwari
- Department of Community Medicine, GMC, Bhopal, Madhya Pradesh, India
| | - Daneshwar Singh
- Department of Community Medicine, GMC, Bhopal, Madhya Pradesh, India
| | - Soumitra Sethia
- Department of Community Medicine, GMC, Bhopal, Madhya Pradesh, India
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