Behavioral interventions for diabetes self-management

This article synthesizes the research on behavioral interventions aimed at diabetes self-management, describes current trends in diabetes self-management, and proposes future directions for diabetes self-management care and research. Interventions that are multifaceted, tailored to the individual, and provided six months or longer demonstrate modest effects in improving diabetes-related outcomes. Improving access to behavioral interventions, maintaining the effects of behavioral interventions, and addressing the more complex social and environmental factors that contribute to behavior change are current challenges in diabetes self-management that warrant further attention and research.     

An economic analysis of comparable worth

Comparable worth has been called the civil rights issue of the 1980s. Nursing is in the forefront of this movement. Although several governmental agencies are implementing salary programs based on comparable worth, establishing such a program in the hospital setting could yield problems for nurse executives. Implementation could be costly and demand a significant investment of resources. This paper discusses how wages are determined in a competitive market and what happens to that process when restrictions and barriers make the market noncompetitive. Of most importance, alternative strategies for increasing nursing salaries are presented.     

An integrative literature review of lifestyle interventions for the prevention of type II diabetes mellitus

Aims and objectives. An integrative literature review was undertaken to determine what type II diabetes prevention programmes have been evaluated, what type of programme is the most effective and how adherent to lifestyle changes adults are after participating in a prevention programme. Background. Type II diabetes is important because the disease is affecting millions of people worldwide. Obesity and sedentary lifestyles are preventable risk factors for type II diabetes, leading many researchers from around the world to examine different programmes that are focussed on prevention of the disease. Design. Integrative literature review. Method. Search of electronic databases. Results. Diet, exercise, counselling and diet plus exercise were the types of prevention programmes, with the diet plus exercise being the most efficacious. Although many studies demonstrated excellent results initially, maintaining the effects of the lifestyle behaviour change proved to be difficult for participants, with only one study demonstrating the persistence of results after six years. Conclusion. Future research should focus on long‐term maintenance programmes, rather than just short‐term prevention programmes to determine the need for booster interventions or other means to ultimately decrease the incidence of type II diabetes. Relevance to clinical practice. As front‐line healthcare providers working across a broad array of settings, nurses are particularly well‐suited to play an integral part in future applications of diabetes prevention programmes. Lifestyle interventions are being delivered in a variety of settings and venues such as the workplace, the Internet and places of worship. In addition, at‐risk populations also can be targeted, particularly overweight and obese persons, with at least one parent having type II diabetes or persons with gestational diabetes.     

Principles of economic evaluation for interventions of chronic musculoskeletal pain

Economic evaluation is attracting increasing attention to inform policy makers, insurers and other payers of the value of existing and new treatment modalities. Hence, it is desirable to assess not only the medical but also the economic consequences the new treatments produce. The available literature on economic evaluation revealed an urgent need for sound economic evaluation studies in the field of chronic musculoskeletal pain. Due to the generally weak methodology, the intended purpose of economic evaluation to help set funding priorities has often been bypassed. Although in general therapists have no direct responsibility for allocating scarce resources in the field of musculoskeletal pain, they are confronted with the results of these decisions in their everyday work. A clear understanding of the main principles of economic evaluation studies might therefore be advantageous. This paper addresses important methodological issues in economic evaluation research, such as the techniques for economic evaluation studies and the analytic perspective. In addition, the paper pays attention to the inclusion of costs and outcomes in economic evaluation research, sensitivity analysis, discounting, incremental analysis and ratios, and collecting of data.Further emphasis is placed on the transparent reporting of methods and study results. A clear reporting may help therapists and other researchers interpret the results of published studies and apply them to their own studies, and it may help decision makers generalize results from one setting to another.     

An economic analysis of the nurse practitioner role

Today's rapidly changing health care environment directly affects nurse practitioners. NPs will be practicing in increasingly competitive situations and with mounting pressures for cost-effective services. Ignoring the issues in the health care marketplace can threaten NP survival. This article will analyze the changes in the health care system, relate the economic effects of these changes to nursing practice, and apply a homeostatic model of interprofessional competitive behavior. As NPs gain perspective on the dynamics of competition and the influence of economics, they will be better able to successfully position themselves in the health care marketplace.     

Pharmacologic interventions for type 1 and type 2 diabetes

A variety of pharmacologic interventions are available to treat people with type 1 and type 2 diabetes. This article provides an update of pharmacologic interventions for diabetes, including a discussion of the drug classifications with specific examples of each, and their background, dosing, and side effects. Combination therapy is reviewed, and information is provided on two new therapeutic classes of diabetes medications: incretin mimetics and antihyperglycemics.     

糖尿病患者家庭护理干预效果评价

目的探讨糖尿病患者家庭护理干预效果。方法将165例2型糖尿病患者分为干预组85例和对照组80例,出院前对两组患者发放健康教育资料,并进行健康指导,干预组在此基础上对患者进行心理支持、糖尿病相关知识培训、饮食指导、运动训练、用药指导等家庭护理干预,比较两组患者的健康知识水平、自我管理能力、血糖控制效果。结果干预组的健康知识水平、自我管理能力、血糖控制效果均高于对照组（P〈0.05）。结论对糖尿病患者进行家庭护理干预能提高糖尿病患者的健康知识水平、自我管理能力及血糖控制效果。     

Nutrition education and social learning interventions for type II diabetes

Two diabetes education programs were compared to a control condition. Seventy-eighty type II (non-insulin-dependent) diabetic outpatients were randomly assigned to nutrition education, nutrition education plus social learning intervention, or wait-list control conditions. Both interventions involved five weekly meetings that focused on reducing calorie intake, increasing dietary fiber, and decreasing fat consumption. The social learning condition also included individualized goal setting and feedback and training in problem-solving and relapse prevention. Within-group analyses and between-group comparisons generally revealed greater improvement in targeted goals (e.g., calorie intake, fat reduction) among intervention conditions than the control condition. There were few differences in more distal measures of outcome such as weight or glycosylated hemoglobin. The social learning component did not improve outcome more than the nutrition education program. Possible reasons for the observed findings and the advantages and limitations of focused time-limited diabetes education efforts are discussed.     

Efficient cutoff points for three screening tests for detecting undiagnosed diabetes and pre-diabetes: an economic analysis

OBJECTIVE: Opportunistic screening for undiagnosed type 2 diabetes and pre-diabetes (either impaired glucose tolerance or impaired fasting glucose) is recommended by the American Diabetes Association. The aim of this study was to determine efficient cutoff points for three screening tests for detecting undiagnosed diabetes alone or both undiagnosed diabetes and pre-diabetes. RESEARCH DESIGN AND METHODS: We estimated the number of individuals with undiagnosed diabetes alone or with both undiagnosed diabetes and pre-diabetes that could be detected by using different cutoff points for each screening test as the product of the prevalence of each condition, the sensitivity of the tests at each cutoff point for identifying each condition, and the number of individuals who would be eligible for screening in the U.S. We estimated the total cost of opportunistic screening by multiplying the cost for screening one person by the number of individuals screened. RESULTS: The most efficient cutoff points for both detecting pre-diabetes and undiagnosed diabetes (100 mg/dl for the fasting plasma glucose test, 5.0% for the HbA(1c) test, and 100 mg/dl for the random capillary blood glucose test) were less than those for detecting undiagnosed diabetes alone (110 mg/dl for the fasting plasma glucose test, 5.7% for the HbA(1c) test, and 120 mg/dl for the random capillary blood glucose test). CONCLUSIONS: A lower cutoff value should be used when screening for pre-diabetes and undiagnosed diabetes together than when screening for undiagnosed diabetes alone.     

The challenges of economic evaluations of remote technical health interventions

There are many difficulties in applying standard economic evaluation techniques to health care services, and telemedicine services, being relatively new and diverse, pose particular challenges to evaluators. Blanket statements about the "cost-effectiveness" of programs cannot and should not be made. Indeed, the benefit of discussing CEA (cost-effectiveness analysis) ratios is in the comparison between programs and their alternatives. In the last few years attention has focused on the actual resource implications of existing and expanding telemedicine services such as teleradiology and telepsychiatry among others. Several Canadian case studies are available to illustrate various evaluation techniques and assumptions employed. Economic barriers to the diffusion of telemedicine remain; both with capital outlay costs and issues surrounding the reimbursement of physicians for telemedicine services. This paper reviews the main tenets of economic evaluations applied to health care services but uses case studies from telemedicine services to illustrate the possibility and importance of comparative analyses. Other broader policy issues of economic incentives and implications of reimbursement are also explored.     

Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions

BackgroundAs resources for healthcare are scarce, decision-makers increasingly rely on economic evaluations when making reimbursement decisions about new health technologies, such as drugs, procedures, devices, and equipment. Economic evaluations compare the costs and effects of two or more interventions. Musculoskeletal disorders have a high prevalence and result in high levels of disability and high costs worldwide. Because physical therapy interventions are usually the first line of treatment for musculoskeletal disorders, economic evaluations of such interventions are becoming increasingly important for stakeholders in the field of physical therapy, including physical therapists, decision-makers, and reseachers. However, economic evaluations are relatively difficult to interpret for the majority of stakeholders.ObjectiveTo support physical therapists, decision-makers, and researchers in the field of physical therapy interpreting trial-based economic evaluations and translating the results of such studies to clinical practice.MethodsThe design, analysis, and interpretation of economic evaluations performed alongside randomized controlled trials are discussed. To further illustrate and explain these concepts, we use a case study assessing the cost-effectiveness of exercise therapy compared to standard advice in patients with musculoskeletal disorders.ConclusionsEconomic evaluations are increasingly being used in healthcare decision-making. Therefore, it is of utmost importance that their design, conduct, and analysis are state-of-the-art and that their interpretation is adequate. This masterclass will help physical therapists, decision-makers, and researchers in the field of physical therapy to critically appraise the quality and results of trial-based economic evaluations and to apply the results of such studies to their own clinical practice and setting.     

An analysis of clinical pharmacist interventions in an intensive care unit.

In a 6-month study period, 170 pharmacist interventions in an intensive care unit (ICU) were analysed. Of the interventions, 68.8% were solicited and 31.2% were initiated by the pharmacists. The majority of the interventions were initiated by specialists (69.4%) followed by the medical officers (15.9%) and nurses (9.4%). Most of the interventions occurred during the grand rounds (75.9%), followed by ward visits (12.9%) and communication through the satellite pharmacy (10.5%). The most frequent type of intervention made was for indication or therapeutic efficacy followed by general product information, drug regimen, laboratory assessment, disease state, pharmaceutical availability and adverse drug reaction or side effect. It was also found that 83.7% of pharmacists' suggestions were accepted, 6.4% were accepted with changes, and 9.9% were not accepted. The majority of the interventions were made by direct verbal communications followed by telephone and written communications. In conclusion the study indicates that pharmacist therapeutic recommendations form an important integral element of patient care in an ICU.     

高级临床护士对糖尿病手术病人的干预及效果

目的介绍糖尿病高级临床护士(DM-APN)对手术糖尿病病人的术前、术后干预措施并评价其效果.方法对91例糖尿病手术病人在床边教育的基础上,由DM-APN每天随访,与外科医生共同管理病人;评价血糖控制情况、感染的发生率、住院天数等指标.结果病人术前、术后的血糖得到良好的控制,术后切口感染率2.22%,住院天数与其他糖尿病手术病人差别无显著意义.结论 DM-APN的干预,有利于病人治疗的完善、血糖的控制、以及降低术后切口感染率.     

干预前后居民心脑血管病、糖尿病知信行水平分析

目的了解人群对心脑血管病和糖尿病相关知识的掌握情况,评价以社区为基础的以健康教育为手段的干预效果。方法干预Methods为创造社区健康支持环境、家庭动员、家庭行为干预和健康讲座。干预前后采用随机抽样的方法抽取杭州市常住居民,进行心脑血管病糖尿病防治知信行调查,干预前调查798例,干预后调查500例;结果初查显示杭州市六个区的常住居民对心脑血管病和糖尿病防治知信行水平较低;通过一年的综合干预,28项知信行指标均有了显著提高。结论健康促进是控制心脑血管病和糖尿病的重要措施,行为干预的效果优于一般的健康教育,以社区为基础的心脑血管病和糖尿病综合干预在我国是切实可行且行之有效。