What factors influence nurses’ behavior in supporting patient self-management? An explorative questionnaire study

BackgroundA major challenge for nurses in hospital care is supporting chronically ill patients in self-managing their chronic condition. Self-management support requires a broad range of competencies and is often regarded as difficult to implement in daily practice. So far, we have no insight in nurses’ behavior in daily practice with regard to self-management support and what factors may influence their behavior.ObjectivesThe aim of this survey was to explore (i) the self-reported behavior on self-management support of nurses in a university hospital; and (ii) the factors influencing this behavior.DesignTotal sample approach with cross-sectional design.Participants and settingNurses employed by a university hospital received an invitation for the research through e-mail containing a link to the survey. Of the 2054 nurses who had been invited to participate, 598 responded (29.11%). The entire questionnaire was completed by 379 nurses, 32 of whom indicated they did not work with patients on a daily basis. After excluding those 32, the final sample included 347 valid responses (16.9%). 90.5% of the respondents was female, mean age was 38.8 years.MethodsIn a web-based questionnaire, the self-efficacy and performance in self-management support instrument (SEPSS-36) was used, with additional questions about attitude, subjective norms, and perceived barriers for self-management support.ResultsThis study shows that nurses are self-confident of their capabilities to support self-management. They also feel that most of the time they acted accordingly. Still, a significant gap between self-efficacy and behavior of self-management support was found (p < 0.001). Nurses themselves perceive lack of time and patients’ lack of knowledge as barriers for self-management support, but this did not influence their behavior (p > 0.05). Regression analysis showed that perceived lack of own knowledge, the presumed absence of a patients’ need for self-management support, and nurses’ self-efficacy in self-management support are factors that influence the behavior of self-management support. 41.1% of the variance of behavior is explained by these three factors.ConclusionThis study shows a significant gap between self-reported self-efficacy and behavior in self-management support in nurses working in a university hospital. To enhance self-management support, managers and educators should take these influential factors into account. A third of the nurses did not report a need for additional training on self-management support. This implies that programs should also aim to improve reflective skills and raising awareness.     

Does comprilan bandage have any influence on peripheral perfusion in patients with oedema?

Aim: Comprilan bandage may be an attractive treatment of leg oedema, but theoretically bandage could compromise peripheral circulation. The present study was undertaken to investigate circulation in the first toe before, during, and after treatment with comprilan bandage. Methods and study population: Blood flow rate was measured by the heat‐washout method in the pulp of the first toe of 10 patients (eight women, two men, aged 75–94) with leg oedemas, and systolic toe blood pressure was determined by the strain gauge method. Oedema was scored according to a visual scale, and the patients were treated with comprilan (short stretch) bandage for 1 week. Toe blood flow rate was measured before, during and after the use of the bandages, and toe blood pressure was measured before and after the use of bandages. Results: According to the visual scale, all subject benefited from the treatment by reduction of oedema, and they reported increased well‐being after. Blood flow rate was not significantly altered during and after the treatment. Systolic toe pressure was normal in all patients (R/L = 94/83 mmHg), and no significant change took place during and after the use of the bandages (92/90 mmHg). Conclusion: Comprilan bandage has a positive effect on legs oedemas, visually as well as according to the patients well‐being. The treatment does not have any significant influence on toe blood pressure. It cannot, however, be excluded that the use of comprilan bandage may compromise toe blood flow rate slightly (<5%). A larger study with more subjects has to be made to come this closer, and additional capillary blood flow rate should be measured in an area without arteriovenous anastomoses.     

Does an aerobic endurance programme have an influence on information processing in migraineurs?

Background

Migraine is a disorder of central information processing which is characterized by a reduced habituation of event-related potentials. There might be positive effects of aerobic exercise on brain function and pain. The aim of this study was to investigate the influence of exercise on information processing and clinical course of migraine.

Methods

33 patients completed a ten-week aerobic exercise programme. To examine the influence of the treatment on information processing and attention, Trail Making Test (TMT) A and B, d2-Letter Cancellation Test (LCT) and recordings of the Contingent Negative Variation (CNV) were performed before and after the training.

Results

Patients showed a significant reduction of the migraine attack frequency, the iCNV-amplitude and the processing time for TMT-A and TMT-B after treatment. Moreover, there was a significant increase of the habituation and positive changes in parameters of attention (d2-LCT) after the training.

Conclusions

This study demonstrates that aerobic exercise programme influences central information processing and leads to clinical effects on the migraine symptomatology. The results can be interpreted in terms of an improvement of a dysfunctional information processing and a stimulus selection under aerobic exercise.     

Does intensive therapy of type 2 diabetes help or harm? Seeking accord on ACCORD

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial tested the hypothesis that intensive glucose-lowering (with a hemoglobin A1c target of less than 6.0%) would reduce the incidence of atherosclerotic disease events and death compared with standard treatment (with a hemoglobin A1c target of 7.0% to 7.9%) in more than 10,000 patients with type 2 diabetes at high risk of cardiovascular events. The study was terminated early because more people had died in the intensive-treatment group than in the standard-treatment group (257 vs. 203). The ACCORD results should not substantially alter our usual approach to glucose-lowering, which should still be "as low as we can get it safely" while avoiding hypoglycemia, significant weight gain, complex regimens, and, perhaps, the "stress" of maintaining glycemic control, especially in patients at high risk of coronary heart disease.     

Does virtual colonoscopy have a major role in population-based screening?

In summary, technical advances in the performance of VC are occurring at a very rapid pace. These technical improvements will undoubtedly improve the polyp detection rate and reduce false-positive and false-negative examinations. The concept of VC is clearly attractive and the general public is enamored with everything that has an association with virtual reality. As other articles in this issue have revealed, there are many techniques in development to help stratify patients at risk for colon cancer. As we begin to focus our health care resources on those at highest risk, the less need there is for inexpensive, broadly based screening techniques. Clearly, those patients at high risk for having polyps are better served by colonoscopy because of its therapeutic potential. That being said, in the view of this author, if a virtual preparation can be achieved and the cost of VC can be kept relatively low, then this technique will become part of our mainstream clinical practice. If an immaculate colon preparation must be performed and if the costs reflect standard abdominal and pelvic CT rather than a special reduced cost for VC, then it is doubtful that there will be any significant impact from this technology     

Does osteoprotegerin relate to micro- and macrovascular complications in long-term type 1 diabetes?

Abstract

Purpose. Markers of micro- and macrovascular disease are needed in type 1 diabetes in order to identify patients at risk of severe complications. Osteoprotegerin (OPG) is expressed in vascular myocytes, and increasing levels have been reported in type 1 diabetes. Consequently, we investigated OPG as a non-invasive marker of micro- and macrovascular complications in long-term type 1 diabetic patients. Methods. This was a cross-sectional study of 200 type 1 diabetic patients with long diabetes duration from a population-based cohort from Fyn County, Denmark. Patients were examined in 2007–2008, and OPG was measured and correlated to diabetes-associated complications: retinopathy, nephropathy, neuropathy and macrovascular disease. Results. Median age and duration of diabetes was 58.7 years (range 37.7–84.4 years) and 43 years (range 34–70 years), respectively. Median level of OPG was 1257 pg/ml (range 379–5706 pg/ml). In univariate analyses, OPG was related to age, duration of diabetes, female gender, nephropathy and inversely to diastolic blood pressure. In an age- and sex-adjusted model, higher levels of OPG were associated with a higher risk of nephropathy (OR 2.54, 95% confidence interval 1.09–5.90 for third vs. first tertile). Statistical significance was, however, lost in a multivariate model, and proliferative diabetic retinopathy, neuropathy and macrovascular disease was not associated with OPG in either model. Conclusions. Some associations of OPG and nephropathy were found in a long-term type 1 diabetic cohort. Prospective studies are needed in order to determine whether OPG can be used to predict nephropathy.     

Does low bone mineral density start in post-teenage years in women with type 1 diabetes?

OBJECTIVE: Type 1 diabetes has been associated with decreased bone mineral density (BMD). However, the natural history and etiopathogenesis of osteoporosis in type 1 diabetes are not clear. The aims of this study were to assess BMD in a cohort of young women with type 1 diabetes compared with nondiabetic control subjects and to evaluate the possible association of BMD with diabetes duration, HbA(1c), and biomarkers of bone metabolism. RESEARCH DESIGN AND METHODS: BMD was measured by dual-energy X-ray absortiometry scan in 39 teenage (age 13-19 years) and 33 post-teenage females (age 20-37 years) with type 1 diabetes and 91 female age-matched control subjects. Serum osteocalcin, IGF-I, IGF binding protein-3 (IGFBP-3), HbA(1c), and urine N-telopeptides were measured. RESULTS: After adjustment for age and BMI, BMD values were significantly lower at the femoral neck and lateral spine in women with type 1 diabetes older than age 20 years compared with control subjects but not in the case subjects younger than age 20 years, nor at the anterio-posterior spine, wrist, or whole body. No association was found between BMD and diabetes duration or glycemic control. IGF-I, IGFBP-3, osteocalcin, and N-telopeptides were similar in diabetic subjects and control subjects. CONCLUSIONS: This study indicates that women with type 1 diabetes exhibit BMD differences early in life with significant differences already present in the post-teenage years. Lower hip BMD in these young women may explain, in part, the higher incidence of hip fracture experienced in postmenopausal women with type 1 diabetes.     

Pancreatic fat in type 2 diabetes: Causal or coincidental?

Type 2 diabetes (T2D) is a multifactorial metabolic disorder affecting more than 450 million people across the globe. With the increasing prevalence of T2D and obesity, the role of fat accumulation at sites other than subcutaneous adipose tissue has received significant attention in the pathophysiology of T2D. Over the past decade and a half, a pressing concern has emerged on investigating the association of pancreatic fat accumulation or pancreatic steatosis with the development of disease. While a few reports have suggested a possible association between pancreatic fat and T2D and/or impaired glucose metabolism, a few reports suggest a lack of such association. Pancreatic fat has also been linked with genetic risk of developing T2D, prediabetes, reduced insulin secretion, and beta cell dysfunction albeit some confounding factors such as age and ethnicity may affect the outcome. With the technological advancements in clinical imaging and progress in assessment of pancreatic beta cell function, our understanding of the role of pancreatic fat in causing insulin resistance and development of various etiologies of T2D has significantly improved. This review summarizes various findings on the possible association of pancreatic fat accumulation with the pathophysiology of T2D.     

Does serum cystatin C level reflect insulin resistance in patients with type 1 diabetes?

ObjectivesThe aim of study was to evaluate the relationship between serum cystatin C and insulin resistance (IR) in type 1 diabetic patients being the participants of Poznan Prospective Study.Design and methodsThe study was performed on 71 Caucasian patients (46 men); with type 1 diabetes, who were recruited into the Poznan Prospective Study, at the age of 39 ± 6.1 meanly, and treated with intensive insulin therapy since the onset of the disease. The follow-up period and diabetes duration were 15 ± 1.6 years. Insulin resistance (IR) was assessed by estimated glucose disposal rate (eGDR) calculation with cut-off point 7.5 mg/kg/min. Patients were divided into two groups, according to the presence or absence of IR.ResultsFrom among 71 patients, 31 patients (43.7%) presented decreased sensitive to insulin with eGDR below 7.5 mg/kg/min. Patients who had eGDR < 7.5 mg/kg/min (insulin resistant), compared with subjects with eGDR > 7.5 mg/kg/min (insulin sensitive), had higher level of serum cystatin C [0.59 (IQR:0.44–0.84) vs 0.46 (IQR:0.37–0.55) mg/L, p = 0.009]. A significant negative correlation between cystatin C and eGDR was revealed (Rs = − 0.39, p = 0.001). In regression model cystatin C was related to insulin resistance, adjusted for sex, BMI, eGFR and duration of diabetes [OR 0.03 (0.001–0.56), p = 0.01].ConclusionsHigher level of serum cystatin C is related to decreased insulin sensitivity in patients with type 1 diabetes. This relationship seems to have an important clinical implication.