Eye on diabetes: a multidisciplinary patient education intervention

PURPOSE: The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. METHODS: Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. RESULTS: The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (chi(2) = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (chi(2) = 11.67, P > .11). CONCLUSIONS: Patients who participated in the educational intervention demonstrated an increase in knowledge across time. Patients may benefit from education emphasizing the importance of dilated eye examinations in the absence of ocular symptoms.     

Images and realities of alcohol

The paper discusses the relationship between the images of alcohol and society, on one hand, and the reality of drinking and drinking problems on the other hand, from the point of view of policy-relevant research. Images of alcohol influence policy but they also depend on the social and cultural environment of policy-making. The epidemiological total consumption theory of alcohol-related problems is used as an example. The theory is embedded in the modern welfare state's ideals and its policy relevance presupposes that these ideals-universalism, consequentialism and public planning-are respected. If the approach today receives less attention by policy-makers than its empirical validity merits, it may be due to an erosion of these ideals, not of the epidemiological model itself. Images of alcohol influence behaviour and drinking problems but they also articulate the social context in which the images are constructed. This paper demonstrates the point, applying Levi-Straussian cultural theory to an analysis of a recent beer advertisement addressed to young people. The advertisement not only reflects the images associated with youthful drinking but also the ambiguous status of youth as non-adults in contemporary society. The author stresses that for social and cultural research alcohol is a two-way window, to look at society through alcohol and to look at alcohol through society. Both directions are necessary for policy-relevant research.     

Strokes and the carotid: myths and realities

Cervical bruits in asymptomatic individuals identify persons at increased risk of future stroke and at even higher risk of ischemic heart disease. Strokes in these patients rarely occur in the same vascular distribution as the bruit. In prospective studies, an asymptomatic bruit does not identify patients at higher risk of perioperative stroke even in patients undergoing coronary bypass or other major vascular surgery. When a stroke occurs in the perioperative setting, it is much more likely due to embolism from the cross-clamped aorta or extraneous material from the bypass machine than from hypoperfusion of, or embolism from, the carotid arteries.     

Effects of multidisciplinary education on outcomes in patients with irritable bowel syndrome.

BACKGROUND & AIMS: The impact of education on irritable bowel syndrome (IBS) is not well known. This study evaluated the effect of a onetime group education program on patient-based outcomes in IBS. METHODS: All adults referred by Mayo Clinic physicians to the Gastroenterology Division with a diagnosis of IBS between May 1997 and March 1998 were asked to participate. Questionnaires were administered at baseline and 6 months. Symptom resolution, change in pain severity, quality of life, Health-Promoting Lifestyle Profile score, overall patient satisfaction, and health care utilization were compared among those patients who attended the multidisciplinary class and those who did not. RESULTS: Of the 506 patients approached, 403 (80%) agreed to participate. The clinical diagnosis was confirmed in 344 patients (85%) on chart review; 211 patients (61%) subsequently completed a follow-up questionnaire. Overall, 29% of class attendees who met Rome criteria for IBS at baseline no longer met Rome criteria at follow-up, compared with 7% of nonattendees. By multivariate analysis, class attendance predicted higher odds of not meeting Rome criteria at follow-up in individuals meeting Rome criteria at baseline (odds ratio, 7.91; 95% confidence interval, 0.97-64.41) than in nonattendees, but the opposite effect was seen with class attendance in those not meeting Rome criteria at baseline. This interaction between baseline Rome status and class attendance was significant (P < 0.05). Class attendance was associated with improvement in Health-Promoting Lifestyle Profile scores (P < 0.05) but not with change in pain, quality of life, satisfaction, or health care utilization. CONCLUSIONS: A onetime, multidisciplinary class for patients with IBS was associated with improvement in symptoms and health-promoting lifestyle behavior.     

Autoimmune hepatitis: The realities and the uncertainties

The concept of autoimmue hepatitis has developed over the past 35–40 years. Despite continuing debate over the nosologie status of this disease, there are certain “realities” that argue for autoimmune hepatitis as an entity. The uncertainties include valid criteria for distinguishing the autoimmune from other types of CAH, and the applicability of the marker antibodies for diagnosis. A reliable animal model is lacking. The initiating process, infectious or other, is unknown. The immunological events that determine self-perpetuation need elucidation. These include the identity of the liver membrane autoantigen, the immunogenetic contribution, the respective roles in pathogenesis of helper, suppressor and cytotoxic T lymphocytes, and the identification of a specific liver membrane autoantibody. Clear advances are perceptible on each of these fronts.     

Myths and realities in clinical research

It is often argued that clinicians should be more actively involved in research and that this inactivity is due to shortage of time and funds. This may be so, but more important and less obvious constraints are the differences in the philosophical foundations of clincial practice and research. Researchers must strive to abolish uncertainty, to be unwaveringly committed to truth and to rid themselves of all bias. Clincians, in contrast, must frequently manage patients in the absence of certainty, handle truth creatively and be willing to be biased on their patients’ behalf as part of a professional obligation. These differences constitute powerful selection pressures for individuals with particular skills, personalities and sources of job satisfaction. Clinical practice and research are instrinsically different activities and it is probably unreasonable to expect an individual talented in one to be similarly expert in the other.