Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial

Objective

To evaluate the efficacy of ongoing group based diabetes self-management education (DSME) for patients with type 2 diabetes.

Methods

146 patients were randomised to either group education or waiting list control. Primary outcomes were A1C and patient activation measured with patient activation measure (PAM).

Results

There were no differences in the primary outcomes between the groups at 12 months, but the control group had an increase in A1C of 0.3% points during follow-up. Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group. A sub group analysis was conducted for the quartile with the highest A1C at baseline (>7.7, n = 18 in both groups). There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control.

Conclusions

The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level.

Practice implications

Locally developed programs may be less effective than programs developed for studies.     

Communication about self-care in traditional acupuncture consultations: The co-construction of individualised support and advice

Objective

To analyse the co-construction of self-care advice in traditional acupuncture consultations.

Method

Analysis of 27 audio-recorded and transcribed consultations, involving 7 practitioners, augmented by integrating the data from 15 patient interviews and regular practitioner discussions.

Results

Self-care talk was initiated equally by practitioner and patient, and was threaded through and between acupuncture consultations. It involved interactive discussions that were interwoven with other types of talk, especially life-world and acupuncture talk. Practitioner engagement in self-care talk appeared to increase with experience. The self-care talk was co-constructed within the context of a relationship that was characterised by continuity, mutuality and trust.

Conclusion

Self-care support and advice was integral to the practice of traditional acupuncture and individualised in terms of the patient's life-world and/or the Chinese medicine diagnosis. The co-construction of self-care talk did not replicate the asymmetry of conventional medical consultations.

Practice implications

The active participation of both patients and acupuncture practitioners in self-care talk may be related to professional practice that is underpinned by a holistic theory base such as Chinese medicine and is delivered in the context of therapeutic relationships based on continuity, mutuality and trust. These findings may inform professional education and the design of multi-disciplinary care pathways.     

静态平衡仪对脑卒中偏瘫患者平衡功能的影响

目的研究PC-708A静态平衡仪对脑卒中偏瘫患者平衡功能的影响。方法将52例脑卒中偏瘫伴有平衡功能障碍的患者随机均分为治疗组和对照组。两组患者均给予常规的康复训练、针刺治疗及药物治疗,治疗组在此基础上采用PC-708A静态平衡仪治疗,共治疗6周,治疗前后分别采用Berg平衡量表及日常生活活动能力(ADL)评定表进行评定。结果治疗前治两组平衡能力、ADL能力比较差异无统计学意义(P>0.05),治疗后两组患者的平衡能力及ADL能力均较治疗前明显提高(P<0.01),且治疗组功能改善情况优于对照组(P<0.01)。结论 PC-708A静态平衡仪提供视觉反馈、提高治疗的注意力及兴趣,能更好的改善卒中患者的平衡功能,值得临床实践。     

提高急性心肌梗死康复期患者自我护理能力作用的探讨

目的：探讨急性心肌梗死康复期患者自我护理能力与康复效果、生活质量的关系。方法：81例急性心肌梗死患者在出院时给予提高自我护理能力的健康教育。采用欧洲心力衰竭患者自我护理行为量表（EHFScBS）和明尼苏达心力衰竭生活质量调查表进行自我护理能力和生活质量的评价,并记录患者心力衰竭发生和心肌梗死再入院的例数。随访6个月。结果：患者EHFScBS评分为（41.6±11.8）分;自我护理能力受文化程度影响。文化程度较高者,自我护理能力相对越高（F=5.446,P=0.008）。同时自我护理能力较强的患者生活质量也相对较高（F=6.354,P=0.000）。EHFScBS评分和明尼苏达心力衰竭生活质量评分呈正相关（r=0.711,t=3.224,P=0.012）;在EHFScBS评分中低分者越易造成心力衰竭的发生（χ2=8.188,P=0.042）,也更倾向于再次入院（χ2=8.188,P=0.042）。结论：急性心肌梗死康复期患者的自我护理能力和生活质量及心力衰竭发生及再入院率有密切的关系,应努力提高其自我护理能力。     

电话随访对Miles手术患者自我管理能力的影响

目的探讨电话随访是否能提高Miles患者自我管理能力,提高生活质量,提升医护患满意度。方法将普外科Miles手术患者按随机数字表法随机分为电话随访组和常规组。常规组接受Miles手术常规护理;电话随访组在常规护理基础上,由专职护士通过每周1次的电话随访对患者进行院外生活方式、心理、社会支持。比较6个月后两组患者自我管理能力问卷调查情况。结果经过干预电话随访组患者自我管理能力明显提高,其中电话随访组患者术后适应能力得分为（50．45±4．87）分,常规组为（43．19±5．76）分,组间比较差异具有统计学意义（t=6．48,P〈0．05）。结肠造口患者自我管理总分与造口适应能力、社会支持、自尊和认知性症状管理各变量总分均呈正性相关（r分别为0．45,0．39,0．37,0．33;P〈0．01）;干预6个月后电话随访组医患及护患关系满意度为99．2％,常规组为94．2％,组间比较差异具有统计学意义（x2=4．56,P〈0．05）。结论电话随访能明显提高Miles手术患者自我管理能力,改善Miles手术患者生活质量,提升护理服务满意度。     

同伴教育在精神分裂症患者自理行为训练中的应用

目的观察同伴教育在精神分裂症患者自理行为训练中的应用效果。方法对36例精神分裂症患者应用同伴教育的理念进行自理行为训练,为期12周,用自行设计的精神病患者自理行为评分表对患者进行评估。结果训练后1周、4周、8周、12周的患者自理行为评分提高,与训练前比较有统计学意义。结论同伴教育可提高精神分裂症患者的自理行为。     

NURSE: Five Micropractices to Reduce Stress

The Coronavirus pandemic affected patients’ health and heightened stress among the frontline caregivers, especially radiology nurses. Although there is literature on the effects of stress on nurses, there is a gap on interventions to mitigate the impact of stress. There are evidence-based mindful interventions to maintain balance in stressful situations and reduce perceived stress in sports, neuroscience, and positive psychology. Studies show that even brief periods of self-care reduce stress and cortisol levels. Nurses work long hours and have personal, family, and community responsibilities. Nurses may not have the luxury of extra time to devote to self-care. Therefore, this essay summarizes what stress does to the body; the tangible and intangible costs associated with unmanaged stress among nurses. Five self-care micropractices requiring no additional time called NURSE are offered. When practiced consistently, these micropractices can enhance nurses’ well-being, leading to the retention of nursing talent and improved patient care.     

基于PDCA循环的过渡期护理对老年人瓣膜置换术后ICU出科时期的干预效果

目的探讨基于PDCA循环的过渡期护理对老年人瓣膜置换术后重症监护室（ICU）出科时期的干预效果。 方法选取2020年10月至2021年9月在遵义医科大学附属医院行瓣膜置换术的老年患者60例，其中30例在ICU出科过渡期采用常规护理（对照组），余30例采用基于PDCA循环的过渡期护理（观察组）。观察两组患者干预前后超声心动图相关指标左室射血分数（LVEF）和左心室舒张末期容积（LVEDV）、医院焦虑抑郁评分量表（HADS）评分、中文版Mishel疾病不确定感量表（MUIS）评分，以及日常生活能力评估量表（ADL）评分变化情况。计数资料的比较采用χ²检验，计量资料的比较采用t检验。 结果护理后，观察组LVEF和LVEDV指数均高于对照组（t=3.286、2.035，P<0.05），HADS-A、HADS-D和MUIS评分均低于对照组（t=3.873、3.873、6.076，P<0.01），ADL评分高于对照组（t=6.076，P<0.01）。 结论基于PDCA循环的过渡期护理可明显改善老年人瓣膜置换术后从ICU转入普通病房期间的焦虑情绪和疾病不确定感，促进心功能恢复，提高自理能力。