Pilot trial of diabetes self-management education in the hospital setting

AimsDiabetes self-management education (DSME) is recommended for all patients with diabetes. Current estimates indicate that <50% of patients receive DSME, increasing risk for hospitalization which occurs more frequently with diabetes. Hospitalization presents opportunities to provide DSME, potentially decreasing readmissions. To address this, we investigated the feasibility of providing DSME to inpatients with diabetes.MethodsPatients hospitalized on four medicine units were randomized to receive DSME (Education Group) (n = 9) prescribed by a certified diabetes educator and delivered by a registered nurse, or Usual Care (n = 12). Participants completed Diabetes Knowledge Tests (DKT), Medical Outcomes Short Form (SF-36), Diabetes Treatment Satisfaction Questionnaire (DTSQ), and the DTSQ-inpatient (DTSQ-IP). Bedside capillary blood glucoses (CBG) on day of admission, randomization and discharge were compared.ResultsThere were no group differences in demographics, diabetes treatment, admission CBG (186 ± 93 mg/dL vs. 219 ± 84 mg/dL, p = 0.40), DKT scores (Education vs. Usual Care 48 ± 25 vs. 68 ± 19, p = 0.09), SF-36, and DTSQ scores (28 ± 6 vs. 25 ± 7, p = 0.41). Patients receiving education reported more satisfaction with inpatient treatment (83 ± 13 vs. 65 ± 19, p = 0.03), less hyperglycemia prior to (2.7 ± 4.5 vs. 4.5 ± 1.4, p = 0.03) and during hospitalization (3.9 ± 1.9 vs. 5.5 ± 1.2, p = 0.04); and had lower mean discharge CBG (159 ± 38 mg/dL vs. 211 ± 67 mg/dL, p = 0.02).ConclusionsInpatient diabetes education has potential to improve treatment satisfaction, and reduce CBG.     

螨制剂舌下免疫治疗对单一和多重致敏变应性鼻炎的疗效评估

目的观察单一和多重变应性鼻炎患者舌下脱敏的疗效异同并分析原因。方法回顾性分析舌下脱敏治疗1年以上单一和多重变应性鼻炎患者终止治疗1年后的疗效,并对粉尘螨变应原组分与其他点刺变应原作同源进化树分析。结果纳入患者50例,舌下免疫治疗显效22例,有效15例,无效13例,总有效率为74%。50例患者中30例(60%)为多重变态反应患者,阳性率最高的前3种变应原依次为蟑螂(83%)、冬季花粉(70%)和蚕丝(63%)。用有序多分类资料比较的秩和检验分析舌下脱敏治疗1年以上单一尘螨过敏患者与多重变态反应患者的疗效,两组总体分布相同。结论使用舌下含服粉尘螨滴剂治疗变应性鼻炎,多重与单一尘螨变态反应患者治疗效果相当。粉尘螨滴剂亦可用于多重变态反应患者常规治疗。     

How national context,project design,and local community characteristics influence success in community-based conservation projects

Community-based conservation (CBC) promotes the idea that conservation success requires engaging with, and providing benefits for, local communities. However, CBC projects are neither consistently successful nor free of controversy. Innovative recent studies evaluating the factors associated with success and failure typically examine only a single resource domain, have limited geographic scope, consider only one outcome, or ignore the nested nature of socioecological systems. To remedy these issues, we use a global comparative database of CBC projects identified by systematic review to evaluate success in four outcome domains (attitudes, behaviors, ecological, economic) and explore synergies and trade-offs among these outcomes. We test hypotheses about how features of the national context, project design, and local community characteristics affect these measures of success. Using bivariate analyses and multivariate proportional odds logistic regressions within a multilevel analysis and model-fitting framework, we show that project design, particularly capacity-building in local communities, is associated with success across all outcomes. In addition, some characteristics of the local community in which projects are conducted, such as tenure regimes and supportive cultural beliefs and institutions, are important for project success. Surprisingly, there is little evidence that national context systematically influences project outcomes. We also find evidence of synergies between pairs of outcomes, particularly between ecological and economic success. We suggest that well-designed and implemented projects can overcome many of the obstacles imposed by local and national conditions to succeed in multiple domains.     

正畸支抗之“惑”

与医学其他学科一样,口腔正畸学也不乏用模糊概念来取代精确测量的习惯做法,正畸支抗控制便是其中之一。随着循证医学的发展,正畸医师越来越重视临床证据的准确性,于是,以往对于正畸支抗控制的经验性描述逐渐显露出其弊端。本文根据笔者近年来对支抗的系列研究结果,阐述了最大支抗传统概念的模糊性、定量测量支抗丧失时常被忽略的问题及解决方法,并讨论了最大支抗的限度问题。     

Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût

Purpose

Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.

Methods

This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.

Results

Our study showed a significant decrease in the number of drugs (mean  ±  standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.

Conclusion

Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted.     

Facilitating change in health-related behaviors and intentions: a randomized controlled trial of a multidimensional memory program for older adults†

Objectives: Many older adults are concerned about memory changes with age and consequently seek ways to optimize their memory function. Memory programs are known to be variably effective in improving memory knowledge, other aspects of metamemory, and/or objective memory, but little is known about their impact on implementing and sustaining lifestyle and healthcare-seeking intentions and behaviors.

Methods: We evaluated a multidimensional, evidence-based intervention, the Memory and Aging Program, that provides education about memory and memory change, training in the use of practical memory strategies, and support for implementation of healthy lifestyle behavior changes. In a randomized controlled trial, 42 healthy older adults participated in a program (n = 21) or a waitlist control (n = 21) group.

Results: Relative to the control group, participants in the program implemented more healthy lifestyle behaviors by the end of the program and maintained these changes 1 month later. Similarly, program participants reported a decreased intention to seek unnecessary medical attention for their memory immediately after the program and 1 month later.

Conclusions: Findings support the use of multidimensional memory programs to promote healthy lifestyles and influence healthcare-seeking behaviors. Discussion focuses on implications of these changes for maximizing cognitive health and minimizing impact on healthcare resources.