bluuebunny/crossref_metadata_2025 huggingface dataset:
The ambivalent dynamics of loyalty in mentorship
Authors: Oglensky Bonnie D.
Published: April 2008

This investigation shows that mentorship loyalty is an ambivalent source of tension in the relationship. Data from in-depth interviews show that the mentoring attachment that is rooted in a protective, devoted, affectionate side of loyalty can also compel conformity, suppress dissent, and curb professional growth. The ambivalence stirred up by loyalty issues manifests itself in the nuts and bolts of ordinary interaction. Consideration about what each party `does' for the other, what they are willing to give up or sacrifice for the other, and what each party comes to expect from the other in return evoke conflicts between strategic, emotional, and normative strivings. Ritualized expressions of loyalty — involving material and emotional work — reflect the asymmetry in the mentor—protégé authority relationship. Implications for mentoring theory and practice are discussed.
Coping With Pain in the Motivational Context of Values
Authors: Páez-Blarrina Marisa , Luciano Carmen , Gutiérrez-Martínez Olga , Valdivia Sonsoles , Rodríguez-Valverde Miguel , Ortega Jose
Published: April 2008

This study compares the effect of an acceptance-based protocol (ACT) and a cognitive control—based (CONT) protocol on three measures of pain coping: tolerance, self-report, and believability. Specific methodological controls were employed to further isolate the role of the value of participating in a pain task, compared to previous investigations on the alteration of the function of aversive stimulation. Twenty participants were randomly assigned to one of the conditions (ACT vs. CONT), and a pre—post design was used. In the ACT condition, the protocol established a relation of coordination between the pain-related thoughts and the actions in the valued direction. In the CONT condition, the protocol established a relation of opposition between the same aspects. Results show an increase in pain tolerance and a reduction of self-reported pain at posttest for both conditions. However, ACT participants showed significantly lower believability of pain than did CONT participants. Conceptual and clinical implications are discussed.
Use of Clinical Practice Recommendations for Exercise by Individuals With Type 1 Diabetes
Authors: Colberg Sheri R.
Published: April 2008

PURPOSE

The purposes of this study were to determine the extent to which physically active individuals with type 1 diabetes actually follow exercise recommendations and to compare their use of current with previous recommendations.

METHODS

A questionnaire was developed consisting of the American Diabetes Association's current clinical practice recommendations for exercise and some previous recommendations. The questionnaire was mailed to approximately 1700 members of the International Diabetic Athletes Association; responses from 238 questionnaires were included in the results. Respondents indicated to what extent they currently use all of these recommendations and any modifications that they employ.

RESULTS

The responses indicated that individuals with type 1 diabetes closely followed the majority of the current clinical exercise recommendations and did so to a greater extent than previous ones. Individuals' specific modifications to the current recommendations are summarized.

CONCLUSIONS

The current clinical practice recommendations are used by exercisers with diabetes and are followed more closely than previous ones. The significant number of reported modifications made by individuals indicates, however, that a substantial need still exists to modify and individualize the recommendations.
Recommendations of Dietitians for Overcoming Barriers to Dietary Adherence in Individuals With Diabetes
Authors: Williamson Amy R. , Hunt Alice E. , Pope Janet F. , Tolman Nancy M.
Published: April 2008

PURPOSE

The purposes of this research were to (1) identify factors that contribute to the barriers to dietary adherence in individuals with diabetes identified in a 1998 study and (2) obtain recommendations from registered dietitians for strategies to overcome these barriers.

METHODS

A 10-item, open-ended telephone questionnaire was used to obtain information. The sample included 75 registered dietitians who participated in a previous survey to identify barriers and agreed to a follow-up telephone interview.

RESULTS

Of the 75 participants, 28% reported spending 5 hours or less per week counseling individuals with diabetes, 64% spent between 6 and 30 hours, and 8% spent more than 31 hours per week. Almost half of the participants (47%) were certified diabetes educators. Factors identified as the greatest contributors to the barriers being evaluated included lack of time, lack of symptoms, lack of education (including follow-up), poor self-esteem/lack of empowerment, and misinformation from family/peers/others with diabetes. The primary recommendations for overcoming each of these barriers included individualizing meal plans and planning ahead, teaching about complications, and setting obtainable goals.

CONCLUSIONS

The registered dietitians who were surveyed emphasized the importance of individualizing dietary counseling.
A Stress Management Intervention for Adolescents With Type I Diabetes
Authors: Hains Anthony A. , Davies W. Hobart , Parton Elaine , Totka Joan , Amoroso-Camarata Jo
Published: April 2008

PURPOSE

The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes cope with stress.

METHODS

Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies. Treatment impact was assessed on measures of coping, anxiety level, diabetes-specific stress, and metabolic control.

RESULTS

Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up. However, the small sample size and within-group variability may have precluded finding significant results. Therefore, within-group comparisons were conducted, and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety, stress, and coping measures. No differences were found in the control group.

CONCLUSIONS

Results suggest that the intervention had some positive impact, although this interpretation must be considered preliminary. Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific populations.
Issues for the Coming Age of Continuous Glucose Monitoring
Authors: Pichert James W. , Campbell Keith , Cox Daniel J. , D'Lugin Jay J. , Moffat James W. , Polonsky William H. ,   The Psychology of Glucose Data Proliferation Symposium Group
Published: April 2008

PURPOSE

this article reports the results of a symposium in which diabetes educators considered and discussed issues that are likely to arise when continuous glucose monitoring (CGM) becomes available and readily accessible.

METHODS

Fifteen certified diabetes educators and 5 others with complementary expertise participated in a discussion based on their responses to 11 questions designed to elicit perspectives on issues related to CGM. Issues for discussion and debate include those related to patient acceptance and lifestyle, implications for professional practice and reimbursement, concerns about professional liability, use of CGM data by insurers and payers, and CGM data transfer.

RESULTS

Educators offered varied and sometimes conflicting responses to CGM-related issues.

CONCLUSIONS

Awareness of CGM-related issues will likely become an important part of diabetes professional development and perspectives in practice. Identifying and framing the issues before the new technologies become available allow diabetes educators to participate proactively in structuring the emerging policies, procedures, and standards of care.
Identifying Variables Associated With Inaccurate Self-Monitoring of Blood Glucose: Proposed Guidelines to Improve Accuracy
Authors: Bergenstal Richard , Pearson Jan , Cembrowski George S. , Bina Dawn , Davidson Janet , List Sue
Published: April 2008

PURPOSE

this study was conducted to evaluate patients' proficiency in self-monitoring of blood glucose (SMBG).

METHODS

Diabetes nurse educators in 4 suburban Minneapolis clinic sites surveyed the SMBG training/cure practices of 280 patients with type 1 and type 2 diabetes. Participant SMBG technique was measured by direct observation. Participants performed a finger puncture and used their own meters to measure the first blood sample. A second sample was measured on the HemoCue B Glucose analyzer, and a third sample was used to measure hemoglobin. The series of tests were then repeated. If either of the 2 glucose tests was more than 15% from the HemoCue value, participants were reeducated about the manufacturer's suggested procedure.

RESULTS

Of the 280 participants, 19% had blood glucose test results greater than the 15% limit for meter accuracy. After reeducation, 69% of those who had initially failed achieved acceptable results. The most significant problems were lack of periodic meter technique evaluation, difficulty using wipe meters, incorrect use of control solutions, lack of hand washing even when observed, and unclean meters.

CONCLUSIONS

As a result of the study, guidelines were subsequently developed to evaluate meter accuracy in an outpatient setting. Further effort is needed to establish standards for evaluating SMBG.
The Impact of Barriers and Self-Efficacy on Self-Care Behaviors in Type 2 Diabetes
Authors: Aljasem Layla I. , Peyrot Mark , Wissow Larry , Rubin Richard R.
Published: April 2008

PURPOSE

this cross-sectional, correlational study examined the relationships of diabetes-specific treatment barriers and self-efficacy with self-care behaviors.

METHODS

A total of 309 people with type 2 diabetes participated in this study. All of the factors were assessed by selfreport questionnaires. Self-care behaviors included exercise, diet, skipping medication, testing blood for glucose, adjusting insulin to avoid or correct hyperglycemia, and adjusting diet to avoid or correct hypoglycemia.

RESULTS

Perceived barriers to carrying out self-care behaviors were associated with worse diet and exercise behavior. Greater selfefficacy predicted more frequent blood glucose testing, less frequent skipping of medication and binge eating, and closer adherence to an ideal diet. Nontraditional dimensions of selfefficacy were associated with worse self-care. Self-efficacy explained 4% to 10% of the variance in diabetes self-care behaviors beyond that accounted for by patient characteristics and health beliefs about barriers.

CONCLUSIONS

The findings of this study provided support for Rosenstock's proposal that a person's self-perceived capability to carry out a behavior should be incorporated into an expanded health belief model.
A Quality Improvement Project for Better Glycemic Control in Hospitalized Patients With Diabetes
Authors: Gilman Judy A.
Published: April 2008

PURPOSE

a quality improvement (QI) study was designed to improve nursing interventions that impact glycemic control in hospitalized patients with diabetes. The objective was to improve the timing of premeal insulin to allow a half hour lag time for regular insulin.

METHODS

An interdisciplinary planning team was established that included both medical and surgical units. Data were collected by concurrent review of electronic charts, evaluated monthly by management and the diabetes clinical coordinator, and shared with staff.

RESULTS

This QI study increased staff nurses' awareness of the importance of their role in achieving better glycemic control for inpatients with diabetes. By the end of the study, the nurses delivered premeal insulin correctly 82% of the time on the medical unit, 65% of the time on the cardiac unit, and 61% of the time on the surgical unit. Even with concerted effort, however, it was difficult to consistently administer regular insulin with a half hour lag time in the hospital environment.

CONCLUSIONS

By working together with the patient, family, and other staff, nurses can more consistently deliver premeal insulin at appropriate times to help improve glycemic control in the hospitalized patient with diabetes.
A Diabetes-Specific Measure of Patient Desire to Participate in Medical Decision Making
Authors: Golin Carol E. , DIMatteo MR , Leaks Barbara , Duan Nalhua , Gelberg Lillian
Published: April 2008

PURPOSE

the goal of this study was to develop a diabetesspecific scale of patient desire to participate in medical decision making (DPMD) and examine its internal consistency reliability, stability, and validity (content, discriminant, convergent, and construct).

METHODS

In a cross-sectional study, 65 patients with type 2 diabetes from a teaching hospital's general medical clinic were interviewed at baseline and 2 weeks later to measure their DPMD scores. Data were collected on demographic/clinical features, health value, social support, desire to make a final decision, and value of patient autonomy.

RESULTS

Of the 11 DPMD items, 2 distinct factors emerged representing desire for discussion and desire for information. The DPMD scale had high internal consistency reliability, was stable over 2 weeks and demonstrated good content validity. DPMD scale items were more correlated with each other than with health value or social support. Overall, patients who obtained diabetes education reported greater desire to participate in decisions. Younger patients had a greater overall desire for discussion. The DPMD desire for discussion subscale correlated with patients' desire to make the final treatment decision but not with patients' value of autonomy.

CONCLUSIONS The DPMD is a brief, reliable, valid measure for assessing patient desire to participate in diabetes medical decision making.
The Content, Integrity, and Efficacy of a Nurse Coaching Intervention in Type 2 Diabetes
Authors: Whittemore Robin , Chase Susan , Mandle Carol Lynn , Roy Sister Callsta
Published: April 2008

PURPOSE

the purpose of this study was to systematically evaluate the content, integrity, and efficacy of a nurse coaching intervention provided after diabetes education that focused on dietary and exercise lifestyle change in persons with type 2 diabetes.

METHODS

A multimethod design incorporated an interpretive approach to examine the content and integrity of the intervention and a multiple-baseline, single-subject method to determine the preliminary efficacy of the intervention.

RESULTS

The primary strategies of the nurse coaching intervention consisted of facilitating lifestyle change through educational reinforcement, psychosocial support, and motivational guidance. Aggregate quantitative outcomes revealed a modest increase in health-promoting behaviors and a decrease in fasting blood glucose, indicating a trend toward physiologic adaptation. Participants demonstrated a significant increase in integration reflective of psychosocial adaptation.

CONCLUSIONS

Providing individualized nursing care after diabetes education may improve health outcomes and the quality of life of persons newly diagnosed with type 2 diabetes. This multimethod design is a cost-effective approach for preliminary evaluation of complex and/or novel interventions.
Feasibility of a Health Promotion Intervention for a Group of Predominantly African American Women With Type 2 Diabetes
Authors: Rimmer James H. , Silverman Katie , Braunschweig Carol , Quinn Laurie , Liu Yang
Published: April 2008

PURPOSE

this feasibility study was undertaken to determine if a group of predominantly low-income, low-education, African American women with type 2 diabetes could achieve good compliance and improved health outcomes with a carefully structured health promotion intervention.

METHODS

The sample consisted of 30 participants from an urban setting who were diagnosed with type 2 diabetes but also had multiple chronic conditions (eg, obesity, hypertension, joint pain, and depression). Participants attended a university-based health promotion program where they completed a 12-week intervention that addressed diet, nutrition, and health behavior. Transportation was provided at no cost to the participants.

RESULTS

Compliance with the 12-week program was 72.5%. Participants made significant improvements in total cholesterol and LDL-cholesterol levels, cardiovascular fitness, muscular strength and endurance, and nutrition knowledge.

CONCLUSIONS

African American women with type 2 diabetes residing in difficult living environments (ie, poverty, high crime, and lack of family support) can achieve good compliance and health outcomes with a structured health promotion program provided that barriers to participation (eg, transportation, cost, and commitment) are removed prior to and during the intervention.
A Review of Measures of Self-Management of Type 1 Diabetes by Youth and Their Parents
Authors: Schilling Lynne S. , Grey Margaret , Knafl Kathleen A.
Published: April 2008

PURPOSE

The purpose of this paper was to identify and critique relevant existing instruments designed to measure self-management of type 1 diabetes in children and adolescents.

METHODS

Literature on the self-management of type 1 diabetes in children and adolescents was systematically searched to identify instruments measuring self-management. After eliminating instruments that measured only one aspect of self-management, those published prior to DCCT findings, and those for which little information was available, 6 instruments were identified for review. Each instrument is discussed in terms of history and description of the instrument, definitions, psychometrics, findings from studies using the instrument, availability of the instrument, and evaluation.

RESULTS

All of the instruments measure some of the activities of self-management; 1 expressly measures self-management; 1 measures the frequency of various self-care activities, and 4 measure adherence to prescribed diabetes regimens. Only 1 instrument comprehensively assesses the process of self-management. None measure the goals of self-management.

CONCLUSIONS

Instrument development has been hindered by the lack of clarity concerning the concept of self-management of type 1 diabetes in children and adolescents. Existing measures need to be further developed and new measures need to be designed.
Evaluating Group Visits in an Uninsured or Inadequately Insured Patient Population With Uncontrolled Type 2 Diabetes
Authors: Clancy Dawn E. , Cope Dennis W. , Magruder Kathryn Marley , Huang Peng , Salter Kathy H. , Fields Aleatha W.
Published: April 2008

PURPOSE

this study was conducted to evaluate the feasibility and acceptability of a managed-care approach (group visits) on delivering care to uninsured or inadequately insured patients with type 2 diabetes.

METHODS

One hundred twenty patients with uncontrolled type 2 diabetes were randomly assigned to receive care in group visits or usual care for 6 months. At baseline, 3 months, and 6 months, the feasibility and acceptability of this model of healthcare delivery were assessed through the patients' responses to the Primary Care Assessment Tool and the Trust in Physician Scale. Attendance records were kept for each group.

RESULTS

Patients who received care in group visits showed an improved sense of trust in their physician compared with patients who continued to receive usual care. There was a tendency for patients in groups to report better coordination of their care, better community orientation, and more culturally competent care. Patient attendance at the groups also indicated good acceptance of this form of healthcare delivery.

CONCLUSIONS

Group visits were feasible and acceptable to these uninsured and inadequately insured patients with uncontrolled type 2 diabetes and fostered an improved sense of trust in their physician.
Overcoming Obstacles to Behavior Change in Diabetes Self-Management
Authors: Hall Rosemary F. , Joseph Dayle Hunt , Schwartz-Barcott Donna
Published: April 2008

PURPOSE

this study describes how 5 individuals with type 2 diabetes overcame obstacles that interfered with maintaining behavior changes in diet, exercise, and self-monitoring of blood glucose (SMBG).

METHODS

In-depth interviews provided the framework for this descriptive study. During audiotaped, face-to-face, follow-up structured and unstructured interviews, the participants shared their experiences about obstacles encountered and strategies used to overcome them. Each case was examined independently, and all cases were then compared with each other.

RESULTS

Obstacles that interfered with maintaining a diet plan were hunger, planned and unplanned meal events, and the desire for new foods. Physical illness and unexpected life events were obstacles to maintaining an exercise and SMBG plan.

CONCLUSIONS

Health professionals who assist patients who are beginning behavior change or having difficulty maintaining changes need to have an understanding of the various obstacles and how patients can maintain behavior changes over time.
Exploring the Connection Between Self-Efficacy and Effective Diabetes Self-f Management
Authors: Krichbaum Kathleen , Aarestad Vivian , Buethe Marie
Published: April 2008

PURPOSE

the purpose of this study was to review the existing empirical evidence about factors that contribute to effective diabetes self-management as indicated by healthy outcomes in persons with the disease, with a specific focus on self-efficacy, to determine the link between learned self-efficacy and effective diabetes self-management in adults.

METHODS

A systematic review was conducted of the extant literature from 1985-2001 that described factors related to effective self-management of diabetes. The review included theoretical and empirical articles. The search engines included CINAHL, MEDLINE, PUBMED, and COCHRANE.

RESULTS

Empirical evidence supports the following factors to improve the education outcomes for adults with diabetes: involve people with diabetes in their own care, guide them in actively learning about the disease, explore their feelings about having the disease, and teach them the skills necessary to adjust their behavior to control their own health outcomes. Thus, the goal for educating people with diabetes is to improve their individual self-efficacy and, accordingly, their self-management ability.

CONCLUSIONS

Education sessions need to involve fewer lectures and more practical, interactive exercises that focus on developing specific skills. Follow-up contact is a valuable method for helping people make a healthy adjustment to living with diabetes.
Compliance From a Patient's Perspective
Authors: Hoover Joan
Published: April 2008

The non-compliant patient is a sub ject guaranteed to elevate the blood pressure of most diabetes health care professionals. But have you considered the frustration, the guilt, and the stigma of being labeled a non-compliant patient? It's an unfair burden to lay on someone who is already coping with this complex disease. For your sake, and that of your patient, we need a frank dis cussion of the reasons for non-com pliance. Then maybe we can treat the problem and not just its symp toms.
Diabetes And Amputations
Authors: Rowbotham John L.
Published: April 2008

Foot problems are due to either vascular or neuropathic causes. All methods of evaluation and initial treatment must be exhausted before amputation is considered. Indi cations and techniques of toe amputation, transmetatarsal (TMA), below the knee (BKA), and above the knee (AKA) amputations are discussed. Modern monitoring methods and safer anesthesia techniques have lowered the surgical risk for amputation for the diabetic.
Rote of the Special Dressing Service
Authors: Frasca Jance , Gray Michelle
Published: April 2008

The Special Dressing Service at the New England Deaconess Hospital has charge of dressings for diabetic foot problems such as infections, ulcers, and post operative care of vascular surgery and amputation. Responsibili ties of the SDS also include both pa tient and professional education. A care study of a woman requiring femoral-popliteal bypass surgery demonstrates the use of dressings.
Physical Therapy Management of Diabetics Undergoing Lower Extremity Amputations
Authors: Rizzo Nancy
Published: April 2008

The Rehabilitation Team at New Eng land Deaconess Hospital includes the surgical and medical attendees, the dressing nurse, physical therapist, and prosthetist. The importance of wound healing, dressings, and progressive ambulation is stressed. A study of 260 diabetic amputees gives a basis for the most appropriate post operative timing for initial exercises, ambulation, fitting of prosthesis, and training with the prosthesis.
A Competency Based Diabetes Diet Program
Authors: Argo Jana K. , Singh Rani H. , Ostapchenko Georjan
Published: April 2008

Competency based education is a systematic and effective approach to diet education. Of the 48 clients en rolled in this program, 20 completed the full course through the second month followup session. Although there was no significant change in fast ing blood glucose (p > .05), there was a significant weight change (p < .001).
Diabetes Education In Australia
Authors: Cusworth Sister Lesley
Published: April 2008

Australia is a large continent of 15 mil lion people, 3% of whom have dia betes. The interior, or outback, has few facilities for medical care. Diabetes Centres are located in the large south- eastern coastal towns like Melbourne and Sydney. During the last ten years the growth in diabetes education has resulted in specialists in diabetes edu cation, week-long programs for both patients and professionals, and the formation of an Australian Diabetes Educators Association which has 300 members.
Outcomes of a Diabetes Professional Education Seminar
Authors: Pichert James W.
Published: April 2008

Sixty seven practicing diabetes edu cators attended a day-long seminar on patient education in Nashville, Ten nessee. At the end of the conference, participants recorded specific inten tions to revise their practice and the extent of actual accomplishment was assessed via mail three months later. On the average, each participant listed just over three intentions and had a 60% implementation rate. Results are discussed in terms of the strengths and weaknesses of the evaluation tech nique.
Care of the Infant With Type I Diabetes Mellitus
Authors: Charron-Prochownik Denise , Schwartz Stephanie
Published: April 2008

The incidence of Type I diabetes mellitus in children less than two years of age appears to be on the increase. Management of this age group is ex tremely challenging. Education and management should be individualized and needs to focus specifically on this developmental stage.

This article will describe normal de velopmental milestones for the child less than two years of age and present the approach used at The Children's Hospital in Boston, Massachusetts in the management of Type I diabetes occurring in this age group.
A Volunteer Support Group For Parents of Children With Diabetes
Authors: Baumgardner Pat B. , Buss Barbara S. , Caldwell Annie-Margaret A. , Clement Suzanne T. , Dowling Nancy B. , Miller Bonnie G. , Berry Roy H. , Rinaldi F. William , Wheeler Frances C.
Published: April 2008

Because diabetes in a child has such a dramatic impact upon the whole family, a chapter of the ADA-South Carolina Affiliate formed a Parent Support Group to offer hospital visita tion opportunities for parents to share their emotional feelings and frustra tions, and to offer support and accept ance.
Who Said TV is just for Entertainment
Authors: Dries Linda , Ratazak Judy
Published: April 2008

The promotion of health education via closed circuit TV in a hospital set ting can be approached in a systematic manner, thus capitalizing on the ap peal of TV learning. Whoever said TV was just for entertainment is mistaken.
Ask a Pharmacist
Authors: Campbell R. Keith
Published: April 2008

The pharmacist is an important member of the diabetes teaching team. This department gives authoritative answers to your pharmaceu tical problems. Send your questions to head- quarters, care of Ask a Pharmacist.
Breaking the Cycle of Pain In Diabetic Peripheral Neuropathy
Authors: Lee Patricia Rahe
Published: April 2008

An attitude of helplessness pervades both patients and health professionals when dealing with the problems of dia betic peripheral neuropathy. Those afflicted are often over whelmed by the pain and find themselves unable to fulfill the daily requirements of their diabetes regimen. The in consistencies in amounts and timing of meals, levels of ac tivity, and scheduling of insulin injections can result in hyperglycemia, a state that has been found to correlate strongly with the occurrence of nerve damage. Thus the pain perpetrates itself. For the health professional, having to confront this devastating pain without objective factors to assess and few scientific treatment measures to offer con tributes to a sense of inadequacy and ignorance. It is fre quently assumed that "nothing can be done." In reality, health professionals do have something to offer the person suffering from this condition. First, they can provide infor mation about the relationship between control and compli cations, and explain the need for the patient to change those behaviors that may be perpetuating the pain. Sec ond, and most importantly, health professionals can con vey support and confidence, without which many patients will be unable to make the changes in their behavior neces sary to resolve their pain.
A Test of Instructional Approaches Designed to Influence Food selection
Authors: Maryniuk Melinda Downie , Kauwell Gail P.A. , Thomas R.G.
Published: April 2008

Eighty-nine children par ticipated in an education program designed to expose them to new foods and increase variety in their diet. Campers in an active involvement group prepared plain yogurt as part of their lesson in trying new foods; campers in a didactic instruction group had a traditional lecture/ discussion on trying new foods with a focus on yogurt; and a control group attended a general nutrition class. When campers were given a choice of a fruited yogurt pudding or peanut butter and crackers for a snack, children in the active involvement group were more likely to select the yogurt than were the children in the other groups.
Diabetes Self-Care Involvement in Children, Age Two to Four: Case Report
Authors: Atkin Kurt L.
Published: April 2008

The earliest that a young child with type I diabetes can begin to become ac tively involved in diabetes self-care is probably be tween the ages of 2 and 4 years, when he/she is beginning to follow sim ple instructions and com municate with parents. With encouragement, these young children can assume at least three main types of self-care respon sibilities: making choices, helping with diabetic skills, and communicating changes in their state of wellness. By increasing a child's involvement in diabetes self care, the educator and the parents assist the child's develop ment through allowing him more control over self and environment and helping him to learn how the diabetes regimen fits into the family's lifestyle.
Diabetes Patient Education: Nurse Specialist Approach
Authors: Guthrie Diana W.
Published: April 2008

The diabetes nurse specialist must possess many skills and be able to work in many settings with a variety of patients and with other profes sionals. This paper discusses the skills and knowledge required to deliver high-quality care to persons with diabetes mellitus and the kind of training that will best achieve this level of care. It is concluded that specialized professional training in diabetes management is necessary.
Diabetes Patient Education in Hospital Settings
Authors: Leichter Steven B.
Published: April 2008

Most American hospitals apparently do not offer formal programs of diabetes-related patient education. In many in stitutions, patient educa tion consists only of the provision of written materials or is assumed to be an informal respon sibility of the primary care nurse. Both of these instructional arrangements are inadequate: many written materials are too difficult for patients to read, and most floor nurses lack the training to carry out diabetes patient education. As a result, substantial gaps exist in patient knowledge and performance of essential aspects of self-care. These gaps appear unrecognized in many institutions.
Wide, Wide World of Diabetes Mellitus
Authors: Krall Leo P.
Published: April 2008

It is conservatively estimated that 100 million persons have diabetes. This paper presents an overview of diabetes worldwide; identifies some of the problems in diabetes health care, par ticularly among develop ing nations; and offers some possible solutions.
The Prevention of Plantar Ulceration in the Diabetic Foot Through the Use of Running Shoes
Authors: Soulier Scott M. , Godsey Cynthia , Asay Elvin D. , Perrotta Dennis M.
Published: April 2008

Many diabetes-related amputa tions are the result of plantar calluses that become ulcerated, infected, and gangrenous. One hundred diabetic volunteers with plantar calluses were studied for 18 months in Salt Lake City. The patients' calluses were measured monthly. To provide a base line for comparison, the patients wore regular shoes for a minimum of three months, after which they switched to run ning shoes. The study found that the wearing of running shoes reduced the size of the patients' calluses significantly, leading to the conclusion that running shoes may contribute to a reduc tion in foot problems of persons with diabetes.
Development of the Diabetes Health Belief Scale
Authors: Harris Rachel , Linn Margaret W. , Skyler Jay S. , Sandifer Richard
Published: April 2008

A Diabetes Health Belief Scale (DHBS) was developed to measure attitudes about diabetes care that could help to explain compliance with prescribed medical regimens. A preliminary version of the scale contained 71 items covering areas identified previously as important in determining health behavior. From pretesting of the scale, 40 items were selected for further study. Items were submitted to factor analysis to determine the dimensions measured. Seven factors using 38 items emerged that were relatively independent and reliable. Validity of the scale was tested by its ability to predict compliance with medical regimens six weeks later in 120 men. Compliance was measured by self-report and nurse's evaluation as well as by metabolic control of diabetes. Different factors were associated significantly with compliance and control. Although tested only on men, the DHBS should be useful in describing the health beliefs of diabetic patients and could suggest areas where intervention was needed to improve compliance.
Establishing and Operating a Third-Party Reimbursed Outpatient Diabetes Care Center
Authors: Abourizk Nicolas N. , Reardon George E. , Schnatz J. David
Published: April 2008

In treating diabetic persons, busy practitioners traditionally prefer hospitalization because they lack the time to assess patient needs and to educate the patient and initiate an individualized treatment plan. Regulation and education of newly diagnosed diabetes patients on an outpatient basis is implemented on a narrow scale nationwide because of limited data on effectiveness and the reluctance of third-party payers to reimburse this mode of therapy. We report our experience in establishing and operating a diabetes care center that offers a weekly outpatient program and that is reimbursed by private insurers, Blue Cross/Blue Shield, Medicare and Medicaid. The program provides education, psychologic support, clinical evaluation of diabetes, and initiation or adjustment of medications. Factors that we found important in achieving reimbursement are discussed.
The Therapeutic Role of Exercise in Diabetes Mellitus
Authors: Brown Stanleyp. , Thompson Walter R.
Published: April 2008

The holistic approach to the management of diabetes mellitus necessarily involves the use of exercise as part of the diabetic person's daily plan for proper glycemic control. The incorpo ration of "wellness"principles in the education of chronic disease patient populations has featured the importance of exercise and physical fitness in disease control and maintenance. Persons with diabetes are especially likely to be assisted by the therapeutic use of exercise training that reduces the secondary risk of medical compli cations such as cardiovascular degeneration, which leads to earlier mortality. This paper summarizes normal and diabetic carbohydrate metabolism and normal and diabetic exercise physiology. Understanding these is essential so that educators can communicate effectively the importance of a personalized fitness regimen for the daily management of diabetes mellitus.
Diabetes Secondary to Cystic Fibrosis: An Increasing Clinical Problem
Authors: Nettles Anne T. , Weinhandl Joyce
Published: April 2008

As children with cystic fibrosis (CF) survive longer, some who reach young adulthood are developing diabetes secondary to CF. The challenge to diabetes educators in managing these patients is to incorporate basic diabetes treatment into a life-style that includes chronic infections, variable food intakes, multiple demands on time for self-care procedures, and the psychosocial problems posed by cystic fibrosis. Of particular concern is a meal plan that will attain and maintain a desirable body weight and yet control blood glucose levels.
Diabetes Care Organization, Process, and Patient Outcomes: Effects of a Diabetes Control Program
Authors: Carlson Anita , Rosenqvist Urban
Published: April 2008

Effects of a diabetes control program were evaluated in 17 primary health centers after 18 months'participation (17 nonparticipating centers served as controls). Studied were the effects of the program on the organization of diabetes care, on the process of care in terms ofservices delivered to patients, and on the outcomes of care as measured by improved self care, dietary knowledge, and HbA1c values. While findings showed that patientsfrom the intervention centers received a higher quality of service and monitored their blood glucose levels more often than did patients from the control centers, they did not demonstrate significantly better metabolic control. The reasons for this, and ways to improve the program are discussed.
Spaseeba Balshohyi-Kharohshiyi! (Thank you very much—it was great!)
Authors: Franz Marion J.
Published: April 2008

In January 1990, as partial fulfillment of a 5-year contract to train Soviet health professionals, a six-person team from the International Diabetes Center went to Moscow to present a program on diabetes education and management to 45 of the USSR's leading endocrinologists and 20 physicians from Moscow's Central Institute for Advanced Medical Studies. The IDC team found a nation faced with major problems and shortages but filled with physicians and patients eager to learn and ready to act. Diabetes education as practiced in the United States is unknown in the Soviet Union, but through training programs such as this, the Soviets are updating and expanding their knowledge of diabetes education and management.
Diabetes Education in a Mexican-American Population: Pilot Testing of a Research-Based Videotape
Authors: Brown Sharon A. , Duchin Sally P. , Villagomez Evangelina T
Published: April 2008

A diabetes education videotape was designed and pilot tested in a sample of 30 Spanish-speaking Hispanic diabetic adults in a rural Texas-Mexico border community. The videotape provided an overview of diabetes, with emphasis on the concept of blood glucose; relationships between food, medications, exercise, and blood glucose levels; and blood glucose monitoring. Outcomes of videotape effectiveness were based on a 20-item knowledge test and interview data to assess acceptability of videotapes as a learning tool. Comparison of the knowledge test scores of the experimental group (those who viewed the tape before taking the knowledge test) with the control group (those who took the test before viewing the tape) produced a positive, moderate effect size of 0.61. Interviews with subjects indicated enthusiastic acceptance of the videotape as a means of transmitting diabetes information.
Screening for Diabetic Retinopathy in Communities
Authors: Stepien Cathie J. , Bowbeer Marilyn A. , Hiss Roland G.
Published: April 2008

Twelve retinopathy screening clinics serving 489 diabetic patients were conducted in three Michigan communities as part of the outreach effort of the Michigan Diabetes Research and Training Center. Screening activities were initiated by local diabetes educators who conducted a program designed to promote detection of diabetic eye disease and increase patient and health care provider awareness of accepted ophthalmic evaluation guidelines. This experience suggests that retinopathy screening clinics can be successfully conducted if health care professionals in the community consider diabetic retinopathy to be a serious problem, one individual is willing to oversee the organizational aspects of the clinic, and an ophthalmologist with laser treatment capability is present or nearby. These clinics are effective in detecting diabetic eye disease and facilitating subsequent patient visits to an ophthalmologist for evaluation in accordance with national recommendations.
Pancreas Transplantation: A University of Minnesota Perspective
Authors: Nettles Anne T.
Published: April 2008

Because of various difficulties, transplantation is restricted to specific situations. Surgery is considered elective by many insurers, so costs are often borne by the patient. Surgical work-up includes a thorough evaluation of diabetes-related complications, tissue typing, psychological state, and social issues. Options of cadaver versus living related donors are explored. The surgical procedure is lengthy and the hospital stay long and intensive. Once a patient is ambulatory, education is begun to meet the extensive learning needs. After discharge, surgical follow-up focuses primarily on blood chemistries, medication doses, and surgical complications. Medical follow-up includes monitoring for infections and rejection as well as addressing long-term complications of diabetes. Studies of the effects of transplantation on diabetes complications are encouraging which, when coupled with improved surgical outcomes, may increase opportunities for transplant.
Parents of Children With Diabetes: What Are They Worried About?
Authors: Vandagriff Julie L. , Marrero David G. , Ingersoll Gary M. , Fineberg Naomi S.
Published: April 2008

Parental worries, specific to having a child with diabetes, have been associated with poor diabetes control. This study addressed three questions relating to this issue: Does parental worry affect the metabolic control of the child with IDDM? What specific aspects of diabetes are the most worrisome to parents? Do these concerns change with the child's age and disease duration? Parents of 93 children with IDDM were given a modified version of the Diabetes Quality of Life measure to evaluate diahetes-specific worries. No correlation was found between parental worry and the child's metabolic control. Parents of younger children expressed the largest amount of worry, yet the kinds of things that parents were most concerned about were the same, regardless of age or duration of the child's disease.
Coping With a Chronic Disease
Authors: Wikblad Karin F.
Published: April 2008

Interviews were conducted with 55 experienced patients with insulin-dependent diabetes with the aim of identifying strategies for coping with diabetes. This study was based on a health-oriented approach known as Antonovsky's salutogenic model, which conceptualizes the person as being actively involved in maintaining biological, psychological, and social homeostasis. All patients had developed some strategy for maintaining biological balance. Twenty-two also had strategies for coping both psychologically and socially with the disease. The remaining 33 patients had developed either a psychological or a social strategy in addition to their biological strategies. The results indicate that it is important for the patient's well-being and self-esteem to establish all three coping strategies-biological, psychological, and social. The diabetes care team could be a valuable resource for the patient in this respect.
Vitamin and Mineral Supplementation in Patients with Diabetes Mellitus
Authors: Baker Danial E. , Campbell R. Keith
Published: April 2008

Most patients with diabetes generally do not require routine vitamin and mineral supplementation, just like the rest of the population. However, based on the published medical literature, it would appear that some degree of supplementation with certain vitamins (eg, vitamins C and E) and minerals (eg, magnesium) may be worthwhile and become more commonly recommended in the future. The role of vitamins and minerals in controlling blood glucose levels in the patients with diabetes also is discussed.
The Effectiveness of Parents Teaching Elementary School Teachers About Diabetes Mellitus
Authors: Jarrett Lucie , Hillam Kandy , Bartsch Cathy , Lindsay Rob
Published: April 2008

A program to teach parents how to instruct elementary school teachers about children with diabetes mellitus was evaluated using a 14-point questionnaire prior to intervention and 6 to 8 weeks after intervention. There was a significant improvement in many aspects of the teacher's knowledge of diabetes, although a few basic concepts remained unclear. We feel that refining the presentation and repeating the program as teachers encounter more children with diabetes will provide effective basic diabetes education to the elementary school teacher.
Resistance Training Guidelines For Individuals With Diabetes Mellitus
Authors: Soukup Jeffrey T. , Maynard Timothy S. , Kovaleski John E.
Published: April 2008

Resistance/strength training is added to an exercise regimen to create a well-rounded program that enhances muscular conditioning and improves health, physicalfitness, and/or athletic peformance. This article presents resistance training guidelines for individuals with diabetes mellitus, with and without vascular complications. The existing literature concerning exercise prescription and the acute and chronic physiological responses to resistive-type exercise is discussed. The educator is provided with principles that govern resistance training so that safe and effective programs can be prescribed for individuals with diabetes.
Situational Obstacles to Adherence for Adolescents with Diabetes
Authors: Schlundt David G. , Pichert James W. , Rea Melinda R. , Puryear Wonder , Penha Marie L.I. , Kline Susan S.
Published: April 2008

Twenty adolescents with insulin -dependent diabetes mellitus were interviewed to obtain samples of problem situations that create obstacles to dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 stimulus features. A hierarchical cluster analysis was used to identify 10 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbidden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when home, alone, or bored; and social pressure to eat. Diabetes educators should consider an individual's ability to cope with this array of obstacles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.