bluuebunny/crossref_metadata_2025 huggingface dataset:
An Interagency Effort for Media Development
Authors: Kass Pearl , Exelbert Lois , Romero Renee , Hurtak Pat
Published: April 2008

Synopsis: Multidisciplinary health professionals from six competing health care agencies jointly created patient education materials for their mutual use. The group process and challenges of planning are discussed as well as the resulting series of flip- charts.
Initiation of Insulin Pump Therapy in the Ambulatory Setting
Authors: D'Agostino Margaret , Bucholtz Joan Lieber , Pelle Anita , Robins Bernard , Bucholtz Harvey K.
Published: April 2008

Insulin pump therapy can be successfully initiated in an ambulatory setting if the patient's motivation is high, the health care team is available 24 hours a day, and a comprehensive educational program is implemented. Details of patient selection and teaching sessions are discussed.
The Nutritional Therapy of Non-Insulin Dependent (Type II) Diabetes
Authors: Crapo Phyllis
Published: April 2008

Confusion in the dietary manage ment of diabetes often arises from the lack of distinction between the two main types of diabetes and the dra matic difference in their dietary man agement. For obese Type II (NIDDM) diabetic individuals the achievement and maintenance of a desirable body weight is the primary nutritional goal of therapy. Other goals include achieving euglycemia and attempting to minimize the vascular manifesta tions of diabetes by correcting lipid ab normalities. Goals and nutritional strategies must be clearly understood so that concepts can be applied indi vidually. The optimal nutrient content of a diabetic diet (C, P, F) cannot yet be precisely defined and may be differ ent for different individuals. Dietary fiber may help to lower the blood glu cose and lipids, and natural foods con taining unrefined carbohydrates and fiber are recommended. Many nutri tive and non-nutritive sweeteners are on the market and, with some appro priate restrictions, can be used. With continual research and the emergence of new facts, it is inevitable that nutri tional recommendations will change.
Staff Nurses as Patient Educators
Authors: Weinzierl Sondra
Published: April 2008

Most staff nurses were hesitant to initiate diabetes teach ing because they lacked clear expectations and were un comfortable about their knowledge and ability. The dia betes educator, using a problem-solving approach, pro vided clear guidelines for teaching, revised the Diabetes Chart Form, lengthened the monthly inservice meeting to include methods and expectations for staff teaching, and initiated a one-to-one Diabetes Orientation Day for each of 20 staff nurses. One year later an audit showed a mean of 95 % score in four areas of teaching compared to a mean of 61 % five years earlier.
Reactions of Diabetic Children and Their Parents to Advertising by Diabetes Organizations
Authors: Silverstein Janet H. , Spillar Rebecca P. , Rosenbloom Arlan L.
Published: April 2008

Sixty-two campers with diabetes, aged 12 to 15 years, and 77 of their parents were asked to complete ques tionnaires asking about their reactions to television, radio, and newspaper advertisements from the 1981-82 ad vertising campaigns of the Juvenile Diabetes Foundation and the Ameri can Diabetes Association. Eighty- seven percent of the children and 56 % of the parents were motivated to try harder to take care of the diabetes. 27% of children and 39 % of parents were more worried about the child's diabetes after viewing the ads, but only 6% of children and 4% of parents felt there was little hope. All considered TV the most effective advertising medium and most thought that the educational, motivational, and fund- raising potential of the ads outweighed any negative aspects, such as inducing fear in young patients.
Using Change Theory to Help the Diabetic
Authors: Bailey Brenda J.
Published: April 2008

A framework that offers a rich appreciation of the client's needs is that of change theory. Planned change includes unfreezing from the present situation, changing, and re freezing into the revised situation. Educators should be aware of the types of resistance to change as well as the strategies used to effect change. Working collaboratively with the client is the suggested approach.
Patient Burnout, and Other Reasons for Noncompliance
Authors: Hoover Joan Williams
Published: April 2008

Patients, as well as healthcare pro fessionals, can suffer from "burnout." The author suggests that the constant stress and frustration of diabetes man agement can lead to "patient burn out. " When considering patient com pliance healthcare professionals should be aware of this phenomenon as well as their own attitudes and ap proaches toward the patient.
Child Protective Services In Parental Mismanagement Of Diabetes
Authors: Cantwell Hendrika B.
Published: April 2008

Two cases of childhood diabetes are presented in which County Child Pro tective Services (CCPS) were re quested to intervene concerning medi cal neglect. The dynamics were quite different, but in both cases the child's diabetes was being neglectfully dealt with by the family. This resulted in one child being seriously emaciated with ascites and liver enlargement. The other child had been hospitalized eight times in the previous eleven months, each time presenting with severe keto acidosis. These cases are appropriate for referral to CCPS. Mismanagement of insulin dependent childhood dia betes may at times be more than "medical" neglect, becoming more like "Munchausen Syndrome by Proxy," or "Polle Syndrome. "
Camps for Children with Diabetes: A Philosophy and its Application
Authors: Travis Luther B. , Schreiner Barbara
Published: April 2008

The establishment of residential summer camps for children with dia betes has filled multiple needs: recrea tional, educational, and social. Provid ing a safe, fun, and productive sum mer program is the subject of this paper, with a focus on experiences ac cumulated over 25 years at one pro gram in Texas. Successful diabetes camps are forged from solid beliefs about diabetes management, high expectations, and qualifications of the medical staff, thoughtful and reasoned considerations of the purposes for camp, and the incorporation of know ledge about diabetes into quality, well- child care.
Effect of Meditation on Insulin Dependent Diabetes Mellitus
Authors: Maras Mary L. , Rinke Wolf J. , Stephens Carl R. , Boehm Timothy M. , yoga Hatha
Published: April 2008

Eight stable nonobese adults with insulin dependent diabetes were eval uated before, during, and after a four week program of daily meditation. There were no statistically significant changes in diabetes control parame ters including fasting serum glucose, two-hour postprandial serum glucose, HbA1c' and 24-hour urinary glucose. Patients did, however, express a sig nificantly (p < .05) improved percep tion of well being following meditation. Meditation may prove useful as an ad junctive treatment modality in the stress management of certain patients with IDDM.
A Mastery Learning Program for Self Blood Glucose Monitoring
Authors: Czech Melanie S.
Published: April 2008

According to Bloom's Mastery Learning Theory, no one is incapable of learning given enough time and an optimal environment. Through assess ment, individualized teaching strate gies are developed which attain the same objectives for everyone. In this article the theory is illustrated through its application to self blood glucose monitoring. A learning program and evaluation are described, and case studies are included as examples.
Breaking Away From Hospital Boundaries
Authors: Roome Donna L.
Published: April 2008

Diabetes educators often find themselves limited to teaching only the acutely ill within a hospital. Diabetics out side the institution must learn to care for themselves on a hit or miss basis. Stepping outside of the hospital bound aries and opening doors to the public not only increases job satisfaction but provides information for diabetics on a longterm basis. Gathering professional personnel, gain ing the support of the administration, and contacting out side resources such as public health nurses, pharmacists, endocrinologists, state health department staff, drug sales representatives, and diabetes organizations are all helpful in creating a diabetes program to educate the community.
The Effectiveness of Diabetes Education for Non-Insulin-Dependent Diabetic Persons
Authors: Scott Russell S. , Beaven Donald W. , Stafford John M.
Published: April 2008

Individuals with noninsulin depend ent diabetes mellitus referred to a dia betes education programme were al located at random to treatment (n = 32) or non-treatment (n = 28) groups to assess the effectiveness of this pro gramme. The education course lasted four weeks, at the end of which the participants showed reductions of HbA1c and post-prandial glucose levels, improvement in knowledge and less anxiety. On the other hand, the control group experienced more anxiety and did not show significant changes in measured indices of glu cose control. Nevertheless, these im provements in glucose control were not sustained. Within four weeks of cessation of the intervention pro gramme, HbA1c and glucose levels were not significantly different from those measured at entry to the pro gramme. In addition, a delay of four weeks from the time of referral until initiation of education was associated with lack of significant reduction of HbA1c and glucose levels.
Modifying Dietitians' Use of Patient Time
Authors: Pichert James W. , Hanson Stephanie L. , Pechmann Connie A.
Published: April 2008

Recent research indicates that as sessment time does not positively cor relate with patient understanding. By having patients complete a 24-hour recall form in the waiting room, we at tempted to reduce assessment time during the dietary interview, thereby providing more opportunity for in struction. Fifty-seven diabetic patients were randomly assigned to the 24- hour recall group, a dietary interest in ventory group, or a control group. The 24-hour group spent less assess ment time with the dietitian, but in structional time did not increase. This research suggests that clinicians may need to be taught to take advantage of time savings brought about by the introduction of support systems.
Nursing Care of the Biostator Patient
Authors: Witt Laurel , Fuqua Laurel , Young Alma , Jones Mary Jo
Published: April 2008

The majority of patients placed on the Biostator are either brittle Type I diabetics, pregnant diabetics, or pre- pump patients. Nursing care is coupled with an interdisci plinary team approach in order to assist the patient to bal ance nutrition, exercise, and insulin requirements. Biosta tor patients are involved in an extensive diabetes education program that includes individual instruction as well as group activities. This article provides information on how diabetes patient education can be enhanced through knowledge gained from the Biostator run. Nursing care is comprehensive and complex. Although the Biostator is supervised by an endocrinologist, various procedures are performed by specially trained nurses such as set-up of the instrument, connecting the patient to the Biostator, calibrat ing the instrument, and programming the computer. The responsibilities of the monitor nurses, including drift checks, documentation, and trouble-shooting, are described in de tail. Since exercise and diet are major components of thera py for Biostator patients, the dietitian and physical therapist work closely with the monitor nurse in simulating the pa tient's normal daily activity. It has been our experience that caring for the Biostator patient involves comprehensive fol low-up. This article describes various components neces sary to accomplish this objective.
Exercise: A Vital Component for Patients on the Biostator
Authors: Summers Sally
Published: April 2008

Exercise was incorporated into the treatment of diabetic patients on the Biostator. As the purpose of the Bio stator is to determine the patient's in sulin requirements over a 24 hour pe riod, activity and exercise are impor tant to normalize that 24-hour period as much as possible.

Individual exercise programs were developed for each of the patients on the Biostator. The most common ex ercise vehicle chosen was a bicycle ergometer. Physical Therapy devel oped these programs based on the pa tient's "Home Activity Assessment. " Nursing and Physical Therapy then monitored the patient's compliance with the exercise program during the "run" on the Biostator.

The Biostator print-out (see Table I, p. 13) was used in a retrospective study of the effect of exercise on the patient's blood glucose levels. It was found that the median decrease in blood sugar immediately after cessa tion of exercise was - 6mgldl and for 15 minutes after cessation of exercise was — 12mg/dl. Empirical data is im portant to the patient so that they may balance exercise, diet, and insulin to keep blood glucose levels in control.
Biostator Education For Staff Development
Authors: Jacobson Bonnie
Published: April 2008

The Biostator Glucose Controller requires a profession al team that has received specialized training in setting up the machine, monitoring, and troubleshooting the system. The training program at United Hospitals of St. Paul covers a three-day orientation, plus further education for set-up and monitoring, hands on exploration through the use of worksheets and practicum assignments, and reviews of procedures every couple of months as needed.

One expanded role for a diabetes educator is that of the Biostator Nurse Specialist, who has the overall respon sibility for the Biostator and its operation. The technical education required of the nursing staff is delineated in this article in terms of specific competencies that are required, monitoring skills, and evaluation.
Aiding the Person who is Visually Impaired from Diabetes
Authors: Cleary Margaret E.
Published: April 2008

Some degree of diabetic retinopathy exists with alarm ing frequency in persons who have diabetes mellitus. The diabetes educator is often in a position to direct, teach, and counsel the patient who is involved in diagnosis, treat ment, and rehabilitation.

The educator's role may vary — offering an informed listening ear; providing simple explanations about the eye, the disease processes, and treatment; giving clear instruc tions about how to perform some activity independently; and directing the person to the appropriate resources for specialized assistance.

Being an expert in retinopathy or rehabilitation of per sons who are visually impaired is not necessary. Being in terested, innovative, aware, and curious can help the dia betes educator obtain the knowledge, skills, and direction that need to be imparted to the patient.

This article is offered to provide information about the effects of diabetic retinopathy on vision, the difficulties ex perienced by persons with both diabetes and visual impair ment, and helpful hints as a means of resolving some dilemmas. The text will indicate references where further information can be obtained. A numbered resource list will be found at the end.
Video Teacher: Peer Instruction
Authors: Gross Alan M. , Anderson Jean E. , Delcher Harry K. , Stiger Micky
Published: April 2008

Children can be motivated to learn procedures by having the opportunity both to view peer children on televi sion and by performing and seeing themselves on a videotape. This tech nique is easy to perform and is becom ing more available in hospitals.
CDC Diabetes Control Programs - Overview of Diabetes Patient Education
Authors: Alogna Maria
Published: April 2008

In 1974, Congress established the National Commission on Diabetes which recommended that the Centers for Disease Control implement the health care and educational com ponent of a Long Range Plan. In 1977, at the Commission's recom mendation, the CDC established Dia betes Control Programs in 20 states. The wide variety of interventions and special studies conducted by these states include patient and professional education projects as well as activities related to primary care, complications, and others such as insulin pump sur veillance and hypertension. This paper focuses on project activities, implementation, evaluation of educa tion interventions, and preliminary results of these programs.
Reagent Strip Performance as Evaluated by a Meter
Authors: Auerhahn Carolyn , Bergman Michael , Kumar Sunita Ravi , Morgan Joan
Published: April 2008

The stability of 98 Chemstrip bG (CS) was assessed with a specially de signed meter (Accu-Chek) to deter mine the length of time patient-read CS can be saved in order to evaluate the accuracy of self-monitoring. Visual readings of 70 CS from 21 patients were compared with meter readings immediately after capillary blood glu cose (CBG) determination to assess patient accuracy.

The rate with which meter-read CS changed was significant by three days (p<0.001). To determine the clinical significance of this change, the abso lute values of initial meter readings were compared to subsequent meter readings for 14 days. Significant changes in CBG values occurred after 5-10 days dependent upon the initial CBG value. If the initial CBG value was less than or equal to 180 mg/dl, CS deteriorated significantly after ten days. When the initial CBG value was greater than 180 mgldl, significant deterioration occurred after five days. Patient accuracy was found to be 97% ± 15.

In conclusion, (1) when properly stored, CS can be saved for up to ten days in order to assess individual pa tient accuracy in performing self-moni toring, and (2) despite considerable variability, patient interpretation of CS is accurate.
Ethnic Tailoring Improves Dietary Compliance
Authors: Maras Mary Lou , Adolphi Celia L.
Published: April 2008

Nutritional counseling for ethnic patients requires understanding and individualized tailoring to personal preferences. An appreciation and un derstanding of cultural differences may be enhanced by visiting ethnic markets and gourmet stores. Measuring units and equipment may be different in an ethnic household. Nutritional coun selors must also be careful to recognize that individual habits and customs oc cur within each ethnic group.
Auckland Diabetes Centre
Authors: Robinson Mary
Published: April 2008

The growing international exposure of AADE has led to a variety of contributions about diabetes education in other cultures. Those of greatest interest will be passed on to our readers.
Quality Control for Glucose Monitoring Programs
Authors: Peterson Charles M.
Published: April 2008

Patients and hospitals are increas ingly monitoring blood glucose with sticks or meters. Until recently little thought has been given to quality con trol of blood glucose measurements outside the laboratory whether per formed by professionals or patients. Quality control programs assess both the test and those who perform the test. Accuracy is determined by using reference specimens. Precision is doc umented by repeat measurements of a given sample. Statistical analyses of the results can provide quantitative limits of confidence for all concerned. Since the professional may be held ac countable for the accuracy and preci sion of tests performed outside the laboratory, it is encumbent upon all to become involved in programs of quali ty control.
A Comparison of the American Diabetes Association 1984 Diabetic Dietary Recommendations with the Food Intake of Individuals with Type II Diabetes
Authors: Kohn Harriet , Goddard Kathy
Published: April 2008

This article compares the actual eat ing patterns of a sampling of individ uals with Type II diabetes with the 1984 dietary recommendations for them from the American Diabetes Association (ADA). The subjects were 316 Type II diabetics enrolled in the Nebraska Diabetes Project in-home teaching study. Dietary intakes of the subjects were calculated and com pared with ADA recommendations. While the overall mean nutrient intake was good, a significant number of people were in need of education to improve in a number of dietary aspects. The deficient educational areas were identified as the following: improved distribution of percent of calories from protein, carbohydrate, and fat; decreased intake of saturated fatty acids; and increased vitamin A, vitamin C, and calcium. One of the most deficient areas in diabetes in struction was on weight control. The study found 66 percent of the subjects were obese.
The Health Belief Model Applied to Understanding Diabetes Regimen Compliance
Authors: Becker Marshall H. , Janz Nancy K.
Published: April 2008

Inadequate adherence to prescribed treatment plans is perhaps the most serious obstacle to achieving success ful therapeutic outcomes, and non compliance by diabetic patients is no exception. This is partly based on pa tients' realization that compliance does not necessarily result in lack of illness. A psychosocial framework for under standing patient compliance is the Health Belief Model, which is based upon the value an individual places on the identified goal and the likelihood that compliance will achieve that goal. This Model has been useful to explain noncompliance, to make an "educa tional diagnosis," and for designing compliance-enhancing interventions.
Increasing the Accuracy of Blood Glucose Values Using Visually-read Chemstrips
Authors: Gross Alan M. , Magalnick Lauren , Richardson Pat , Davidson Paul C.
Published: April 2008

Four insulin-dependent diabetic adults were exposed to a feedback program designed to improve accu racy of blood glucose values obtained by patients using visually interpreted Chemstrips. Three of the four subjects demonstrated a dramatic increase in agreement between visually deter mined and reflectance photometer de termined blood glucose values follow ing exposure to the feedback treat ment. The implications of these find ings are discussed.
Counseling Diabetics in the Use of Substitute Sweeteners
Authors: Lapworth Dora J. , Hallburg Jeanne C.
Published: April 2008

For persons with diabetes, diet is prescribed as a cornerstone of ther apy. Unease over just what is safe and prudent to eat is an important con cern, and health professionals who work with persons who have diabetes must strive to keep abreast of current nutritional research. One area of con troversy is the role of sweeteners in the diet. Rather than removing most sweeteners from the diet, a more feasible approach may be intensive patient education so that the person with diabetes can make more knowl edgeable decisions as to which types of sweeteners to include in the diet and how to calculate the food values in relation to insulin supply. Five sub stitute sweeteners (saccharin, fructose, sorbitol, xylitol, and aspartame) are considered from the standpoint of taste, availability and costs, metabolic activity, carcinogenic risks, and cur rent American Diabetes Association recommendations.
A Possible Role for Self-Management Techniques in Control of Diabetes
Authors: Linn Margaret W. , Skyler Jay S. , Linn Bernard S. , Edelstein Jacqueline , Sandifer Richard
Published: April 2008

Individuals with diabetes on insulin for at least one year, were studied in regard to styles of coping with stress and metabolic control of their disease. Those in good control used self-con trolling and avoiding styles of coping; whereas, those in poor control more often used fight/anger reactions to stress. Findings suggest self-controlling behaviors might be enhanced and anger/fight reactions to stress reduced through self-management programs. Such programs would be designed to increase self-efficacy through setting of achievable short-term goals with rein forcement of positive behaviors, modeling of successful coping styles, and attention to relaxation and stress reduction techniques.
Community-Based Diabetes Education: An Outreach Program
Authors: Balik Barbara , Moynihan Patricia M. , Haig Broatch
Published: April 2008

State-of-the-art educational and clinical management services for chronic illness are generally found in referral centers. In Minnesota, those referral centers are based in metropolitan areas and are not easily accessible to people living in small communities or rural areas. In 1979, a pro gram was developed to work with community health pro fessionals to provide and support pediatric diabetes care in nonmetropolitan areas. In the past five years, the Minne sota Diabetes in Youth Program (MDYP) has provided an innovative approach to community-based care for children with diabetes. It emphasizes education for families to help them deal more effectively with diabetes management.
Diabetes Education and the Older Patient
Authors: Jeffries MariAnn R. , McIntosh Elaine N.
Published: April 2008

Teaching the older patient with dia betes presents unique challenges. The difficulties commonly associated with diabetes education become more pro nounced. In addition, there frequently are special problems that can interfere with desired learning outcomes. This article addresses these obstacles and offers practical suggestions for dealing with them.
Diabetes and Pregnancy: A Retrospective 5-Year Description Comparing Two Management Settings
Authors: Kushion Wendy , Tomak Marie-Therese , Harrison Linda
Published: April 2008

During a five year period, informa tion was collected on fifty pregnant women with diabetes mellitus who had been referred to the Diabetes Education Program. Half were man aged in a high risk obstetrical clinic; half were managed by private physi cians. In both the clinic and private set ting, the trend over the last five years has been toward tighter control. Methods to achieve better control of diabetes are described; statistical data and outcomes of the two groups are presented and discussed.
Using the Team Approach in Pediatric Diabetes Care: A Retrospective Audit
Authors: Slack Robin , Mensing Carolé
Published: April 2008

A retrospective chart audit revealed improvement in documentation of quality team care, especially of the nurse educator's role, but a lack of documentation of follow-up telephone consultations.
Anxiety and the Timing of Diabetes Teaching in the Hospital: A Literature Review
Authors: Griesbach Ellen H.
Published: April 2008

The literature on anxiety and learn ing, especially as it relates to the newly diagnosed hospitalized adult diabetic patient, was reviewed. The concept that the diabetes diagnosis does consti tute an anxiety-producing event was well substantiated, as well as the con cept that such anxiety can and does interfere with learning. The literature suggests that the deterrent effect of this anxiety may be modified by proper timing of the teaching as well as knowledge of other environmental stressors. Useful strategies for the health educator to employ in such situations are suggested.
Flexible Diets For Diabetes Care
Authors: Tietyen Janet , Jones Sarah E. , Leichter Steven B.
Published: April 2008

The nutritional aspect of diabetes treatment is often the most difficult component of care for the patient and the health professional. The demands imposed by major alter ations in lifestyle, the artificiality of therapeutic eating pro grams, and the lack of available and proven counseling are possible causes of poor patient compliance. "Diets" may also be socially stigmatic to patients with diabetes. While advances have been made in many areas of nutrition and diabetes, there has been relatively little change in the traditional nutritional counseling methods, intended to lead to an understanding and adherence to a sound nutritional program.

The evolving definition of the general goals of nutri tional therapy and the lack of success with traditional ap proaches to nutritional care of diabetes have recently stimu lated the search for alternate nutritional regimens. These programs have been called "flexible diets. " They all base food selection upon the quality of food content rather than food group as in the exchange diet. Indiuidual counseling is important and is directed primarily to modify present eat ing habits rather than radical changes. The continued de velopment of flexible diets may be an exciting area of nutri tional development in the future.
Diabetes and Grief
Authors: Brown Sharon A.
Published: April 2008

The newly-diagnosed person with diabetes may respond to the diagnosis with feelings of grief, a reaction that interferes with patient learning of self-management and results in poor disease control. Recognition of patient grief moves the focus of effective diabetes teaching from the hos pital to the community setting.
An Item Bank of Diabetes-Related Test Questions
Authors: Nowacek George A. , Pichert James W.
Published: April 2008

Most published tests of knowledge and skill do not fit the instructional content, setting, and audience of specific diabetes education pro grams, so diabetes education program direc tors must develop their own. A computerized item bank of diabetes test questions can save the program director time in constructing appro priate tests by taking advantage of computers and compatible software for entering, sorting, and retrieving test questions; analyzing results; revising items; and printing a master copy of the test for reproduction. Such an item bank of diabetes- related test questions is described, and procedures for requesting test ques tions from the item bank are included.
Dental Care for the Person with Diabetes Mellitus
Authors: Villeneuve Mary E. , Treitel Linda , D'Eramo Gail
Published: April 2008

The oral complications in patients with diabetes and the specific steps in oral home care that should be taught to them are discussed. Professional care recommendations and treatment methods are also addressed.
The Accuracy of Glucose Monitoring by Diabetic Individuals in Their Home Setting
Authors: Most Randi S. , Gross Alan M. , Davidson Paul C. , Richardson Pat
Published: April 2008

This study evaluated the accuracy of patient self- monitoring of blood glucose. Determinations were performed at home with simultaneous collec tions of whole blood into capillary tubes. Specimens were mailed to the laboratory where they were analyzed by a glucose-oxidase analyzer. A significant correlation was observed between pa tient determined and laboratory determined glucose values. However, patient-determined values differed from the laboratory values by >+20% in 53.8% of the samples. Inaccuracies were unrelated to training format, time since train ing, type of monitor, age, sex, duration of diabetes, frequency of monitor use, educational level, or knowledge of monitoring technique.
Teaching Braille Reading to Tactilely Impaired, Blind Adults with Diabetes: Case Report
Authors: Harley Randall K. , Pichert James W. , Morrison Merrie B.
Published: April 2008

Whether diabetic adults with diminished tactile sensitivity can learn braille for use in daily living was investigated. Three subjects, two of whom are followed up from a recent study in which they learned grade 1 braille, learned to apply their braille knowledge to the reading of labels and telephone numbers. Characteristics of these adults and their training program are discussed. One implication of this study is that, although blind persons with diabetes and impaired tac tile sensitivity present a challenge, their condition should not necessarily be an excuse for denying braille training.
Evaluating a Workshop Model for Improving Diabetes Patient Education Programs: Is It Really Successful?
Authors: Cook Sandy , Cohen Rita M.
Published: April 2008

Over a threx-year period, 54 health professionals at tended three two-day workshops designed to improve diabetes patient education programs, par ticularly program manage ment and evaluation of skills. A commitment-to- change strategy was used to determine the long-term effectiveness of the workshops. Fifty-nine per cent overall of the com mitments to change were reported as attained in the six-month follow-up surveys. The evidence suggests not only that the workshops were suc cessful, but that measurable changes in participants' programs can be attained in a cost- effective manner.
Evaluation of "Life with Diabetes" Patient Education Booklets
Authors: Wolf Fredric M. , Sherwood Lisa Sylvest , Funnell Martha M.
Published: April 2008

Evaluation of written patient education materials is a necessary part of pro viding education to pa tients with diabetes. Evaluation, however, is useful only if the needs of both those who use the materials (patients) and those who recommend and distribute the materials (health care professionals) are considered. Eight booklets in the "Life with Diabetes" patient educa tion series (developed by the Michigan Diabetes Research and Training Center) were evaluated by both health professionals and patients. Twenty-eight to 37 health professionals including nurses, dieti tians, and physicians evaluated each booklet. Their comments were used to revise and im prove the booklets before publication (formative or process evaluation).
Insulin Pump Therapy for Older Adults: Case Report
Authors: Rosenberg Carol S.
Published: April 2008

Pump therapy offers some people with insulin-treated diabetes a way to achieve stricter blood glucose con trol and more flexible lives. While strict control may be most important for young people, older adults may benefit from the freedom possible with pump therapy. This case presentation describes the use of an insulin pump by a 68-year-old man whose main goal was to have more flexibility in his meal frequency and timing. Some special con siderations for pump therapy in older adults in clude the use of a sim pler, less expensive in sulin pump, visual aids, and less strict blood glucose targets.
Impacts of Professional Education in Diabetes on Trainees' Reports
Authors: Warren-Boulton Elizabeth , Hershey Phyllis S. , Hopper Susan V. , Lange Marcia H. , Flavin Karen S. , Epstein Marilyn G. , Auslander Wendy F. , Fisher Edwin B.
Published: April 2008

Over a three-year period, 202 nurses and dietitians attended professional edu cation courses conducted at the Diabetes Research and Training Center. The courses were designed to develop trainee knowledge and skill for diabetes management and to guide the expansion of patient education programs. Trainees' satisfaction with the course components was high and knowledge changes were significant. Sixty-one percent of the trainees returned a follow- up survey indicating im provements in counseling and teaching skills. Trainees' reports indicated greatest progress in areas over which they had most direct control.

Professional education may have positive effects on trainee knowledge, teaching preparation and counseling skills, and patient education programs.
Diabetes Patient Education: A Consumer View
Authors: Sims Dorothea F.
Published: April 2008

Currently there is no cure for diabetes of either type. Thinking for the pancreas remains an awesome re sponsibility, involving daily demands far beyond simple compliance . People who live with diabetes need lifelong access to up-to-date education pro grams for self-care that meet national standards for quality. Health profes sionals and patients need to collaborate as equals in designing individualized treatment plans. Prompt, well-coordinated, and documented referral for prevention and early diag nosis of complications is essential. Optimal use of community resources for support services can reduce the high cost of acute care. These ap proaches call for fundamen tal changes in national health strategies and in the attitudes, skills, and habits of health professionals.
Diabetes Patient Education: A Health Care Provider Perspective
Authors: Mazze Roger S.
Published: April 2008

Diabetes patient educa tion, a preventive health service, is an integral component of the overall program of care for the diabetic patient. Affecting both biomedical and psychosocial status, it may be analyzed through its knowledge- and behavior-based com ponents. Both are impor tant to the overall result, and each involves distinct provider knowledge and skills for successful, effec tive application. This application optimally in cludes a reproducible process involving a needs assessment, educational content planning, im plementation strategies, and appropriate evaluative methods. Familiarity with these concepts and tech niques will benefit the interested health care provider.
A Diabetes Psychosocial Profile
Authors: Hess George E. , Davis Wayne K. , Van Harrison R.
Published: April 2008

An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com bined with demographic and clinical information, these scores form a com prehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individ ualized graphic profile that highlights possible prob lem areas to be consid ered when developing patient education and management plans.
Patient and Spouse Expectations of and Reactions to Continuous Subcutaneous Insulin Infusion (CSII) Therapy: Case Report
Authors: Wigg Duncan S. , Shapiro Johanna , Perley Michael J. , Charles Merle A.
Published: April 2008

Six insulin-dependent women with diabetes and their spouses were assessed (1) prior to continuous subcutaneous insulin infu sion (CSII) therapy, and (2) three months after implementation of CSII therapy. The pre-CSII interviews revealed that both patient and spouse were interested in the positive emotional conse quences of improved metabolic control. How ever, patients were most interested in the personal benefits of metabolic stabilization, whereas spouses were more con cerned about potential improvement of the marital relationship. Post- CSII interviews showed that most fears regarding CSII therapy expressed in the pre-CSII interview were not realized, but many unanticipated negative and positive responses to treatment were experienced.
Congenital Anomalies in Offspring of Insulin-Dependent Diabetic Mothers
Authors: Diamond Michael P. , Salyer Sheron L. , Boehm Frank H. , Vaughn William K.
Published: April 2008

Congenital malformation continues to be a major problem for infants of diabetic mothers. Over a seven-year period, 199 insulin-requiring diabetic mothers were delivered at Vanderbilt University Medical Center. Con genital anomalies were identified in 26 (13%) newborns. There was no significant difference in the incidence of fetal anomalies between the various categories of White's classification of maternal diabetes mellitus. A review of proposed etiologies of anomalies in diabetic pregnancies is presented, and suggestions are made for the manage ment of women with dia betes desiring to conceive.
Diabetes Patient Education in The Office Setting
Authors: Hiss Roland G. , Frey Mary L. , Davis Wayne K.
Published: April 2008

The diabetes patient education provided in ran domly chosen primary care physician offices in small and large com munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-de livered, informal, and in terwoven with the clinical care offered. They usually did not include a sys tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx imately 48 minutes per year per patient in the of fice setting. The study suggested several develop mental activities that might improve patient education in physician of fices where the majority of patients with diabetes receive most of their care.
Building a Helpful Relationship: The Foundation of Effective Patient Education
Authors: Westberg Jane , Jason Hilliard
Published: April 2008

To have a lasting impact on patients, patient educators need to build relationships that are characterized by trust and collaboration. Without trust, patients are likely to withhold intimate, often critical, information. Pa tients are not likely to give credence to or to carry out advice offered by health professionals they do not trust. In col laborative relationships, patients take an active role, have a sense of ownership of the changes they make, and assume responsibility for their own care to the extent they are able. Health pro fessionals who function in authoritarian ways can foster passivity and dependency in patients; postures that are counter productive to lasting change and growth.
Problems of Diabetes Education in Different Cultures
Authors: Mellor Lorna , Hoskins Penny
Published: April 2008

Views of diabetes educa tion in several parts of the world are presented. Im pressions of diabetes care in Tanzania, Ethiopia, Fiji, Papua New Guinea, and in various Australian cultures are discussed.
Diabetic Peripheral Neuropathy
Authors: Cyrus Jahangir , Broadstone Vasti L. , Pfeifer Michael A. , Greene Douglas A.
Published: April 2008

Diabetic autonomic neuropathies (DAN) are clinical syndromes resulting from impairments of the autonomic nervous system in patients with diabetes mellitus. Since the autonomic nervous system innervates most body organs, any or all of those organs may be affected by DAN. A high index of suspicion is the best diagnostic tool. Proper management, with patient and family education in its center, improves the quality of life of persons with DAN. Undiagnosed and ignored, DAN could cause severe disability and even death.
Filling the Gaps Between Patients and Professionals
Authors: Harris Gillian
Published: April 2008

Diabetes educators face a unique and challenging task in pro viding patients with the motiva tion and skills they need to make sound judgments and decisions regarding their treatment. Care ful assessment reveals gaps between the patient and profes sional that can ultimately influence the outcome of treat ment. Such gaps may include cultural differences, differing expectations and priorities, lack of knowledge and expertise, and different understandings about patients' rights to choice.
Designing Culturally Relevant Educational Materials for Mexican American Clients
Authors: Hall Teri A.
Published: April 2008

The California Diabetes Control Program developed a set of pictorial bilingual materials featuring traditional Mexican food patterns to meet a need for culturally relevant diabetes education materials. Culturally appropriate nutrition education materials are not merely translated from English but must be adapted or redesigned, using culturally relevant concepts, methods, activities, and meal plans.
A Model for Diabetes Health Care Delivery in Developing Countries
Authors: Kovacevic Ratimir , Granic Mate , Skrabalo Zdenko
Published: April 2008

Developing countries can make considerable progress in providing diabetes health care if they adopt ideas and technologies already being applied in diabetes health care in other parts of the world, but they must adapt them to their own particular circumstances. Too often efforts in this direction fail because it is not possible to transfer programs from developed nations intact and expect them to function in the circumstances of less developed nations. Success on a national level requires the application of a systematic health care model tailored to the needs of the developing country. As discussed in this paper, the model's elements include organization of the available national health care delivery system; education of health care personnel, patients, their families, and communities; diabetes-related epidemiological research; education program planning; and continuous program evaluation and adjustment.
A Computer Progam for Teaching and Auditing Patients' Knowledge of Diabetes
Authors: Cook Galen B.
Published: April 2008

Professionals responsible for the care of persons with diabetes mellitus are ever more convinced that patients need a strong, pragmatic knowledge about the disease to survive and thrive. Considerable expertise is being directed toward defining exactly what should be taught and how achievement should be measured and rewarded. This paper briefly reviews the accomplishments computers have made to this end, and describes a new soft ware program using dBASE III Plus that is derived from the author's previous clinical experience.
Discrepancies Between Blood Glucose and Glycosylated Hemoglobin in Intensively Treated Diabetic Patients
Authors: Ahern Jo Ann , Bates Sue , Tamborlane William V.
Published: April 2008

Self blood glucose monitoring (SBGM) results in nine insulin- dependent diabetic patients who had elevated levels of glycosylated hemoglobin (HbA1 9.8% ±0.4%) despite intensive treatment were compared with those of 11 patients who were able to achieve strict diabetes control (HbA1 8.1% ± 0.2% ; normal 5.6%-8.0%). Surprisingly, both groups reported similar SBGM values and testing frequency, and both groups measured glucose levels accurately when values were checked in the laboratory. On the other hand, laboratory glucose values were lower and correlated with HbA 1 levels only in the group that achieved near normal HbA1 values. These data suggest that problems with SBGM may impede achievement of strict glycemic control during intensive treatment of insulin-dependent diabetes.
Dietary Skills and Adherence in Children With Type I Diabetes Mellitus
Authors: Delamater Alan M. , Smith Jeffrey A. , Kurtz Steven M. , White Neil H.
Published: April 2008

This study was designed to objectively measure dietary skills of diabetic children and their mothers and to assess dietary adherence in specific situations. Subjects were 34 children with Type I diabetes mellitus and their mothers. Recall of diet prescriptions and performance on skills tests averaged around 50% for both children and mothers. Adherence problems were most frequent during afternoon snack, while at school, with friends, and at restaurants. Significant relationships between glycosylated hemoglobin values and adherence at school and with friends were observed. Older children had more adherence problems with afternoon snack, while alone, and while with parents. Dietary skills were unrelated to adherence. These findings demonstrate that children with diabetes and their mothers have substantial dietary skills deficits and situationally related dietary adherence problems.
A Contract for Change in Diabetes Self-Management: Case Report
Authors: Wilson Marianne , Boyer Cynthia
Published: April 2008

Written contracting can be an effective supplement to patient education. This case report demonstrates the development and use of a contract between the diabetes educator and CR, a 34-year-old certified public accountant. CR achieved better glucose control through the process of contracting and insulin adjustment. The contract was designed to be clear, fair, and honest—three essential components of a contract. As CR met each of the specific contractual goals, he was rewarded with an educator's time and praise. Through a systematic process of education, contracting, and follow-up, CR was able to obtain the desired outcome of better glucose control.
Length of Hospitalization of Children With Diabetes: Effect of a Clinical Nurse Specialist
Authors: Hendler Lipman Terri
Published: April 2008

Expeditious discharge of children with newly diagnosed diabetes is desirable for both psychological and financial reasons. Does length of hospitalization depend upon who is educating the child and family? This study compares the length of stay in newly diagnosed diabetic children educated by staff nurses (SN) with the length of stay of children educated by a clinical nurse specialist plus staff nurses (CNS/SN). The length of hospitalization of the CNS/SN group was significantly shorter (x = 6.2 days) than the SN group (x = 8.4 days; P<0.01). The two groups were not significantly different in age, admission serum pH, or admission blood glucose level, nor were they different in socioeconomic status or criteria for discharge. The ulitization of a CNS as a diabetes educator may significantly decrease the length of hospitalization of children with newly diagnosed diabetes.