RESUMEN
We implemented the "Diabetes conversations", programme of the International Diabetes Federation-Europe, characterised by the use of the Conversation Map, an educational interactive kit addressed to groups of diabetic patients on: Living with diabetes, What is diabetes, Healthy diet and physical activity, Initiating insulin therapy. After at least three month from the end of the 4-session course, clinical data of 63 participants from the first 10 groups--age (mean +/- std dev) 61.7 +/- 10.2 years, 56% women, 18.5% T1DM-improved: fasting glycemia decreased from 152.9 +/- 55.2 to 138.2 +/- 38.9 mg/dl (P < 0.05), HbA1c from 8.2 +/- 1.2 to 7.8 +/- 1.4% (P < 0.01), BMI from 27.6 +/- 15.1 to 25.5 +/- 15.5 kg/m2 (P < 0.02). The patients' satisfaction about the topics and the educational materials was very high.The Conversation Maps are useful because: (a) contribute to improve glycometabolic control; (b) educate patients on the main topics related to diabetes; (c) give to the nurse a key and active role in patients'education; (d) facilitate the connection between knowledge and behaviour; (e) involve the volunteers of the diabetic association as tutors; (f) improve the relationship and the communication between the doctor/nurse and the patient.
Asunto(s)
Diabetes Mellitus/terapia , Educación del Paciente como Asunto , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Programas InformáticosRESUMEN
We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications.
Asunto(s)
Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Precoz , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: To assess the effectiveness of a nurse-led protocol for the management of hypo/ hyperglicaemia in a medical ward. METHODS: Protocols for standard therapy, and parenteral intensive insulin therapy for severe hypo/hyperglycaemia in hospitalised patients were implemented. PERIOD: march-november 2007. RESULTS: 189 patients (19%) were labelled as "hyperglycaemic" at admission in Emergency Department. Median (+/-IQR) age was 77 (70-84) years, 41% were men, with known diabetes 74%, 18% had skin ulcers. Median glycaemia at admission was 144.5 (98-220) mg/dl. Thirty-six percent of patients was euglycaemic (60-126 mg/dl), 3% hypoglycaemic (<60 mg/dl). The glicaemic values ranged from 127-140 mg/dl (9% patients), from 141-280 mg/dl, (40%patients) and > 280 mg/dl (12% patients). The glicaemic values of the 14 patients requiring the intravenous intensive insulin regimen remained in a safe range (80-250 mg/dl) in the first 15 hours from the infusion start. No patient experienced a life-threatening hypoglycaemia nor hypoglycaemic coma. After three days on standard therapy, glicaemic levels were acceptable: 142 (98-185) pre-breakfast, 144(107-200) pre-lunch, 131 (102-190) pre-dinner, 183 (123-230) mg/dl postprandial. CONCLUSION: Data showed the effectiveness and safety of a nurse-led protocol for the care of hyperglicaemia in a medical ward.
Asunto(s)
Hiperglucemia/tratamiento farmacológico , Hiperglucemia/enfermería , Evaluación en Enfermería , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , MasculinoRESUMEN
Aim of the present study was to explore how the 76 general practitioners (GPs) - serving Carpi district (90,000 residents) - value their own role compared with the hospital, ambulatory, academic, and health organisation physicians'. GPs had a positive self-image only in comparison with health organisation doctors (7 vs 7 grades). GPs disappointed with themselves when comparing their role with ambulatory (-1.6 grades), academic (-1.9 grades) and hospital doctors (-2.2 grades). Secondarily, GPs perceived patients' valuing their professional role mostly 'subordinate' to the other physicians', except health organisation colleagues'.
Asunto(s)
Medicina Familiar y Comunitaria , Medicina , Autoimagen , Especialización , Academias e Institutos , Adulto , Atención Ambulatoria , Estudios Transversales , Femenino , Humanos , Masculino , Cuerpo Médico de Hospitales , Persona de Mediana EdadAsunto(s)
Atención a la Salud , Emigración e Inmigración , Trabajo de Parto , Servicios de Salud Materna , Femenino , Humanos , Italia , EmbarazoRESUMEN
We implemented simple tools for Clinical Practice in Primary Care, i.e. reports of Diabetes Project's Registry addressed to Primary Care Groups in Modena in order to promote the clinical practice through a detailed peer-review of program indicators. The efforts of health organisations to involve the general practitioners in clinical practice should be improved by implementing audit-and-feedback tools of simple interpretation for clinical practice.