Practical diabetes international : the journal for diabetes care teams worldwide最新文献

英文中文

Diabetic cystopathy: do we recognise this in our patients? 糖尿病性膀胱病变:我们在患者中认识到这一点吗?

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-04-01 DOI: 10.1002/PDI.1575

B. Jose, E. Karampini, M. Pucci, W. Burbridge, S. Irwin, P. De

A 44-year-old South Asian woman, with type 2 diabetes requiring insulin, presented with multiple syncopal episodes. Her diabetes was complicated by peripheral neuropathy, diabetic retinopathy and nephropathy. She also had features of autonomic neuropathy. Short synacthen test ruled out adrenal insufficiency; thyroid function was normal. HbA1c was elevated at 14.6% (136mmol/mol). Abdominal computed tomography showed grossly dilated bladder (9.5cm x 14cm x 17.5cm), compressing the mid-ureter. The size suggested an on-going chronic process, consistent with diabetic cystopathy. An indwelling urethral catheter relieved the bladder distension and the patient was later successfully educated to void the bladder by the clock rather than bladder sensation. Euglycaemia was achieved with twice-daily pre-mixed analogue insulin. Diabetic cystopathy is an under-diagnosed complication of diabetes. Most contemporary investigators believe that the aetiology is multifactorial, including disturbances of the bladder detrusor muscle, urethra, autonomic nerves and perhaps the urothelium. This most troublesome of all the genitourinary complications of diabetes is often overlooked. Copyright © 2011 John Wiley & Sons.

44岁南亚女性，患有2型糖尿病，需要胰岛素，表现为多次晕厥发作。她的糖尿病并发周围神经病变、糖尿病视网膜病变和肾病。她还具有自主神经病变的特征。短synacthen试验排除肾上腺功能不全;甲状腺功能正常。HbA1c升高14.6% (136mmol/mol)。腹部计算机断层扫描显示膀胱严重扩张(9.5cm x 14cm x 17.5cm)，压迫输尿管中段。大小提示持续的慢性过程，与糖尿病性膀胱病变一致。留置导尿管减轻了膀胱膨胀，患者后来成功地接受了由时钟而不是膀胱感觉排尿的教育。每日两次预混合类似胰岛素达到血糖。糖尿病性膀胱病变是糖尿病的一种未被诊断的并发症。大多数当代研究者认为病因是多因素的，包括膀胱逼尿肌、尿道、自主神经和尿路上皮的紊乱。这是糖尿病泌尿生殖系统并发症中最麻烦的一种，却经常被忽视。版权所有©2011 John Wiley & Sons。

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引用次数: 2

Doing diabetes: an evaluation of communication skills and behaviour change training for health professionals 治疗糖尿病:对卫生专业人员沟通技巧和行为改变培训的评估

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-04-01 DOI: 10.1002/PDI.1573

V. Swanson, A. Gold, A. Keen

Good communication skills enhance consultations between health professionals and patients, leading to better patient outcomes and increased satisfaction. Health professionals working in diabetes can find it difficult to understand patients' apparent self-management ‘failures’, but may lack psychological skills to support efforts at behaviour change. This paper reports on the impact of three-day workshops using evidenced psychological theory as a basis for promoting communication and behaviour change skills in health professionals working in diabetes. Workshops were delivered in seven urban or rural health service areas in Scotland by a multidisciplinary team. Each included three full-day sessions two weeks apart, and used a range of theoretically-underpinned and evidenced teaching and learning methods. Eighty-one health professionals working in diabetes care participated. Pre-and post-evaluations utilised questionnaires with closed and open questions. Participants recorded a significant increase in ‘positive’ communication and behaviour change techniques and a decrease in ‘negative’ techniques over the three workshops. Improved communication and behaviour change skills were perceived as having a positive impact on their understanding of patients' motivations and on their own day-to-day practice. In conclusion, communication and behaviour change skills are very important tools for health professionals working in diabetes care. They can be taught effectively in relatively few sessions using theoretically-based and evidenced approaches, and have a perceived benefit in relation to enhancing patient care and professionals' satisfaction with clinical practice. Copyright © 2011 John Wiley & Sons.

良好的沟通技巧可以加强卫生专业人员与患者之间的磋商，从而改善患者的治疗效果，提高患者的满意度。从事糖尿病工作的卫生专业人员可能很难理解患者明显的自我管理“失败”，但可能缺乏心理技能来支持行为改变的努力。这篇论文报告了为期三天的研讨会的影响，使用有证据的心理学理论作为促进糖尿病卫生专业人员沟通和行为改变技能的基础。一个多学科小组在苏格兰的七个城市或农村保健服务区举办了讲习班。每个课程包括三个全天的课程，间隔两周，并使用一系列理论支持和证明的教学方法。81名从事糖尿病护理的卫生专业人员参与了研究。前评估和后评估采用封闭式和开放式问卷。在三个研讨会上，参与者记录了“积极的”沟通和行为改变技巧的显著增加，而“消极的”技巧的减少。改进的沟通和行为改变技巧被认为对他们理解病人的动机和他们自己的日常实践产生了积极的影响。总之，沟通和行为改变技能对于从事糖尿病护理的卫生专业人员来说是非常重要的工具。他们可以在相对较少的课程中使用基于理论和证据的方法有效地教授，并且在提高患者护理和专业人员对临床实践的满意度方面具有明显的好处。版权所有©2011 John Wiley & Sons。

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引用次数: 9

Psychological insulin resistance: a critical review of the literature 心理胰岛素抵抗:文献综述

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-04-01 DOI: 10.1002/PDI.1574

A. Gherman, I. Vereșiu, Raluca Sassu, J. Schnur, Bl Scheckner, G. Montgomery

objective was to conduct a critical review of the factors that account for psychological insulin resistance (PIR) and of the available strategies to reduce it. Medline, PubMed, Cochrane reviews, PsycInfo, ProQuest, Science Direct, and EBSCO databases were searched and 60 studies were included in the final review. Topics reviewed included: research methods, instruments to assess PIR, PIR in patients and in the medical care team, and proposed strategies for overcoming it. The results showed that a large number of factors account for PIR in patients. The main categories are emotional, cognitive, social/cultural, and interaction with health providers. Physicians mainly delay insulin because they lack knowledge on guidelines or pancreas physiology, they fear inducing hypoglycaemia in elderly or impaired patients, and/or they lack time or personnel resources to teach initiation. Strategies proposed to reduce PIR are educational and psychological (exposure, desensitisation, relaxation and counselling). We concluded that there is a great need of evidence-based interventions that help remove psychological barriers about insulin use in patients, as well as in health care providers. Copyright © 2011 John Wiley & Sons. Practical Diabetes Int 2011; 28(3): 125-128

目的是对导致心理胰岛素抵抗(PIR)的因素和减少心理胰岛素抵抗的可用策略进行批判性审查。检索了Medline、PubMed、Cochrane综述、PsycInfo、ProQuest、Science Direct和EBSCO数据库，最终纳入了60项研究。审查的主题包括:研究方法、评估PIR的工具、患者和医疗团队的PIR，以及克服PIR的建议策略。结果表明，许多因素导致了患者的PIR。主要类别是情感、认知、社会/文化以及与卫生保健提供者的互动。医生推迟使用胰岛素主要是因为他们缺乏指南或胰腺生理学方面的知识，他们害怕在老年人或受损患者中引起低血糖，和/或他们缺乏时间或人力资源来教授起始。建议的减少PIR的策略是教育和心理(暴露、脱敏、放松和咨询)。我们的结论是，非常需要基于证据的干预措施，以帮助消除患者以及卫生保健提供者对胰岛素使用的心理障碍。版权所有©2011 John Wiley & Sons。实用糖尿病杂志2011;28 (3): 125 - 128

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引用次数: 43

Practical Diabetes Care. By David Levy. 3rd Edition Published by Wiley‐Blackwell, 2011 Paperback, price: ISBN: 978 1 4443 3385 5 Website: www.wiley.com 实用糖尿病护理。David Levy著，Wiley‐Blackwell出版，2011年第3版平装，价格:ISBN: 978 144443 3385，网址:www.wiley.com

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-04-01 DOI: 10.1002/PDI.1577

A. Begg

引用次数: 0

What do patients prefer: insulin pumps or multiple daily injections and structured education? 患者更喜欢什么:胰岛素泵还是每天多次注射和有组织的教育?

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1561

Lf Clark, Jc Bilbie, P. Abraham

Potential advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) include improved glycaemia, and reduced frequency and severity of hypoglycaemia. In our hospital, to be considered for CSII, patients must be using MDI, and then undergo a Dose Adjustment For Normal Eating (DAFNE) structured education course. We reviewed the records of the 21 patients with type 1 diabetes who had sequentially undergone MDI, then DAFNE and are now treated with CSII. HbA1c improved as patients increased the intensity of the management of diabetes despite reductions in total daily insulin dose. Patients did a similar number of home blood glucose tests per day and spent a similar amount of time managing their diabetes. Contacts with health care team members were the same for all modalities in the first three months but reduced for those on MDI with or without having completed a structured education course, while contacts with the health care team remained higher on pumps. Patients were generally satisfied with all modalities of treatment and would recommend each modality. The input into the management of diabetes from both patients and health care professionals remained high even after the initial stages of being commenced on CSII therapy. This reflects the additional input needed in assessing the various basal rates and other ratios. However, patient preference was in favour of pumps in this select group who had sequentially experienced all three options. Copyright © 2011 John Wiley & Sons.

持续皮下胰岛素输注(CSII)相对于多次每日注射(MDI)的潜在优势包括改善血糖，降低低血糖的频率和严重程度。在我院，考虑CSII的患者必须使用MDI，然后接受正常饮食剂量调整(DAFNE)结构化教育课程。我们回顾了21例1型糖尿病患者的记录，这些患者先后接受了MDI、DAFNE和CSII治疗。尽管每日胰岛素总剂量降低，但随着患者糖尿病管理强度的增加，HbA1c有所改善。患者每天在家做的血糖测试次数相似，治疗糖尿病的时间也相似。在前三个月，所有方式的人与保健小组成员的接触都是相同的，但无论是否完成了结构化教育课程，接受MDI的人与保健小组成员的接触都有所减少，而接受泵治疗的人与保健小组的接触仍然较多。患者普遍对所有治疗方式感到满意，并会推荐每种治疗方式。即使在开始CSII治疗的初始阶段之后，患者和卫生保健专业人员对糖尿病管理的投入仍然很高。这反映了在评估各种基本比率和其他比率时需要额外的投入。然而，在这个连续经历了所有三种选择的选择组中，患者偏好于支持泵。版权所有©2011 John Wiley & Sons。

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引用次数: 3

Is there a role for vitamin D in prevention of diabetes and metabolic syndrome 维生素D在预防糖尿病和代谢综合征方面是否有作用

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1555

Adriana Buitrago-López, Geordan D Shannon, O. Franco

引用次数: 0

The surgical panacea for diabetes: time for diabetologists to discriminate facts from fiction and flights of fantasy 手术治疗糖尿病的灵丹妙药:糖尿病专家是时候区分事实与虚构和幻想了

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1562

J. Pinkney

引用次数: 2

Spirit of respect 尊重精神

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1565

F. Kirkland

引用次数: 1

The work of a dedicated inpatient diabetes care team in a district general hospital 一个专门的住院糖尿病护理小组在地区综合医院的工作

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1560

A. Brooks, J. L. Chong, S. Grainger‐Allen, M. McDonald, S. Nero, M. Atkin, S. Deshmukh

We describe the work of a multidisciplinary inpatient diabetes care team in a 400 bed district general hospital over a four-year period. Also included are some observations on a positive contribution to reduced length of stay for people with diabetes in hospital, and low incidences of prescription and management errors in the first National Diabetes Inpatient Audit in 2009. Specifically between 2005 and 2007 the average length of stay in days for all patients whose diagnosis included diabetes fell from 9.39 to 3.76 days despite the total number of patients increasing from 507 to 633 over the same quarter each year. The inpatient team provided almost 1000 visits to patients with diabetes in the first six months of each year 2008 and 2009, and at the first National Diabetes Inpatient Audit had only 5% prescription errors and 3% management errors (versus 19% and 14% respectively nationally) with 100% appropriate blood glucose testing. We suggest that a dedicated inpatient diabetes care team raises the quality of care for patients and enhances patient and professional education; we also suggest that audit standards should be developed for inpatient diabetes care and assessed in future national audits. Copyright © 2011 John Wiley & Sons.

我们描述了一个多学科住院糖尿病护理团队在400个床位的地区综合医院四年期间的工作。还包括在2009年第一次全国糖尿病住院患者审计中对减少糖尿病患者住院时间的积极贡献以及处方和管理错误率低的一些观察结果。特别是在2005年至2007年期间，所有诊断为糖尿病的患者的平均住院天数从9.39天降至3.76天，尽管每年同一季度患者总数从507人增加到633人。在2008年和2009年的前六个月，住院团队为糖尿病患者提供了近1000次就诊，在第一次全国糖尿病住院患者审计中，只有5%的处方错误和3%的管理错误(而全国分别为19%和14%)，100%正确的血糖检测。我们建议建立一个专门的糖尿病住院护理团队，以提高患者的护理质量，并加强患者和专业教育;我们还建议为住院糖尿病患者制定审计标准，并在未来的国家审计中进行评估。版权所有©2011 John Wiley & Sons。

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引用次数: 4

Factors affecting attendance at postpartum diabetes screening in women with gestational diabetes mellitus 影响妊娠期糖尿病妇女产后糖尿病筛查出勤率的因素

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2011-03-01 DOI: 10.1002/PDI.1559

Vicky Sterne, T. Logan, M. Palmer

of women diagnosed with gestational diabetes mellitus (GDM) will be diagnosed with type 2 diabetes within five years. Attendance rates at postpartum screening are only 48-56%. As the barriers or facilitators to screening attendance among women diagnosed with GDM have not previously been determined, this study aimed to examine the barriers and facilitators to attendance at postpartum diabetes screening as reported by women following a recent history of GDM. This study was a cross-sectional telephone survey of Australian women diagnosed with GDM in a Queensland hospital during the period July 2006 to June 2007. Rates of attendance at postpartum diabetes screening were assessed, and reported barriers and facilitators to postpartum screening were grouped into themes. Of 187 eligible participants, 88 women were surveyed (aged 33±6 years, parity 1 (0-5)). Half (53.4%) of respondents attended postpartum diabetes screening. Barriers to screening included a lack of awareness of the need to attend screening, the inconvenience associated with the two to three hour length of the OGTT, and the need to attend screening with infants and young children. Reported facilitators included improved awareness of the need for screening, multiple reminders, and a more pleasant and convenient test. Facilitation strategies aimed at increasing the awareness of postpartum diabetes risks and promoting the provision of accurate and consistent screening advice from medical providers may assist in improving attendance at postpartum diabetes screening. A more acceptable screening test and establishment of a national database for routine screening reminders may also encourage women to attend postpartum diabetes screening. Copyright © 2011 John Wiley & Sons. Practical Diabetes Int 2011; 28(2): 64-68

诊断为妊娠期糖尿病(GDM)的妇女将在五年内被诊断为2型糖尿病。产后筛查的出勤率仅为48-56%。由于先前尚未确定诊断为GDM的妇女参加筛查的障碍或促进因素，本研究旨在检查最近有GDM病史的妇女报告的参加产后糖尿病筛查的障碍和促进因素。本研究是对2006年7月至2007年6月期间在昆士兰一家医院诊断为GDM的澳大利亚妇女进行横断面电话调查。评估产后糖尿病筛查的出勤率，并将产后筛查的障碍和促进因素按主题分组。在187名符合条件的参与者中，88名女性接受了调查(年龄33±6岁，胎次1(0-5))。一半(53.4%)的受访者参加了产后糖尿病筛查。筛查的障碍包括缺乏对参加筛查的必要性的认识，OGTT的两到三个小时的时间带来的不便，以及需要对婴儿和幼儿进行筛查。报告的促进因素包括提高对筛选需求的认识，多重提醒，以及更愉快和方便的测试。旨在提高对产后糖尿病风险的认识和促进医疗提供者提供准确和一致的筛查建议的促进战略可能有助于提高产后糖尿病筛查的出勤率。一个更容易被接受的筛查试验和建立一个例行筛查提醒的国家数据库也可以鼓励妇女参加产后糖尿病筛查。版权所有©2011 John Wiley & Sons。实用糖尿病杂志2011;28 (2): 64 - 68

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