Self-care and empowerment in diabetes care: Use of instruments in clinical practice - a review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenPrevalence of diabetes is increasing worldwide. Education is regarded as an essential part in diabetes care to enable people with diabetes self-care. Self-care in diabetes can be demanding and it is regarded impossible to separate treatment and education. Clinical guidelines in diabetes care recommend using empowerment approach in diabetes education. The empowerment approach emphasizes that people with diabetes are assisted to make informed decisions. Instruments measuring knowledge, self-care, empowerment, well-being and distress were translated into Icelandic, according to internationally accepted guidelines. The questionnaires were tested in a cross-sectional study and used in an educational intervention study. It was found that the instruments are practical and useful and can be used in clinical practice in Iceland. It is argued that in diabetes care, health care practitioners should make more use of appointed instruments that enable them to focus their care on specific needs of each person. The care should be based on answers from the instruments and goals which people with diabetes choose to work towards. The education should be based on the empowerment approach. Keywords: diabetes, education, empowerment, instruments used in clinical practice. Correspondence: Arun K. Sigurdardottir, [email protected] sykursýki vex stöðugt í heiminum. Kennsla í sykursýki er talin einn af hornsteinum meðferðar við sykursýki og nú er almennt álitið að aðgreining læknisfræðilegar meðferðar frá kennslu og leiðbeiningum um sjálfsumönnun sé ógerleg. Alþjóðlegar klínískar leiðbeiningar mæla með því að fólk með sykursýki sé virkir þátttakendur í kennslunni og bandaríska sykursýkissambandið leggur auk þess til að kennslan sé byggð á hugmyndafræði sjálfseflingar. Hugmyndafræði sjálfseflingar leggur áherslu á að markmið kennslu og meðferðar sé að hvetja til upplýstrar ákvarðanatöku, þar sem fólk með sykursýki beri ábyrgð á og stjórni meðferð sinni í samvinnu við fagfólk. Mikilvægt er að Íslendingar með sykursýki fái meðferð sem tekur mið af ofangreindu og að heilbrigðisstarfsfólk hafi sambærilega aðferðafræði og sýn er byggi eftir föngum á gagnreynd-um aðferðum. Hér er gefið yfirlit yfir þessi fræði og kvarða sem nota má til að greina þekkingu, sjálfsumönnun, eflingu, vellíðan og streitu meðal fólks með sykursýki. Kvarðarnir voru þýddir á íslensku eftir alþjóðlegum viðmiðum um þýðingar mælitækja, prófaðir í þverskurðarkönnun og notaðir í meðferðarrannsókn þar sem niðurstaðan var að hluti kvarðanna hefði notagildi í klínískri vinnu með fólki með sykursýki. Lagt er til að nota tiltekna kvarða til að auðvelda markvissa meðferð sem veitt er eftir hugmyndafræði sjálfseflingar, en meðferðin er síðan byggð á svörum kvarðanna og markmiðum sem fólk setur sér

Changing situational contexts present a constant challenge to software developers.

A software process can take many forms and its optimality demands that it should be harmonised with the needs of the given software development situational context. This theoretical proposition is reasonably clear. However, the finer details of the interaction between the software process and the factors of the situational context are much less obvious. In previously published research, the authors have elaborated a reference framework that identifies the factors of a situational context that affect the software process [1]. In this paper, we report on the application of our reference framework in an examination of the changing nature of software development situational contexts. Our corresponding study of fifteen software development companies indicates that certain factors appear more subject to change than others. This finding is a potentially important insight that can help us with the recurring challenge of adapting the software process to changing circumstances

Skin-sparing mastectomy and radiotherapy: an update

Despite the lack of randomised controlled trials and paucity of the published data, the current evidence suggests that the post-mastectomy radiation therapy (PMRT) does not represent a contraindication to skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) in the multidisciplinary setting. Although PMRT is associated with a higher incidence of complications, a satisfactory cosmetic outcome can be achieved in most patients. Radiation has a deleterious effect on autologous flap reconstruction that relies on fat for volume replacement such as the deep inferior epi-gastric perforator (DIEP) flap reconstruction and this method of reconstruction should be delayed until RT is completed. Until better methods of RT delivery are developed to minimise complications, women at high risk of requiring PMRT, can be safely offered SSM and IBR with a sub-pectoral saline-filled tissue expander and this can be replaced with a permanent prosthesis or converted into an autologous flap reconstruction after the completion of RT. Any capsule formation can be surgically treated at this stage. This new concept, known as immediate-delayed reconstruction, can avoid the cosmetic and RT delivery problems that can occur after IBR. Furthermore, prior RT does not represent a contra-indication to SSM and IBR, however it increases the incidence of complications

Management of asthma in pregnant women by general practitioners: A cross sectional survey

<p>Abstract</p> <p>Background</p> <p>Poorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care.</p> <p>Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care.</p> <p>Methods</p> <p>A pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of individual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence.</p> <p>Results</p> <p>Inhaled corticosteroids (ICS) were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%), whilst leukotriene receptor antagonists were the least preferred (2.9%). A quarter (25.8%) of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9%) reported encountering medication nonadherence during pregnancy.</p> <p>Conclusion</p> <p>A lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.</p

Multisource and multitemporal data fusion in remote sensing:A comprehensive review of the state of the art

The recent, sharp increase in the availability of data captured by different sensors, combined with their considerable heterogeneity, poses a serious challenge for the effective and efficient processing of remotely sensed data. Such an increase in remote sensing and ancillary data sets, however, opens up the possibility of utilizing multimodal data sets in a joint manner to further improve the performance of the processing approaches with respect to applications at hand. Multisource data fusion has, therefore, received enormous attention from researchers worldwide for a wide variety of applications. Moreover, thanks to the revisit capability of several

Belonging to a different landscape: repurposing nationalist affects

This is an article about the embodied, sensual experience of rural landscape as a site where racialized feelings of national belonging get produced. Largely impervious to criticism and reformation by 'thin' legal-political versions of multicultural or cosmopolitan citizenship, it is my suggestion that this racialized belonging is best confronted through the recognition and appreciation of precisely what makes it so compelling. Through an engagement with the theorization of affect in the work of Divya Praful Tolia-Kelly, I consider the resources immanent to the perception of landscapes of national belonging that might be repurposed to unravel that belonging from within. I suggest that forms of environmental consciousness can unpick the mutually reinforcing relationships between nature and nation, opening up opportunities for thinking identity and belonging in different ways, and allowing rural landscapes to become more hospitable places