Living with Hypoglycemia

OBJECTIVE: To increase understanding of the everyday experiences of hypoglycemia for patients with type 1 diabetes through the use of a narrative research approach. SETTING: Center for diabetes treatment and research. DESIGN: Cross-sectional assessment using a narrative research approach. PATIENTS/PARTICIPANTS: Twenty outpatients (aged 21–30 years) diagnosed with type 1 diabetes for at least 10 years. MEASUREMENTS AND MAIN RESULTS: Experiences of hypoglycemia were investigated during in-depth, semistructured interviews that were tape-recorded, transcribed, and analyzed to identify common themes. Self-report measures of depression (Revised Hamilton Rating Scale for Depression) and anxiety (State-Trait Anxiety Inventory) also were administered. Subjects reported the following common themes: interpersonal conflict including fears of dependency and loss of control and problems addressing concerns about hypoglycemia with significant others; difficulty making sense of their hypoglycemic behaviors in relation to their usual ways of functioning; and perceived lack of understanding by others, including physicians, about the emotional experiences of hypoglycemia. Subjects were neither clinically depressed nor anxious. CONCLUSIONS: These findings suggest that type 1 diabetes patients' experiences of hypoglycemia negatively affect their interpersonal relationships and views of themselves. Hypoglycemia also was described as an extremely private experience that was rarely discussed with others. Patient education and professional support in the treatment of hypoglycemia are recommended to enhance treatment decision making for patients with type 1 diabetes

Fostering Professionalism in Medical Education: A Call for Improved Assessment and Meaningful Incentives

Increasing attention has been focused on developing professionalism in medical school graduates. Unfortunately, the culture of academic medical centers and the behaviors that faculty model are often incongruent with our image of professionalism. The need for improved role modeling, better assessment of student behavior, and focused faculty development is reviewed. We propose that the incentive structure be adjusted to reward professional behavior in both students and faculty. The third-year medicine clerkship provides an ideal opportunity for clinician-educators to play a leading role in evaluating, rewarding, and ultimately fostering professionalism in medical school graduates

The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

<p>Abstract</p> <p>Background</p> <p>The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care.</p> <p>Methods</p> <p>Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system.</p> <p>Results</p> <p>The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1) performance of <it>tasks </it>such as monitoring symptoms or administering treatments, (2) the occurrence of various <it>events </it>and the pursuit of <it>valued outcomes </it>regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3) operating with available <it>resources </it>and within certain <it>constraints </it>(4) over the passage of <it>time</it>, (5) while mentally representing or <it>depicting </it>the ever-changing situation and <it>detecting </it>possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies.</p> <p>Conclusions</p> <p>The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.</p