Decision-making: initiating insulin therapy for adults with diabetes

<b>AIM:</b> This paper is a report of a study to describe nurses' perceptions of decision-making and the evidence base for the initiation of insulin therapy. <b>BACKGROUND:</b> Several theoretical perspectives and professional's attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions. <b>METHOD:</b> A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37.7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent. <b>RESULTS:</b> People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses' identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated. <b>CONCLUSION:</b> Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy

Evaluation of Adrenal Suppression of a Lipid Enhanced, Topical Emollient Cream Formulation of Hydrocortisone Butyrate 0.1% in Treating Children with Atopic Dermatitis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75102/1/j.1525-1470.2007.00342.x.pd

Small steps towards a large framework: a workshop approach

This article follows the progress of a project to support DSNs in meeting Standard 3 of the NSF for Diabetes. The workshop format provided the delegates with the opportunity to discuss shared issues and concerns

Identification of the Biotransformation Products of 2-Ethylhexyl 4-(N,N-Dimethylamino)benzoate

Nowadays, 2-ethylhexyl 4-(N,N-dimethylamino)benzoate (EDP) is one of the most widely used UV filters in sunscreen cosmetics and other cosmetic products. However, undesirable processes such as percutaneous absorption and biological activity have been attributed to this compound. The in vitro metabolism of EDP was elucidated in the present work. First of all, the phase I biotransformation was studied in rat liver microsomes and two metabolites, N,N-dimethyl-p-aminobenzoic acid (DMP) and N-monomethyl-p-aminobenzoic acid (MMP), were identified by GC-MS analysis. Secondly, the phase II metabolism was investigated by means of LC-MS. The investigated reactions were acetylation and glucuronidation working with rat liver cytosol and with both human and rat liver microsomes, respectively. Analogue studies with p-aminobenzoic acid (PABA) were carried out in order to compare the well established metabolic pathway of PABA with the unknown biotransformation of EDP. In addition, a method for the determination of EDP and its two phase I metabolites in human urine was developed. The methodology requires a solid-phase extraction prior to LC-MS analysis. The method is based on standard addition quantification and has been fully validated. The repeatability of the method, expressed as relative standard deviation, was in the range 3.4–7.4% and the limit of detection for all quantified analytes was in the low ng mL−1 range

Insulin initiation in adults: evidence based or context driven?

Aim.  To describe insulin initiation practices across the United Kingdom (UK) and identify factors influencing current practice. Background.  The number of people commencing insulin therapy has escalated in recent years; due to increased incidence of diabetes and the evidence that improvements in glycaemic control can reduce and delay the onset of diabetic complications. However, the process of insulin initiation is not well described and the optimal way to start insulin therapy is unclear. There is currently a strong emphasis on moving diabetes care from secondary to primary care and this change in policy may also influence insulin initiation. Methods.  A quantitative, cross-sectional, nationwide survey of diabetes specialist nurses (DSNs) and practice nurses (PNs) was completed in 2006. Data were gathered using a postal questionnaire, 1310 were returned (37·7% response rate). Results.  Almost all DSNs working in secondary, or across primary and secondary, care initiate insulin in people with type 1 diabetes, but only 37·7% of DSNs working in primary care or 2·5% of PNs (p < 0·001). Most DSNs initiate insulin in adults with type 2 diabetes compared with only 37·7% of PNs (p < 0·001). Only 23·5% of respondents initiate insulin for those with gestational diabetes (GD), most working in secondary care (p < 0·001). The most commonly used insulin regimen was multiple injection in type 1 diabetes (43·9%), a twice-daily mixture (19·2%) and night only basal insulin (17·9%) in type 2 diabetes and multiple injection in GD (46·8%). Analogue insulins were more frequently used than non-analogues in type 1 and 2 diabetes but almost equally in those with GD. Conclusion.  Despite the drive for much more diabetes care to be delivered in primary care insulin initiation remains largely the province of secondary care, and regardless of the contested nature of the evidence base, analogue insulins are widely used. Relevance to clinical practice.  The focus of this study was on one aspect of diabetes care (insulin initiation), however the findings illustrate that whilst policy relating to the care of people with a long-term condition such as diabetes may change, the practice implications in terms of community provision and availability of appropriate expertise are complex