A Methodological Description of a Randomised Controlled Trial Comparing Hospital-Based Care and Hospital-Based Home Care when a Child is Newly Diagnosed with Type 1 Diabetes

AIM AND OBJECTIVE: To describe the study design of a randomised controlled trial with the aim of comparing two different regimes for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care. BACKGROUND: Procedures for hospital admission and sojourn in connection with diagnose vary greatly worldwide and the existing evidence is insufficient to allow for any conclusive determination of whether hospital-based or home-based care is the best alternative for most families. Comparative studies with adequate power and outcome measurements, as well as measurements of cost-effectiveness are needed. DESIGN: The study design was based on the Medical Research Council framework for complex interventions. After two to three days with hospital-based care, children between the ages of 3 and 16 were randomised to receive either continued hospital-based care for a total of 1-2 weeks or hospital-based home care, which refers to specialist care in a home-based setting. The trial started in March 2008 at a University Hospital in Sweden and was closed in September 2011 when a sufficient number of children according to power calculation, were included. The primary outcome was the child's metabolic control during the following two years. Secondary outcomes were set to evaluate the family and child situation as well as the organisation of care. DISCUSSION: Childhood diabetes requires families and children to learn to perform multiple daily tasks. Even though intervention in health care is complex with several interacting components entailing practical and methodological difficulties, there is nonetheless, a need for randomised controlled trials in order to evaluate and develop better systems for the learning processes of families that can lead to long-term improvement in adherence and outcome

PENGARUH DISIPLIN KERJA TERHADAP KINERJA GURU DI SMA NEGERI SE-KECAMATAN COBLONG KOTA BANDUNG

Penelitian ini berjudul “Pengaruh Disiplin Kerja Terhadap Kinerja Guru di SMA Negeri se-Kecamatan Coblong Kota Bandung”. Masalah yang dikaji dalam penelitian ini adalah seberapa besar pengaruh disiplin kerja terhadap kinerja guru. Secara umum penelitian ini bertujuan untuk mengetahui gambaran yang jelas terkait pengaruh disiplin kerja terhadap kinerja guru di SMA Negeri se-Kecamatan Coblong Kota Bandung. Metode yang digunakan dalam penelitian ini yaitu metode deskriptif dengan pendekatan kuantitatif. Teknik pengumpulan data menggunakan angket tertutup dengan lima skala penilaian (Likert) yang disebar pada 56 guru yang berada di SMA Negeri Kecamatan Coblong sebagai sampel penelitian. Hasil perhitungan kecenderungan umum dengan menggunakan Weighted Means Scored (WMS), menunjukkan bahwa rata-rata kecenderungan variabel X (Disiplin Kerja) berada dalam kategori sangat baik, dan rata-rata kecenderungan variabel Y (Kinerja Guru) berada dalam kategori sangat baik. Hasil pengujian normalitas distribusi data bahwa variabel X dan variabel Y berdistribusi normal. Hasil perhitungan koefisien korelasi menunjukkan bahwa terdapat hubungan yang kuat antara variabel X dan variabel Y, serta nilai uji signifikansi yang terbukti signifikan. Perolehan analisis determinasi sebesar 40,5%, hal ini menunjukan bahwa besarnya pengaruh disiplin kerja terhadap kinerja guru adalah sebesar 40,5% dan sisanya dipengaruhi oleh faktor lain. Kesimpuln dari penelitian ini yaitu adanya pengaruh yang positif dan signifikan antara disiplin kerja terhadap kinerja guru di SMA Negeri se-Kecamatan Coblong Kota Bandung, hal telah tersebut dibuktikan secara perhitungan statistik. ;---This research “The effect of labor discipline on the performance of teachers in the District small hole SMA in Bandung”. Problem in this research is how much influence the discipline of work on teacher performance. In general, this study aims to determine a clear picture of work-related discipline influence the performance of teacher the District small hole SMA in Bandung. The method used in this research is descriptive method with quantitative approach. Data collection techniques using closed questionnaire with 5 rating scale (Likert) distributed in 56 high school teachers in the country districts as a small hole sample. The calculation results by using Weighted Means Scored (WMS),general trend shows that the average propensity variable X (Work Discipline) is the excellent category, and the average tendency of variable Y (Teacher Performance) is the excellent category. Results of testing the normality of the data distribution that the variables X and Y variables with normal distribution. Correlation coefficient there are shows that a strong relationship between the variables X and Y variables, as well as the significance test which proved significant. Acquition analysis of determination of 40,5%, this suggests that the influence of labor discipline on teacher performance was 40,5% and the rest influenced by other factors. Conclusions of this analysis, the influence of positive and significant correlation between discipline of work on teacher performance in SMA Bandung District of small hole it can be proven statistical calculations

The initial care when a child is diagnosed with type 1 diabetes

When a child is diagnosed with diabetes, the symptoms may be in its most severe form with ketoacidosis, to mild symptoms of diabetes, detected incidentally. Moderate and severe symptoms of diabetes presentation require infusion therapy and thereby necessitate hospitalisation for the first few days. The initial management is largely a preparation for family members to help them gain the practical understanding and skills needed for integrating the treatment in everyday life. Some units routinely admit the children to hospital, while others say they can be safely managed at home. There is no high-quality evidence concerning the consequences that the differences in the type of service might have for the child, family or health system. The overall aim of this thesis was to investigate the initial care for children newly diagnosed with type 1 diabetes, receiving conventional hospital-based care and hospital-based home care (HBHC), i.e. specialist care in a home-based setting. A further aim was to identify families where the child runs the risk of decreased metabolic control and to give these families increased support. Two studies have been carried out at Skåne University Hospital Lund in Sweden. The first had a retrospective design with the aim of assessing whether temporal changes in the initial management over a ten year period affected children’s metabolic control two years after diagnosis. The results showed that during the years 1997 up to 2006 all children, except one, were admitted to hospital. The duration of the hospital stay decreased from a mean of three weeks to two weeks. Seventy-five per cent of the children were not acutely ill (defined as pH ≥7.30) at diagnosis and 94% of the children initially received intravenous insulin treatment. Neither the length of the hospital stay nor any differences in insulin treatment were associated with children’s metabolic control over time. The second study had a randomised design with the aim of comparing two different regimes for children diagnosed with type 1 diabetes: hospital-based care and HBHC. The follow-up of the study was two years. In this thesis, results one and six months from diagnosis are presented. No adverse events or severe acute diabetes complications have occurred during the trial or during the follow-up. Results one month from diagnosis showed small advantages to HBHC in the children’s metabolic control with regards to plasma glucose values and numbers of episodes of hypoglycaemia. Parents were more satisfied with the service in HBHC, and healthcare costs were 30% lower in HBHC compared to the hospital-based service. The results six months from diagnosis showed that parents continued to be more satisfied with the service in HBHC. Furthermore, the results showed that there were no differences in the children’s HbA1c, in the arrangement of the parents’ working hours after the child’s diagnosis or in the amount of absence from work related to the child’s diagnosis. The categorical risk for families’ psychosocial distress, assessed by professionals at the time of diagnosis, was associated with subsequent resource use, although not HbA1c. Families that received HBHC had less use of healthcare resources, compared to families having received hospital-based care. When summarising the first month and the period from 1-6 months, the total healthcare costs were 27% lower in HBHC compared to hospital-based care. In summary, for children diagnosed with type 1 diabetes, the length of the hospital stay has decreased significantly over a ten year period. During this time, children have usually been routinely admitted to hospital irrespective of their medical condition. The results support the suggestion that an HBHC programme is just as safe for the child as hospital-based care. The results further indicate equivalence in the efficacy of the services. These results, in combination with a high degree of acceptance by those to whom the HBHC service was offered and lower healthcare costs, could suggest that the HBHC service is more effective as compared to the conventional hospitalbased care. As a whole, there are not many well-designed and controlled studies that have compared hospital services with different models of home care. This thesis, although limited in answers by power and knowledge stability, provides empirical support for the safety and effectiveness of healthcare services when a child is diagnosed with type 1 diabetes. The evaluation will continue to assess the consequences, of both HBHC and hospital-based care, for the child, family and health services over time and from different perspectives

Översättning och testning av ett livskvalitetinstrument: : The PedsQL™ Family Impact Module

The whole family is affected when a child is ill. Families facing the same illness stressors respond in different ways and have different needs forhealthcare. However, assessing a family’s needs is difficult. Few instruments for assessment of families’ health related quality of life, when achild in the family has a chronic illness, exist. The purpose of this study was to translate The PedsQL™ Family Impact Module from English intoSwedish and to test the instrument in clinical practise. This process was done in four steps. Two forwards, independently translations were com-pared and outlined in a first version. This version was backwards translated and compared with the original version and outlined in a secondversion. Five parents tested through face to face interviews the translated instrument. The questionnaire was field-tested in 103 parents to chil-dren with diabetes (aged 4–19), consecutively sampled when their child visited a children hospital in Sweden for their regular diabetes check.Internal consistency reliability alpha coefficient for the Swedish version of The PedsQL™ Family Impact Module (36 items) exceeded all scalesthe minimum reliability standard of 0.70. The instrument is suggested to be useful in quality improvement work and may be a help to identifyfamilies with chronic illness in need of support

Standardized minimal acupuncture, individualized acupuncture, and no acupuncture for infantile colic: study protocol for a multicenter randomized controlled trial - ACU-COL.

Despite weak evidence, the use of acupuncture has increased in infantile colic. The only three randomized trials conducted evaluated standardized minimal acupuncture in one single point. Two showed effect but one did not so further research is necessary. The aims of the study are 1) to test if results in earlier trials conducted in private acupuncture clinics can be repeated at Child Health Centers (CHC) and 2) to compare the effect of two types of acupuncture and no acupuncture in infants with colic at CHC

The Influence of Initial Management and Family Stress on Metabolic Control in Children with Type 1 Diabetes

The aim was to assess whether temporal changes in the initial management for children diagnosed with type 1 diabetes over a ten year period affected metabolic control two years after diagnosis. A further aim was to investigate if social factors, registered at diagnosis, had an impact on metabolic control two years after diagnosis. During the years 1997-2006, 247 children and adolescents were diagnosed with type 1 diabetes at a University Hospital in Sweden. The analysed data included HbA1c, pH at diagnosis, initial intravenous insulin infusion and length of hospital stay at diagnosis, subcutaneous insulin type, number of diabetes check-up visits, emergency visits, re-admissions and social factors. Length of hospital stay decreased significantly over the ten year period. Neither hospital stay nor differences in insulin treatment was significantly correlated with children’s metabolic control over time. Length of hospital stay was not related with families’ social stress situation. However, girls in families with more family stress at the time of diagnosis had higher HbA1c during follow-up than girls with less family stress or boys. Factors of importance for the child’s long-term metabolic control need to be further investigated so the initial management can be tailored to each individual family’s needs. This would imply an effective utilization of both families’ and health care resources