68 research outputs found
What works for whom in the management of diabetes in people living with dementia: a realist review
Background
Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD.
Methods
This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference.
Results
We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement.
Conclusions
Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs.
Trial registration
PROSPERO, CRD42015020625. Registered on 18 May 2015
Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems
Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options
Language development after cochlear implantation: an epigenetic model
Growing evidence supports the notion that dynamic gene expression, subject to epigenetic control, organizes multiple influences to enable a child to learn to listen and to talk. Here, we review neurobiological and genetic influences on spoken language development in the context of results of a longitudinal trial of cochlear implantation of young children with severe to profound sensorineural hearing loss in the Childhood Development after Cochlear Implantation study. We specifically examine the results of cochlear implantation in participants who were congenitally deaf (N = 116). Prior to intervention, these participants were subject to naturally imposed constraints in sensory (acoustic–phonologic) inputs during critical phases of development when spoken language skills are typically achieved rapidly. Their candidacy for a cochlear implant was prompted by delays (n = 20) or an essential absence of spoken language acquisition (n = 96). Observations thus present an opportunity to evaluate the impact of factors that influence the emergence of spoken language, particularly in the context of hearing restoration in sensitive periods for language acquisition. Outcomes demonstrate considerable variation in spoken language learning, although significant advantages exist for the congenitally deaf children implanted prior to 18 months of age. While age at implantation carries high predictive value in forecasting performance on measures of spoken language, several factors show significant association, particularly those related to parent–child interactions. Importantly, the significance of environmental variables in their predictive value for language development varies with age at implantation. These observations are considered in the context of an epigenetic model in which dynamic genomic expression can modulate aspects of auditory learning, offering insights into factors that can influence a child’s acquisition of spoken language after cochlear implantation. Increased understanding of these interactions could lead to targeted interventions that interact with the epigenome to influence language outcomes with intervention, particularly in periods in which development is subject to time-sensitive experience
An exploration of the family resilience needs of a rural community in South Africa: a sequential explanatory mixed methodological study design
The aim of the study is to identify and explore
family resilience needs in a rural community in the West
Coast region of South Africa. An explanatory mixed methodological
sequential design was implemented. Firstly, Sixbey’s
(2005) Family Resilience Assessment Scale, was employed to
conduct the quantitative assessment via a door-to-door sample
of convenience identified with the assistance of a local nongovernmental
organisation. Of the 656 participants, 39.8%
were male and 60.2% were female, with an average age of
37.90 years (standard deviation 13.92). Secondly, four focus
groups involving 27 community participants provided qualitative
data. Results from the quantitative assessment show that
family connectedness and utilising social and economic
resources were the lowest scoring, and belief systems the
highest scoring, dimensions in family resilience. Based on
the quantitative findings and the discussions, three thematic
categories emerged: community and family challenges; community
belief systems; and current family functioning and
organisational patterns. A number of families and groups
within the community were able to provide feedback, recommendations
and work collaboratively in this study. This contributed
to the argument we make for the transformative
mixed methods paradigm that is discussed. This study provides
further insight into the theory of family resilience.ISI & Scopu
Resource use in two contrasting habitat types raises different challenges for the conservation of the dryad butterfly Minois dryas
Do supportive family behaviors promote diabetes self-management in resource limited urban settings? A cross sectional study
Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes
Improving diabetes control for Syrian refugees in Jordan: a longitudinal cohort study comparing the effects of cash transfers and health education interventions
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