Smart tattoo: technology for monitoring blood glucose in the future.

New ways of measuring blood glucose bring hope of easing the burden of diabetes management for patients living with the conditions. The smart tattoo is an innovation that represents a nascent nanotechnology, which is designed to be implanted within the skin to provide continuous and reliable glucose detection for individuals diagnosed with diabetes. The potential benefits of the smart tattoo are compelling not only due to the potential of these nanodevices to prevent diabetic complications and decrease the related social costs, but also due to ease of use and relative user comfort. However, despite the advantages of the smart tattoo, it is important that health professionals, in embracing nanotechnology, understand the ethical implications of using these innovative devices.

'Knowing where I am': self-monitoring of blood glucose in diabetes.

Although the prevalence of all types of chronic conditions is increasing, diabetes is one of the few long-term metabolic disorders that individuals can successfully manage, monitor and control on a day-to-day basis. Self-monitoring of blood glucose (SMBG) is considered an essential component of diabetes self-care management. When used appropriately, SMBG can help to identify factors associated with hyper- and hypoglycaemia, facilitate learning, and empower people with diabetes to make changes to improve their glycaemic control. SMBG can be a useful tool for healthcare providers, who can teach individuals to monitor glucose at specific times to assess the effectiveness of medications and guide medication management. However, there is an ongoing debate regarding whether, as is the case with type 1 diabetes, all people with type 2 diabetes should also be given the opportunity to learn about the value of, and skills required to, monitor blood glucose as appropriate to their specific needs.

Health care in a technological world.

Ongoing innovation in the field of mobile health (mHealth) has the potential to change the landscape of healthcare practice both inside and outside formal clinical settings. mHealth could enhance patient education, prevent disease, improve diagnosis and research-based treatment, reduce healthcare costs and enable patients to manage long-term conditions. In addition, unimpeded by geographical distance, smartphone-linked wearable sensors, built around real-time connectivity, will improve communication between health professionals and improve the understanding of physiological variability, thereby improving clinical decisions and quality of care. However, despite the potential of mHealth, there are still significant information gaps regarding its long-term effects, acceptability, costs and risks. There is therefore a significant need for continued research to evaluate the functions and appropriateness of these medical devices that are slowly entering the healthcare arena, while not neglecting the rights of the individual.

Using mixed methods when researching communities.

AIM: To argue for the use of mixed methods when researching communities. BACKGROUND: Although research involving minority communities is now advanced, not enough effort has been made to formulate methodological linkages between qualitative and quantitative methods in most studies. For instance, the quantitative approaches used by epidemiologists and others in examining the wellbeing of communities are usually empirical. While the rationale for this is sound, quantitative findings can be expanded with data from in-depth qualitative approaches, such as interviews or observations, which are likely to provide insights into the experiences of people in those communities and their relationships with their wellbeing. DATA SOURCES: Academic databases including The Cochrane Library, MEDLINE, CINAHL, AMED, INTERNURSE, Science Direct, Web of Knowledge and PubMed. REVIEW METHODS: An iterative process of identifying eligible literature was carried out by comprehensively searching electronic databases. DISCUSSION: Using mixed-methods approaches is likely to address any potential drawbacks of individual methods by exploiting the strengths of each at the various stages of research. Combining methods can provide additional ways of looking at a complex problem and improve the understanding of a community's experiences. However, it is important for researchers to use the different methods interactively during their research. CONCLUSION: The use of qualitative and quantitative methods is likely to enrich our understanding of the interrelationship between wellbeing and the experiences of communities. This should help researchers to explore socio-cultural factors and experiences of health and healthcare practice more effectively.

The setting of healthcare priorities through public engagement.

Global fiscal constraints mean that the UK healthcare system of the 21st century can no longer provide all possible services and treatment for all the people it serves. Currently, more than ever, there is a need to set priorities in terms of resources. The allocation of scarce healthcare resources will result in some care programmes being supported while others are not. Decision makers are increasingly engaging the public in policy making and priority-setting processes. Advocates of increased public engagement argue that public services are paid for by the people and, therefore, should be shaped more extensively by them, preferably by a fully representative sample. Central to the concept of public engagement is a desire for open dialogue and debate between groups that might not ordinarily have the channels to understand or speak to one another. Public engagement activities aim to link the healthcare community with the general public, community groups, civil society organisations and any other groups or communities in the outside world where healthcare decision-making gains its relevance. This article, therefore, aims to discuss the importance of promoting public engagement.

In pursuit of excellence in diabetes care: trends in insulin delivery.

Diabetes mellitus has been estimated to affect 2.9 million people in the UK. Large-scale clinical trials conclusively demonstrate that elevated blood glucose levels are associated with an increased risk of micro- and macrovascular complications. The high rates of morbidity and mortality associated with this condition demonstrate how important effective glycaemic control is. Subcutaneous insulin injection continues to be the mainstay of therapy for all people with type 1 diabetes mellitus and the majority of individuals with type 2 diabetes mellitus. However, there are a number of barriers to insulin therapy. For example, conventional insulin delivery is arguably time consuming. Furthermore, it has been associated with common errors, such as inaccurate dosing and administration (National Patient Safety Agency, 2010). Insulin pen devices have various advantages over conventional delivery. Their ease of use and incorporation into busy lifestyles may improve diabetes control with much less effort, while maintaining adherence and quality of life. Research in insulin delivery shows there is a prospect of needle-free delivery in the near future. Despite such progress, the role of the healthcare professionals in involving, assessing, supporting and educating people having insulin therapy, including the attainment of the agreed blood glucose levels, cannot be overestimated.

Assessing glycaemic control: self-monitoring of blood glucose.

Diabetes Mellitus is a chronic, lifelong metabolic disorder characterized by an elevated blood glucose level resulting from an absolute or relative shortage of insulin. Self-monitoring of blood glucose (SMBG) has escalated over the years following the outcomes of evidence demonstrating a strong correlation between tight blood glucose control and the significant reduction of diabetes-related complications. While glycosylated haemoglobin (HbA1c) measures mean glycaemic exposure during the preceding 2-3 months, it does not provide day-to-day changes in glucose levels. SMBG represents an important adjunct to HbA1c because it distinguishes among fasting, preprandial (before a meal) and postprandial (after a meal) hyperglycaemia and provides immediate feedback about the effect of food choices, activity and medication on glycaemic control. The successful outcome of glycaemic control cannot be effectively achieved without the input of the nurse. The nurse's role is to identify people with diabetes who are most likely to benefit from SMBG and provide them with appropriate education, problem solving skills and ongoing support.

In too deep: understanding, detecting and managing DVT.

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious health and social care problem of the developed world, affecting 1 in 1000 adults every year, and with an annual financial overhead of approximately £640 million. The nature of DVT means that often the condition can go unrecognized until the thrombus becomes an embolus. The pathogenesis of DVT continues to be based on Virchow's triad, which attributes VTE to 'hypercoagulability', 'stasis' and 'intimal injury'. The diagnosis of DVT is often the result of a number of tests performed either sequentially or in combination before mechanical and/or chemical treatment is embarked on. Creating public awareness of DVT and PE is the best way to prevent this condition. Nurses are in an ideal position to discuss the importance of lifestyle changes and other related measures to prevent DVT.

The imperative of human obesity: an ethical reflection.

Good health for all has become an accepted international goal. Arguably there have been broad gains in life expectancy over the past century. However, the escalating epidemic of adult obesity, estimated at more than 1 billion worldwide, has become a major public health concern. Obesity affects people of all ages and socioeconomic backgrounds. It is invariably perceived as a product of biological, psychological and social conditions, thereby casting aside its ethical imperatives. Without undermining the role of medicine in managing obesity, this article proposes to discuss the need for nurses to consider relevant ethical principles when supporting people with obesity.

Nanotechnology: the revolution of the big future with tiny medicine.

The historically unprecedented developments of nanoscience and nanotechnology (NT) promise to revolutionize the diagnosis, treatment and prevention of disease and traumatic injury, to relieve pain, and to preserve and improve human health, using molecular tools and molecular knowledge of the body. This article focuses on what is known as nanomedicine, referring to a definition of NT, its historical overview and developments as well as its application to medicine. In revolutionizing the manufacturing process to a nanoscale, NT promises to resolve the problems currently faced by the human race. However, in embracing this panacea, its implications, particularly within health care, cannot be ignored. This article, therefore, provides a thought-provoking consideration of how NT is likely to impact on nursing, together with the issues likely to be encountered during the care delivery process. Finally, some of the ethical questions nurses need to debate has been raised.

Nanotechnology: is there a need for ethical principles?

Nanotechnology (NT) is concerned with materials and systems whose structures and components exhibit novel physical, chemical and biological properties due to their nanoscale size. This new scientific discipline is fast becoming a major driver of the future direction of health care and is likely to have a significant impact on society, medicine and nursing. This article demonstrates that ethical reflections lie at the heart of nursing. In contextualizing the ethics of NT, this article questions the conclusion reached by others that ethical reflections on NT lag behind its scientific developments. Instead it proposes that the ethical issues raised by NT are similar to those relating to biotechnology, considered by ethicists since the 1970s. Consequently, this article argues that a foundation of ethical reflections already exists that can be transferred to NT. Finally, this article asserts the need for nurses to be proactively involved in interdisciplinary discussions likely to extend the current ethical reflections of autonomy, non-maleficence, beneficence and justice to NT.

Chronic diseases: the silent global epidemic.

In most industrialized nations and many developing countries chronic diseases or non-communicable diseases (NCDs) are the leading cause of death. In 2005, chronic diseases, such as cardiovascular disease, cancer, respiratory disease and diabetes caused 58 million deaths worldwide (World Health Organization, 2005). Despite strong evidence for the magnitude of this burden, the preventability of NCD causes and the threat they pose to already strained healthcare systems, national and global responses have been slow. This article provides a global overview of chronic diseases. It further explores the impact of globalization as an important determinant of NCD epidemics. Finally, in addition to working alongside policy-makers, the fundamental roles of nursing to promote health, prevent disease and alleviate suffering call for expression of caring for humanity and environment through political activism at all levels to bring about reforms of current global economic order.

An epidemiological overview of diabetes across the world.

Once the Cinderella of chronic diseases, diabetes mellitus is now fast emerging as one of the biggest health catastrophes the world has ever witnessed. Almost 6% of the world's adult population now live with diabetes (Sicree et al, 2003; International Federation of Diabetes, 2006). It has been predicted that the total number of people with diabetes will rise to 366 million in less than 30 years if preventative action is not taken (Wild et al, 2004). Diabetes is no longer a concern of an individual country. It has huge global and societal implications, particularly in developing countries where the development of diabetes at an early age can lead to untoward human suffering, disability and socioeconomic cost. An internationally coordinated effort is required to improve human behaviour and lifestyle to halt the global diabetes epidemic and the development of such complications as retinopathy, nephropathy, neuropathy, cardiovascular diseases, peripheral vascular diseases and stroke. For such a formula to be successful, it is important for nurses to be proactive in their political role in ensuring that people with diabetes become expert in their condition. In so doing, healthcare systems and resources could be used more effectively to reduce real human and economic costs.

Dietary pattern of self-care among Asian and Caucasian diabetic patients.

Diabetes mellitus is a growing pandemic and its self-care management rests primarily with the individual. This qualitative case study investigated the self-care dietary pattern among a group of 25 Asians and 24 Caucasians diagnosed with type 1 or type 2 diabetes. Data collected from a semi-structured interview and a 7-day health diary explored the self-care activities undertaken by the participants to establish metabolic control. From an analytical perspective, the collective responses were placed on a continuum ranging from strict adherence, moderately flexible adherence to very flexible adherence. The findings suggest that most of the participants were located in the latter two categories of diet related to self-care. Implications for healthcare professionals in promoting self-care will be discussed.

Clinical skills: empowering people with diabetes to minimize complications.

Diabetes mellitus is a lifelong condition. It represents a major cause of morbidity and mortality, often brought about by diabetic microvascular (retinopathy, nephropathy and neuropathy) and macrovascular (peripheral vascular disease, cardiovascular disease and stroke) complications. Although incurable, it is nevertheless possible for the person with diabetes to lead a normal life by adhering to a self-care management regimen. However, this complex, lifelong activity cannot be achieved in isolation. The role of the nurse, particularly as an educator and facilitator of learning, is therefore critical. This article aims to increase nurses' knowledge regarding the importance of ongoing education for the person with diabetes in order to minimize the development of microvascular and macrovascular complications. It also emphasizes the importance of including the individual in any decision-making process to ensure that empowerment is visible.