Neonatal Hypocalcemia in the Infant of a Diabetic Mother.

Neonatal hypocalcemia (NHC) is one of the most common disorders of calcium metabolism in infants admitted to the NICU. Presentation can range from asymptomatic to generalized seizures or tetany. In this case study, an infant with NHC is presented along with an overview of the pathophysiology, prevalence, diagnosis, and management of NHC for neonatal clinicians.

Type 2 Diabetes Self-Management Barriers in Older Adults: An Integrative Review of the Qualitative Literature.

Type 2 diabetes is a prevalent chronic health condition more frequently affecting adults ages 65 and older. Furthermore, these individuals tend to have more type 2 diabetes-associated complications, compared with younger individuals with diabetes, and face unique challenges throughout the self-management process. Despite many studies and reviews about diabetes self-management, few researchers focus specifically on older adults. Of particular importance is the need to understand self-management challenges through the patient's lens. Therefore, the purpose of the current review is to examine and summarize the qualitative literature concerning type 2 diabetes self-management barriers in older adults. Following critical appraisal of literature published from 2007-2018, 10 articles were reviewed and content analysis performed. Four themes emerged: Lack of Knowledge and Understanding, Self-Management Implementation Challenges, Culture and Language Barriers, and Health Care Providers as a Perceived Barrier. The state of the qualitative science, implications for nursing practice, and recommendations for future research are discussed. [Journal of Gerontological Nursing, 45(3), 43-54.].

Glycaemic management during the inpatient enteral feeding of people with stroke and diabetes.

This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area.

[Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery].

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes.

AIMS: To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS: The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS: Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS: Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).

Content validation study of nursing interventions intended to prevent cardiovascular events in diabetic patients.

AIMS AND OBJECTIVES: To validate nursing interventions from the Nursing Interventions Classification for preventing cardiovascular events in outpatients with diabetes. BACKGROUND: Cardiovascular disease is the main cause of death among diabetic patients. Although nurses play an important role in preventing cardiovascular events in this population, their specific contribution is difficult to measure. Documenting nursing interventions using a standardised nursing system may provide nursing visibility. However, there are no studies that analysed which nursing interventions would be the most relevant, based on expert opinion, aimed at preventing cardiovascular events in diabetic patients. DESIGN: This is a content validation study, which was designed as a descriptive one. METHODS: For this content validation study, we used the Fehring model. Nursing interventions were selected from the Nursing Intervention Classification. Experts were asked to analyse the degree of relevance of 225 nursing interventions regarding the prevention of cardiovascular events in diabetic patients, considering its title and definition. We considered nursing interventions which obtained weighted arithmetic averages >0·80 to be valid. RESULTS: Among 50 invited experts, 14 (71·4% female; 36·5 + 9·7 years) responded and agreed to participate in this study. They analysed 225 preselected nursing interventions, and validated 29. CONCLUSION: The validated nursing interventions included documentation as well as biological, social and spiritual issues. RELEVANCE TO CLINICAL PRACTICE: The validated nursing interventions encompass a wide range of nursing knowledge, and these results provide empirical evidence for further studies.

A Nurse's Guide to the Prevention of Neuropathic Ulcers in Patients with Diabetes.

Neuropathic ulcers present a significant issue for patients with diabetes. Neuropathic ulcers reduce mobility and increase the risk for infection and other complications. Prevention of ulceration is a primary nursing goal in the care of patients with diabetes.

Prevention and management of diabetic foot ulcers.

As part of an annual foot review, trained and competent personnel should examine patients' feet to detect risk factors for ulceration. Foot examination with shoes and stockings removed should include: palpation of foot pulses; testing foot sensations using 10g monofilament or vibration; inspection for significant callus or deformed nails; inspection for any structural deformity; asking about any previous ulceration; checking for signs of ulceration; asking about any pain; and inspecting footwear. Following assessment, a foot risk classification score should be given. The person with diabetes should then be informed of their risk score, with education offered regarding future foot-care management. Diabetic foot complications include ulceration, Charcot foot, painful neuropathy, gangrene and amputation. Risk factors for ulceration include non-palpable pulses, insensate foot, significant callus, deformed nails, history of previous ulcer or amputation, tissue damage or signs of ulceration, foot pain and unsuitable footwear.

Trials, tribulations, and triumphs of a pilot initiative to optimize the management of wounds complicated by diabetes within the home.

To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.

Diabetes and cataract surgery: preoperative risk factors and positive nursing interventions.

PURPOSE: In the United States, approximately three million cataract surgeries are performed annually. Although cataract surgery has been demonstrated to improve vision in up to 95% of patients, those with diabetes may be at increased risk of complications and poor visual outcomes. Preoperative risk factors such as age, retinal diseases, hypoglycemic medications, and hemoglobin A1C (Hgb A1C) levels may play a role in patient outcomes following cataract surgery. Furthermore, intraoperative risk factors such as the use of pupillary expanders, trypan blue staining, and additional procedures such as anterior vitrectomy may also be considered as a challenge for diabetic patients. This article will describe preoperative risk factors associated with visual outcomes for diabetic patients undergoing cataract surgery and appropriate nursing interventions for these patients. METHODS: Literature review of risk factors and cataract surgery outcomes in terms of complications, visual acuity, and visual functioning of diabetic patients was undertaken. Preoperative risk factors (i.e., age, retinal diseases, advanced macular disease [AMD], hypoglycemic medications, and Hgb A1C levels) and postoperative complications, including inflammation and cystoid macular edema (CME), were also examined. To emphasize evidence of best practices, the role of the nurse as educator and advocate was further explored in terms of their impact on diabetes management of the patient to improve visual results. RESULTS: Diabetic patients of advanced age, with a history of diabetic retinopathy who are taking insulin and have elevated Hgb A1C levels, may have an increased risk of intraoperative and postoperative complications and decreased postoperative visual acuity and visual functions that may affect their quality of life. CONCLUSIONS: High-risk factors should be identified in diabetic patients when developing a perioperative patient education plan to help reduce their risk of cataract complications and improve their visual outcomes.

An indispensible role.

Freezing the vacant posts of diabetes nurse specialists is affecting patient care and will cost the NHS more in the long run, warns a major charity.

[Validation of nursing interventions in people with diabetes mellitus]. / Validação de intervenções de enfermagem em pessoas com diabetes mellitus.

This descriptive, exploratory study aimed to validate nursing interventions proposed by the Nursing Interventions Classification for impaired skin integrity, deficient knowledge, ineffective therapeutic regimen management for predominant nursing diagnoses in people with diabetes. Participants were 21 specialist nurses in diabetes mellitus in Brazil, in 2007. Interventions were analyzed according to Fehring's evaluation model. The nursing interventions with the highest weighted average were care to injuries: closed drainage and circulatory precautions for the impaired skin integrity nursing diagnosis, teaching: disease process and teaching: prescribed medication for deficient knowledge and teaching: disease process and teaching: prescribed diet for ineffective therapeutic regimen management. Among the 1005 activities of nursing, 51% were validated as very characteristic by experts. Other studies should be carried out to expand the validation of the nursing interventions to people with diabetes mellitus in Brazil, searching for scientific evidences for care to these clients.

CT Image Features of the FBP Reconstruction Algorithm in the Evaluation of Fasting Blood Sugar Level of Diabetic Pulmonary Tuberculosis Patients and Early Diet Nursing.

The study was aimed at exploring the application value of the CT image based on a filtered back projection (FBP) algorithm in the diagnosis of patients with diabetes complicated with tuberculosis and at analyzing the influence of dietary nursing on patients with diabetes complicated with tuberculosis. In this study, the FBP algorithm was used to optimize CT images to effectively obtain reconstructed ROI images. Then, the deviation from measurement values of reconstructed images at different pixel levels was analyzed. 138 patients with diabetes complicated with tuberculosis were selected as research subjects to compare the number of lung segments involved and the CT imaging manifestations at different fasting glucose levels. All patients were divided into the control group (routine drug treatment) and observation group (diet intervention on the basis of drug treatment) by random number table method, and the effect of different nursing methods on the improvement of patients' clinical symptoms was discussed. The results showed that the distance measurement value decreased with the increase in pixel level, there was no significant difference in the number of lung segments involved in patients with different fasting glucose levels (P > 0.05), and there were statistically significant differences in the incidence of segmental lobar shadow, bronchial air sign, wall-less cavity, thick-walled cavity, pulmonary multiple cavity, and bronchial tuberculosis in patients with different fasting glucose levels (P < 0.05). Compared with the control group, 2 h postprandial blood glucose level in the observation group was significantly improved (P < 0.05), there was a statistical significance in the number with reduced pleural effusion and the number with reduced tuberculosis foci in the two groups (P < 0.05), and the level of hemoglobin in the observation group was 7.1 ± 1.26, significantly lower than that in the control group (8.91 ± 2.03, P < 0.05). It suggested that the changes of CT images based on the FBP reconstruction algorithm were correlated with fasting blood glucose level. Personalized diet nursing intervention can improve the clinical symptoms of patients, which provides a reference for the clinical diagnosis and treatment of patients with diabetes complicated with tuberculosis.

Nurses' responses to differing amounts and information content in a diagnostic computer-based decision support application.

Nurses often need to make quick decisions with incomplete diagnostic information while they are under time pressure. The use of a data-driven, computerized decision support approach in daily work activities has great potential to facilitate precise and context-sensitive use of the information implicit in nursing diagnoses. This study explored optimal information amounts and levels of information content for designing and implementing a diagnostic nursing decision support system. Specifically, the use of probability data for likely nursing problems and the preferred number of displayed nursing problems were presented to expert and novice nurses. The study used a counterbalanced, repeated-measures, and factorial design. The authors developed two scenarios: (1) a pneumonia patient with diabetes mellitus complications and (2) a patient with controlled diabetes who also had a bone fracture. A previously developed prototype for a diagnostic nursing decision support system was used to display the information. Eighteen novice and expert nurses from two hospitals in Korea participated. Results for the differing levels of content did not differ significantly with level of expertise, but the preferred amount of information was significant for the two groups of nurses. The differing information needs of novices and experts should be considered when designing future computer-based decision support.

I Cannot Afford Off-loading Boots: Perceptions of Socioeconomic Factors Influencing Engagement in Self-management of Diabetic Foot Ulcer.

This study aimed at uncovering the factors influencing individuals' ability to engage in self-management of diabetic foot ulcer (DFU) and presenting a theoretical model depicting these factors and the outcomes. We used constructivist grounded theory methodology to guide this study and recruited 30 participants with an active DFU attending a wound care clinic in Ontario, Canada. The study's findings indicate that participants' engagement in self-management of DFU was influenced by internal and external factors. While some factors contributed to enhance participants' engagement in everyday self-management, others seemed to have prevented them from achieving engagement and hence the desired DFU outcomes.