Serum osmolality measured in fingertip capillary blood is comparable to serum osmolality measured in venous blood.

Blood osmolality is considered the gold standard hydration assessment, but has limited application for technical and invasive reasons. Paired antecubital-venous blood and fingertip-capillary blood were collected pre- and 30 min post-drinking 600 mL water in 55 male/female participants. No bias (0.2 mOsmo/kg, limits of agreement = -2.5 to 2.8 mOsmo/kg) was found between sampling methods, with high linear correlation (Spearman's r = 0.95, P < 0.001). Capillary blood sampling offers an accurate less-invasive method for determining serum osmolality than venous blood sampling.

Overcoming obstacles: collaboration for change.

Effective diabetes care requires a partnership between prepared, proactive practice teams and informed, activated patients. Diabetes education helps to overcome many of the barriers to effective self-management by enabling people with diabetes to make informed decisions about their day-to-day self-care. Both psychosocial and health outcomes have been improved through a variety of training programmes; however, education must be coupled with ongoing self-management support if these benefits are to be sustained. The principal goal of diabetes education has undergone a major shift over the past few years--evolving from primarily didactic interventions, focused on encouraging patients to adhere to the prescribed therapy, towards more interactive learning that supports people in making informed, self-directed decisions.

Hemispheric processing asymmetries: implications for memory.

Recent research has demonstrated that memory for words elicits left hemisphere activation, faces right hemisphere activation, and nameable objects bilateral activation. This pattern of results was attributed to dual coding of information, with the left hemisphere employing a verbal code and the right a nonverbal code. Nameable objects can be encoded either verbally or nonverbally and this accounts for their bilateral activation. We investigated this hypothesis in a callosotomy patient. Consistent with dual coding, the left hemisphere was superior to the right in memory for words, whereas the right was superior for faces. Contrary to prediction, performance on nameable pictures was not equivalent in the two hemispheres, but rather resulted in a right hemisphere superiority. In addition, memory for pictures was significantly better than for either words or faces. These findings suggest that the dual code hypothesis is an oversimplification of the processing capabilities of the two hemispheres.

Assessing the cultural relevance of an education program for urban African Americans with diabetes.

PURPOSE: This study was conducted to assess the cultural relevance of an education program for urban African Americans with diabetes. METHODS: A set of 12 videotape vignettes were developed for use in diabetes education for urban African Americans with diabetes. Focus groups and questionnaires were used to determine if patients and diabetes educators would find the materials stimulating, culturally appropriate, and useful. RESULTS: The videotape and discussion guide were perceived as valuable by both healthcare professionals and patients. CONCLUSIONS: This education program could be a valuable resource for diabetes educators who want to provide culturally sensitive and relevant diabetes education for urban African Americans with diabetes.

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy.

OBJECTIVE: The purpose of this study was to assess the validity, reliability, and utility of the Diabetes Empowerment Scale (DES), which is a measure of diabetes-related psychosocial self-efficacy. RESEARCH DESIGN AND METHODS: In this study (n = 375), the psychometric properties of the DES were calculated. To establish validity, DES subscales were compared with 2 previously validated subscales of the Diabetes Care Profile (DCP). Factor and item analyses were conducted to develop subscales that were coherent, meaningful, and had an acceptable coefficient alpha. RESULTS: The psychometric analyses resulted in a 28-item DES (alpha = 0.96) with 3 subscales: Managing the Psychosocial Aspects of Diabetes (alpha = 0.93), Assessing Dissatisfaction and Readiness To Change (alpha = 0.81), and Setting and Achieving Diabetes Goals (alpha = 0.91). Consistent correlations in the expected direction between DES subscales and DCP subscales provided evidence of concurrent validity. CONCLUSIONS: This study provides preliminary evidence that the DES is a valid and reliable measure of diabetes-related psychosocial self-efficacy. The DES should be a useful outcome measure for various educational and psychosocial interventions related to diabetes.

The influence of treatment modality and ethnicity on attitudes in type 2 diabetes.

OBJECTIVE: The study examines diabetes attitude differences by treatment modality (insulin vs. no insulin), race/ethnicity, and the interaction of these two variables for people with type 2 diabetes. RESEARCH DESIGN AND METHODS: Data were collected with the Diabetes Care Profile (DCP), an instrument that assesses psychosocial factors related to diabetes. Participants (n = 672) were recruited in the metropolitan Detroit, Michigan, area from 1993 to 1996. A total of 68% of these participants were African-Americans with type 2 diabetes, and 32% were Caucasians with type 2 diabetes. Analyses of covariance were performed to examine the effects of race/ethnicity, treatment, and their interaction for each DCP scale. RESULTS: The four patient categories (two ethnicities by two treatment modalities) differed by age, years with diabetes, education, and sex distribution. Treatment modality had a significant effect on 6 of the 16 DCP scales (Control, Social and Personal Factors, Positive Attitude, Negative Attitude, Self-Care Ability, and Exercise Barriers). Ethnicity was a significant effect for three scales (Control, Support, and Support Attitudes). The interaction of race/ethnicity and treatment modality was a significant effect for two related attitude scales (Positive Attitude and Negative Attitude). CONCLUSIONS: The results suggest that attitudes toward diabetes are similar for African-American and Caucasian patients with type 2 diabetes. The results also suggest that treatment modality has a greater effect on attitudes than either race/ethnicity or the interaction effect. However, Caucasian patients using insulin differed from the other patient groups by having the least positive and the most negative attitudes regarding diabetes.

An evolutionary perspective on hemispheric asymmetries.

The evolution of hemispheric specialization of function has obvious benefits in terms of overall processing capacity, but it may also have associated costs to each hemisphere in isolation. These costs are not apparent in an intact brain since information can be readily transferred between the hemispheres via the cortical commissures. We suggest that the evolution of language in the left hemisphere may have occurred at the expense of some visuospatial functions. Because the right hemisphere was still capable of performing those functions, the relative left-hemisphere impairment for visuospatial processing would be invisible. If the cortical commissures are severed, as in callosotomy patients, the costs of specialization may become more apparent. We report data supporting the idea that the left hemisphere may have lost visuospatial abilities that it once possessed, and suggest that this process may also result in right hemisphere deficits in abilities related to linguistic processing.

Insights into the functional specificity of the human corpus callosum.

Patient VP underwent complete callosotomy for the control of intractable epilepsy at the age of 27 years. Subsequent MRI, however, revealed spared callosal fibres in the rostral and splenial ends of the corpus callosum. We report a series of experiments designed to determine whether these fibres support functional transfer of information between the two cerebral hemispheres. Although we found no evidence for transfer of colour, shape or size information, there is good evidence for transfer of word information. This suggests that the spared splenial fibres in VP's corpus callosum are material-specific. The results of these experiments illustrate the remarkable degree of functional specificity within the corpus callosum

Compliance and adherence are dysfunctional concepts in diabetes care.

Recognizing that adherence and compliance are dysfunctional concepts is not a passing fad or the latest trend in behavioral approaches to diabetes care and education. Shifting from the acute-care/compliance-focused paradigm to an empowerment/collaborative approach requires a new vision of diabetes education and a new definition and enactment of the roles of educators and patients. Our practice is always an expression of our vision; therefore, if our vision is transformed, our practice will most likely change to reflect our vision. Eliminating the concepts of adherence and compliance makes it possible for our patients to discover and actualize their personal responsibility for their diabetes self-management. Also, it helps us to practice diabetes education as win-win collaboration among equals.

A deficit in perceptual matching in the left hemisphere of a callosotomy patient.

Decades of research have demonstrated dramatic differences between the hemispheres of the brain. While the most obvious asymmetries are in the areas of language and motor control, the visuospatial abilities of the left hemisphere are also known to differ from those of the right hemisphere. This hemispheric difference has been demonstrated empirically but its basis is thus far unclear. In this paper, we investigate the hypothesis that the left hemisphere is capable of sophisticated visual processing, but represents spatial information relatively crudely compared to the right hemisphere. The implication of this hypothesis is that pattern recognition is a function of both hemispheres but the right hemisphere is further specialized for processing spatial information. In a series of seven experiments we examined perceptual matching of mirror-reversed stimuli by the divided cerebral hemispheres of a callosotomy patient. In each experiment the left hemisphere's performance was impaired relative to the right hemisphere. This finding was independent of stimulus type, response bias and stimulus duration. These results are consistent with the idea that visual processing in the left hemisphere is directed towards pattern recognition at the expense of spatial information.

A dissociation between spatial and identity matching in callosotomy patients.

Although they are structurally similar, the two hemispheres of the human brain have many functional asymmetries. Some of these, such as language and motor control, have been well characterized. Others, such as visuospatial asymmetries, are less well understood. Many researchers have noted that the right hemisphere appears to be specialized for visuospatial processing. We investigated the abilities of the divided cerebral hemispheres of two callosotomy patients to perform discriminations based on spatial or identity information. The data revealed a robust right-hemisphere superiority for spatial judgments. In contrast, the left hemisphere was somewhat better than the right at making identity judgments. These results suggest that the right hemisphere is specialized for spatial processing, and the left is specialized for pattern recognition.

Care of the nursing-home resident with diabetes.

Diabetes is a common and costly illness among elderly nursing-home residents. People with diabetes more often require skilled care, experience more frequent health problems and hospitalizations, and have longer nursing-home stays. This article provides information about recommendations for diabetes care in nursing homes, the current level of care, and strategies to improve the quality of care for residents with diabetes.

Theory is the cart, vision is the horse: reflections on research in diabetes patient education.

PURPOSE: In this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories. METHODS: The vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories. RESULTS: Both our vision and our theoretical assumptions should be articulated, discussed, debated, and studied. CONCLUSIONS: Diabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education.