Systematic review on the cost-effectiveness of self-management education programme for type 2 diabetes mellitus.

OBJECTIVES: A review of cost-effectiveness studies on self-management education programmes for Type 2 diabetes mellitus. METHODS: Cochrane, PubMed and PsycINFO databases were searched for papers published from January 2003 through September 2015. Further hand searching using the reference lists of included papers was carried out. RESULTS: In total, 777 papers were identified and 12 papers were finally included. We found eight programmes whose effectiveness analyses were based on randomised controlled trials and whose costs were comprehensively estimated from the stated perspective. Among these eight, four studies showed a cost per unit reduction in clinical risk factors (HbA1c or BMI) of US$491 to US$7723 or cost per glycaemic symptom day avoided of US$39. In three studies the cost per QALY gained, as estimated from a life-time model, was less than US$50,000. However, one study found the programme was not cost-effective despite a gain in QALYs at the one-year follow up. CONCLUSION: A small number of cost-effectiveness studies were identified with only eight of sufficiently good quality. The cost of a self-management education programme achieving reduction in clinical risk factors seems to be modest and is likely to be cost-effective in the long-term.

Diabetic retinopathy screening: global and local perspective.

Diabetes mellitus has become a global epidemic. It causes significant macrovascular complications such as coronary artery disease, peripheral artery disease, and stroke; as well as microvascular complications such as retinopathy, nephropathy, and neuropathy. Diabetic retinopathy is known to be the leading cause of blindness in the working-age population and may be asymptomatic until vision loss occurs. Screening for diabetic retinopathy has been shown to reduce blindness by timely detection and effective laser treatment. Diabetic retinopathy screening is being done worldwide either as a national screening programme or hospital-based project or as a community-based screening programme. In this article, we review different methods of screening including grading used to detect the severity of sight-threatening retinopathy and the newer screening methods. This review also includes the method of systematic screening being carried out in Hong Kong, a system that has helped to identify diabetic retinopathy among all attendees in public primary care clinics using a Hong Kong-wide public patients' database.

Which patient should be resuscitated first?

The core principles of deontology are justice and beneficence. The principle of justice and egalitarianism guide health care professionals to treat every client with fairness and equity regardless the prognosis of illness, social and economic status of clients, the social and financial consequences impose on others. Whereas, the principle of beneficence and utilitarianism direct health care professionals to make an ethical decision to provide the maximum benefit and to minimise harm to the greatest number of people involved. When distributing limited health care resources, there could be conflicts between the principle of justice and beneficence or between egalitarians and utilitarians. At times health care professionals have to make a painful decision which only complies with certain ethical principles, but does not adhere to others.

Reflective practice: a critical incident.

Reflection identifies one's professional capabilities, increases knowledge of self and improves understanding and management of patients. Conducting reflective practice is conducive to professional development and growth. A complex medical and nursing management of a psychiatric emergency is illustrated through this critical incident. Psychiatric nurses play a key role in deescalating the aggressive behaviour of psychotic patients. Through reflection, the basic tools of psychiatric nurses are reviewed and the prime components of psychiatric therapy are discussed.