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.

Radiofrecuencia en la cicatrización de heridas crónicas. Una revisión en hospital de media estancia / Radiofrequency in the healing process in chronic wounds. A review in a half-stay hospital

Las heridas crónicas son un problema de salud significativo. Parece que la estimulación eléctrica produce una reducción significativamente mayor en el área de superficie y cicatrización más completa de las úlceras de difícil cicatrización y de evolución tórpida en comparación con la terapia habitual, sin vendaje compresivo. OBJETIVOS: Evaluar el efecto que la radiofrecuencia a baja intensidad y con efectos no térmicos tiene sobre los diferentes componentes del mecanismo del proceso de cicatrización. METODOLOGÍA: Para el tratamiento, se utilizó un dispositivo de tecarterapia (CAPENERGY C200). Se aplicaron un total de 10 sesiones de radiofrecuencia con una periodicidad de 1 vez a la semana con una potencia del 60% y una frecuencia de 1,2 MHz durante 30 minutos. RESULTADOS: La presencia de edema, observada en todos los pacientes en la región de la extremidad inferior, desapareció en 30 de los 36 pacientes (Wilcoxon p = 0,004). Este resultado fue confirmado por ultrasonido. El edema celular subcutáneo medio disminuyó en 1,73 cm (Friedman p = 0,000). La temperatura del área tomada antes y después del tratamiento se incrementó en un promedio de 1,4 °C. Estas diferencias son estadísticamente significativas (Wilcoxon p = 0,000). CONCLUSIONES: La radiofrecuencia parece que puede reducir el largo proceso de cicatrización de las lesiones de evolución tórpida, y nos encontramos con unas diferencias significativas a lo largo del tratamiento y con una reducción progresiva en las mediciones de las lesiones y mayor rapidez en la cicatrización de las heridas complejas

Chronic wounds are a significant health problem. Electrical stimulation seems to produce a significantly greater reduction in surface area and more complete healing of difficult-to-heal and poorly healing ulcers compared to standard therapy without compressive bandaging. OBJECTIVES: To evaluate the effect that radiofrequency at low intensity and with non-thermal effects has on the different components of the mechanism of the healing process. METHODOLOGY: A tecartherapy device (CAPENERGY C200) was used for the treatment. A total of 10 radiofrequency sessions were applied once a week with a power of 60% and a frequency of 1.2 MHz for 30 minutes. RESULTS: The presence of oedema, observed in all patients in the lower extremity region, disappeared in 30 of the 36 patients (Wilcoxon p = 0.004). This result was confirmed by ultrasound. The mean subcutaneous cellular oedema decreased by 1.73 cm (Friedman p = 0.000). The temperature of the area taken before and after treatment increased by an average of °C. These differences are statistically significant (Wilcoxon p = 0.000). CONCLUSIONS: Radiofrequency appears to be able to reduce the long healing process of torpidly evolving lesions, and we found significant differences throughout the treatment and a progressive reduction in lesion measurements and faster healing of complex wounds

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia / Desarrollo del rol profesional de la enfermera en diabetes en Cataluña en atención especializada y en atención primaria

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p < 0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p < 0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p < 0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings

OBJETIVOS: Describir la educación terapéutica en diabetes en Cataluña y las diferencias según el ámbito asistencial donde esta se imparte (asistencia primaria [AP] y asistencia especializada [AE]). MÉTODO: Estudio descriptivo, transversal y comparativo en PE de AE y de AP en Cataluña. La muestra se obtuvo a partir de todos los PE de AE y una muestra aleatoria por conglomerados de PE de AP. Se utilizó el cuestionario del Study of European Nurses in Diabetes validado al español. RESULTADOS: Se analizaron 287 cuestionarios (24,3% AE y 75,6% AP). Se observó más formación en diabetes a nivel de máster, posgrado y formación continuada en AE (p < 0,001). Más programas de educación estructurada, escritos y que combinan las estrategias de educación individual y grupal en AE (p < 0,05). Los roles educador, asesor, investigador, director, colaborador e innovador así como el seguimiento de pacientes vía telemática están más desarrollados en AE (p < 0,05). En ambos grupos el grado de satisfacción laboral es elevado. CONCLUSIONES: 1) Los profesionales de enfermería de AE asumen más roles de enfermera clínica especialista, además de tener más formación en diabetes y educación terapéutica que los profesionales de AP. 2) En AE se trabaja en mayor proporción con programas de ETD estructurados pero en ambos ámbitos se debería mejorar. De acuerdo con los resultados obtenidos y la evidencia científica disponible sería necesario acreditar la formación de los PE que trabajan en la atención de personas con diabetes, aumentar la utilización de programas estructurados y la investigación propia en ambos ámbitos de asistencia

Eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas / Effectiveness of patient-directed nursing protocols with diabetic complications / Eficacia de los protocolos de enfermería dirigidos al paciente con complicaciones diabéticas

Objetivo: Investigar na literatura científica a eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas. Método: Revisão integrativa, realizada de agosto a setembro de 2019, seguindo as recomendações do PRISMA. As bases de dados utilizadas foram: Web of Science e Scopus, através dos cruzamentos: "Diabetes Mellitus AND Nursing AND Protocols" e "Amputation AND Nursing AND Protocols". Identificaram-se 672 artigos, sendo selecionados 17. Resultados: A maior parte dos estudos foram publicados em inglês e realizados nos Estados Unidos. Verificaram-se protocolos de controle glicêmico, da cetoacidose e do autocuidado, os quais apresentaram bons resultados para o que se propõem. Um artigo abordou superficialmente os cuidados de enfermagem direcionados a pessoas com amputação. Conclusão: Os protocolos de enfermagem direcionados ao paciente com complicações diabéticas apresentaram-se eficazes.

Objective: To investigate in the scientific literature the effectiveness of nursing protocols directed to patients with diabetic complications. Method: Integrative review, conducted from August to September 2019, following the recommendations of the PRISMA.The databases used were: Web of Science and Scopus, through the crossovers: "Diabetes Mellitus AND Nursing AND Protocols" and "Amputation AND Nursing AND Protocols". A total of 672 articles were identified and 17were selected. Results: Most studies were published in English and conducted in the United States. Glycemic control, ketoacidosis and self-care protocols were verified, which presented good results for their purpose. One article superficially addressed nursing care directed to people with amputation. Conclusion: Nursing protocols directed to patients with diabetic complications were effective

Objetivo: Investigar en la literatura científica la efectividad de los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas. Método: Revisión integradora, realizada de agosto a septiembre de 2019, siguiendo las recomendaciones de PRISMA. Las bases de datos utilizadas fueron: Web of Science y Scopus, a través de los crossovers: "Diabetes Mellitus AND Enfermería AND Protocolos" y "Amputación AND Enfermería AND Protocolos". Se identificaron un total de 672 artículos y se seleccionaron 17. Resultados: La mayoría de los estudios se publicaron en inglés y se realizaron en los Estados Unidos. Se verificaron los protocolos de control glucémico, cetoacidosis y autocuidado, que presentaron buenos resultados para su propósito. Un artículo abordó superficialmente la atención de enfermería dirigida a personas con amputación. Conclusión: Los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas fueron efectivos

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.

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.

Teamwork and Oral Health in Diabetes Care.

BACKGROUND: The integration of oral health into primary care is often limited, despite its significant connection with many diseases, including diabetes mellitus (DM). OBJECTIVE: This project aimed to develop, implement, and evaluate an oral health education program for medical assistants (MAs) to increase oral health knowledge and enhance practice using standardized oral health screening questions for patients with DM. METHODS: A nurse practitioner-led oral health program was implemented. Medical assistants completed a pre-test and post-test to assess oral health knowledge, a pre-survey and post-survey to assess likelihood of performing screening questions, and a post-implementation survey to assess barriers. RESULTS: Analyses of pre-test and post-test results using the Wilcoxon matched pairs signed rank test (two-tailed) showed a significant increase in correct answers on the post-test (W = 0, N = 8, p ≤ 0.05), with the mean score increasing from 81% to 95%. In addition, the MAs' likelihood of asking screening questions increased and 62.5% reported no barriers to implementation after 1 week. CONCLUSIONS: All participants demonstrated an increase in knowledge and likelihood of using screening questions. IMPLICATIONS FOR NURSING: An oral health program using a team approach to equip MAs with training offers a practical method to incorporate evidence-based recommendations into primary care.

Improving Glycemic Control and Quality of Life With Diabetes Self-Management Education: A Pilot Project.

Diabetes self-management education and support (DSME/S) has been demonstrated as an effective intervention and a billable service; however, DSME/S has yet to be successfully translated and diffused into mainstream practice. This project sought to improve glycemic control (measured by A1C or fasting blood glucose [FBG]) and quality of life (QOL) of Medicare patients age 65 years and older with type 2 diabetes (T2DM) using DSME/S. DSME/S included information sharing between patients and providers, psychosocial support, behavioral support with lifestyle modification, multi-disciplinary integration, and care coordination. Patient-specific data were compared before and 4 weeks after project implementation. Use of DSME/S increased by 15% (p < .005). Participants demonstrated a statistically significant decrease in mean FBG and a statistically significant increase in QOL. This project demonstrated the successful translation of evidence related to DSME/S into practice through improving diabetes care and promoting continuing education for all of the providers. [J Contin Educ Nurs. 2020;51(3):119-123.].

Empowerment comunitário em saúde escolar - adolescente com diabetes mellitus tipo 1 / Community empowerment in school health - adolescent with diabetes mellitus type 1

Type 1 Diabetes Mellitus (DM1) is one of the most prevalent chronic diseases in school age. Health policies point to a greater intervention and accountability of the community towards the health of its members and their full integration in society, promoting the development of health literacy based on an empowerment philosophy. Since the school is a favorable context for intervention, this study, through a review of the literature and based on the Empowerment Nursing-User Model and Laverack Community Empowerment Model, aims to elaborate a Nursing Care Plan Model aimed at training the school community with adolescents with DM1, using ICNP 2017. Agglutinating the first phase of the Laverack Community Empowerment Model (personal action) with the examples of Empowerment Nursing-User Model empowering behaviors (access to information, support, resources, opportunities to learn and grow, informal power and formal power), we identified diagnoses as: potential to raise awareness of the relationship between the therapeutic regimen and DM1 control and potentiality to improve the problematic meaning attributed to the therapeutic regime or illness by the adolescent. According to the phases of approach of small community groups and development of community organizations, we identified diagnoses aimed at the school community and the family like the potential to improve awareness of their role towards the adolescent with DM1. Community empowerment is an instrument to be used in the development of the process of school inclusion and training adolescents with DM1 as well as the whole school community

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Literacia e qualidade de vida na diabetes mellitus tipo 2 num aces do Minho, Portugal / Literacy and quality of life in diabetes mellitus type 2 in Minho, Portugal

Background: Diabetes Mellitus is a chronic disease responsible for disability, entailing high costs for the National Health Service. Investing in health literacy and empowerment are crucial for effective disease management. Objectives: To analyze the knowledge about the disease and quality of life of people with Type 2 Diabetes Mellitus. Methodology: Cross-sectional, exploratory, descriptive and correlational study. A sociodemographic and clinical characterization questionnaire and the portuguese version of DKT, DES-SF and EQ-5D-5L were applied to a convenience sample of 410 subjects. Results and discussion: The sample reveals a low level of knowledge and high perception of quality of life, especially in men, showing mean +/- SD of DKT and EQ-5D-5L, 51.90 +/- 13.83 and 0.90 +/- 0.15, respectively. A significant positive association between knowledge and QOL (rs = 0.060, p <0.01) was found, which reinforces other studies findings. Conclusions: From the study emerges the need for health education programs that enable especially in the field of food and soft skills especially in response to adversity, thus raising the quality of life of these people

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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.

Management of Type 1 Diabetes.

Comprehensive type 1 diabetes management requires understanding of the pathophysiology of disease and the ability to contrast this process with type 2 diabetes. Nurses are often the first contact with patients and must be aware of the advancements in detection, therapies, and signs of complications in these patients. Individuals with type 1 diabetes are at high risk for glycemic complications caused by potentially preventable errors in medication administration, which can be mitigated with appropriate education.

The How-To for Type 2: An Overview of Diagnosis and Management of Type 2 Diabetes Mellitus.

This article presents an overview of type 2 diabetes diagnosis and management. A brief discussion of epidemiology, including incidence, prevalence, and etiology, provides the basis for the importance of the discussion. The review then proceeds to outline diagnostic criteria and follow-up monitoring guidelines. Recommendations for evidence-based lifestyle measures and current pharmacologic options are addressed. A priority on individualized, holistic care with patient-specified goals and the management of comorbidities is emphasized.

Noninsulin Diabetes Medications.

Pharmacotherapy for diabetes has changed greatly owing to drugs and drug classes available. There are 11 classes of noninsulin diabetes medications available in the United States. With the use of 1 drug alone or in combination with different drugs, it is possible to improve glycemic control in patients with diabetes. Important properties of antidiabetic agents play a role in the choice of that particular medication for individual patients. Prescribing a diabetes medication regimen is based careful assessment of patient needs, and consideration of the medication's efficacy, impact on weight, hypoglycemia risk, potential side effects, cost, and patient preferences.

Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit.

BACKGROUND: Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis. OBJECTIVE: To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock. METHOD: Retrospective and exploratory study that involved collection of patients' sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions. RESULTS: Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions. CONCLUSION: Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes.

Obesidad, diabetes y trasplante / Obesity, diabetes and transplantation

El trasplante renal es la mejor opción terapéutica en términos de supervivencia y calidad de vida para los pacientes con enfermedad renal crónica. Los pacientes trasplantados son cada vez más mayores y con más pluripatologia asociada. Los avances en inmunosupresión y en el tratamiento han hecho que los pacientes trasplantados fallezcan con el injerto renal funcionante. Existe un incremento de peso del 10% durante el primer año del trasplante, la obesidad se relaciona con la aparición de diabetes mellitus postrasplante. Con el objetivo de analizar la incidencia de obesidad y los factores de riesgo relacionados, en una cohorte de pacientes trasplantados renales realizamos un estudio observacional y prospectivo de estos pacientes, desde enero del 2014 hasta marzo del 2015, con seguimiento de 1 año. Obteniendo como resultado, que los grupos son homogéneos en sexo, tiempo en terapia renal sustitutiva pero distintos en edad. A partir de los 3 meses los pacientes con índice de masa corporal mayor a 25 presentaron mayor incidencia de diabetes mellitus post trasplante respecto al grupo de pacientes con índice de masa corporal inferior a 25 (AU)

Renal transplantation is the best therapeutic option in terms of survival and quality of life for patients with chronic kidney disease. The transplanted patients are becoming older and with more pluripatologia associated. Advances in immunosuppression and in treatment have caused the transplanted patients to die with the functioning renal graft. There is a 10% weight gain during the first year of transplantation, obesity is related to the onset of post-transplant diabetes mellitus. In order to analyze the incidence of obesity and related risk factors in a cohort of renal transplant patients, we conducted an observational and prospective study of these patients, from January 2014 to March 2015, with a 1-year follow-up. As a result, the groups are homogeneous in sex, time in renal replacement therapy but different in age. After 3 months, patients with a body mass index greater than 25 had a higher incidence of post-transplant diabetes mellitus than the group of patients with a body mass index below 25 (AU)