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2.
Wilderness Environ Med ; 30(4S): S121-S140, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31753543

RESUMO

The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Medicina Selvagem/normas , Atletas , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Padrões de Prática Médica , Sociedades Médicas , Medicina Esportiva/métodos , Medicina Selvagem/métodos
3.
Nat Biotechnol ; 37(12): 1446-1451, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31712773

RESUMO

Vagus nerve stimulation can ameliorate autoimmune diseases such as rheumatoid arthritis by modulation of the immune system. Its efficacy for the treatment of type 1 diabetes has not been explored, in part because the nerves projecting to the pancreatic lymph nodes (pLNs) in mice are unmapped. Here, we map the nerve projecting to the pancreas and pLNs in mice and use a minimally invasive surgical procedure to implant micro-cuff electrodes onto the nerve. Pancreatic nerve electrical stimulation (PNES) resulted in ß-adrenergic receptor-mediated-accumulation of B and T cells in pLNs and reduced production of pro-inflammatory cytokines following lipopolysaccharide stimulation. Autoreactive T cells showed reduced proliferation in pLNs of mice receiving PNES as compared to sham controls. In a spontaneous mouse model of autoimmune diabetes, PNES inhibited disease progression in diabetic mice.


Assuntos
Diabetes Mellitus Tipo 1 , Terapia por Estimulação Elétrica , Pâncreas , Animais , Linfócitos B/imunologia , Glicemia/metabolismo , Citocinas/metabolismo , Diabetes Mellitus Experimental/imunologia , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Insulina/metabolismo , Linfonodos/citologia , Linfonodos/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos NOD , Camundongos SCID , Pâncreas/imunologia , Pâncreas/inervação , Pâncreas/metabolismo , Linfócitos T/imunologia
5.
Int J Sports Med ; 40(14): 909-920, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31639864

RESUMO

The aim of this study was to investigate the ameliorative effect of moderate-intensity exercise training in sole and simultaneous forms with insulin on experimental type 1 diabetes (T1D)-induced apoptosis. A total of 36 mature male Wistar rats were divided into six equally sized groups, including sedentary control (Con), moderate-intensity exercise training (E-sole), sedentary T1D-induced (D-sole), moderate-exercise-trained T1D-induced (DE), insulin-treated sedentary T1D-induced (DI) and exercise-trained, and insulin-treated T1D-induced (DEI) groups. The 6-week exercise training intervention was involved 30 min of moderate-intensity running on a treadmill once daily (5 days/week). Next, tubular differentiation (TDI) and spermiogenesis (SPI) indices were assessed. The Bcl-2, Bax and caspase-3 expressions were determined using RT-PCR, immunohistochemistry and western blot techniques. Finally, the TUNEL staining was used to analyze the apoptosis ratio. The moderate-intensity exercise training in the sole and when simultaneously considered with insulin (DEI) maintained testicular cellularity, up-regulated Bcl-2 expression, reduced Bax expression and ameliorated the diabetes-induced apoptosis. We failed to show remarkable alterations in caspase-3 mRNA and protein levels in the DE group versus D-sole animals. In conclusion, the moderate-intensity exercise training is able to potentially protect testicular cells from T1D-induced intrinsic apoptosis via up-regulating Bcl-2 and downregulating Bax expressions. Moreover, it amplifies the insulin-induced anti-apoptotic impacts.


Assuntos
Apoptose , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Tipo 1/patologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Condicionamento Físico Animal , Testículo/patologia , Animais , Caspase 3/genética , Caspase 3/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/terapia , Regulação para Baixo , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , RNA Mensageiro/metabolismo , Ratos Wistar , Espermatogênese/fisiologia , Regulação para Cima , Proteína X Associada a bcl-2/genética , Proteína X Associada a bcl-2/metabolismo
6.
Res Nurs Health ; 42(6): 500-508, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31587327

RESUMO

Two minds theory (TMT) offers a new approach to changing health behavior. Here, TMT is applied to self-management of Type 1 diabetes. TMT can be conceptualized as a cycle where a stimulus produces an immediate Intuitive system response leading to health behavior, followed by a conscious narrative system response that is temporally delayed. Narrative responses do not produce behaviors directly but instead lead to conscious beliefs about past events and behavioral intentions for the future, both of which become part of the material considered by the intuitive system in selecting future behaviors. Because of the temporal delay between intuitive behavior and narrative interpretation, and the nonconscious nature of intuitive thought, there is often a gap between intentions and behaviors. This has implications for nursing practice. First, nurses should consider that patient-reported impressions of the past or future are fundamentally narrative system responses and understand that these may be less predictive of behavior than biopsychosocial measures that are more temporally immediate. Second, nurses can use TMT to inform new strategies for behavior change interventions. For diabetes self-management, nurses can encourage individuals to leverage environmental cues to prompt self-management (tricking the intuitive system), provide rewards for self-management (training the intuitive system), or engage the narrative system via planning, reframing, or attention practices for healthier future decisions. Overall, the TMT addresses the gap between intentions and behavior and should be further developed to inform behavioral health interventions.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Comportamentos Relacionados com a Saúde , Autogestão , Humanos , Intenção , Teoria de Enfermagem
7.
Expert Rev Med Devices ; 16(10): 845-853, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540557

RESUMO

Introduction: Automated insulin delivery for people with type 1 diabetes has been a major goal in the diabetes technology field for many years. While a fully automated system has not yet been accomplished, the MiniMed™ 670G artificial pancreas (AP) system is the first commercially available insulin pump that automates basal insulin delivery, while still requiring user input for insulin boluses. Determining the safety and efficacy of this system is essential to the development of future devices striving for more automation. Areas Covered: This review will provide an overview of how the MiniMed 670G system works including its safety and efficacy, how it compares to similar devices, and anticipated future advances in diabetes technology currently under development. Expert Opinion: The ultimate goal of advanced diabetes technologies is to reduce the burden and amount of management required of patients with diabetes. In addition to reducing patient workload, achieving better glucose control and improving hemoglobin A1c (HbA1c) values are essential for reducing the threat of diabetes-related complications further down the road. Current devices come close to reaching these goals, but understanding the unmet needs of patients with diabetes will allow future technologies to achieve these goals more quickly.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Pâncreas Artificial/efeitos adversos , Humanos , Sistemas de Infusão de Insulina , Vigilância de Produtos Comercializados , Resultado do Tratamento
9.
Lancet ; 394(10205): 1265-1273, 2019 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-31533908

RESUMO

Technological advances have had a major effect on the management of type 1 diabetes. In addition to blood glucose meters, devices used by people with type 1 diabetes include insulin pumps, continuous glucose monitors, and, most recently, systems that combine both a pump and a monitor for algorithm-driven automation of insulin delivery. In the next 5 years, as many advances are expected in technology for the management of diabetes as there have been in the past 5 years, with improvements in continuous glucose monitoring and more available choices of systems that automate insulin delivery. Expansion of the use of technology will be needed beyond endocrinology practices to primary-care settings and broader populations of patients. Tools to support decision making will also need to be developed to help patients and health-care providers to use the output of these devices to optimise diabetes management.


Assuntos
Tecnologia Biomédica , Diabetes Mellitus Tipo 1/terapia , Glicemia/análise , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Insulina/administração & dosagem , Insulina/uso terapêutico , Sistemas de Infusão de Insulina , Monitorização Fisiológica/instrumentação
10.
J Clin Nurs ; 28(23-24): 4478-4487, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410916

RESUMO

AIMS AND OBJECTIVES: To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND: Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN: This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS: A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS: The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION: In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE: This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Família/psicologia , Resiliência Psicológica , Autogestão/psicologia , Adolescente , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Autorrelato , Inquéritos e Questionários , Adulto Jovem
11.
Int J Clin Pract ; 73(11): e13411, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31456268

RESUMO

AIMS: Fear of hypoglycaemia seems to be one of the strongest barrier to physical activity for individuals with type 1 diabetes mellitus (T1DM).The aim of the study was to describe clinical characteristics of participants with T1DM in the intense sporting event of runs and bike rides"SPORTGIVECHANCE-Diabetic runners and cyclists for more sport for all in Europe", and investigate factors associated with self-reported hypoglycaemia episodes during the competition, in particular the use of continuous and flash glucose monitoring systems (CGM/FGM). METHODS: The sporting event took place in Spoleto, Italy from 30 August 2018 to 2 September 2018. An online survey was distributed among 150 participants with diabetes. Only T1DM patients were invited to complete the survey that included questions on baseline clinical characteristics as well as glucose control and meal related issues during the competition. Logistic regression was used to determine factors associated with reported hypoglycaemia. RESULTS: There were 35 T1DM individuals who completed the questionnaire: eight subjects were continuous glucose monitoring system (CGM) users, 10 used flash glucose monitoring systems (FGM), while the others performed self-measured blood glucose measurements (SMBG) on glucose meters. Mild hypoglycaemia episodes during the competition were reported by four CGM/FGM users and six non-users (OR: 0.73, CI: 0.34-1.53). No severe hypoglycaemic episode was reported. Body mass index (BMI) (OR: 1.47, CI: 1.01-2.13) and subjectively very hard or maximal intensity of the competition (OR: 4.90, CI: 1.51-15.89) were associated with a higher risk of hypoglycaemia. CONCLUSIONS: Data obtained from the self-selected sample of T1DM patients suggests that T1DM individuals can participate in intense sport competitions with moderate risk of mild hypoglycaemia regardless of CGM/FGM or SMBG use.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Exercício/fisiologia , Hipoglicemia/sangue , Esportes , Adulto , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Internist (Berl) ; 60(9): 912-916, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31375851

RESUMO

Technological progress has led to numerous innovations in diagnostic and therapeutic applications in diabetes and will also improve the treatment of patients with diabetes in the future. The first commercially available hybrid closed-loop system has been available in the USA since 2016 and the next developmental step toward a fully automated artificial pancreas has been made. The automated control of the basal insulin secretion provides a stabilization of blood glucose with a reduction of hypoglycemia and improvement of long-term control as indicated by improved hemoglobin A1c levels. Although closed-loop systems are not yet officially available in Germany, patients with type 1 diabetes mellitus already benefit from a new generation of continuous glucose monitoring (CGM) systems. Apart from the increased accuracy these new devices can be used for up to 180 days and do not require daily calibration. This article provides a short overview of the innovations in CGM systems and the current status in the development of the artificial pancreas.


Assuntos
Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/terapia , Hipoglicemia/terapia , Pâncreas Artificial , Glicemia , Alemanha , Humanos , Sistemas de Infusão de Insulina
13.
J Clin Nurs ; 28(21-22): 4062-4076, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31327174

RESUMO

AIM AND OBJECTIVES: To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND: Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN: Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS: Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS: Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS: The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE: Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.


Assuntos
Doença Crônica/psicologia , Pessoal de Saúde/psicologia , Pais/psicologia , Transição para Assistência do Adulto/organização & administração , Adolescente , Adulto , Criança , Doença Crônica/terapia , Fibrose Cística/psicologia , Fibrose Cística/terapia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Cardiopatias Congênitas/psicologia , Cardiopatias Congênitas/terapia , Humanos , Irlanda , Masculino , Relações Profissional-Paciente , Pesquisa Qualitativa , Adulto Jovem
14.
Diabetes Metab Syndr ; 13(2): 1159-1164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336459

RESUMO

AIM: To examine management of diabetes mellitus (DM) and patients' attitude towards DM in a random sample of the adult Greek population. METHODS: s: We selected a random sample of adults with self-reported DM (n = 1002) from a population-based nationwide study using the effective random sampling technique. Collection of data was performed through phone interviews. RESULTS: Prevalence of type 1 DM was 3.5% and of type 2 DM 96.5%. Prevalence of type 1 DM declined while of type 2 DM increased with age. No gender or residency differences were found between type 1 and type 2 DM. A total of 72.0% of subjects with type 2 DM were treated with oral antidiabetic drugs (OAD), 11.5% were treated with insulin and 7.1% were treated with both OAD and insulin. Internists specialized in DM were mainly doctors who started insulin treatment. Almost half of insulin naive subjects were skeptical towards insulin initiation and their main concern was the needle punch. CONCLUSIONS: In a random nationwide sample of the adult population in Greece the majority of subjects with self-reported DM had type 2 DM. Most patients with type 2 were treated with OAD. Almost half of insulin naive subjects were skeptical towards insulin initiation.


Assuntos
Atitude Frente a Saúde , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Dieta para Diabéticos , Exercício , Hipoglicemiantes/uso terapêutico , Autocuidado/psicologia , Adulto , Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Feminino , Seguimentos , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários , Adulto Jovem
15.
Diabetes Metab Syndr ; 13(2): 1353-1357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336491

RESUMO

OBJECTIVE: The objective of this scoping review was to identify peer-reviewed medical literature on the use of telemedicine in patients with Types I or II DM in the United States, assess its impact on self-management processes and clinical outcomes of care, and to delineate research gaps. METHODS: We utilized a structured scoping review protocol to conduct this research. We searched the published medical literature utilizing two databases, PubMed and CINHAL, and we included all original research articles published prior to July 20th, 2018. Using a 4-step systematic approach, we identified, reviewed, extracted and summarized data from all relevant studies. RESULTS: We identified 47 articles overall. Telemedicine impact was reported as positive in articles addressing the following components of patient self-management: adherence to blood glucose monitoring, day-to-day decision-making related to self-care, and adherence with medications. The most commonly reported clinical outcome was HbA1c level. Few or no studies evaluated impact on long term clinical outcomes such as blindness, amputation, cardiovascular events, development of chronic kidney disease, or mortality. DISCUSSION: This scoping review provides important information about studies conducted in the United States evaluating the impact of telemedicine on patient self-management and on clinical outcomes in patients with DM. CONCLUSIONS: Results suggest that telemedicine has a positive impact on self-management processes and on HbA1c levels. However, future evaluative reviews are necessary to confirm and quantitate the impact of telemedicine on self-management processes and primary studies are necessary to evaluate its impact on long term clinical outcomes.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Monitorização Fisiológica/métodos , Autogestão/métodos , Telemedicina/métodos , Glicemia/análise , Automonitorização da Glicemia , Humanos , Cooperação do Paciente , Prognóstico
16.
J Assoc Physicians India ; 67(4): 34-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309793

RESUMO

Objective: Widely used in the management of diabetes, insulin therapy is influenced by several patient preferences and physician choices. This article reports the findings of the IMPACT survey, designed to assess insights on various factors which influence the choice of insulin therapy in India. Methods: We administered a questionnaire which focused on the practice and patient profiles and the preferred regimens in specific clinical situations using a case scenario. Respondents were asked about preferred insulin regimens for various phases of life, comorbid conditions, dietary choices and psychological factors. Results: Overall, 314 doctors participated in the survey. Majority were general physicians (51%) and diabetologists (37%). In clinical practice, the most preferred regimens included premix insulin BD in adults (59%) and elderly (53%), and basal bolus therapy in pregnant women (>47%) and in acute illness (62%). Both regimens were equally preferred for symptomatic patients (41% basal bolus and 38% premix insulin) and those with renal or hepatic failure (36% each). Premix insulin was preferred for patients with high carbohydrate intake (73%) while basal bolus was preferred for patients with variable meal timings (39%) and in pronounced postprandial glucose excursions (45%). Insulin co-formulation and high-mix insulins were not a part of the survey questionnaire. Summary: Indian physicians exercise logic in the choice of insulin regimens. Preference is based on patient characteristics including glucophenotype, dietary patterns, psychosocial needs, clinical situations, and comorbid conditions.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Idoso , Glicemia , Feminino , Humanos , Índia , Gravidez
19.
JMIR Mhealth Uhealth ; 7(7): e11527, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290400

RESUMO

BACKGROUND: Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. OBJECTIVE: The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. METHODS: Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients' subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. RESULTS: Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. CONCLUSIONS: We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Gerenciamento Clínico , Telemedicina/normas , Adulto , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão/métodos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
20.
J Pediatr Endocrinol Metab ; 32(8): 821-826, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31287798

RESUMO

Background The purpose of this study was to assess the benefit of a short workshop addressing knowledge and confidence of inpatient caregivers (physicians and nurses) treating pediatric type 1 diabetes mellitus (T1DM) patients. Methods Questionnaires to determine familiarity with T1DM management and confidence in care were distributed at three university-affiliated medical centers. A 5-h practical-skills workshop was conducted at one center. Same questionnaires were filled out immediately after the workshop and 3 months later. Evaluation of knowledge was based on 16 multiple-choice questions, and confidence based on 10 categorical questions. Results Nurses and physicians (total 135, 106 women, 85 nurses) completed the questionnaires. The median knowledge score was 53.33 (40-66) and 46.7 (26.7-66.7) for nurses and physicians, respectively (p = 0.76). The confidence scores were 1.44 (1.1-1.9) and 1.56 (1.2-1.8), respectively (p = 0.7). More experience among nurses (>10 years) was associated with higher confidence scores (p = 0.04). Twenty-one physicians and 52 nurses, 66 women, attended the workshop. The median knowledge grade improved from 60 (47-67) to 81 (69-81), p < 0.001, immediately after, and to 69 (63-81), p < 0.001, 3 months post-workshop. The median confidence score improved from 1.8 (1.6-2) to 2.4 (2.1-2.6), p < 0.001, and to 2.2 (2-2.6), p < 0.001, respectively. There was no association with profession or seniority. Conclusions Knowledge and confidence in care of medical staff treating inpatient T1DM pediatric patients are lacking. Both improved significantly after the workshop, independent of seniority or profession.


Assuntos
Competência Clínica/normas , Diabetes Mellitus Tipo 1/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Corpo Clínico/educação , Administração dos Cuidados ao Paciente/normas , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Inquéritos e Questionários
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