A controlled trial on the effects of patient education in the treatment of insulin-dependent diabetes.

The effect of patient education on diabetic control in insulin-treated diabetic adults was studied in 77 subjects randomized into two groups: intensive patient education (group A) and control (group B). The subjects in group A received intensive patient instruction, both individually and in small groups, from a team of physicians, teaching nurses, and a dietitian. The patients in group B received a short instruction course consisting mainly of printed material. A highly significant improvement in diabetic control was observed in both groups immediately after the education programs, with gradual return to the original level during the following 3-6 mo. No difference was observed between the two groups in any of the measured parameters during the 18-mo investigation. Factors related to good control during the study included the length of school education, the quality of the control at the beginning of the study, and the high degree of self-confidence and lack of signs of anxiety in the psychological tests. The results demonstrate that the effects of educational programs are of limited value if they do not lead to permanent changes in attitudes and motivation, which are critical factors affecting long-term diabetic control.

Effects of anaesthesia on the psychological function of patients.

The psychological effects of halothane, methoxyflurane, combined analgesic-relaxant anaesthesia, and epidural anaesthesia were assessed before one, and seven days after anaesthesia in 72 patients having operations for varicose veins. Subjective anxiety evaluation (Hamilton Anxiety Rating Scale) and personality tests of self-appraisal (Minnesota Multiphasic Personality Inventory) as well as of superficial (Wartegg's test) and profound (Rorschach's test) projection showed no significant differences among these methods of anaesthesia. Performance tests measuring memory for designs (modified Graham-Kendall memory for designs), short-term memory (digit span of Wechsler Adult Intelligence Scale), learning (nonsense word series), perception (symmetry-drawing), speed of observation (Bourdon-Wiersma) and visualization also revealed no significant psychological changes compared to the control (epidural anaesthesia) group. The methods of anaesthesia used therefore showed no harmful psychological effects and are in this respect safe in clinical use.