IMPLEMENTING CLINICAL GUIDELINES IN THE TREATMENT OF DIABETES MELLITUS IN GENERAL PRACTICE

2000 ◽  
Vol 16 (1) ◽  
pp. 210-227 ◽  
Author(s):  
Irene Hetlevik ◽  
Jostein Holmen ◽  
Øystein Krüger ◽  
Pål Kristensen ◽  
Hege Iversen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Patient Outcome ◽  
General Practice ◽  
Risk Score ◽  
Clinical Guidelines ◽  
Intervention Group ◽  
Health Centers ◽  
Group Differences ◽  
Control Group ◽  
Significant Group

Objectives: To evaluate the implementation of clinical guidelines for diabetes mellitus in general practice with a specific computer-based clinical decision support system (CDSS) as part of the intervention.Methods: Randomized study with health center as unit. General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. Seventeen health centers with 24 doctors and 499 patients with diabetes mellitus were in the intervention group and 12 health centers with 29 doctors and 535 patients were in the control group. Main outcome measures were group differences in fractions of patients without registrations (process evaluation) and mean group differences for the same variables (patient outcome evaluation).Results: Statistically significant group differences were experienced for fractions of patients without registration of cigarette smoking (intervention group, 82.6%; control group 94.5%), body mass index (78.2% vs. 93.0%), and sufficient registrations for calculation of risk score for myocardial infarction (91.1% vs. 98.3%); all during 18 months. Large center variations were shown for all variables. The only statistically significant group difference was −2.3 mm Hg (95% CI, −3.8, −0.8) in diastolic blood pressure in favor of the intervention group. Statistically insignificant differences in favor of the intervention group were HbA1c, −0.1% (95% CI, −0.4, 0.1), systolic blood pressure, −1.2 mm Hg (95% CI, −4.4, 2.0). Statistically insignificant differences in favor of the control group were fractions of smokers, +3.0% (95% CI, −4.0, 10.0), body mass index, +0.3 kg/m2 (95% CI, −0.8, 1.4), risk score in female +0.1 (95% CI, −5.1, 5.2), and risk score in male +2.6 (95% CI, −14.2, 19.5).Conclusions: Implementation of clinical guidelines for diabetes mellitus in general practice, by means of a CDSS and several procedures for implementation, did not result in a clinically significant change in doctors' behavior or in patient outcome.

Effects of Interactive Book Reading for Increasing Children’s Knowledge of Instructional Verbs

2018 ◽  
Vol 39 (4) ◽  
pp. 477-489 ◽  
Author(s):  
Joneen Lowman ◽  
Laura T. Stone ◽  
Jing Guo
Keyword(s):  
Intervention Group ◽  
Teacher Talk ◽  
Book Reading ◽  
Group Differences ◽  
Control Group ◽  
Reading Group ◽  
Significant Group ◽  
Academic Content ◽  
Interactive Book

Interactive book reading (IBR) has proven effective for increasing children’s lexicons with most of the results based on students’ learning of nouns. Little is known about the application of IBR to instructional verbs (i.e., words used during the instruction of academic content). To address this gap, 122 prekindergarten children were recruited from seven elementary schools. Each school was randomly assigned to the intervention group or the control group. Children in the intervention group were taught 12 instructional verbs across a 3-week period using interactive book-reading strategies. Children assigned to the control group only received implicit exposure to instructional verbs during teacher talk. Children in the book-reading group knew significantly more words on a receptive picture identification task than children in the control group both at posttesting and at follow-up testing in the fall. No significant group differences were noted at spring testing.

scholarly journals The Efficacy of an Intensive Lifestyle Modification Program on Psychosocial Outcomes among Rural Women with Prior Gestational Diabetes Mellitus: Six Months Follow-Up of a Randomized Controlled Trial

2021 ◽  
Vol 18 (4) ◽  
pp. 1519
Author(s):  
Jia Guo ◽  
Qing Long ◽  
Jundi Yang ◽  
Qian Lin ◽  
James Wiley ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Social Support ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Perceived Stress ◽  
Lifestyle Modification ◽  
Intervention Group ◽  
Control Group ◽  
Significant Group ◽  
Lifestyle Modification Program

Women with prior gestational diabetes mellitus (GDM) are at a higher risk of type 2 diabetes and other health issues after delivery. They may have a lower quality of life (QoL), experience more medical-related stress, and need more support than those without it. This study aimed to examine the six-month efficacy of an intensive lifestyle modification program on perceived stress, social support, and QoL among women with prior GDM in rural China. A total of 320 women with prior GDM were randomly assigned to an intervention group (n = 160) and a control group (n = 160). Participants in the intervention group received an intensive lifestyle modification (ILSM) program, including a series of six biweekly face-to-face sessions and five biweekly phone sessions delivered by trained local health workers. The control group received the usual care. Data about perceived stress, social support, QoL, and HbA1c were collected at baseline, at three months, and at six-month follow-ups. Generalized estimating equation analysis was used to assess the efficacy of the intervention. There were significant improvements in the psychological domain (β = 0.479 ± 0.153, p = 0.002) and environmental domain (β = 0.462 ± 0.145, p = 0.001) of QoL over six months; there were significant group effects (β = −0.718 ± 0.280, p = 0.010) and time effects (β = 0.453 ± 0.211, p = 0.032) in physiological domain, and there were significant group effects in the social relations domain (β = −0.669 ± 0.321, p = 0.037). The ILSM group had a more pronounced downward trend in HbA1c than the control group (β = −0.050 ± 0.026, p = 0.059). The ILSM program can help women with GDM improve their psychological and environmental domain of QoL. It can be recommended as a form of health promotion for improving QoL among women with prior GDM in rural primary care settings in developing countries.

scholarly journals Promoting the Quality of Teacher-Toddler Interactions: A Randomized Controlled Trial of “Thrive by Three” In-Service Professional Development in 187 Norwegian Toddler Classrooms

2021 ◽  
Vol 12 ◽  
Author(s):  
Elisabet Solheim Buøen ◽  
Ratib Lekhal ◽  
Stian Lydersen ◽  
Turid Suzanne Berg-Nielsen ◽  
May Britt Drugli
Keyword(s):  
Professional Development ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Differences ◽  
Control Group ◽  
Post Intervention ◽  
Significant Group ◽  
Randomized Controlled ◽  
Service Professional

The effectiveness of the Thrive by Three intervention, a 10-month, multicomponent, in-service professional development model to promote the quality of caregiver-toddler interactions (i.e., process quality), was tested utilizing a clustered randomized controlled design. Eighty childcare centers with 187 toddler classrooms in Norway were randomly assigned to either the Thrive by Three intervention group (n=87) or a usual-activity wait list control group (n=100). Interactional quality was assessed with the Toddler version of the Classroom Assessment Scoring System (CLASS-Toddler) at three timepoints: pre-, mid-, and post-intervention. There were significant group differences in change in quality during the intervention period in both CLASS domains, Emotional and Behavioral Support (EBS), and Engaged Support for Learning (ESL), with greater overall differences in the ESL domain. Quality increased in the intervention groups, but quality decreased in the control group from baseline to post-intervention. There were significant group differences in quality at baseline. The Thrive by Three intervention had a positive effect on teacher-toddler interactions in both the EBS and ESL domains. Results need to be replicated preferably in more diverse samples.Clinical Trial Registration:ClinicalTrials.gov #NCT03879733.

SUPPORTIVE EDUCATIVE SYSTEM DALAM MENINGKATKAN KEMANDIRIAN MERAWAT KAKI PADA PASIEN DIABETES MELLITUS TIPE II

2019 ◽  
Vol 9 (2) ◽  
pp. 63-72
Author(s):  
Nova Nurwinda Sari ◽  
Herlina Herlina
Keyword(s):  
Diabetes Mellitus ◽  
Health Center ◽  
Intervention Group ◽  
T Test ◽  
Control Group ◽  
P Value ◽  
Type Ii ◽  
Foot Care ◽  
Control Group Design ◽  
Patients With Diabetes

Diabetes mellitus dapat menyebabkan cukup banyak komplikasi seperti kelainan mata, kelainan ginjal, kelainan pembuluh darah dan kelainan pada kaki. Penderita diabetes mellitus yang mengalami komplikasi kronis perlu diberikan upaya preventif untuk mencegah komplikasi, salah satunya adalah kemampuan perawatan kaki. Penelitian ini dilakukan untuk menguji efektivitas supportive educative system dalam meningkatkan kemandirian perawatan kaki pada pasien dengan diabetes mellitus Tipe II di Puskesmas Permata Sukarame, Bandar Lampung. Penelitian ini menggunakan metode quasy eksperimen dengan desain pretest-posttest with control group dengan total masing-masing kelompok sebanyak 18 responden. Pengumpulan data dilakukan dengan menyebarkan kuesioner kepada responden yang memenuhi kriteria inklusi penelitian. Penelitian ini diuji menggunakan analisis univariat, bivariat dan uji T-test. Hasil penelitian menunjukkan bahwa terdapat perbedaan rata-rata dalam kemandirian perawatan kaki pada kelompok intervensi dan kelompok kontrol dengan p-value 0,000. Pendidikan dan praktik perawatan kaki harus diberikan sejak dini sebagai upaya pencegahan untuk komplikasi.   Kata kunci : Supportive educative system, kemandirian perawatan kaki   SUPPORTIVE EDUCATIVE SYSTEM IN IMPROVING INDEPENDENCE OF FOOT CARE IN PATIENTS WITH DIABETES MELLITUS TYPE II   ABSTRACT Diabetes mellitus can cause quite a lot of complications such as eye disorders, kidney disorders, vascular disorders and abnormalities in the legs. Patients with diabetes mellitus who have chronic complications need to be given a preventive effort to prevent complications, one of which is foot care ability. This research was conducted to examine the effectiveness of supportive educative systems in increasing the independence of foot care in patients with Type II diabetes mellitus in the Permata Sukarame Health Center Bandar Lampung Working Area. This study used a quasi-experimental method with pretest-posttest with control group design with a total of 18 respondents each. Data collection is done by distributing questionnaires to respondents who meet the research inclusion criteria. This study was tested using univariate, bivariate, T-Test analysis. The results showed that the mean differences in the independence of foot care in the intervention group and the control group in the Permata Sukarame Community Health Center work area with a p-value of 0,000. Education and practice of foot care should be given early as a preventative effort for complications.   Keywords: Supportive educative system, independence of foot care

scholarly journals Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—results of the cluster-randomised controlled DEBATE trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anja Wollny ◽  
Christin Löffler ◽  
Eva Drewelow ◽  
Attila Altiner ◽  
Christian Helbig ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Decision Making ◽  
Type 2 Diabetes Mellitus ◽  
Shared Decision Making ◽  
Intervention Group ◽  
Control Group ◽  
Shared Decision ◽  
Patient Centeredness

Abstract Background We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus? Methods We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline. Results Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups. Conclusions The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness. Trial registration The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.

scholarly journals Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial

2021 ◽  
Author(s):  
K. Wernicke ◽  
J. Grischke ◽  
M. Stiesch ◽  
S. Zeissler ◽  
K. Krüger ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Periodontal Health ◽  
Randomized Controlled ◽  
Hba1c Levels

Abstract Objectives The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. Materials and methods Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). Results Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). Conclusions Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.

scholarly journals OP0159 EFFICACY OF COMPREHENSIVE TECHNOLOGY-ASSISTED HOME-BASED EXERCISE IN ANKYLOSING SPONDYLITIS: A RANDOMIZED, CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Group Differences ◽  
Control Group ◽  
Home Based ◽  
The Mean

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared

The Effect of Community Empowerment on The Implementation of Diabetes Mellitus Management in Malangsuko, West Java

2020 ◽  
Author(s):  
Tavip Dwi Wahyuni ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Positive Impact ◽  
Intervention Group ◽  
Community Empowerment ◽  
Wilcoxon Test ◽  
Control Group ◽  
West Java ◽  
Control Group Design ◽  
Knowledge And Skills ◽  
Diabetes Mellitus Management

ABSTRACT Background: Efforts to deal with Diabetes Mellitus (DM) disease require support from various parties, especially the community and family apart from the sufferer himself. The community in an effort to reduce the risk of DM disease, among others, by providing knowledge and understanding to families and sufferers directly, including empowering the community. This study was carried out by empowering health cadres by training in knowledge and skills in medical examinations, starting from checking blood pressure, anthropometry, and blood sugar. This study aimed to analyze the effect of community empowerment on the implementation of DM management. Subjects and Method: This was an experimental study with a control group design. This study was carried out in Malangsuko Village, West Java. Total of 30 cadres were divided into 15 cadres in the control group and 15 cadres in the treatment group. The independent variable was community empowerment. The dependent variable was the implementation of DM management. Data were collected using questionnaire and observation sheet skills results. Data were analyzed using Wilcoxon test. Results: After a post test, a total of 73% cadres had moderate knowledge and 80% had low skill in control group, while in intervention group, 73.3% cadres had good knowledge and 100% had good skill. Conclusion: The empowerment of health cadres in Malangsuko Village is effective because it has a positive impact on knowledge and skills in early detection of DM disease. Keywords: community empowerment, diabetes mellitus management Correspondence: Tavip Dwi Wahyuni. School of Health Polytechnics, Malang, East Java. Email: [email protected] DOI: https://doi.org/10.26911/the7thicph.04.11

scholarly journals Impact of ELKa, the Electronic Device for Prandial Insulin Dose Calculation, on Metabolic Control in Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Agnieszka Kowalska ◽  
Katarzyna Piechowiak ◽  
Anna Ramotowska ◽  
Agnieszka Szypowska
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Metabolic Control ◽  
Electronic Device ◽  
Intervention Group ◽  
Insulin Dosage ◽  
Control Group ◽  
Prandial Insulin

Background. The ELKa system is composed of computer software, with a database of nutrients, and a dedicated USB kitchen scale. It was designed to automatize the everyday calculations of food exchanges and prandial insulin doses. Aim. To investigate the influence of the ELKa on metabolic control in children with type 1 diabetes mellitus (T1DM). Methods. A randomized, parallel, open-label clinical trial involved 106 patients aged <18 years with T1DM, HbA1C≤10%, undergoing intensive insulin therapy, allocated to the intervention group, who used the ELKa (n=53), or the control group (n=53), who used conventional calculation methods. Results. After the 26-week follow-up, the intention-to-treat analysis showed no differences to all endpoints. In per protocol analysis, 22/53 (41.5%) patients reporting ELKa usage for >50% of meals achieved lower HbA1C levels (P=0.002), lower basal insulin amounts (P=0.049), and lower intrasubject standard deviation of blood glucose levels (P=0.023) in comparison with the control. Moreover, in the intervention group, significant reduction of HbA1C level, by 0.55% point (P=0.002), was noted. No intergroup differences were found in the hypoglycemic episodes, BMI-SDS, bolus insulin dosage, and total daily insulin dosage. Conclusions. The ELKa system improves metabolic control in children with T1DM under regular usage. The trial is registered at ClinicalTrials.gov, number NCT02194517.

scholarly journals Effects of Five-Finger Relaxation Technique on Depression in Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rosliana Dewi ◽  
Fanny Dwi Agustina ◽  
Johan Budhiana ◽  
Syiva Dwi Fatmala
Keyword(s):  
Diabetes Mellitus ◽  
Intervention Group ◽  
Wilcoxon Test ◽  
Relaxation Technique ◽  
Control Group ◽  
P Value ◽  
Relaxation Techniques ◽  
Psychological Changes ◽  
Type 2 Dm

Diabetes mellitus (DM) can cause physical and psychological changes for sufferers. Psychological changes include changes in self-concept and depression. Psychological changes can be treated with nonpharmacological therapies, one of which is five-finger relaxation technique. The research aimed to reveal the effect of five-finger relaxation technique on depression experienced by type 2 DM patients. The five-finger relaxation technique is one of the generalist relaxation techniques by recalling pleasant experiences. This research is a quasi-experiment. Samples of this research were 34 respondents whom were selected using purposive sampling.  The intervention was carried out once a day for 3 consecutive days.  In order to measure depression, a valid and reliable questionnaire of Indonesian version of the Beck Depression Inventory (BDI) was employed.  Data were analyzed using the Wilcoxon Test and the Mann-Whitney Test. The results showed the was a decrease in depression in the control group (p-value of 0.008) and the intervention group (p-value of 0.000) and there were differences in depression in the control group and the intervention group (p-value of 0.000). It can be concluded that there is an effect of five-finger relaxation technique on depression in type 2 DM patients<em>.</em>

Sign in / Sign up

Export Citation Format

Share Document