Promoting Health in Type 2 Diabetes: Nurse-Physician Collaboration in Primary Care

2005 ◽  
Vol 6 (3) ◽  
pp. 207-215 ◽  
Author(s):  
Katherine I. Taylor ◽  
Kathleen M. Oberle ◽  
Rodney A. Crutcher ◽  
Peter G. Norton

The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study. Forty patients from a family practice clinic with type 2 diabetes were randomly assigned to control or experimental groups. The control group received standard care, whereas the experimental group received standard care plus home visits from a nurse, as well as consultation with an exercise specialist and/or nutritionist. Follow-up continued for 3 months. Clinical end points included standard measures of diabetes activity as well as quality-of-life indicators. Focus group interviews were used to explore patients’ responses to the program. Although findings were not statistically significant, a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure. Quality oflife measures also showed a trend toward small to moderate, but nonsignificant, improvements in physical functioning, bodily pain, vitality, social and global functioning, energy, impact of diabetes, and health distress. Focus group interviews indicated a very positive response from patients, who expressed feelings of empowerment. In this study, patients treated with nurse-physician collaboration demonstrated small, but nonsignificant, improvements in blood chemistry after only 3 months. Physical and social functioning, energy, and bodily pain also showed a small improvement. Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S871-S872
Author(s):  
Eun hae Kim ◽  
Kyong Hee Chee ◽  
Clay DeStefano ◽  
Anna Broome

Abstract Structured social support may enhance the benefits of an exercise class for participants. This study examined the effects of an intergenerational exercise buddy program on participant well-being. A convenience sampling was used to recruit participants from Central Texas (N = 51): 34 were community-dwelling adults aged 65 and above, and 17 were university students aged 18-25 years. The study used a pretest-posttest, quasi-experimental design and focus group interviews. Randomly selected 18 older-adult participants were paired with young-adult participants as an exercise buddy for each other to attend 8 weekly Tai Chi or Chair Yoga classes at a community center. Meanwhile, 16 older-adult participants formed a control group attending different exercise classes without young-adult buddies. The survey results show that, compared to the control group, the intervention group (n = 35) had significantly greater satisfaction with life (p < .09 ) and a more positive attitude towards aging (p < .01) after attending exercise classes with their buddies. In focus group interviews, the participants most frequently mentioned that commitment to their buddies as a key factor for class attendance. The participants typically perceived that their buddies were pleasant and did not judge or treat them based on their age. They stressed the positive effects of building relationships with all involved in the program, including the exercise instructors. Meanwhile, control-group participants wished that they, too, had buddies. Although the study should be replicated with a larger sample, its findings suggest that an intergenerational exercise program offers added benefits for participants.


2021 ◽  
Author(s):  
Youlim Kim ◽  
Hyeonkyeong Lee ◽  
Sookyung Kim ◽  
Junghee Kim

Abstract Background: Migrant workers struggle to access health services and adapt to a new culture. Self-care agency can be important for health self-management. It is necessary to investigate in detail how migrant workers engage in health promotion behaviors. This study examines the effects of a health engagement program to improve self-care agency using a living lab approach among migrant workers living in South Korea. Methods: Participants included 42 migrant workers from 9 countries, recruited via flyers, posters, and internet bulletins posted by a migrant community organization. This pilot study used a mixed-methods design including a nonequivalent pre-post-test control group and three focus group interviews. During the 12-week period, only the intervention group participants received four workshops addressing healthy physical activity, healthy dietary habits, effective cultural adaptation, stress management, and two outdoor cultural activities. They also participated in focus group interviews after the second, third, and fourth group activities and discussed the benefits of health behaviors and specific ways to implement them in real life. The control group received no intervention. Results: After the 12-week intervention period, participants in the intervention group showed an increase in the levels of self-care agency (U = 82.5, p < .001), health literacy (U = 91.5, p < .001), and acculturation (U = 119.0, p = .010) compared to the control group. As results of qualitative content analysis, various themes were derived for three areas: healthy diet, acculturation, and stress management based on lessons learned from living lab activities, barriers to health behavior practices and methods to overcome barriers.Conclusions: This study demonstrated that interventions using a living lab were effective in increasing migrants’ participation in health promotion activities by strengthening their self-care agency. The qualitative approach was useful in obtaining more comprehensive results on strategies aimed at enhancing health behavior engagement.


2008 ◽  
Vol 99 (5) ◽  
pp. 1025-1031 ◽  
Author(s):  
Rachel Barratt ◽  
Gary Frost ◽  
D. J. Millward ◽  
Helen Truby

Obesity and type 2 diabetes are inextricably linked. It is therefore unfortunate that insulin, the ultimate treatment to improve glycaemic control in type 2 diabetes, is associated with significant weight gain. The aim of the present investigation was to ascertain whether a dietitian-led intensive lifestyle intervention could attenuate weight gain associated with commencing insulin therapy. Subjects (n 50) with type 2 diabetes, within 4 weeks of starting insulin therapy, were randomly allocated to a control or intervention group. The control group continued with standard care whilst the intervention group followed a dietitian-led intensive lifestyle intervention. Over 6 months the control group gained 4·9 (sd 3·6) kg (P < 0·001), whilst the intervention group maintained their weight ( − 0·6 (sd 5·1) kg (NS). The difference in weight change between the groups was 5·5 kg (P < 0·001). The control group had significant increases whilst the intervention group had slight decreases in: BMI (+1·7 (sd 1·3) kg/m2 (P < 0·001) v. − 0·3 (sd 2·0) kg/m2 (NS)), waist circumference (+5·3 (sd 5·0) cm (P < 0·001) v. − 0·4 (sd 5·2) cm (NS)) and percentage body fat (+1·5 (sd 2·0) % (P < 0·001) v. − 0·4 (sd 2·8) % (NS)). Differences between the groups for these parameters were significant (P < 0·01). Throughout the study, both groups experienced significant reductions in HbA1c, but only minor changes in blood lipids. The present study demonstrates that weight gain is not an inevitable consequence of starting insulin therapy, but attenuation of the weight gain requires a high level of intervention. The first 6 months to 1 year after initiating insulin therapy provides the ideal ‘window of opportunity’.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Rachana Bhoite ◽  
Anitha Chandrasekaran ◽  
Varalakshmi Lalithya Pratti ◽  
Vinita Satyavrat ◽  
Shivani Aacharya ◽  
...  

Background. Foods rich in protein and dietary fibre could potentially improve lipid profile in overweight or obese diabetic patients with dyslipidemia and, thereby, mitigate their risk of cardiovascular disease (CVD). In this study, the effect of providing high-protein high-fibre (HPHF) nutritional supplement in addition to standard care of type 2 diabetes mellitus (T2DM) on lipid profile was evaluated. Methods. In this open-label, parallel-arm, prospective, randomized study, a total of 100 overweight/obese participants with T2DM were randomized to either an intervention group (25 g HPHF nutritional supplement given twice daily along with a standard care of T2DM) or a control group (standard care of T2DM) for 24 weeks. Change from baseline in lipid parameters such as total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) was assessed between the intervention and control group at week 12 and week 24. Participant compliance was assessed using the dietary 24-hour recall. Statistical analysis was performed to assess the main effects on within- and between-group changes from baseline to end of 24 weeks. Results. Participants in the HPHF nutritional supplement group showed a statistically significant improvement in HDL-C levels by the end of 24 weeks ( p = 0.04 ) and a significant increase in protein and total dietary fibre intake ( p = 0.002 and p = 0.00 , respectively) compared to the control group. The TChol/HDL-C ratio was significantly lower ( p = 0.03 ) in the HPHF group from baseline to 24 weeks. Conclusion. Twice-daily consumption of a HPHF nutritional supplement significantly improved HDL-C levels. Inclusion of the HPHF supplement would be a useful effective aid for managing dyslipidemia in overweight/obese individuals with T2DM.


2021 ◽  
Vol 4 (4) ◽  
pp. 316-326
Author(s):  
Nail Ilhan

Research in the field of education plays a pivotal role in developing evidence-based practices in teaching and improving the quality of education. However, research conducted in recent years has highlighted the unwillingness of teachers to benefit from scientific studies. This study set out to assess whether Research Evidence-Based Practices in Science Teaching (EBPST) influences the teaching practices of student teachers and their attitudes towards education research. Mixed methods research design was used in this study. The study was conducted through Quasi-experimental methods and focus group interviews. The data were collected with the "Teachers Attitude Scale towards Educational Research (TASTER)" and focus group interviews. Participants of the study included 106 third-year undergraduate student teachers. The experimental group applied EBPST during their teaching, while the control group applied existing traditional teaching at primary schools. The Quantitative findings showed that student teachers in the experimental group had significantly increased positive attitudes towards educational research when compared with student teachers in the control group. In addition, qualitative findings revealed that several factors negatively and positively influence the understanding and use of educational research for student teachers on the applicability of EBPST. Considering the results of this study, student teachers' EBPST effect on improving their attitudes, understanding, and the use of educational research in teaching.


2021 ◽  
Author(s):  
Dao Pham

<p><b>Coherence has been claimed to be one among the difficult aspects of writing to teach and learn . Both teachers and learners find it hard to explain why one piece of writing is incoherent and another is not. There have been a few studies (Gramegna, 2007; Wikborg, 1990) investigating the types of coherence breaks in EFL/ESL writing and a few studies (Johns, 1986; Lee, 2002b) investigating the effects of teaching aspects of coherence on students’ writing performance. However, there have been no studies identifying the coherence problems in students’ writing and then using these to teach students how to avoid these coherence problems. In addition to teaching students to avoid coherence problems, an approach called topical structure analysis (TSA) (Liangprayoon, Chaya, & Thep-ackraphong, 2013; Schneider & Connor, 1990) has been considered as an effective technique to help improve students’ writing coherence. Some studies (Attelisi, 2012; Connor & Farmer, 1990) have examined the effect of teaching TSA in promoting EFL students’ awareness of coherence, but investigating the effect of the combination of teaching coherence problems and TSA on EFL students’ writing performance has not been done in any previous studies. My study fills both of these gaps.</b></p> <p>There are two main phases in my study. In Phase 1, I developed a system of coherence problems based on the analysis of 69 essays written by Vietnamese EFL students. Then, this system of coherence problems was used to identify the types and frequency of coherence problems in the writing of Vietnamese EFL students. In Phase 2, an intervention was conducted in a university in Vietnam. Fifty-eight students participated in the intervention and were divided into a control group and a treatment group. While the combination of teaching the system of coherence problems developed in Phase 1 and teaching TSA was delivered to the treatment group in the intervention, the control group was taught other aspects of writing such as grammar, vocabulary, etc. The aim of Phase 2 of this study was to examine the effect of the intervention on students’ writing performance, especially on coherence and overall writing quality.</p> <p>Data for Phase 1 was 69 essays on a single topic. Using this set of essays, the types of coherence problems and their frequency were identified. Data for Phase 2 included three sets of writing. The first set of writing was 58 essays written by students in both the treatment group and the control group before the intervention was conducted. The second set of writing involved the students revising their first draft right after the intervention finished. The third set of writing was 58 new essays on a different topic from the first and the second sets written by students in the control and treatment groups four weeks after the intervention. These three sets of writing were analysed and rated by the same raters as in Phase 1. In addition, students completed questionnaires and participated in focus group interviews in Phase 2.</p> <p>Findings of Phase 1 show that there were five main types of coherence problems that Vietnamese EFL students had in their writing. These were macrostructure-related problems, topic unity-related problems, paragraph unity-related problems, cohesion-related problems, and metadiscourse-related problems. Of these five main types of coherence problems, paragraph unity-related problems were the most frequent ones, and “no/ little elaboration of the proposition made” was the most frequent subtype of paragraph-unity problems. </p> <p>Findings from Phase 2 show that there was a significant difference in terms of coherence problems, types of topical progression, and writing quality between the two groups after the intervention finished. To be specific, there were significantly fewer instances of coherence problems in the writing of the treatment group than in the writing of the control group, and the scores for coherence and overall quality achieved by the treatment group were significantly higher than those achieved by the control group. Also, the focus group interviews suggest that most students found the intervention helpful in improving their writing performance. This means the combination of teaching coherence problems and TSA to students had a positive impact on students’ writing coherence and writing quality. Based on the findings, some suggestions are made for teaching writing to EFL students in general and for the teaching of coherence in the Vietnamese university context in particular.</p>


2021 ◽  
Author(s):  
Dao Pham

<p><b>Coherence has been claimed to be one among the difficult aspects of writing to teach and learn . Both teachers and learners find it hard to explain why one piece of writing is incoherent and another is not. There have been a few studies (Gramegna, 2007; Wikborg, 1990) investigating the types of coherence breaks in EFL/ESL writing and a few studies (Johns, 1986; Lee, 2002b) investigating the effects of teaching aspects of coherence on students’ writing performance. However, there have been no studies identifying the coherence problems in students’ writing and then using these to teach students how to avoid these coherence problems. In addition to teaching students to avoid coherence problems, an approach called topical structure analysis (TSA) (Liangprayoon, Chaya, & Thep-ackraphong, 2013; Schneider & Connor, 1990) has been considered as an effective technique to help improve students’ writing coherence. Some studies (Attelisi, 2012; Connor & Farmer, 1990) have examined the effect of teaching TSA in promoting EFL students’ awareness of coherence, but investigating the effect of the combination of teaching coherence problems and TSA on EFL students’ writing performance has not been done in any previous studies. My study fills both of these gaps.</b></p> <p>There are two main phases in my study. In Phase 1, I developed a system of coherence problems based on the analysis of 69 essays written by Vietnamese EFL students. Then, this system of coherence problems was used to identify the types and frequency of coherence problems in the writing of Vietnamese EFL students. In Phase 2, an intervention was conducted in a university in Vietnam. Fifty-eight students participated in the intervention and were divided into a control group and a treatment group. While the combination of teaching the system of coherence problems developed in Phase 1 and teaching TSA was delivered to the treatment group in the intervention, the control group was taught other aspects of writing such as grammar, vocabulary, etc. The aim of Phase 2 of this study was to examine the effect of the intervention on students’ writing performance, especially on coherence and overall writing quality.</p> <p>Data for Phase 1 was 69 essays on a single topic. Using this set of essays, the types of coherence problems and their frequency were identified. Data for Phase 2 included three sets of writing. The first set of writing was 58 essays written by students in both the treatment group and the control group before the intervention was conducted. The second set of writing involved the students revising their first draft right after the intervention finished. The third set of writing was 58 new essays on a different topic from the first and the second sets written by students in the control and treatment groups four weeks after the intervention. These three sets of writing were analysed and rated by the same raters as in Phase 1. In addition, students completed questionnaires and participated in focus group interviews in Phase 2.</p> <p>Findings of Phase 1 show that there were five main types of coherence problems that Vietnamese EFL students had in their writing. These were macrostructure-related problems, topic unity-related problems, paragraph unity-related problems, cohesion-related problems, and metadiscourse-related problems. Of these five main types of coherence problems, paragraph unity-related problems were the most frequent ones, and “no/ little elaboration of the proposition made” was the most frequent subtype of paragraph-unity problems. </p> <p>Findings from Phase 2 show that there was a significant difference in terms of coherence problems, types of topical progression, and writing quality between the two groups after the intervention finished. To be specific, there were significantly fewer instances of coherence problems in the writing of the treatment group than in the writing of the control group, and the scores for coherence and overall quality achieved by the treatment group were significantly higher than those achieved by the control group. Also, the focus group interviews suggest that most students found the intervention helpful in improving their writing performance. This means the combination of teaching coherence problems and TSA to students had a positive impact on students’ writing coherence and writing quality. Based on the findings, some suggestions are made for teaching writing to EFL students in general and for the teaching of coherence in the Vietnamese university context in particular.</p>


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