scholarly journals Healthcare Professionals’ Perspectives on the Cross-sectoral Treatment Pathway for Women with Gestational Diabetes During and After Pregnancy – A Qualitative Study

2020 ◽  
Author(s):  
Anne Timm ◽  
Karoline Kragelund Nielsen ◽  
Ulla Christense ◽  
Helle Terkildsen Maindal
Keyword(s):  
Knowledge Transfer ◽  
Gestational Diabetes ◽  
General Practitioners ◽  
Healthcare Professionals ◽  
Treatment Pathway ◽  
Health Visitors ◽  
Before And After ◽  
Tailored Communication ◽  
Local Municipality ◽  
The Cross

Abstract Background: Gestational diabetes increases the risk of complications during and after pregnancy, including a long-term risk of type 2 diabetes. Women with gestational diabetes have to navigate a complex treatment pathway during pregnancy, which they often experience as incoherent. These women also report a lack of preventive care after pregnancy. The objective of this study is to investigate healthcare professionals’ views on the cross-sectoral treatment pathway for women with gestational diabetes – under and after pregnancy. Methods: Nine healthcare professionals handling women with gestational diabetes before and after pregnancy in Denmark were interviewed (two general practitioners, four midwives, two obstetricians and one diabetes nurse). Further, eight health visitors participated in focus group discussions. The data material was analysed using systematic text condensation. Results: Three major themes emerged: 1) professional identity which varied across the healthcare professionals and consequently shaped care practices; 2) lack of priority in the area of gestational diabetes contributed to uncertainty of tasks and responsibilities across the treatment pathway; and 3) cross-sectoral collaboration relied heavily on knowledge transfer between hospitals, general practitioners, and the local municipality. Conclusion: Knowledge transfer was fragmented as guidelines for treatment in the postpartum period were unclear to healthcare professionals outside the hospital. More awareness should be given to structures that ease clear and transparent guidelines and tailored communication strategies for healthcare professionals who provide care to women with gestational diabetes under and after pregnancy.

scholarly journals Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study

2021 ◽  
Vol 10 (4) ◽  
pp. 843
Author(s):  
Anne Timm ◽  
Karoline Kragelund Nielsen ◽  
Ulla Christensen ◽  
Helle Terkildsen Maindal
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Adverse Outcomes ◽  
Treatment Pathway ◽  
Healthy Behaviors ◽  
The Cross

Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.

Evaluating the implementation potential of a transcultural tool for Tamil migrants with gestational diabetes mellitus living in Switzerland

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Binary Logistic Regression ◽  
Private Practices ◽  
Populations At Risk ◽  
Management Procedures

Background: Gestational diabetes mellitus is a condition that affects many pregnancies and ethnicity appears to be a risk factor. Data indicate that approximately 18% of Tamil women are diagnosed with gestational diabetes mellitus. Today, approximately 50,000 of Tamils live in Switzerland. To date, there is no official tool available in Switzerland that considers the eating and physical activity habits of this migrant Tamil population living in Switzerland, while offering a quick overview of gestational diabetes mellitus and standard dietetics management procedures. The NutriGeD project led by Bern University of Applied Sciences in Switzerland aimed at closing this gap. The aim of this present study was to evaluate the implementation potential of the tools developed in the project NutriGeD for dietetic counseling before their wide scale launch in Swiss hospitals, clinics and private practices. Method: An online survey was developed and distributed to 50 recruited healthcare professionals working in the German speaking region of Switzerland from October – December 2016 (31% response rate). The transcultural tools were sent to participants together with the link to the online survey. The evaluation outcome was analysed using binary logistic regression and cross tabulation analysis with IBM SPSS version 24.0, 2016. Results: 94% (N=47) respondents believed that the transcultural tools had good potential for implementation in hospitals and private practices in Switzerland. A binary logistic regression analysis revealed that the age of participants had a good correlation (42.1%) on recommending the implementation potential of the transcultural tool. The participants with age group 34- 54 years old where the highest group to recommend the implementation potential of the transcultural tool and this was found to be statistically significant (p=0.05). 74% (34 out of 50) of the respondents clearly acknowledged the need for transcultural competence knowledge in healthcare practices. 80% (N =40) of the respondents agreed that the information presented in the counseling display folder was important and helpful while 60% (N= 30) agreed to the contents being clinically applicable. 90% (N=45) participants recommended the availability of the evaluated transcultural tools in healthcare settings in Switzerland. Conclusion: The availability in healthcare practice of the evaluated transcultural tools was greatly encouraged by the Swiss healthcare practitioners participating in the survey. While they confirmed the need for these transcultural tools, feed-backs for minor adjustments were given to finalize the tools before their official launch in practice. The developed materials will be made available for clinical visits, in both hospitals and private practices in Switzerland. The Migmapp© transcultural tool can serve as a good approach in assisting healthcare professionals in all fields, especially professionals who practice in areas associated with diet - related diseases or disorders associated with populations at risk.

Study of Possible Relation between Fasting Plasma Glucagon, Gestational Diabetes and Development of Type 2 DM

2020 ◽  
Vol 16 (2) ◽  
pp. 148-155 ◽  
Author(s):  
Ashraf Okba ◽  
Salwa Seddik Hosny ◽  
Alyaa Elsherbeny ◽  
Manal Mohsin Kamal
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Post Partum ◽  
Plasma Glucagon ◽  
Type 2 Dm ◽  
Fasting Plasma ◽  
Before And After ◽  
Two Phases

Background and Aims: Women who develop GDM (gestational diabetes mellitus) have a relative insulin secretion deficiency, the severity of which may be predictive for later development of diabetes. This study aimed to investigate the role of fasting plasma glucagon in the prediction of later development of diabetes in pregnant women with GDM. Materials and Methods: The study was conducted on 150 pregnant women with GDM after giving informed oral and written consents and being approved by the research ethical committee according to the declaration of Helsinki. The study was conducted in two phases, first phase during pregnancy and the second one was 6 months post-partum, as we measured fasting plasma glucagon before and after delivery together with fasting and 2 hour post-prandial plasma sugar. Results: Our findings suggested that glucagon levels significantly increased after delivery in the majority 14/25 (56%) of GDM women who developed type 2 DM within 6 months after delivery compared to 6/20 (30%) patients with impaired fasting plasma glucose (IFG) and only 22/105 (20%) non DM women, as the median glucagon levels were 80,76, 55, respectively. Also, there was a high statistical difference between fasting plasma glucagon post-delivery among diabetic and non-diabetic women (p ≤ 0.001). These results indicated the useful role of assessing fasting plasma glucagon before and after delivery in patients with GDM to predict the possibility of type 2 DM. Conclusion: There is a relatively high glucagon level in GDM patients, which is a significant pathogenic factor in the incidence of subsequent diabetes in women with a history of GDM. This could be important in the design of follow-up programs for women with previous GDM.

Habits-GDM mobile application in managing gestational diabetes in Singapore: A mixed-methods study (Preprint)

2020 ◽  
Author(s):  
Shilpa Surendran ◽  
Chang Siang Lim ◽  
Gerald Choon Huat Koh ◽  
Tong Wei Yew ◽  
E Shyong Tai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomised Controlled Trial ◽  
Gestational Diabetes ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Perceived Usefulness ◽  
Mixed Methods Study ◽  
Automatic Data ◽  
Glucose Testing ◽  
Randomised Controlled

BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing in Singapore and the cost of providing traditional care for GDM is high. Mobile health (mHealth) applications may act as useful tools in the management of GDM. OBJECTIVE The objective of this mixed-methods study was to measure the usage behaviour and explore users’ perceived usefulness of the Habits-GDM application when managing GDM in a randomised controlled trial. METHODS We conducted a quantitative analysis of the application usage behaviour in 170 Habits-GDM application users and 14 semi-structured interviews with users from a randomised controlled trial. RESULTS The convenience of automatic data transfer of weight values to the Habits-GDM application helped users (116/170, 68%) log their weight at least once a week. However, when the application had usability challenges, users avoided using that feature, i.e. users logged only an average of less than one meal/week out of the recommended six meals/week. Of the usability challenges, many users (12/14, 85.7%) mentioned food items not worded in the commonly known way and limited ethnic food database as the primary barriers. Only half of the users (84/170, 49.4%) accessed the educational lessons, but many (9/14, 64%) identified the provision of always available, valuable health-related information as an advantage of the educational lessons. ‘Healthy eating’ and ‘Why exercise’ were the most (56/84, 66.67%) and least (38/84, 45.24%) frequently accessed educational lessons, respectively. Users (10/14, 71.4%) reported sending messages to the coach via the chat interface only when they faced logistic issues and 86.45% of all the coach messages were replies typed by the research coordinator in response to the logistics issues (i.e. a request for blood glucose testing strips and appointment confirmation) raised by the users. Healthcare professionals lack of access to the coach’s dashboard discouraged users from asking queries related to GDM via the e-coaching feature. CONCLUSIONS The findings suggest that mHealth application acts as a useful tool in managing GDM. Culturally sensitive mHealth applications with a provision for women to interact with healthcare professionals should be developed in cooperation with the users. CLINICALTRIAL Not applicable.

scholarly journals Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 747
Author(s):  
Sahbanathul Missiriya Jalal ◽  
Fahima Akhter ◽  
Amal Ismael Abdelhafez ◽  
Ahmed Mansour Alrajeh
Keyword(s):  
Work Experience ◽  
Healthcare Professionals ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Cross Sectional ◽  
Biomedical Waste ◽  
Respiratory Therapists ◽  
Global Pandemic ◽  
Before And After ◽  
Knowledge Practice

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.

Application of Thermo-Frictional and Chemical-Thermal Methods Treatments for Surface Strengthening of Materials

2021 ◽  
Vol 1038 ◽  
pp. 93-99
Author(s):  
Alexander Levterov ◽  
Julia Nechitailo ◽  
Tatyana Plugina ◽  
Oleg Volkov
Keyword(s):  
Cross Sections ◽  
Experimental Studies ◽  
Metallographic Analysis ◽  
Thermal Treatments ◽  
Strengthening Effect ◽  
Thermal Methods ◽  
Surface Strengthening ◽  
Before And After ◽  
The Cross

In the article, the issues of using the methods of thermo-frictional and chemical-thermal treatments for surface strengthening of steel tools were disclosed. 65G steel and U8A steel were considered. A flat graver and a cylindrical root roller were considered to be tools in need of hardening. The nature of the jewellery work using such a tool has been described. Hardening techniques, experimental studies and macro photographs of the samples were presented in this article. A detailed metallographic analysis and measurement of the microhardness of the cross-sections of the prototypes after their strengthening using various methods was carried out. The metallographic nature of the reinforcement with the formation of surface "white layers" was shown. Comparison of the properties of the samples before and after strengthening was carried out. Conclusions about the strengthening effect of the thermo-frictional and chemical-thermal methods of strengthening were made.

scholarly journals A Five-Year Study of Influenza in Families Joint Public Health Laboratory Service/Royal College of General Practitioners Working Group

1981 ◽  
Vol 87 (2) ◽  
pp. 191-200 ◽  
Author(s):  
P. G. Mann ◽  
M. S. Pereira ◽  
J. W. G. Smith ◽  
R. J. C. Hart ◽  
W. O. Williams ◽  
...  
Keyword(s):  
Public Health ◽  
General Practitioners ◽  
Royal College ◽  
Working Group ◽  
Virus Isolation ◽  
Collaborative Study ◽  
Influenza Viruses ◽  
Public Health Laboratory ◽  
Laboratory Service ◽  
Before And After

SummaryA five year collaborative study of influenza in volunteer families from 1973–78 covered a period in which there were outbreaks every year but no major epidemics of influenza. Volunteers over the age of 15 years were bled before and after each of the five winters, and virus isolation was attempted from as many as possible when they reported episodes of illness. Children under 15 in the volunteer families were also swabbed when they were ill. Although most families experienced one or more attacks by influenza viruses, there was little transmission within families.

scholarly journals Effectiveness and acceptability ofmyo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022831 ◽  
Author(s):  
Chiamaka Esther Amaefule ◽  
Zoe Drymoussi ◽  
Julie Dodds ◽  
Lorna Sweeney ◽  
Elena Pizzo ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Plasma Glucose ◽  
Healthcare Professionals ◽  
Randomised Trial ◽  
Pilot Trial ◽  
Qualitative Evaluation ◽  
Nutritional Supplement ◽  
Cost Data ◽  
Advisory Group ◽  
Double Blind

IntroductionGestational diabetes increases maternal and offspring complications in pregnancy and cardiovascular complications in the long term. The nutritional supplementmyo-inositol may prevent gestational diabetes; however, further evaluation is required, especially in multiethnic high-risk mothers. Our pilot trial onmyo-inositol to prevent gestational diabetes will evaluate trial processes, assess acceptability to mothers and obtain preliminary estimates of effect and cost data prior to a large full-scale trial.Methods and analysisEMmY is a multicentre, placebo-controlled, double-blind, pilot, randomised trial, with qualitative evaluation. We will recruit pregnant women at 12–15+6weeks’ gestation, with gestational diabetes risk factors, from five maternity units in England between 2018 and 2019. We will randomise 200 women to take either 2 g ofmyo-inositol powder (intervention) or placebo, twice daily until delivery. We will assess rates of recruitment, randomisation, adherence to intervention and follow-up. Gestational diabetes will be diagnosed at 24–28 weeks as per the National Institute for Health and Care Excellence (NICE) criteria (fasting plasma glucose: ≥5.6 mmol/L and 2-hour plasma glucose: ≥7.8 mmol/L). We will assess the effects ofmyo-inositol on glycaemic indices at 28 weeks and on other maternal, fetal and neonatal outcomes at postnatal discharge. Qualitative evaluation will explore the acceptability of the trial and the intervention among women and healthcare professionals. Cost data and health-related quality of life measures will be captured. We will summarise feasibility outcomes using standard methods for proportions and other descriptive statistics, and where appropriate, report point estimates of effect sizes (eg, mean differences and relative risks) and associated 95% CIs.Ethics and disseminationEthical approval was obtained through the London Queen Square Research Ethics Committee (17/LO/1741). Study findings will be submitted for publication in peer-reviewed journals. Newsletters will be made available to participants, healthcare professionals and members of Katie’s Team (a patient and public advisory group) to disseminate.Trial registration numberISRCTN48872100.Protocol version and dateVersion 4.0, 15 January 2018.

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