Assessment of knowledge, attitude and practice of diabetic eye care among non-ophthalmic speciality doctors at a tertiary institute in India

Aim of this study was to assess the knowledge, attitude and practices (KAP) in eye care of diabetics by non-ophthalmic doctors of different specialization. The was a cross-sectional questionnaire based KAP survey among 108 non-ophthalmic diabetes mellitus treating faculties of various departments at our institute. The level of Knowledge was considered excellent if the overall average score was > 75%, similarly questionnaire focusing on attitude was considered positive if the average score was > 50% and excellent practice constituted an average score > 75%. The findings will be noted in percentages with 95% confidence interval limit. Out of the 108 subjects, 75.57% {95%CI(61%-78%)} of participants had excellent knowledge, while >87.6% {95%CI(73%-88%)} of participants had a positive attitude towards diabetic eye care, whereas there were glaring deficits in diabetic eye care practices accounting to only 45.5%{95%CI(32.8%-51.4%)} which was considered poor. Knowledge and attitude regarding diabetic eye care was excellent, there was glaring deficits in the practice of diabetic eye care by non-ophthalmic treating doctors. The deficit was probably due to busy schedule of some doctors, due to lack of uniform eye care protocols of diabetic patients, and lack of updated timely education of eye care practices among non-ophthalmic medical professionals. Hence based on the findings of our study we aim to train and educate our non-ophthalmic medical faculty regularly for adequate and better management of spectrum of diabetic eye disease.

Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland

Background The medical field causes significant environmental impact. Reduction of the primary care practice carbon footprint could contribute to decreasing global carbon emissions. This study aims to quantify the average carbon footprint of a primary care consultation, describe differences between primary care practices (best, worst and average performing) in western Switzerland and identify opportunities for mitigation. Methods We conducted a retrospective carbon footprint analysis of ten private practices over the year 2018. We used life-cycle analysis to estimate carbon emissions of each sector, from manufacture to disposal, expressing results as CO2 equivalents per average consultation and practice. We then modelled an average and theoretical best- case and worst-case practices. Collected data included invoices, medical and furniture inventories, heating and power supply, staff and patient transport, laboratory analyses (in/out-house) waste quantities and management costs. Results An average medical consultation generated 4.8 kg of CO2eq and overall, an average practice produced 30 tons of CO2eq per year, with 45.7% for staff and patient transport and 29.8% for heating. Medical consumables produced 5.5% of CO2eq emissions, while in-house laboratory and X-rays contributed less than 1% each. Emergency analyses requiring courier transport caused 5.8% of all emissions. Support activities generated 82.6% of the total CO2eq. Simulation of best- and worst-case scenarios resulted in a ten-fold variation in CO2eq emissions. Conclusion Optimizing structural and organisational aspects of practice work could have a major impact on the carbon footprint of primary care practices without large-scale changes in medical activities.

Go to Fight! parents' experiences in caring for their disabled child / Ir à Luta! vivências dos pais nos cuidados do filho com deficiência

The objective was to understand the experience of parents in caring for children with disabilities. The Grounded Theory was adopted as a methodological framework, 9 parents of children and adults with intellectual or multiple disabilities were interviewed, between August/2015 and June/2016. The categories were obtained: Pre, peri, post-natal aspects, Posture assumed by the professional, Go to Fight! and Another world. It is, therefore, a parenting that is configured as these parents enter the Another world, which leads them to adjust their practices and beliefs about their child, about themselves and the universe of disability, sometimes under a perception of disability as a social disadvantage and incapacity, having as an intervening factor the Posture assumed by the professional, thus knowing these experiences from the GT allows: the improvement of care practices for these parents and their children, the planning of actions psychoeducational from a social perspective of disability in order to empower them and guide them about aspects of their children's development, enabling a look beyond the diagnosis and a more positive family adaptation.

Evidence-based practice and management-by-knowledge of disability care: rigid constraint or fluid support?

Background: Although increasingly accepted in some corners of social work, critics have claimed that evidence-based practice (EBP) methodologies run contrary to local care practices and result in an EBP straitjacket and epistemic injustice. These are serious concerns, especially in relation to already marginalised clients.Aims and objectives: Against the backdrop of criticism against EBP, this study explores the ramifications of the Swedish state-governed knowledge infrastructure, ‘management-by-knowledge’, for social care practices at two care units for persons with intellectual disabilities.Methods: Data generated from ethnographic observations and interviews were analysed by applying a conceptual framework of epistemic injustice; also analysed were national, regional and local knowledge products within management-by-knowledge related to two daily activity (DA) units at a social care provider in Sweden.Findings: In this particular case of disability care, no obvious risks of epistemic injustice were discovered in key knowledge practices of management-by-knowledge. Central methodologies of national agencies did include perspectives from social workers and clients, as did regional infrastructures. Locally, there were structures in place that focused on creating a dynamic interplay between knowledge coming from various forms of evidence, including social workers’ and clients’ own knowledge and experience.Discussion and conclusions: Far from being a straitjacket, in the case studied management-by-knowledge may be understood as offering fluid support. Efforts which aim at improving care for people with disabilities might benefit from organisational support structures that enable dynamic interactions between external knowledge and local practices.<br />Key messages<br /><ul><li>Examining one case of disability care in Sweden, both social workers’ and clients’ experiences were included in EBP infrastructures.</li><br /><li>In this study, Swedish EBP infrastructures functioned more like fluid support than a straitjacket.</li><br /><li>Organisational structures that combine different knowledge sources at service providers can minimise the risk of epistemic injustice within social care.</li></ul>

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.