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1
Davies, B. "Painful diabetic neuropathy : exploring management options." Thesis, University of the West of England, Bristol, 2017. http://eprints.uwe.ac.uk/31786/.
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Painful diabetic neuropathy (PDN) is one microvascular complication of diabetes mellitus (DM) and the focus of this thesis. PDN is a neuropathic pain condition characterised by severe burning pain in the feet and sometimes hands. It has significant impacts on peoples’ mobility, sleep quality and overall quality of life. The personal and societal burden associated with DM and PDN is predicated to rise as prevalence rates increase. Pharmacological management of PDN is often less than optimal, and people are left with few strategies to cope. Multidisciplinary pain management programmes (PMPs) use physical activity and psychological coping strategies to help people live better with persistent pain, yet people with PDN are rarely referred. It is unknown whether these strategies would be appropriate to help people live with PDN. This thesis aimed to: 1) locate and appraise all literature relating to physical activity and psychological coping strategies in PDN; 2) interview people with PDN and explore how PDN impacted on their lives; 3) explore the perspectives of patients and clinicians on the relevance of PMP approaches; and 4) explore patients’ treatment priorities and whether these might be addressed by PMP strategies. To address these aims, firstly a systematic literature review was conducted. The review identified a paucity of studies investigating physical activity or psychological coping strategies for PDN. Two interview studies were conducted, and data were analysed using thematic analysis (TA). A study with patients (n=23) found the impacts of PDN were wide ranging, people had experimented with many coping strategies unsuccessfully and there was some scepticism that PMP strategies were relevant to PDN, though few participants had direct experience of them. The second study interviewed specialist diabetes and pain clinicians and representatives from primary care (n=19). Clinicians relied primarily on medication strategies and did not have alternatives when these failed. Diabetes clinicians highlighted that people with PDN were medically complex patients and were at risk of tissue damage from too much physical activity. Pain clinicians felt PMP strategies could be adapted to suit the population with PDN. Informed by the patient interview study, an Internet survey was developed to explore the management priorities of people with PDN (n=63 respondents). Sleep disturbance was the top priority in all subgroups analysed. There were six impacts most frequently prioritised by respondents, which did not include pain. Potential clinical management strategies for these impacts have been described, and suggestions made for future research. This thesis has shown a scarcity of existing evidence for non-pharmacological strategies in the management of PDN. PMP strategies were not necessarily viewed as appropriate by patient participants. The impacts prioritized by people with PDN could however be matched to management strategies from other conditions where persistent pain is common. There is no a priori reason why these strategies could not be trialled with PDN. Managing the impacts of PDN on peoples’ lives remains a complex process.
2
Fuller, Caroline Anne. "Diabetic diet management : a native Indian perspective." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29707.
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Maturity-onset diabetes has become a growing health problem among Canadian Native Indians. Although there is a growing body of literature examining the etiology and cultural meanings of diabetes in this population, there is little knowledge of the Native perspective of diabetic diet management among groups in Western Canada. Therefore, the purpose of this study was to examine the problems perceived by Native Indians in managing a diabetic diet.
Kleinman's conceptual framework guided the formulation of the research question and methodololgy. In order to elicit and understand the experience of diabetic diet management from the perspective of the Native Indian, the qualitative research method of phenomenology was employed. Data were collected through the use of unstructured tape-recorded interviews that allowed the subjects to describe the phenomenon in their own words according to their own reality. The sample consisted of three men and three women all living on reserve from three Coast Salish bands in the Fraser Valley of British Columbia. Four of the subjects were interviewed twice, the other two were seen three times for a total of fourteen in-depth interviews.
Data were collected and analyzed simultaneously over a period of seven months. After being transcribed verbatim, interview data were examined for common themes that emerged and the raw data were coded accordingly. As themes surfaced during the analysis, they were clarified, validated, and/or discounted during subsequent meetings with the informants. In this process, the nature of diabetic diet management was elucidated.
The problems experienced by the informants were embedded in the larger phenomenon of diabetes management. How the illness was understood and dealt with in the context of daily living shaped the experience of diet management and the nature of the problems that surfaced. Two central interrelated concepts emerged from the data that explained how the subjects lived with their diets on a daily basis. The first concept entailed the evolving
personal understanding of diabetes as it was shaped by the subjective experience of symptoms and the anecdotal stories of the numerous relatives with the same illness. The second concept emerged from the interwoven social environment in which the subjects lived out their daily lives. This was discovered to be both a source of difficulty and a source of strength for the individuals of the study.
A variety of implications for nursing surfaced from the findings. For nursing practice, diabetic education and program development need to be planned and implemented in collaboration with Native leaders and clients. Educators must examine how nursing curricula can focus on the client's perspective of the illness experience to better enhance communication and health care delivery. There also remain many unanswered questions regarding the diabetic experience in this cultural group and how it is tied to the social network of such communities.Applied Science, Faculty of
Nursing, School of
Graduate
3
Dang, Cuong Nguyen. "Aetiopathogenesis and Management of Diabetic Foot Problems." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.512177.
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Oyibo, Samson Oghenetsovwe. "Studies on the management of diabetic foot problems." Thesis, University of Manchester, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.557096.
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Diabetic peripheral neuropathy affecting the lower limbs is a common debilitating complication of diabetes mellitus. A significant proportion of affected patients are plagued by severe intractable painful symptoms. In addition to this, the insensitive foot is prone to deformity, trauma and resultant foot ulceration. This thesis deals with the management of diabetic foot problems, with particular reference to painful diabetic neuropathy and foot ulceration. The treatment of painful diabetic neuropathy is far from satisfactory and present therapeutic agents are not without undesirable side effects. The first study (Chapter 3) examines the relationship between blood glucose excursions and pain in patients with symptomatic diabetic neuropathy. Twenty type 1 diabetic patients with peripheral neuropathy (10 painful and 10 painless) wore a continuous glucose monitoring system (CGMS) for 3 days. Symptomatic patients kept a daily pain score diary. Measures of glycaemic stability, the mean amplitude of glycaemic excursions (MAGE) and the M-value were calculated. The study demonstrated that patients with painful neuropathy have greater glucose flux and possibly poorer diabetes control, compared to patients with painless neuropathy. The use of electrical stimulation therapy such as transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS), have been shown to provide some benefit when used to treat painful diabetic neuropathy. In a previous open-labelled study, pulsed-dose electrical current delivered through stocking electrodes was shown to produce an 80% reduction in painful symptoms. In the second study (Chapter 4) a double blind, controlled crossover study was carried out to assess the efficacy of pulsed-dose electrical current delivered through stocking electrodes. Thirty patients with painful diabetic neuropathy were randomised to wear silver plated stocking electrodes for 8 hours a night for 6 weeks (pulsed electric current of 50 micro amps delivered by a microcomputer). The control, identical stockings received an insignificant current (5 micro amps). Pre-treatment, weekly and end-of-treatment pain and sleep-disturbance scores were recorded. This study demonstrated that although symptomatic relief occurred, this form of treatment was no more effective than control in the treatment of painful diabetic neuropathy, suggesting that placebo may play a significant role in electro-analgesia. For adequate management of foot ulcers a systematic approach is required. A foot ulcer classification system should aid in planning treatment strategies, monitoring treatment effectiveness, predicting clinical outcomes, and improving communication among healthcare providers. The third study (Chapter 5) examines wound classification systems and factors, which affect the outcome of diabetic foot ulcers. Diabetic patients with new foot ulcers presenting during a 12-month period, had demographics and ulcer characteristics recorded at presentation. Ulcers were followed up until an outcome was noted. This study demonstrated that ulcer area, a measure of ulcer size, predicts the outcome of foot ulcers and that its inclusion into a diabetic foot classification system will make that system a better predictor of outcome. In the fourth study (Chapter 6), two commonly used foot ulcer classification systems are compared as predictors of clinical outcome. Both the Wagner system (grade) and the University of Texas system (grade and stage) were applied to new foot ulcers at presentation, and ulcers were followed up until an outcome was noted. The study revealed that increasing stage, regardless of grade, is associated with increased risk of amputation and prolonged ulcer healing time. The University of Texas system, which combines grade and stage, is a better predictor of outcome. Therefore, strict glucose control should be the first step in the struggle for pain control in patients with painful diabetic neuropathy before other forms of therapy are employed. Additionally, the use of a robust, fully descriptive foot ulcer classification system, such as the University of Texas system should be employed in the management of diabetic foot ulcers. A systematic approach to foot care will aid in reducing the high incidence of lower limb amputations.
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Quinton, T. R., P. A. Lazzarini, F. M. Boyle, A. W. Russell, and D. G. Armstrong. "How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey." BioMed Central, 2015. http://hdl.handle.net/10150/610321.
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BACKGROUND: Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors' knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists' diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. METHODS: A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. RESULTS: Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11-15 years median experience. Participants reported treating a median of 21-30 diabetes patients each week, including 1-5 with foot ulcers. Overall, participants registered median scores of at least "very often" (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: "never" (1 (1 - 3)) using total contact casting, "sometimes" (4 (2 - 5)) performing an ankle brachial index, "sometimes" (4 (1 - 6)) using University of Texas Wound Classification System, and "sometimes" (4 (3 - 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). CONCLUSIONS: This study provides the first baseline information on Australian podiatrists' adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.
6
McEwen, Marylyn Morris, Rogelio Andrès Elizondo-Pereo, Alice E. Pasvogel, Irene Meester, Javier Vargas-Villarreal, and Francisco González-Salazar. "A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study." FRONTIERS MEDIA SA, 2017. http://hdl.handle.net/10150/625711.
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Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.
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Hill, C. "Diabetic kidney disease : a study of management and outcomes." Thesis, Queen's University Belfast, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.676518.
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Diabetes mellitus is the most common cause of end-stage renal disease requiring renal replacement therapy in the United Kingdom. However, many aspects of the prevalence, management and outcomes of diabetic patients with chronic kidney disease (CKD) remain unclear. This thesis consists of three studies using local (Northern Irish) data, national data (from the National Diabetes Audit) and international data (combined as part of a multi-centre collaborative meta-analysis). Its aims were to assess the survival of Northern Irish diabetic patients with CKD, examine the prevalence and associations of diabetes-related CKD in the UK National Diabetes Audit and to assess the association between glycosylated haemoglobin (HbA1c) and survival in diabetic haemodialysis patients.
8
Yan, Min, and 严敏. "Effects of self-management education on diabetic control among patients with type 2 diabetes : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193810.
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Objective: To systematically review the effect of self-management education on diabetic control in type 2 diabetes
Research design and methods: PubMed was searched for English-language articles published between 2010 and 2013. All the studies were original articles selected manually and used randomized control trials generating results of self-management education in people with type 2 diabetes referring to diabetic control. Relevant data were divided and tabulated into factors of population characteristics, interventions and outcomes. Interventions were classified into three sections as collaborative information intervention, lifestyle intervention, and skills teaching intervention based on the patterns of education. Outcomes were categorized into glycemic control, cardiovascular disease (CVD) risk factors and nephropathy risk factors.
Results: A total of 24 studies were identified of initial 41 articles for this review. Effects of self-management education on glycemic control were demonstrated to be positive both in short-term (<10 months) and long-term (>10 months) follow-up, but more positive effects in short-term follow-up. The same effectiveness happens to CVD risk factors, including lipids, weight and blood pressure. On the other hand, with short-term follow-up, teaching skills intervention of self-management education is more effective than collaborative information intervention and lifestyle intervention on reducing glycemic control and CVD risk factors. Also with long-term follow-up, teaching skills intervention of self-management education had more effectiveness than collaborative information intervention and lifestyle intervention on reducing glycemic control. However, few studies including CVD risk factors in the long-term follow-up, so it is difficult to evaluate the effectiveness of on CVD risk factors with long-term follow-up.
Conclusions: Evidences supports the positive effectiveness of self-management education with collaborative information intervention, lifestyle intervention and skills teaching intervention among type 2 diabetes patients on diabetic control, in both short-term follow-up and long-term follow-up, but short-term follow-up is more effective than long-term follow-up. Further research is needed to develop self-management interventions to maintain long-term follow-up effects on glycemic control, CVD risk factors and other diabetes complications.published_or_final_version
Public Health
Master
Master of Public Health
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Vora, Sadhna Raju. "Multiple Laser Photocoagulation Treatments for the Management of Diabetic Macular Edema." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-150918/.
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The purpose of this study was to evaluate functional and funduscopic outcomes amongst patients receiving multiple treatments with macular laser photocoagulation for clinically significant diabetic macular edema. A record review was conducted of patients who had multiple macular laser treatments for diabetic macular edema. As part of routine follow-up for diabetic macular edema, visual acuity and funduscopic findings were assessed before a given laser treatment and at 6 months afterwards. The study included 64 eyes from 41 patients. There was no statistically significant difference between the proportion of eyes that showed funduscopic improvement after treatment 1 versus the proportion of eyes that improved after subsequent treatments. For the first laser treatment, 44 of the 64 eyes (69%) showed funduscopic improvement in edema. 35/64 (55%) of eyes showed improvement after the second treatment (p=0.15); 29/40 (72.5%) eyes showed improvement after the third treatment (p=0.85); 15/18 (83.3%) eyes showed improvement after treatments[greater than or equal to]4 (p=0.36). Similarly, in terms of visual acuity outcomes, there was no statistically significant difference between the proportion of eyes with preserved visual acuities after treatment 1 compared to repeat treatments. This study found that the majority of eyes that receive re-treatment after initial laser therapy will respond with an improvement in macular edema.
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Dzivakwe, Vanessa G. "Religiosity As a Coping Resource for Depression and Disease Management Among Older Diabetic Patients." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc700076/.
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Compared to the general population, diabetic patients experience a higher prevalence of depression, which can often exacerbate diabetic symptoms and complicate treatment. Studies show that religion is associated with both better physical health and better psychological functioning; however, studies incorporating religion and depression among diabetic individuals are scarce. The present study addressed this gap in the literature by examining archival data from the 2008 and 2010 data waves of the Health and Retirement Study (HRS). Cross-sectional findings confirmed that stronger religiosity was positively correlated with perceived diabetes control and positive diabetes change, and negatively correlated with total number of depressive symptoms and total number of weeks depressed. Longitudinal findings confirmed that stronger religiosity in 2008 was positively correlated with perceived diabetes change in 2010 and negatively correlated with total number of depressive symptoms in 2010. Logistic regression and multiple regression analyses were performed to test four moderation models. Results showed that religiosity significantly moderated the relationship between perceived diabetes control and total number of weeks depressed. More specifically, for diabetics with low levels of religiosity, whether they believed their diabetes was under control or not did not make a significant difference in the total number of weeks depressed. However, high levels of religiosity served as a buffer against the duration of depressive symptoms but only for diabetics who perceived to have their diabetes under control. Understanding how these constructs jointly influence diabetes management and psychological functioning is critical in that medical professionals may utilize such knowledge to enhance treatment outcomes.
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Cagle, Jonathan. "After receiving language concordant, individual health education interventions, do Spanish speaking, diabetic inpatients at a safety net hospital demonstrate acquired diabetes self-management competency as measured by pre-training and post training evaluation of key, diabetes self-management knowledge?" Thesis, The University of Arizona, 2018. http://hdl.handle.net/10150/626844.
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Sando, Trisha A. "The Influence of Clinically Meaningful Factors on the Performance of the Recommended Annual Diabetic Foot Screening." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5323.
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Background: Diabetic foot ulcers are the result of multiple complications from hyperglycemia and lead to poor quality of life and high healthcare costs. The annual diabetes foot screening exam (ADFSE) and prevention interventions can reduce DFUs up to 75%. In 2015, 71% of the US population received the ADFSE.
Objectives: The main objectives of this dissertation were: 1) to determine the association between adherence to diabetes self-management behaviors and the ADFSE, 2) to determine the association between concordant and discordant comorbidities and the ADFSE and 3) to determine the association between the performance of diabetes preventive care processes, number of office visits for diabetes and the completion of the ADFSE.
Methods: Three cross-sectional studies used data from the 2015 Behavioral Risk Factor Surveillance System. Logistic regression models were evaluated to assess the association between the self-management behaviors and the ADFSE. Structural equation modeling (SEM) was used to assess the simultaneous, direct effects of concordant and discordant comorbidity loads on the ADFSE and the performance of diabetes preventive care processes and the number of office visits for diabetes care on the ADFSE.
Results: In 2015, between 78.2% and 80.4% of the US population with diabetes received the ADFSE. Performance of the ADFSE was 77% less likely (OR: 0.33, 95%CI: 0.25-0.44) in those who do not perform self-foot inspections and 40% (OR: 0.59, 95%CI: 0.45-0.76) less likely in those who have never received the pneumococcal vaccination. Receiving the ADFSE was 50-80% less likely in patients who do not self-monitor blood glucose at least one time per day, depending on insulin use and receipt of diabetes education. Neither concordant comorbidities (β=0.226, p=0.086) nor discordant comorbidities (β=0.080, p=0.415) had a direct association with the performance of the ADFSE. The collection of preventive care processes demonstrated a 7% (OR: 1.07, 95% CI: 1.05-1.10) increase in the likelihood the ADFSE was performed
Conclusions: Performance of the ADFSE may be improved through multiple types of interventions. Patient-based interventions to increase adherence to self-management behaviors is one route. Programs to improve overall diabetes care in the clinical setting may also help to further improve completion of the ADFSE.
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Leontidis, Georgios. "Early screening and diagnosis of diabetic retinopathy." Thesis, University of Lincoln, 2016. http://eprints.lincoln.ac.uk/26473/.
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Diabetic retinopathy (DR) is a chronic, progressive and possibly vision-threatening eye disease. Early detection and diagnosis of DR, prior to the development of any lesions, is paramount for more efficiently dealing with it and managing its consequences. This thesis investigates and proposes a number of candidate geometric and haemodynamic biomarkers, derived from fundus images of the retinal vasculature, which can be reliably utilised for identifying the progression from diabetes to DR. Numerous studies exist in literature that investigate only some of these biomarkers in independent normal, diabetic and DR cohorts. However, none exist, to the best of my knowledge, that investigates more than 100 biomarkers altogether, both geometric and haemodynamic ones, for identifying the progression to DR, by also using a novel experimental design, where the same exact matched junctions and subjects are evaluated in a four year period that includes the last three years pre-DR (still diabetic eye) and the onset of DR (progressors’ group). Multiple additional conventional experimental designs, such as non-matched junctions, non-progressors’ group, and a combination of them are also adopted in order to present the superiority of this type of analysis for retinal features. Therefore, this thesis aims to present a complete framework and some novel knowledge, based on statistical analysis, feature selection processes and classification models, so as to provide robust, rigorous and meaningful statistical inferences, alongside efficient feature subsets that can identify the stages of the progression. In addition, a new and improved method for more accurately summarising the calibres of the retinal vessel trunks is also presented. The first original contribution of this thesis is that a series of haemodynamic features (blood flow rate, blood flow velocity, etc.), which are estimated from the retinal vascular geometry based on some boundary conditions, are applied to studying the progression from diabetes to DR. These features are found to undoubtedly contribute to the inferences and the understanding of the progression, yielding significant results, mainly for the venular network. The second major contribution is the proposed framework and the experimental design for more accurately and efficiently studying and quantifying the vascular alterations that occur during the progression to DR and that can be safely attributed only to this progression. The combination of the framework and the experimental design lead to more sound and concrete inferences, providing a set of features, such as the central retinal artery and vein equivalent, fractal dimension, blood flow rate, etc., that are indeed biomarkers of progression to DR. The third major contribution of this work is the new and improved method for more accurately summarising the calibre of an arterial or venular trunk, with a direct application to estimating the central retinal artery equivalent (CRAE), the central retinal vein equivalent (CRVE) and their quotient, the arteriovenous ratio (AVR). Finally, the improved method is shown to truly make a notable difference in the estimations, when compared to the established alternative method in literature, with an improvement between 0.24% and 0.49% in terms of the mean absolute percentage error and 0.013 in the area under the curve. I have demonstrated that some thoroughly planned experimental studies based on a comprehensive framework, which combines image processing algorithms, statistical and classification models, feature selection processes, and robust haemodynamic and geometric features, extracted from the retinal vasculature (as a whole and from specific areas of interest), provide altogether succinct evidence that the early detection of the progression from diabetes to DR can be indeed achieved. The performance that the eight different classification combinations achieved in terms of the area under the curve varied from 0.745 to 0.968.
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Luttig, Jana. "Evaluation and management of diabetic patients in a primary healthcare clinic / Jana Luttig." Thesis, North-West University, 2007. http://hdl.handle.net/10394/1834.
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In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42).
The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications.
The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview.
The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic.
In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions.
Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can
be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy.
The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs.
As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better.
It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease.
One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control.
The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families.
Certain recommendations and restrictions were formulated and discussed.Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.
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Williams, Gareth. "Investigation and management of brittle diabetic patients unresponsive to continuous subcutaneous insulin infusion." Thesis, University of Cambridge, 1986. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.685001.
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Jyothi, Sreedhar. "Current and new concepts in the diagnosis and management of diabetic macular oedema." Thesis, Cranfield University, 2013. http://dspace.lib.cranfield.ac.uk/handle/1826/8600.
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Diabetic macular oedema, which can cause rapid visual deterioration, may not have early warning signs at times. Assessment of diabetic retinal complications is made chiefly by clinical examination combined with optical coherence tomography (OCT) and fundus fluoroscein angiography (FFA). However, assessment usually does not occur until the late stages of diabetic retinopathy (DR), and, as retinal neurologic changes precede clinical changes, as tested in this thesis, by the time clinical assessment is performed, much of the functional visual loss has already occurred. More robust diagnostic modalities are required to detect progression of retinopathy in the early stages, before irreversible damage has already happened, and advances in the treatment of diabetic macular oedema is imperative as the current standard treatment in the form of laser photocoagulation is ineffective in improving the vision as authenticated in the following chapters. In this thesis, both treatment and diagnostic strategies of diabetic macular oedema (DMO) are investigated. Although laser photocoagulation is effective in short term in treating diabetic macular oedema, its mechanism of action is unknown; is associated with considerable collateral damage; and long term visual prognosis is meagre at a mean change in visual acuity at 5 years of -5.23. The 3-year outcome was also inferior to the clinical trial results with more people gaining vision (≥ 15 letter gain) in the diabetic retinopathy clinical research network (DRCRN) group compared to this cohort (26% versus 9%). Furthermore, three times more patients lost vision (> 15 letter loss) in the real-life setting of this cohort compared to the clinical trial results of the DRCRN group (27% versus 8%, respectively). Therefore, improved preventative and treatment modalities are essential to prevent progression in the early stages and to improve functional vision in late stages. In an attempt to look for new treatment strategies, we hypothesized that retinal oxygenation by inhibition of dark adaptation in the rod photoreceptor, could possibly inhibit progression of diabetic maculopathy. Illuminated-mask treatment of individuals with early diabetic maculopathy revealed encouraging results that point to an inexpensive and non-invasive therapy. Whilst 19 out of 34 study eyes with cysts at the beginning of the trial improved, 11 out of 30 fellow eyes with no demonstrable cysts at the onset developed cystic macular changes towards the end of 6 month trial. In the final chapters the correlation of visual functions with anatomic appearance were examined. The results of functional assessments, including visual acuity, colour contrast sensitivity, and microperimetry, had variable relation to structural changes at the macula with OCT. Therefore, an urgent need remains for the development of reliable diagnostic and preventative tools for the early assessment and treatment of visual function defects related to diabetic macular oedema.
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Garrison, Melissa Sue. "A Proposal for the Development and Validation of a Diabetic Self-Management Education (DSME) Program." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/354.
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The World Health Organization has estimated that by 2030, approximately 350 million people will be diagnosed with Type 2 diabetes mellitus (T2DM). Currently, 18.8 million people are diagnosed with T2DM. An additional 7 million people have high blood sugar but have yet to have an official diagnosis of diabetes. The literature supports early identification and prevention are key to reducing the severity of T2DM its complications. The Health Belief Model, the Chronic Care Model and Orem's Theory of Self-Care guided the current proposal, whose purpose was to develop and validate a new T2DM DSME module. A validation of the DSME module was completed by 5 local diabetic clinical experts. Each expert reviewed the DSME modules then completed a 10-question Likert-type scale survey. The survey was used to measure the content amount, ease of use, and visual presentation. Descriptive analysis was employed to analyze these data.
Results revealed that all strongly agreed that the education module was easy to read and follow. They also strongly agreed that there was an adequate amount of educational information within the module. Additional comments from the experts resulted in minor revision to the new DSME. A future pilot study comparing current education to the newly validated DSME module will be implemented post-graduation. Changing the diabetic teaching culture into an improved patient focus role has the potential to reduce the economic healthcare impact and empower patients to bring about positive social change. Social change will also improve trust and confidence among patients within the healthcare organization.
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Scarlett, Marjorie V. "Evidence-Based Diabetic Discharge Guideline| A Standardized Initiative to Promote Nurses' Adherence." Thesis, Nova Southeastern University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10685982.
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Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care.
Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida.
Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses.
Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests.
Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p = 0.046 Wilcoxon; p = 0.041t test), and question 13 (p = 0.022 Wilcoxon; p = 0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use.
Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.
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Fourie, René. "Registered nurses' knowledge related to the management of patients with diabetic keto-acidosis (DKA)." Thesis, Nelson Mandela Metropolitan University, 2006. http://hdl.handle.net/10948/448.
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Diabetes Mellitus (DM) is on the increase globally, with further increases expected in developing countries, such as South Africa. World Health Organization (Medical Chronicle, 2006:14) estimations indicate that the number of DM sufferers will double over the next 30 years. This increasing number of diabetics is expected to have enormous economical implications. One of the consequences of the increase in DM sufferers is the increase in deaths due to diabetes related complications. In 2000, 3.2 million people died of DM and diabetes related complications compared with 3 million who died from HIV/AIDS related illnesses (William & Pickup, 2004:64). Health services are financially burdened by DM complications that result in heavy demands in both direct costs of hospitalization and medication as well as indirect costs such as manpower of staff involved in the care of the patient (Leuner, 2000:410). Diabetic ketoacidosis (DKA) is a prominent life-threatening complication of type 1 diabetes mellitus and, if not treated medically, it can lead to coma and death. DKA accounts for 14 per cent of all diabetic related hospital admissions and has a mortality rate of 5 to 10 per cent (Pickup & Williams, 2003:1). Rapid identification of DKA is necessary to improve patient care. George- Gray and Chernecky (2002:96) suggest patient outcomes are affected by the nurse’s ability to recognize the clinical features of DKA. It is important, therefore, for the nurses to understand the signs and symptoms and treatment of this diabetes related complication. National health policies and treatment guidelines should be aimed at addressing DKA treatment through setting guidelines for diabetic care (Peters, 2004:22). The main goal of this study was to determine registered nurses’ knowledge of DKA and to develop guidelines to assist registered nurses in providing adequate and effective health care to prevent DKA reoccurrence. The research study is based pm Bergam’s model on quality of care and accountability. Bergman claims that several preconditions must be filled in order to be accountable, including: • Accountability • Responsibility • Authority • Ability (Bergman (1982:8) emphasizes that ability reflects the registered nurses’ accountability, which is composed of values, knowledge and skills.) The study was divided into two phases. Phase one determined registered nurses’ knowledge related to the management of DKA. Phase two of the study included the developing guidelines to assist registered nurses in providing adequate and effective health care to patients with DKA. The design of the study is quantitative, explorative, descriptive and contextual; a survey was performed using a questionnaire based on a literature study. Ethical principals were maintained throughout the study. Permission to the study was sought from the Local Health Authorities and the heads of department where the research was undertaken. Findings of the research were analysed and discussed in the research. The knowledge of the majority of the respondents was found to be average. Out of the thirty- two respondents 52.8 percent possessed adequate knowledge the management of DKA and 63.4 percent possessed adequate knowledge on the management of DM. Two recommendations to assist registered nurses in the implementation of guidelines of the recommendations were also provided.
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Fang, Lei. "Development and Characterization of an Iridium-Modified Electrochemical Biosensor for Potential Diabetic Patient Management." Cleveland, Ohio : Case Western Reserve University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1223049333.
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Thesis (Ph.D.)--Case Western Reserve University, 2008Department of Chemical Engineering Abstract Title from OhioLINK abstract screen (viewed on 10 April 2009) Available online via the OhioLINK ETD Center
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Okafor, Eugene O. "Decreasing Acute Diabetes Complications Through Self-Management Education." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5922.
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Diabetes mellitus is a chronic disease that affects millions of people in the United States. The purpose of this project was to develop a guideline to help clinical staff provide clear and concise diabetes self-management instructions to patients in a community setting. Orem's self-care deficit theory (SCD) and health belief model (HBM) provided a platform to assess how patients' self-care deficit contributes to illness and the effect of patients' perception of illness. SCD theory and the HBM provided the framework for the development of the guideline to decrease diabetes acute complications through self-management education. The practice-focused question was whether the diabetes treatment guideline would decrease diabetes complication, improve the quality of care received by the diabetic patients, and if the facility would adopt the developed guideline. AGREE II Tool was used to assess the quality of the guideline and the staffs' desire for the adoption of the guideline. Data were collected from questionnaires given to staff members at the practice site in 2 rounds. Six medical staff were asked to critique the initial guideline, and 5 medical professionals were asked to assess the final guideline. Most of the participants' scores indicated strong agreement that full consideration was met. The score in all 6 AGREE II domains was above 90%, and 100% of the participants recommended the guideline to be adopted in the facility. Data analysis indicated the diabetes practice guideline is valid, will enhance the treatment of diabetes, and the practice site employees were eager to adopt the treatment guideline. Findings may be used to increase population health and reduce acute complications from diabetes mellitus.
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Bahremand, Saeid. "Blood Glucose Management Streptozotocin-Induced Diabetic Rats by Artificial Neural Network Based Model Predictive Control." Thesis, Southern Illinois University at Edwardsville, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10249804.
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Diabetes is a group of metabolic diseases where the body’s pancreas does not produce enough insulin or does not properly respond to insulin produced, resulting in high blood sugar levels over a prolonged period. There are several different types of diabetes, but the most common forms are type 1 and type 2 diabetes. Type 1 diabetes Mellitus (T1DM) can occur at any age, but is most commonly diagnosed from infancy to late 30s. If a person is diagnosed with type 1 diabetes, their pancreas produces little to no insulin, and the body’s immune system destroys the insulin-producing cells in the pancreas. Those diagnosed with type 1 diabetes must inject insulin several times every day or continually infuse insulin through a pump, as well as manage their diet and exercise habits. If not treated appropriately, it can cause serious complications such as cardiovascular disease, stroke, kidney failure, foot ulcers, and damage to eyes.
During the past decade, researchers have developed artificial pancreas (AP) to ease management of diabetes. AP has three components: continuous glucose monitor (CGM), insulin pump, and closed-loop control algorithm. Researchers have developed algorithms based on control techniques such as Proportional Integral Derivative (PID) and Model Predictive Control (MPC) for blood glucose level (BGL) control; however, variability in metabolism between or within individuals hinders reliable control.
This study aims to develop an adaptive algorithm using Artificial Neural Networks (ANN) based Model Predictive Control (NN-MPC) to perform proper insulin injections according to BGL predictions in diabetic rats. This study is a ground work to implement NN-MPC algorithm on real subjects. BGL data collected from diabetic rats using CGM are used with other inputs such as insulin injection and meal information to develop a virtual plant model based on a mathematical model of glucose–insulin homeostasis proposed by Lombarte et al. Since this model is proposed for healthy rats; a revised version on this model with three additional equations representing diabetic rats is used to generate data for training ANN which is applicable for the identi?cation of dynamics and the glycemic regulation of rats. The trained ANN is coupled with MPC algorithm to control BGL of the plant model within the normal range of 100 to 130 mg/dl by injecting appropriate amount of insulin. The ANN performed well with less than 5 mg/dl error (2%) for 5-minute prediction and about 15 mg/dl error (7%) for 30-minute prediction. In ¬¬addition, the NN-MPC algorithm kept BGL of diabetic rats more than 90 percent of the time within the normal range without hyper/hypo-glycaemia.
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Qadri, Sara Fatima. "Perceived Barriers of Adult Medicine Nurses for Providing Self-Management Education to Type 2 Diabetic Patients." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1388677153.
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Primomo, Janet. "Patterns of chronic illness management, psychosocial development, family and social environment and adaptation among diabetic women /." Thesis, Connect to this title online; UW restricted, 1989. http://hdl.handle.net/1773/7227.
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Craig, Kathrine Jane. "Identification, investigation and management of patients with diabetic nepropathy at the primary and secondary care interface." Thesis, Cardiff University, 2007. http://orca.cf.ac.uk/55733/.
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Approximately 170 million individuals worldwide have been diagnosed with Diabetes Mellitus and between 85--90% of the total population have Type 2 Diabetes Mellitus. Health care is facing an epidemic not only of Diabetes Mellitus but also of the consequence of the attendant morbidity including macro and micro diseases of the vascular system. Of particular interest for the purposes of this thesis, is the progression to nephropathy and development of cardiovascular risk of a proportion of this population and the investigation of strategies that may slow the decline to end stage renal failure and the need for renal replacement therapy or premature death due to cardiovascular disease. Initially, screening practice for microalbuminuria was altered, with patients being identified during their clinic visit, rather than retrospectively. In addition, data on blood pressure levels and antihypertensive agents prescription was collected and collated. Subsequently, a nurse specialist optimised the risk factor management of a cohort of patients with Diabetic Nephropathy using an algorithm driven evidenced based approach. Finally, analysis was undertaken of the factors that might contribute to the development of anaemia in diabetic nephropathy and hence to increased cardiovascular risk. The work described in this thesis demonstrates the inherent complexities of dealing with a problem that involves the maintenance of health within a system that has been set up primarily to deal with the consequences of illness.
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Sharma, Masti Venugopal Srihari. "Identification of diagnostic biomarkers to improve the management of diabetes-related foot ulcers." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/116374/1/Masti%20Venugopal%20Srihari_Sharma_Thesis.pdf.
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The project aimed to investigate biomarkers of therapeutic importance in diabetic foot ulcer samples. The thesis hypothesised that proteins and peptides are altered as diabetic foot ulcers transition from a non-healing to a healing state. The project profiled these biomolecules from diabetic wound fluid samples using MS approaches and identified biomarkers whose appearance or levels would correlate to the healing status of the wound.
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Mudumbi, John Baptist Nzukizi. "Bioaccumulation of Perfluoroalkyl Substances in African marigold (Tagetes erecta L.) used for Diabetes mellitus Management and in Diabetic Serum of a South African Population." Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/2990.
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Thesis (DPhil (Environmental Health))--Cape Peninsula University of Technology, 2019Polyfluoroalkyl substances (PFASs), including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) are anthropogenic chemicals. For more than half a century, these long-chain compounds have been used in a wide range of industrial applications, such as the manufacturing of consumer products, ranging from grease-proof food packing to aqueous fire-fighting foams and to stain repellents such as Teflon®. Subsequently, these ubiquitous contaminants which are environmentally persistent, toxic, and bioaccumulative, have been a focus of public concern worldwide. Hence, due to public health apprehensions and environmental risks posed by PFASs, their manufacturers and various environmental agencies decided on restricting their use, and whereby the use of these chemicals could not be stopped, their replacement by other alternative chemicals was suggested. Therefore, per- or polyfluorinated carbon chains, e.g. perfluorobutane sulfonate (PFBS), which has been regarded as one of the most important short-chain PFASs and less harmful to the environment at large. However, a systematic review from the current work reveals that physicochemical properties of short-chain PFASs are not different from their predecessors thus suggesting that short-chain PFASs are as harmful as their homologues. Similarly, the literature reviewed demonstrated how novel technologies have also been proven to be incapable of removing these substances, including to short-chain PFASs, from various environmental matrices. Moreover, plant species have extensively been susceptible to PFASs, and various other POPs accumulation. However, the mechanisms that led to their uptake and storage by plants stayed unknown until proteins belonging to the family of major intrinsic proteins (MIPs) and ater named as Aquaporins (AQPs) were discovered. Hence, the present work has reported that there are diverse AQPs in plants than in mammals, with specific functions, even though first reports on these proteins suggested that their significant impact was water for transportation only. To date, it is well known that plant AQPs possess subclasses or isoforms. Some of these include SoPIP2;1 and AtTIP2;1, prevalent in Spinacia oleracea and Arabidopsis thaliana, respectively. We report that these two isoforms have individual pore diameters or sizes: SoPIP2;1 (2.1 Å) and AtTIP2;1 (3 Å), which might play a role in the selectivity process of molecules which pass through the water transportation channels of the concerned plants. This ultimately suggested SoPIP2;1 pore diameter serving as a pathway of smaller molecules, while AtTIP2;1 pore diameter would serve as a conduit for both smaller and larger compounds. As such, the pore diameters of these two isoforms made them potential conduits of PFASs whose carbon–fluorine bond typical size is 1.35 Å, much smaller than that of AtTIP2;1_2.1 Å and PIP2s, i.e. SoPIP2;1_3 Å, thus substantiating the uptake and ultimate storage of PFASs by plant species. Subsequently, the uptake and storage of PFASs and other POPs by plants have been proven to lead to unprecedented environmental and human risks. As plants with the potential to heal or manage certain ailments, such as Diabetes mellitus (DM), when exposed to PFASs, it was necessary to substantiate such a phenomenon. This current study further determined the propensity of PFASs, such as PFOA, PFOS and PFBS, to accumulate in a plant commonly used in the management of DM, namely the African marigold (Tagetes erecta L.). The study was important as this plant is used in diabetes management in the Western Cape, South Africa, thus implying the plant being a pathway through which humans might be exposed to PFASs and its precursors. Accordingly, the target analytes of the study, PFOA, PFOS and PFBS, were identified and quantified in samples collected from the said plant, i.e. Tagetes erecta L., in contaminated river water used to irrigate the studied plant, as well as diabetic serum samples from patients likely to use the plant. The analysis was done using a liquid chromatography coupled with tandem mass spectrometry (Shimadzu LCMS-8030, Canby, OR, USA). The MS operational conditions were sourced with an MS interface electrospray ionisation in negative ion mode. A multiple reaction monitoring (MRM) mode of analysis was used to quantify the targeted PFASs in samples. Hence MRM transition for PFOA, PFOS and PFBS being of 413.00 > 368.95 (acquisition time: 8.6 min), 499.00 <80.15 (8.9 min) and 299.00 > 80.10 (6.8 min), respectively. A Luna® Omega Polar C18 column (2.1 × 100 mm, 3.0 µm, Phenomenex, Aschaffenburg, Germany), with 40 °C in temperature, assisted in the separation of the analytes. The mobile phase at a flow rate of 0.3 L/min was made of 20 mM ammonium acetate and MeOH (100%). The process followed (for solid samples, i.e. plants) (n = 8) was: 1) sample drying, 2) milling, 3) screening, 4) digestion, 5) sonication, 6) filtration, 7) Solid phase extraction (SPE), 8) analyte elution and 9) analysis; for water samples (n = 20) the process was: 1) filtration, 2) SPE, 3) analyte elution and 4) analysis; while for serum samples (n = 179) the process was: 1) sample uptake, 2) buffers, 3) Mix, 4) centrifuge, 5) Dissolve, 6) filtration, 7) SPE, 8) conditioning, 9) elution, 10) reconstitute, 11) analysis. PFOA, PFOS and PFBS were observed in all the plant samples and were found in concentrations of up to 94.83 ng/g, 5.03 ng/g, and 1.44 ng/g, for PFOA, PFOS and PFBS, respectively. Similarly, PFOA, PFOS and PFBS were identified in all the river water samples and were found in concentrations ranging between 1.15 to 107.82, 1.24 to 20.75 and ND to 0.06 ng/L for PFOA, PFBS and PFOS, respectively, for regime A (winter/wet season) and
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Zhao, Wenxia (Helen). "Comorbidity in prediction of in-hospital mortality among diabetic patients: A study-derived index." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/27100.
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The present study developed and validated a comorbidity index specifically for prediction of in-hospital mortality among diabetic inpatients in Canada. The analysis was based on data from the Hospital Person-Oriented Information Database (HPOI) for the study period from 1995/96 through 2000/01. The study included all the hospitalizations with a primary or secondary diagnosis of diabetes (ICD-9 code: 250.x) in acute care hospitals for patients aged 45 years or older with a length of stay of 90 days or less in ten provinces. All episodes of hospitalization for each patient were linked using a unique patient identifier, and one was randomly selected for the analyses. The study population of 578,222 diabetic inpatients was randomly divided into two parts, which were used either to develop or to validate the index. Multiple logistic regression models were used to develop and validate the index. A total of 22 diabetic comorbidities including 14 coexistent general medical conditions and 8 diabetic complications were included in the study-derived index, which had a better predictive performance as compared with D'Hoore-Charlson index and the simple count of comorbidities. The study-derived index can be used to control for potential confounding caused by comorbidity in the exploratory data analysis of diabetes research, to assist in creating more effective diabetes management system and to evaluate the prognosis of diabetic inpatients for health care provider.
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Buhajeeh, Eman A. A. "Diabetes in Kuwait - current patients' experiences of their medical treatment(s) with emphasis on renal complications as compared with worldwide guidelines." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14182.
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Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.
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Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /." Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).
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Ramasobane, Maureen Khanyisa Mlati. "A description of the knowledge, understanding and outcome of disease management in diabetic patients in dedicated, semi-dedicated and non-dedicated institutions." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/211.
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Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010.Diabetes Mellitus (DM) is a self -managed condition and it is essential for patients to have the relevant knowledge, skills and attitudes needed for successful diabetes management. Follow-up and proper counselling are major components in diabetes management as these will improve adherence and optimise diabetes management. The aim of this study was to compare the knowledge, understanding and outcome of the disease management in four health institutions ; a dedicated institution, a semi-dedicated institution and two non-dedicated institution. The study objectives were: To describe the level of knowledge and understanding of diabetic patients in the management of their condition at the different institutions , to describe the outcome of diabetes management at the different institutions , to describe consulting and dispensing times for diabetic patients at the different institutions , and to obtain patients’ perceptions on the quality of the health care services pertaining to the treatment of their diabetes. A total of 120 patients were interviewed, 30 per institution. A questionnaire was used to collect data for the different objectives. Prospective and retrospective data were collected. Knowledge of DM was assessed in ten patients from each institution. Patients were asked to explain their understanding on five aspects of the condition. Median scores for patients from the two non-dedicated institutions were compared using Wilcoxon two-sample test, and were found not to differ significantly for any of the questions or the overall score. The groups did not differ significantly in their understanding of whether there was a cure for diabetes mellitus and in their understanding of hypoglycaemia and its management. Patients at the dedicated clinic were significantly more knowledgeable of the condition, it’s causes and their overall understanding of the questions asked. Hyperglycaemia and its management were understood significantly better by the patients at the dedicated iv institution than those at the non-dedicated institutions , with patients at the semi-dedicated institution not differing significantly from either group. The outcome of diabetes management was recorded from the patients file for a six month period. The proportions of elevated blood pressure results recorded at the three institution types differed significantly. The semi-dedicated institution had a significantly higher proportion of uncontrolled blood pressure results (33 of 55 results recorded, or 60%) than the non-dedicated institutions (32 of 91, 35%) or the dedicated institution (9 of 36, 25%,). None of the ten patients at the semi-dedicated institution had all their values within the controlled range, as compared to six of 20 at the non-dedicated and six of ten at the dedicated institution. The glucose control was least achieved in patients at the semidedicated institution, where only one of ten (10%) of patients had no recorded value outside the controlled range, as opposed to four of ten (40%) at the dedicated institution and nine of eighteen (50%) at the non-dedicated institutions. Median visit times differed between all types of institutions. Time spent on consulting and dispensing was the shortest at the non-dedicated (median=7min), it took longer at the semi-dedicated (median=9), and longest at the dedicated institution (median=18min). The patient’s perception on the quality of care was recorded for patients. They were asked whether they were satisfied with the amount of time that they spent with the healthcare worker. Patient satisfaction with visit time was not linked to the duration of the visit. Actual visit time did appear to be linked to patients’ perception of whether they got enough time to ask questions. As for perceived quality of service, fewer patients were informed about their progress at the non-dedicated institution than at the others. Family members of fewer patients were educated at the dedicated than at the other institutions. More patients at the dedicated institution than at the other institutions were informed of treatment changes. Suggestions for improvement of patient care were made by 18% of v patients attending non-dedicated institutions , 23% of patients at the semi-dedicated institution and 63% at the dedicated institution. The conclusion based on the results is that the more dedicated a service is, the better the diabetic care of patients. Patients at the dedicated clinic had more time with the health worker during consultation and dispensing of treatment. They were informed about treatment changes more than the patients at other institutions. Patients at the dedicated clinic also showed a better knowledge and understanding of their condition than patients in other institutions. They also had higher affirmative responses in terms of lifestyle modification as compared to the other institutions.
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Фадєєва, Ганна Анатоліївна, Анна Анатольевна Фадеева, Hanna Anatoliivna Fadieieva, and Ahmad L. Abbas. "Advantages of incretin-based treatment in management of type 2 diabetes." Thesis, Sumy state university, 2017. http://essuir.sumdu.edu.ua/handle/123456789/54972.
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The risk of hypoglycemia with sulfonylureas is higher in the presence of diabetic nephropathy. Selective DPP-4 inhibitors lead to physiologic increases in the incretins GLP-1 and gastric inhibitory polypeptide and preferable for the management of postprandial hyperglycemia due to lack of many adverse effects observed with other diabetes medications.
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Nguyen, Vi H. "Will culturally competent Vietnamese-speaking healthcare providers reduce hemoglobin A1C-readings for Vietnamese diabetic patients?" Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1524147.
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This retrospective study was conducted to evaluate whether culturally competent resources, such as Vietnamese-speaking healthcare providers, one-on-one public health nurse (PHN) education session(s), and free healthcare services would affect the results of the following questions: (a) Will the 114 study subjects achieve HbAIC reduction at 6-month and 12-month periods? (b) Is there a correlation between HbA1C reduction and the number of the provider visits? and (c) Is there a significant HbA1C reduction for the one-on-one PHN education participants compared to the non-participants? The result findings were analyzed using the Chi-Square tests and the two-sample t-tests. On average, the 114 subjects achieved HbA1C reductions of0.57% and 0.63% at 6-month and 12-month periods, respectively. However, there was no direct correlation between the HbA1C reductions and the frequency of provider visits. Furthermore, the PHN education session(s) did not significantly affect the rate of HbA1C reduction for the attendees. In conclusion, future studies on culturally competent interventions should be studied in the Vietnamese patients diagnosed with diabetes mellitus.
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Zequera, DiÌaz Martha Lucia. "A computer assisted model for orthotic management of the diabetic foot in the early stages of the disease." Thesis, University of Strathclyde, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423862.
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Whyte, Megan. "Glycemic Control in a Type I Diabetic Athlete: Recommendations for Athletic Trainers in Management, Athlete Care, and Performance." Scholarly Commons, 2019. https://scholarlycommons.pacific.edu/uop_etds/3605.
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Type I diabetes in athletes is a relatively rare condition and as a certified athletic trainer it is critical to know how to manage all aspects of this disease in an athlete. Current National Athletic Trainers’ Association (NATA) guidelines exist for developing a basic plan for management and care of an athlete with Type I Diabetes, but there is room to improve current guidelines, using evidence-based practice. Purpose: to address: medical management of a type I diabetic athlete as a case study, obtain first person observations from the athlete’s perspective, and provide additional evidence based practice recommendations to athletic trainers based on the findings. Methods: case study narrative with one subject, a 22-year-old male collegiate soccer player was performed. Data were collected via open-ended questionnaire, open-ended interview, and subject’s submission of pertinent medical information and records. Results: The NATA Position Statement on Type I Diabetes and other peer review articles informed this study. While NATA guidelines created a good general baseline for how to approach providing diabetic athlete care; additional recommendations are suggested based on the findings of this case study. These recommendations include: Creating safe pre-participation blood glucose ranges to prevent hypoglycemia during exercise, establishing greater knowledge about the technology the patient uses, what medical supplies the patient should be responsible for versus the athletic trainer, developing a relationship with the patient’s endocrinologist or primary care physician, and administration of insulin by an athletic trainer. These additional suggested recommendations inform athletic trainers to attain a better understanding of how to manage and care for a patient with Type I Diabetes, and increase the likelihood of both streamlining patient care and preventing metabolic crisis.
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McLaughlin, Gayla Diane. "Achieving Glycemic Control in Rural Clinics." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6065.
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Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.
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Meashi, Hadia. "HBA1C IN NON-DIABETIC ADULTS USING NHANES 2013-2014 DATA: THE RELATIONSHIP WITH CAFFEINE, CARBOHYDRATES, AND PHYSICAL ACTIVITY." University of Akron / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=akron1542667283140221.
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Ho, I.-Van. "The role of tele-ophthalmology as part of a community health service to remote top end Northern Territory communities cost-effectiveness study of diabetic retinopathy screening, monitoring and management /." Connect to full text, 2006. http://hdl.handle.net/2123/5432.
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Thesis (Ph. D.)--University of Sydney, 2006.Title from title screen (viewed Oct. 7, 2009) Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine. Includes bibliography. Also available in print form.
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Bowling, Frank Lee. "The role of non-pharmacological treatments and a new wound measurement system in the management of the diabetic foot." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.506251.
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Clinical observational study to determine if maggots are effective in eradicating MRSA-colonisation from diabetic foot ulcers. A randomised controlled clinical trial to determine if maggots, Biogun and silver are effective in eradicating MRSA colonisation from diabetic foot ulcers. To perform an assessment of the accuracy and usability of a novel optical wound measurement system to test the validity of the methods used in both trials.
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Sonday, Farhaana. "Medicine therapy management for diabetic club Patients at a primary health care clinic: exploring a Potential role for pharmacists." University of the Western Cape, 2019. http://hdl.handle.net/11394/7479.
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Magister Pharmaceuticae - MPharmDiabetes mellitus is a complex chronic condition and has become a major public health concern worldwide. Many diabetic patients are accessing primary health care (PHC) clinics for diabetes care. Diabetic patients who are considered stable are referred to chronic diseases of lifestyle club at the PHC facility. Effective management of this chronic condition requires a multidisciplinary team approach to diabetes care. Pharmacists are not often included in a multidisciplinary team and would consist of doctors, nurses and dieticians. Teams may be expanded and require specialist healthcare members’ expertise who can assist in the management of this disease, for example, ophthalmologists and podiatrists. Adherence to standard treatment guidelines (STGs) for the management of diabetes by healthcare professionals at a primary care level can improve glycemic control, decrease health costs and reduce the development of long-term diabetic complications.
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Gambrel, Michael Steven. "Diabetic Caregiver Finance Education and Resulting Stress: A Quantitative Correlational Study." Franklin University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=frank1626087352819533.
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Andersson, Simon. "Point-of-care beta-hydroxybutyrate determination for the management of diabetic ketoacidosis based on flexible laser-induced graphene electrode system." Thesis, Linköpings universitet, Sensor- och aktuatorsystem, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-179116.
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Diabetic ketoacidosis (DKA) is a life-threatening condition that can appear in patients with diabetes. High ketones in the blood lead to acidity of the blood. For DKA diagnosis and management, ketones such as hydroxybutyrate (HB) can be used to quantify the severity of the disease. The fabrication of electrochemical biosensors for the detection of HB is attractive since their capability to deliver fast response, high sensitivity, good selectivity and potential for miniaturisation. In this thesis, an integrated electrode system was prepared for the detection of HB. Laser-induced graphene (LIG) with a 3D porous structure was used as the flexible platform. Poly (toluidine blue O) (PTB) was electro-deposited on LIG (PTB/LIG) under the optimised conduction (pH of 9.7 and from 0.4 to an upper cyclic potential of 0.8 V). The single PTB/LIG working electrode demonstrated excellent performance towards the detection of NADH with a linear range of 6.7 M to 3 mM using chronoamperometry, high sensitivity of detecting NADH and excellent anti-fouling ability (94 % response current retained after 1500 s). Further integration of the 3-electrode system realised the static amperometric detection of NADH over the range of 78 M to 10 mM. Based on the excellent performance of PTB/LIG to NADH sensing, hydroxybutyrate dehydrogenase was immobilised via encapsulation with chitosan and polyvinyl butyral (PVB) which was used for HB biosensing over the linear range of 0.5 M to 1 mM with NAD+ dissolved in solution. In addition, the co-immobilisation of NAD+ and HBD on PTB/LIG was conducted by optimisation of enzyme and NAD+ amount per electrode, which shows excellent reproducibility and satisfactory HB biosensing performance. Further experiments to improve the long-term stability of the enzyme electrode is expected in the future. The proposed integrated electrode system also possesses the potential to extend to a multichannel sensor array for the detection of multiple biomarkers (e.g. pH and glucose) for diagnosis and management of DKA.
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Santos, Tânia Raquel Martins dos. "Novel therapeutic strategies for the management of diabetic foot infections : the evaluation of selected antimicrobial peptides against clinically isolated bacterial pathogens." Doctoral thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2020. http://hdl.handle.net/10400.5/20150.
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Tese de Doutoramento em Ciências Veterinárias na Especialidade de Ciências Biológicas e BiomédicasDiabetic foot infections (DFIs) are a frequent complication of Diabetes mellitus. These ulcers are prone to be colonized by Staphylococcus aureus and Pseudomonas aeruginosa, including multidrug resistant and biofilm-producing strains, possibly leading to DFI chronicity and amputation. New therapeutic strategies for DFI management are urgent and the antimicrobial peptides (AMPs) nisin and pexiganan are potential candidates. This project aimed to evaluate the activity of these AMPs, incorporated in a guar gum biogel, against selected DFI clinical isolates. Firstly, nisin’s activity against a collection of S. aureus DFI clinical isolates was determined. Results showed that nisin was able to inhibit and eradicate S. aureus planktonic and biofilm cells at concentrations below its acceptable daily intake. When incorporated in the biogel, nisin kept its antimicrobial activity. This work also evaluated the potential of nisin to complement the activity of conventional antiseptics and antibiotics against established biofilms formed by these isolates. An in vitro antimicrobial schematic protocol was developed to mimetize DFI management guidelines. Fifteen antimicrobial combinations, including nisin-biogel, chlorhexidine, clindamycin, gentamicin and vancomycin, were tested. Results showed that the higher levels of biofilm inhibitory effects were presented by therapeutic combinations that included the nisin-biogel formulation. Nisin-biogel ideal storage conditions and cytotoxicity were also evaluated. Results demonstrate that if stored at temperatures between -20 and 22ºC, nisin-biogel is able to maintain its antimicrobial activity up to 24 months. Moreover, after 24 h of exposition, the nisin-biogel presented no significant levels of toxicity regarding the human keratinocytes under study. Lastly, to cover the complex microbiota present in DFIs, a combination of AMPs with different action spectra was developed, based on the simultaneous incorporation of nisin and pexiganan in the biogel. The activity of this dual-AMPs formulation was tested against two S. aureus and P. aeruginosa strains isolated from the same DFI. Acting together, these AMPs were able to diffuse from the biogel and inhibit and eradicate biofilms formed by these DFI isolates. The effectiveness of AMPs, particularly nisin and pexiganan, as novel antimicrobial strategies for the management of DFIs is still an unknown territory that merits investigation. In vitro biofilm models are the basis of preliminary research; however, they underrepresent the complex microbiota present in DFIs and their interaction with the immune system and skin cells constituents. Further research is necessary to understand the AMPs full potential regarding the clinical management of biofilm-related diseases, such as DFIs.
RESUMO - As infecções do pé diabético (IPDs) são uma complicação frequente da Diabetes mellitus. Estas úlceras tendem a ser colonizadas por Staphylococcus aureus e Pseudomonas aeruginosa, incluindo estirpes multirresistentes e produtoras de biofilme, possivelmente causando cronicidade da IPD e amputação. É urgente criar novas estratégias para o tratamento das IPD e os péptidos antimicrobianos (PAMs) nisina e pexiganan são potenciais candidatos. Este projecto avaliou a actividade destes PAM, incorporados num biogel de goma de guar, contra isolados de IPD. Primariamente, foi determinada a actividade da nisina contra uma colecção de S. aureus isolados de IPD. Os resultados mostraram que a nisina é capaz de inibir e erradicar S. aureus na forma planctónica e de biofilme a concentrações abaixo da dose diária recomendada. Quando incorporada no biogel, a nisina manteve a sua actividade. Foi ainda avaliado o potencial da nisina para complementar a actividade de antissépticos e antibióticos convencionais contra biofilmes formados por estes isolados. Foi criado um protocolo que simula in vitro o tratamento convencional das IPDs. Foram testadas 15 combinações de antimicrobianos, incluindo biogel de nisina, clorohexidina, clindamicina, gentamicina e vancomicina. Os resultados mostraram que o maior efeito inibidor de biofilmes pertencia a combinações que incluam o biogel de nisina. Foram também avaliadas as condições de armazenamento ideais para o biogel de nisina e a sua citotoxicidade. Quando armazenado a temperaturas entre -20 e 22ºC, o biogel de nisina manteve a sua actividade antimicrobiana durante pelo menos 24 meses. Adicionalmente, após exposição durante 24 horas, o biogel de nisina não apresentou níveis significativos de toxicidade relativamente aos queratinócitos humanos em estudo. Por último, para abranger a complexa microbiota presente nas IPDs, foi avaliada uma combinação de PAMs com diferentes espectros de acção, baseada na incorporação simultânea de nisina e pexiganan no biogel. A actividade desta formulação foi testada contra duas estirpes de S. aureus e P. aeruginosa isoladas da mesma IPD. Conjuntamente, estes PAMs foram capazes de se difundir do biogel e inibir e erradicar biofilmes formados por estes isolados. A eficácia dos PAMs como novas estratégias para o tratamento das IPD é ainda uma área desconhecida. Os modelos in vitro de biofilmes são a base da investigação; contudo, não representam a microbiota presente nas IPD nem a sua interacção com o sistema imunitário e outros constituintes celulares. É essencial continuar a investigar para compreender o potencial dos PAMs na terapêutica de doenças onde haja formação de biofilmes, como é o caso das IPDs.
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Paton, J. S. "A comparison of functional and prefabricated insoles used for the preventative management of neuropathic diabetic foot ulceration : a single blind randomised control trial." Thesis, University of Plymouth, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.504794.
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Background: Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues can be modified. Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk. The type of insole best suited for purpose is unknown. Aim: The study compared custom-made functional insoles with prefabricated insoles for the preventative management of neuropathic diabetic feet, assessing effects on peak pressure, forefoot pressure time integral, total contact area, forefoot rate of loading, duration of load as a percentage of stance, quality of life, perceived foot health and cost. Method: A single-blind randomised control trial recruited 119 neuropathic participants with diabetes from two Primary Care Trusts and randomly allocated them to either custom-made functional or prefabricated insoles. Data was collected at issue and 6-month follow-up using the F-scan in-shoe pressure measurement system. Patient perceptions were evaluated with the Bristol Foot Score and Audit of Diabetes Dependant Quality of Life. Further separate sub-group analyses assessed insole effect in participants with pronated feet and insole durability. Results: The results presented in this abstract are based on intention-to-treat analysis. The custom-made functional insole was more effective than the prefabricated insole in reducing forefoot pressure time integral both at issue (25% vs. 22%) and 6-month follow-up (27% vs. 23%). No other significant difference between insoles in kinetic measures or patient perceptions was evident either in full or sub-sample analyses. Both insoles showed a beneficial effect on peak pressure, peak pressure in pronated feet, total contact area, rate of forefoot loading and perceived foot health. The prefabricated insole was provided at less cost (£554 vs. £656). Conclusion: This study has shown that the custom-made functional insole is more effective in reducing forefoot pressure time integral than the less expensive prefabricated insole, amongst people with diabetes and neuropathy. There was no difference in other measures. A definitive recommendation regarding insole selection cannot be made at this time. However should further research establish pressure time integral as a better predictor of neuropathic foot ulceration than peak pressure, then the custom-made functional insole is likely to be the more cost-effective.
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Paton, J. S. "A comparison of functional & prefabricated insoles used for the preventative management of neuropathic diabetic foot ulceration : a single blind randomised control trial." Thesis, Exeter and Plymouth Peninsula Medical School, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701064.
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Petersen, Fazlyn. "Determinants for the acceptance and use of mobile health applications: Diabetic patients in the Western Cape, South Africa." University of Western Cape, 2019. http://hdl.handle.net/11394/7832.
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Philosophiae Doctor - PhDThe increased pervasiveness of information communication and technology and increasing internet access creates anticipation for how contemporary technologies can address critical developmental problems. Non-communicable diseases are the leading cause of death globally, even though more than 40% of the deaths are premature and avoidable. Diabetes is such a disease that causes 80% of non-communicable disease deaths in low and middle-income countries. Diabetes is also the leading cause of death in the Western Cape province of South Africa. Diabetes thus constitutes a challenge to achieve Sustainable Development Goal 3 that focuses on health and well-being for all people, at all ages. The potential of technology, such as the use of m-health applications, is recognised as a means to advance the Sustainable Development Goals through supporting health systems in all countries.
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Beukes, Daniel Wilhelm. "How to improve diabetic care in the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/20439.
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Thesis (MMed) -- Stellenbosch University, 2010.Bibliography
Introduction: Diabetes in Africa has been described as a pandemic, with the prevalence in South Africa estimated at 4.5% of the population. Despite clear national guidelines from the Society of Endocrinology, Metabolism and Diabetes of South Africa, an unpublished quality improvement cycle in 2007 has shown poor patient knowledge with associated uncontrolled glycaemic and hypertensive control in diabetic patients in a district health system. The purpose of the study was to identify possible reasons for this and to find solutions for improving diabetic care within the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape. Methods: A cooperative inquiry group was established, consisting of primary health care providers at a district hospital and a primary health care clinic. The inquiry completed several cycles of action-reflection over a period of eight months, and included training in diabetic related topics and critical reflection techniques. At the end of the inquiry consensus was reached on key findings by group and learning within the group. Findings: Consensus was expressed in two key findings. The group identified and prioritized continuity of care and diabetic education key areas where diabetic care could be improved in the research population. The first was addressed by initiating diabetic registries, establishment of a regular diabetic clinic, implementation of a diabetic schedule within the medical records and the forming of a diabetic team that could support continuity of relationships, clinical management and organisation of care between both facilities. The diabetic team involved non-governmental organizations, private health providers and the community to increase awareness and develop capacity to improve diabetic care. The other finding confirmed diabetic education as a critical area in diabetic self management. The diabetic team initiated a diabetic community forum for educational and informative group activities. There was also continued professional development with education sessions within the cooperative inquiry group themselves. Conclusions: Improving diabetic care through continuity of care and education is well supported in known evidence based literature. The challenge is to translate/ transfer the available knowledge and render it operational and clinical in any health setting. The co-operative inquiry process was a valuable tool to identify, prioritized and addresses unique challenges for improving diabetic care in our specific context.
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Chuma, Thandi. "A qualitative study on diabetic and hypertensive patients in Cape Town, South Africa: their experiences of primary health care and their struggles with self-management." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/12818.
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Includes bibliographical references.The overall aim of this study was to understand how diabetic and hypertensive patients experience PHC in Cape Town, as well as their capacity for self- management of their condition. The specific objectives were: to explore how patients react to existing health care materials/interventions at the health care facility; to identify the needs these patients have for information and behavioural change counselling; to investigate the perceived barriers to lifestyle modification in relation to the patients and to the broader social and economic environment and to investigate the sources of personal motivation to control their illness through lifestyle modification.
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Myers, Valerie Harwell Herbert James D. "Mood and anxiety symptomatology in adults with insulin-dependent Diabetes Mellitus using intensive management regimens /." Philadelphia, Pa. : Drexel University, 2003. http://dspace.library.drexel.edu/handle/1860/233.
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Mitev, Nikolay. "E-health for people with diabetes : Adoption and use of diabetes self-management applications among diabetics in Bulgaria." Thesis, Internationella Handelshögskolan, Högskolan i Jönköping, IHH, Informatik, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-39081.
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The purpose of this thesis is to study the level of understanding of e-health applications among users with diabetes in Bulgaria, to find out how they use those applications, and to provide knowledge on what m-health applications provide to people with diabetes, and what they actually need. This research used TAM variables combined with Innovation Diffusion Theory to produce knowledge on technology acceptance. Therefore, the factors of relative advantage, compatibility, complexity, trialability and observability will be used to determine perceived usefulness, perceived ease of use and behavior intention to use a technology. This research was intended to gather information on the use of diabetes self-management mobile apps in a standardized manner. The instrument used for the survey, a questionnaire, aimed to provide information on the use and experience of mobile health apps for managing diabetes. The final online survey was completed by 71 participants, 38 of which were female, 28 were male and 7 were of non-specified gender. The introductory stage of the survey showed that most of the respondents were between the ages of 31 to 40 years old (28.2 %), and that the largest part of the population sample has been diabetic for five years (32.4%). By taking into consideration the results, it can be said that 74.6% of relative advantage correspond to very high perceived usefulness on behalf of the respondents. And a score of 53.5% shows that the people who took part in the survey exhibit high perceived ease of use of the mobile applications. This concludes that initially upon using diabetes self-management applications, the respondent’s exhibit high behavioral intention to do so and due to that the applications are not defined as complex, they are suitable for constant use.