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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.

Thesis (M.Occ.Ther.(Occupational Therapy))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 5 uppsatser.

Nursing has its own unique contribution to make to diabetes care, but that impact is rarely quantified, measured or conceptualised. The thesis makes this contribution in the form of three published research projects and proposes an adaptation to Abbott’s conceptual framework on the division of expert labour. The first research project demonstrates the value of the hospital based diabetes specialist nurse using a randomised controlled trial; the second delineates the competences of different levels of nurses in diabetes care using a nominal group technique and the third project provides a baseline of the state of nursing in relation to the initiation of insulin therapy using a survey approach. Each project is followed by a personal reflection and discussion of the implications in the light of Abbott’s framework. Abbott’s thesis is that the development of professions is determined by a series of jurisdictional disputes rather than by a grand plan of the professions themselves. While this assertion does not always hold true in diabetes care the studies do concur with Abbott in other ways, particularly that the profession can be taken forward by taking responsibility for appropriate educational preparation, extending the boundaries of knowledge and the nursing role where appropriate. The discussion cautions against setting up professional edifices that become self-serving and stifle development, either by rigid enforcement of competences or by fossilising the nursing contribution to diabetes care. In terms of the care of the person with diabetes, nursing remains most effective within the umbrella of a multi-disciplinary team while demonstrating its own contribution. Nursing should show professionalism by continually striving for excellence, developing new knowledge and pushing role boundaries when it is in the best interests of the patient. The original contribution to knowledge is shown in the research projects’ contribution to the evolution of diabetes nursing in the United Kingdom and the proposal that Abbott’s framework be modified to put more emphasis on the task of work to achieve optimum patient outcomes than on the jostling of professions; acknowledging the growth in multi-disciplinary team-working and rise in the power of organisations at the expense of the power of individual professions since his work was first published.

Made available in DSpace on 2014-06-11T19:23:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-26Bitstream added on 2014-06-13T19:28:57Z : No. of bitstreams: 1 pinheiro_cm_me_arafcf.pdf: 768209 bytes, checksum: cba436e655065dfd90d0f20696a3bc21 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Universidade Estadual Paulista (UNESP) / O Diabetes mellitus é um dos mais importantes problemas de saúde pública, ocasionando complicações crônicas como a atrofia muscular e perda da qualidade de vida do paciente. Quando ocorre uma lesão articular, o músculo responde com um processo de atrofia onde é gerada uma modificação no tecido muscular funcionalmente relacionado com essa articulação. Contudo, estudos experimentais que contribuam ao esclarecimento da relação entre inflamação articular e as modificações histológicas e da expressão gênica do músculo de animais diabéticos não têm sido desenvolvidos. Outro parâmetro importante que deve ser estudado é a atividade da enzima creatina cinase (CK) uma vez que sua atividade pode ser alterada em função de várias causas como na injúria, distrofia, inflamação ou necrose da musculatura esquelética ou cardíaca. O presente projeto teve por objetivo estudar o efeito da inflamação aguda do tornozelo sobre os músculos Sóleo (SO) e Tibial Anterior (TA), investigando a presença de alterações histológicas, alterações na expressão gênica dos atrogenes atrogina-1e MuRF-1 e na atividade da creatina cinase em músculos de ratos não-diabéticos e diabéticos com e sem tratamento insulínico. Foram estudados 54 ratos Wistar (150g). A indução do diabetes foi por via intrapenitoneal com 50mg de estreptozotocina (STZ) por Kg de peso corporal, dissolvida em tampão citrato pH 4,5. Para a inflamação a articulação do tornozelo foi mantida em 90° localizando a fossa distal e posterior ao maléolo lateral, introduzindo nesta zona uma agulha de diâmetro 26 com 0.03ml carragenina a 3%. Os grupos de animais diabéticos com terapia insulínica foram tratados duas vezes ao dia (as 8h e 17h) com 2,5 U de insulina NPH durante 13 dias, totalizando 5U/dia A insulina foi administrada por via subcutânea... / Diabetes mellitus is one of the most serious public health problems, which diminishes the quality of life of the patient and leads to many chronic complications, one of which is muscle atrophy. When a joint is injured, the muscle responds with a process of atrophy in which a change occurs in the muscle tissue functionally related to the joint. However, no experimental studies have been carried out to clarify the relationship between joint inflammation and changes in the histology and gene expression of muscles in diabetic animals. Another important variable that should be studied is the activity of the enzyme creatine kinase (CK), since it can be altered under various conditions, such as injury, muscular dystrophy, inflammation or necrosis of skeletal or heart muscle. The aim of this project was to study the effect of acute inflammation of the ankle on the soleus (SO) and tibialis anterior (TA) muscles, by noting the histological changes, changes in the expression of the atrophy-related genes (atrogenes) atrogin-1 and MuRF-1 and activity of CK in muscles of non-diabetic and diabetic rats, treated and untreated with insulin. We studied 54 Wistar rats (150g). Diabetes was induced by intraperitoneal injection of 50mg streptozotocin (STZ) per kg body weight, dissolved in citrate buffer (pH 4.5). To induce inflammation, the ankle joint was held at 90°, with the fossa located distal and posterior to the lateral malleolus, and inserting a 26-gauge needle into this region, with 0.03mL of 3% carrageenan. The groups of insulin-treated diabetic animals were treated twice a day (at 8 am and 5 pm) by subcutaneous injection with... (Complete abstract click electronic access below)

published_or_final_version / Community Medicine / Master / Master of Public Health

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