...Diabetes transition Assessment of current best practice and development of a future work programme to improve transition processes for young people with diabetes. Transition in healthcare is only one part of the evolution from dependent child to independent adult (David, 2001). Submitted by Ruth Gordon, Ruth Gordon Associates Ltd to NHS Diabetes. Supporting, Improving, Caring August 2012 Acknowledgements This project was funded by NHS Diabetes and supported by Gillian Johnson, North East Regional Programme Manager. The expert panel was made up of a group of clinicians and others who provided information, commented on the process and contributed to the views included in this final report. Others have influenced the later stages of the work and will be involved in planning how to take this project forwards. Therefore thanks go to: • Fiona Campbell • Deborah Christie • Chris Cooper • Julie Cropper • Gail Dovey-Pearce • Jane Edmunds • Gavin Eyres • Sue Greenhalgh • Peter Hammond • Gillian Johnson • Susannah Rowles • Carolyn Stephenson • Helen Thornton • Peter Winocour • Alison Woodhead Without the two clinical leads, Peter Hammond from Harrogate and Fiona Campbell from Leeds, this work and report would not have been possible. Contents Executive summary Context Background and rationale Aims of the project Timing of the project Process undertaken for the project Evidence base and policy background Results from the snapshot research Good practice Examples of good practice...
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...ability to do something. A nurse, who embodies the role of a teacher provides information that prompts the client to engage in activities that lead to desired change. Teaching is most effective when it responds to the learner’s needs (Potter, Perry, Ross-Kerry, & Wood, 2006, p. 318). In this paper I will include an assessment of the learner, teacher, and resources with a teaching plan. I will provide evidence of implementation along with discussion of teaching material used in the presentation, including the rationale for its use. The paper will be able to clarify the description of the evaluation strategies as well as process and outcome evaluation. For the health teaching project paper I will interview Mrs. Patel, who is an immigrant from India and lives in Toronto GTA area with her two sons and in-laws. Mrs. Patel, who lost her husband 20 months ago, is 68 years old female diagnosed with diabetes two years ago with a family history of both parents who died from diabetes related complications. Mrs. Patel weighs 190 pounds and five feet three inches tall. Her health history includes high cholesterol and high blood pressure. Mrs. Patel is a physically inactive retired high school teacher, who is fond of eating Indian sweets and smokes one pack of cigarettes a day; she has a pack life of 40. The intended focus of the teaching sessions will be to define specific behavioural objectives with the patient and family and to make the learning experience outcome oriented and measurable...
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...Summary The common-sense model of self-regulation of health and illness was developed in the 1980s by Howard Leventhal and his colleagues (Diefenbach & Leventhal, 1996). It was based on Leventhal’s research from the prior decade that studied the effect of fear in relation to health related behaviors. The theory has various titles such as the, Self Regulation Theory, Common Sense Model of Illness Representation or Leventhal’s Theory (Hale et al, 2007). For ease of communication it will be referred to as the Common Sense Model (CSM). It’s primary goal and function is to explain how a person processes an illness threat. The CSM is centered on the individual and his or her idea of health and illness. It works under the premise that the individual is “an active problem solver.” CSM also theories an individual’s representation of the illness will be the primary cause of their actions and behavior and the process of illness representation will lead the individual to make common sense health behaviors. (Diefenbach & Leventhal, 1996). Self-regulation is the processing of information by a patient regarding their health and the actions that an individual takes to return to a normal state of health. A stimuli such as a symptom of an illness or a diagnosis starts a three-phase feedback cycle of self-regulation. First, the individual constructs a cognitive “representation” of the illness. Secondly, the individual acts and “copes” with the illness. In the third stage, the...
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...Individual Wellness Change Project The client I selected for this project is a 70 year old female. This client resides in a household with her husband, and adult son. Retirement has not equated with rest and relaxation for my client as she also takes care of two of her adult brothers in poor health. Three granddaughters have been the source of joy for her as they’ve grown from precious infants to teenagers. My client also assumes the role of family matriarch for her other nine siblings. With many demands for time and attention, I predicted the needs assessments to direct us towards stress management. The results we received sent out project in another direction. With my initial prediction of the focus needed being on stress management, I had my client complete the Holmes and Rahe Stress Scale (Holmes and Rahe, n.d.) first. In spite of numerous responsibilities and various family members always seeking advice, her score was only a 16. Scores below 150 represent only a slight risk of illness due to stress. The one area where stress does affect my client is in her sleeping habits. Many nights she experiences insomnia while contemplating current family situations, and consequentially suffers from fatigue. My client’s concern over taking care of everyone else leaves little time for her to focus on herself. The remainder of our assessments helped to point out what she already knew about her nutrition and physical activity levels. The results of the LiveWell assessment...
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...DIABETES TEST KIT MANUFACTURING INDUSTRY ANALYSIS STRATEGIC MANAGEMENT 1 SECTION A | GROUP 9 IIM RAIPUR Submitted by: Anshoo Saini 15PGP008 Gautham Balaji 15PGP015 Isha Tayal 15PGP018 Koundinya Niggamadda 15PGP026 Piyush Gaurav 15PGP037 Shekhar Suman 15FPM009 Index Industry Definition…………………………………………………………………………………………………………………………….2 Industry Activities 2 Similar Industries 2 Market Participants 2 Porter’s Five Forces Analysis 3 PESTEL Analysis 4 Industry Outlook 5 Products & Markets 6 Future Outlook 7 Competitive Landscapes, Success factors and Business Locations 7 Major Companies 8 Strategic Recommendations 10 Industry Analysis Industry Definition This industry develops and produces blood glucose meters and testing supplies that help users monitor blood glucose levels. Most manufacturers also develop other medical devices. Industry Activities * Diabetes market research * Glucose meter monitoring research and development * Glucose meter * Glucose meter accessory Similar Industries * Dental Laboratories * Diagnostic & Medical Laboratories * Dialysis Equipment Manufacturing * Health & Medical Insurance * Hearing Aid Manufacturing * Medical Device Manufacturing * Medical Instrument & Supply Manufacturing * Ophthalmic Instrument Manufacturing * Pacemaker Manufacturing * Robotic Surgery Equipment Manufacturing * Syringes & Injection Needle Manufacturing ...
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...fully developed and their may be some ethical concerns concerning this form of treating disease. In your research consider the following points: 1. What is gene therapy? 2. What are the advantages of gene therapy as opposed to conventional therapy for some disorders? 3. What procedures are used in gene therapy, eg., what is a vector? 4. Are there some types of cells which are more suitable for gene therapy than other types? 5. What are some conditions in humans which could be potentially treated with gene therapy? 6. Are there any conditions in humans which are being successfully treated with gene therapy on a routine basis? 7. Does gene therapy have any practical potential? 8. What is diabetes? How many kinds of diabetes are there and what are the differences between them? 9. Are there any ethical concerns surrounding gene therapy? 10. References of all your research sources are required. There are no marks allocated for Part 1, but you will need the information obtained in Part 1 to answer the questions in Part 2. PART 2 Part 2 is an ‘open book’ examination BUT only original, personal, individual hand written notes will be allowed into the examination to be...
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...I. Introduction Diabetes is on the rise in the United States and the resultant health problems are leading to visits to physicians’ offices and hospitals more than ever before. Diabetic neuropathy, a debilitating nerve disorder which can affect almost any part of the nervous system, occurs in nearly 50 percent of patients with diabetes. Diabetic peripheral neuropathy is found in 12 percent of insulin dependent diabetics and 32 percent of those who are not, equaling approximately 3 million people in the United States. (Chen et al. 2007) The number of patients with other neuropathies, such as autonomic, proximal, and focal, comprises the other 1 million diabetic neuropathy patients, most of whom suffer in pain from the dysfunction of the nervous system. (Chen et al. 2007) This disorder’s elusive nature is such that it can not only present in any part of the body but it can be completely without symptoms that the average patient would report to their physician. Since the patients themselves are less likely to naturally disclose their suffering through their assumption that their symptoms are not relevant to their diabetic condition, the physician’s role in the diagnosis and recognition of this disorder is even more critical. II. Definition and Types of Diabetic Neuropathy The most common type of diabetic neuropathy is peripheral, considered, more generally, sensorimotor. Peripheral neuropathy causes pain or loss of feeling in the toes, feet, legs, hands, and arms....
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...important part of the body. If someone has diabetes he/she is more likely to have to foot problems. Diabetes can damage your nerves. This, in turn, may make you less able to feel an injury or pressure on the skin of your foot. You may not notice a foot injury until severe damage or infection develops. This may led to gangrene in the through simple injuries eventually amputation will be the final choice. So a diabetes patient always has to wear specialized footwear that can protect the foot in more sophisticated way. Diabetes changes your body's ability to fight infections. Damage to blood vessels causes because of diabetes results in less blood and oxygen getting to your feet. Because of this, small sores or breaks in the skin may become deeper skin ulcers. The affected limb may need to be amputated when these skin ulcers do not improve, get larger, or go deeper into the skin. Worldwide, 50% of all leg amputations happen to people living with diabetes. In India, an estimated 50,000 amputations are carried out every year due to diabetes related foot problems. By employing reconstructive and corrective footwear, to remove the high pressure points, a large number of such amputations can be prevented. Thus the patient can lead a near normal life, free from complications. WHO predicts that developing countries will bear the brunt of diabetes epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries. ...
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...Teaching Plan: Diabetes Assessment of Learner: A 54 year old obese male with a history of alcohol abuse, is participating in a 28 day rehab program as an inpatient. Patient will be living at a sober house for an extended period of time after rehab program completed and will be able to get medications that are needed without difficulty. The patient has expressed that because of his alcohol abuse he was non compliant in caring for his diabetes. Patient express a strong desire to improve overall health and is motivated to learn. The patient can read and understand English. Nursing Diagnosis: Ineffective health maintenance r/t deficient knowledge and treatment of disease process AEB poorly controlled blood glucose levels Long Term Goal: Maintain blood glucose levels with medication treatment according to doctor’s prescribed orders daily Intermediate Goal: Will verbally recite at least 1 diabetes management technique prior to dishcharge. Short Term Goals: Will notify staff as soon as hypo or hyper glycerin are evident Behavioral Objective Content Outline Teaching Method 1.Describe I. Identify medications Provide handout the diabetic medications they are on , including of medication that they are on and how to side effects and proper education. properly take the medications administration Demonstrate how ...
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...Primary Medical Diagnosis: Diabetes mellitus 2. Relevant Pathophysiology: Type-2 diabetes mellitus is a heterogeneous syndrome characterized by an abnormality in carbohydrate and fat metabolism. The cause of type-2 diabetes are multifactorial and include both genetic and environmental elements that affect beta cell function and tissue (muscle, liver, adipose tissue, pancreas) insulin sensitivity. A number of factors have been suggested as possibly linking insulin resistance and beta cell dysfunction in the pathogenesis of type-2 diabetes. A majority of individual suffering from type-2 diabetes are obese, with central visceral adiposity. Therefore, the adipose tissue should play a crucial role in the pathogenesis of type-2 diabetes. Medications related to medical diagnosis: My patient is taking Lantus insulin 6 units every day at night before she goes to bed, and my patient is also taking Glimepride 4 mg everyday by mouth. Subjective: my client told me that she had been diabetic for almost 25-30 years. She also told me that she feels dizzy most of the time. She said that she spends most of time in bed by taking plenty of rest. Objective: I seen my client became tired really soon. For example, after taking shower she feels tired and goes to bed. Evidence Based Research Related to Medical Diagnosis: 1. Diabetes Mellitus type-2 2. Prevention of complications of diabetes Oral therapies for T2D. Nursing Diagnoses (prioritized): (1) Fluid volume deficit r/t osmotic diuresis...
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...electronic questions a day X 7 days read and understand rationales * Saunders – Choose content material to test on with rationales that was below 80% on RN Comprehensive Predictor 2013 * Generate Focused review and review material that I need to review * Read Weekly Kaplan Chapters and complete quizzes as due. Retake for higher grasp of material if possible * Retake Predictor exams throughout semester and adjust study topics as needed Journal Entry: My preceptorship at the Veterans Administration at White River Junction takes place at the Green Mountain Clinic, one of the several clinics at WRJ. This week I was up there twice. The first visit this week was to meet with a multidisciplinary team that runs a “Diabetes Shared Medical Appointment.” The meeting is the first of a series of three meetings that take place in a conference room with about 10 diabetic or pre diabetic patients that have been screened with high A1C results. The multidisciplinary team consists of an MD, nutritionist/diabetic educator and a diabetic and disease psychologist. The initial meeting was about three hours long and covered physiology of the disease, diabetic nutrition and a question and answer session. It was interesting to learn that many of these patients take insulin every day, and have for years, but they do not really know why they are taking the medication and they don’t really understand the disease process of diabetes. Many of the questions asked were about nutritional myths...
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...American Diabetes Association Name of Student Institutional Affiliation Organizational Structure of the American Diabetes Association There are various health care organizations and facilities in America and across other parts of the world. They are involved in the provision of different services. The success of each of these organizations depends significantly on their structural organization, strategic plans, as well as their goals and organizational objectives. The vision and mission of the association also play a critical role in promoting their success, growth, and development. One such healthcare association is the American Diabetes Association. Its role is to ensure that patients in the rural areas receive adequate services to manage the condition, as well as the city residents. This paper discusses the organizational structure of the organization. It defines the vision and mission statements and draws the relationship between the statements and the strategic plans of the American Diabetes Association. Additionally, new programs that could be incorporated into the services that the organization offers are recommended. The American Diabetes Association The American Diabetes Association is based at Alexandria in the state of Virginia in the United States of America. It was established in 1940. It has developed into one of the key medical organizations in the US. It plays a crucial role in combatting diabetes. Its primary aim is to help in fighting...
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...DASH Diet for Preventing Diabetes The Dietary Approach to Stop Hypertension, DASH diet, is a diet intended to prevent hypertension. This diet is now recommended for all adults. It is a diet consisting of increased whole grain, fruits, vegetables, and low-fat dairy. It is high in fiber, antioxidants, and unsaturated fatty acids. Sodium is restricted on the DASH diet. Research shows that a diet such as this may improve insulin resistance and hyperglycemia, thereby decreasing the risk for the development of type 2 diabetes. Since type 2 diabetes is a worldwide health problem, this information could change the incidence of this disease significantly. Diet plays an important role in preventing and controlling diabetes. Nine random clinical trials were used to compile the information in this article. Six of these were from the United States, one was from the United Kingdom, and two were conducted in Iran. Included in these trials were 453 adult men and 786 adult women. All participants were between the ages of 21 and 69 years old. The random clinical trials lasted a range of 3-24 weeks total. The authors of the article used these nine trials to compile data on the effects of the DASH diet on three main components effecting the development of diabetes. Studies were done using information from these trials using data for fasting insulin, fasting blood glucose, and fasting HOMA-IR. These studies did not show a significant reduction of fasting blood glucose, nor did...
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...in my feet. I had to buy new shoes, and my shoe size went from a size 10 to a size 12.” It was determined that B.J. should have a CT scan of his head to assess for pituitary adenoma. 1. What information from the above scenario would indicate a possible pituitary adenoma? 2. What other signs or symptoms might be apparent if B.J. does indeed have a pituitary adenoma? 3. B.J. is dianosed with pituitary adenoma and undergoes a trans-sphenoidal hypophysectomy to remove the tumor. After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data support this diagnosis? 4. B.J. receives subcutaneous vasopressin (ADH) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed? ________________________________________ Case 2 D.K. is a 35-year-old high school secretary who began to experience weight loss despite ravenous appetite and increased dietary intake. She has to make frequent trips to the bathroom to urinate and has difficulty concentrating on her work because of fatigue. She drinks large volumes of coffee to help with a constant dry mouth and to combat her fatigue. At a clinic appointment, it was noted that D.K.’s weight has dropped from 140 to 128 pounds. She is 5 feet 7 inches tall. Her urine is positive for sugar (2%) and ketones. A chemstick blood glucose level is 412 mg/dl. D.K. had eaten breakfast 3 hours before the...
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...high. • LDL levels are elevated at 155mg/dL and ideal values are below 100mg/dL; LDL is the value you want to be the lowest. • HDL levels are low and the HDL levels need to be high, 40-60mg/dL is desired. • Urine Analysis indicates that Y.L. is spilling glucose into her urine. 2. Identify the three methods used to diagnose DM. - Fasting blood glucose of > 126 mg/dl - Random Glucose Level >200 mg/dl (plus presence of other symptoms) - A1C > 6.5% 3. Identify three functions of insulin. • regulates glucose metabolism • stimulates lipogenesis • stimulates growth 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. • Type 1 diabetes, the body produces insufficient insulin to regulate blood glucose levels, known as ‘insulin dependent’. • Type 2 diabetes, the body produces sufficient insulin, but the body’s cells do not respond effectively to insulin, thus ‘insulin resistant’. 5. What are the risk factors for type 2 DM? Place a star or asterisk next to those that Y.L. exhibits. • *Weight • Fat distribution primarily...
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