XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

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Medscape

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Research Design: Qualitative, Quantitative, and Mixed Methods Approaches

Quasi-experimentation - design and analysis issues for field settings - cook,td, campbell,dt

Educating Children with Autism

Background

Children with autism spectrum disorder (ASD) may be a stressor for family members yet there is little published research on the impact of having a child with ASD on their typically developing (TD) adolescent siblings. According to Antonovsky's salutogenic model, a strong sense of coherence leads to the view that the stressor is a manageable challenge rather than a burden and promotes healthier adaptation. This study examines the relationship between stress, TD sibling resources and the sense of coherence in TD siblings.



Method

This quantitative mail-based study uses a survey methodology, analysing the responses of TD adolescent siblings (n = 96) of individuals with autism, Asperger's syndrome, or pervasive developmental disorder – not otherwise specified to several rating scales. Adolescent siblings, ages 11 to 18 years, completed the Adolescent Coping Orientation for Problem Experience (ACOPE), Network of Relationship Inventory – Social Provision Version (NRI-SPV), Youth Self Report (YSR), and Sense of Coherence (SOC) instruments; parents completed the Child Autism Rating Scale – 2nd Edition (CARS-2).



Results

The salutogenesis model was used to guide and inform this research. Findings suggested the following: (a) the stress of ASD severity and resource of adjustment are related in TD adolescent siblings; (b) TD sibling adjustment has a strong relationship with sense of coherence levels; and (c) a greater number of positive coping strategies buffer TD sibling coherence levels when ASD severity scores are high.



Conclusions

ASD severity and TD adolescent sibling resources influence sense of coherence in adolescent TD siblings of individuals with ASD.

Predictors of sense of coherence in typically developing adolescent siblings of individuals with autism spectrum disorder.

Most research on family interventions of children with autism has focused on the role of the mother, and little is known about the effects of training fathers. Through a series of National Institutes of Healthâ€“funded studies we have demonstrated treatment success by focusing on fathers who are trained at home. Although our research has been successful, this work introduces questions related to how best to train fathers when on-site, in-home training is not a viable option due to geographical distance or a variety of other logistical constraints. This article describes the development and initial use of an Internet-based tool to offer this training more broadly. We briefly describe past research as well as the need for the implementation of an Internet-based tool. We then describe the system, document early indicators of success, and discuss metrics we are using with our fathers. The article concludes with a discussion of future goals and research needs.

Autism and Family Interventions Through Technology: A Description of a Web-Based Tool to Educate Fathers of Children with Autism

Social interactional theory posits that child behavior and parent behavior are interdependent. Interactions that encourage reciprocity and balanced turn-taking are considered most conducive to chil...

Social turn-taking of children with neuropsychiatric impairments and their parents.

PurposeThe purpose of this study was to identify the educational needs and technological preferences of fathers of youth aged 6 to 17 years with type 1 diabetes (T1DM).MethodsParticipants completed 2 surveys and 1 in-person semistructured interview. Survey data were collected via Qualtrics; interviews were recorded and transcribed. The quantitative data were analyzed with SPSS 22.ResultsThirty fathers/stepfathers of youth 6 to 17 years old with T1DM participated in the study. Participants reported high levels of unmet diabetes-related educational needs, including needs in fundamental areas of diabetes management such as treatment of hyperglycemia, hypoglycemia, and calculating and adjusting insulin doses. A majority of participants identified educational needs in more nuanced aspects of diabetes management, indicating a need for more information about insulin pumps and continuous glucose monitors, managing diabetes at school, and finding help for diabetes challenges. All participants used smartphone techn...

Jennifer H. Elder

Papers

Predictors of sense of coherence in typically developing adolescent siblings of individuals with autism spectrum disorder.

Autism and Family Interventions Through Technology: A Description of a Web-Based Tool to Educate Fathers of Children with Autism

Social turn-taking of children with neuropsychiatric impairments and their parents.

Educational Needs and Technological Preferences of Fathers of Youth With Type 1 Diabetes.

Single subject experimentation for psychiatric nursing