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

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

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

Parent Training Intervention to Manage Externalizing Behaviors in Children With Autism.

?Developmental Stifling? is a term recently developed by us to denote a symptom pattern observed in a variety of clinical practice sites. The purpose of our paper is to define developmental stifling and compare this recently identified condition with Munchausen Syndrome by Proxy. A case example of developmental stifling is provided, as well as recommendations for early identification and treatment.

Developmental Stifling: an emerging symptom pattern.

Purpose: This study examined the efficacy of parent training interventions to facilitate social reciprocity and language development in children with autism. Methods: The social interaction behaviors of mothers and children over time were compared using single subject design experimentation methodology. Five children who were diagnosed with autism and their mothers participated in the study. The participants were recruited from U city, Korea. The mothers were trained using training videotapes and demonstrations on how to facilitate social interaction with their children as well as promoting language development. Following the training, data were collected three times per week by video taping mother-child interaction in their homes. Results: Four of the five mothers demonstrated increases in the use of imitation with animation and expectant waiting after the intervention compared to the baseline sessions; the children demonstrated noticeable increases in the use of initiation of interaction, vocalizations, and verbal production after their mothers received the training intervention. Conclusion: Results of this study demonstrate the efficacy of mother training to improve social interactions of children with autism. Additional important information can be gained by replicating this study with more participants and comparing intervention and control groups. Clearly, this intervention shows promise and has implications for clinical practice.

자폐아동을 위한 어머니 훈련 프로그램이 가정에서의 사회적 상호작용에 미치는 효과

A major deficit exists in the delivery of mental health services to developmentally delayed and/or emotionally handicapped children and their families. Individuals well seasoned in child psychiatry and related fields recognize that it is impossible to effectively treat children and maintain behavioral gains without family involvement and follow-up. Unfortunately, statistics suggest that most treatment of developmentally delayed/emotionally handicapped children focuses only on the child.The incorporation of family members in the treatment process is essential and can be accomplished by teaching families to use basic behavioral management prinicples. Psychiatric clinical nurse specialists, and other nurses proficient in behavior management, can provide the training and intervention needed to assist families in managing the children.Nurses at the Children's Mental Health Unit (CMHU), University of Florida have developed a family training program to help meet the needs of families who must interact regularly ...

Behavioral management training for families of emotionally handicapped and/or developmentally delayed children.

Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms−how it is perceived and reported−remain challenging in pediatric clinical and research settings. To synthesize the existing pediatric literature on children's and adolescents’ word descriptors of asthma symptoms. In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents’ word descriptors of asthma symptoms. The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents’ descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. ‘helpless’, ‘afraid of dying’) and sensory words (e.g. ‘pressure in chest’, ‘tightness, lungs feel shut’) to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking. Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents’ experience of asthma symptoms. 

Jennifer H. Elder

Papers

Parent Training Intervention to Manage Externalizing Behaviors in Children With Autism.

Developmental Stifling: an emerging symptom pattern.

자폐아동을 위한 어머니 훈련 프로그램이 가정에서의 사회적 상호작용에 미치는 효과

Behavioral management training for families of emotionally handicapped and/or developmentally delayed children.

Children's and Adolescents’ Descriptors of Asthma Symptoms: An Integrative Review