[Barriers to blood glucose level management in the health care system: view points of patients, families and medical personnel]

Health care system barriers are major barriers to management and control of blood glucose level control. Documenting the viewpoints of patients, their families and the medical team, on these barriers is an important step towards correct planning and effective control of blood glucose. This study aimed to document and compare viewpoints of patients, their families and medical team about health care system barriers to control of glucose levels in diabetes centers of Isfahan city. This was a descriptive- comparative, cross-sectional, one stage, study of three groups, in which a total of 938 subjects, including 420 type2 diabetic patients, 420 members of their families and 98 medical staff participated. Data were collected using a researcher-designed questionnaire that was completed by subjects. Data were analyzed using descriptive and inferential statistical methods and SPSS software. Results showed significant differences between viewpoints of the 3 groups, i.e. patients, their families and the medical team regarding barriers of the health care system to blood glucose control [Pvalue< 0.001]. The medical team gave the highest importance to these barriers, while patients gave the lowest. Regarding the significant differences between the viewpoints of these three groups, it can be concluded these differences account for lack of success in controlling patient glucose levels, because medical teams focus on barriers that are not so important to patients and their families, while barriers which are important to patients and their families are less considered by members of the medical team

[Facilitators of adherence to self-management in type 2 diabetic patients: a phenomenological study]

Diabetes is chronic disease affecting all aspects of daily life and hence is a priority health care strategy. Its treatment needs a bio-psychosocial approach. One of the major problems in its management is patient noncompliance to therapeutic regimens. This qualitative phenomenological study aimed at assessing to patient experiences of factors facilitating self-management. Patients were recruited from the "Glands and Metabolism Research Center" and "Alzahra hospital" in Isfahan in 2006. A purposive sample of 11 diabetic patients volunteered to participate in the study. Unstructured one-on-one interview were conducted and interview data were transcribed and analyzed for themes using the Collizi method. Themes, identified as facilitators to patient adherence to the therapeutic regimen are fear, satisfaction, support objective alarm, feedback. The research highlights that factors such as patient satisfaction of treatment, insight into nature of disease, patient anxiety, family involvement as a major source of support, feedback on test results and the self-management process should be considered in designing health care strategies to facilitate changes in behavior and enhance motivation

[Nurses' experiences of pain management in children]

Pain Management is an important children right and a priority in treatment. Pain alleviation prevents severe complications and side effects and provides the children, a normal growth and development. Nurses are the key personnel who have the most interactions with pain experiencing children. They can prevent further problems by assessing and managing pain. Studying their experiences could play a valuable role in managing pain. The present study aimed at exploring the experiences of nurses of pain management in hospitalized children. A phenomenology study was recruited to conduct the study. In-depth interviews were undertaken with a theoretical purposive sample of 19 nurses working in medical-surgical and infection pediatric wards in a hospital in Esfahan. The data analysis using Coallizzi seven-stages method. Nurses experiences were studied in two main areas of assessments and interventions. Three major themes were identified namely: the ability of detection, reaction and beliefs. The sub-themes included: being aware of pain reality, caregiver role, medication dependency, having tolerance, interpersonal interaction, beliefs regarding placebo, negative attitude to mother's attendance during procedures. Nurses' experiences reflect their abilities and knowledge of pain, the influential factors and understanding the mother role. Studying their experiences is a valuable contribution in better pain management. So, it's necessary to pay more attention to the pain subject in nursing curriculum and providing pain management educational programme to train experienced nurses. The role of physician and their participation should be considered in managing children's pain. The required facilities and condition for applying standards of pain management should be provided as well

[Relation between the number of major negative stressful life events and undiagnosed glucose metabolism disorders [IGT, diabetes] in first-degree relatives of type 2 diabetics]

Current evidence suggests that stressful experiences may affect both onset and exacerbation of type 1 or type 2 diabetes. The aim of this study was to assess the relation between the number of stressful life events and prevalence of glucose metabolism disorders [IGT, Diabetes] In this cross sectional study, 35-55 year old first degree relatives of type 2 diabetics without history of diabetes were included. Questionaires of stressful life events, physical activity and basic chacteristics were completed. Waist and hip circumference was also measured and OGTT was performed in all patients. Of 477 participants, 288, 146 and 43 were normal, IGT and diabetics respectively; the mean number of stressful events for these groups was 3.15, 3.55, 3.91 [P=0.016], respectively. The prevalence of glucose metabolism disorders was 26.8 in those who reported no stress and 41.5% in participants with stressful events [p=0.03]. The prevalence of diabetes was 25.6% vs. 3.2% in subjects with 8 or more stressful events in comparison to subjects with less than 8 stressful events. Considering the probable contribution of stress in the development of diabetes, it is suggested to evaluate the relationship between stress and diabetes as well as the role of education on coping with stress in diabetes prevention, specially in high risk groups, in a more precise manner

[Patients' viewpoints concerning post surgical pain management]

Pain is one of the most usual facts and events in human's life. It has been one of the main concerns of human in his life so that he has always tried to diagnose and manage that. Knowing about, fighting with it, treating and relieving it are among the key responsibilities of health car staffs. They should screen patients, evaluate their pain and tread them appropriately. This study has tried to define patients' viewpoints concerning the assessment, management and evaluation concerning pain management. This is a descriptive study. There were 100 subjects selected through convenient sampling in Isfahan Medical University hospital. The data were collected by a questionnaire and analysed through SPSS soffware. The findings showed that 92% of the patients were in pain after surgery, 81% nedded pain killers to relieve their pain of whom 80% had their pain relieved. The findings also reported 85% of the patients were satisfied with their given services concerning pain management. Meanwhile, 15% were dissatisfied with the services. Although, based on the findings of the research, post surgical pain had been managed and relieved, it had not been assessed and evaluated well after management, reported by the subjects