[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

[Effect of linear and stepwise sodium and ultra filtration profiles on intradialytic hypotension and muscle cramps in renal disease patients]

Intradialytic hypotension and muscle cramps are most frequent complications in patients receiving haemodialysis [HD]. So, preventing of these complications is one of the main challenges of the treatment team, especially for nurses. One of the preventive methods that have been recently introduced is the use of sodium profile and ultra filtration [UF] profile. The aim of this study was to evaluate the effects of two types of sodium and UF profiles on Intradialytic hypotension and muscle cramps. In this clinical trial study, twenty six stable HD patients from two dialysis centers [Ali Asghar and Al-Zahra Hospitals] of Isfahan University underwent three different treatments: [1] control, constant dialysate sodium concentration of 138 mmol/l with constant UF, [2] linear sodium profile + UF profile [type1], a linearly decreasing dialysate sodium concentration [146-138mmol/l] combination with a linearly decreasing UF rate. [3] a stepwise sodium profile + UF profile [type2], a stepwise decreasing dialysate sodium concentration [146-138 mmol/l] combination with a stepwise decreasing UF rate. Each treatment was applied in 3 dialysis sessions. Data were analyzed using ?[2] test using SPSS software. A total of 26 patients [14 men, 12 female] were participated in this study. The mean age of patients was 46.8 +/- 19 years. In each group, 78 dialysis sessions and a total of 234 dialysis sessions were analyzed. The incidence of intradialytic hypotension and cramps was significantly reduced during two type of profiles compared with control group [P<0.05, respectively]. However, there was no significant differences between profiles [P>0.05]. Sodium profile and UF profile are simple and cost effective method that modulate the dialysate sodium and ultrafiltration rate and preserve the homodynamic status of patients during dialysis. So, using of sodium profile and UF profile groups [linear and stepwise] is recommended for prevention of hypotension and cramps during dialysis process

[Impact of two types of sodium and ultra filtration profiles on systolic and diastolic blood pressure in patients during hemodialysis]

Intradialytic hypotension is the most frequent complication in patients receiving haemodialysis [HD]. This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodium profile and ultra filtration [UF] profile. The aim of this study was to compare the effects of linear sodium + UF profile [type1] with stepwise sodium + UF profile [type3] on systolic and diastolic blood pressure in HD patients. In this crossover design study, 26 HD patients from two dialysis centers at Esfahan University underwent three kinds of treatment: [1] control, constant dialysate sodium concentration of 138 mmol/L with constant UF; [2] linear sodium profile + UF profile [type1], a linearly decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a linearly decreasing UF rate; and [3] stepwise sodium profile + UF profile [type2], a stepwise decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a stepwise decreasing UF rate. Eachtreatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS. Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours [P>0.05]. The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles [1 and 3] compared with the routine care group [P<0.05]. The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles [1 and 3] compared with the routine group [P<0.05]. There was no significant difference between the profiles 1and 3 [P>0.05]. In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile [type1 and type 3] is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process

[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