What is diabulimia and what are the implications for practice?

Diabulimia has become a common term used to describe a condition when a person with type 1 diabetes has an eating disorder. The individual may omit or restrict their insulin dose to lose/control weight. Evidence suggests that as many as 20% of women with type 1 diabetes may have this condition. The serious acute and long-term complications of hyperglycaemia are well documented. Detection of this condition is challenging and health professionals need to be vigilant in assessing reasons for variable glycaemic control and weight changes. Management requires a collaborative response from the specialist diabetes team in conjunction with the mental health team. Nurses must ensure that they are aware that the condition may be possible in all patients with type 1 diabetes but especially younger female patients. These patients require timely intervention to prevent any severe acute or long-term complications.

The benefits of interprofessional education 10 years on.

Interprofessional education (IPE) was first conceived in 1973 by a World Health Organization (WHO) expert group in Geneva. WHO member states were then charged with implementing medical education IPE pilot projects and from then to today there has a been a rapid proliferation in the number of publications on the subject. IPE has generated research into its use, conferences specific to IPE, organisations dedicated to it and policy championing it. The authors question whether there has been any major shift in the silos in which different professions might be working. The authors published an article on the benefits of IPE ( Illingworth and Chelvanayagam, 2007 ). Ten years have now passed and many changes have been implemented and experienced in health and social care and therefore a review of the literature is required. Also, it is 7 years since the publication of WHO's report outlining the role of IPE in the preparation of health professionals ( WHO, 2010 ) and, increasingly, UK Government policy champions collaborative and integrated working. The conclusions from the 2007 article acknowledged the development of IPE; however, it highlighted the need for empirical evidence to demonstrate the effectiveness of IPE in service user and carer outcomes. This article will explore whether IPE has achieved the benefits discussed in the previous article and what developments have occurred since it was published.

Addressing older people's mental health needs in the community setting.

It is estimated that more than one third of older people may experience problems with their mental health. While, in some of these cases, people will be able to self-manage with little or no support, individuals who are socially isolated or physically unwell may experience significant mental distress. Community nurses are ideally placed to identify mental health problems in patients who are housebound, and to make appropriate referrals. Yet many nurses report apprehension regarding a perceived lack of knowledge and skills in which to undertake an initial assessment. This article outlines the most common mental illnesses experienced by older people living in the community and provides guidance for community nurses on conducting an initial assessment to ensure that patients' holistic needs are met.

Bowel problems and coping strategies in people with multiple sclerosis.

Multiple sclerosis (MS) is a common neurological disease, estimated to affect 100,000 people in the UK. Bowel symptoms are reported to be common in MS, with constipation affecting 29-43% and faecal incontinence affecting just over 50%. Both have an impact on quality of life. Very little is known about how people with MS manage their bowels and the effectiveness of different interventions. We conducted a 2-part survey of people with MS and bowel problems. MS Society members were invited to participate in an online survey: 155 replied. 47 people additionally filled in a more detailed postal questionnaire. In this self-selected sample, 34% spend more than 30 minutes a day managing their bowel. Managing bowel function was rated as having an impact equal to mobility difficulties on quality of life. Respondents used a wide range of strategies to manage their bowel but few were rated as very helpful. There is a need for high quality research on all aspects of managing bowel dysfunction in MS in order to improve patients' quality of life.

Fecal incontinence: the quality of reported randomized, controlled trials in the last ten years.

PURPOSE: This study was designed to analyze the characteristics and the quality of reporting of randomized, controlled trials published during the last ten years on fecal incontinence. METHODS: An electronic search for all randomized, controlled trials on fecal incontinence was undertaken by using the MEDLINE database via PubMed. The data collected were divided into general data, characteristics of reporting, methodology quality assessment using the Jadad scale and a validated methodology quality score (MINCIR score), evaluation of the items published in the CONSORT statement, and the journal impact factor. Reports were divided into two groups: published articles from 1996 to 2000 (Group 1), and from 2001 to 2005 (Group 2). RESULTS: Forty-two trials fulfilled the inclusion criteria of the study (Group 1, n = 15; and Group 2, n = 27). There were no significant differences in general characteristics of randomized, controlled trials between the two groups. In Group 2, there were a statistically significant higher number of studies that reported a flow chart (P < 0.001), written informed consent (P = 0.008), sample size calculation (P = 0.023), and withdrawals and dropouts (P < 0.001). We found a statistically significant higher score in Jadad scale (P = 0.046) and MINCIR score (P = 0.016) in the published studies in Group 2. Also we found higher journal impact factor of journals that published these randomized, controlled trials during the most recent years (P = 0.04). CONCLUSIONS: There is a lack of high-quality reported randomized, controlled trials on fecal incontinence during the last ten years. Reports of randomized, controlled trials involving patients with fecal incontinence published after 2001 were better reported than in the previous five years.

Benefits of interprofessional education in health care.

This article examines some of the literature regarding the benefits of interprofessional education (IPE) in the field of health care. These benefits in relation to service users (and carers), higher education institutions, service providers and students are all explored. Barriers to IPE are being broken down by many of the various stakeholders working towards a similar agenda. However, currently there remains some doubt as to whether IPE has a direct positive impact on the health gain of service users and carers. Research is needed to demonstrate if service users and carers benefit directly from IPE and if they do not, the reason for pursuing it needs to be questioned.

Using therapeutic groups to support women with faecal incontinence.

In this paper, the authors describe the use of facilitated patient groups, in the management of women with faecal incontinence (FI). Two types of groups are discussed--a psychoeducational group and a psychotherapy group. Detailed descriptions of some of the themes which emerged in these groups are provided. The effectiveness of such groups is described, with regard to both psychological and physical functioning. Further investigation into the use of groups for this patient population is recommended.

Randomized controlled trial of biofeedback for fecal incontinence.

BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.