An integrated pre-pregnancy care programme framework theoretically modelled from the perspectives of women with Type 2 diabetes and healthcare professionals.

BACKGROUND: Pregnancies in women with diabetes are associated with significant additional risks for the fetus, infant and mother such as, higher risk of stillbirths or congenital anomalies. Pre-pregnancy care can attenuate these risks. However, while women with Type 2 diabetes account for half of pregnancies in women with pre-existing diabetes, they are much less likely to receive pre-pregnancy care than women with Type 1 diabetes. This discrepancy may be related to the fact that most pre-pregnancy care is located in specialist diabetes centres where women with Type 1 diabetes are managed; whereas women with Type 2 diabetes are managed in primary care and reproductive care is not a routine element of diabetes care. Therefore, to improve pre-pregnancy care among women with Type 2 diabetes strategies need to be tailored to the specific needs of this group and the context of their diabetes care. OBJECTIVES: This paper seeks to inform the development of an integrated pre-pregnancy care programme by presenting strategies identified by women with Type 2 diabetes and healthcare professionals that address some of the barriers they experience in relation to pre-pregnancy care. METHODS: A qualitative study using semi-structured in-depth interviews with women of reproductive age with Type 2 diabetes (n=30) and diabetes healthcare professionals (n=22) from both primary and secondary care. Data were transcribed verbatim and analysed thematically using Framework Analysis. The identified themes were then mapped to create a theoretical intervention framework using Normalisation Process Theory and the Capabilities, Opportunity, and Motivation to perform a Behaviour model. RESULTS: Six themes were identified expressing the need for a multimodal approach for improving the uptake of pre-pregnancy care in women with Type 2 diabetes. These themes were then mapped onto the constructs of Normalisation Process Theory as follows: coherence (enhancing understanding of reproductive needs among women and healthcare professionals); cognitive participation (constructing a positive narrative for pregnancy and Type 2 diabetes); collective action (increasing the visibly of the reproductive needs of women, integrating healthcare systems and utilising supportive technologies); and reflexive monitoring (using multi-modal approaches to support systemised care). The data were also modelled to identify target behaviours for intervention detailing what needs to be done by whom, when and where. CONCLUSION: Women with Type 2 diabetes account for half of pregnancies in those with pre-existing diabetes; however, they are less likely to receive pre-pregnancy care than women with Type 1 diabetes. Pre-pregnancy care can reduce the maternal and fetal risks associated with Type 2 diabetes. This study presents strategies to improve the current low uptake of pre-pregnancy care for women with Type 2 diabetes. These strategies have been tailored to the specific needs of women and healthcare professionals and support integration within the woman's routine diabetes management.

Reducing restrictive practice: a pertinent issue for children's services.

The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of 'restrictive practices' across all sectors of health care, including the difference between 'restrictive practices' (such as attitudes of control, limit setting and unnecessary ward rules) and 'restrictive interventions' (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.

Understanding the endocrinopathies associated with the treatment of childhood cancer: part 2.

This is part 2 of an article exploring the endocrinopathies associated with cancer treatments, a growing area of care. More than 80% of all childhood cancers are treatable and the number of survivors of childhood cancer is increasing, but up to two thirds of these children reportedly present with significant health problems resulting from their treatments and about 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment, and its implications for their current and future health. It focuses on the specific endocrine risks to survivors of childhood cancer following treatment with chemotherapy and radiotherapy. This is the final article in a series that has illustrated the breadth of work undertaken by nurse specialists in endocrinology and oncology.

Understanding the endocrinopathies associated with the treatment of childhood cancer: part 1.

This article explores endocrinopathies associated with late effects of treatments for childhood cancers. It is the first of two articles on the subject, the second to be published in November. This is a growing area of care, as more than 80% of all childhood cancer is treatable, resulting in an increase in survivors of childhood cancer. However, up to two thirds of these children are reported to present with significant health problems resulting from their treatments, and approximately 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment and its implications for their health. This knowledge is the foundation for individually-tailored care plans that enable young people to be confident to self-care and self-monitor their long-term health.

Educating children and families about growth hormone deficiency and its management: part 2.

Growth hormone deficiency (GHD) is a long-term condition, therefore creating ongoing partnerships with families is a fundamental part of the role of a paediatric endocrine nurse specialist (PENS). Teaching children, young people and their families about GHD and exploring what it means to them and how they can manage their ongoing treatment is central to building positive relationships. Educating children about the management of their growth hormone treatment (GHT) is an ongoing process and professionals must respond to the changing needs for that information children may have as they grow and develop. Long-term relationships with families are strengthened by recognising and respecting the developing expertise of families as they gain confidence and competence to manage GHT. This article is the second of two parts. Part one was published in the February issue of Nursing Children and Young People and covered an overview of growth hormone, causes and clinical presentation of GHD, development and availability of GHT and the role of the PENS in building partnerships with parents. The focus of this article is the education role of the PENS and the importance of providing information that is appropriate to the child or young person's developmental age.

Educating children and families about growth hormone deficiency and its management: part 1.

The management of growth hormone deficiency is long term. Children may be diagnosed at pre-school age meaning relationships with the paediatric endocrine team may last more than 15 years. The education role of the paediatric endocrine nurse specialist is essential in working in partnership with families over a long period of time. Children and young people have changing needs for information to help them understand their condition and growth hormone deficiency treatment as they grow up. Developing positive working relationships with parents, children and young people enables their developmental needs and the context in which they live their lives to be central to any educational planning for them. Addressing developmental needs when providing information on growth hormone deficiency to children and young people reinforces the need for education to be an ongoing process and not a one-off event. This is part one of a two-part article. The second part will be published in the March issue of Nursing Children and Young People and it focuses on educating children, young people and their parents about the condition, and includes case studies.

Fever phobia: The impact of time and mortality--a systematic review and meta-analysis.

BACKGROUND: Fever phobia is a term that has been used to describe the exaggerated and unrealistic fear of fever expressed by parents and carers. Since the term was first used in the early 1980s, there have been numerous publications and guidelines stating that fever is not, in itself dangerous, however these fears persist. OBJECTIVES: Investigate the extent of fever phobia and to explore potential associations with time, under-5 mortality rate and geography. DATA SOURCES: Embase (1980 to week 1 2015) and Medline (1946 to week 1 2015) were searched using the terms 'fever' and 'phobia'; and 'fever phobia' as a free text term. One additional paper was published during the review period. STUDY ELIGIBILITY CRITERIA: Studies giving proportion of parents, carers or professionals expressing fear of fever. STUDY APPRAISAL AND SYNTHESIS METHODS: Meta-analysis and cluster analysis using metafor, meta and Cluster in R. RESULTS: Fear of brain damage, coma, convulsions, death and dehydration was high across many of the studies; however there was significant variation as shown by the high I(2) scores which exceeded 95%. This was not explained by the two predictive variables of year of publication, or background mortality apart from a reduction in the fear of brain damage (-0.0185, CI -0.0313 to -0.0057, p=0.0046) and dehydration (-0.0831, -0.1477 to -0.0184, p=0.0118) associated with increased child mortality. LIMITATIONS: Studies were all cross-sectional surveys with a high risk of bias. The pooled estimate, although statistically significant is not the outcome of interest and so should be interpreted with caution. CONCLUSIONS AND IMPLICATIONS: Fever phobia is common and has not significantly declined over time. This may suggest that it is a cultural, rather than individually learned trait and that individual educational programmes are unlikely to be successful in the face of widespread cultural transmission.

Management of vitamin D deficiency in childhood and adolescence.

There are some children and young people who will need specialist management for vitamin D deficiency in paediatric endocrine services. However, health problems caused by vitamin D deficiency are generally preventable, hence the National Institute for Health and Care Excellence recommendations for the provision of NHS Healthy Start vitamins to be available to all pregnant and breastfeeding women and children under five years of age. All health professionals, not just specialist services, need to be confident in their knowledge and understanding of the importance of vitamin D in normal growth and development to enable early identification of children and young people at risk who are in need of early intervention and education.

Understanding clinical investigations in children's endocrinology.

Children and young people referred to paediatric endocrinology services present with a wide range of illnesses and disorders varying from minor to life-threatening conditions. This article introduces the role of the children's endocrine nurse in caring for children and families undergoing investigations that are frequently undertaken to identify specific problems associated with pituitary, adrenal and thyroid glands. Although children with endocrine problems may be cared for in specialist centres, they may also present, for other health reasons, in secondary and primary care. In schools some children may need teachers to administer emergency medication. There is a high incidence of children diagnosed with growth hormone deficiency and an even higher incidence of congenital hypothyroidism. These children would benefit from health professionals having a broader understanding of their conditions. This article--the third in the endocrinology nursing series--aims to disseminate information and educate colleagues in children's nursing to raise the profile of children with long-term endocrine conditions.

An overview of the nursing issues involved in caring for a child with adrenal insufficiency.

Adrenal insufficiency is an endocrine condition defined as the inadequate production or action of glucocorticoids, principally a steroid hormone called cortisol. While rare in childhood, it carries the risk of adrenal crisis in the event of a child becoming unwell as a result of intercurrent illness, injury or surgery. Children's nurses must be vigilant in caring for a child with adrenal insufficiency and have a clear understanding and awareness of the principles of emergency management at home and in hospital.

An introduction to growth and atypical growth in childhood and adolescence.

This is the first of a series of continuing professional development articles that provide insight into the sphere of practice of paediatric endocrinology nurse specialists. The article is aimed at registered nurses and nursing students who are interested in reviewing their knowledge of normal childhood growth and exploring potential reasons for, and consequences of, atypical growth. It discusses the stages and physiology of growth through childhood and adolescence. There is a focus on auxology, reviewing usual and more specialist measurement and assessment techniques used to collect data on a child's growth. Potential causes of atypical growth are explored, which may present as tall or short stature, requiring referral to specialist services.

Catalytic, enantioselective intramolecular hydroamination of primary amines tethered to di- and trisubstituted alkenes.

The in situ preparation of chiral amido alkyl ate yttrium complexes from an array of chiral N-benzyl-like-substituted binaphthyldiamines is reported. These chiral heteroleptic complexes are shown to be efficient catalysts for the enantioselective intramolecular hydroamination of primary amines tethered to sterically demanding alkenes at high reaction temperatures. Fine tuning of their chiral environment allowed up to 77% ee to be reached for the cyclization of aminoalkenes bearing 1,2-dialkyl-substituted carbon-carbon double bonds. These chiral complexes also demonstrate the ability to promote the cyclization of amine-tethered trisubstituted alkenes in up to 55% ee, as the first report of the formation of enantioenriched quaternary centers by an hydroamination reaction.

Synthesis of rare earth catalysts and their applications for enantioselective synthesis of heterocyclic ß-amino alcohols.

A new family of chiral lanthanide complexes derived from (R)-binaphthol has been synthesized by a one-pot procedure using only commercially available substrates. These complexes were evaluated for the aminolysis of meso-epoxides and proved to be efficient enantioselective catalysts. The samarium complex coordinated by two (R)-binaphthoxide ligands was the most enantioselective catalyst of this series. ß-Amino alcohols including heterocycles have been isolated with enantiomeric excesses up to 84%.

Well-defined and easily accessible yttrium complexes for enantioselective cyclisation of amines tethered to 1,2-di-substituted alkenes.

A straightforward in situ preparation of new chiral amido alkyl ate yttrium complexes is described. They catalysed the enantioselective cyclisation of 1,2-dialkyl-substituted aminopentenes in up to 77% ee, a significant value for this challenging transformation. Complex [(R)-L(0)][Y(CH(2)TMS)(2).Li(THF)(4)] undergoes C-H bond activation resulting in the formation of an original dimeric heterobimetallic yttrium complex which also acts as an active precatalyst.

Laparoscopic-assisted resection of a giant colonic diverticulum: a case report.

INTRODUCTION: Diverticular disease of the colon is a common benign condition. The majority of patients with diverticular disease are asymptomatic and are managed non-operatively, however complications such as perforation, bleeding, fistulation and stricture formation can necessitate surgical intervention. A giant colonic diverticulum is defined as a diverticulum larger than 4 cm in diameter. Despite the increasing incidence of colonic diverticular disease, giant colonic diverticula remain a rare clinical entity. CASE PRESENTATION: This is the first reported case of laparoscopic-assisted resection of a giant colonic diverticulum. We discuss the symptoms and signs of this rare complication of diverticular disease and suggest investigations and management. Reflecting on this case and those reported in the literature to date, we highlight potential diagnostic difficulties and consider the differential diagnosis of intra-abdominal gas-filled cysts. CONCLUSION: The presence of a giant colonic diverticulum carries substantial risk of complications. Diagnosis is based on history and examination supported by abdominal X-ray and computed tomography findings. In view of the chronic course of symptoms and potential for complications, elective surgical removal is recommended. Colonic resection is the treatment of choice for this condition and, where possible, should be performed laparoscopically.

Convenient method for the rapid generation of highly active and enantioselective yttrium catalysts for asymmetric hydroamination.

A facile method for the preparation of highly active and enantioselective yttrium precatalysts for asymmetric hydroamination of gem-disubstituted aminoalkenes, from the combination of YCl(3) or YCl(3)(THF)(3.5) with ligand (R)- and n-BuLi is described.

New chiral lanthanide amide ate complexes for the catalysed synthesis of scalemic nitrogen-containing heterocycles.

New chiral binaphthylamido yttrium and ytterbium ate complexes with lithium and potassium counterions have been synthesised and characterised. X-ray structures have been obtained for [Li(thf)4][Ln{(R)-C20H12(NC5H9)2}2] (Ln=Yb, Y) and [K(thf)5][Yb{(R)-C20H12(NCH2CMe3)2}2] as isostructural complexes. The efficiency of these complexes for the enantioselective intramolecular hydroamination was examined. [Li(thf)4][Yb{(R)-C20H12(NC5H9)2}2] afforded the highest enantiomeric excess (up to 87 %) for the synthesis of a spiropyrrolidine, while [Li(thf)4][Y{(R)-C20H12(NC5H9)2}2] proved to be slightly more active. The role of the counter cation in the active catalytic species was evidenced by the comparison between lithium and potassium ate complexes. The most active catalyst of this series, [Li(thf)4][Yb{(R)-C20H12(NCH2CMe3)2}2], was successfully used for the cyclisation of aminopentenes with internal double bonds.

Asymmetric hydroamination of non-activated carbon-carbon multiple bonds.

The catalysed enantioselective formation of carbon-nitrogen bonds by the hydroamination reaction is reviewed. All examples deal with substrates containing non-activated carbon-carbon multiple bonds which are transformed either via intramolecular or intermolecular reactions. Structurally different complexes already provided nitrogen containing compounds/heterocycles with high enantioselectivities.

Enantioselective intramolecular hydroamination catalyzed by lanthanide ate complexes coordinated by N-substituted (R)-1,1'-binaphthyl-2,2'-diamido ligands.

Ytterbium and lutetium ionic complexes derived from enantiopure substituted (R)-binaphthylamine ligands, of the general formula [Li(THF)n][Ln[(R)-C20H12(NR)2]2], have been investigated for the hydroamination/cyclization of several aminopentenes and an aminohexene. Complexes with isopropyl or cyclohexyl substituents on nitrogen atoms were found to be efficient catalysts under mild conditions for the formation of N-containing heterocycles with enantiomeric excesses up to 78%.