Impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses: a qualitative study.

AIMS: To examine the impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses. METHODS: Nine younger (30-49 years) and 11 older (50-70 years) patients with Type 1 diabetes and 14 spouses participated in eight focus groups specific to age and role (patient or spouse). Audio-recorded data were transcribed, coded and analysed using thematic analysis and aided by NVivo software. RESULTS: Qualitative analysis revealed participants perceived continuous glucose monitoring as positively influencing hypoglycaemia management by decreasing spouses' anxiety, vigilance and negative experiences. Participants also described continuous glucose monitoring as promoting collaborative diabetes management and increasing spousal understanding of diabetes, especially when planning and managing pregnancy. Couples' conflicts occurred when (1) patients assumed sole responsibility for continuous glucose monitoring and/or did not respond to night-time glucose alarms and (2) spouses did not understand alarms and felt frustrated and helpless to assist patients. CONCLUSIONS: Our findings suggest that continuous glucose monitoring may positively impact collaborative diabetes management and marital relationships of patients with Type 1 diabetes and their spouses. However, reluctance to collaborate and lack of understanding may contribute to couples' conflicts around continuous glucose monitoring. Our findings have important implications for clinical care and point to the need for interventions that include spouses in continuous glucose monitoring training to increase their understanding of continuous glucose monitoring, minimize risk for spousal conflict and enhance collaborative diabetes management. Further studies are needed to explore these issues in more detail and depth with larger and more diverse populations.

The "noncompliant" transplant patient: a persistent ethical dilemma.

The term noncompliant patient may evoke the image of a difficult, demanding, and troublesome patient. In the transplant environment, patients who are unable or unwilling to adhere to a prescribed plan of treatment raise a number of medical, ethical, and other concerns with respect to individual patient care. Their behavior also raises questions of justice and fairness, especially in light of the limited numbers of transplantable organs available and the very large number of people who are waiting for a transplant. Patients who are unable to do what is necessary to maintain a transplanted organ may create a moral dilemma for the healthcare providers who treat them. This article will (1) attempt to develop a more complete understanding of "patient noncompliance," (2) address concerns that arise both before and after the transplant, and (3) suggest strategies for dealing with noncompliant patients.

Activation of antibacterial silver coatings on surgical implants by direct current: preliminary studies in rabbits.

Staphylococcus aureus contamination on intramedullary silver pins in the femurs of rabbits was decreased 69% by the application of 9 muA for 1 hour of positive direct current/cm2 (9muAH+DC/cm2). Injection of a solution of silver chloride or silver nitrate into the bone marrow before insertion of the contaminated pins and subsequent application of 12 muAH+DC/cm2 to the stainless steel pins reduced the colony counts 25% and 64%, respectively, and indicated a need for the Ag+ and Cl- ionic state on the pins' surfaces. Stainless steel pins electroplated with silver and charged with 12 muAH+DC/cm2 decreased the bacterial counts by 85%. A 91% inhibition with stainless steel pins electroplated with silver and chlorided indicated that bacteriostasis was possible due to the Ag+/AgCl/Cl- surface effect. Total bacterial inhibition was achieved by 12 muAH+DC/cm2 on stainless steel pins coated with 100 monomolecular layers of silver stearate. The electrical activation of this coating eliminated up to approximately 3,000 S aureau contaminating the intramedullary pins.

The benefits and the risks of publicity.

As one of its primary functions, the hospital public relations department weighs the risks of proposed media coverage against its potential benefits in light of the objectives of both parties.

Activated silver coatings for surgical implants.

Increase in current from 1.8 to 3 and then to 9 microAH+DC/cm2 controlled respectively 25%, 37%, and 69% of S aureus on intramedullary silver pins (too soft in practice) in femurs of rabbits. Then optimal current of 12 muAH+DC/cm2 was used. On stainless steel pins with intramedullary injection of AgCl or AgNO3, a 25% or 64% bacterial control was achieved. Stainless steel pin, silver electroplated or electroplated and chloridized gave 85% and 91% bacterial control. One hundred percent of the bacteria was eliminated with stainless steel pins coated with 100 monomolecular layers of silver stearate.

Would you listen to what they're saying.

Particularly at a children's hospital, the views and comments of patients and other publics can be a useful source of ideas in the creation of films, brochures, and other materials used to promote and explain the hospital. The words are frequently there; only the background needs to be provided.