Translation of the Diabetes Knowledge Questionnaire into French and its validation / Traduction et validation en langue française de l'instrument « Diabetes Knowledge Questionnaire ¼

Introduction: Improving patients' knowledge of diabetes would support adherence to treatment, prevent complications, and promote shared decision-making. Healthcare professionals need to assess patients' knowledge using a validated questionnaire in the local language. Objective: The aim of the study was to translate the Diabetes Knowledge Questionnaire from English to French and assess the psychometric properties of the translated version. Methods: A cross-sectional method was used. Individuals with diabetes were recruited from diabetes clinics, as well as dialysis units, since approximately 30 percent of dialysis patients have diabetes. Participants with type 1 or type 2 diabetes completed the translated questionnaire. The questionnaire targeted both groups, with additional questions for those with type 1 diabetes. Reliability and validity were assessed according to COSMIN approach. Results: Analysis of the translated questionnaire (n=102) showed good internal consistency (α=0.77), similar to the original questionnaire. The removal of an item on the self-monitoring of blood glucose increased the α Cronbach coefficient by 0.03. Discussion: Despite its validation, the questionnaire should be updated according to new clinical and medical recommendations to ensure consistency between the desired knowledge and the intended goals of care. Conclusion: The French version of the Diabetes Knowledge Questionnaire demonstrated good validity and reliability. It can be used in practice and research, after deleting item 9.

Introduction: L'amélioration des connaissances des patients sur le diabète pourrait soutenir leur adhésion au traitement, prévenir les complications et favoriser la prise de décision partagée. Les professionnels de la santé ont besoin d'évaluer les connaissances des patients à l'aide d'un questionnaire validé dans la langue locale. Objectif: L'étude avait pour but de traduire le Diabetes Knowledge Questionnaire en français et d'évaluer les qualités psychométriques de la version traduite. Méthodes: Dans cette étude transversale, les personnes diabétiques ont été recrutées dans les services de diabétologie, ainsi que dans les services de dialyse, car environ 30 % des patients dialysés sont diabétiques. Les participants diabétiques de type 1 ou 2 ont répondu au questionnaire traduit, le questionnaire s'adressant aux deux populations, avec des questions supplémentaires pour les diabétiques de type 1. La fidélité et la validité ont été évaluées selon la démarche COSMIN. Résultats: L'analyse du questionnaire traduit (n = 102) a montré une bonne cohérence interne (α = 0,77), similaire au questionnaire d'origine. La suppression d'un item portant sur les autocontrôles de glycémie a augmenté le coefficient α Cronbach de 0,03. Discussion: Malgré sa validation, le questionnaire mériterait une mise à jour selon les nouvelles pratiques et recommandations médicales, pour garantir une cohérence entre les connaissances souhaitées et les objectifs de soins visés. Conclusion: La version française du Diabetes Knowledge Questionnaire a démontré une bonne validité et fidélité, et peut être utilisée dans la pratique et la recherche, après la suppression de l'item n° 9.

"Undergraduate students' perceptions of learning nursing theories: A descriptive qualitative approach".

AIM: This study examined undergraduate students' perceptions of learning nursing theories and the contribution of these theories to clinical practice. BACKGROUND: Nursing theories are the foundation of the discipline. Students' perceptions of learning nursing theories are under-investigated. DESIGN: This descriptive study used a qualitative approach with five questions survey and group narratives. METHODS: 163 first-year nursing students (female= 85%) participated in the study. Participants chose the best-fit theory to answer individually questions on the contribution of six learnt theories (McGill Model of Nursing, Self-Care Deficit Nursing Theory, Theory of Humanbecoming, Theory of Interpersonal Relations, Adaptation Model of Nursing and Theory of Human Caring) to their clinical practice. They discussed their answers in groups and provided group narratives. RESULTS: Responses of 163 participants showed no theory to be predominant. Narratives' analysis revealed four themes: Pluralism in the view of nursing theories, Dualism in the view of nursing practice, Monism in the view of the person and Learning based on personal values and social context. CONCLUSIONS: Students recognize the plurality of theories and the Person holistically. Teaching nursing theory in the undergraduate program should support the use of theoretical knowledge relevant to practice and promote its direct application during clinical training. TWEETABLE ABSTRACT: This study examined undergraduate students' perceptions of learning nursing theories using a qualitative approach. Narratives revealed Pluralism in the view of theories, Dualism in the view of practice, Monism in the view of the person and Learning based on personal values and social context.

A Multidisciplinary Approach for Improving Quality of Life and Self-Management in Diabetic Kidney Disease: A Crossover Study.

Individuals with diabetic kidney disease are at high risk of complications and challenged to self-manage. Previous research suggested that multidisciplinary approaches would improve health outcomes. This study investigated the effect of a multidisciplinary self-management approach of diabetic kidney disease on quality of life, and self-management, glycemic control, and renal function. A uniform balanced crossover design was used because it attains a high level of statistical power with a lower sample size. A total of 32 participants (aged 67.8 ± 10.8) were randomized into four study arms. In differing sequences, each participant was treated twice with three months of usual care alternated with three months of multidisciplinary management. The intervention improved the present dimension of quality of life demonstrating higher mean rank as compared to usual care (52.49 vs. 41.01; p = 0.026, 95% CI) and three self-care activities, general diet habits, diabetes diet habits, and blood sugar testing (respectively: 55.43 vs. 38.31; p = 0.002, 56.84 vs. 37.02; p = 0.000, 53.84 vs. 39.77; p = 0.008; 95% CI). Antihypertensive medication engagement was high across the study period (Mean = 95.38%, Min = 69%, Max = 100%). Glycemic control and renal function indicators were similar for the intervention and the usual care. Studies are needed to determine how the new recommended therapies for diabetic kidney disease such as SGLT2 inhibitors and GLP-1 receptor agonists impact on self-management and quality of life.

Multidisciplinary management of diabetic kidney disease: a systematic review and meta-analysis.

BACKGROUND: The increasing prevalence of diabetes poses significant challenges to healthcare systems around the world. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease (DKD) is becoming a global health concern because it is a progressive disease associated with major health complications and increased health costs. The treatment goals for DKD are to slow the progression of the renal disease and prevent cardiovascular events. Accordingly, patients are expected to adhere to prescribed treatments and manage a wide range of daily self-care activities. Multidisciplinary management of chronic diseases, like diabetes and kidney disease, has been suggested as a means to improve patients' adherence to treatment and enhance health-related outcomes. This systematic review of multidisciplinary management of DKD is an important step in evaluating if such a management approach is effective in delaying disease progression. OBJECTIVES: The goal of this systematic review was to identify the best available evidence regarding multidisciplinary management of DKD and to determine if a multidisciplinary management of DKD can improve patient outcomes. Specifically the review question was: What is the impact of multidisciplinary management of DKD on patient outcomes? INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered adults aged 18 years and older who had been diagnosed with type 1 or type 2 diabetes and chronic kidney disease. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The current review examined studies that compared multidisciplinary interventions with usual standard care in ambulatory settings for patients with DKD. OUTCOMES: The current review considered studies with the following primary outcomes: kidney function, incidence of kidney failure, generic or specific health-related quality of life, patient self-care abilities, adherence to treatment recommendations or goals; and the following secondary clinical outcomes: mortality rates secondary to DKD, glycemic control, blood pressure (BP) control, lipid profile, incidence of cardiovascular disease/events, patient knowledge on diabetes or DKD, patient empowerment or self-efficacy, generic or specific patient satisfaction with care and patient healthcare utilization. TYPES OF STUDIES: The current review will consider randomized and quasi-experimental trials but included only randomized controlled trials (RCTs). SEARCH STRATEGY: A three-step search strategy was utilized starting with a search of MEDLINE and CINAHL for the identification of keywords, followed by a search using keywords and index terms across MEDLINE, CINAHL and Embase databases and clinical trials registry platforms, and finally a search of the reference list of all identified papers. Studies published from the time of the respective database inception to November 2014 in English, German and French were considered. METHODOLOGICAL QUALITY: Two independent reviewers assessed the methodological validity of the papers prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Quantitative data were pooled using the RevMan 5 software for kidney function using estimated Glomerular Filtration Rate (eGFR), glycated hemoglobin, BP and total cholesterol (TC). Results were considered significant for P < 0.05. RESULTS: Three RCTs were included in this review. Meta-analysis showed that multidisciplinary management was associated with a statistically significant improvement of glycated hemoglobin as compared with standard usual care (Relative Risk [RR] -0.49, at 95% confidence interval [CI] -0.83, -0.16, P < 0.01). The meta-analysis for eGFR showed a tendency to favor standard care; however, this finding cannot be conclusive because the CI was too wide (RR -3.30, at 95% CI -6.55, -0.05, P = 0.05). Meta-analysis results for BP and TC failed to show a difference between the multidisciplinary management of DKD and the usual standard care. Only one study measured patient-oriented primary and secondary outcomes and showed an improvement in health-related quality of life, patient self-care abilities, patient level of knowledge on diabetes and exercise self-efficacy. CONCLUSION: Multidisciplinary management of DKD has the potential for improving glycemic control and thus preventing complications. Its effect on other clinical and patient-oriented outcomes, especially on delaying the progression of the disease through preserving and preventing the decline in kidney function, has yet to be determined. There is not enough evidence to recommend multidisciplinary management for preserving kidney function. Further studies are needed.

The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control, and renal function in diabetic kidney disease: A Cross-over Study Protocol.

BACKGROUND: Diabetic kidney disease, a global health issue, remains associated with high morbidity and mortality. Previous research has shown that multidisciplinary management of chronic disease can improve patient outcomes. The effect of multidisciplinary self-care management on quality of life and renal function of patients with diabetic kidney disease has not yet been well established. METHOD/DESIGN: The aim of this study is to evaluate the impact of a multidisciplinary self-care management program on quality of life, self-care behavior, adherence to anti-hypertensive treatment, glycemic control, and renal function of adults with diabetic kidney disease. A uniform balanced cross-over design is used, with the objective to recruit 40 adult participants with diabetic kidney disease, from public and private out-patient settings in French speaking Switzerland. Participants are randomized in equal number into four study arms. Each participant receives usual care alternating with the multidisciplinary self- care management program. Each treatment period lasts three months and is repeated twice at different time intervals over 12 months depending on the cross-over arm. The multidisciplinary self-care management program is led by an advanced practice nurse and adds nursing and dietary consultations and follow-ups, to the habitual management provided by the general practitioner, the nephrologist and the diabetologist. Data is collected every three months for 12 months. Quality of life is measured using the Audit of Diabetes-Dependent Quality of Life scale, patient self-care behavior is assessed using the Revised Summary of Diabetes Self-Care Activities, and adherence to anti-hypertensive therapy is evaluated using the Medication Events Monitoring System. Blood glucose control is measured by the glycated hemoglobin levels and renal function by serum creatinine, estimated glomerular filtration rate and urinary albumin/creatinine ratio. Data will be analyzed using STATA version 14. DISCUSSION: The cross-over design will elucidate the responses of individual participant to each treatment, and will allow us to better evaluate the use of such a design in clinical settings and behavioral studies. This study also explores the impact of a theory-based nursing practice and its implementation into a multidisciplinary context. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01967901 , registered on the 18th of October 2013.

Predicting falls using two instruments (the Hendrich Fall Risk Model and the Morse Fall Scale) in an acute care setting in Lebanon.

AIMS AND OBJECTIVES: To assess the predictive value of two instruments (the Morse Fall Scale (MFS) and the Heindrich II Fall Risk Model (HFRM)] in a Middle Eastern country (Lebanon) and to evaluate the factors that are related to falls. DESIGN: A prospective observational cross-sectional design was used. BACKGROUND: Falls and fall-related injuries in the acute care settings contribute a substantial health and economic burden on patients and organisations. Preventing falls is a priority for most healthcare organisations. While the risk of falling cannot be eliminated, it can be significantly reduced through accurate assessment of patients' risk of falling. METHODS: Data from 1815 inpatients at the American University of Beirut Medical Center (AUBMC) in Lebanon were evaluated using two instruments to predict falls: the MFS and the HFRM. RESULTS: The incidence of falls was 2·7% in one year. The results indicate that while the instruments were significantly correlated, the HFRM was more sensitive in predicting falls than the MFS. The internal consistency of both scales was moderate, but inter-rater reliability was high. Patients using antiepileptic drugs and assistance devises had higher odds of falling. CONCLUSIONS: Although both instruments were easy to use in a Middle Eastern country, the HFRM rather than the MFS is recommended for inpatients in an acute care setting as it had higher sensitivity and specificity. RELEVANCE TO CLINICAL PRACTICE: It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient.

Statins decrease mortality in Lebanese patients with sepsis: A multicenter study.

BACKGROUND: Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients. OBJECTIVE: The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis. METHODS: A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS. RESULTS: THREE HUNDRED FIFTY ONE LEBANESE PATIENTS WERE INCLUDED (AGE: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). CONCLUSIONS: At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis.

Statins decrease mortality in Lebanese patients with sepsis: A multicenter study / Las estatinas disminuyen la mortalidad en pacientes libaneses con sepsis: estudio multicéntrico

Background: Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients. Objective: The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis. Methods: A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS. Results: Three hundred fifty one Lebanese patients were included (age: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). Conclusion: At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis (AU)

Antecedentes: La sepsis es un significativo problema de salud pública. La respuesta clínica a las estatinas es variable entre los pacientes con sepsis. Objetivo: El objetivo del estudio fue determinar el efecto del tratamiento con estatinas en la mortalidad de pacientes libaneses con sepsis. Métodos: Se realizó un estudio multicentrico retrospectivo en pacientes libaneses con sepsis entre enero 2008 y marzo 2012. Se incluyeron los pacientes con un diagnóstico primario de sepsis ingresados en la unidad de cuidados intensivos de dos hospitales de Beirut. Se incluyó en el grupo de tratamiento a los pacientes que continuaron recibiendo estatinas para dislipidemia durante la estancia hospitalaria. El grupo control consistió en pacientes que no tomaron estatinas. Utilizando análisis univariado, se compararon entre estos dos grupos las características demográficas, signos clínicos, resultados de laboratorio y tratamiento recibido. Se realizó una regresión logística y un análisis de supervivencia con un SPSS. Resultados: Se incluyó a 351 pacientes libaneses (edad 71,33 DE=14,97 años; 56% hombres). Entre ellos, el 30% tomaba estatinas a dosis recomendadas para dislipemia. La comparación de los dos grupos mostró que en el grupo de tratamiento con estatinas: el nivel sérico medio de proteína C-reactiva estaba significativamente disminuido (p=0,050), la estancia en UCI significativamente aumentada (p=0,047) y la mortalidad significativamente reducida (p<0,001). Los resultados se confirmaron con una regresión Antecedentes: La sepsis es un significativo problema de salud pública. La respuesta clínica a las estatinas es variable entre los pacientes con sepsis. Objetivo: El objetivo del estudio fue determinar el efecto del tratamiento con estatinas en la mortalidad de pacientes libaneses con sepsis. Métodos: Se realizó un estudio multicentrico retrospectivo en pacientes libaneses con sepsis entre enero 2008 y marzo 2012. Se incluyeron los pacientes con un diagnóstico primario de sepsis ingresados en la unidad de cuidados intensivos de dos hospitales de Beirut. Se incluyó en el grupo de tratamiento a los pacientes que continuaron recibiendo estatinas para dislipidemia durante la estancia hospitalaria. El grupo control consistió en pacientes que no tomaron estatinas. Utilizando análisis univariado, se compararon entre estos dos grupos las características demográficas, signos clínicos, resultados de laboratorio y tratamiento recibido. Se realizó una regresión logística y un análisis de supervivencia con un SPSS. Resultados: Se incluyó a 351 pacientes libaneses (edad 71,33 DE=14,97 años; 56% hombres). Entre ellos, el 30% tomaba estatinas a dosis recomendadas para dislipemia. La comparación de los dos grupos mostró que en el grupo de tratamiento con estatinas: el nivel sérico medio de proteína C-reactiva estaba significativamente disminuido (p=0,050), la estancia en UCI significativamente aumentada (p=0,047) y la mortalidad significativamente reducida (p<0,001). Los resultados se confirmaron con una regresión (AU)

Adverse drug events associated with vitamin K antagonists: factors of therapeutic imbalance.

BACKGROUND: Adverse drug events (ADE) occur frequently during treatment with vitamin K antagonists (AVK) and contribute to increase hemorrhagic risks. METHODS: A retrospective study was conducted over a period of 2 years. Patients treated with AVK and admitted to the emergency room of a tertiary care hospital in Beirut were included. The aim of the study was to identify ADE characterized by a high international normalized ratio (INR) and to determine the predictive factors responsible for these events. Statistical analysis was performed with the SPSS statistical package. RESULTS: We included 148 patients. Sixty-seven patients (47.3%) with an INR above the therapeutic range were identified as cases. The control group consisted of 81 patients (54.7%) with an INR within the therapeutic range. Hemorrhagic complications were observed in 53.7% of cases versus 6.2% of controls (P < 0.0001). No significant difference was noticed between cases and controls regarding the indication and the dose of AVK. Patients aged over 75 years were more likely to present an INR above the therapeutic range (58.2%, P = 0.049). Recent infection was present in 40.3% of cases versus 6.2% of controls (P < 0.0001) and hypoalbuminemia in 37.3% of cases versus 6.1% of controls (P < 0.0001). Treatment with antibiotics, amiodarone, and anti-inflammatory drugs were also factors of imbalance (P < 0.0001). CONCLUSION: Many factors may be associated with ADE related to AVK. Monitoring of INR and its stabilization in the therapeutic range are important for preventing these events.

Variation of postprandial PYY 3-36 response following ingestion of differing macronutrient meals in obese females.

AIM: This study investigated the effect of macronutrient composition of meals on postprandial peptide YY(3-36) (PYY(3-36)) response in obese hyperinsulinemic females. METHODS: Eight obese females consumed three iso-energetic meals of different macronutrient composition, high carbohydrate (HC; 60% CHO, 20% protein, 20% fat), high fat (HF; 30% CHO, 20% protein, 50% fat) and high protein (HP; 30% CHO, 50% protein, 20% fat), on three separate occasions, 1 month apart. PYY(3-36), insulin and glucose were measured before and 15, 30, 60, 120 and 180 min following each meal. RESULTS: PYY(3-36) levels increased significantly following the three meals, with the HC meal resulting in a sustained postprandial increase in PYY(3-36) level throughout the experimental period. Comparing the three meals, the HF meal induced a significantly higher increase in postprandial PYY(3-36) levels, at 15 and 30 min as compared to the HP meal (p < 0.05), whereas the postprandial increase following the HP meal became significantly higher than that following the HF meal at 120 min. Postprandial increase in PYY(3-36) was highest in the first hour following the HF meal, while that following the HP meal was delayed by 1 h. CONCLUSION: Increasing both protein and fat content of a meal may induce an immediate and prolonged increase in PYY(3-36), resulting in increased satiety and its maintenance for a longer period of time.