A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes.

We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design. One hundred and sixty-four participants with poorly controlled diabetes from two settings were randomized using computer-generated list into control (n = 82) and intervention (n = 82) groups, of which 151 completed the study. Monthly interventions over 12 weeks addressed the self-care practices of diet, physical activity, medication adherence and self-monitoring of blood glucose (SMBG). These self-care practices were assessed at Weeks 0 and 12 using pre- and post-questionnaires in both groups together with glycated haemoglobin A1c (HbA1c) and diabetes knowledge. In the intention-to-treat analysis (n = 164), the intervention group improved their SMBG (P = <0.001), physical activity (P = 0.001), HbA1c (P = 0.03), diabetes knowledge (P = <0.001) and medication adherence. At Week 12, HbA1c difference adjusted for SMBG frequency, medication adherence and weight change remained significant (P = 0.03) compared with control group. For within group comparisons, diabetes knowledge (P = <0.001), HbA1c level (P = <0.001), SMBG (P = <0.001) and medication adherence (P = 0.008) improved from baseline in the intervention group. In the control group, only diabetes knowledge improved (P = <0.001). These findings can contribute to the development of self-management diabetes education in Malaysia.

Elements of a systematic review.

This paper examines the subject of systematic reviews from a nursing viewpoint. The history of the evidence-based healthcare movement and the major differences between systematic reviews and traditional literature reviews are discussed. The steps of the process used by those conducting reviews are examined in detail. These include structuring a research question, searching and appraising the literature, data extraction, analysis and synthesis, and reporting the results. It is this process that ensures reviews can be considered as a legitimate form of nursing research.

Propofol or midazolam--which is best for the sedation of adult ventilated patients in intensive care units? A systematic review.

Intensive care patients are commonly sedated to maintain comfort and to facilitate life saving therapy. Although sedation is ordered by medical staff, nurses are usually responsible for its administration and titration and thus the question of which drug regime should be chosen is an important practice issue for nurses (1,2). This paper is a report on a systematic review that was conducted to compare the effectiveness of two of the most common drugs used for the sedation of adult ventilated patients in Australian intensive care units (ICUs)--propofol and midazolam (3). All randomised controlled trials (RCTs) which compared propofol with midazolam for the sedation of adult ventilated patients in ICUs were included in the study. The outcome measures evaluated were the quality of sedation achieved, the length of time from cessation of sedation till extubation, recovery time, duration of admission to the ICU and the incidence of haemodynamic complications. Meta-analysis was used to compare results of studies where subjects had the same characteristics and the outcome criteria were measured in the same manner. The review found that infusions of both midazolam and propofol appear to provide similar quality sedation, that extubation time and recovery time is shorter in patients sedated with propofol and that haemodynamic complications related to either drug regime are not usually clinically significant.

Sedation of adult critically ill ventilated patients in intensive care units: a national survey.

The aim of this survey was to review the practice of sedation for adult artificially ventilated patients in Australian intensive care units. In particular, the survey sought to investigate the drugs used, how they were administered, who was responsible for the administration, how sedation was assessed, and if, in the opinion of charge nurses, complications were occurring as a result of their practice. Questionnaires were sent by post to the clinical nurse consultants (CNCs) in charge of 72 units containing five or more beds, as identified in the Hospital Health Services Yearbook. By June 1996, 65 questionnaires had been returned (a 90 per cent response rate). Results showed that the most common form of sedation is a combination of benzodiazepines and narcotics (88 per cent); in particular, morphia (92 per cent) and midazolam (94 per cent). In 79 per cent of units, these drugs are administered by continuous infusion. Neuromuscular blocking agents are no longer commonly used in conjunction with sedation, with the majority of units (88 per cent) indicating occasional use only. Also in the majority of units (94 per cent), nurses are responsible for titrating and administering sedation. The experience of these nurses varied; in 61 per cent of units it ranged from first year post-graduation to the holding of a critical care certificate. In most units (63 per cent), the aim is to lightly sedate patients. Methods of assessing sedation vary, with few units using sedation scales (17 per cent). Twenty six CNCs (40 per cent) reported that, in their opinion, there were no complications related to their practice of sedation. The most common complication reported (by 21 CNCs or 32 per cent) was over-sedation. It appears that there is no consistent method of assessing the level of sedation in critically ill ventilated patients and that over-sedation is common. Therefore, it is recommended that clinicians investigate the possibility of introducing sedation scales in their units. However, the efficacy of such scales in ensuring a more appropriate level of sedation needs to be researched.