Investigation of the relationship between patient empowerment and glycaemic control in patients with type 2 diabetes: a cross-sectional analysis.

OBJECTIVE: To determine whether there is an association between patient empowerment and diabetes management in terms of the primary outcomes of metabolic control as measured by glycaemic control (glycated haemoglobin, HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and triglycerides. DESIGN: Retrospective cross-sectional analysis conducted in 2012. SETTING: Data from Diabetes Federation of Ireland from participants enrolled in the Community Orientated Diabetes Education (CODE) Programme. PARTICIPANTS: 569 patients diagnosed with type 2 diabetes. EXPOSURES: Patient empowerment levels, as measured by the Diabetes Empowerment Scale-Short Form. Additional information collected included patients' gender, age, body mass index (BMI), smoking status and number of years with diabetes. OUTCOME MEASURES: HbA1c, HDL, LDL, TC and triglycerides values. RESULTS: Partial correlation analyses failed to show any statistically significant relationship between patient empowerment and glycaemic control or other diabetes management variables (HbA1c, p=0.32; HDL, p=0.95; LDL, p=0.77; TC, p=0.49; triglycerides, p=0.77). Logistic regression analysis confirmed that patient empowerment score was not a significant predictor of level of glycaemic control. Time since diagnosis of diabetes was associated with increased HbA1c levels. Age and gender were significant predictors of HDL and LDL levels, while gender and age were associated with changes in TC and triglycerides levels, respectively. CONCLUSIONS: No significant association was found between patient empowerment levels and other measures of diabetes control in this study. Further research into the short-term and long-term outcomes of the empowerment model, at different levels of disease management, and across different settings, is required to evaluate its value in the management of patients with diabetes.

Student nurses' intention to get the influenza vaccine.

INTRODUCTION: There is no national or international recommendation for nursing students to receive the influenza vaccine. Nurses are among the group of health professionals who traditionally have a low uptake of the vaccine and who arguably have the closest contact with patients. AIM: To investigate the uptake of influenza vaccination among student nurses, explore reasons for either declining or receiving it in the past, and establish if and to what extent the theory of planned behaviour (TPB) can explain vaccination behaviour. METHODS: A quantitative, descriptive, correlational design was used. Data were collected with a researcher-developed questionnaire; 131 student nurses participated. Ethical approval was gained. RESULTS: 79% (n=104) had never received the vaccine. The most common reason was 'I don't need it as I rarely get ill'. Low mean 'intention' scores indicated that students were unlikely to get the vaccine once qualified. Past behaviour was significantly associated with future intentions. The TPB explained 41.9% of the variance in intention. Attitude emerged as the greatest predictor. CONCLUSION: Student nurses do not have strong intentions to get the vaccine. Results serve to guide future educational and occupational health initiatives, which would benefit from a framework based on TPB.

Quality-assured screening for diabetic retinopathy delivered in primary care in Ireland: an observational study.

BACKGROUND: At present, there is no national population-based retinopathy screening programme for people in Ireland who have diabetes, such as those operating in the UK for over a decade. AIM: To evaluate a community-based initiative that utilised existing resources in general practice and community optometry/ophthalmology services to provide screening for diabetic retinopathy. DESIGN AND SETTING: Cross-sectional study using electronic ophthalmic patient screening records in community optometry clinics in Cork, Ireland. METHOD: A purposive sample of 32 practices was recruited from Diabetes in General Practice, a general practice-led initiative in the South of Ireland. Practices invited all adult patients registered with diabetes to participate in free retinopathy screening (n = 3598), provided by 15 community optometry practices and two community ophthalmologists. Data were recorded on an electronic database used by optometrists and the performance was benchmarked against proposed national standards for retinopathy screening. RESULT: In total, 30 practices participated (94%). After 6 months, 49% of patients (n = 1763) had been screened, following one invitation letter and no reminder. Forty-three per cent of those invited consented to their data being used in the study and subsequent analyses are based on that sample (n = 1542). The mean age of the patients screened was 65 years (standard deviation = 13.0 years), 57% were male (n = 884), and 86% had type 2 diabetes (n = 1320). In total, 26% had some level of retinopathy detected (n = 395); 21% had background retinopathy (n = 331), 3% had pre-proliferative retinopathy (n = 53), and 0.7% had proliferative retinopathy (n = 11). CONCLUSION: The detection of retinopathy among 26% of those screened highlights the need for a national retinopathy screening programme in Ireland. Significant learning, derived from the implementation of this initiative, will inform the national programme.

Practice nurses and general practitioners: perspectives on the role and future development of practice nursing in Ireland.

AIMS AND OBJECTIVES: To explore the role dimensions, competence and professional development needs of practice nurses in Ireland from both the general practitioner's and practice nurse's perspective and highlight any agreement/disagreement between the professions. BACKGROUND: Economic pressure on healthcare delivery is promoting a re-evaluation of professional roles and boundaries. This coupled with a primary care sector that is evolving prompted an investigation into the role dimensions and competence of the practice nurse. There is a lack of empirical data comparing the general practitioner's and practice nurse's perspective on the current role of the nurse, clinical competence (existing and required), strategic direction for the role and continuing professional development. DESIGN: A descriptive cross-sectional survey design was used. METHODS: A random sample of general practitioners (n = 414) and a purposeful sample of practice nurses (n = 451) participated. Data from each profession were analysed and comparisons drawn. RESULTS: General practitioners and practice nurses agree (±5%) that the nursing role is centred on immunisation, direct clinical care and elements of chronic disease management. However, in some areas such as preconceptual advice, family planning, advice on menopause, continence promotion and research, there was a 30% difference between the general practitioners perceptions of the nurse's involvement and the practice nurse's actual involvement in the role. Perceived competency differed in a number of areas with nurses more likely to indicate competency in health promotion activities. Both disciplines acknowledged that only a minority of practice nurses were competent in audit, research and dealing with 'problems with living' (relationship breakdown, addiction and parenting). CONCLUSION: There is some congruence of opinion among practice nurses and general practitioners in Ireland regarding the current role of the practice nurse. Divergent opinions on the nurses' involvement in a particular aspect of the role may be due to the general practitioners underestimating the nurse's involvement in the role. Training is required in the areas of audit, research and 'problems with living'. RELEVANCE TO CLINICAL PRACTICE: This research provides data for role clarity and evidence-based role development for practice nurses within the context of evolving primary care services. It also indicates how general practitioners perceive the nursing role.

Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives.

BACKGROUND: The aim of the present study was to assess the performance of three primary care-led initiatives providing structured care to patients with Type 2 diabetes in Ireland, a country with minimal incentives to promote the quality of care. METHODS: Data, from three primary care initiatives, were available for 3010 adult patients with Type 2 diabetes. Results were benchmarked against the national guidelines for the management of Type 2 diabetes in the community and results from the National Diabetes Audit (NDA) for England (2008/2009) and the Scottish Diabetes Survey (2009). RESULTS: The recording of clinical processes of care was similar to results in the UK however the recording of lifestyle factors was markedly lower. Recording of HbA1c, blood pressure and lipids exceeded 85%. Recording of retinopathy screening (71%) was also comparable to England (77%) and Scotland (90%). Only 63% of patients had smoking status recorded compared to 99% in Scotland while 70% had BMI recorded compared to 89% in England. A similar proportion of patients in this initiative and the UK achieved clinical targets. Thirty-five percent of patients achieved a target HbA1c of < 6.5% (< 48 mmol/mol) compared to 25% in England. Applying the NICE target for blood pressure (≤ 140/80 mmHg), 54% of patients reached this target comparable to 60% in England. Slightly less patients were categorised as obese (> 30 kg/m²) in Ireland (50%, n = 1060) compared to Scotland (54%). CONCLUSIONS: This study has demonstrated what can be achieved by proactive and interested health professionals in the absence of national infrastructure to support high quality diabetes care. The quality of primary care-led diabetes management in the three initiatives studied appears broadly consistent with results from the UK with the exception of recording lifestyle factors. The challenge facing health systems is to establish quality assurance a responsibility for all health care professionals rather than the subject of special interest for a few.

Formation of rectus sheath hematoma with antibiotic use and warfarin therapy: a case report.

INTRODUCTION: This case is reported to inform physicians of a case of amoxicillin/clavulanate potassium use in a patient taking warfarin and the subsequent alteration (prolongation) in the international normalized ratio (INR) that resulted in the formation of a rectus sheath hematoma (RSH). CASE SUMMARY: A 75-year-old man receiving long-term warfarin therapy developed a lower respiratory tract infection with paroxysmal coughing that was treated with oral amoxicillin 250 mg/clavulanate potassium 125 mg TID for 7 days. In the 3 days after completing antibiotic treatment, he developed increasingly severe lower abdominal pain that was clinically diagnosed as RSH. The patient was admitted to the local hospital for confirmation of the diagnosis and appropriate management. Before this episode, his INR was consistently within therapeutic range (2-3); on admission it had risen to 5.7. His condition was managed conservatively, and he was discharged home 6 days postadmission. DISCUSSION: This case is reported to highlight the potential interaction between warfarin and amoxicillin/clavulanate potassium and subsequent RSH formation. The potential mechanism of the interaction between amoxicillin/clavulanate potassium and warfarin may be either pharmacokinetic (via metabolism in the cytochrome P4S0 system and preferential metabolism of clavulanate potassium in the liver) or pharmacodynamic (via interference with the production of vitamin K-dependent clotting factors II, VI, IX, and X). CONCLUSION: This case of RSH in an elderly patient receiving long-term stable warfarin anticoagulation is probably associated with amoxicillin/clavulanate potassium use and paroxysmal coughing.