Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.

AIMS: To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND: Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS: Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. RESULTS: A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. CONCLUSIONS: Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.

Comparing and contrasting the clinical nurse specialist and the advanced nurse practitioner roles.

There is currently a great deal of ambiguity regarding the difference between the role of clinical nurse specialist and advanced nurse practitioner. In distinguishing one title from another, factors such as the educational requirements of such, what the role involves, who the client is and whether the role encroaches on a doctor's role are discussed. This paper sets out the factors that are seen by some as significant in distinguishing between a clinical nurse specialist and advanced nurse practitioner.

The role of the infection control nurse as a clinical nurse specialist or advanced nurse practitioner.

The specialty of infection control is examined regarding the role of the infection control nurse and the educational requirements for practitioners in this field in relation to post titles of clinical nurse specialist and advanced nurse practitioner. Whilst not fulfilling all the role constituents of a clinical nurse specialist, the infection control nurse is seen as more akin to a clinical nurse specialist than an advanced nurse practitioner.

MRSA in the critically ill.

MRSA colonization and infection rates were prospectively examined over an 18 month period in a general Intensive Care Unit. Of 642 admissions, 305 were in ICU for longer than 48 h and were hence included and a further three patients were already colonized at admission but stayed less than 48 h. Ninety-seven patients were colonized with MRSA including 19 who were already colonized at admission. There were 56 episodes of clinical infection in 43 patients. The mortality rates in the colonized and infected groups, were 14.8% and 16.2% respectively, while the rate in those not colonized was 23%. These figures were not statistically different. Those colonized or infected with MRSA had significantly longer ICU stays than those not colonized. Sputum colonization and infection was a major site for MRSA. There was diagnostic certainty of MRSA infection in 40% of cases emphasizing the difficulty in diagnosis of infection due to MRSA in the critically ill. Both colonization and infection with MRSA are associated with longer ICU stay but do not appear to influence mortality.

Computerised databases in infection control.

The use of databases in health care is expanding. Systems are now available specifically designed for the management of infection control information. This article examines the expanding role of such databases and looks at the advantages and disadvantages for nurses.

The sensitive detection of fluorescently labelled PCR products using an automated detection system.

The polymerase chain reaction plays a central role in many detection assays and methods to improve the sensitivity and specificity of these detection systems are constantly being explored. In this study we investigated the use of an automated laser fluorescent system (ALF) in the context of DNA-based diagnostics for pathogenic bacteria. PCR products were generated using species-specific primer sets, one of which was labelled with a 5' fluorescein. PCR products with a fluorescent label were detected on line with an ALF DNA sequencer and the sensitivity of detection was found to be comparable to that for DNA probe hybridization with a radioactive probe. The technology was successfully applied to the detection of Mycobacterium tuberculosis supplemented into sputum samples and to the detection of listeria in paraffin-embedded tissue samples.