Explore the risk perception and evaluate the effectiveness of competency-based intervention (CBI) on knowledge and lifestyle changes among type 2 diabetes mellitus patients.

OBJECTIVE: This is a study to explore the risk perception among T2DM patients and to compare the pre-test and post-test levels of knowledge and lifestyle changes among T2DM patients at selected hospitals in Chennai. Most diabetics have type 2 diabetes, accounting for 85-90% of cases. Diabetes is a worldwide epidemic disease with distressing human, societal, and economic effects. It affects an estimated 382 million people worldwide in 2021. PATIENTS AND METHODS: The research design used mixed-method research, such as Exploratory Sequential Design. The phenomenological approach, in that sequential exploratory design for the qualitative and true experimental design for the quantitative study, was chosen. 60 samples of T2DM patients were selected using a simple random sampling technique through the lottery method and divided into experimental and control groups for every 30 samples in quantitative. Five samples were selected using convenient sampling for qualitative. RESULTS: In the quantitative study, the pre-test showed 4 (13.3%), and 5 (16.7%) adequate knowledge and lifestyle changes in both groups. Post-test experimental group showed that 23 (76.7%) had adequate knowledge and 23 (76.7%) changes in lifestyle found a drastic transformation from the pre-test as well as in the control group. The calculated Chi-square value showed a significant difference in the post-test level of lifestyle change among the T2DM patients between the groups at p<0.001 level. CONCLUSIONS: This inferred that Competent Based Intervention (CBI) on knowledge and lifestyle changes administered to T2DM patients in the experimental group was found to be effective. Competent Based Intervention is a nursing intervention that is well accepted and adopted by patients and easily implemented by nurses. It can be included in the nursing curriculum. In-service education can be arranged once a month for staff nurses and faculty members regarding Competent Based Intervention. The Nurse educator should encourage the nurses to effectively utilize research evidence-based practice related to Competent Based Intervention for patients with type 2 diabetes mellitus.

Suspected common bile duct stones: reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice to remove sludge/stones from the common bile duct (CBD). In a small but clinically important proportion of patients with suspected choledocholithiasis ERCP is negative. This is undesirable because of ERCP associated morbidity. We aimed to map the diagnostic pathway leading up to ERCP and evaluate ERCP outcome. METHODS: We established a prospective multicenter cohort of patients with suspected CBD stones. We assessed the determinants that were associated with CBD sludge or stone detection upon ERCP. RESULTS: We established a cohort of 707 patients with suspected CBD sludge or stones (62% female, median age 59 years). ERCP was negative for CBD sludge or stones in 155 patients (22%). Patients with positive ERCPs frequently had pre-procedural endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) imaging (44% vs. 35%; P = 0.045). The likelihood of ERCP sludge and stones detection was higher when the time interval between EUS or MRCP and ERCP was less than 2 days (odds ratio 2.35; 95% CI 1.25-4.44; P = 0.008; number needed to harm 7.7). CONCLUSIONS: Even in the current era of society guidelines and use of advanced imaging CBD sludge or stones are absent in one out of five ERCPs performed for suspected CBD stones. The proportion of unnecessary ERCPs is lower in case of pre-procedural EUS or MRCP. A shorter time interval between EUS or MRCP increases the yield of ERCP for suspected CBD stones and should, therefore, preferably be performed within 2 days before ERCP.

High frequency of vitamin B12 deficiency in a Brazilian population.

OBJECTIVE: There are few studies regarding vitamin B12 deficiency in developing countries. In Brazil, a late diagnosis of vitamin B12 deficiency progressing to severe neurological damage is common. Thus, the aim of the present study was to verify the frequency of vitamin B12 deficiency in two Brazilian populations (elderly and adult participants) and to compare different methods of vitamin B12 deficiency detection. DESIGN: Five hundred participants were recruited from health centres from south-east Brazil and were separated into two groups: 60 years old or more and 30-59 years old. Vitamin B12 and folate concentrations were measured using electrochemiluminescence immunoassay (ECI) and RIA. Methylmalonic acid (MMA) was measured by LC coupled to tandem MS. Full blood counts were acquired using standard methods. RESULTS: All participants had normal blood count results and mean cell volume less than 99 fl; none of them presented folate deficiency according to the results, which were all greater than 3 ng/ml. Cobalamin levels less than 200 pmol/l were identified by one of the two or by both methods in 7.2 % of the participants aged 60 years or more and 6.4 % of the participants aged 30-59 years. MMA levels were higher in older subjects (P = 0.007) compared with younger subjects. A greater correlation of MMA v. RIA was observed than of MMA v. ECI (P = 0.0017 v. P = 0.014). MMA quantification estimated that cobalamin deficiency was present in more than 11 % of the subjects for both studied groups. CONCLUSIONS: The study shows that vitamin B12 deficiency is frequent in Brazilian adults and suggests that RIA is more sensitive than ECl for measuring cobalamin levels.