Fifteen patients began insulin treatment in a diabetic day-care unit and 14 patients began insulin treatment in hospital. The cost per patient of initiating insulin treatment in hospital was nine times the cost in a day-care program. In general, the disease of patients with juvenile-onset diabetes was initially under poorer control in those admitted to hospital than in those in the day-care program. However, the day-care juvenile with disease under poorest control was comparable to the most severely affected patient admitted to hospital. No major differences in the improvements in control achieved by the two programs were found.

Adolescent↗

PubMed1976

The diabetic day-care unit. I. Development of an index to evaluate diabetes control.

In order to measure the effect of a diabetic day-care unit on diabetes control two scoring scales were constructed, one for insulin-dependent diabetics and the other for patients managed by diet or oral agents or both. Both scales were based on observations of blood and urine glucose concentrations, ketonuria, symptoms of diabetes and deviation from ideal weight. The scale for insulin-dependent diabetics also included the frequency and severity of insulin reactions and frequency of hospital admission for acidosis. Scores for 45 insulin-dependent patients and for 55 diabetics treated by diet with or without oral agents in the unit indicated significant improvement in diabetes control in both groups.

Administration, Oral↗

PubMed1976

Medical manpower: criteria for surveillance.

A physician manpower surveillance project, undertaken in the Canadian province of Ontario, is presented as a feasible prototype, using five essential critera: 1. Personal data and population information must be linked. 2. Corresponding geographic jurisdictions must be small enough to permit the identification of manpower trends in catchment areas at the community level. 3. The type of practice must be distinguished into at least two categories: primary care physicians and second-line physicians. 4. Personal and educational data must be kept to a minimum. 5. Surveillance determinations must be made frequently, with prompt publication of data.

Canada↗

PubMed1975

The psychosomatic approach in the practice of medicine.

The psychosomatic approach requires of the practitioner broad knowledge and skills relevant to the psychosocial, metabolic and physical responses of patients. The approach, being holistic, becomes appropriate in many different clinical situations (and should not be restricted to a few so-called psychosomatic diseases). Wise physicians and perceptive laymen have recognized the validity of an holosomatic approach for over 4000 years. Although the prevalence and incidence of psychosomatic disturbances are difficult to estimate (and probably underestimated in many surveys), data support the statement that family physicians should employ a psychosomatic approach in at least 15 per cent of cases. The general internist will probably encounter primarily psychosomatic disturbances in about 30 per cent of his patients; for example, many common presenting symptoms such as fatigue and chest pain arise in a setting of psychological stress. Apart from a sound knowledge of the genesis and manifestations of metabolic and structural changes, the physician must be familiar with the causes and symptoms of psychological disorders. Skillful interviewing and histroy-taking provide the data necessary to analyze and unravel psychosomatic interplay. Psychotherapeutic interviews often enable both the patient and the physician to understand the clinical problem: this understanding appears to aid recovery.

Behavior Therapy↗

PubMed1975