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At least 19 recordsLinked to original sources
PubMed1997

Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes.

AIMS: To define outcome measures for auditing the clinical care of children and adolescents with insulin dependent diabetes mellitus (IDDM) and to assess the benefit of appointing a dedicated paediatric trained diabetes specialist nurse (PDSN). METHODS: Retrospective analysis of medical notes and hospital records. Glycaemic control, growth, weight gain, microvascular complications, school absence, and the proportion of children undergoing an annual clinical review and diabetes education session were assessed. The effect of the appointment of a PDSN on the frequency of hospital admission, length of inpatient stay, and outpatient attendance was evaluated. RESULTS: Children with IDDM were of normal height and grew well for three years after diagnosis, but grew suboptimally thereafter. Weight gain was above average every year after diagnosis. Glycaemic control was poor at all ages with only 16% of children having an acceptable glycated haemoglobin. Eighty five per cent of patients underwent a formal annual clinical review, of whom 16% had background retinopathy and 20% microalbuminuria in one or more samples. After appointing the PDSN the median length of hospital stay for newly diagnosed patients decreased from five days to one day, with 10 of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median of 19 to 10%. CONCLUSIONS: Outcome measures for evaluating the care of children with IDDM can be defined and evaluated. Specialist nursing support markedly reduces the length of hospital stay of newly diagnosed patients without sacrificing the quality of care.

Adolescent↗
PubMedDate not supplied

Evaluation of a paediatric diabetes specialist nurse post.

The specialist nurse caring for children with diabetes is widely recognized as a valued member of the paediatric diabetes team. However, there has been minimal exploration or examination of the clinical role of the paediatric diabetes specialist nurse (PDSN). This in-depth evaluation critically examines the impact of a PDSN post, comparing data from the first 2 years of the post against corresponding data from the previous 2 years. Results are encouraging, showing that much has been achieved. Home management was successfully introduced, length of stay was halved for newly diagnosed children initially hospitalized, suggested guidelines for length of stay for readmissions were met, age-banded education sessions were implemented and clinic non-attendance was substantially reduced. The readmission rate for children with established diabetes was increased, and reasons for this are discussed outlining intervention being introduced to proactively address this problem. The findings from this evaluation support the belief that PDSNs, as members of a multidisciplinary team, make a substantial and valuable contribution to paediatric diabetes care.

Adolescent↗
PubMed1990

Is a specialist paediatric diabetic clinic better?

Diabetic control in 88 children attending three general paediatric clinics was compared prospectively over one year with that of 89 children attending a specialist paediatric diabetic clinic. Glycated haemoglobin (HbA1) concentration and days admitted were significantly lower in the group attending the specialist clinic. This has implications for the organisation of paediatric diabetic services.

Child↗
PubMed2005

Haemoglobin A1c: evaluation of three point of care analysers for use in a paediatric diabetes clinic.

BACKGROUND: The measurement of haemoglobin A1c(HbA1c) by high-performance liquid chromatography (HPLC) is generally deemed unsuitable for point of care testing (POCT) due to its complexity and extended turnaround times (TAT). The aim of this project was to evaluate two new HPLC instruments, the Bio-Rad D10 and the Primus PDQ, as POCT instruments compared with Bayer's DCA2000 HbA1c immunoassay analyser in our paediatric diabetes clinic. METHODS: A total of 228 samples were analysed, of which 160 analyses were performed in our paediatric diabetes clinic. HbA1c results were compared by the Passing-Bablok agreement test, the Bland-Altman difference analysis, within- and between-run imprecision, and TAT. RESULTS: : The agreement test and difference analysis showed a correlation of r2 = 0.96 and a mean HbA1c difference of < 0.1% between the three analysers. The PDQ and the D10 achieved the within-run target coefficient of variation (CV) of < 2% at an HbA1c of 7.5%. Between-run imprecision at an HbA1c of 10.8% produced CV of 3.5%, 2.4% and 1.6% for the D10, DCA2000 and PDQ, respectively. TAT studies confirmed that the PDQ was substantially faster than the DCA2000 and D10. CONCLUSIONS: The PDQ had the shortest TAT, afforded random access and exhibited acceptable imprecision, and hence is the preferred instrument for our POCT environment.

Autoanalysis↗
PubMed1987

Liaison psychotherapy in a hospital paediatric diabetic clinic.

A psychotherapist joined the medical team of the paediatric diabetic clinic three years ago. After some initial difficulties all agreed there had been appreciable benefits, not only to individual patients but also to the team in their handling of the psychological aspects of diabetes.

Adolescent↗
PubMed2001

The paediatric diabetes specialist nurse and diabetes education in childhood.

AIMS OF THE STUDY: The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process. DESIGN AND METHODS: A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%). FINDINGS: The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education. CONCLUSIONS: The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.

Attitude of Health Personnel↗
PubMed2002

Adaptation and negotiation as an approach to care in paediatric diabetes specialist nursing practice: a critical review.

Considerable attention has been given to diabetes care in children. However, nursing practice may be guided by biomedical models. Diabetes care in children should focus on family-centred approaches arguably based in the community. Psychosocial constructs have an important role in the development of self-management of chronic illness in children. Paediatric diabetes nurse specialists are pivotal in facilitating family-centred care based on personal models of child and family interventions.

Adaptation, Psychological↗
PubMedDate not supplied

Improving paediatric diabetes care.

The authors review the management of paediatric patients in diabetic ketoacidosis. Paying particular attention to the pathophysiology of the illness and nursing documentation, they have developed a new diabetic ketoacidosis flow chart to improve nursing care.

Child↗
PubMed1999

An assessment of paediatric diabetes care in three centres in Russia and in Southampton, UK. The Paediatric Teams in Moscow, Tula, Tambov, Southampton.

AIMS: Young people in Russia with diabetes have an increased morbidity and a 10-fold increase in mortality compared with many European countries. This joint international study was set up to compare of care and outcomes against published guidelines in three Russian centres and one UK centre. METHODS: An assessment of the diabetic care of 368 children, based on the principles of the St Vincent Declaration, was undertaken in each centre. Data on prevalence, management, control and complications were collected in young people with diabetes < 16 years of age in each of the four centres over a 4-week period. RESULTS: The prevalence of diabetes was greater in Southampton (1:702 vs. 1:1378). At diagnosis Russian children had a higher incidence of ketoacidosis (69 vs. 29%) and stayed in hospital longer (30 vs. 3 days). In management Russian children received more injections per day (5 vs. 2). There was no significant difference in insulin dose for those under 10 years between countries (Southampton 0.69 U/kg vs. Russian 0.73 U/kg, P=NS). Older Russian children did not increase their insulin dosage, while children over 10 years in Southampton received significantly more insulin than the Russian children (Southampton 1.0 U/kg vs. Russian 0.77 U/kg, P< or =0.001). Twenty-nine per cent of the Russian children reported that they had insufficient insulin and 14% had to buy extra. HbA1c was higher in the Russian children (9.8% vs. 8.3%), increasing significantly with age. The Russian children showed a height deficit which correlated with HbA1c and diabetes duration. The Southampton children were heavier and with a higher body-mass index and their HbA1c did not rise similarly as in Russia. Severe hypoglycaemia was more common in the Southampton children (32 vs. 12%). Retinopathy was reported in 12% of the Russian children (Southampton 0%) and systolic blood pressure > 95th centile in 21% (Southampton 8%). CONCLUSIONS: This study demonstrates a significant difference in diabetic control and complications between the two countries which could be partially explained by a decreased availability and prescribing of insulin and blood glucose monitoring in Russia. Southampton has an education and management policy based on ambulatory care resulting in reduced hospital stay.

Adolescent↗
PubMed2002

The quality circle: how to improve the outcome of paediatric diabetes care.

Most multicentre studies demonstrate that the outcome of diabetes therapy falls below the targets set up in recent guidelines. Applying quality control methodology may provide one means better to achieve such targets. Before setting up a quality circle, objective, standardized documentation of relevant quality indicators is necessary. Based on internal (for example longitudinal changes over time) and external quality control (comparison with other institutions), both favourable and unfavourable results achieved by each institution are identified. Such data provide the basis for intensive discussion among the members of diabetes care teams on how to remedy such deficits. In Germany, the working group on paediatric diabetology set up a system for external quality assessment in 1995: For 6 continuous years, quality indicators are compared twice yearly, and regional quality circles for more open discussions have been established, in addition to yearly nationwide meetings among all participants.

Child↗
PubMed2005

Organization of paediatric diabetes units in Italy.

Aim of this work is to give a realistic picture of the medical care situation in Italy and to verify its congruence with ISPAD and SIEDP guidelines and the law. In Italy diabetes is recognized as a disease of great social interest by a state act. Sixteen years after its approval, all of the Italian Regions have received the law n. 115/87 with the different acts. Nearly all regional acts provide for both the institution of specialized centres of paediatric diabetology and their individuation at local level. In Italy diabetological paediatric care is well distributed all over the national territory. Activities are operating in almost every region. Actually a lot of paediatric diabetology activities have no formal recognition and no operating autonomy and sometimes the person in charge of the activity is not a diabetologist paediatrician. In spite of what stated by ISPAD and SIEDP guidelines, this is the real situation. Perhaps in the future a larger presence of scientific societies involved in problems concerning sanitary politics about diabetes, will bring to an appreciable improvement of the quality of care system of paediatric diabetology.

Adolescent↗
PubMed2005

A phase 2 clinical trial of metformin as a treatment for non-diabetic paediatric non-alcoholic steatohepatitis.

BACKGROUND: Children with non-alcoholic steatohepatitis are insulin-resistant and metformin has been proposed as a potential therapy. However, paediatric safety and efficacy data are absent. AIM: To test the hypothesis that metformin therapy will safely improve markers of liver disease in paediatric non-alcoholic steatohepatitis. METHODS: Single-arm open-label pilot study of metformin 500 mg twice daily for 24 weeks in non-diabetic children with biopsy-proven non-alcoholic steatohepatitis. RESULTS: Ten obese children (mean body mass index 30.4) enrolled and completed the trial. Mean alanine aminotransferase and aspartate aminotransferase (AST) improved significantly (P < 0.01) from baseline (184, 114 U/L) to end of treatment (98, 68 U/L). Alanine aminotransferase normalized in 40% and AST normalized in 50% of subjects. Children demonstrated significant improvements in liver fat measured by magnetic resonance spectroscopy (30-23%, P < 0.01); insulin sensitivity measured by quantitative insulin sensitivity check index (0.294-0.310, P < 0.05); and quality of life measured by pediatric quality of life inventory 4.0 (69-81, P < 0.01). CONCLUSION: Open-label treatment with metformin for 24 weeks was notable for improvement in liver chemistry, liver fat, insulin sensitivity and quality of life. A large randomized-controlled trial is needed to definitively determine the efficacy of metformin for paediatric non-alcoholic steatohepatitis.

Adolescent↗
PubMed1989

Patterns of hospitalisation in a paediatric diabetes clinic in Sydney.

The hospital notes of all children with diabetes admitted to the Children's Hospital (both newly diagnosed and subsequent admissions) for the period 1985-1987 were examined. The information collected included basic demographic data, number of bed-days per admission, and reasons for admission. The direct cost of a bed-day and an admission for diabetes in this hospital were calculated. The median duration of an admission at diagnosis was 12 days, and of a subsequent admission 7 days. The proportion of total admissions to the Children's Hospital in 1987 which were due to diabetes (post diagnosis) was eight times the prevalence of IDDM in the 0-14-year population. In 1987, 5.5% of the diabetic patients (excluding new cases) aged 0-19 years and registered with this Diabetes Unit were admitted to hospital. Most of these admissions were for poor control, and were thus potentially preventable. The age group most at risk for admission due to ketoacidosis was the 10-14-year group. The cost of a diabetic bed-day was $Aust 295, average cost of an admission at diagnosis $Aust 3660, and of a post-diagnosis admission $Aust 2680. Thus, even in this young age group there is considerable morbidity due to diabetes, most of which can probably be prevented.

Adolescent↗
PubMed2005

Twenty years of a multidisciplinary paediatric diabetes home care unit.

As only a minority of patients with type 1 diabetes are unwell at diagnosis, these patients could be managed at home if appropriate facilities were available. A multidisciplinary diabetes home care service was established over 20 years ago at Birmingham Children's Hospital, to support children with diabetes mellitus within the home environment from diagnosis, reducing emotional upset and separation. Despite increase in the size and distribution of the unit over this time (from 230 to 400 patients (now spread over two hospitals)), the proportion of newly diagnosed children managed wholly at home (median 43%; range 31-67%), and the reduction in number and duration of admissions has been sustained (readmission rate with diabetic ketoacidosis 4.1 bed-days per 100 patients/year; range 2.9-7.1), with no deterioration in overall blood glucose control. In this way the savings achieved by reductions in expensive hospital bed occupancy have more than offset the costs of maintaining the unit.

Bed Occupancy↗