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Role of Diabetes Education Program in Controlling Posttransplant Diabetes in a Recent Renal Transplant Bodybuilder: Case Report and Review of the Literature.
Othman, N, Gheith, O, Al-Otaibi, T, Abdou, H, Halim, MA, Mahmoud, T, Nair, P, Yagan, J, Maher, A, Dahab, M, et al
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2019;(Suppl 1):169-171
Abstract
Posttransplant diabetes is a common complication of solid-organ transplantation. We present the possible role of diabetes education in improvement of posttransplant diabetes in a 36-year-old bodybuilder who was a kidney transplant recipient. The patient had been abusing some medications to help in bodybuilding. He underwent living unrelated-donor renal transplant with thymoglobulin induction and was maintained on steroids, tacrolimus, and mycophenolate mofetil. Posttransplant diabetes was confirmed by blood tests. His blood sugar was partially controlled by 3 oral agents. The patient participated in our structured diabetes education program. This program was created to cover different items related to diabetes control, including diet, proper exercise, blood sugar monitoring, sick day management, and pathophysiologic roles of diabetes medications. Within 4 months of participation in this program, the patient's blood sugar became well controlled and his diabetes medications started to be minimized. He presently has stable graft function with hemoglobin A1c level around 5.6% on only diet management. Bodybuilders are at risk of deterioration of their kidney function. A proper diabetes education program is recommended to help renal transplant recipients with early posttransplant diabetes mellitus to control their disease. Success requires close evaluation and a multidisciplinary approach.
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Supportive interventions to improve physiological and psychological health outcomes among patients undergoing cystectomy: a systematic review.
Quirk, H, Rosario, DJ, Bourke, L
BMC urology. 2018;(1):71
Abstract
BACKGROUND Our understanding of effective perioperative supportive interventions for patients undergoing cystectomy procedures and how these may affect short and long-term health outcomes is limited. METHODS Randomised controlled trials involving any non-surgical, perioperative interventions designed to support or improve the patient experience for patients undergoing cystectomy procedures were reviewed. Comparison groups included those exposed to usual clinical care or standard procedure. Studies were excluded if they involved surgical procedure only, involved bowel preparation only or involved an alternative therapy such as aromatherapy. Any short and long-term outcomes reflecting the patient experience or related urological health outcomes were considered. RESULTS Nineteen articles (representing 15 individual studies) were included for review. Heterogeneity in interventions and outcomes across studies meant meta-analyses were not possible. Participants were all patients with bladder cancer and interventions were delivered over different stages of the perioperative period. The overall quality of evidence and reporting was low and outcomes were predominantly measured in the short-term. However, the findings show potential for exercise therapy, pharmaceuticals, ERAS protocols, psychological/educational programmes, chewing gum and nutrition to benefit a broad range of physiological and psychological health outcomes. CONCLUSIONS Supportive interventions to date have taken many different forms with a range of potentially meaningful physiological and psychological health outcomes for cystectomy patients. Questions remain as to what magnitude of short-term health improvements would lead to clinically relevant changes in the overall patient experience of surgery and long-term recovery.
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Effects of Web-Based Educational Intervention on Self-Management in Kidney Recipients.
Çetin, Ç, Cebeci, F
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2018;(Suppl 1):117-118
Abstract
Information technology and the Internet are rapidly becoming effective tools for teaching. Selfmanagement skills are important for adaptation and long-term survival in kidney recipients. Web-based training may help patients develop self-management skills through information access. This literature review aimed to determine the effects of Web-based educational intervention on self-management in kidney recipients. The Internet supports effective health education intervention strategies by providing a learning environment that is always available. Medicine management, routine follow-up, awareness of the signs and symptoms of rejection, infection prevention, self-monitoring, physical activity, and nutrition are important during the posttransplant period. Another important component of achievement in related matters is the competence of individuals with their own self-management. Webbased training is beneficial for appointment follow-up, nutritional adaptation, and treatment of anxiety and depression. Web-based training allows kidney recipients to access information at any time and place; this information promotes proper self-management.
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A Systematic and Integrated Review of Mobile-Based Technology to Promote Active Lifestyles in People With Type 2 Diabetes.
McMillan, KA, Kirk, A, Hewitt, A, MacRury, S
Journal of diabetes science and technology. 2017;(2):299-307
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AIM: The aim was to review studies examining the effectiveness, acceptability, and feasibility of mobile-based technology for promoting active lifestyles in people with type 2 diabetes (T2D). BACKGROUND Benefits of leading an active lifestyle following a diagnosis of T2D, including improved glycemic control, have been reported. Studies examining the specific use of mobile-based technologies to promote an active lifestyle in T2D have not previously been reviewed. METHODS Research studies examining effectiveness, feasibility or acceptability of mobile-based technology for active lifestyle promotion for T2D management were included (n = 9). The databases searched included PubMed, Medline, ScienceDirect, and ACM Digital Library (January 2005 to October 2015). Studies were categorized as (1) informing, (2) monitoring, (3) provoking, or (4) sustaining behavior change. RESULTS Technologies used included smartphone or tablet apps, diabetes personal digital assistant, continuous glucose monitor and accelerometer, pedometer, and a website delivered by a smartphone. No articles examined the effectiveness of mobile-based technology in monitoring health behaviors and behavior change. Four of the studies found mobile-based technology to be motivational and supportive for behavior change. The visual reinforcement was identified as motivational. The feasibility and acceptability of using mobile-based technology to provide sustained lifestyle change and the effectiveness of mobile-based technology in monitoring health behaviors and behavior change have not been investigated. No studies examined all 3 of the outcomes or focused decreasing the participants' sedentary behavior. CONCLUSIONS Limited research has examined the feasibility, acceptability, and effectiveness of mobile-based technology to promote active lifestyles and subsequently good diabetes management in people with T2D.
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Prescribing exercise to help your patients lose weight.
Higgins, JP, Higgins, CL
Cleveland Clinic journal of medicine. 2016;(2):141-50
Abstract
Exercise, in conjunction with diet, is critical to losing weight and maintaining health in obese patients. While it can be challenging for an obese person to transition to a healthy lifestyle, the physical and emotional benefits of a regular exercise program make it worth the effort.
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Targeting Lifestyle Behavior Change in Adults with NAFLD During a 20-min Consultation: Summary of the Dietary and Exercise Literature.
Hallsworth, K, Avery, L, Trenell, MI
Current gastroenterology reports. 2016;(3):11
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Non-alcoholic fatty liver disease (NAFLD) is largely linked to poor diet, lack of physical activity/exercise, and being overweight. In the absence of approved pharmaceutical agents, lifestyle modification, encompassing dietary change and increased physical activity/exercise to initiate weight loss, is the recommended therapy for NAFLD. Despite this, the use of lifestyle therapy within clinical settings is lacking with limited guidance available about what it should involve, how it should be delivered, and whether it can be feasibly delivered as part of standard care. This paper highlights the evidence for the use of lifestyle modification in NAFLD. While there is evidence to support use of behavioral strategies to support lifestyle behavior change in other clinical populations, these are yet to be assessed in people with NAFLD. However, there is sufficient evidence to suggest that behavioral intervention targeting diet and physical activity to promote weight loss in general is effective and a number of practical strategies are presented on how this could be achieved.
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Games and Diabetes: A Review Investigating Theoretical Frameworks, Evaluation Methodologies, and Opportunities for Design Grounded in Learning Theories.
Lazem, S, Webster, M, Holmes, W, Wolf, M
Journal of diabetes science and technology. 2015;(2):447-52
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Here we review 18 articles that describe the design and evaluation of 1 or more games for diabetes from technical, methodological, and theoretical perspectives. We undertook searches covering the period 2010 to May 2015 in the ACM, IEEE, Journal of Medical Internet Research, Studies in Health Technology and Informatics, and Google Scholar online databases using the keywords "children," "computer games," "diabetes," "games," "type 1," and "type 2" in various Boolean combinations. The review sets out to establish, for future research, an understanding of the current landscape of digital games designed for children with diabetes. We briefly explored the use and impact of well-established learning theories in such games. The most frequently mentioned theoretical frameworks were social cognitive theory and social constructivism. Due to the limitations of the reported evaluation methodologies, little evidence was found to support the strong promise of games for diabetes. Furthermore, we could not establish a relation between design features and the game outcomes. We argue that an in-depth discussion about the extent to which learning theories could and should be manifested in the design decisions is required.
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Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement.
Ligibel, JA, Alfano, CM, Hershman, D, Ballard, RM, Bruinooge, SS, Courneya, KS, Daniels, EC, Demark-Wahnefried, W, Frank, ES, Goodwin, PJ, et al
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015;(33):3961-7
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Observational evidence has established a relationship between obesity and cancer risk and outcomes. Interventional studies have demonstrated the feasibility and benefits of lifestyle change after cancer diagnosis, and guidelines recommend weight management and regular physical activity in cancer survivors; however, lifestyle interventions are not a routine part of cancer care. The ASCO Research Summit on Advancing Obesity Clinical Trials in Cancer Survivors sought to identify the knowledge gaps that clinical trials addressing energy balance factors in cancer survivors have not answered and to develop a roadmap for the design and implementation of studies with the potential to generate data that could lead to the evidence-based incorporation of weight management and physical activity programs into standard oncology practice. Recommendations highlight the need for large-scale trials evaluating the impact of energy balance interventions on cancer outcomes, as well as the concurrent conduct of studies focused on dissemination and implementation of interventions in diverse populations of cancer survivors, including answering critical questions about the degree of benefit in key subgroups of survivors. Other considerations include the importance of incorporating economic metrics into energy balance intervention trials, the need to establish intermediate biomarkers, and the importance of integrating traditional and nontraditional funding sources. Establishing lifestyle change after cancer diagnosis as a routine part of cancer care will require a multipronged effort to overcome barriers related to study development, funding, and stakeholder engagement. Given the prevalence of obesity and inactivity in cancer survivors in the United States and elsewhere, energy balance interventions hold the potential to reduce cancer morbidity and mortality in millions of patients, and it is essential that we move forward in determining their role in cancer care with the same care and precision used to test pharmacologic and other interventions.
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Beyond positivism: Understanding and addressing childhood obesity disparities through a Critical Theory perspective.
Schroeder, K, Kulage, KM, Lucero, R
Journal for specialists in pediatric nursing : JSPN. 2015;(4):259-70
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PURPOSE We apply Critical Theory to examine menu labeling with the aim of uncovering important implications for nursing practice, research, and policy. CONCLUSIONS Our critical analysis uncovers barriers to menu labeling's effectiveness, particularly for vulnerable populations. Nurses must work to minimize the impact of these barriers and optimize the effectiveness of menu labeling, in order to strengthen the fight against obesity. PRACTICE IMPLICATIONS We suggest changes, guided by this critical analysis, which can be implemented by nurses working in clinical practice, research, and policy.
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Diabetic education in rural areas.
Maez, L, Erickson, L, Naumuk, L
Rural and remote health. 2014;(2):2742
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INTRODUCTION Diabetes mellitus type II is a growing concern in the USA, with 6% of the population diagnosed with diabetes and another 5% having pre-diabetes. The prevalence of diabetes is 17% higher in rural areas than in central cities{1}. Adult diabetics living in rural areas often see negative outcomes related to their limited access to care, cultural barriers, and lack of educational resources. This article seeks to evaluate best evidence-based strategies directed at improving diabetic outcomes of rural populations through hemoglobin A1C (HbA1C) reductions. METHOD A search of Medline, CIHNAL, PubMed, and Sage Pub was undertaken. The search was structured around the following key terms: adult, diabetes, education, hemoglobin a1c, and rural. The search limits were set to English-language publications between 2004 and 2012 in industrialized countries. Only articles from scholarly, peer-reviewed publications were considered. Literature that used an inpatient setting, focused on children or adolescents, and did not meet any inclusion criteria were excluded from this review. RESULTS A total of 15 articles met the selection criteria from the 1819 citations sourced from the search. After reviewing the sources, nutritional patient education, motivational counseling and lifestyle modifications were found to be the most influential factors that favorably changed measurable outcomes for this population. Education for providers did not have an appreciable effect on patient outcomes. CONCLUSION This review adds to the literature by outlining best-practice guidelines for evidence-based practice based on current research. Primary care providers in rural areas should encourage their patients to actively participate in diabetes education when possible, and provide this education in a culturally competent manner.