CPCPH

Self-management and psychological interventions for diabetes have become increasingly common and have shown some positive impact on glycemic control. The association of such interventions with psychosocial outcomes is however, less clear. The current review examines the impact of these interventions on psychosocial outcomes including depression, anxiety, adjustment and quality of life. A systematic search of the literature was performed on Medline, Embase and Psychlit. Reference lists were screened for studies that met inclusion/exclusion criteria. Studies were coded on outcomes both over time and relative to control groups. In addition studies were classified as being principally educational, self-management or psychological in type, and the different components in the intervention were determined. Thirty-six studies were identified. Detrimental effects were not generally seen following any type of intervention. Depression seemed to be particularly improved following psychological interventions, whilst quality of life improved more following self-management interventions. A number of methodological issues, such as the specificity of measure used, characteristics of the population and type of intervention were however, influential in the impact of interventions on outcomes. It is recommended that future studies would benefit from being larger with controlled designs, using diabetes specific measures and providing clearer descriptions of intervention components. This will allow greater understanding of what contexts different interventions are most suited to, and which components are key to, improving psychological well-being and quality of life. #

Aims  To determine whether continuous glucose information provided through use of either the GlucoWatch G2 Biographer or the MiniMed continuous glucose monitoring system (CGMS) results in improved glycated haemoglobin (HbA1c) for insulin-treated adults with diabetes mellitus, relative to an attention control and standard care group.Methods  Four hundred and four adults taking at least two daily insulin injections and with two consecutive HbA1c values ≥ 7.5% were recruited to this randomized controlled trial (RCT). All were trained at baseline to use the same monitor for traditional capillary glucose testing throughout the 18-month study. The CGMS group were asked to wear the device three times during the first 3 months of the trial and on another three occasions thereafter. The GlucoWatch group wore the device a minimum of four times per month and a maximum of four times per week during the first 3 months and as desired for the remainder of the trial. Trained diabetes research nurses used downloaded data to guide therapy adjustments. Proportional reduction in HbA1c from baseline to 18 months was the primary outcome measure.Results  Neither an intention-to-treat nor per-protocol analysis showed improvement in HbA1c in the device groups compared with standard care. For the intention-to-treat analysis, when the standard care group was compared with each of the other groups, this equated to differences in mean relative HbA1c reduction (95% confidence interval) from baseline to 18 months of 3.5% (−1.3 to 8.3; GlucoWatch), 0.7% (−4.1 to 5.5; CGMS), and −0.1% (−4.6 to 4.3; attention control).Conclusions  The additional information provided by these devices did not result in improvements in HbA1c in this population.

Objective To evaluate the effectiveness of self management as a first line intervention for men with lower urinary tract symptoms. Design Randomised controlled trial. Setting A teaching hospital and a district general hospital in London. Participants 140 men (mean age 63 (SD 10.7) years), recruited between January 2003 and April 2004, referred by general practitioners to urological outpatient departments with uncomplicated lower urinary tract symptoms. Interventions Self management and standard care (n = 73) or standard care alone (n = 67). The self management group took part in three small group sessions comprising education, lifestyle advice, and training in problem solving and goal setting skills. Main outcome measures The primary outcome measure was treatment failure measured at 3, 6, and 12 months. Symptom severity (international prostate symptom score; higher scores represent a poorer outcome) was used as a secondary outcome. Results At three months, treatment failure had occurred in 7 (10%) of the self management group and in 27 (42%) of the standard care group (difference = 32%, 95% confidence interval 18% to 46%). Corresponding differences in the frequency of treatment failure were 42% (27% to 57%) at six months and 48% (32% to 64%) at 12 months. At three months, the mean international prostate symptom score was 10.7 in the self management group and 16.4 in the standard care group (difference = 5.7, 3.7 to 7.7). Corresponding differences in score were 6.5 (4.3 to 8.7) at six months and 5.1 (2.7 to 7.6) at 12 months. Conclusions Self management significantly reduced the frequency of treatment failure and reduced urinary symptoms. Because of the large observed benefit of self management, the results of this study support the case for a large multicentre trial to confirm whether self management could be considered as first line treatment for men with lower urinary tract symptoms. Trial registration National Research Register N0263115137; Clinical trials NCT00270309. BMJ BMJ Online First

Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting.

Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, ⑀4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting.

The purpose of this study was to investigate the relationship between dispositional optimism, dispositional pessimism, repressive coping and trait anxiety. The Marlowe-Crowne scale (MC) and the Bendig version of the Taylor Manifest Anxiety Scale (MAS) were used to select repressor and control groups (N = 143, aged between 18 and 47 years), who subsequently completed a measure of dispositional optimism, the Life Orientation Test (LOT), which consists of two sets of items: optimism and pessimism. Repressors (high MC, low MAS) reported signi®cantly lower pessimism than all other participants. When the pessimism scale was divided into high and low categories, there were signi®cantly more repressors in the low pessimism group than the other low trait anxiety group, low anxious (low MC, low MAS). However, for the optimism scale the opposite pattern of results was found, with signi®cantly more low anxious in the high optimism group than repressors. These results support the assertion that the pessimism and optimism scales of the LOT are not the same construct and should be measured separately. #

energy expenditure. 'Exercise' refers to planned, structured and repetitive movement to improve or maintain one or more components of physical fitness (Chodzko-Zajko et al, 2009). So a person may take little exercise but be physically active with low levels of sedentary behaviour, whereas another might do structured exercises but be habitually inactive and spend long periods sedentary. Thus, the end points of some of the reviewed trials and the methods used to measure those end points require more critical discussion. For example, the authors acknowledge that aerobic exercise tolerance may not reflect aerobic fitness -but neither of those necessarily translates into improved habitual physical activity. The authors acknowledge the challenge of achieving current physical activity guidelines, but do not mention potential end points at the lower end of the physical activity continuum -for example, breaking up sedentary behaviour with light activity -which may be critical in cancer survivors, given recent recognition of the adverse health consequences of high levels of sedentary behaviour in cancer populations (Lynch et al, 2013).

Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis.

ABSTRACT This groundbreaking book provides a much-needed overview of self-management in chronic physical illness. It provides the theoretical and conceptual background to self-management, as well as examining issues related to the delivery of self-management interventions in chronic illness. The chapters systematically review the efficacy and effectiveness of interventions in a range of different chronic conditions, including: asthma, coronary artery disease, heart failure, COPD, hypertension, diabetes, rheumatoid arthritis. Authored by a range of leading international authors, each of them experts in the chronic diseases they discuss, the book is key reading for a wide range of health care professionals dealing with individuals with chronic conditions, including nurses, doctors, physiotherapists, health psychologists and occupational therapists. The book concludes by looking at the future of self-management for chronic illness.

User acceptability of new health technologies is important in determining their widespread use and adoption. The aim of this current study was twofold: first, to investigate the acceptability of two continuous glucose monitoring devices for people with diabetes; and second, to develop a valid questionnaire measure to assess the acceptability of continuous glucose monitoring devices. Semi-structured interviews were conducted with six people with diabetes who had previously used the GlucoWatchBiographer (Animas Corp., West Chester, PA) or the CGMS continuous glucose monitoring system (Medtronic MiniMed, Northridge, CA) in order to increase understanding of the issues relating to acceptability of, and satisfaction with, the devices. Interview transcripts were analyzed qualitatively using framework analysis. These analyses, together with consultation with researchers and health professionals in the field, provided the foundation for development of a questionnaire measure that was pilote...