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PubMed1996

Vestibular telemedicine and rehabilitation. Applications for virtual reality.

This paper will discuss the use of Virtual Reality (VR) technologies in the rehabilitation of patients with vestibular disorders and in the provision of remote medical consultations for those patients. Patients with a vestibular problem are very common (vertigo is the second most common neurological complaint after headache) and yet there are very few vestibular neurotologists: specialists in their diagnosis and treatment. New treatments for various disorders causing vertigo now exist. This means that appropriate diagnosis can significantly improve patients' well-being. Remote medical diagnosis and treatment facilities could make the few vestibular disorder specialists much more available to patients. An analysis of the technological and economic factors influencing the provision of this service is necessary. The main long term effect of many vestibular disorders is damage to the sensing apparatus of the inner ear. The damage can lead to inappropriate interaction between visually driven orientation sensing and sensing of orientation by the inner ear. The consequence for the patient is vertigo (a sensation of turning), motion sickness and imbalance. Current rehabilitation efforts are intended to drive the nervous system to adapt to the disordered vestibular input. Adaptation appears to occur slowly in many subjects, even those within rehabilitation programs. An appropriately designed VR experience could greatly increase the rate of adaptation in these patients.

Humans↗
PubMedDate not supplied

Hospital preparedness for possible nonconventional casualties: an Israeli experience.

Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite appropriate preparedness programs.

Biological Warfare↗
PubMedDate not supplied

Preparing international relief workers for health care in the field: an evaluation of organizational practices.

The growth of the humanitarian aid industry has led to the proliferation of relief programs and the rapid rise in the number of relief personnel working in the field. One major necessity in developing successful international programs is appropriately trained field personnel. The purpose of this study was to evaluate the educational practice and training methods for field workers by non-government organizations (NGO). Of the 53 organizations surveyed, 64% responded that they sent health care workers to acute human emergencies. A majority of organizations, 31/53 (59%), used manuals as the primary method of training for workers before going into the field. Eighty-five percent of organizations (45/53) supplied their workers with trip briefings from prior personnel before going into the field, and 91% (48/53) had an on-site coordinator. Only 34% (18/53) provided classroom teaching or orientation prior to departure. The average number of months spent by workers abroad was < or = 1 for nearly half (49%) of the NGOs. Only 34% (18/53) of the NGOs required that personnel had previous international experience. Training of humanitarian workers varies significantly between non-governmental organizations. Lack of standardization in training programs and wide variation of provider preparedness indicates the need by NGOs for enhanced training for field personnel.

Altruism↗
PubMed1998

Nurturing humanism through teaching palliative care.

After many years of neglect by the medical establishment, the discipline of palliative medicine is finally moving into academic health centers (AHCs). While hospice programs have cared for dying patients in the community for years with little input from mainstream medicine, palliative care is gaining a foothold in AHCs, challenging these centers to integrate the hospice approach with biomedicine. The discipline of palliative care promises to be a rich source of learning and growth for physicians-in-training. Teaching about palliative care affirms two essential but vulnerable dimensions of the practice of medicine--the importance of relationship-centered care and the value of doctoring as a source of meaning and growth for physicians. In addition to fostering fundamental humanistic learning, palliative medicine is an excellent vehicle for teaching basic but often neglected clinical competencies, including pain and symptom control, communication, and working as part of a health care team. Because palliative care settings offer extraordinary learning opportunities, the authors recommend that clinical experiences in palliative care be integrated into the core curricula of all medical schools as well as appropriate residency programs.

Academic Medical Centers↗
PubMed1992

Health perceptions and behaviors of school-age boys and girls.

This study described and compared the health perceptions and behaviors of 83 school-age boys and girls. An age-appropriate interview schedule was designed to collect data related to demographic characteristics, health perceptions, safety, life-style practices, nutrition, dental health, and care of minor injuries. Findings indicated that most boys and girls viewed themselves as healthy and managed their own care fairly well in the areas of seat belt use, exercise, and dental health. Nutrition was identified as an area of concern, with 10% of the children skipping breakfast, and over half eating snacks with empty calories. Generally, children were found to be knowledgeable in the management of simple injuries and how to respond in the event of an emergency. Boys and girls were similar in all areas of health perceptions and behaviors except for dental health, with boys reporting more regular visits to the dentist than did girls. Further research is needed to learn more about the process by which school-age children acquire positive health behaviors to assist nurses to design and implement intervention programs that appropriately address the needs of this age group.

Child↗
PubMedDate not supplied

[Evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment in primary care in Chile].

OBJECTIVE: To conduct a preliminary evaluation of the Program for Depression Detection, Diagnosis, and Comprehensive Treatment, which was developed by the Ministry of Health of Chile. MATERIAL AND METHODS: A group of women who had entered the Depression Program in eight primary care centers in three regions of Chile were monitored for three months. The initial sample was made up of 229 women, of whom 169 were able to be interviewed at the end of the three months. Sociodemographic variables, psychosocial risk factors, anxiety and somatic symptoms, and the degree of satisfaction with the care received were studied. Depressive symptoms were evaluated with the Beck Depression Inventory (BDI). The treatments prescribed for the women were also analyzed. RESULTS: The clinicians' decision to enroll the patients in the Depression Program was appropriate, with 95.2% of the women having depressive symptoms, according to the BDI. The accuracy in the clinical assessment of the severity of the symptoms was around 50%, with a tendency to underestimate the severity of the depression. The dropout rate for the women was 19.5% at the end of three months of monitoring. Those who dropped out tended to present less severe clinical symptoms (less intense anxiety and somatic symptoms), a smaller number of psychosocial risk factors, and a lower level of satisfaction with the care received. The patients showed good adherence (73.3%) with the pharmacological treatment, but less with the individual psychotherapy (47.4%) and the group psychotherapy (37.8%). A significant decline was seen in the intensity of the depressive symptoms by the end of the three months, with the decline being greater among the women with more serious symptoms. There was also a significant decline in anxiety and somatic symptoms. CONCLUSIONS: The preliminary evaluation indicates that the Depression Program is meeting the proposed objectives, although there appears to be a need to develop specific strategies to improve the accuracy of the clinical diagnosis as well as compliance with the treatments that are offered.

Adult↗
PubMed2003

Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer.

Colorectal cancer (CRC), the third most prevalent cancer worldwide, imposes a significant economic and humanistic burden on patients and society. One study conservatively estimated the annual expenditures for colorectal cancer to be approximately dollars US 5.3 billion in 2000, including both direct and indirect costs. However, other investigators estimated inpatient costs alone incurred in the US in 1994 to be around dollars US 5.14 billion. Therefore, the economic burden of colorectal cancer in the US could be projected to be somewhere in the range of dollars US 5.5-6.5 billion by considering that inpatient costs approximate 80% of total direct costs. No worldwide data have been published, but assuming that the US represents 25-40% of total expenditures in oncology, as seen for breast and lung cancers, a rough estimate for colorectal cancer would be in the range of dollars US 14-22 billion. Screening helps increase patient survival by diagnosing colorectal cancer early. The ideal method among the four tests most used (faecal occult blood test, flexible sigmoidoscopy, colonoscopy and double contrast barium enema) has not been identified. Economic studies of colorectal cancer screening are complex because of the many variables involved, as well as the fact that the outcomes must be followed for many years, and the lack of consensus on screening guidelines. Intuitively, modelling colorectal cancer is one way to overcome these hurdles; published modelling studies predict colorectal cancer screening programs to be within the threshold of dollars US 40000 per life-year saved. The faecal occult blood test appears to be the only clearly effective test, both from a clinical and an economic viewpoint. Important limitations are the invasiveness and inconvenience of the screening procedures, except faecal occult blood test. Patients' comfort and satisfaction are essential in improving compliance with screening recommendations, which appears to be low even in the US (35% of the general population aged over 40 years and 60% of the high-risk population), the country with the highest awareness and compliance in the world. Since colorectal cancer is generally a disease of the elderly, its economic burden is expected to grow in the near future, mainly due to population aging. Potential avenues to pursue in order to contain or reduce the economic burden of colorectal cancer would be the design and implementation of efficient screening programmes, the improvement of patient awareness and compliance with screening guidelines, the development of appropriate prevention programs (i.e. primary and secondary), and earlier diagnosis.

Antineoplastic Agents↗
PubMed1989

Development and evaluation of a colour-coded scale for birthweight surveillance in rural Egypt.

Birthweight surveillance is an important epidemiologic tool, yet it is largely unattainable in locales where most births occur at home attended by traditional midwives. A tempered-steel hand-held scale developed by Program for Appropriate Technology in Health (PATH, Seattle, USA) was adapted for use by Egyptian traditional midwives; it identified newborns weighing less than 2.5 kg by a colour code (yellow versus blue). The scale and reporting system were field tested in a rural Egyptian village. Traditional midwives reported 98% of 299 livebirths attended and 85% were reweighed by Salter scale within 48 hours. Sensitivity of the scale was 100%, specificity 94%. Field conditions are specified for incorporating this method into a surveillance system.

Adult↗
PubMed1982

[Uveitis: a rational diagnostic program for practice in internal medicine].

Uveitis, as an inflammation of the uvea, the vitreous body or the choroid, should not be regarded as a disease but only as a sign of an underlying multisystem disorder. The cause of iritis cannot be established by examining the eye only. Differential diagnosis should take into consideration geographic, possible environmental and genetic background factors. Furthermore, it should be recognized that some causes are infectious, some allergic and some autoimmune in nature. Many, even sophisticated tests are available to detect and underlying disorder. To establish an expedient program for investigation of uveitis, 39 patients with uveitis were examined prospectively from May 1979 to December 1980. In taking the history, the geographical and genetic background and simultaneous therapy were noted. The full systemic examination paid special attention to accompanying oral or genital ulcerations or joint disorders. A tuberculin skin test, the blood sedimentation rate (BSR), leukocyte count, serological tests for herpes, cytomegaly, mycoplasma, venereal and brucella infections, toxoplasmosis, rheumatoid factor and antinuclear bodies must also be carried in every patient. In each patient a chest radiograph was taken. In 5 patients uveitis was due to toxoplasmosis, in 3 to Behçet's disease in 3 to sarcoidosis, in 2 to ankylosing spondylitis, and in 1 to ulcerative colitis. In 36% uveitis was associated with an underlying disease, while in 64% the investigations failed to disclose an accompanying disorder. A detailed history, a full systemic examination, BSR and a whole blood count, a tuberculin skin test, a TPHA test, a toxoplasma dye test, and a chest radiograph are recommended as an appropriate minimal program.

Adolescent↗
PubMed2003

Blood pressure control in the hypertension clinic.

BACKGROUND: One effort to improve hypertension care in the United States is the development of the "Hypertension Specialist" program with appropriate training and certification of individual physicians. METHODS: We examined the impact of a hypertension clinic on blood pressure (BP) levels and control. RESULTS: By one year, BP declined 18/9 mm Hg, (P =.001) and BP control rates increased from 26% to 55% (P <.001) for systolic BP, from 47% to 82% (P <.001) for diastolic BP and from 18% to 52% (P <.001) for both. Age and systolic BP were significantly higher in uncontrolled patients. CONCLUSIONS: Attendance in a hypertension clinic significantly impacts BP control.

Adult↗
PubMed2001

Ethics of rural health care.

One quarter of the US population live in areas designated as rural. Delivery of rural health care can be difficult with unique challenges including limited access to specialists such as oncologists. The Rural Cancer Outreach Program is an alliance between an academic medical center and five rural hospitals. Due to the presence of this program, the appropriate use of narcotics for chronic pain has increased, the number of breast conserving surgeries has more than doubled and accrual to clinical trials has gone from zero to nine over the survey period. An increase in adjuvant chemotherapy has been noted. The rural hospitals and the academic center have seen a positive financial impact. The most prominent ethical issues focus on justice, especially access to health care, privacy, confidentiality, medical competency, and the blurring of personal and profession boundaries in small communities. As medical care has become more complex with an increasing number of ethical issues intertwined, the rural hospitals have begun to develop mechanisms to provide help in difficult situations. The academic center has provided expertise and continued education for staff, both individually and within groups, regarding ethical dilemmas.

Academic Medical Centers↗
PubMed2001

Controlling attentional priority by preventing changes in oculomotor programs: a job for the premotor cortex?

Abruptly presented items capture attention automatically so they constitute the first items to be examined [Yantis and Jonides, Journal of Experimental Psychology: Human Perception and Performance, 1984;10:601; Jonids and Yantis, Perception and Psychophysics, 1988;43:346; Theeuwes, Perception and Psychophysics, 1992;51:599; Theeuwes, Journal of Experimental Psychology: Human Perception and Performance, 1994;20:799]. This attentional priority can be controlled in a top-down manner by directing attention towards the locus of interest [Yantis and Johnson, Journal of Experimental Psychology: Human Perception and Performance, 1990;16:812; Theeuwes. Perception and Psychophysics, 1991;49:83; Miller, Perception and Psychophysics, 1989;45:567; Folk et al., Journal of Experimental Psychology: Human Perception and Performance, 1992; 18:1030]. The premotor theory of attention [Rizzolatti et al., Neuropsychologia 1987;25:31; Rizzolatti et al., Attention and Performance XV, 1994, p. 231] assumes that the mechanism responsible for the attentional shifts is strictly linked to that responsible for eye movements, and several studies [Corbetta et al., Society of Neuroscience Abstracts 1997;23:122.12; Nobre et al., Brain 1997;120:515; Theeuwes et al., Journal of Experimental Psychology: Human Perception and Performance, 1999;25:1595] suggested that the premotor cortex plays a role in the control of attention. However, the nature of this involvement is still unclear. We have been asking a patient (RJ) with a damage of the right premotor cortex to decide whether a target had a discontinuity on its right or left side. The absolute location of the target was pre-cued. In Section 2, an interference was observed when a sudden onset occurred in the visual space, suggesting that RJ was not able to control attentional capture. The possibility to attribute this interference to an insufficient focalization of attention or a grouping effect were discarded by Sections 3 and 4, respectively. Section 5 revealed that this interference followed exclusively the onset occurring in the hemifield opposite the one containing the target (meridian effect [Rizzolatti et al., Neuropsychologia 1987;25:31]). The results suggest that the control of attentional capture may be achieved by keeping constant the parameters of the appropriate oculomotor program.

Adult↗
PubMed2005

Knowledge, attitudes, and reported practices among obstetrician-gynecologists in the USA regarding antibiotic prescribing for upper respiratory tract infections.

BACKGROUND: Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers. METHODS: An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists. RESULTS: The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction. CONCLUSION: Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

Adult↗
PubMed2006

Prevalence of four developmental disabilities among children aged 8 years--Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1996 and 2000.

PROBLEM/CONDITION: In the United States, developmental disabilities affect approximately 17% of children aged <18 years, resulting in substantial financial and social costs. REPORTING PERIOD: 1996 and 2000. DESCRIPTION OF SYSTEM: The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) monitors the occurrence of mental retardation, cerebral palsy, hearing loss, vision impairment, and autism spectrum disorders among children aged 8 years in the five-county metropolitan Atlanta area (Clayton, Cobb, DeKalb, Fulton, and Gwinnett). MADDSP uses a multiple source ascertainment methodology. RESULTS: During 1996, the prevalence of mental retardation was 15.5 per 1,000 children aged 8 years; it decreased to 12.0 per 1,000 in 2000. The overall prevalence of cerebral palsy was 3.6 per 1,000 in 1996 and 3.1 per 1,000 in 2000. The prevalence of mental retardation and cerebral palsy was highest among males and black children. The prevalence of hearing loss was 1.4 per 1,000 in 1996 and 1.2 per 1,000 in 2000; the prevalence of vision impairment during 1996 was 1.4 per 1,000 and 1.2 per 1,000 in 2000. Minimal differences by study year were observed in the prevalence of all four disabilities when examined by sex, race, and severity. INTERPRETATION: The prevalence of these four select developmental disabilities in MADDSP was higher in 1996 than the annual average prevalence estimates for these disabilities during previous MADDSP study years (1991-1994) study years; the highest increase was observed among children with mental retardation. However, prevalence estimates during 2000 were more consistent with the estimates from the early 1990s. Data from additional surveillance years (2002 and beyond) are needed to determine if the prevalence for 1996 was an anomaly and to continue to monitor trends in the prevalence of developmental disabilities over time. PUBLIC HEALTH ACTIONS: MADDSP data will continue to be used to examine trends in the occurrence of these disabilities over time, facilitate the development and implementation of appropriate intervention programs, and provide a framework for conducting population-based etiologic studies.

Autistic Disorder↗
PubMedDate not supplied

Centers of Excellence in Bariatric Surgery: design, implementation, and one-year outcomes.

BACKGROUND: Bariatric surgery procedures increased from <20,000 annually in the early 1990s to >100,000 in 2003. The complications related to surgery have increased disproportionately, causing some payers to discontinue coverage for bariatric procedures and reducing patient access to an effective treatment modality. This report describes an alternative approach-the creation of a network of Centers of Excellence (COE) in Bariatric Surgery. METHODS: Blue Cross and Blue Shield of North Carolina developed a COE program by working collaboratively with the bariatric surgery community. Through systematic review, the collaborative identified bariatric surgical programs that appropriately select patients, comprehensively evaluate and prepare patients for surgery, produce superior outcomes, and provide long-term follow-up for patients. RESULTS: Seven practices were selected as Blue Cross and Blue Shield of North Carolina Bariatric Surgery COE. The short-term results comparing the 12 months before COE implementation and the 12 months after implementation included a 14% decline in the number of bariatric procedures performed (693 versus 596), a 23% decrease in the number of surgeons billing for bariatric procedures (53 versus 41), a 30-day readmission rate of 4.7% for COE providers and 8.3% for non-COE providers, and an average inpatient length of stay of 2.5 days for COE providers and 3.0 days for non-COE providers. The proportion of procedures performed by the COE providers increased from 55% to 61%. CONCLUSION: The preliminary results are encouraging, with COE providers demonstrating reduced 30-day readmission rates and, surprisingly, overall reductions in the rate and number of procedures performed and the number of physicians performing them.

Bariatric Surgery↗
PubMedDate not supplied

Meeting the challenge of continuing education with eLearning.

For many of us, the concept of "e" anything invokes a sense of skepticism and even dread. However, the Web and all it has to offer is certainly an integral part of modern life and, once reconciled, offers great opportunities for commerce and knowledge building. One particular area of promise is that of online learning or "eLearning" as it is referred to in the literature. Particularly for sonographers and technologists, the ability to travel to seminars and conferences on hospital budgets and time is a distant memory. Conversely, the pressure to stay current with CE requirements is greater than ever. With the growing phenomena of accreditation and the use of that as standard for quality care, these staff members are under more pressure than ever to maintain their certification. There is also the issue of accountability. What is being done to track employee training and assist in on-going development? How do we know that the program was appropriate for that particular employee and that an adequate ROI was achieved from a learning perspective? With eLearning, the opportunity to track the employee's progress, scores and areas of interest are possible. This can assist the administrator in "managing" the learning within the group and taking an active role in the development of the staff. The ultimate eLearning experience provides the right content at the right time. It motivates people to learn and apply their knowledge and skills to improve their individual and organizational performance. This is achieved by providing learners with easy and immediate access to the content. The design elements of the site should include a friendly format that facilitates easy navigation through the content. Other helpful features are: book-marking that allows the student to return to the last page studied, interactivity, visualization technologies, and feedback throughout the learning experience. The opportunities for the utilization of eLearning in the global medical community are remarkable. eLearning facilitates learning at anytime and anywhere. It reduces the obstacles of time and distance, providing greater equality of opportunity.

Attitude to Computers↗
PubMed1989

Facilitating drug-use evaluation with spreadsheet software.

The use of a personal computer spreadsheet program, Lotus 1-2-3, as an aid in drug-use evaluation is described. Dipyridamole was chosen for review because the drug is widely prescribed and often given for questionable indications. Developing criteria that could be translated into conditional logic statements made possible the use of the spreadsheet program for determining appropriateness of drug use. As data are entered into spreadsheet cells, the program simultaneously determines if the criteria for appropriate drug use are met. The program is not particularly difficult to apply to drug-use evaluation and is faster, more accurate, and more consistent than manual processing of data. In addition, the program allows the user to extract subsets of data for more detailed examination of drug-use patterns. Because decisions by the operator are unnecessary during data entry, this step can be performed by secretarial or technical personnel rather than pharmacists. A commercially available spreadsheet software program was faster and more accurate than a manual system for determining appropriate drug use.

Drug Utilization↗
PubMed1993

Problems encountered by primary care physicians in the care of patients with diabetes.

OBJECTIVE: The purpose of this study was to identify problems encountered by primary care physicians in the care of patients with diabetes in order to develop appropriate education programs for physicians. METHODS: A random, stratified telephone survey of 832 physicians in Pennsylvania who listed their specialty as internal medicine, family practice, or general practice was conducted. The response rate was 73%. RESULTS: Following diet and weight control were by far the most common problems reported by physicians for patients with insulin-dependent and non-insulin-dependent diabetes mellitus. Although physicians reported that education regarding diet is discussed during office visits, fewer than 25% of the physicians routinely refer patients to a dietician or health educator. Maintaining glucose control and dealing with the complications of diabetes were the next most common problems for patients with insulin-dependent diabetes mellitus, while compliance issues were common problems for patients with non-insulin-dependent diabetes mellitus. CONCLUSIONS: Efforts to improve the care of patients with diabetes need to recognize and address the problems identified by primary care physicians. Education programs for physicians should deal with attitudes as well as knowledge and should focus on problems such as diet, compliance, referrals to eye doctors, and methods to improve glucose control, such as the use of multiple injections.

Blood Glucose Self-Monitoring↗