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Gosden C.,Diabetes UK | James J.,University of Leicester | Anderson U.,South Central Region | Morrish N.,Bedford Hospital NHS Trust
Journal of Diabetes Nursing | Year: 2010

Aims: To establish a database of UK DSNs to help predict manpower needs over time, assist with workforce planning, and to identify roles, qualifications, work settings and banding. Methods: A questionnaire was developed and distributed to all identifiable UK DSNs (n=1363) in September 2009 and responses (n=838) collected until January 2010. Respondents could often give multiple answers, and missing responses have been omitted from the analysis. Results. Respondents gave 238 separate job tides representing the role of the DSN; 47% of DSNs work in hospital, 22% in the community and 28% work in both; 76% indicated that their role includes general adults, 41% inpatients, 23% paediatrics, but only 10% in research; 74% have a diabetes diploma/certificate, 54% have undertaken ad hoc degree modules ana 17% have a diabetes-related degree; 18% have completed ad hoc masters modules and 8% have a diabetes-related masters degree; 44% expect to retire within the next 10 years. Conclusion: Fewer DSNs are working across both hospital and community settings, jeopardising opportunities for joint working, sharing knowledge and skills. Most DSNs are qualified to the levelrequirea of DSNs, however some services are operating without a clinical lead. By repeating this study annually, it can help to identify trends with which to guide service and manpower planning in the future. Source


Gosden C.A.,University of Southampton | Barnard K.,University of Southampton | Williams D.R.R.,University of Swansea | Tinati T.,University of Southampton | And 2 more authors.
Diabetic Medicine | Year: 2015

Aims: To assess the impact of continual major National Health Service reorganization on commissioning, organizational and delivery arrangements for secondary care diabetes services. To explore how consultant diabetologists and diabetes specialist nurses perceive the issues facing diabetes specialist services in 2011 and how these have changed in the preceding decade. Methods: We used a longitudinal case study approach that combined quantitative and qualitative methods. Five locations in England were purposively selected to represent the wider diabetes specialist community, and seven semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim and analysed using Framework analysis. Findings were compared with and contrasted to results from national quantitative surveys of diabetes specialist services undertaken in 2000 and 2006. Results: Clinicians viewed positively the expertise and commitment of multidisciplinary teams and their ability to adapt to new situations. Negative perceptions persisted throughout the decade, relating to the continual change that threatens to dismantle relationships and services which had taken many years to establish. Lack of resources, inadequate manpower planning and poor access to psychological support for people with diabetes remained constant themes from 2000 to 2011. Conclusions: A willingness to innovate and work differently to improve services was identified; however, clinicians must be supported through organizational changes to ensure people with diabetes receive high-quality care. The disruptive nature of organizational change was a recurrent theme throughout the decade. Periods of stability must exist within commissioning to allow relationships, which are key to integration, to be maintained and permit service improvements to develop. © 2015 Diabetes UK. Source


Corbett A.,Kings College London | Owen A.,University of Western Ontario | Hampshire A.,Imperial College London | Grahn J.,University of Western Ontario | And 7 more authors.
Journal of the American Medical Directors Association | Year: 2015

Introduction: Cognitive training (CT) offers a potential approach for dementia prevention and maintenance of cognitive function in older adults. Online delivery provides a cost-effective means of implementing CT compared with in-person interventions, with the potential of providing an effective public health intervention for risk reduction. Methods: A double-blind 6-month online randomized controlled trial in adults older than 50 randomized to General CT, Reasoning CT, or control. The primary outcome was instrumental activities of daily living (IADL) in adults older than 60. Secondary outcomes were reasoning, verbal short-term memory, spatial working memory, verbal learning (VL), and digit vigilance in adults older than 50. Secondary analyses were performed with a group defined as showing age-associated impairment in reasoning according to baseline scores in this domain. Results: A total of 2912 adults older than 60 (6742 > 50) participated. General and reasoning packages conferred benefit to IADL (P = .008, P = .011), reasoning (P < 0.0001, P < .0001), and VL (P = .007, P = .008) at 6 months. Benefit in reasoning was evident from 6 weeks. Other benefits developed over 6 months. Analysis of participants with age-associated impairment also showed the same pattern of benefit. A clear dose-response effect was seen. Conclusions: Online CT confers significant benefit to cognition and function in older adults, with benefit favoring the Reasoning package. Scale of benefit is comparable with in-person training, indicating its potential as a public health intervention. Impact on the group with age-associated impairment indicates a particular sensitivity to this at-risk group, which merits further investigation. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Source


Rylance A.,Diabetes UK
Nursing Times | Year: 2015

Information prescriptions are designed to give people with diabetes the information they need to understand, engage with and improve on their health targets. The prescriptions are short, personal, easy to read and clinically accurate, and are designed to support care planning and behaviour change. Source


Barnard K.D.,University of Southampton | Lloyd C.E.,Open University Milton Keynes | Dyson P.A.,University of Oxford | Davies M.J.,University of Leicester | And 5 more authors.
Diabetic Medicine | Year: 2014

National Audit Data highlight persistent sub-optimum control among increasing numbers of people living with diabetes, with severe consequences for the individual and the NHS. The aim of the present review was to introduce a new cohesive, holistic model of care, tailored to individual needs to support optimum diabetes outcomes. This model of diabetes is necessary in order to understand the driving forces behind behaviour and their impact on diabetes management. Feelings (an emotional state or reaction) and beliefs (an acceptance that something is true or real) are fundamental behavioural drivers and influence diabetes self-management choices. Individually, these explain some of the complexities of behaviour and, collectively, they impact on personal motivation (rationale/desire to act) to achieve a specific outcome. Inevitably, they independently affect diabetes self-management and the environment in which individuals live. A model of care that proposes the encompassing of environment, intrinsic thought and therapy regimens to provide tailored, personalized healthcare should support enhanced diabetes self-management and outcomes from diagnosis. The Kaleidoscope model of care could be deliverable in routine care, incorporating each of the influences on diabetes self-management, and should benefit both individuals with diabetes and healthcare professionals. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK. Source

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