Experiences of Using a Continuous Glucose Monitoring System in Children-A Descriptive Study with Parents in the Republic of Georgia

The benefits of medical devices are often multifaceted and may have an important impact on patients’ and relatives’ physical, mental and/or social well-being. Diabetes is a metabolic disorder and a continuous subcutaneous glucose monitoring sensor can suggest increasing treatment satisfaction. The purpose of this study was to describe parents’ experiences during their daily lives and support needs when a child uses a Flash Glucose Monitoring system (FGM). Twenty parents (n = 3 men vs. n = 17 women) to children (age ranged between 22 months and 16 years) with diabetes disease type 1, treated with an FGM unit (used for an average of 7 months (range 1–72)) at home, participated in this study. A qualitative questionnaire survey with open questions including follow-up dialogues was distributed to the parents, and collected data were analysed using qualitative content analysis. Overall satisfaction with the Libre device was Md 10 (IQR 9.25–10). One main theme “Advances in technology significantly improved everyday life” emerged from 2 categories: Improvements in quality of life and Elements of challenges. In conclusion, this qualitative study determined that parents of children with DMT1 experience a great improvement in daily life when given the opportunity to use the Libre device.

Information for better or for worse: interviews with parents when their foetus was found to have choroid plexus cysts at a routine second trimester ultrasound

The aim of the study was to gain a theoretical understanding of parents' experiences and handling of the situation, when their foetus was diagnosed as having choroid plexus cysts, at a routine second trimester ultrasound examination. Nine couples and one mother were interviewed using one open question. Analysis method was Grounded Theory. The main concern was anxiety and the core category became need for knowledge. The other categories were frightening and confusing, judging risk and making a choice and comforting. The parents felt information during the ultrasound examination was insufficient. The time delay between the diagnosis and the doctor's appointment was also often criticized. Most of the parents in this study wanted to know what can be diagnosed by ultrasound, even if there is a small risk that the child will have a malformation or chromosome abnormality. However, when the diagnosis is made, they need adequate information, otherwise unnecessary anxiety arises. By giving sufficient information without days of delay, anxiety can hopefully be minimized. Some written information was also requested. It is of utmost importance that the staff use the same terminology and the correct name of the soft marker to the parents.

Diabetes and pregnancy: women's opinions about the care provided during the childbearing year

BACKGROUND

The extended programmes for pregnant women with diabetes, needed to improve pregnancy outcome, might negatively influence the experience of expecting a baby.

AIM

To investigate opinions about care during pregnancy, childbirth and the postnatal period among women with diabetes mellitus (DM) and gestational DM (GDM).

METHOD

A four-part questionnaire was constructed, covering the childbearing year, with a focus on treatment and information. A total of 156 women were asked to participate (53 DM, 103 GDM), three refused. The questionnaire was anonymous.

RESULTS

The reply frequency was 94%. Of all answers, 95% fell in neutral-satisfied range (Lickert scale 2-5). Three answering patterns deviated positively (care on Specialist Antenatal Clinic, accessibility, and participation-responsibility-respect). Four patterns deviated negatively (information flow, preparation, postpartum care and postpartum check-up). Increased supervision caused problems with time for the family and at work. Comments showed focus on diabetes, forcing the healthy pregnancy aspects into the background. The answers concerning treatment indicated satisfaction (4 + 5 Lickert scale). Women with GDM felt badly prepared before the glucose tolerance test. It was doubtful whether they had been able to make an informed choice about participating. Lack of knowledge among staff was pointed out. Need for more written material was expressed.

CONCLUSION

Satisfaction with care was shown. A discussion about the implication of informed choice with both staff and mothers are needed. Sharper implementation of the diabetes-care-chain was also an area for improvement.

Problem based learning and the case method--medical students change preferences during clerkship

BACKGROUND

The Case Method (Case) and Problem Based Learning (PBL) are two student active methods, increasingly used in medical education.

AIM

The aim of this study was to compare medical student satisfaction with the two different active methods of learning and to see if there was any variation in preference between two stages in medical training.

METHODS

A short questionnaire was given out to 254 students during the eighth and eleventh term of medical training. Answers were obtained from 221 students. The results were computer analysed.

RESULTS

Students in the eighth term rated both methods high, while students in the eleventh term rated Case even higher while PBL decreased in popularity. Traditional lectures were given constant neutral rating. Case was rated better for problem solving.

CONCLUSIONS

It seems that Case is more suitable than PBL for the later stages of medical training when clinical problem-solving skills need to be honed.

Applying the case method for teaching within the health professions--teaching the teachers

The case method provides training in problem solving and is useful in clinical education within health professions. The method consumes less teaching resources and might be useful in a situation with increasing numbers of students and staff cuts. As it is a relatively new method within the Faculty of Medicine, University of Lund, a training program for teachers has been established with a short, practical, course. This paper describes the application and introduction of the case method and evaluation of the introductory course by 106 teachers. In this course the case method is introduced and demonstrated. The participants construct cases and take an active part as both students and teachers. Almost everyone was planning to incorporate the case method in their teaching practice, at both undergraduate and graduate levels. To have constructed and led cases themselves was considered a great strength. More time was requested as well as a follow-up session after practically using the case method.

A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden

OBJECTIVE

to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy.

DESIGN, SETTING AND PARTICIPANTS

a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes.

FINDINGS

the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.

Midwives' attitudes to and knowledge about a newly introduced foetal screening method

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.

Maternal serum screening for Down syndrome--opinions on acceptance from Swedish women

BACKGROUND

Different screening procedures are becoming an important part of health care. Information about screening and its consequences can be difficult to both impart and understand. This study examined women's theoretical acceptance of a new screening procedure, before its introduction.

METHODS

A group of women (n = 823), who had made an informed choice about the form of foetal diagnosis they wished for, were also asked, in a questionnaire, about their opinion on the acceptability of serum screening for Down syndrome. The main purpose of the this was to ascertain their feelings when making a choice.

RESULTS

Replies were received from 80.4%. The answers indicated that serum screening would be acceptable to 86% of the women who had chosen a second trimester ultrasound examination. Of the women who had chosen amniocentesis, 51% would consider the test acceptable as a first alternative.

CONCLUSIONS

The ease with which the women were able to make their choice of prenatal diagnosis had bearing on their degree of acceptance of serum screening for Down syndrome.

Factors influencing informed choice of prenatal diagnosis: women's feelings and attitudes

OBJECTIVE

To obtain knowledge about factors that could influence women's informed choice and extent of prenatal diagnosis, her feelings when implementing it, and her satisfaction.

METHOD

A questionnaire including Visual Analogue Scale was given to 823 women and replies received from 662 (80.4%). Ease of choice was the basis for the statistical analysis.

RESULTS

The factors that most often influenced choice were the fetus health, maternal age, and knowledge of the consequences. The choice was easy to make, only 2% finding it very difficult. The time period from the amniocentesis until the results were available was the most difficult time reported.

CONCLUSIONS

The choice of method for prenatal diagnosis was very easy for most women. Satisfaction with choice was high (98%). Extra support can be needed while awaiting results of invasive prenatal diagnosis.

Women's informed choice of prenatal diagnosis: early ultrasound examination-routine ultrasound examination-age-independent amniocentesis

The antenatal clinics in the catchment area of the Department of Obstetrics and Gynecology, University Hospital, Lund, were divided into a study group and a control group. At the study antenatal clinics during a 15-month period 1,004 pregnant women received a written and verbal information that a routine ultrasound examination during gestational week 18 should be considered as a prenatal diagnostic method. They even got information on alternatives: to decline all, to have an early abdominal ultrasound examination, or to have both a routine ultrasound examination and an amniocentesis performed. At the control antenatal clinics, 1,408 pregnant women received standard information. No women in either group chose not to have an ultrasound examination performed, but 1% chose an early abdominal examination in the study group. The percentage of women older than 35 years who asked for an amniocentesis was equal in the two groups. However, women younger than 35 years in the study group requested amniocentesis significantly more frequently than the women in the control group.