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Briefly trained physicians assistants using protocols (clinical algorithms) for diabetes, hypertension, and related chronic arteriosclerotic and hypertensive heart disease abstrated information from the medical record and obtained history and physical examination data on every patient-visit to a city hospital chronic disease clinic over a 18-month period. The care rendered by the protocol system was compared with care rendered by a "traditional" system in the same clinic in which physicians delegated few clinical tasks. Increased thoroughness in collecting clinical data in the protocol system led to an increase in the recognition of new pathology. Outcome criteria reflected equivalent quality of care in both groups. Efficiency time-motion studies demonstrated a 20 per cent saving in physician time with the protocol system. Coct estimates, based on the time spent with patients by various providers and on the laboratory-test-ordering patterns, demonstrated equivalent costs of the two systems, given optimal staffing patterns. Laboratory tests were a major element of the cost of patient care,and the clinical yield per unit cost of different tests varied widely.
Diabetes 1976 Apr
PMID:Quality, efficiency, and cost of a physician-assistant-protocol system for managment of diabetes and hypertension. 0 25

An optimal diet cannot yet be defined. If we knew what an optimal diet was, additional research in nutrition would not be necessary. There is abundant evidence, however, that the usual American diet is not optimal and adequate reason to recommend modification. Current dietary recommendations were developed to prevent the occurrence of nutritional deficiency disease in the 1930's and 1940's. They have been largely successful. They were made, however, before any knowledge was available about the effects of diet upon chronic disease which now represent the primary health problems of the United States. Large amounts of data are available indicating the kids of recommendations which should be made to control hypercholesterolemia--a primary risk factor of coronary artery disease. These kinds of data together with less information upon diet and cancer, hypertension, obesity, diabetes, etc. lead to sensible and consistent dietary recommendations to moderate the dietary practices of most Americans.
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PMID:Optimal nutrition. 44 85

A study has been carried out on 262 children with juvenile diabetes and their parents, treated up to 10 yr on an ambulatory basis by a multidisciplinary team composed of pediatric endocrinologist, nurse, dietitian, psychologist, and social worker. Comparison of the findings with those of a study performed before inception of the Counselling Center for Juvenile Diabetics revealed the following positive influences: the degree of control attained was both higher and sustained with greater regularity; there were fewer complications with no episodes of coma, brittle diabetes, or severe ketoacidosis and almost no need for hospitalization; the attitude of the affected child, his parents, and his teachers was found to be considerably improved; there was better understanding of the nature of the disease and its requirements; the child's motivation to maintain the diabetic regimen was greater and conflicts within the family circle were markedly reduced; the child's self-concept was much higher; and both scholastic achievements and social adjustment were greater. We concluded that psychological stability is a basic factor in the control of diabetes, and the value of the multidisciplinary approach in the treatment of this chronic disease is indicated.
Diabetes Care
PMID:A multidisciplinary, comprehensive, ambulatory treatment scheme for diabetes mellitus in children. 51 Jan 29

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease.
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PMID:Guidelines for maintaining adequate nutrition in old age. 64 78

Patients who have difficulty in the control of diabetes often have negative self-concepts, feel hopeless and, therefore, become lax about following their regimen. Diabetes, like any chronic disease, does not affect the patient alone. By treating diabetes as a disease involving the whole family, the family physician can help the patient shape a positive self-concept and build a base for good clinical control.
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PMID:Self-concept and the control of diabetes. 84 24

Diabetes mellitus is a chronic disease with a high prevalence of about 2.0 per cent in the australian community. Although hospital diabetic clinics play an important role in the management of diabetic patients, the majority are managed by their local doctor. In this article the possible role of a health centre in the care of diabetics is outlined.
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PMID:The care of diabetes mellitus at a community health centre. 95 37

In a study of thromboembolism and oral contraceptive drugs, 136 cases of myocardial infarction in women aged 30 to 44 years were identified, a rare disease in women of this age group. Data from their hospital medical records were compared with those of several other groups, including women without chronic disease admitted for various acute or elective conditions unrelated to thromboembolism, patients with thromboembolic disease other than myocardial infarction, and women queried or examined in the National Health Survey. The following attributes were found to be associated with myocardial infarction in younger women: presence of diabetes; hypertension; history of increased cigarette smoking; and hypercholesterolemia. A history of the use of oral contraceptive drugs was found with greater frequency in cases than in controls. The literature on the possible association of myocardial infarction and the use of oral contraceptives was reviewed.
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PMID:Myocardial infarction in younger women. Associated clinical features and relationship to use of oral contraceptive drugs. 97 71

Accumulated literature over the past 25 years about the team approach to chronic disease can be divided into three broad categories: (1) the opinion base which reflects statements of belief and faith, (2) the descriptive base which contains details and personal testimony of programs using team concepts and (3) the study base which includes serious research efforts to investigate the effectiveness of team care in various settings. An analysis of the articles in the last category provides a useful insight into the problems and possibilities associated with this neglected area of health care research. The populations studied include patients with heart disease, hypertension, stroke, hip fracture, rheumatoid arthritis, diabetes and groups referred for comprehensive rehabilitation. The majority of the studies demonstrated improved outcomes in one or more areas for patients receiving coordinated team care when compared with control groups. Although these studies serve as a useful guide, the extent to which the findings can be generalized is open to serious question. In the absence of additional research, team care will remain as it is today, largely a matter of faith and the subject of many platitudes. An outline is proposed of the major methodological features which should be considered in the planning and/or evaluation of future studies in this area.
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PMID:Team care in chronic illness: a critical review of the literature of the past 25 years. 98 51

Epidemiology as practiced to day has become outmoded. The authors propose a dynamic epidemiology, that is one applied throughout the country and which is in a stak of continuous development. This implies ascertainment of the major causes of diabetes : heredity and environment. Thus conceived, dynamic epidemiology can hope to tackle prevention in the prediabetic stage of a widespread chronic disease. A description is given of the method of application and a test of effectiveness.
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PMID:[Dynamic epidemiology of diabetes mellitus (author's transl)]. 101 Jan 20

The person who develops diabetes late in life needs carefull assessment of his abilities to assume the new self-care activities required by the advent of a chronic disease. Knowledge of both the aging process and the complications and management of diabetes is needed to assist him toward this goal. His commitment may have to be to a part of the whole plan, but to the elderly person, any participation will provide a measure of independence and control over his life.
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PMID:Diabetes mellitus in elderly persons. 104 67


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