人類遺傳學(xué)導(dǎo)論3000字

1、人類遺傳學(xué)導(dǎo)論論文 Systematic review to determine the barriers to and facilitators of optimal diabetes self-care and management within educational settings for children and young people with type 1 diabetesIntroductionIn this chapter we report a mixed-method systematic review that focused on self-care and ma

2、nagement of diabetes within educational settings. The review builds on the diabetes stream of the scoping review of the empirical literature conducted and reported as part of the IMP.1An important element of the original funder brief was to, when possible, include children and young people who had e

3、xperience of living away from their families. As reported in Chapter 4 on the intervention development, we were unable to achieve this ideal. A pragmatic decision was therefore made in collaboration with our funder project manager to focus the review on diabetes self-care and management wi

4、thin educational settings as an example of a context in which children have to manage their diabetes away from their families.We first briefly report a review of reviews, which confirmed that there is a gap in the evidence and provided a clear rationale for focusing on educational settings. The revi

5、ew methods, processes and findings are then reported and the chapter closes by drawing out evidence to inform the development of the EPIC intervention.Brief review of reviewsWe searched Scopus and MEDLINE for existing systematic reviews conducted over the last 10 years on the broad topic of children

6、 with T1D. The preliminary keywords that were searched are displayed in Box 25. This exercise identified 26 reviews.3,7,73,97119 The aim and focus of the reviews were contrasted in a summary table (see Appendix 3, Summary table of reviews of children and young people with type 1

7、diabetes). Published reviews covered a wide range of topics but there was little evidence on optimal diabetes self-management in educational establishments. Two recent reviews98,99found that the majority of research into managing diabetes in school investigated a broad range of issues including scho

8、ol attendance, peer relations, classroom behaviour and psychosocial status, cognitive functioning and classroom attention, levels of school achievement, teachers awareness of diabetes, on-campus nurses as resources and the educational/legal rights of students. The quality of the studies and the rese

9、arch methodology were not assessed and both of the reviews were narrative in nature. The review by Tolbert98 used a very limited keyword search.BOX 25Preliminary keywords Diabetes.Given that managing self-care away from home and parents was a key issue that we had not been able to address in fi

10、eldwork, we set out to conduct a systematic review focusing on self-care and management of T1D in children and young people within educational settings.School as a context for self-care and management of diabetesChildren and young people with T1D who are enrolled at educational establishments spend

11、a long time away from their families on a daily basis. It is important that systems are in place so that children and young people feel comfortable in these settings to confidently manage their diabetes. To optimise the childs diabetes management, school personnel must be knowledgeable about diabete

12、s self-care issues and provide an environment that promotes optimal diabetes management. As a principle of equality, the pupil with diabetes should be able to participate fully in all school activities while performing blood glucose testing, eating appropriately and administering insulin as needed.I

13、n the following sections we highlight key aspects of best practice from the UK and Europe and the USA as a general practice framework to contextualise and analyse findings. There was insufficient time and resources to describe additional country contexts, and most of the evidence mapped onto best pr

14、actice indicators originates from the UK, Europe or the USA. There was also considerable overlap from the limited number of best practice guidelines obtained and so we have assumed that there are likely to be some core similarities in a global developed country context.Policy and best practice conte

15、xt in the UK and EuropeIn the UK the DH120 recommends that all children should be supported to manage their diabetes according to their individual health-care plan and that school and early years settings should be encouraged to offer effective levels of support so that parents do not have to a

16、ttend school to administer medication. In the UK the use of individual health-care plans in educational settings is recommended to ensure that school staff are sufficiently informed about a pupils medical needs and, in relation to T1D, they should describe all parties responsibilities regarding diab

17、etes supplies and provisions.121 Common elements that current guidelines and policy documents27,33,56,120125 recommend for the management of children and young people with T1D in school are shown in Box 26.BOX 26Best practice guidelines on the management of children and young people w

18、ith T1D in UK and US schools Individualised health plan.In the UK there is no legal duty requiring school staff to administer insulin to children and young people with T1D. However, in an emergency situation or under certain circumstances school staff might be expected to administer insulin or take

19、other appropriate action. This is seen as a voluntary role, but school staff who are responsible for children and young people with T1D on a daily basis have a responsibility to ensure that children and young people remain safe and healthy while on school premises.126A DH working group examined the

20、current challenges surrounding children and young people with diabetes, producing the report Making Every Young Person with Diabetes Matter.120 The need for effective, integrated and accessible services for children and young people and their families was set out in this document.Policy an

21、d best practice context in the USAIn the US, federal law requires schools to have a trained nurse available to manage children with T1D, and the most recent guidelines for diabetes management state that at least one adult should be available for all diabetes management needs if a school nurse is una

22、vailable.127In the US a number of key publications set out the components of diabetes care at school.128,129 The American Diabetes Association128 has produced a position statement to provide recommendations for the management of children with diabetes in the school and day care setting (p.

23、 S76) and the National Diabetes Education Program publication Helping the Student with Diabetes Succeed. A Guide for School Personnel129 is designed to educate school personnel about effective diabetes management and to share a set of practices that enable schools to ensure a safe learning

24、 environment for pupils with diabetes (p. 1).The recommendations within these documents are not necessarily required by the federal laws enforced by the US Department of Education for each student with diabetes. State and local requirements in the USA vary from state to state and from school distric

25、t to school district. But it is recommended that they be used in conjunction with federal as well as state and local laws.In the USA a Diabetes Medical Management Plan (DMMP) outlines how each students diabetes will be managed. The DMMP should be used as the basis for the development of an Individua

26、lized Health Care Plan (IHP) and Emergency Care Plans for Hypoglycemia and Hyperglycemia within a school setting. Common elements that the plans are likely to address are shown in Box 26.對(duì)確定障礙的系統(tǒng)評(píng)價(jià)和對(duì)于糖尿病最佳的自我照顧和管理。這種管理是針對(duì)患有1型糖尿病的兒童和年輕人的教育環(huán)境。介紹：在這個(gè)章節(jié)，我們會(huì)對(duì)使用混合方法的系統(tǒng)的評(píng)論做一個(gè)報(bào)告。這個(gè)評(píng)論關(guān)注自我照顧和用教育背景對(duì)糖尿病的管理

27、。這個(gè)評(píng)論建立在糖尿病流行范圍的以前被發(fā)表過，報(bào)告過的實(shí)證文獻(xiàn)作為IMP的一部分。對(duì)于開始的一個(gè)簡(jiǎn)短準(zhǔn)備的一個(gè)重要的因素是，如果有可能的話，讓那些有生活經(jīng)歷的兒童和年輕人遠(yuǎn)離他們的家人。正如在第四節(jié)在干預(yù)的發(fā)展上所報(bào)告的那樣，我們不能去完成這個(gè)理想。所以我們做了一個(gè)務(wù)實(shí)的決定，和我們投資項(xiàng)目的管理者合作去關(guān)注糖尿病的自我照顧和用教育背景對(duì)糖尿病的管理，把這個(gè)作為兒童必須遠(yuǎn)離他們的家人去治療糖尿病的一個(gè)例子。我們首先對(duì)那些確信證據(jù)有差距和提供一個(gè)清晰地理由關(guān)注教育背景的評(píng)論做一個(gè)報(bào)告。評(píng)論的過程方法和結(jié)果隨后被報(bào)道，章節(jié)通過提出證據(jù)去證實(shí)EPIC干預(yù)的發(fā)展去被接受。對(duì)評(píng)論的評(píng)價(jià)：我們?cè)谒垢吲了箶?shù)

28、據(jù)庫和（美）聯(lián)機(jī)醫(yī)學(xué)文獻(xiàn)分析和檢索系統(tǒng)中尋找過去10年發(fā)表過的在T1D兒童主題中存在的系統(tǒng)評(píng)論。被找到的最初的關(guān)鍵詞被發(fā)表在Box 25.這個(gè)聯(lián)系識(shí)別26個(gè)評(píng)論。3,7,73,97119 這些評(píng)論的目的和焦點(diǎn)會(huì)被做成一個(gè)簡(jiǎn)易的表格并作比較（關(guān)于患有1型糖尿病的兒童和年輕人的評(píng)論的簡(jiǎn)易的表格 Appendix 3）。已發(fā)表的評(píng)論包含了廣泛的題目，但是在教育機(jī)構(gòu)方面，最佳糖尿病自我管理上沒有證據(jù)可以表明。兩個(gè)最近的評(píng)論98,99發(fā)現(xiàn)，對(duì)于在學(xué)校管理糖尿病的研究主體是調(diào)查范圍廣泛的問題。這些問題包括學(xué)校出勤率、青少年關(guān)系、課堂行為和心理狀態(tài)，認(rèn)知功能和課堂注意力、學(xué)業(yè)成績、教師對(duì)

29、糖尿病的認(rèn)識(shí)，校園護(hù)士作為資源和學(xué)生的合法權(quán)利。研究的質(zhì)量和研究的方法沒有被評(píng)估，并且評(píng)論的都是故事。評(píng)論通過Tolbert98 使用關(guān)鍵字搜索非常有限。初步關(guān)鍵詞糖尿?。鸿b于管理自我保健，遠(yuǎn)離家和父母是一個(gè)關(guān)鍵問題,我們沒能解決在野外工作,我們?cè)赥1D教育背景下兒童和年輕人自我照顧和管理進(jìn)行系統(tǒng)評(píng)論。學(xué)校作為糖尿病自我照顧和管理的一個(gè)過渡：T1D在教育機(jī)構(gòu)中的兒童和年輕人在日常訓(xùn)練花費(fèi)了很長的時(shí)間遠(yuǎn)離他們的家人。系統(tǒng)到位所以兒童和年輕人在幫助他們自信的治療糖尿病的背景下感到很舒服是非常重要的。優(yōu)化兒童糖尿病管理、學(xué)校人員必須了解糖尿病自我照顧的問題,并且提供一個(gè)環(huán)境促進(jìn)最佳的糖尿病管理。在平等的原則下,患有糖尿病的學(xué)生應(yīng)該能夠全面參與學(xué)?；顒?dòng)而進(jìn)行血糖測(cè)試,適當(dāng)?shù)倪M(jìn)食并根據(jù)需要注射胰島素。在接下來的部分，我們強(qiáng)調(diào)最好的實(shí)踐的關(guān)鍵的方面，這些實(shí)踐是從英國和歐洲和美國一般實(shí)踐框架融入背景并且分析結(jié)果。這里沒有足夠的時(shí)間和