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PURPOSE The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered. METHODS An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed. RESULTS Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA,, was the most frequently employed outcome measure, with little, if any, description of the interventions. CONCLUSIONS Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

The quality of reported research representing a number of disciplines involved in diabetes patient education was investigated in this study. A rigorous literature search identified 47 studies reported between 1954 and 1986 that met inclusion criteria; 29 were published studies, 18 were unpublished. Quality of the research was measured by Duffy's Research Appraisal Checklist (RAC) and also by coding each study as to the number of threats to internal and external validity present. Overall quality as measured by the RAC ranged from 34 to 95 on a 100-point scale. A statistically significant relationship was found between publication date of the research report and quality, indicating improvement in quality during recent years. Quality of published versus unpublished research reports was not found to differ significantly. Recommendations for improving methodological rigor of future studies include: (a) the use of more rigorous designs, particularly those involving control groups such as randomized clinical trials; (b) reporting of more complete data in research reports; and (c) monitoring of the quality of future studies.

Background and Aims Doctors are exposed to high levels of stress in their profession and are particularly susceptible to experiencing burnout. Rare disease researches are enlightening, with more workload to clinicians, especially during the Covid-19 pandemic. We aim to explore the mental influence of participating in rare disease researches on clinicians. Method Doctors received electronic questionnaires regarding job-burnout in October 2020. The modified Maslach Burnout Inventory-General Survey (MBI-GS) was used to evaluate job burnout state. The MBI-GS consisting of three dimensions, emotional exhaustion (five questions), cynicism (five questions), and reduced personal accomplishment (six questions). The 7-grade Likert scale is adopted in each question, from 0 point (never) to 6 points (very frequently). Job burnout was considered if the average score of any dimension is no less than three. Results Questionnaires from all 203 doctors were analysed in this study, with females (70.0%, n=140). Age ranging from 25 to 39, 40 to 54, and above 55 were 41.4%, 50.7%, 7.9%, respectively. Nearly half of the subjects (50.2%, n=102) fulfil the definition of job-burnout, which was fewer than that in the residency program (50.2% vs. 62.9%, p=0.02). An inappropriate evaluation system (36.0%) and lack of private time (35.5%) were the leading cause of job-burnout. The pressure of scientific researches (79.3%) and career promotion (58.1%) was the major source of mental pressure. Doctors who participated in rare disease researches (46.8%, n=95) did not show significant differences in burnout rate than individuals who did not (44.2% vs 55.6%, p=0.123), nor as in three dimensions (27.3% vs 36.1%, p=0.183 for emotional exhaustion, 21.1% vs 20.4%, p=0.905 for cynicism, 21.1% vs 27.8%, p=0.267 for reduced personal accomplishment). Logistic analysis revealed that high requirement from superior (22.5% vs 6.9%, p= 0.001), pressure from family (33.3% vs 17.8%, p=0.010), inappropriate job allocation (47.1% vs 29.7%, p= 0.019) as well as delayed off-work time (p=0.013) were independent risk factors of job-burnout. Physicians who participate in rare disease research had better job allocation (75.8% vs. 49.1%, p Conclusion More workload did not increase the job-burnout of physicians participating in the rare disease research, which might be contributed by the appropriate job allocation.

Background and Aims Appropriate disease and healthcare management are key behaviours for health optimisation in people with long-term conditions including CKD. Effective self-management of health requires appropriate knowledge, skills and confidence. Digital health interventions are potentially appealing tools to improve knowledge and self-management behaviours, as well as actively involving individuals in their healthcare, particularly in the post-COVID-19 era. However, the development strategies and processes behind such interventions are poorly defined. Here we describe the systematic development of a digital self-management programme for people living with non-dialysis CKD which includes novel approaches to improving self-management and health behaviours. Method Intervention mapping (IM) was used to guide the development of a digital self-management programme called ‘My Kidneys and Me’ (MK&M) to ensure that it can be implemented in clinical practice. The development process was guided by the first four steps of IM: (1) establish multidisciplinary and patient and public involvement (PPI) steering groups to describe the context of the intervention and programme goals; (2) identify objectives and determinants at early design stages to maintain a focus on the strategies adopted; (3) generate the programme components underpinned by appropriate psychological theories and models; (4) develop the programme content and describe the iterative process of refining the content and format of the digital programme for evaluation and implementation. The last two steps (adoption, implementation, and evaluation plan) will be evaluated alongside a forthcoming trial. Results A multidisciplinary steering group was formed consisting of 23 healthcare professionals, researchers, and digital health experts who provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behaviour change research. A PPI steering group of 12 patients and family members identified the needs and priorities of MK&M, providing feedback at relevant time points. As a result of previous literature and input from both steering groups, MK&M was developed with the aim to improve and maintain self-management behaviours, including to improve knowledge, promote self-care skill, increase self-efficacy, improve well-being, and increase physical activity. These target behaviours were translated into key programme goals: 1) increase patient activation; 2) reduce health risks; 3) manage symptoms; and 4) increase physical function. Based on patient input and needs, MK&M was designed to comprise educational (Learn about …) and behaviour change (How to …) sessions, health trackers (e.g. blood pressure, weight, fruit and veg consumption), symptom tracker, exercise trackers, goal setting features, and social support. For example, to improve symptom management behaviours, patients can use MK&M to: 1) learn about symptoms associated with CKD and strategies to help manage these symptoms; 2) learn how to recognise and keep track of their symptoms so that they can modify their lifestyle accordingly and speak to their healthcare professional if needed; 3) track their symptoms using a bespoke tool. Conclusion Applying the IM framework enabled us to systematically use theory, empirical evidence, and practical perspectives in the development of MK&M. Our evidence- and theory-based online self-management programme provides ongoing support and guidance to people with CKD. The efficacy of MK&M to improve patient self-management behaviour is being studied in a multi-site RCT in the UK.

Background and Aims We aimed to investigate a new team-based remote teaching model (TRTM) among M.D and Ph.D. candidates major in nephrology to improve their scientific research training and reduce stresses during the COVID-19 pandemic. Method From February 1 to April 30 in 2020, we set up TRTM (Fig 1) via online conferencing systems as: (i) Plan-Do-Check-Action cycle every two to three days to promote project progress, (ii) weekly lab meetings for sharing experiences and ideas; and (iii) weekly journal clubs for literature reading and knowledge expansion. We recruited nine students in TRTM training, and another 25 students as control group, who arranged their schedule by themselves during the quarantine. Results 1. A survey about the remote teaching 25 mentors and 34 students had received a survey and all believed that teamwork, lab meeting, and short-term academic goals were essential in remote training. Non-scheduled discussion (72.0%,18/25) and regular online lab meetings (60.0%,15/25) were the most common traditional methods. About 85.3% of students and 28.0% of the mentors agreed that “poor self-control” was the main cause of remote-teaching difficulty. 2. The effectiveness of TRTM training Compared to the control group, students in TRTM had more self-reported benefits from “mentors’ feedback”, “team support”, and “team communication” (All P Conclusion Our team-based remote teaching model helped students gain more supports and growth in academics and reduce psychological pressures caused by isolation.