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Diabetes educator (DE) has a clear and important role in the overall management of patients with diabetes in all stages of care by providing much needed detailed information and support on adequate understanding of the pathology and safe-execution of the prescription by the specialist and other life-style changes to combat diabetes effectively. This is more significant in countries like India where there is an unfavourable ratio of physicians to patients with diabetes. The accessibility of the health-care team by the huge number of patients with diabetes in the government hospitals and consequent rush hours can be effectively compensated by the DE by relieving the physician of routine and repeated individual counselling contributing to effective physician utilization and avoiding fatigue and burnout. Literature has evidence that this cost-effective intervention can improve patient outcome and warrants more investment in formal training and continuous academic development of DEs. In this manuscript, a step-by-step counselling of patients with diabetes is described for easy understanding and execution. [ABSTRACT FROM AUTHOR]

Background and aims: Caring for patients with multiple sclerosis causes family caregivers many problems and challenges. Self-management interventions can facilitate the caring process and increase the quality of patient care. Therefore, the aim of this study was to investigate the effect of a self-management program on Self-concept of the family caregivers of multiple sclerosis patients. Methods: This quasi-experimental study was conducted in 2018 at the MS Treatment Center of Shahrekord. The samples were selected through convenience sampling method. First, participants were assigned to two groups of men and women by stratified random sampling, and then men and women were assigned randomly to intervention (n=35) and control (n=35) groups. For the intervention group, the selfmanagement program was implemented twice a week in 8 sessions. Data collection was performed using the Coopersmith self-concept Inventory in two groups before, immediately after, and three months after the intervention. Data were analyzed by SPSS version 16.0. Results: The mean scores of self-concept in the intervention and control groups before the intervention were 72.6±9.1 and 72±10.6, respectively. There was no significant difference between the mean score of self-concept between the intervention and control groups before the intervention (P > 0.05). The mean scores of self-concept immediately after the intervention in the two groups were 86.4±9.2 and 73±10.6, and three months after the intervention, they were 103±7.4 and 73.9±10.5, respectively. A significant increase in the scores of self-concept in the intervention group (P<0.001) was observed. Moreover, the independent t test showed a significant difference in the two groups immediately after and three months after the intervention (P<0.001). Conclusion: Self-management program increased the self-concept of multiple sclerosis (MS) patients' caregivers. Therefore, selfmanagement can play a critical role in improving the quality of life of family caregivers and coping with the physical and psychological stress related to their caring role. [ABSTRACT FROM AUTHOR]

Background: Asthma exacerbations affect the quality of life of patients with asthma and have a major effect on the overall costs of asthma care. An asthma self-management plan that advises the temporary quadrupling of inhaled corticosteroid dose may prevent asthma exacerbations, but this needs to be confirmed before being adopted widely. Objectives: To compare the clinical effectiveness and cost-effectiveness of an asthma self-management plan that advises patients to temporarily quadruple the dose of inhaled corticosteroid when asthma control starts to deteriorate with a standard self-management plan. Design: A multicentre, parallel-group, pragmatic randomised trial, with follow-up for 12 months. Setting: Primary and secondary care across 207 sites in the UK. Participants: Asthma patients aged ≥ 16 years treated with an inhaled corticosteroid who had experienced at least one exacerbation in the previous 12 months. Interventions: Participants were randomised (1 : 1) to a usual-care self-management plan or to a modified self-management plan that advised a temporary quadrupling of the inhaled corticosteroid at the point of asthma deterioration, both of which were actively implemented and supported by local research staff. Primary outcome: The primary outcome of ‘time to first asthma exacerbation’ was defined as the need for systemic corticosteroids (for at least 3 consecutive days) and/or unscheduled health-care consultations for asthma (i.e. reaching zone 3 or 4 of the Asthma UK self-management plan). Results: A total of 1922 participants were randomised: the primary analysis included 938 participants (97%) in the usual-care group and 933 participants (97%) in the modified self-management group. The number of participants having at least one exacerbation of asthma in the year after randomisation was 484 (51.6%) in the usual-care group and 420 (45.0%) in the modified self-management group [adjusted hazard ratio 0.81, 95% confidence interval (CI) 0.71 to 0.92; p = 0.002]. There were fewer serious adverse events reported in the modified self-management group than in the usual-care group (11 vs. 32, respectively). Eight and six events of pneumonia, lower respiratory tract infections or influenza were reported in the usual-care group and the modified self-management group, respectively. Health-care-related costs were lower in the modified self-management group. The modified self-management group was £24 (bootstrapped 95% CI –£122 to £71) less costly than usual care, with a greater quality-adjusted life-year gain of 0.02 (bootstrapped 95% CI –0.005 to 0.04). Therefore, the modified self-management group was ‘dominant’, with a 94–95% probability of being cost-effective at the £20,000–30,000 threshold. Limitations: As the Fourfold Asthma STudy (FAST) was an open-label pragmatic trial, the possibility of treatment bias that may have affected the participants in the modified self-management group cannot be ruled out. Poorer than expected completion of participant diary cards, particularly within the usual-care self-management group, could have led to a null bias, underestimating the true effect of the intervention. Conclusions: An asthma self-management plan that advises patients to temporarily quadruple their dose of inhaled corticosteroid at the point of asthma symptoms worsening does reduce clinically important asthma exacerbations. In addition, the plan is cost-effective compared with the usual-care self-management plan. Future work: To effectively implement asthma self-management plans that advise a temporary quadrupling of inhaled steroid at asthma deterioration into routine practice. Trial registration: Current Controlled Trials ISRCTN15441965. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 70. See the NIHR Journals Library website for further project information.

Background: Asthma is one of the commonest chronic diseases in the UK. Acute exacerbations of asthma are unpredictable, disruptive and frightening. They cause considerable morbidity and account for a large component of the health service costs of asthma. The widespread use of an asthma self-management plan, designed to encourage disease monitoring and timely intervention, can reduce exacerbations and is, therefore, recommended for all patients with asthma. Unfortunately, the majority of patients are not provided with such a plan. There are a variety of reasons for this but uncertainty about what to include in the plan when asthma control is deteriorating, but before the need for orally administered corticosteroids, is a contributing factor. The aim of this trial is to determine whether an asthma self-management plan, which includes a temporary quadrupling of the dose of inhaled corticosteroid when asthma control starts to deteriorate, reduces asthma exacerbations requiring orally administered corticosteroids or unscheduled health care consultation for asthma. Methods: A multicentre, pragmatic, randomised trial in adults aged over 16 years with a clinical diagnosis of asthma, treated with a licensed dose of inhaled corticosteroid and at least one exacerbation in the previous 12 months requiring treatment with systemic corticosteroids. Participants will be randomised to either a self-management plan, which includes a temporary (maximum of 14 days) fourfold increase in inhaled corticosteroid or the same plan without an increase in inhaled corticosteroid. Participants will be followed up at 6 and 12 months and will attend the clinic for an additional visit if their asthma control deteriorates. The primary outcome is time to first asthma exacerbation, defined as the need for systemic corticosteroids and/or unscheduled health care consultation for asthma. The estimated sample size is 1800 participants. Discussion: The FAST trial is an independent study that has been prioritised and commissioned by the National Institute for Health Research (NIHR) in the United Kingdom. It will provide high-quality evidence to inform clinical decision-making on the role of an asthma self-management plan, which includes a temporary fourfold increase of inhaled corticosteroid, when asthma control starts to deteriorate. The first participant was randomised on 17th May 2013 and recruitment will close on 31 January 2016 with the last patient last visit taking place in January 2017. [ABSTRACT FROM AUTHOR]

Self-management plans (SMPs) focus on the early recognition of unstable or deteriorating asthma. Patients without SMPs are more likely to have an asthma exacerbation. The author developed an individualised credit card-sized pictorial asthma plan (ICPAP). Fifty-three patients with asthma aged between 16-60 years were recruited from attendees of a hospital-based, nurse-led clinic. Patients completed a standardised asthma quality-of-life questionnaire and were given the ICPAP. Spirometry, emergency/out-patient/GP attendances, hospital admission and exacerbation data were collected. The patients were reviewed at three and six months. At six months, 79% of patients had used their ICPAP, 100% understood it and 49% were carrying it with them. The most popular aspect of the ICPAP was size and pictures. There was a reduction in exacerbation rate (P=0.0360), unscheduled attendances to general practice (P=0.0005) and hospital admissions (P=0.0044). [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of self-management such as medical plan and self efficacy on older adult's negative risk behaviors using the 2011-2012 California Health Interview Survey. An increase of self-efficacy is found to decrease the patient's engagement in negative dietary behaviors. Medical practitioners are also recommended to consider the patient' level of confidence in managing heart disease and in making interventions.

Objective: The use of combination inhaled corticosteroid/long-acting β-agonist therapy within the framework of a self-management plan has yet to be investigated. Methodology: In this randomized open-label study, 69 adult asthmatic patients taking ≤ 1000 m g per day of beclomethasone dipropionate (BDP) or equivalent were treated for 3 months with Symbicort Turbuhaler (200 m g budesonide/6 μ g formoterol). Patients were assigned to one of two self-management plans, based on either a fixed or adjustable dose regimen. The primary outcome variable was episode-free days. Results: Both regimens resulted in good asthma control, at least comparable to that obtained with previous high dose inhaled corticosteroid therapy. There were no significant differences in clinical outcome measures between the regimens. The mean ( ± SD) usage of Symbicort was similar for the fixed and adjustable dose regimens (3.8 ± 0.68 vs 3.6 ± 1.54 puffs per day, respectively). Conclusion: We conclude that Symbicort is effective when administered as either a fixed or adjustable dose regimen as part of a self-management plan. [ABSTRACT FROM AUTHOR]

Current treatments have failed to stem the continuing rise in health care resource use and fatalities associated with exacerbations of chronic obstructive pulmonary disease (COPD). Reduction of severity and prevention of new exacerbations are therefore important in disease management, especially for patients with frequent exacerbations. Acute exacerbation treatment includes short-acting bronchodilators, systemic corticosteroids, and antibiotics if bacterial infections are present. Oxygen and/or ventilatory support may be necessary for life-threatening conditions. Rising health care costs have provided added impetus to find novel therapeutic approaches in the primary care setting to prevent and rapidly treat exacerbations before hospitalization is required. Proactive interventions may include risk reduction measures (eg, smoking cessation and vaccinations) to reduce triggers and supplemental pulmonary rehabilitation to prevent or delay exacerbation recurrence. Long-term treatment strategies should include individualized management, addressing coexisting nonpulmonary conditions, and the use of maintenance pharmacotherapies, eg, long-acting bronchodilators as monotherapy or in combination with inhaled corticosteroids to reduce exacerbations. Self-management plans that help patients recognize their symptoms and promptly access treatments have the potential to prevent exacerbations from reaching the stage that requires hospitalization.