CONFERENCE REPORT

Putting good ideas into practice Manchester - 5 February 1998

A British Diabetic Association Education & Care Section (BDA ECS) Conference organised by Mary Burden on behalf of the Education & Care Section Committee and run by Profile Productions

This 2nd Regional Conference was an oppor- tunity for people who were unable to attend the joint ECS and Medical & Scientific Section (MSS) BDA Conference at Bourne- mouth in 1997, to hear some key talks: Answering questions patients ask; Delivery of footcare; Exercise; Driving; Communi- cation. Delegates also had the opportunity to look at the exhibitions and view posters selected from the Bournemouth Conference.

Answering questions patients ask The joint Chaiman of the conference, Dr Tim Dornan, introduced Professor Edwin Gale (Professor of Diabetic Medicine, Bristol) whose topic was ‘Why did I get diabetes?’ This excellent talk gave background reasons for why some people get diabetes and others do not. Professor Gale argued that health professionals need to be cautious with their answers to such queries because often we do not know ourselves. We should avoid gues- sing or giving answers that are difficult to understand, such as “. . . a 10% chance.. .”

Delivering footcare In Anne Middleton’s (Manager, Dept of Podiatry, Diet and Foot Health, Salford) informative and interesting talk on setting up and integrating diabetes foot care services in Salford, she discussed some of the problems encountered and how they had been over- come, as well as Salford’s plans for the future. This session gave the audience plenty of ideas on how to improve their own footcare services. Mrs Middleton would be happy forpeople to contact her if they wish to know more.

Exercise Dr Renee Page (Consultant Physician, Nottingham) summarised the Exercise and Diabetes Symposium from Bournemouth and gave a practical talk on exercise and how to measure activity. She made the point that it was important to find out how much exercise people were doing before advising them to increase their activity.

Some of the reasons people did not exer- cise included injury; felt too fat; weren’t sporty; no energy; no time; could not afford it and no-one to do it with. Such people should

be told that exercise has been shown to have psychological, cardiovascular, metabolic, skeletal and muscular benefits (especially in the older population, with the effect of fewer falls).

Many studies showed difficulties with compliance with exercise; one 10 year study had had a 50% drop-out at three months with only 10% still taking part in the study at one year. The reasons for non-compliance were explored; it had been found that people were more likely to continue if they self-referred and if their spouse also participated. The strategies needed by healthcare profes- sionals to encourage more exercise were:

Know the person’s current activity level. Be realistic in your expectations (unrea-

Build exercise into the daily routine. Suggest contact with others who wish to

Give encouragement ++ +

listic goals act as barriers).

exercise.

Driving Dr Kenneth McLeod (Consultant Physician, Exeter) spoke about driving in relation to diabetes. He asked the audience to think about how important their own cars were to them and showed how diabetes impacts on the eyehrain link. He stated statistics on the evidence of causal associations with acci- dents and gave as an example collapse at the wheel, where epilepsy accounted for 30- 40% of cases, diabetes 17% and cardiac reasons 10%. A minority had declared their medical problems to the DVLA.

There was lively discussion about the new regulations for driving which would have a huge impact on people taking insulin who would now be limited as to the weight of their vehicle - a policy which would forbid them driving minibuses etc. Dr McLeod argued that it was a delicate balance between pro- tecting the public and allowing someone with diabetes to drive (even though they might take greater care than the general population).

The audience felt it was important that doctors fill in their patients’ DVLA forms sympathetically, as patients have been known to be deprived of their driving licences un- necessarily.

The BDA’s Professional Development Project Sue Cradock (Clinical Nurse Specialist, Portsmouth, and Chair of the BDA ECS) briefly introducted the BDA’s Professional Development Project to explain that this had been initiated to try to ensure that training of health professionals complied to set stan- dards. The project was progressing slowly but she was hopeful that two pilot sites would soon be found and a project manager appointed. This was to be a two year study which would be reported on to the BDA.

Communication As the second joint Chairperson of the con- ference, Sue Cradock introduced the second session with Simon Griffin (GP, South- ampton) who reported on a randomised control trial of patient-centred care in general practice in Wessex. It had involved GPs and practice nurses in Wessex whose practices were randomised into either interventon or control group.

The practices in the active wing of the study were given training on how to en- courage patients to ask questions and join in more actively during the consultation; out- comes of the study included biochemical analyses as well as patient satisfaction. The study results showed that although patients felt they benefited from the intervention in terms of better communication with doctors, higher treatment satisfaction and quality of life, some of the biochemical data did not

There was much discussion focused on trying to explain these results -perhaps the study was not big enough or did not go on long enough, perhaps it was a training issue withnurses learning new skills but forgetting old ones, or perhaps the study was biased by different diabetes therapies.

support this.

Workshops There were workshop sessions on: The diabetic foot (Dr Felix Burden); Exercise (Dr Renee Page); Driving (Dr Kenneth McLeod and Jean Sykes); Communication (Dr Simon Griffin); Patient participation (Eileen Turner). These workshops were intended to allow the delegates to choose one of their interests and develop the sessions of the morning.

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CONFERENCE REPORT Putting good ideas into practice

The Janet Kinson Lecture The conference concluded with the Janet Kinson Lecture delivered by Adele Mc- Evilly (Diabetes Home Care Unit, Birming- ham Children’s Hospital) entitled ‘Real care in the community’. Mrs McEvilly described how the care system worked at the Bir- mingham Children’s Hospital and showed a video produced by patients and their families to describe their experience of the care programme.

Mary Burden RGN MPH Diabetes Specialist Nurse Research &

Development, Diabetes Care, Leicester General Hospital

Footnote The conference attracted 150 multidisciplinary delegates. Evaluation of the day by delegates (55% response rate) showed that the various sessions were rated as either ‘excellent’ or ‘very good’ by 74-97% of the delegates. Suggestions from delegates included the need to allocate more timefortheWorkshops;this willbeacteduponfor future conferences. Just over half the audience had not attended an Education & Care Section con- ference previously, and this led us to believe that we were reaching an appropriate audience. We would like to improve our evaluation procedures to encourage people to take the time to fill in the forms. If you have any suggestions about this, please send them to Mary Burden or any other member of the BDA Education Advisory Com- mittee.

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Posters displayed at the conference included:

Patient acceptability of two commercially available digital retinal screen cameras com- paredtoa Polaroidbasedsystem. Taylor DJ, Jacob J, Took JE, Exeter

Local DiabetesServices Advisory Groupsin the UK: the BDA 1996enquiry. Rothman D, on behalf of the BDA survey enquiry group BDA, London

Dietetic sewices for children and adolescent with diabetes. Walson S, Swift PGF, Bowles S, Leicester Royal Infirmary, Leicester

ACE lnhiition fails to improve reduced transcutaneous oxygen tension and the impaired hyperaemic response in diabetic patients: a placebo-controlled clinical trial. Malik RA, Williamson S, Abbott C, Boulton AJM, Department of Medicine, Manchester Royal Infirmary

The Role of catecholamines in the impaired circadian homeostasis of sodium excretion in NIDDM. Evans PMS‘, TaylorA*, MacDonald I&, Lightman SL‘, OHare JP4 (I - Department of Medicine, Bristol, - Department of Biochemistry, Royal United Hospital, Bath, c- Department of Physiology, Nottingham, ‘- Department of Medicine, University of Warwick

Insulin injection times and meals: a population based study on patients’ views and preferences. Burden ML, Warwick S, Raymond N, Burden AC, Leicester General Hospital, and Department of Epidemiology, Leicester

Identification of two novel missense mutations in the hepatocyte nuclear factor 4 alpha gene associated with maturity onset diabetes of the young (MODY 1). Bulman MP, Frayling T, Beards F, Appleton M, Ellard S, Hattersley AT, University of Exeter

Patient safisfaction with a diabetes foot screening and education service. Whalley A, Hulton J, Thorpe S, Abboty CA, Boulton AJM (Manchester)

CONFERENCE NOTICE

Making the Connection 3rd Annual FEND Conference, Barcelona, Spain

5-7 September 1998 The Federation of European Diabetes Nurses (FEND) cordially welcomes all healthcare professionals working in the field of diabetes to attend this conference.

Afeature of the conference will be a guided tour of the poster Abstracts, in groups, with expert researchers facilitating the guided tour. The posters themselves represent the work of nurses from across Europe who have a research capacity as part of their job.

There will be interactive Workshops for participants.

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FEND is pleased to announce that negotiations regarding the pilot Training Project for Nurses have been completed and that the first programme will be held in Uppsala, Sweden in conjunction with the University and the Faculty of Caring Sciences. Further details will be announced at the conference or may subsequently be obtained from Anne-Marie Felton (see below).

FEND Chairperson:

Registtation:

Anne-Marie Felton. Tel: +44 (0)181 876 61 22, Fax: +44 (0)181 255 91 69, E-mail: fend@felton.cornpuIink.co.uk Internet: www.fend.org

Stina Wallenkrans, PI9747 Husebaken, S-44497 Svenshogen, Sweden. Fax: +46 303 7741 1 1

98 Practical Diabetes International May 1998 Vol. 15 No. 3