Experiencia Educativa Inglesa


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Experiencia educativa para personas con DBT1, en Inglaterra. Aplicación del Método de Conteo de hidratos de carbono

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  • DUK and DH highlighted a gap in the delivery of such education to children and adolescents and now provides quality standards for education programmes ………………….
  • DH has highlighted one programme that meets the criteria for type 1 diabetes …………
  • Experiencia Educativa Inglesa

    1. 1. The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s NHS Trust
    2. 2. Diabetes UK and Department of Health 2005 <ul><li>Evidence based </li></ul><ul><li>Clear aims and objectives </li></ul><ul><li>To meet personal learning needs </li></ul><ul><li>Trained educators </li></ul><ul><li>Structured </li></ul><ul><li>Quality assured and audited </li></ul>Recommendations/guidelines Diabetes NSF 2001 NICE 2004 and 2004
    3. 3. DAFNE – Dose Adjustment for Normal Eating for Adults <ul><li>5 day structured training programme </li></ul><ul><li>4-5 injections a day </li></ul><ul><li>4-5 blood tests a day </li></ul><ul><li>Free diet </li></ul><ul><li>Insulin dose to match carbohydrate intake </li></ul><ul><li>Reduce HbA1c </li></ul><ul><li>Improved QOL </li></ul>
    4. 4. Paediatric KICk-OFF course research project Phase 1 – 2002 -Development of a curriculum Funded by Sheffield Children’s Appeal Phase 2 – 2004 - Pilot courses, refinement of curriculum Grant from DUK Phase 3 - Multicentre Randomised Control Trial To be funded by DUK awaiting confirmation of start date
    5. 5. <ul><li>Development of the KICk-OFF curriculum </li></ul><ul><li>PDNS survey (Autumn 2002) </li></ul><ul><li>Focus groups </li></ul><ul><li>(Jan. 2003 Comparing current </li></ul><ul><li>education programmes with DAFNE ) </li></ul><ul><li>Lubeck, Germany (Jan. 2004) </li></ul><ul><li>School teachers </li></ul>
    6. 6. Working with school teachers <ul><li>DAFNE to KICk-OFF </li></ul><ul><li>National schools curriculum </li></ul><ul><li>“ Intellectual development” - growth in pupils knowledge understanding and skill </li></ul><ul><li>“ Social development” - growth in self esteem, self confidence, greater maturity </li></ul><ul><li>Office For Standards in Education (OFSTED) </li></ul><ul><li>Is it clear what the purpose of the lesson is? </li></ul><ul><li>Has the lesson taken into account the learners </li></ul><ul><li>needs? </li></ul>
    7. 7. Working with school teachers <ul><li>Style of teaching (observation) </li></ul><ul><li>Lesson planning </li></ul><ul><li>Specific teaching skills </li></ul><ul><li>Presentation </li></ul><ul><li>Setting boundaries/learning environment </li></ul><ul><li>Reading age </li></ul>
    8. 8. Monday Tuesday Wednesday Thursday Friday Introduction to the course What is diabetes? Group discusses blood sugar levels Hypoglycaemia Discuss overnight blood sugar levels. How to adjust insulin Discuss blood sugar levels Healthy eating/weight control Sweets, treats and snacks [Friends invited] Discuss overnight blood sugar levels. Friends recap what is diabetes Everyone discusses using Kick-Off in school Break Break Break Break Break Signs and symptoms, Insulin Types of food and CP’s CP booklet and diary Insulin/CHO relationship Hypoglycaemia and Kick-off treatment CP/insulin ratio Work out CP’s for packed lunch How to manage illness using KICkOFF guidelines Alcohol and social issues Poster display Exercise [theory] Managing hypos in and out of school Puberty awareness and control What happens next? Follow-up after the course Discuss school packs Recap weeks learning objectives Evaluation Lunch Packed lunch Lunch Lunch Lunch - buffet Insulin/CHO continued Correction dose Monitoring Practicing counting grams of CHO + practical Diabetes and long term health discussion Healthy lifestyle vs unhealthy Exercise Practical session. Parents will discuss follow-up care, discussion about the week and continued support Children do fun activity Break Break Break Break Millionaire game Recapping the days objectives Plan evening insulin dose. Personal interviews Practical session continued Quiz Prepare food for parents Recap objectives of the day Plan evening insulin dose Quiz Students to plan evening insulin dose Quiz Free session for guest speaker or other activity Continued Presentation of quiz winners Finish
    9. 9. Day 2, session 2. Counting grams of carbohydrate <ul><li>TUESDAY </li></ul><ul><li>Session 2:- </li></ul><ul><li>Counting grams of carbohydrate </li></ul><ul><li> Practical session </li></ul><ul><li>Learning Objectives </li></ul><ul><li>Continue with carbohydrate and insulin ratios </li></ul><ul><li>Continuing with learning the skills for counting grams of carbohydrate </li></ul><ul><li>Materials </li></ul><ul><li>Scales </li></ul><ul><li>Food ingredients </li></ul><ul><li>Recipes </li></ul><ul><li>Flip chart </li></ul><ul><li>Pens </li></ul><ul><li>Diaries </li></ul><ul><li>Work sheets </li></ul><ul><li>Calculators </li></ul><ul><li>Plates </li></ul><ul><li>Kitchen equipment </li></ul><ul><li>Digital scales </li></ul><ul><li>Pots and pans </li></ul><ul><li>Baking tins </li></ul><ul><li>Washing up materials </li></ul><ul><li>(tea towels, cloths, washing up liquid) </li></ul>
    10. 10. Educator Dietitian and nurse Preparation Transport children to school cookery room. Set up the work stations with foods needed for recipes. TIME EDUCATOR ACTIVITY STUDENT ACTIVITY MATERIALS 11am Explain:- This session is a practical session to learn how to work out how much CHO is in the food you prepare. Group to split into pairs and they are each given a recipe <ul><li>Response: </li></ul><ul><li>Split into pairs but not the same pairs as the morning </li></ul><ul><li>Follow recipes </li></ul><ul><li>Tidy up after the food is prepared </li></ul><ul><li>Complete work sheet </li></ul>4 recipes for fruit muffins fruit scones jam and butter scales Paper plates ingredients utensils Calculators Pens Flip charts Worksheet for estimating CP’s in rice, pasta, potato, cereals.
    11. 11. Pilot Study 2004 <ul><li>8 per course, 11-13 and 14-16 yr </li></ul><ul><li>2 research educators and 1 local </li></ul><ul><li>educator </li></ul><ul><li>3 Paediatric centres Sheffield, </li></ul><ul><li>Manchester and Derby </li></ul><ul><li>Training the trainers course </li></ul><ul><li>Sheffield Hallam University </li></ul><ul><li>3 days (2 theory, 1 practical) </li></ul>
    12. 12. <ul><li>independent peer review </li></ul><ul><li>interview </li></ul><ul><li>daily feedback questionnaire </li></ul>EVALUATION Effectiveness : Teaching, curriculum, course format : <ul><li>HbA1c pre course , 3 and 6 months </li></ul><ul><li>hypoglycaemia rates </li></ul><ul><li>BMI </li></ul><ul><li>Psychological outcome at 0, 2 weeks, 3 and 6 months </li></ul><ul><li>QoL </li></ul><ul><li>Satisfaction with treatment </li></ul><ul><li>family conflict </li></ul><ul><li>self management responsibility </li></ul><ul><li>self efficacy </li></ul>
    13. 14. Table 1. Mean HbA1c Values Over Time More mild hypo’s No more moderate or severe hypo episodes No significant change BMI Baseline 3-months 6-months Mean (sd) 8.58 (1.80) 8.72 (1.98) 8.69 (1.98)
    14. 15. QOL: Generic <ul><li>Children </li></ul><ul><li>F(3,81)=8.00,p=.0001 *** </li></ul><ul><li>Parents </li></ul><ul><li>F(3,81)=6.14, p=.001** </li></ul>QOL: Diabetes Children F(3,81)=9.25, p=.0001 *** Parents F(3,81)=4.56, p=.005 **
    15. 16. Psychosocial Outcomes for child and parent Satisfaction with Treatment: Greater satisfaction with diabetes treatment after the course. Self-Efficacy: Children more confident managing their diabetes after the course. Family Conflict: no significant change (minimal before and after course). Parent-child Responsibility: more responsibility for managing diabetes after the course. Coping with Diabetes: more able to cope after the course.
    16. 17. Changes to the course: <ul><li>Venue </li></ul><ul><li>Timings of difficult sessions- in the first 2 sessions </li></ul><ul><li>More practical sessions </li></ul><ul><li>Specific parent teaching – 1 day teaching course </li></ul><ul><li>Improved school support </li></ul><ul><li>Follow-up </li></ul><ul><li>Interactive booklet </li></ul><ul><li>More CHO/Ratio practice </li></ul><ul><li>5 day skills training programme for educators </li></ul>
    17. 18. <ul><li>Multi-centre cluster randomised controlled trial comparing </li></ul><ul><li>intensive education with standard education in 11-16 year olds on </li></ul><ul><li>intensive insulin therapy. </li></ul><ul><li>Sponsored by DUK </li></ul><ul><li>36 UK paediatric diabetes clinics (576 total participants) </li></ul><ul><li>18 intervention/18 control – both using MDI </li></ul><ul><li>2 year follow-up </li></ul><ul><li>Control group receives skills training course and KICk-OFF curriculum </li></ul><ul><li>Outcomes measured at 0, 6, 12, 24 months:- </li></ul><ul><li>HbA1c </li></ul><ul><li>Psychological outcomes </li></ul><ul><li>Hypoglycaemia episodes </li></ul><ul><li>DKA </li></ul><ul><li>BMI </li></ul><ul><li>Diet related behaviours </li></ul>