OBJECTIVE -To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes. RESEARCH DESIGN AND METHODS-A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA 1c , lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. RESULTS-After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA 1c (12.0 -8.3%, P Ͻ 0.0001), total cholesterol (5.82-4.86 mmol/l, P Ͻ 0.0001), LDL cholesterol (3.39 -2.79 mmol/l, P Ͻ 0.0001), and diastolic blood pressure (80 -76 mmHg, P Ͻ 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P ϭ 0.024), treatment satisfaction (P ϭ 0.001), and culturebased beliefs (P ϭ 0.001) were also improved.CONCLUSIONS -A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations. Diabetes Care 27:110 -115, 2004T he incidence of diabetes is rapidly increasing in Western societies. Specific racial and ethnic groups, such as Mexican Americans, African Americans, Asian Americans, and Native Americans, are disproportionately affected by diabetes (1,2). The adverse impact on health of uncontrolled diabetes in these groups is compounded by lack of access to traditional primary care and preventive health care services (3-5).In response to this lack of adequate care for the uninsured, there is an increasing impetus for defining and implementing additional methods of improving diabetes care. The Centers for Disease Control and Prevention's national health objectives for year 2010 include increasing the percentage of individuals with diabetes who achieve specific standards of diabetes care (6). Diabetes management and education programs have been shown to have a significant impact on improving health outcomes (7-10). However, there remains a significant gap in translating and implementing effective approaches in the treatment of diabetes, particularly in underserved racial and ethnic groups (11-13). There is limited experience and available data assessing nontraditional approaches to diabetes self-management and empowerment models in diverse ethnic groups and none testing a comprehensive management approach (14 -17). Project Dulce was designed to test ...

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The influence of a new haemostatic material on surgical bleeding was evaluated in 100 patients who were prospectively randomized to either normal surgical gauze or calcium alginate swabs used throughout cholecystectomy (n = 40), simple mastectomy (n = 18) or inguinal hernia repair (n = 42). Overall, median (range) blood loss was 91 (3-329) ml for gauze and was significantly reduced by calcium alginate swabs to 72 (2-181) ml (P less than 0.05). Unexpectedly, operation times were also shortened from 45 (17-95) min for gauze to 35 (13-70) min with calcium alginate swabs (P less than 0.02). This reduction in blood loss and operating time was greatest for mastectomy, was still statistically significant for cholecystectomy, but was unimportant in inguinal hernia repair. Calcium alginate haemostatic swabs may become routine in major surgery, particularly where blood loss leads to the need for transfusion.

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An audit of 100 new patients attending a specialist lymphoedema clinic revealed 52% presented with chronic oedema. More than half (58%) of the chronic oedema group presented with skin changes whereas 14% of those with lipoedema, 4% with lymphoedema of the arm, and 8% with lymphoedema of the leg developed skin changes. None of the primary lymphoedema group developed skin changes. Chronic venous disease (CVD) was significantly more prevalent in the chronic oedema group. More patients with bilateral chronic oedema suffered from cellulitis (41%) compared to unilateral (27%). Skin changes, CVD and red leg syndrome (RLS) also occur more often in bilateral leg swelling. Incidence of cellulitis is highest in the chronic oedema group (36.5%), closely followed by the primary lymphoedema group (33.3%). 85% of the patients who were weighed (n=93) were overweight, 39% obese, and 29% morbidly obese. The findings from this audit highlight the importance of skin care training for community nurses managing chronic oedema patients.