Background: Diabetes-related anxiety influences the quality-of-life of people with diabetes. Aim: To compare diabetes-related concerns in insulin-treated patients with type 1 and type 2 diabetes. Method: A cross-sectional questionnaire survey was carried out in two cohorts of adult outpatients with type 1 diabetes (n=223) and insulin-treated type 2 diabetes (n=104). Assessment of concerns about mild and severe hypoglycaemia, blindness and kidney failure was carried out using the seven-point Likert scale. Results: Insulin-treated patients with type 1 or 2 diabetes worry mostly about late diabetic complications, less about severe hypoglycaemia and little about mild hypoglycaemia. Patients with type 1 diabetes worry more about severe hypoglycaemia than those with type 2 diabetes; no differences in levels of anxiety about mild hypoglycaemia, blindness and kidney failure exist. Severe hypoglycaemia in the preceding year is associated with more worry about severe hypoglycaemia in patients with type 1 or 2 diabetes. Those with type 1 or 2 diabetes who have impaired awareness of hypoglycaemia tend to worry more about severe hypoglycaemia than those with normal awareness of hypoglycaemia. The presence of eye or kidney complications does not influence the level of anxiety in people with type 1 diabetes. Patients with type 2 diabetes without complications tend to worry more about mild and severe hypoglycaemia than those with complications. Conclusion: Patients with insulin-treated diabetes worry considerably about microvascular complications and severe hypoglycaemia risk. Recent experience of severe hypoglycaemia and presence of impaired hypoglycaemia awareness are associated with increased worry scores for severe hypoglycaemia in patients with type 1 or 2 diabetes. Screening for diabetes-related concerns should be integrated into diabetes care.

ObjectiveThis systematic review examines the medical, psychological and educational literature for training in practising leadership of a team leader in emergencies. The objectives of this paper are (1) describe how literature addresses operational training in practising leadership for the emergency medical team-leader (2) enhance understanding of leadership training in the medical environment.BackgroundWorldwide, medical supervisors find it difficult to get students to rise to the occasion as leaders of emergency teams. It appears that many residents feel unprepared to adopt the role as a leader in emergencies.MethodA systematic review was conducted (May–December 2016) in accordance with the PRISMA 2009 Checklist. A literature search was conducted against a set of inclusion criteria. Databases searched included PubMed, Psycinfo (via Ovid), and ERIC.Results27 articles covering the period 1986–2016 were analysed. Four sources of data were identified: Intervention studies practising leadership, intervention studies on simulation and leadership assessment, observation studies assessing leadership, interview/survey studies about the need for leadership training. No workable training in practising leadership in emergencies for doctors was found. The majority of the research projects focused on various different types of taxonomies.ConclusionsNo consistent and workable leadership training for the emergency medical teamleader was identified. One study for paramedics succeeded in training empowering leadership skills. For many years multiple taxonomies and leadership assessment tools have been developed but failed to come to terms with workable leadership training. The literature describes lack of leadership as highly detrimental to performance during a critical, clinical situation.

IntroductionWorldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account.AimThe overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills.BackgroundAn orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority.MethodA conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment.ConclusionThe transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority.PerspectivesIf this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic.

ObjectiveAn investigation to determine any consensus in opinions and views in the literature about challenges or barriers in training leadership for emergencies.Summary of background dataLeadership in emergencies is reported as being very important for patient outcome. A systematic review failed in 2016 to find any focused leadership training. In the literature, the research has described and focused on developing tools to evaluate leadership.MethodArticles identified in the systematic review combined with other reviews and opinions were included to incorporate experiences, perceptions and emotions connected with leadership training in emergency situations. Two qualitative content analyses were conducted. The first analysis searched for opinions about leadership and leadership training in emergencies. The method was abductive – inductive qualitative content analysis. The second analysis searched, on the basis of an article written in 1986, statements about challenges regarding leadership training in all articles. This method was directed qualitative content analysis.FindingsIn total 40 articles covering the years 1986–2016 were analysed. An explicit need for workable leadership training of team leaders in emergencies was identified. The importance of the teamleader in emergencies was repeatedly stressed by 31/40 articles, leadership training is needed or required was stated by 30/40 articles, 27/40 articles described the emergency situation as stressful, complex, chaotic or unpredictable, 17/40 described the importance of self-confidence by the teamleader, and 8/40 described that the situation was perceived as creating concern, anxiety or panic.ConclusionsThe literature recommends finding a solution to teach residents to gain courage and confidence in stressful surroundings. The literature recommends finding a way to work with body language, non-verbal communication, attitude and appearance in order to radiate credibility in a setting separated from medical knowledge.

Aim: To compare self-treatment of mild symptomatic hypoglycaemia in people with type 1 diabetes with national Danish guidelines recommending 10-20 g of refined carbohydrate initially followed by unrefined carbohydrates. Methods: A cohort of 201 patients with type 1 diabetes filled in a questionnaire including self-treatment of mild symptomatic hypoglycaemia and occurrence of mild and severe hypoglycaemia. Initial intake of less than 10 g of refined carbohydrate was defined as under treatment and intake of 20 g or more as over treatment. Results: A total of 147 patients (73%) answered both questions about initial and follow-up self-treatment of hypoglycaemia. Fifty per cent of patients treated themselves with 10-20 g refined carbohydrates (female:male = 59%:43%; p<0.05), whereas 37% over treated (female:male = 34%:39%; not significant) and 13% under treated (female:male = 6%:18%; p<0.05). Initial treatment was followed by consumption of unrefined carbohydrates in 70% of the patients. Overall, 37% (female:male = 49%:28%; p<0.05) of the patients adhered to guidelines. The number of severe hypoglycaemic episodes (lifetime) and amount of carbohydrate intake were positively correlated (r=0.2; p<0.05). Adherence to guidelines was not related to occurrence of mild and severe (in the last year) hypoglycaemia, glycated haemoglobin, or fear of hypoglycaemia. Conclusions: Only about one-third of patients with type 1 diabetes treat mild hypoglycaemia according to guidelines. Female patients show better compliance. Patients with frequent episodes of severe hypoglycaemia over treat more often.