Aim: This study investigated the effect of macronutrient composition of meals on postprandial peptide YY3–36 (PYY3–36) response in obese hyperinsulinemic females. Methods: Eight obese females consumed three iso-energetic meals of different macronutrient composition, high carbohydrate (HC; 60% CHO, 20% protein, 20% fat), high fat (HF; 30% CHO, 20% protein, 50% fat) and high protein (HP; 30% CHO, 50% protein, 20% fat), on three separate occasions, 1 month apart. PYY3–36, insulin and glucosewere measured before and 15, 30, 60, 120 and 180 min following each meal. Results: PYY3–36 levelsincreased significantly following the three meals, with the HC meal resulting in a sustained postprandial increase in PYY3–36 level throughout the experimental period. Comparing the three meals, the HF meal induced a significantly higher increase in postprandial PYY3–36 levels, at 15 and 30 min as compared to the HP meal (p < 0.05), whereas the postprandial increase following the HP meal became significantly higher than that following the HF meal at 120 min. Postprandial increase in PYY3–36 was highest in the first hour following the HF meal, while that following the HP meal was delayed by 1 h. Conclusion: Increasing both protein and fat content of a meal may induce an immediate and prolonged increase in PYY3–36, resulting in increased satiety and its maintenance for a longer period of time.

The increasing prevalence of diabetes poses significant challenges to healthcare systems around the world. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease (DKD) is becoming a global health concern because it is a progressive disease associated with major health complications and increased health costs. The treatment goals for DKD are to slow the progression of the renal disease and prevent cardiovascular events. Accordingly, patients are expected to adhere to prescribed treatments and manage a wide range of daily self-care activities. Multidisciplinary management of chronic diseases, like diabetes and kidney disease, has been suggested as a means to improve patients' adherence to treatment and enhance health-related outcomes. This systematic review of multidisciplinary management of DKD is an important step in evaluating if such a management approach is effective in delaying disease progression. The goal of this systematic review was to identify the best available evidence regarding multidisciplinary management of DKD and to determine if a multidisciplinary management of DKD can improve patient outcomes. Specifically the review question was: What is the impact of multidisciplinary management of DKD on patient outcomes? The current review considered adults aged 18 years and older who had been diagnosed with type 1 or type 2 diabetes and chronic kidney disease. The current review examined studies that compared multidisciplinary interventions with usual standard care in ambulatory settings for patients with DKD. The current review considered studies with the following primary outcomes: kidney function, incidence of kidney failure, generic or specific health-related quality of life, patient self-care abilities, adherence to treatment recommendations or goals; and the following secondary clinical outcomes: mortality rates secondary to DKD, glycemic control, blood pressure (BP) control, lipid profile, incidence of cardiovascular disease/events, patient knowledge on diabetes or DKD, patient empowerment or self-efficacy, generic or specific patient satisfaction with care and patient healthcare utilization. The current review will consider randomized and quasi-experimental trials but included only randomized controlled trials (RCTs). A three-step search strategy was utilized starting with a search of MEDLINE and CINAHL for the identification of keywords, followed by a search using keywords and index terms across MEDLINE, CINAHL and Embase databases and clinical trials registry platforms, and finally a search of the reference list of all identified papers. Studies published from the time of the respective database inception to November 2014 in English, German and French were considered. Two independent reviewers assessed the methodological validity of the papers prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Quantitative data were pooled using the RevMan 5 software for kidney function using estimated Glomerular Filtration Rate (eGFR), glycated hemoglobin, BP and total cholesterol (TC). Results were considered significant for P < 0.05. Three RCTs were included in this review. Meta-analysis showed that multidisciplinary management was associated with a statistically significant improvement of glycated hemoglobin as compared with standard usual care (Relative Risk [RR] -0.49, at 95% confidence interval [CI] -0.83, -0.16, P < 0.01). The meta-analysis for eGFR showed a tendency to favor standard care; however, this finding cannot be conclusive because the CI was too wide (RR -3.30, at 95% CI -6.55, -0.05, P = 0.05). Meta-analysis results for BP and TC failed to show a difference between the multidisciplinary management of DKD and the usual standard care. Only one study measured patient-oriented primary and secondary outcomes and showed an improvement in health-related quality of life, patient self-care abilities, patient level of knowledge on diabetes and exercise self-efficacy. Multidisciplinary management of DKD has the potential for improving glycemic control and thus preventing complications. Its effect on other clinical and patient-oriented outcomes, especially on delaying the progression of the disease through preserving and preventing the decline in kidney function, has yet to be determined. There is not enough evidence to recommend multidisciplinary management for preserving kidney function. Further studies are needed.

Diabetic kidney disease, a global health issue, remains associated with high morbidity and mortality. Previous research has shown that multidisciplinary management of chronic disease can improve patient outcomes. The effect of multidisciplinary self-care management on quality of life and renal function of patients with diabetic kidney disease has not yet been well established. The aim of this study is to evaluate the impact of a multidisciplinary self-care management program on quality of life, self-care behavior, adherence to anti-hypertensive treatment, glycemic control, and renal function of adults with diabetic kidney disease. A uniform balanced cross-over design is used, with the objective to recruit 40 adult participants with diabetic kidney disease, from public and private out-patient settings in French speaking Switzerland. Participants are randomized in equal number into four study arms. Each participant receives usual care alternating with the multidisciplinary self- care management program. Each treatment period lasts three months and is repeated twice at different time intervals over 12 months depending on the cross-over arm. The multidisciplinary self-care management program is led by an advanced practice nurse and adds nursing and dietary consultations and follow-ups, to the habitual management provided by the general practitioner, the nephrologist and the diabetologist. Data is collected every three months for 12 months. Quality of life is measured using the Audit of Diabetes-Dependent Quality of Life scale, patient self-care behavior is assessed using the Revised Summary of Diabetes Self-Care Activities, and adherence to anti-hypertensive therapy is evaluated using the Medication Events Monitoring System. Blood glucose control is measured by the glycated hemoglobin levels and renal function by serum creatinine, estimated glomerular filtration rate and urinary albumin/creatinine ratio. Data will be analyzed using STATA version 14. The cross-over design will elucidate the responses of individual participant to each treatment, and will allow us to better evaluate the use of such a design in clinical settings and behavioral studies. This study also explores the impact of a theory-based nursing practice and its implementation into a multidisciplinary context. ClinicalTrials.gov identifier: NCT01967901 , registered on the 18th of October 2013.

Individuals with diabetic kidney disease are at high risk of complications and challenged to self-manage. Previous research suggested that multidisciplinary approaches would improve health outcomes. This study investigated the effect of a multidisciplinary self-management approach of diabetic kidney disease on quality of life, and self-management, glycemic control, and renal function. A uniform balanced crossover design was used because it attains a high level of statistical power with a lower sample size. A total of 32 participants (aged 67.8 ± 10.8) were randomized into four study arms. In differing sequences, each participant was treated twice with three months of usual care alternated with three months of multidisciplinary management. The intervention improved the present dimension of quality of life demonstrating higher mean rank as compared to usual care (52.49 vs. 41.01; p = 0.026, 95% CI) and three self-care activities, general diet habits, diabetes diet habits, and blood sugar testing (respectively: 55.43 vs. 38.31; p = 0.002, 56.84 vs. 37.02; p = 0.000, 53.84 vs. 39.77; p = 0.008; 95% CI). Antihypertensive medication engagement was high across the study period (Mean = 95.38%, Min = 69%, Max = 100%). Glycemic control and renal function indicators were similar for the intervention and the usual care. Studies are needed to determine how the new recommended therapies for diabetic kidney disease such as SGLT2 inhibitors and GLP-1 receptor agonists impact on self-management and quality of life.

This study examined undergraduate students' perceptions of learning nursing theories and the contribution of these theories to clinical practice. Nursing theories are the foundation of the discipline. Students' perceptions of learning nursing theories are under-investigated. This descriptive study used a qualitative approach with five questions survey and group narratives. 163 first-year nursing students (female= 85%) participated in the study. Participants chose the best-fit theory to answer individually questions on the contribution of six learnt theories (McGill Model of Nursing, Self-Care Deficit Nursing Theory, Theory of Humanbecoming, Theory of Interpersonal Relations, Adaptation Model of Nursing and Theory of Human Caring) to their clinical practice. They discussed their answers in groups and provided group narratives. Responses of 163 participants showed no theory to be predominant. Narratives' analysis revealed four themes: Pluralism in the view of nursing theories, Dualism in the view of nursing practice, Monism in the view of the person and Learning based on personal values and social context. Students recognize the plurality of theories and the Person holistically. Teaching nursing theory in the undergraduate program should support the use of theoretical knowledge relevant to practice and promote its direct application during clinical training. This study examined undergraduate students' perceptions of learning nursing theories using a qualitative approach. Narratives revealed Pluralism in the view of theories, Dualism in the view of practice, Monism in the view of the person and Learning based on personal values and social context.