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Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews
Get PDFBackground
Successful treatments for gestational diabetes mellitus (GDM) have the potential to improve health outcomes for women with GDM and their babies.
Objectives
To provide a comprehensive synthesis of evidence from Cochrane systematic reviews of the benefits and harms associated with interventions for treating GDM on women and their babies.
Methods
We searched the Cochrane Database of Systematic Reviews (5 January 2018) for reviews of treatment/management for women with GDM. Reviews of pregnant women with pre-existing diabetes were excluded.
Two overview authors independently assessed reviews for inclusion, quality (AMSTAR; ROBIS), quality of evidence (GRADE), and extracted data.
Main results
We included 14 reviews. Of these, 10 provided relevant high-quality and low-risk of bias data (AMSTAR and ROBIS) from 128 randomised controlled trials (RCTs), 27 comparisons, 17,984 women, 16,305 babies, and 1441 children. Evidence ranged from high to very low-quality (GRADE). Only one effective intervention was found for treating women with GDM.
Effective
Lifestyle versus usual care
Lifestyle intervention versus usual care probably reduces large-for-gestational age (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.50 to 0.71; 6 RCTs, N = 2994; GRADE moderate-quality).
Promising
No evidence for any outcome for any comparison could be classified to this category.
Ineffective or possibly harmful
Lifestyle versus usual care
Lifestyle intervention versus usual care probably increases the risk of induction of labour (IOL) suggesting possible harm (average RR 1.20, 95% CI 0.99 to 1.46; 4 RCTs, N = 2699; GRADE moderate-quality).
Exercise versus control
Exercise intervention versus control for return to pre-pregnancy weight suggested ineffectiveness (body mass index, BMI) MD 0.11 kg/m², 95% CI -1.04 to 1.26; 3 RCTs, N = 254; GRADE moderate-quality).
Insulin versus oral therapy
Insulin intervention versus oral therapy probably increases the risk of IOL suggesting possible harm (RR 1.3, 95% CI 0.96 to 1.75; 3 RCTs, N = 348; GRADE moderate-quality).
Probably ineffective or harmful interventions
Insulin versus oral therapy
For insulin compared to oral therapy there is probably an increased risk of the hypertensive disorders of pregnancy (RR 1.89, 95% CI 1.14 to 3.12; 4 RCTs, N = 1214; GRADE moderate-quality).
Inconclusive
Lifestyle versus usual care
The evidence for childhood adiposity kg/m² (RR 0.91, 95% CI 0.75 to 1.11; 3 RCTs, N = 767; GRADE moderate-quality) and
hypoglycaemia was inconclusive (average RR 0.99, 95% CI 0.65 to 1.52; 6 RCTs, N = 3000; GRADE moderate-quality).
Exercise versus control
The evidence for caesarean section (RR 0.86, 95% CI 0.63 to 1.16; 5 RCTs, N = 316; GRADE moderate quality) and perinatal death or serious morbidity composite was inconclusive (RR 0.56, 95% CI 0.12 to 2.61; 2 RCTs, N = 169; GRADE moderate-quality).
Insulin versus oral therapy
The evidence for the following outcomes was inconclusive: pre-eclampsia (RR 1.14, 95% CI 0.86 to 1.52; 10 RCTs, N = 2060),
caesarean section (RR 1.03, 95% CI 0.93 to 1.14; 17 RCTs, N = 1988), large-for-gestational age (average RR 1.01, 95% CI 0.76 to 1.35; 13 RCTs, N = 2352), and perinatal death or serious morbidity composite (RR 1.03; 95% CI 0.84 to 1.26; 2 RCTs, N = 760). GRADE assessment was moderate-quality for these outcomes.
Insulin versus diet
The evidence for perinatal mortality was inconclusive (RR 0.74, 95% CI 0.41 to 1.33; 4 RCTs, N = 1137; GRADE moderate-quality).
Insulin versus insulin
The evidence for insulin aspart versus lispro for risk of caesarean section was inconclusive (RR 1.00, 95% CI 0.91 to 1.09; 3 RCTs, N = 410; GRADE moderate quality).
No conclusions possible
No conclusions were possible for: lifestyle versus usual care (perineal trauma, postnatal depression, neonatal adiposity, number of antenatal visits/admissions); diet versus control (pre-eclampsia, caesarean section); myo-inositol versus placebo (hypoglycaemia); metformin versus glibenclamide (hypertensive disorders of pregnancy, pregnancy-induced hypertension, death or serious morbidity composite, insulin versus oral therapy (development of type 2 diabetes); intensive management versus routine care (IOL, large-for-gestational age); post- versus pre-prandial glucose monitoring (large-for-gestational age). The evidence ranged from moderate-, low- and very low quality.
Authors’ conclusions
Currently there is insufficient high-quality evidence about the effects on health outcomes of relevance for women with GDM and their babies for many of the comparisons in this overview comparing treatment interventions for women with GDM. Lifestyle changes (including as a minimum healthy eating, physical activity and self-monitoring of blood sugar levels) was the only intervention that showed possible health improvements for women and their babies. Lifestyle interventions may result in fewer babies being large. Conversely, in terms of harms, lifestyle interventions may also increase the number of inductions. Taking insulin was also associated with an increase in hypertensive disorders, when compared to oral therapy. There was very limited information on long-term health and health services costs. Further high-quality research is needed
Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control – a qualitative study using the theoretical domains framework
Get PDFBackground: Glycaemic target recommendations vary widely between international professional organisations for
women with gestational diabetes mellitus (GDM). Some studies have reported women’s experiences of having GDM,
but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and
barriers for women with GDM to achieve optimal glycaemic control.
Methods: Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to
participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to
achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework.
Results: Sixty women participated in the study. Women reported a shift from their initial negative response to accepting
their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains
across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear
from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman’s
context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment,
health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG
testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and
food diaries in a woman’s first language; long waiting times at clinic appointments; seeing a different health professional
every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate
information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support
groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with
their partners. This created social isolation.
Conclusion: Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The
findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for
women with GDM and support them to achieve optimal glycaemic control
Presentation to Technical University of Liberec academic and research staff.
Get PDFMy presentation gave an overview of Wintec its centres and the research that is being undertaken within CEID and in collaboration with other centres, institutions and industry
Crybaby
No full textAn exhibition of contemporary abstract painting exploring concepts of psychology and political behavior.
Cry Baby List of Works
1. Splenetic. Geoffrey Clarke, Ink on Synthetic Canvas, 1600mm x 2300mm.2018.
2. UKKO. Geoffrey Clarke, Ink on Synthetic Canvas, 1600mm x 2300mm.2018.
3. Mass unit. Geoffrey Clarke, Acrylic on Laser cut Panel, Various Dimen
How to improve business process performance using process mining
Get PDFDue to the increased use of information systems by organizations to support process execution, detailed information on the implementation of business processes is being recorded. This fact enables using process mining projects as a powerful tool for improving performance. Process Mining is a relative young research discipline that sits between data science on the one hand and process modelling and analysis on the other hand. Process mining allows gaining knowledge of the organization’s actual business processes by extracting data from existing information systems mediums such as event logs, transaction logs etc.
The purpose of this presentation is to demonstrate how a process for conducting process mining projects was designed, developed and applied in some organizational units.
The process was implemented through nine research steps, inspired by the V-model, where elements on the right-hand side aim to answer questions presented in steps on the left-hand side. In the first two steps, the research problem and the research objectives were defined. A literature review was performed in step 3. In the fourth step, requirements for the process were identified and implemented. In step 5, a running example was carried out to test the process. Verification and validation of the process were performed in step 6 and step 7. Step 8 covered the discussion of results. The last step concludes the research, including checking if the research problem was solved.
Organizations seeking for performance improvement can now benefit of a process that explicitly states which process mining tools, techniques and algorithms to be used in process mining projects
Arctic Ghillie Suit, 29/10/17: Exhibited in the New Zealand National Contemporary Art Award 2018, Waikato Museum, Hamilton, New Zealand
No full text“What is not seen is for all practical purposes non-existent”. Solomon J Solomon
The need to conceal is at the core of my photographic project Mimetic which looks at the multifaceted ways in which mimicry, camouflage and deception play as much a part in the lives of humans as they do the animal kingdom. Often in my work, there is a tension between what my photographs describe and what they reveal. In the work Arctic Ghillie Suit, 29/10/17, I am exploiting the potential of photography’s indexicality - when it is at its most factual is often when it is most obscure.
Museum Statement: The best and boldest contemporary art always emerges out of the National Contemporary Art Award. The art award has been one of the most prestigious art events for the last eighteen years in Aotearoa because of the calibre of its judges and artists alike. Contemporary art is not just an exhibition of art for the elite, it is an invitation to anyone with an inquiring mind to enjoy. The 2018 judge, Reuben Friend, Director of Pātaka Art + Museum, has selected this year’s finalists from over 300 entries
Project management software (Project management, transition, training and support, Trello, NAS)
Get PDFTo setup a project management software system that will reduce the administration efforts of Classic Events and would be the centre to access all events, logistics, sponsors and key information.
- Technological research by studying organization goals, strategies, practices, and user projects and recommend project management software.
- Accomplish results by communicating job scope: planning, initiating, coordinating, monitoring training, and support
- preserves assets by implementing disaster recovery and back-up procedures and information security and controls
Motives and expectations: A study of accounting students at New Zealand polytechnics
Get PDFThis report aims to investigate student's choices for studying accounting in New Zealand polytechnics. It provides information on students’ motives for choosing the institute and their expectations of the accounting programmes it is offering. The gap between accounting education and practice is an increasing problem for accounting firms. The skills accounting graduates display are often not the skills the workplace is interviewing for. This creates problems for accounting students trying to make a career in the industry. If they are not showing the skills that employers are looking for, their chances of finding paid employment are much lower. Nine polytechnic students studying for an accounting degree were interviewed for this report, using convenience and then snowball methods. The researcher followed a question guide for each interview focused on gaining the student’s opinions. Tentative results have found that students are satisfied with their overall level of learning. Study at the polytechnic was chosen over university because of flexible class times and being able to have a life outside of study. University was considered huge and scary, but also difficult for international students to pass entry criteria. There were 78 percent of students studying the CAANZ major, but only 56 percent wanted to study further to gain Chartered Accountant qualifications. This report will be of benefit to polytechnics as it will assist them in attracting and retaining more students
How could Sunny Bay more effectively use existing marketing channels? What new marketing channels they could use?
Get PDFHealth care products are a popular market in New Zealand. There are more and more health care product stores operating every year. Sunny Bay is a health care product retail store in Hamilton, which has been operating around 15 months. The aim of this research is to evaluate Sunny Bay’s current online marketing channels, and recommend new marketing channels to Sunny Bay. In this study, the researcher used primary and secondary research methods. The primary research involved using questionnaires to randomly survey 50 customers who visited Sunny Bay. Results showed that most customers prefer shopping online and think that store location will affect their purchase decision. The questionnaire showed that Wechat is the most popular social media site, and that Facebook is second most popular.
After analysing the results of the primary and secondary research, I conclude that Sunny Bay could advertise their discount information on social media, which could attract more potential customer and increase sales, and use information technology to integrate online and offline sales. I recommend that Sunny Bay create its own retail official website and create a Facebook account and post profile products and special promotions regularly on the Facebook page
Strategies for the survival of ABC Produce
Get PDFSmall-scale vegetable shops are facing a scenario of stiff competition, posing threat to their viability and existence. The ongoing trend and customer behaviour have made it apparent to research as to what needs to be done to ensure the survival of the vegetable business and further make it a profitable venture. To research on the same, a study is conducted on the operations of ABC Produce, a vegetable and grocery shop in Hamilton. It is jointly owned. They acquired the business around two years ago. The aim of the project is to ascertain factors, strategies, and techniques which can attribute to performance and enhanced productivity. Mixed methods are used to carry the research project as it will give the opportunity for both Qualitative and Quantitative research. Qualitative research will assist in understanding the intricacies of the business by interviewing Employer and Employee. Quantitative research will help to get feedback from customers through a questionnaire that includes both open-ended and closed sample questions. The research results show that they have a good footfall and most customers prefer shopping during evening time. The maximum sale is of vegetables, which constitute around 40% of sales, followed by fruits and dairy produce. More than 70% of the customers were satisfied by quality and services. A better product mix is expected by customers. Some of the key strategies that are recommended include pricing and promotion strategy, waste management strategy, customer retention, attracting new customers, partnership and collaboration