Diabetic patient education and motivation. Available in 2 volumes.

Diabetes mellitus is a condition which requires a high degree of patient cooperation in self-management to achieve optimal glycaemic control. The concept of patient education, to enhance the treatment and management of diabetes, is well recognised. Several diabetes education programmes have already been described, but increased knowledge of diabetes did not necessarily result in improved self-mangement or glycaemic control. Other factors, such as attitudes and motivations, may therefore be particuarly important. The aims of the present study were to investigate the influence of patients' attitudes to diabetes, and to develop motivational aspects which enable the application of knowledge to enhance self-management and compliance with treatment. Thirty-one insulin-dependent diabetic (IDD) patients entered into a 12 month educational programme, particularly designed to increase motivation. Patients' attitudes to diabetes, their knowledge and self-management skills were assessed using questionnaires and practical tests, and parameters of glycaemic control were measured. The progress of these patients was compared at intervals with a close matched group of 25 control IFF patients who continued to receive routine clinic care. Patients completing the educational programme achieved better glycaemic control (p< 0.05), greater knowledge (p< 0.001), more favourable attitudes (p< 0.03) and increased competence in management skills (p< 0.02) compared with the control group. Evaluation procedures indicated that the programme was acceptable to the patients, and was successful in terms of increasing patient motivation. Six months after completion of the programme, glycaemic control deteriorated, although knowledge, attitudes and management skills were unchanged. This might reflect the withdrawal of extrinsic motivation, attention and supervision provided during the programme. It is recommended that consideration be given to the development of patients' intrinsic motivation to achieve maximum benefit from diabetes education programmes.

Selection and education of patients for inhaled insulin

Inhaled insulin is a recent advance in insulin delivery that promises to be an effective alternative to subcutaneous insulin. Several insulin delivery systems are currently in development and the first of these has been approved for clinical use. Inhaled insulin offers greater flexibility and convenience for patients with diabetes and may be particularly useful in those who are reluctant to initiate or intensify insulin treatment. Although promising, potential concerns remain regarding its long-term effects on lungs. Also, excluding certain groups of patients such as smokers and those with respiratory illnesses will restrict its use at present. Lack of familiarity with the technology, especially relating to dose adjustments and inhaler device, is also likely to present fresh challenges. But, careful selection of patients, education, and continued support from health professionals is vital to ensure success with this new technology.

Engineering education research - the UK perspective at a time of change

Engineering education in the United Kingdom is at the point of embarking upon an interesting journey into uncharted waters. At no point in the past have there been so many drivers for change and so many opportunities for the development of engineering pedagogy. This paper will look at how Engineering Education Research (EER) has developed within the UK and what differentiates it from the many small scale practitioner interventions, perhaps without a clear research question or with little evaluation, which are presented at numerous staff development sessions, workshops and conferences. From this position some examples of current projects will be described, outcomes of funding opportunities will be summarised and the benefits of collaboration with other disciplines illustrated. In this study, I will account for how the design of task structure according to variation theory, as well as the probe-ware technology, make the laws of force and motion visible and learnable and, especially, in the lab studied make Newton's third law visible and learnable. I will also, as a comparison, include data from a mechanics lab that use the same probe-ware technology and deal with the same topics in mechanics, but uses a differently designed task structure. I will argue that the lower achievements on the FMCE-test in this latter case can be attributed to these differences in task structure in the lab instructions. According to my analysis, the necessary pattern of variation is not included in the design. I will also present a microanalysis of 15 hours collected from engineering students' activities in a lab about impulse and collisions based on video recordings of student's activities in a lab about impulse and collisions. The important object of learning in this lab is the development of an understanding of Newton's third law. The approach analysing students interaction using video data is inspired by ethnomethodology and conversation analysis, i.e. I will focus on students practical, contingent and embodied inquiry in the setting of the lab. I argue that my result corroborates variation theory and show this theory can be used as a 'tool' for designing labs as well as for analysing labs and lab instructions. Thus my results have implications outside the domain of this study and have implications for understanding critical features for student learning in labs. Engineering higher education is well used to change. As technology develops the abilities expected by employers of graduates expand, yet our understanding of how to make informed decisions about learning and teaching strategies does not without a conscious effort to do so. With the numerous demands of academic life, we often fail to acknowledge our incomplete understanding of how our students learn within our discipline. The journey facing engineering education in the UK is being driven by two classes of driver. Firstly there are those which we have been working to expand our understanding of, such as retention and employability, and secondly the new challenges such as substantial changes to funding systems allied with an increase in student expectations. Only through continued research can priorities be identified, addressed and a coherent and strong voice for informed change be heard within the wider engineering education community. This new position makes it even more important that through EER we acquire the knowledge and understanding needed to make informed decisions regarding approaches to teaching, curriculum design and measures to promote effective student learning. This then raises the question 'how does EER function within a diverse academic community?' Within an existing community of academics interested in taking meaningful steps towards understanding the ongoing challenges of engineering education a Special Interest Group (SIG) has formed in the UK. The formation of this group has itself been part of the rapidly changing environment through its facilitation by the Higher Education Academy's Engineering Subject Centre, an entity which through the Academy's current restructuring will no longer exist as a discrete Centre dedicated to supporting engineering academics. The aims of this group, the activities it is currently undertaking and how it expects to network and collaborate with the global EER community will be reported in this paper. This will include explanation of how the group has identified barriers to the progress of EER and how it is seeking, through a series of activities, to facilitate recognition and growth of EER both within the UK and with our valued international colleagues.