The literature search and review focused on literature published from January 1996 through April 8, 2012, and reference lists from key articles and recent review articles also were examined for additional citations. Both RCTs and observational studies were included in the review. Eligible studies included RCTs offering LDCT lung cancer screening to one group, or noncomparative cohort studies of LDCT screening that provided at least one of the following outcomes: lung cancer-specific or all-cause mortality, nodule detection rate, frequency of additional imaging, frequency of invasive diagnostic procedures (eg, needle or bronchoscopic biopsy, surgical biopsy, or surgical resection), complications from the evaluation of suspected lung cancer, or the rate of smoking cessation or reinitiation. For the primary endpoints of lung cancer mortality and all-cause mortality, only RCT data were considered, whereas RCT and observational data were considered for other endpoints, particularly those pertaining to screening performance (ie, the false-positive rate, frequency of additional imaging tests, and the biopsy rate), and rates of smoking cessation. 33 Case series, studies not published in English, and studies in which elevated lung cancer risk was due to occupational or environmental exposures were excluded. A total of 591 citations were identified by the search strategy, which yielded 8 RCTs and 13 cohort studies. Additional details related to the methodology are published elsewhere. 33
New models are needed for translating information about the social and economic determinants of health for decision makers from parents to politicians. This was the argument made in a paper in the Annual Review of Public Health in early 2015. 8 In it, lead author Dr. Steven Woolf and his team at the Center on Society and Health at Virginia Commonwealth University and my team and I at Washington University in St. Louis offered a framework that includes rigorous research as its basis, but also places emphasis on strategic forms of communication, a thorough understanding of the decision-making context, particularly for policymakers, and thoughtful engagement with key stakeholders. We use as examples of this framework the Education and Health Initiative, a national project led by Dr. Woolf’s center, and a local project I lead to improve the health and well-being of African Americans in St. Louis called For the Sake of All . Although developed separately, each initiative uses the full arsenal of modern communications, from policy briefs and reports to websites, YouTube videos, Twitter feeds, and blog posts to tell the story of how social and economic factors are affecting the health of ordinary individuals. We have some early evidence that the approach is working, or at least that people are talking and thinking in new ways about these issues. The response as measured by web traffic, social media mentions, and local, national, and even international media coverage suggests that this work has hit a nerve. Whether that can translate to changes in policy remains to be seen.
Special attention is needed for the foot care as the foot complication from diabetes are one of the main causes of amputation, and it has a great impact on physical and psychological condition as explained by Alwahbi (2010), foot problems are the most frequent hospital admission in most diabetic cases, therefore diabetic patient should be taught to keep the feet clean and dry, washing them with mild soap daily and to dry them with care especially between toes. Family members can also be involved in helping to inspect the feet especially the area that patient can't reach or visualize, or we can teach the patient how to use mirror to inspect for cuts, swollen areas and to emphasize wearing well fitting, comfortable medical shoes. Nurse can help the patient to be seen by podiatrist to treat corn, calluses and foot sores so more complication can be prevented. Teaching clients to avoid standing on legs dependent for long periods or crossing the legs while setting are essential due to their effects on blood circulation.