PURPOSE The purpose of this study was to evaluate the impact of a peer support program on the health outcomes of patients already receiving well-organized, comprehensive diabetes care. METHODS We used a mixed-methods, nonrandomized, control-group design to evaluate the impact of a peer-mentoring program on the health outcomes and self-management behaviors of adults with type 2 diabetes in 15 primary care practices in San Antonio. Propensity score analysis, t-tests, and multivariable repeated analyses were used to evaluate impact. Qualitative interviews were conducted with 15 participants in the intervention group and analyzed using a grounded theory approach. RESULTS Both intervention and control groups showed significant improvement on all health indicators from baseline to 6-month follow-up (P <.001). Hemo-globin A 1c (HbA 1c) decreased slightly faster for patients in the intervention group (P = .04). Self-management behaviors improved significantly from baseline to 6-month follow-up for the intervention group. Interviewed participants also reported reductions in social isolation and extension of impact of health behavior changes to multiple generations of family members. CONCLUSIONS The addition of peer mentoring to already well-organized comprehensive diabetes care does not improve outcomes. However, findings suggest that the impact of the program extends to members of the participants' families, which is an intriguing finding that deserves further study.

P Pu ur rp po os se e: : This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.S So ou ur rc ce e: : Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.C Co on nc cl lu us si io on n: : Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management. Objectif : C'est la seconde revue qui évalue la prise en charge de patients, dont les pathologies médicales ont été ciblées, qui doivent subir une anesthésie en chirurgie ambulatoire. Les situations choisies comprennent : le diabète, l'obésité morbide, l'enfant né prématurément, l'enfant atteint d'infection des voies respiratoires supérieures, l'hyperthermie maligne et l'usage d'inhibiteurs de la monoamine-oxydase. Source : Les stratégies de recherche dans Medline et le cadre de l'é-valuation de la preuve clinique sont présentés dans la partie I. Constatations principales : Le diabète n'a pas été relié à des événements indésirables à la suite d'une opération ambulatoire. Le patient très obèse est plus à risque de complications respiratoires péri-opératoires mineures, ce qui n'augmente pas les admissions hospitalières imprévues. L'enfant prématuré est admis en chirurgie ambulatoire si l'âge post-conception est > 60 semaines et si l'hématocrite est > 30 %. L'enfant qui a une infection récente des voies respiratoires supérieures

This study compared the use of a desflurane general anesthetic to a small-dose spinal anesthetic in ambulatory gynecological laparoscopy. Using the spinal technique, patients can walk from the operating room table to a stretcher on completion of surgery. Their recovery time was similar to that of the desflurane group.

P Pu ur rp po os se e: : To identify and characterize the evidence supporting decisions made in the care of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: the elderly, heart transplantation, hyper-reactive airway disease, coronary artery disease, and obstructive sleep apnea.S So ou ur rc ce e: : A structured search of MEDLINE (1966MEDLINE ( -2003 was performed using keywords for ambulatory surgery and patient condition. Selected articles were assigned a level of evidence using Centre for Evidence Based Medicine (CEBM) criteria. Recommendations were also graded using CEBM criteria. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The elderly may safely undergo ambulatory surgery but are at increased risk for hemodynamic variation in the operating room. The heart transplant recipient is at increased risk of coronary artery disease and renal insufficiency and should undergo careful preoperative evaluation. The patient with reactive airway disease is at increased risk of minor respiratory complications and should be encouraged to quit smoking. The patient with coronary artery disease and recent myocardial infarction may undergo ambulatory surgery without stress testing if functional capacity is adequate. The patient with obstructive sleep apnea is at increased risk of difficult tracheal intubation but the likelihood of airway obstruction and apnea following ambulatory surgery is unknown.C Co on nc cl lu us si io on n: : Ambulatory anesthesia is infrequently associated with adverse outcomes, however, knowledge regarding specific patient conditions is of generally low quality. Few prospective trials are available to guide management decisions. Objectif Source : Une recherche structurée dans MEDLINE (1966-2003) a été réalisée selon les mots clés pour la chirurgie ambulatoire et l'état du patient. Les articles choisis ont été cotés selon le niveau de preuve des critères du Centre for Evidence Based Medicine (CEBM). Les recommandations ont aussi été graduées selon les critères du CEBM. Constatations principales :

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