Diabetes is a source of stress for patients of all ages, but particularly during adolescence. The transition into adolescence is frequently marked by declines in adherence and metabolic control due to decreased parental responsibility for diabetes care. Many factors affect parents' ability to deliver diabetic care including: knowledge, parental self-efficacy and parental style. The aim of the study was to find the correlation of parenting style, parents' self-efficacy and adherence with glucose level among early adolescents with type I diabetes through an interview questionnaire and the impact of an intervention program on those determinants. Results showed that 40.5% of parents had authoritative style, 39.7% had authoritarian style and 19.8% had permissive style. There was a positive correlation of adherence and metabolic control with knowledge, self-efficacy and authoritative behaviors of parents. Following the intervention, there was improvement in knowledge, self-efficacy, authoritative behaviors and adherence and no significant effect on metabolic control.

Context The quality improvement involved development of a follow up service for patients presenting to a busy district general hospital with Henoch Schoelein Purpura (HSP). Follow up is recommended as the rare but important renal sequelae of the condition can be silent initially. Problem In our department no follow up pathway existed for HSP. Patients were seen in either consultant outpatient clinics, with the majority of children being well, or discharged for primary care follow up which relies on general practitioners and families to organise ill defined follow up creating the potential to miss any renal sequelae Assessment of problem and analysis of its causes The problem was identified during the acute assessment of patients presenting. Following discussion with senior staff about absence of evidence based local follow up procedures and subsequent literature review a structured pathway was proposed. It was felt that all children should have hospital review with consultant follow up focusing on children with complications Intervention The aim was to standardise and rationalise care thereby improving department efficiency without compromising patient safety. A pathway for nurse led follow up which had been piloted elsewhere (1) was used as a model. Children were assessed at presentation and guidance was given for those needing admission or investigation. Otherwise they should be discharged home with urine dipsticks to check early morning urine and information about what concerning features should lead them to seek reassessment. All children were seen seven days later and stratified according to absence or presence of proteinuria, as a marker for renal involvement, to standard follow up (four in the year) and more frequent visits (seven in the year) if proteinuria present. If proteinuria developed in the standard group, they moved to more frequent follow up. Urinalysis was undertaken at each follow up visit and criteria for consultant review were clearly defined. (1) Henoch Schonlein Purpura – A 5-Year Review and Proposed Pathway. Louise Watson, et al Strategy for change During the development stage senior nursing and medical staff were consulted about the practicalities and possibilities of developing a similar pathway and a guideline was produced with department ratification. Only limited information about the pathway was disseminated to junior staff before its introduction. Measurement of improvement Sixteen months on, an audit and service evaluation was undertaken with feedback from patients, their families and staff. Effects of changes Of 22 children followed up none developed renal sequelae at any time. Almost half did not use consultant clinic appointments for follow up with seven completing the pathway appropriately, two having extra nurse follow up and one who had nurse follow up at different intervals to those recommended. Ten children had consultant follow up, which was not clinically indicated. Staff feedback was positive. Parents expressed the benefit of more flexible and quicker appoin...