Utilization of a Standardized Diabetes Self-management Education Program in the Management of Type 2 Diabetes

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ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (135 download)

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Book Synopsis Utilization of a Standardized Diabetes Self-management Education Program in the Management of Type 2 Diabetes by : Stephanie Omotayo

Download or read book Utilization of a Standardized Diabetes Self-management Education Program in the Management of Type 2 Diabetes written by Stephanie Omotayo and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: " It is essential that appropriate mental health support is targeted to support people with eating disorders who have anxiety. The purpose of this evidence-based practice (EBP) change project was to implement Purpose: The purpose of this evidence-based change project was to provide diabetes self-management education (DSME) to participants in a federally qualified health clinic (FQHC) to increase patient knowledge of diabetes self-management behaviors and decrease fasting blood glucose levels. Methods: Thirteen adults with uncontrolled Type 2 Diabetes; able to read, write, and speak English; and who had access to a telephone and a computer or tablet with a stable internet connection were voluntarily recruited at a FQHC. Four bi-weekly DSME one-on-one virtual sessions lasting one hour occurred over a nine-week period, with a 30-minute follow-up phone session during weeks when DSME was not scheduled. Using a pretest/posttest approach, participants' diabetes self-management knowledge, using the Revised Michigan Diabetes Knowledge Scale (RMDKS), and fasting blood glucose were measured before and after the educational intervention session. Statistical analysis utilized a paired t-test for comparison. Results: The data showed a statistically significant post-intervention improvement in both patients' diabetes knowledge with a mean pretest knowledge score of 60% and mean posttest score of 77% (p

Psychosocial Care for People with Diabetes

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Publisher : American Diabetes Association
ISBN 13 : 1580404391
Total Pages : 330 pages
Book Rating : 4.5/5 (84 download)

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Book Synopsis Psychosocial Care for People with Diabetes by : Deborah Young-Hyman

Download or read book Psychosocial Care for People with Diabetes written by Deborah Young-Hyman and published by American Diabetes Association. This book was released on 2012-12-25 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt: Psychosocial Care for People with Diabetes describes the major psychosocial issues which impact living with and self-management of diabetes and its related diseases, and provides treatment recommendations based on proven interventions and expert opinion. The book is comprehensive and provides the practitioner with guidelines to access and prescribe treatment for psychosocial problems commonly associated with living with diabetes.

ADA The Complete Nurse's Guide to Diabetes, Second Edition

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Publisher : American Diabetes Association
ISBN 13 :
Total Pages : 596 pages
Book Rating : 4.:/5 (318 download)

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Book Synopsis ADA The Complete Nurse's Guide to Diabetes, Second Edition by : Belinda Childs

Download or read book ADA The Complete Nurse's Guide to Diabetes, Second Edition written by Belinda Childs and published by American Diabetes Association. This book was released on 2009-05-27 with total page 596 pages. Available in PDF, EPUB and Kindle. Book excerpt: What every nurse must know about diabetes Complete Nurse’s Guide to Diabetes Care is a comprehensive resource for all nurses who work with diabetes patients. Extensively revised, it offers expert advice on the fundamentals of diabetes care and related nursing issues.

Learning to Manage

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Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (958 download)

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Book Synopsis Learning to Manage by : Ifunanya Hilda Ejebe

Download or read book Learning to Manage written by Ifunanya Hilda Ejebe and published by . This book was released on 2015 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The management of type 2 diabetes in the United States is a population health priority. Approximately 1 in 10 adults in the United States have diabetes and a significant majority have inadequately controlled blood glucose, blood pressure, and cholesterol. Previous research shows that many adults with diabetes lack the knowledge, skills, behaviors, and support to properly manage their condition. Diabetes self-management education has become an important part of diabetes care guidelines as a way to improve the self-management of adults with diabetes in order to lead to improve patient health and reduce inappropriate health care use and medical costs. Despite this, it is unclear who is actually receiving diabetes self-management education in the US, overall and by mode of delivery and diabetes educator type, and whether education is associated with improved population health. Therefore, the objective of this dissertation research is to investigate the distribution of diabetes self-management education, patient sociodemographic factors that influence the receipt of that education, and its contribution toward diabetes outcomes, medical expenditures, and healthcare use in US adults. We achieved this research objective by completing three specific research aims. We used nationally representative data from the Medical Expenditure Panel Survey and the National Health and Nutrition Examination Survey. We found that although a substantial majority of individuals received some form of diabetes self-management education, receiving diabetes education was associated with race/ethnicity and income (Aim 1), and varied by mode of education delivery. Individuals who received diabetes self-management education were less likely to have glycemic control but were more likely to receive antiglycemic treatment (Aim 2). Receiving diabetes self-management education was associated with greater diabetes-related ambulatory and prescription use, depending on the mode of education delivery (Aim 3). Our findings highlight some strengths of the current state of diabetes management occurring in usual care, including the widespread delivery of some form of diabetes education and its association with greater ambulatory and prescription use. However, we also found evidence of the need for more effective diabetes education delivery systems in usual care in order to improve patient self-care behaviors and reduce inpatient and emergency room use.

The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook

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Publisher : American Diabetes Association
ISBN 13 : 1580405061
Total Pages : 729 pages
Book Rating : 4.5/5 (84 download)

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Book Synopsis The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook by : Anne L. Peters

Download or read book The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook written by Anne L. Peters and published by American Diabetes Association. This book was released on 2013-03-29 with total page 729 pages. Available in PDF, EPUB and Kindle. Book excerpt: The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook serves as both an evidence-based reference work and consensus report outlining the most critical components of care for individuals with type 1 diabetes throughout their lifespan. The volume serves not only as a comprehensive guide for clinicians, but also reviews the evidence supporting these components of care and provides a perspective on the critical areas of research that are needed to improve our understanding of type 1 diabetes diagnosis and treatment. The volume focuses specifically on the needs of patients with type 1 diabetes and provides clear and detailed guidance on the current standards for the optimal treatment of type 1 diabetes from early childhood to later life. To accomplish the book’s editorial goals, Editors-in-Chief, Drs. Anne Peters and Lori Laffel, assembled an editorial steering committee of prominent research physicians, clinicians, and educators to develop the topical coverage. In addition, a Managing Editor was brought on to help the authors write and focus their chapters.

Outcome Measures for Health Education and Other Health Care Interventions

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Publisher : SAGE Publications
ISBN 13 : 145226497X
Total Pages : 113 pages
Book Rating : 4.4/5 (522 download)

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Book Synopsis Outcome Measures for Health Education and Other Health Care Interventions by : Kate Lorig

Download or read book Outcome Measures for Health Education and Other Health Care Interventions written by Kate Lorig and published by SAGE Publications. This book was released on 1996-04-18 with total page 113 pages. Available in PDF, EPUB and Kindle. Book excerpt: Although Outcome Measurement has become an important tool in the evaluation of health promotion patient education and other health services interventions, problems remain in locating reliable measurements and scales. This book provides a unique compilation of more than 50 self-administered scales for measuring health behaviors, health status, self-efficacy, and health-care utilization.

Effect of Diabetes Self-management Education on the Self-management of Type 2 Diabetes

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Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (135 download)

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Book Synopsis Effect of Diabetes Self-management Education on the Self-management of Type 2 Diabetes by : Ngozi B. Nwankwo

Download or read book Effect of Diabetes Self-management Education on the Self-management of Type 2 Diabetes written by Ngozi B. Nwankwo and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This project is aimed to explore the benefit of diabetes self-management education (DSME) on the self-management of type 2 diabetes mellitus (T2DM). The review of literatures shows the increased concern about the development of type 2 diabetes related complications. The use of diabetes self-management education as revealed by studies helps in a tremendous way in the self-management of type 2 diabetes, thereby helping to reduce the incidence of the complications that occur from poor management of T2DM. The complications when they occur, leads to increased frequency in hospital admission, long hospital stay, high cost of treatment, increased morbidity and mortality rates. Diabetes education has been an ongoing process in the management of diabetes, but the cases of increased hospitalization and development of complications still exist. The aim here is to create more awareness through education for self-management of the condition by the patients with T2DM. The education should be of self-management approach, and not the traditional instructional approach that leaves the patient dependent on the clinicians only for the management of the ill-health. The various literatures reviewed support the use of DSME to achieve this purpose of engaging, empowering, and encouraging the T2DM patients to take control of their diabetes care. The nurses as well as other clinicians can make this happen by reinforcing what is taught and encouraging their patients to adopt the self-management approach. The implication to nursing practice is in the need for nurses to help patients with T2DM to embrace this self-management education approach, and physician/other clinicians should endeavor to refer their patients with T2DM to diabetes classes.

Motivational Interviewing in Diabetes Care

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Publisher : Guilford Publications
ISBN 13 : 1462521657
Total Pages : 257 pages
Book Rating : 4.4/5 (625 download)

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Book Synopsis Motivational Interviewing in Diabetes Care by : Marc P. Steinberg

Download or read book Motivational Interviewing in Diabetes Care written by Marc P. Steinberg and published by Guilford Publications. This book was released on 2015-08-14 with total page 257 pages. Available in PDF, EPUB and Kindle. Book excerpt: People with diabetes often struggle to make healthy choices and stay on top of managing their illness. Filling a vital need, this is the first book to focus on the use of motivational interviewing (MI) in diabetes care. The uniquely qualified authors--physician Marc P. Steinberg has devoted much of his career to diabetes care, and renowned clinical psychologist William R. Miller is the codeveloper of MI--present proven counseling techniques that can make any conversation with a patient more efficacious and motivating. Numerous sample dialogues illustrate specific ways to elicit patients' strengths and help them overcome barriers to change in such areas as eating habits, physical activity, medication use, insulin treatment, substance abuse, psychological issues, and more. This book is in the Applications of Motivational Interviewing series, edited by Stephen Rollnick, William R. Miller, and Theresa B. Moyers. Winner (First Place)--American Journal of Nursing Book of the Year Award, Adult Primary Care Category

Learning to Manage

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Publisher :
ISBN 13 :
Total Pages : 178 pages
Book Rating : 4.:/5 (953 download)

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Book Synopsis Learning to Manage by :

Download or read book Learning to Manage written by and published by . This book was released on 2015 with total page 178 pages. Available in PDF, EPUB and Kindle. Book excerpt: The management of type 2 diabetes in the United States is a population health priority. Approximately 1 in 10 adults in the United States have diabetes and a significant majority have inadequately controlled blood glucose, blood pressure, and cholesterol. Previous research shows that many adults with diabetes lack the knowledge, skills, behaviors, and support to properly manage their condition. Diabetes self-management education has become an important part of diabetes care guidelines as a way to improve the self-management of adults with diabetes in order to lead to improve patient health and reduce inappropriate health care use and medical costs. Despite this, it is unclear who is actually receiving diabetes self-management education in the US, overall and by mode of delivery and diabetes educator type, and whether education is associated with improved population health. Therefore, the objective of this dissertation research is to investigate the distribution of diabetes self-management education, patient sociodemographic factors that influence the receipt of that education, and its contribution toward diabetes outcomes, medical expenditures, and healthcare use in US adults. We achieved this research objective by completing three specific research aims. We used nationally representative data from the Medical Expenditure Panel Survey and the National Health and Nutrition Examination Survey. We found that although a substantial majority of individuals received some form of diabetes self-management education, receiving diabetes education was associated with race/ethnicity and income (Aim 1), and varied by mode of education delivery. Individuals who received diabetes self-management education were less likely to have glycemic control but were more likely to receive antiglycemic treatment (Aim 2). Receiving diabetes self-management education was associated with greater diabetes-related ambulatory and prescription use, depending on the mode of education delivery (Aim 3). Our findings highlight some strengths of the current state of diabetes management occurring in usual care, including the widespread delivery of some form of diabetes education and its association with greater ambulatory and prescription use. However, we also found evidence of the need for more effective diabetes education delivery systems in usual care in order to improve patient self-care behaviors and reduce inpatient and emergency room use.

The Diabetes Textbook

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Publisher : Springer
ISBN 13 : 3030118150
Total Pages : 1014 pages
Book Rating : 4.0/5 (31 download)

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Book Synopsis The Diabetes Textbook by : Joel Rodriguez-Saldana

Download or read book The Diabetes Textbook written by Joel Rodriguez-Saldana and published by Springer. This book was released on 2019-06-27 with total page 1014 pages. Available in PDF, EPUB and Kindle. Book excerpt: Diabetes has become a worldwide health problem, the global estimated prevalence approaches ten percent and the burden of this disease in terms of morbidity and mortality is unprecedented. The advances acquired through the knowledge of the mechanisms of the disease and the variety of therapeutic approaches contrast with the inability of private and public health systems in underdeveloped and even developed countries to achieve the goals of treatment. This paradox has been described in many sources: the surge of scientific advances contrast with an unprecedented amount of human suffering. Thus, a patient centered and an evidence based approach with the capacity to produce measurable clinical and economic outcomes is required. The purpose of this textbook is multiple: to offer a comprehensive resource covering all aspects of outpatient management; to address diabetes as a health problem from an epidemiological, economic and clinical perspective; to discuss the role of social determinants of health on the worldwide increase in diabetes; to highlight the challenges and obstacles in providing adequate care; and to outline a multidisciplinary approach to management in which medical visits retain their importance as part of a team comprising the patient, his or her family and a multidisciplinary group of health professionals who are able to move beyond the traditional approach of diabetes as a disease and greatly improve outcomes.

Chalk Talks in Internal Medicine

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Publisher : Springer Nature
ISBN 13 : 3030348148
Total Pages : 347 pages
Book Rating : 4.0/5 (33 download)

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Book Synopsis Chalk Talks in Internal Medicine by : Somnath Mookherjee

Download or read book Chalk Talks in Internal Medicine written by Somnath Mookherjee and published by Springer Nature. This book was released on 2020-09-30 with total page 347 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.

Management of Type 2 Diabetes Mellitus E-Book

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Publisher : Elsevier Health Sciences
ISBN 13 : 0702049972
Total Pages : 309 pages
Book Rating : 4.7/5 (2 download)

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Book Synopsis Management of Type 2 Diabetes Mellitus E-Book by : Steven Levene

Download or read book Management of Type 2 Diabetes Mellitus E-Book written by Steven Levene and published by Elsevier Health Sciences. This book was released on 2011-11-29 with total page 309 pages. Available in PDF, EPUB and Kindle. Book excerpt: This title is directed primarily towards health care professionals outside of the United States. In the 21st Century, the management of type 2 diabetes has become even more important both in the primary health care setting and in the UK government's health policy. With the publication of the National Service Framework and the allied National Clinical Guidelines, both patients and the government expect practices to deliver appropriate and effective care to a high standard. This handbook addresses many concepts important in the day-to-day management of these patients. In addition to the discussion of specific medical management of type 2 diabetes (including the improvement of cardiovascular risk factors), the book explores the use of self-management techniques, the consultation process, and the use of psychological techniques to influence health-related behavior. All aspects of the text are linked, when appropriate, to the GMS contract. The authors include a full time GP delivering diabetic care and an eminent Consultant/academic at the leading edge of diabetes research The text is completely up-to-date with numerous current references, incorporating the latest guidance The span of the text is comprehensive, including clinical, organisational and psycho-social topics of importance in delivering high-quality diabetes care The text is cross-referenced to the relevant QOF indicators and NSF standards This book also covers the relevant aspects of diabetes in Curriculum Statement 15.6 prepared by the Royal College of General Practitioners, which forms the basis of the new membership examination and the competencies expected of General Practitioners. The management options include extensive balanced discussions about not just drugs, but also health education and appropriate referrals to specialists The approach is neither didactic nor promotional, and aims to provide sufficient practical information to help clinicians make optimal decisions that take full account of the latest authoritative guidance, but which can be tailored rationally to the individual patient's needs Many of the concepts covered - including reduction of cardiovascular risk, health education, audit and lifestyle - are extremely relevant to non-diabetes care The appendices include a detailed drug formulary and the relevant 2006-2008 QOF clinical indicators. Future trends and further reading are clearly set out, ensuring that the book will remain useful for the next few years.

The Internet and Health Care

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Publisher : Routledge
ISBN 13 : 1136683704
Total Pages : 440 pages
Book Rating : 4.1/5 (366 download)

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Book Synopsis The Internet and Health Care by : Monica Murero

Download or read book The Internet and Health Care written by Monica Murero and published by Routledge. This book was released on 2013-09-13 with total page 440 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Internet and Health Care: Theory, Research, and Practice presents an in-depth introduction to the field of health care and the Internet, from international and interdisciplinary perspectives. It combines expertise in the areas of the social sciences, medicine, policy, and systems analysis. With an international collection of contributors, it provides a current examination of key issues and research projects in the area. Methods and data used in the chapters include personal interviews, focus groups, observations, regional and national surveys, online transcript analysis, and much more. Sections in the book cover: *e-Health trends and theory; *searching, discussing, and evaluating online health information at the individual level of analysis; *discussing health information at the group or community level; and *implementing health information systems at the regional and social level. The Internet and Health Care will prove useful for university educators and students in the social, public health, and medical disciplines, including Internet researchers. It is also oriented to professionals in many disciplines who will appreciate an integrative theoretical, empirical, and critical analysis of the subject matter, including developers and providers of online health information.

Helping Patients Manage Their Chronic Conditions

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Publisher :
ISBN 13 : 9781932064841
Total Pages : 50 pages
Book Rating : 4.0/5 (648 download)

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Book Synopsis Helping Patients Manage Their Chronic Conditions by : Thomas Bodenheimer

Download or read book Helping Patients Manage Their Chronic Conditions written by Thomas Bodenheimer and published by . This book was released on 2005-06 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt:

American Diabetes Association Guide to Nutrition Therapy for Diabetes

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Publisher : American Diabetes Association
ISBN 13 : 1580404723
Total Pages : 578 pages
Book Rating : 4.5/5 (84 download)

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Book Synopsis American Diabetes Association Guide to Nutrition Therapy for Diabetes by : Marion Franz

Download or read book American Diabetes Association Guide to Nutrition Therapy for Diabetes written by Marion Franz and published by American Diabetes Association. This book was released on 2012-06-05 with total page 578 pages. Available in PDF, EPUB and Kindle. Book excerpt: Diabetes greatly affects how people's bodies manage the food they eat. It is essential that people with diabetes follow a carefully structured meal plan and learn specific skills in order to better control their blood glucose levels. The tactics for helping people manage their diabetes through how they eat is called medical nutrition therapy (MNT). Here the American Diabetes Association presents all of the key information and strategies for effectively teaching patients how to manage their diets. Drawing on the knowledge and expertise of dozens of experts in the field, this book covers all of the key topics for implementing successful medical nutrition therapy. Topics include: Thorough discussion of nutrients Description of MNT for type 1 and type 2 diabetes Discussion of providing MNT to special populations, including youth and older individuals Explanation of the different complications of diabetes, such as kidney disease, celiac disease, and cystic fibrosis, and how they impact MNT Latest details on new technology used in MNT Guidelines and strategies for teaching patients about nutrition therapy and how to use it in their daily lives Using MNT to help prevent diabetes

DeGroot's Endocrinology, E-Book

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Publisher : Elsevier Health Sciences
ISBN 13 : 0323694136
Total Pages : 2539 pages
Book Rating : 4.3/5 (236 download)

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Book Synopsis DeGroot's Endocrinology, E-Book by : R. Paul Robertson

Download or read book DeGroot's Endocrinology, E-Book written by R. Paul Robertson and published by Elsevier Health Sciences. This book was released on 2022-09-29 with total page 2539 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thoroughly updated to reflect today's recent advances in adult and pediatric endocrinology, DeGroot’s Endocrinology, 8th Edition, remains the comprehensive, international reference of choice for today’s endocrinologists and fellows. A full peer review of the previous edition, conducted by a largely new group of renowned editors, was used to update this trusted, two-volume resource. In-depth coverage of both basic and clinical aspects of endocrinology and up-to-date information on the treatment and management of endocrine disorders are provided by a diverse group of expert contributors from six continents. A full-color format and helpful algorithms summarize clinical decision-making and practical approaches to patient management. Organizes content by all the glands that regulate the endocrine system while integrating basic science and clinical presentations of disease. Includes new chapters: Anatomy and Physiology of the Hypothalmus and Pituitary, Differentiated Thyroid Cancer, Medullary Thyroid Cancer, Drugs that Affect Thyroid Function, Genetic Disorders of the Adrenal Cortex, Adrenal Pathology, Primary Aldosteronism, Transgender Healthcare, Erectile Dysfunction, Prevalence and Causes of Male Infertility, Sexual Dysfunction in the Female, Glucose Toxicity and Oxidative Stress. Emphasizes basic science and evidence-based practice throughout. Features extensive updates to content on thyroid and adrenal disfunction, endocrine-disrupting chemicals and human disease, clinical management of diabetes, and advances in genetics. Includes algorithms to outline effective treatment protocols. Contains new emphasis boxes that highlight key points in each chapter.

The Importance of Diabetes Self Management Education

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Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (135 download)

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Book Synopsis The Importance of Diabetes Self Management Education by : Lisa Davidson

Download or read book The Importance of Diabetes Self Management Education written by Lisa Davidson and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: There are gaps that are present between providing diabetes self management education and actually executing diabetes self management education. Implementing standardized screening tools and education on self care management for nurse to use along with a team approach that includes podiatrist, diabetes educator and nutritionist can help to close that gap and reduces the incidence of diabetes complications. Diabetes is a chronic and complex disease that requires ongoing self management care to prevent complications that includes amputations, disability and even death. The longer the disease is left unmanaged the higher the risk of disabling or life threatening complications. Diabetes education has been proven to help people fully understand their disease process and self management through training and support so that they do not feel isolated. Diabetes education is important to producing good patient outcomes. Diabetes education focuses on eating healthy, staying active, monitoring of blood sugar levels, medication administration and risk reduction. The goal of diabetes education is to create and individualized plan and the tools and support to motivate patient to continue their treatment regimen. Diabetes self management education is the basis for empowering patient to effectively manage their disease and make the important decisions about their care daily. A team approach is beneficial for patients in that the education can be taught from different professionals knowledgeable on diabetes care and management. The information can be practiced and reinforced throughout their hospital stay on a daily basis in order to ensure complications. Doing so will enhance compliance and accountability for self management.