Knowledge can always be acquired by the truly inquisitive. However, certain formats are better adapted to specific goals.
An encyclopedia—whether in print, CD-ROM, or online—tries to encompass all knowledge that is relevant to a subject. The user of an encyclopedia expects to find the answer to virtually all questions about the subject. The most typical use of an encyclopedia starts with a query and ends with separating the relevant article, or even paragraph, from the mass of information that comprises the encyclopedia. Few users of an encyclopedia sit down to read the entire contents. In other words, an encyclopedia does not provide any cohesive educational framework which might guide the student.
Computer format encyclopedias have used various strategies to move beyond the limited role of answering queries. Feature articles that change each time the program is launched try to redirect the reader's attention to new subjects. Slideshows and guided tours also use the encyclopedias resources to draw the reader into areas where self-directed queries would never have gone. Encyclopedias can answer questions and even entertain the reader with knowledge, but none document the reader's competence in a subject.
A preceptored (taught) course is fundamentally different than an encyclopedia. The purpose of a preceptored course is to assure that a student who completes the course requirements has competence in the subject. A course may draw on the resources of an encyclopedia, but the lessons are arranged and directed by a teacher who sets objectives. The best teachers incorporate the interests of their students into the design of the course, but the overall direction of the course is still defined by standards that are set by experts to insure competence.
Live teaching has a number of drawbacks—the teacher must be compensated, space must be found for the program, and participants must all meet at the appointed place.
A further consideration is that live teaching draws upon limited resources. Patients being taught how to manage their diabetes may have only a single hour to speak with a dietician. If the patient is being taught how to estimate the nutritional value of a meal, the dietician may have to show the patient samples of food, say, rubber or plastic models, rather than the patient's own meal.
A further aspect of live teaching is that because of the limited availability of the teaching resources, the patient may have to wait longer than desirable to meet with their educator/healthcare provider. Patients might only meet with their educator/healthcare provider once every 3 months to review their blood glucose levels. This is a valuable time, during which the patient can be taught how to deal with particular or unique situations that are likely to arise, such as what happens when the patient goes to a late afternoon movie and consumes small snacks, followed by a very late dinner, or significant patterns, such as the patient showing higher blood glucose levels at bedtime whenever they eat in restaurants, instead of at home.
Physicians strive to provide the highest possible quality of care to those who have requested their services. Comprehensive education is an essential component of quality care for a person having diabetes. Physicians providing high-quality diabetes care may find their job complicated by the limited time that patients have available to complete their evaluations and the prohibitive costs of extensive individual instruction.
Thus, there is a substantial need for an educational program which provides the benefits of both encyclopedic and preceptored education.
One area where there is a pressing need for an improved educational system is in the ongoing treatment of diabetes. Good diabetes care challenges a person who often has no symptoms to make significant lifestyle changes and to take numerous medications on the belief that reaching certain numerical goals in the present will reduce the risk of complications in the future. Diabetes education has been recognized as an essential component of good diabetes care. Diabetes education should help patients acquire the knowledge and support the attitudes necessary to accept this challenge.
Improved outcomes have been demonstrated when the primary care provider combines an intensive program of patient education with attention to recommended quality of care measures. However, diabetes education is expensive and inconvenient to provide, while tracking quality of care measures can be lost in the details of providing care to a broad range of patients in a busy practice. Referring patients to community classes, suggesting books or even diabetes references online do not assure that the individual patient will acquire the knowledge and skills necessary to reach accepted quality of care measures.
An intensification of treatment is more likely to be successful if the change is made as soon as the patient is motivated to change. This requires that education to inform and motivate patients be linked directly to the physicians and nurses who have the ability to help patients make changes in their diabetes care.
A preceptored course with frequent testing and free communication between teacher and student assures that the student who completes the requirements has competence in the subject. Frequent communication with a knowledgeable health care provider can also sustain the motivation of a patient to adhere to the complex and burdensome requirements of good diabetes care. It is, however, expensive to provide such an education.
Neither computer games nor interactive educational programs for diabetes are new. However, no current program integrates a preceptored course of instruction with the tracking of individual quality of care measures from the patient's clinical record.
There is a further need for an interactive, adaptive educational system which can be used to improve diabetes care.
There is also a particular need for an interactive Internet educational course providing an alternative to individual counseling.
A further need exits for a system to increase the amount of time a diabetic patient receives individualized education from a healthcare provider.
A need also exists for a system which improves the ability of and time available for a healthcare provider to educate and monitor the status of a patient.
As part of the process of teaching patients how to manage their diabetes, patients are taught that the nutritional content of the food which they consume determines the amount of insulin which they require. One school of thought holds that carbohydrates should make up 50-60% of one's total caloric intake; proteins should make up 20-25%; and fats, from 20% to 30% (carbohydrates are broken down into glucose early during digestion and have the most immediate effect on blood glucose, meaning it is preferable to eat starches and other complex carbohydrates, rather than fruit juice and other simple sugars that have a rapid effect on blood glucose). Usually, doctors recommend three small meals and three to four snacks every day to maintain the proper balance between glucose and insulin in the blood. Overweight patients may be encouraged to lower their intake of fat and eat more complex carbohydrates and fiber.
An different school of thought favors the “Mediterranean” diet, in which the some of the carbohydrates are replaced with monosaturated fats such as olive oil. The present invention is equally applicable to the monitoring of such a diet, as well as any other type of diet.
Patients therefore learn that it is important for them to accurately determine the amount and nutritional value of foods that they consume so that they can calculate how much insulin to administer.
While patients may study how to estimate portion size and nutritional value with their diabetes care educator, it is unlikely that the diabetes care educator will be able to review with the patient every type of food that the patient might eat. Accordingly, patients usually only learn from their diabetes care educator the basics of estimating nutritional content, and it is likely the patient will from time to time be unable to properly judge the nutritional value of the foods they consume, for example, because the patient is not familiar with either the food or the food's manner of preparation.
Thus, there is also a need for a system which affords diabetes care educators more opportunities to help teach patients how to analyze the nutritional content of their meals, even in situations where the healthcare provider is not physically present with the patient.
Ulcers of the legs and feet occur in people with diabetes due to the combination of neuropathy and peripheral vascular disease. Neuropathy causes a loss of sensation, so that foot injuries may go untreated and become infected. Decreased circulation to the feet and legs slows healing. Proper nourishment does not reach damaged tissue, and infected material is not destroyed. If not properly cared for, even a small injury may progress to an ulcer, with serious consequences. Consequently, diabetics are encouraged to monitor their extremities, so that potentially troublesome wounds can be promptly spotted and treated. Patients may not, however, always be able to accurately determine whether a wound is medically serious.
Accordingly, there is also a need for a system which, when a diabetic patient discovers a wound on their body, allows the diabetic patient to have a medical professional study the wound to determine what type of care is appropriate.