The Feasibility and Acceptability of a Diabetes Survival Skills Intervention for Persons Transitioning from Prison to the Community.

Community evidenced-based diabetes self-management education (DSME) models have not been examined for feasibility, acceptability, or effectiveness among persons transitioning from prison to the community to independent diabetes self-management (DSM). In a non-equivalent control group design with repeated measures, we examined the feasibility, acceptability, and preliminary effect of a 6-week, 1-h per week Diabetes Survival Skills (DSS) intervention on diabetes knowledge, distress, self-efficacy, and outcome expectancy for transitioning incarcerated males. Of the 92 participants (84% T2D, 83% using insulin, 40% Black, 20% White, 30% Latino, 66% high school or less, mean age 47.3 years, 84% length of incarceration ≤4 years ), 41 completed the study (22 control/19 intervention [TX]). One-way repeated measures ANOVAs revealed significant changes in diabetes knowledge within each group (C, p = .002; TX, p = .027) at all time points; however, a two-way repeated measures ANOVA showed no differences between groups. Additionally, both groups showed improvement in diabetes-related distress and outcome expectancy with the treatment group experiencing greater and sustained improvement at the 12-week time point. Analysis of focus group data (Krippendorf) revealed acceptance of and enthusiasm for the DSS training and low literacy education materials, the need for skill demonstration, and ongoing support throughout incarceration and before release. Our results highlight the complexity of working with incarcerated populations. After most of the sessions, we observed some information sharing between the intervention and the control groups on what they did in their respective sessions. Due to high attrition, the power to detect effects was limited. Yet, results suggest that the intervention is feasible and acceptable with an increased sample size and refined recruitment procedure. NCT05510531, 8/19/2022, retrospectively, registered.

Learning in a Virtual Environment to Improve Type 2 Diabetes Outcomes: Randomized Controlled Trial.

BACKGROUND: Given the importance of self-management in type 2 diabetes mellitus (T2DM), a major aspect of health is providing diabetes self-management education and support. Known barriers include access, availability, and the lack of follow through on referral to education programs. Virtual education and support have increased in use over the last few years. OBJECTIVE: The purpose of the Diabetes Learning in a Virtual Environment (LIVE) study was to compare the effects of the LIVE intervention (educational 3D world) to a diabetes self-management education and support control website on diet and physical activity behaviors and behavioral and metabolic outcomes in adults with T2DM over 12 months. METHODS: The LIVE study was a 52-week multisite randomized controlled trial with longitudinal repeated measures. Participants were randomized to LIVE (n=102) or a control website (n=109). Both contained the same educational materials, but the virtual environment was synchronous and interactive, whereas the control was a flat website. Data were collected at baseline and 3, 6, and 12 months using surveys and clinical, laboratory, and Fitbit measures. Descriptive statistics included baseline characteristics and demographics. The effects of the intervention were initially examined by comparing the means and SDs of the outcomes across the 4 time points between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months. RESULTS: This trial included 211 participants who consented. The mean age was 58.85 (SD 10.1) years, and a majority were White (127/211, 60.2%), non-Hispanic (198/211, 93.8%), married (107/190, 56.3%), and female (125/211, 59.2%). Mean hemoglobin A1c (HbA1c) level at baseline was 7.64% (SD 1.79%) and mean BMI was 33.51 (SD 7.25). We examined weight loss status versus randomized group, where data with no weight change were eliminated, and the LIVE group experienced significantly more weight loss than the control group (P=.04). There were no significant differences between groups in changes in physical activity and dietary outcomes (all P>.05), but each group showed an increase in physical activity. Both groups experienced a decrease in mean HbA1c level, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline HbA1c level was 8.6% or higher. CONCLUSIONS: This study confirmed that there were minor positive changes on glycemic targets in both groups over the 12-month study period; however, the majority of the participants began with optimal HbA1c levels. We did find clinically relevant metabolic changes in those who began with an HbA1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM. TRIAL REGISTRATION: ClinicalTrials.gov NCT02040038; https://clinicaltrials.gov/ct2/show/NCT02040038.

Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development.

PURPOSE: The purpose of this study was to evaluate the relationships of health literacy (HL; Short Test of Functional Health Literacy), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated persons transitioning to the community. METHODS: Using preintervention data from a quasi-experimental nonequivalent control group study evaluating the feasibility of a six-session literacy-tailored Diabetes Survival Skills intervention for incarcerated men transitioning to the community, we conducted correlational analyses among the Short Test of Functional Health Literacy, Montreal Cognitive Assessment, and Spoken Knowledge in Low Literacy in Diabetes Scale using the SPSS PROCESS macro and bias-corrected bootstrapping to test the meditational hypothesis: HL mediates the relationship between CI and DK. RESULTS: Participants ( N = 73) were incarcerated for 1-30 years with a mean age of 47 (9.9) years, 40% Black, 19% White, and 30% Hispanic, with 78% having high school/GED or less education. Most (70%) screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL ( b = 0.866, p = 0.0003) but not on DK ( b = 0.119, p = 0.076). Results indicated a significant indirect effect of cognitive functioning on DK via HL, 95% confidence interval [0.300, 0.1882]. CONCLUSION: Intervention approaches aimed at increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK in this population. IMPLICATIONS: Given the low risk to high benefit of implementing literacy-tailored approaches to persons in prison and the population demographics from studies supporting a high degree of CI, nurses should consider implementing literacy-tailored approaches and screening for CI before participation in all educational programs.

Pain hygiene: A content analysis of student nurses' perspectives.

Pain hygiene (PH) is a new concept that has not been well-defined. A qualitative content analysis was conducted to understand this newly developed concept. Based on the responses from 78 students, the perceptions of the meaning of the term "pain hygiene" and differences between the term "pain hygiene" and "sleep hygiene" through their participation in open-ended surveys was described. Using content analysis, four themes emerged to present students' meaning of the term "pain hygiene": prevention of worsening of pain; cleanliness or hygiene practices to manage pain; self-care to manage pain; and physical and psychological management of pain. Two themes emerged illustrating differences between PH and sleep hygiene: practices that contribute to a better quality of life and condition, and better sleep with no pain. As a newly developing concept, PH can be used to make changes in pain assessment, prevention, and pain management strategies for all people with pain, which can enrich their quality of life and bring change in pain care outcomes.

Social Determinants and Comorbidities in Non-pharmacological Interventions for Chronic Pain in Community- Dwelling Older Adults: A Scoping Review of Randomized Controlled Trials.

BACKGROUND: Chronic pain frequently exists with other comorbid conditions in older adults, yet little is known about the effectiveness of non-pharmacologic interventions. A scoping review was conducted to provide an overview of the nature of the published evidence on the nonpharmacological interventions for chronic pain in communitydwelling older adults with comorbid conditions. METHODS: A literature search of relevant databases was conducted using PRISMA guidelines. Studies were included if they were intervention studies, used a randomized controlled trial design, and met criteria of the critical appraisal. RESULTS: Eleven studies were identified as high quality. Most studies did not quantify a comorbidity index and/or burden, nor reported the specific comorbid conditions of participants with chronic pain. In addition, none of the identified studies measured change in participant comorbidity and/or burden. CONCLUSION: Future research should address the effects of non-pharmacological interventions on pain, comorbidities, and other health outcomes.

NPs caring for people who are incarcerated and negatively impacted by social determinants of health.

ABSTRACT: This article explores roles filled and care provided by NPs in diverse carceral settings along with the impact of health disparities experienced as a result of social determinants of health on the chronic disease burden of people who are incarcerated. Opportunities abound for NPs to positively influence this patient population's health, but specialized education is needed.

CareLink-Corrections Phase 1: A Feasibility Study Inside Prisons to Improve Self-Care Upon Release.

CareLink-Corrections is an evidence-informed self-care management (SCM) program designed to provide nursing and health services students an opportunity to serve a vulnerable justice-involved population while learning to provide clinical care service. Within this program, SCM of health is the clinical focus and is conceptualized as a competency where the individual acquires the knowledge, skills, and attitudes that facilitate health maintenance, health care management, and/or health promotion. Thirty undergraduate nursing students and 47 incarcerated persons participated in this first phase of the program. This article presents the first step in building the program-a feasibility study to test implementation of the program to persons in prison.

Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment.

Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.

Uses of reminiscence intervention to address the behavioral and psychosocial problems associated with dementia: An integrative review.

INTRODUCTION: Reminiscence is a non-pharmacological technique used to manage the behavioral and psychological symptoms of dementia. This integrative review aims to synthesize the research on the health benefits of reminiscence intervention for people with dementia. METHODS: Whittemore and Knafl's five-step method provided the framework for this review. A comprehensive search of PubMed, CINAHL Plus, SCOPUS, and PsycINFO was conducted. The articles were reviewed for eligibility, critically appraised, and extracted the data. RESULTS: Twenty-seven studies met the inclusion criteria. Four themes emerged: (a) Recovery from the Darkness of Depressive Symptoms, (B) Enhancement of Cognitive Functions and Filling the Memory Gap, (C) Living a Fulfilling Life in Late Adulthood, and (D) Fulfilling Reminiscence Functions. DISCUSSION: This review provides a better understanding of the potential benefits of using reminiscence intervention for addressing the behavioral and psychological symptoms of dementia. However, improving the methodological rigor of future studies is necessary to attain conclusive evidence.

A mixed methods evaluation of got care!

This study aimed to assess the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach and Training with Care! (GOT Care!), and the observed 26% reduction in Emergency Department (ED) visits for the 51 older adult participants. A convergent parallel mixed-methods design was utilized. Demographic data and ED visit data were collected and analyzed using paired-samples t-tests, poisson regression and generalized poisson regression. Stakeholder perspectives were assessed via emailed open-ended surveys and analyzed using content analysis. The quantitative results were transformed into trends that were compared and contrasted with the qualitative themes. The results were consistent with the current literature that IPCP models may have a greater impact on older adults with certain demographic characteristics such as polypharmacy, diabetes and prior ED use, while nursing was identified as an ideal leader for IPCP teams.

Integrative Review of Recruitment of Research Participants Through Facebook.

BACKGROUND: Facebook (FB) has been widely used recently to recruit participants for adult health research. However, little is known about its effectiveness, cost, and the characteristics of participants recruited via FB when compared to other recruitment methods. OBJECTIVES: The purpose of this integrative review was to examine the published evidence concerning the use of FB in participant recruitment for adult health research, as compared to other social media, online, and traditional recruitment methods. METHODS: In this integrative review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, SCOPUS, and Web of Science were the electronic databases used to identify the published articles. In regard to language, the search was limited. RESULTS: The efficacy and cost-effectiveness of using FB for recruitment in healthcare research as compared to more traditional forms of recruitment remain unclear. Reporting of recruitment strategies is inconsistent, and costs are often not included. FB is being used for recruitment frequently with other methods and, although often effective, can be costly. DISCUSSION: FB is used to recruit participants for a variety of studies, with researchers using both free and paid ads to reach potential participants. Reporting of recruitment methods needs to be more rigorous, streamlined, and standardized in scientific papers.

Diabetes Self-management Training in a Virtual Environment.

Diabetes self-management training (DSMT) improves diabetes health outcomes. However, low numbers of patients receive DSMT. Using virtual environments (VEs) for DSMT is an innovative approach to removing barriers for patients. The purpose of this paper is to describe the experience of health professionals and diabetes educators establishing and teaching DSMT in a VE, Diabetes LIVE© (Learning in Virtual Environments), and the implications for future use of VEs in DSMT. It was found that providing DSMT in a VE preserves real-time interaction between patients and educators. To facilitate ongoing patient learning and engagement, the DSMT curriculum was expanded beyond the core content as "Above and Beyond" topics. Using a VE for DSMT presents challenges and opportunities. Challenges include overcoming technological barriers and improving comfort levels to orient educators and patients to the functionality of the VE. Opportunities include overcoming barriers to reaching patients, particularly given the diabetes epidemic and relatively small number of diabetes educators. Using a VE also affords a simulated community for experiential learning. VEs may become powerful tools for diabetes and other health educators to reach patients. Ongoing education and support are vital to successful self-management of chronic disease.

Relationships of illness representation, diabetes knowledge, and self-care behaviour to glycemic control in incarcerated persons with diabetes.

Purpose The purpose of this paper is to examine relationships of self-care behavior, illness representation and diabetes knowledge with A1C (level of glycemic control) in 124 incarcerated persons. Design/methodology/approach Using a cross-sectional design, summary scores and items from the self-care inventory revised, brief illness perception questionnaire and the spoken knowledge for low literacy in diabetes were evaluated using linear regression to assess their relationship to A1C. Findings Metabolic control was suboptimal for the majority of inmates with diabetes. The final regression model was statistically significant ( F (3, 120)=9.51, p=0.001, R(2)=19.2 percent). Higher log10 HbA1C (A1C) was associated with lower personal control beliefs ( B=-0.007, t (122)=-2.42, p=<0.02), higher self-report of diabetes understanding ( B=0.009, t (122)=3.12, p=0.00) and using insulin ( B=0.062, t (122)=2.45, p=0.02). Research limitations/implications Similar to findings with community dwelling participants, enhancing diabetes personal control beliefs among inmates may lead to lower A1C. Social implications Highly structured environments with limited options for self-care, personal choices and readily available health care may give some incarcerated persons with diabetes no motivation to improve diabetes control even if they have an understanding of what to do. Originality/value While there is abundant research in the community describing how these factors influence A1C levels, research of this nature with incarcerated persons with diabetes is limited. Findings will inform diabetes programming during incarceration to better prepare inmates for reentry.

Methodological factors conducting research with incarcerated persons with diabetes.

OBJECTIVE: The aim of this study was to describe methodological issues specific to conducting research with incarcerated vulnerable populations who have diabetes. BACKGROUND: Much has been written about the ethical and logistical challenges of conducting research with vulnerable incarcerated populations. However, conducting research with incarcerated persons with diabetes is associated with additional issues related to research design, measurement, sampling and recruitment, and data collection procedures. METHOD: A cross-sectional study examining the relationships of diabetes knowledge, illness representation and self-care behaviors with glycemic control in 124 incarcerated persons was conducted and serves as the basis for describing methodological factors for the conduct of research with an incarcerated population with diabetes. RESULTS: Within this incarcerated population with diabetes, sampling bias due to gender inequity, recruitment of participants not using insulin, self-reported vision impairment, and a lack of standardized instruments especially for measuring diabetes self-care were methodological challenges. Clinical factors that serve as potential barriers for study conduct were identified as risk for hypoglycemia due to insulin timing and other activities. CONCLUSION: Conducting research with incarcerated persons diagnosed with diabetes requires attention to a set of methodological concerns above and beyond that of the ethical and legal regulations for protecting the rights of this vulnerable population. To increase opportunities for conducting rigorous as well as facility- and patient-friendly research, researchers need to blend their knowledge of diabetes with an understanding of prison rules and routines.

Baseline Indicators and Implementation Strategies in a Statewide Correctional Nurse Competencies Program: Mid-Year Report.

BACKGROUND: This 3-year, public-academic workforce development project aimed to establish indicators for quality correctional nursing care to empirically test the translation of correctional nursing standards into practical and applied competencies. METHOD: Approaches to document indicators and achieve implementation of a correctional nurse competency system include (a) knowledge transfer and exchange, (b) system mapping, (c) adherence to implementation plan and strategy, and (d) practice-based action research. RESULTS: Indicators were established. Twenty-five percent (n = 111) of nurses maintained clinical credentials beyond the basic requirements; 86% (n = 381) of nurses received continuing nursing education certificates, 98% (n = 434) of nurses were satisfied with the program, and 43% (n = 9,052) of inmate/patients were satisfied with clinical care. Quality ratings of program educators averaged 4.79 on a 5-point scale. CONCLUSION: Innovation is supported by adding continuous improvement components to the implementation of a correctional nurse competency system effort. Team members' consensus decision making enabled them to apply their domain-specific knowledge to assess the success of the implementation strategy.

Management of rosiglitazone-induced edema: two case reports and a review of the literature.

The thiazolidinediones are an important class of insulin-sensitizing agents used for the treatment of type 2 diabetes. Similar to other antidiabetic agents, use of the thiazolidinediones is limited by adverse drug reactions. Specifically, use of the thiazolidinediones is associated with a triad of fluid retention, edema, and weight gain. In premarketing clinical trials, edema was reported to occur infrequently with minimal severity. However, several published cases from postmarketing data demonstrate that thiazolidinedione-induced fluid retention, exhibited by the initial onset of peripheral edema and weight gain, can progress to a more severe form of pulmonary edema that is refractory to diuretic therapy with resolution of symptoms only through discontinuation of the offending thiazolidinedione. In clinical practice, the occurrence of edema secondary to a thiazolidinedione drug may occur more frequently than reported. Two cases presented in this report illustrate a different outpatient management approach that enables both desired glycemic control and minimal fluid retention while using the thiazolidinediones.