Impact of a community-based diabetes self-management support program on adult self-care behaviors.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; P-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.

Commentary: Deepening understanding of refugee children and adolescents using Bronfenbrenner's bioecological and PPCT models - A Commentary on Arakelyan and Ager (2020).

This commentary provides some context for issues highlighted in the article by Arakelyan & Ager (2020) and discusses potential implications of their analysis for theory, future research, practitioners, and policy makers. It discusses the current global scale of displacement, terminology surrounding refugees and asylum seekers, and the authors' analyses of Bronfenbrenner's bioecological and person-process-context-time (PPCT) models. It also identifies additional areas of research and potential implications for integrating theory, research, policy, and practice.

The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis.

OBJECTIVES: Acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high. Rapid diagnosis and surgery are key to survival, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test. A systematic review and meta-analysis of the available literature was performed to determine diagnostic test characteristics of patient symptoms, objective signs, laboratory studies, and diagnostic modalities to help rule in or out the diagnosis of acute mesenteric ischemia in the ED. METHODS: In concordance with published guidelines for systematic reviews, the medical literature was searched for relevant articles. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) for systematic reviews was used to evaluate the overall quality of the trials included. Summary estimates of diagnostic accuracy were computed by using a random-effects model to combine studies. Those studies without data to fully complete a two-by-two table were not included in the meta-analysis portion of the project. RESULTS: The literature search identified 1,149 potentially relevant studies, of which 23 were included in the final analysis. The quality of the diagnostic studies was highly variable. A total of 1,970 patients were included in the combined population of all included studies. The prevalence of acute mesenteric ischemia ranged from 8% to 60%. There was a pooled sensitivity for l-lactate of 86% (95% confidence interval [CI] = 73% to 94%) and a pooled specificity of 44% (95% CI = 32% to 55%). There was a pooled sensitivity for D-dimer of 96% (95% CI = 89% to 99%) and a pooled specificity of 40% (95% CI = 33% to 47%). For computed tomography (CT), we found a pooled sensitivity of 94% (95% CI = 90% to 97%) and specificity of 95% (95% CI = 93% to 97%). The positive likelihood ratio (+LR) for a positive CT was 17.5 (95% CI = 5.99 to 51.29), and the negative likelihood ratio (-LR) was 0.09 (95% CI = 0.05 to 0.17). The pooled operative mortality rate for mesenteric ischemia was 47% (95% CI = 40% to 54%). Given these findings, the test threshold of 2.1% (below this pretest probability, do not test further) and a treatment threshold of 74% (above this pretest probability, proceed to surgical management) were calculated. CONCLUSIONS: The quality of the overall literature base for mesenteric ischemia is varied. Signs, symptoms, and laboratory testing are insufficiently diagnostic for the condition. Only CT angiography had adequate accuracy to establish the diagnosis of acute mesenteric ischemia in lieu of laparotomy.

Educational and health services innovation to improve care for rural Hispanic communities in the USA.

BACKGROUND: Access to comprehensive and quality healthcare services is difficult for socioeonomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina, USA, is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations, in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural healthcare initiatives targeting minority groups. This article reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

Tolerance of ambiguity among MD/MBA students: implications for management potential.

BACKGROUND: Health care is increasingly characterized by uncertainty and turbulence. In an environment of rapid change, flexibility is critical to the success of managers and organizations. Future physician executives must also be open to change and must be able to deal with the uncertainties of management; they must be able to tolerate the ambiguity in management situations. METHOD: This study uses tolerance of ambiguity measures to analyze students at six medical schools offering dual-degree (MD/MBA) programs. Students enrolled in dual-degree programs were assessed and compared with a control group of traditional medical students. RESULTS: MD/MBA students exhibit a higher tolerance of ambiguity than traditional medical students. FINDINGS: As a characteristic associated with leadership ability, tolerance of ambiguity offers a potential indicator of future success as a physician executive. As such, tolerance of ambiguity might be used for selective admissions to medical school and as an indicator of a student's potential to transition between clinical and management functions. As students match personality traits with career choices, those who serve their learning needs must anticipate differences across selected disciplines, roles, and responsibilities.

The status of injury in upstate South Carolina.

In conclusion, injuries are a leading cause of emergency room visits and hospital admissions in the upstate of South Carolina. Age was a major factor in the type of injury risk, hospitalization and, once hospitalized, length of stay and cost of hospital care. Future research efforts should include both quantitative and qualitative approaches to develop a more precise profile of persons who are most at risk for injury due to falls, motor vehicle crashes and intentional injuries. Information is also needed on follow-up care, including the cost of care post-hospital discharge and after discharge from the emergency room. The recommendations offered in this report may provide health care providers and health care agencies in the four-county upstate region with a guide to begin examining the major types of injuries that occur within their respective communities. Moreover, populations that are disproportionately affected may be delineated, and interventions may be specifically designed for and implemented in partnership with these populations.

Clinical delivery system for intraperitoneal hyperthermic chemotherapy.

A 35-year-old man was treated for pseudomyxoma peritonei by surgery and by thermal infusion and chemotherapy with a machine designed specifically for the treatment of cancers of serosal surfaces. After extensive abdominal resection and closure, the patient's peritoneal cavity was instilled with 2.5 liters of 5% lactated Ringer's solution. He was then attached to hyperthermic perfusion system which elevated the i.p. temperature by warming (to 42 degrees) and recirculating the effusion solution. When the 42 degrees i.p. temperature was attained (after 1.5 hr), chemotherapy was added to the recirculating effusion. A second procedure followed 8 days later. The patient's postoperative course was uneventful except for minor pulmonary atelectasis with bacteremia. Hyperthermic perfusion was tolerated well and was evaluated as safe for intracavitary cancer treatment.

Hyperthermic peritoneal perfusion system in canines.

The thermal infusion filtration system was designed to manage malignant effusions and treat metastatic cancers of the intracavitary serosa. Hyperthermia, chemotherapy, and cell and debris filtration were administered by a dynamic fluid flow. Preclinical evaluations of surgical procedure, temperature studies, fluid dynamics, and physiology were carried out in 15 dogs (17.2 to 25.4 kg) with peritoneal perfusion at 41 degrees C and 10 liters/hr flow. Results suggest that the dynamics of flow achieves total intracavitary equilibrium in 7 min. The time essential to elevate animal body mass temperature from ambient to 41 degrees varied as a function of mass. The hyperthermia induced expected nonlethal responses in physiology. The system was determined to be safe for clinical procedure.