Fear of Punishment in Another World: a Follow-Up Examination of the Religious Beliefs About HIV/AIDS-A Decade of Progress?

This study compared 2000 and 2010 data on the religious beliefs about HIV/AIDS among those with HIV in a Deep South state. The percentage agreeing that HIV/AIDS is a punishment from God had not decreased in that decade. The literature on interventions to reduce religious stigma and increase church involvement in HIV/AIDS prevention was presented. The study concluded with a set of recommendations for future research.

Self-monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes (The SMBG Study): study protocol for a randomised controlled trial.

BACKGROUND: The benefit of Self-monitoring of Blood Glucose (SMBG) in people with non-insulin treated type 2 diabetes remains unclear with inconsistent evidence from randomised controlled trials fuelling the continued debate. Lack of a consistent finding has been attributed to variations in study population and design, including the SMBG intervention. There is a growing consensus that structured SMBG, whereby the person with diabetes and health care provider are educated to detect patterns of glycaemic abnormality and take appropriate action according to the blood glucose profiles, can prove beneficial in terms of lowering HbA1c and improving overall well-being. Despite this, many national health agencies continue to issue guidelines restricting the use of SMBG in non-insulin treated type 2 diabetes. METHODS: The SMBG Study is a 12 month, multi-centre, randomised controlled trial in people with type 2 diabetes not on insulin therapy who have poor glycaemic control (HbA1c ≥58 mmol/mol / 7.5%). The participants will be randomised into three comparative groups: Group 1 will act as a control group and receive their usual diabetes care; Group 2 will undertake structured SMBG with clinical review every 3 months; Group 3 will undertake structured SMBG with additional monthly telecare support from a trained study nurse. A total of 450 participants will be recruited from 16 primary and secondary care sites across Wales and England. The primary outcome measure will be HbA1c at 12 months with secondary measures to include weight, BMI, total cholesterol and HbA1c levels at 3, 6, 9 and 12 months. Participant well-being and attitude towards SMBG will be monitored throughout the course of the study. Recruitment began in December 2012 with the last participant visit due in September 2016. DISCUSSION: This study will attempt to answer the question of whether structured SMBG provides any benefits to people with poorly controlled type 2 diabetes who are not being treated with insulin. The data will also clarify whether the telecare support provides additional value. The overall acceptability of SMBG as a tool for self-management will be assessed. TRIAL REGISTRATION: UKCRN 12038 (Registered March 2012). ISRCTN21390608 (Retrospectively registered 15th May 2014).

Subcutaneous furosemide in advanced heart failure: service improvement project.

OBJECTIVES: In severe heart disease, parenteral administration of loop diuretic is often needed. We present clinical outcomes from episodes of care using subcutaneous continuous subcutaneous infusion of furosemide (CSCI-furosemide). METHODS: Retrospective review of service improvement data. The heart failure nurse specialist, supported by the heart failure-palliative care multidisciplinary team, works with the community or hospice staff who administer the CSCI-furosemide. Data collected for consecutive patients receiving CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, preferred place of care, goal of treatment, infusion-site reactions, and signs and symptoms of fluid retention (including weight and self-reported breathlessness). RESULTS: 116 people (men 86 (66%); mean age 79 years, 49-97; NYHA class 3 (36/116, 31%) or 4 heart failure (80/116, 69%)) received 130 episodes of CSCI-furosemide (average duration 10 days, 1-49), over half in the patient's own home/care home (80/129,; 61%) aiming to prevent hospital admission. 40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. Average daily furosemide dose was 125 mg (40-300 mg). The goal of treatment was achieved in (119/130, 91.5%) episodes.The median reduction in weight was 4 kg (IQR -7 to -2 kgs, -22 to 9 kgs). Self-reported breathlessness reduced from 8.2 (±1.9) to 5.2 (±1.8). Adverse events occurred in 31/130 (24%) episodes; all but 4/130 (3%, localised skin infection) were mild. CONCLUSIONS: These preliminary data indicate that CSCI-furosemide is safe and effective for people with severe heart failure. An adequately powered randomised controlled trial is indicated.

Brief lifestyle interventions for prediabetes in primary care: a service evaluation.

BACKGROUND: The increasing number of cases of prediabetes in the UK is concerning, particularly in Wales where there is no standard programme of support. The aim of the current service evaluation was to examine the effectiveness of brief lifestyle interventions on glucose tolerance in people at risk of developing type 2 diabetes. METHODS: In this pragmatic service evaluation clinical data on people deemed at risk of developing type 2 diabetes were evaluated from two GP clusters. Patients (n = 1207) received a single 15 to 30-min, face-to-face, consultation with a health care practitioner. Interventions were assessed by changes in HbA1c and distribution across the HbA1c ranges 12 months following intervention. Statistical significance of reversion to normoglycaemia and development of diabetes were assessed through comparison with expected rates without intervention. RESULTS: Between baseline and 12-month follow-up HbA1c fell from 43.85 ± 1.57 mmol/mol (6.16 ± 0.14%) to 41.63 ± 3.84 mmol/mol (5.96 ± 0.35%), a decrease of 2.22 mmol/mol (0.20%) (95% CI 2.01 (0.18%), 2.42 (0.22%); p < 0.0001). The proportion of people with normal glucose tolerance at 12 months (0.50 95%CI 0.47, 0.52) was significantly larger than the lower (0.06 (p < 0.0001) and the upper (0.19 (p < 0.0001)) estimates based on no intervention. CONCLUSION: Results indicate significant improvement in glucose tolerance across GP clusters. The brief intervention has the potential to offer a robust and effective option to support people at risk of developing type 2 diabetes. Further research in the form of a randomised trial is needed to confirm this and identify those likely to benefit most from this intervention.

Is there a role for subcutaneous furosemide in the community and hospice management of end-stage heart failure?

Patients with advanced chronic heart failure (CHF) can experience 'revolving door' admissions, often for parenteral diuretics, when time at home is precious. Home intravenous diuretic services are patchy. This retrospective review describes 43 consecutive episodes of continuous subcutaneous infusion of furosemide (CSCI-F) in 32 advanced CHF patients; 28 episodes aiming to correct fluid balance and prevent hospital admission and 15 aiming to prevent symptoms in the dying. Overall, 26/28 (93%) avoided hospital admission. Weight loss occurred in 20/28 (70%): a median loss of 5.6 kg [interquartile range (IQR) 0.1-8.9]). The daily dose of furosemide ranged from 40 to 250 mg. The median number of days on CSCI-F was 10.5 (range 2-48; IQR 6-13.8). Site reactions occurred in 10/43 (23%); all of which were mild except two, one of which required oral antibiotics. Symptoms were controlled in all 15 dying patients. CSCI-F for patients with advanced CHF is effective in terms of weight loss and prevention of hospital admission with the heart failure nurse specialist playing a key overall management role in selection and monitoring. As the majority of community and hospice nurses have access to and are familiar with CSCI pumps, this practice should be nationally transferable. The role in the dying patient requires further assessment.

Addressing Racial Biases in Medicine: A Review of the Literature, Critique, and Recommendations.

This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.

The impact of structured self-monitoring of blood glucose on glycaemic variability in non-insulin treated type 2 diabetes: The SMBG study, a 12-month randomised controlled trial.

BACKGROUND AND AIMS: There is inconsistent evidence supporting the self-monitoring of blood glucose (SMBG) in people with non-insulin treated type 2 diabetes (T2D). Structured SMBG protocols have a greater impact on glycaemic control than unstructured SMBG and may improve measures of glycaemic variability (GV), though few previous studies have reported on specific GV outcomes. Our aim was to determine the impact of structured SMBG on simple measures of GV in people with T2D. METHODS: Participants undertook structured SMBG over 12 months, with HbA1c recorded at baseline and at 3-monthly follow-up. For each participant, the mean blood glucose (MBG), fasting blood glucose (FBG), standard deviation BG (SD-BG), coefficient of variation of BG (CV-BG), mean absolute glucose change (MAG) and HbA1c were determined for each 3-month period. Responders were participants with an improvement in HbA1c of ≥5 mmol/mol (0.5%) over 12 months. RESULTS: Data from two hundred and thirty-one participants were included for analysis. Participants had a baseline median [interquartile range] HbA1c 68.0 [61.5-75.5] mmol/mol (8.4%). Participants demonstrated significant improvements in the MBG (-1.25 mmol/L), FBG (-0.97 mmol/L), SD-BG (-0.44 mmol/L), CV-BG (-1.43%), MAG (-0.97 mmol/L), and HbA1c (-7.0 mmol/mol) (all p < 0.001) at 12 months compared to these measures collected within the first 3 months of SMBG. Responders had a significantly higher baseline median [interquartile range] HbA1c of 70.0 [63.0-78.0] mmol/mol compared to 61.0 [56.5-66.0] mmol/mol in non-responders (P < 0.001). CONCLUSIONS: Structured SMBG improved all the observed measures of GV. These results support the use of structured SMBG in people with non-insulin treated T2D.

Patient preferences: do they contribute to healthcare disparities?

OBJECTIVES: The purpose of this study was to examine the effect of race on whether or not a patient would accept an invasive cardiac procedure when referred by a physician. METHODS: A retrospective longitudinal review of medical records at a public health hospital in southeastern Louisiana was conducted to determine cardiovascular patient acceptance/ rejection differences. Patient charts were examined using specific indicators (type of pain, laboratory values, blood pressure, and radiographic tests) to determine which patients were eligible to be referred. In order to be selected, each medical record had to have documentation of a physician referral for an invasive cardiac procedure. Medical charts without this referral were deemed ineligible for the cohort. RESULTS: Patient preferences were similar for both minorities and Caucasians, despite the fact that the study controlled for disease severity, age, income, sex, race, social support, diagnosis, and family history. CONCLUSION: Race did not contribute to disparate acceptance and rejection rates among African Americans and Caucasians. A possible reason for this occurrence is that the site was a teaching hospital, which may indicate more physician oversight and better articulation of treatment options. Future studies should delve deeper into physician and institutional bias in non-teaching facilities during patient/physician interactions.

Physician bias: does it occur at teaching hospitals that serve a majority of African American patients?

OBJECTIVES: The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hospital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed. METHODS: The hospital in the study was a teaching facility in southeastern Louisiana. We conducted a longitudinal retrospective review of 177 medical records from patients with cardiovascular disease. Patient charts were examined using specific indicators (type of pain, lab work, blood pressure, and x-ray tests) from the Framingham study (1996) to determine whether patients met the criteria for eligibility of invasive procedures, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) and if so, whether they were referred accordingly. Next, these charts were used to obtain confounders (race, sex, income, age, disease severity, and diagnoses) from each patient. Finally, a logistic regression analysis was used to determine the effect of these confounders on a patient being referred by a physician. RESULTS: The model failed to find a statistically significant disparity between physician referrals for African Americans and Caucasians when cardiovascular disease patients met specific criteria. Therefore, physician referral disparities did not exist among this study population. This occurred despite the fact that the study controlled for primary diagnoses, disease severity, age, income, sex, and race. CONCLUSION: This research concludes that physicians' referral patterns for cardiac procedures were similar for both African Americans and Caucasians. Moreover, this research suggests that referral disparities may not exist at teaching hospitals that serve a majority of African American patients. Future studies should delve deeper into physician/patient interaction at these institutions to understand what they do to reduce disparities in the hope of implementing their methods at other hospitals.

Religious beliefs, practices and treatment adherence among individuals with HIV in the southern United States.

Nonadherence with medical treatment is a critical threat to the health of those living with HIV disease. Unfortunately the search for explanatory factors for nonadherence is still not fully developed, particularly in the area of religion and spirituality. Extant literature suggests that church attendance, religious practices and spiritual beliefs may improve health and generally benefit patients. However, religious beliefs may also play a negative role in treatment adherence due to the stigma attached to HIV disease, particularly in geographical areas and in population subgroups where religious practices are strong. In this exploratory study, HIV-positive individuals (n = 306) in a southern state were surveyed as to their attitudes and beliefs surrounding HIV disease and adherence with medical treatment for the disease. The results indicate that multiple factors influence adherence with treatment and that certain religious practices are positively associated with adherence, but certain religious beliefs are negatively related to adherence. The findings of this study reinforce the importance of remembering and addressing a patient's religious beliefs as a part of medical care.

Determinants of satisfaction and turnover among nursing assistants. The results of a statewide survey.

This research is an examination of job satisfaction and turnover among nursing assistants employed in nursing homes. Using a statewide sample with 550 nursing assistants responding, the results indicated that 60% were satisfied with their jobs and 30% planned to quit. The nursing assistants participating in this study identified the relationship with the resident as the most important work issue, and their major reason for staying in the job. They were most dissatisfied with pay, benefits, and recognition and appreciation. Although the respondents were dissatisfied with benefits and salary, these work issues could not explain overall satisfaction or turnover. The multivariate analysis confirmed that professional growth and involvement in work-related decisions, supervision, and management keeping employees informed were significantly related to both turnover and overall satisfaction.

The effect of race and gender on invasive treatment for cardiovascular disease.

The purpose of this study was to investigate racial and gender differences in the utilization of invasive procedures for cardiovascular treatment. Medical records data of 3015 patients were abstracted from a Medical System Database from 1999 to 2001. Logit models were used to estimate the adjusted odds in the utilization, referral, and acceptance of invasive procedures, while controllingfor confounders (age, race, sex, comorbidity, disease severity, payer type, marital status and family history) simultaneously. When considering utilization of invasive procedures, the adjusted odds were lower for African-Americans compared to Caucasians. There was a statistically significant difference (p < .05) in Coronary Artery Bypass Graft (CABG) utilization between African Americans and Caucasians. African Americans were less likely than Caucasians to receive a CABG. Although not statistically significant, African-Americans were less likely than Caucasians to receive a cardiac catheterization and Percutaneous Transluminal Coronary Angioplasty (PTCA). Findings failed to yield a statistical significance for gender disparities regarding invasive procedure utilizations.

State, heal thy physicians: an assessment of the Louisiana Natural Death Act.

In our society, state governments have the major role in regulating physician behavior and actions related to end-of-life decision making. However, in the current confusing and conflicted legal environment, how well are state governments doing with this serious responsibility? The authors of this article report the results of the first statewide survey of Louisiana physicians regarding their knowledge of and compliance with specific parts of one state government's attempt to regulate end-of-life decision making: the Louisiana Natural Death Act (LNDA). Physician respondents were asked to indicate their level of familiarity with the LNDA and several questions examined physician compliance with specific sections contained in the statute. Among many things, the survey revealed most physicians (74%) were not familiar with even the basic provisions of the LNDA, and had not received either medical school or subsequent post graduate training in this area. Based on the results of this survey, the authors offer several policy recommendations that could enhance physician knowledge and subsequent compliance with the LNDA.