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Diabetes in primary care

John J V McMurray, David L DeMets, Silvio E Inzucchi, Lars Køber, Mikhail N Kosiborod, Anna M Langkilde, Felipe A Martinez, Olof Bengtsson, Piotr Ponikowski, Marc S Sabatine, Mikaela Sjöstrand, Scott D Solomon
BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. DESIGN AND METHODS: The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) is an international, multicentre, parallel group, randomized, double-blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i...
March 21, 2019: European Journal of Heart Failure
Kristi L Higgins, Fern R Hauck, Kawai Tanabe, Jeffrey Tingen
BACKGROUND: The International Family Medicine Clinic (IFMC) at University of Virginia Health System serves refugees and special immigrants in Virginia. The IFMC comprises an interprofessional team including a clinical pharmacist. METHODS: A retrospective chart review of electronic medical records was performed. Adult refugee patients who attended a scheduled clinical pharmacist visit between October 6, 2015 and December 31, 2016 were included. The primary outcome was to characterize interventions made by a clinical pharmacist...
March 20, 2019: Journal of Immigrant and Minority Health
Jeremy R Van't Hof, Sue Duval, Jeffrey R Misialek, Niki C Oldenburg, Clarence Jones, Milton Eder, Russell V Luepker
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States, disproportionately affecting African Americans. Aspirin is an effective, low cost option to reduce cardiovascular events. This study sought to describe the use of aspirin for CVD prevention in African Americans and evaluate associations with demographics, cardiovascular risk factors and health behaviors and beliefs. A total of 684 African Americans adults ages 45-79 years completed surveys and were included in this analysis...
March 20, 2019: Journal of Community Health
Lisa M Puchalski Ritchie, Finot Debebe, Aklilu Azazh
BACKGROUND: Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting...
March 20, 2019: BMC Health Services Research
Eduardo Montero, David Herrera, Mariano Sanz, Sangeeta Dhir, Thomas Van Dyke, Corneliu Sima
AIM: To develop and validate a predictive model for moderate-to-severe periodontitis in the adult USA population, with data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) cycle. MATERIAL AND METHODS: A subset of 3017 subjects aged >30 years, with >14 teeth present and having received a periodontal examination in addition to data collected on cardio-metabolic risk measures (smoking habit, body mass index [BMI], blood pressure, total cholesterol and glycated haemoglobin [HbA1c]) were used for model development by multivariable logistic regression...
March 19, 2019: Journal of Clinical Periodontology
Anish Menon, Farhad Fatehi, Dominique Bird, Darsy Darssan, Mohan Karunanithi, Anthony Russell, Leonard Gray
Conventional outpatient services are unlikely to meet burgeoning demand for diabetes services given increasing prevalence of diabetes, and resultant impact on the healthcare workforce and healthcare costs. Disruptive technologies (such as smartphone and wireless sensors) create an opportunity to redesign outpatient services. In collaboration, the Department of Diabetes and Endocrinology at Brisbane Princess Alexandra Hospital, the University of Queensland Centre for Health Services Research and the Australian e-Health Research Centre developed a mobile diabetes management system (MDMS) to support the management of complex outpatient type 2 diabetes mellitus (T2DM) adults...
March 18, 2019: International Journal of Environmental Research and Public Health
Frédéric Bonté, Dorothée Girard, Jean-Christophe Archambault, Alexis Desmoulière
The skin provides the primary protection for the body against external injuries and is essential in the maintenance of general homeostasis. During ageing, resident cells become senescent and the extracellular matrix, mainly in the dermis, is progressively damaged affecting the normal organization of the skin and its capacity for repair. In parallel, extrinsic factors such as ultraviolet irradiation, pollution, and intrinsic factors such as diabetes or vascular disease can further accelerate this phenomenon...
2019: Sub-cellular Biochemistry
Prashanth Patel, Pankaj Gupta, Angela Burns, Ali A Mohamed, Richard Cole, Dan Lane, Samuel Seidu, Kamlesh Khunti
OBJECTIVE: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a new method to objectively and robustly detect nonadherence. We applied this technique to study nonadherence to cardiovascular medications in people with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS: Routine urine samples, received at the time of the annual diabetes review from 228 people with T2DM in primary care, were assessed for adherence by LC-MS/MS. RESULTS: A total of 28...
March 18, 2019: Diabetes Care
Gautam Mankaney, Maged Rizk, Shashank Sarvepalli, Jeannie Bongorno, Ari Garber, Rocio Lopez, John McMichael, Carol A Burke
BACKGROUND AND AIM: We identified patients without medical record evidence of up-to-date colorectal cancer (CRC) screening and sent an invitation letter to self-schedule a colonoscopy without requiring prior primary care or gastroenterologist consultation. The aim of the study was to evaluate the response rate to the letter and factors associated with colonoscopy completion. METHODS: A computer algorithm invited patients not up to date with CRC screening, with an INR < 1...
March 15, 2019: Digestive Diseases and Sciences
Dennis F Bandyk
The pathophysiology of the diabetic foot ulcer and soft-tissue infection is due to neuropathy, trauma, and, in many patients, concomitant peripheral artery occlusive disease. Diabetic neuropathy results in foot deformity, leading to increased skin pressure with walking. Once a foot ulcer develops, the limb is at high risk for invasive infection and, when combined with peripheral artery occlusive disease, the patient should be considered to have critical limb ischemia. A multidisciplinary approach to care for the diabetic foot is recommended, which includes annual (3-month intervals in high-risk patients) assessments by a primary care physician and referral to a podiatrist and vascular surgeon for diabetics with a foot ulcer for evaluation of foot arterial perfusion and off-loading therapy to reduce plantar skin pressure with walking...
June 2018: Seminars in Vascular Surgery
Despo Ierodiakonou, Maria Kampouraki, Ioannis Poulonirakis, Polyvios Papadokostakis, Eleftheria Lintovoi, Dimitris Karanassos, Kyriakos Maltezis, Maria Chorti, Evangelos Petrovitsos, Sofia Dimopoulou, Sam Hamind, Ioannis Gialamas, Polyxeni Athanasiou, Vasiliki Bempi, Irene Lambraki, Ioanna Tsiligianni
BACKGROUND: Frailty is a state of increased vulnerability that has a significant risk of unfavorable outcomes such as increased dependency and/or death, but little is known about frailty in people with chronic obstructive pulmonary disease (COPD). METHOD: We aimed to determine the prevalence of frailty in COPD patients and to identify the associated risk factors. Two hundred fifty-seven COPD patients enrolled from primary care in Greece between 2015 and 2016. Physicians used structured interviews to collect cross-sectional data including demographics, medical history, symptoms and COPD Assessment Tool (CAT) or modified Medical Research Council Dyspnea scale (mMRC) score...
March 15, 2019: BMC Pulmonary Medicine
Sara Hamdi Abdulrhim, Rana Ahmed Saleh, Mohamed Abdelazim Mohamed Hussain, Hend Al Raey, Ahmed Hussein Babiker, Nadir Kheir, Ahmed Awaisu
BACKGROUND: Diabetes mellitus is highly prevalent in the Middle East and the burden associated with it is dramatically increasing. Pharmacists working in collaborative healthcare teams have an important role to improve outcomes in the primary care of diabetes. OBJECTIVES: To evaluate the impact of a collaborative pharmaceutical care service (CPCS) on improving outcomes among patients with diabetes in a primary care setting. METHODS: This was a retrospective, multiple time series study involving patients attending an ambulatory diabetes clinic at Qatar Petroleum Healthcare Center in Dukhan, Qatar...
March 12, 2019: Value in Health Regional Issues
João Luiz Miraglia, Ana Carolina Cintra Nunes Mafra, Camila Nascimento Monteiro, Luciana Morais Borges
BACKGROUND: Noncommunicable diseases (NCDs) were responsible for 72.3% of global deaths in 2016, with cardiovascular diseases accounting for almost half of those deaths and low- and middle-income countries carrying the biggest burden. As a result, the prevention and control of NCDs is recognized as urgent, while better surveillance at the country level could result in more effective policies. Hence, the objective of this study was to obtain more detailed information on the distribution of the prevalence of hypertension and diabetes among the population of two large districts of the city of São Paulo in Brazil, and to compare these findings to the results of a citywide health survey...
2019: PloS One
Julie C Lauffenburger, Jennifer Lewey, Saira Jan, Sagar Makanji, Christina A Ferro, Alexis A Krumme, Jessica Lee, Roya Ghazinouri, Nancy Haff, Niteesh K Choudhry
Importance: Patient adherence to antidiabetic medications, especially insulin, remains poor, leading to adverse outcomes and increased costs. Most adherence interventions have only been modestly effective, partly because they are not targeted to patients who could benefit most. Objective: To evaluate whether delivering more intensive insulin-adherence interventions only to individuals with type 2 diabetes predicted to benefit most was more effective than delivering a lower-intensity intervention to a larger group of unselected individuals...
March 1, 2019: JAMA Network Open
Makiko Ozaki, Shinji Matsumura, Momoko Iwamoto, Satoshi Kamitani, Takahiro Higashi, Manabu Toyama, Seiji Bito, Kazuhiro Waza
Background: Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. Methods: Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background)...
March 2019: Journal of General and Family Medicine
Martina Kamradt, Dominik Ose, Johannes Krisam, Christian Jacke, Hans-Joachim Salize, Werner Besier, Manfred Mayer, Joachim Szecsenyi, Michel Wensing
AIMS: This study explored the impact of a care management intervention aiming to improve self-care behavior in multimorbid individuals with Type 2 diabetes mellitus on health-related quality of life (HRQoL). METHODS: A patient-level randomized parallel-group superiority trial with 32 primary care practice teams, 11 care managers and 495 patients was conducted. The intervention was delivered as add-on to an already implemented disease management program and embedded in a network of primary care practices...
March 11, 2019: Diabetes Research and Clinical Practice
Michael Annear, Peter Lucas, Tim Wilkinson, Yasuo Shimizu
Dementia is increasing in Australia in line with population ageing and is expected to peak by mid-century. The development of common forms of dementia, including Alzheimer's disease, is associated with lifestyle-related risk factors that are prevalent among middle-aged Australians, including obesity, hypertension, high cholesterol, diabetes and depression. These risk factors can be significantly ameliorated through regular participation in moderate aerobic physical activity (PA). Current national and international guidelines recommend at least 150 min of aerobic PA per week for achieving health protective effects...
March 15, 2019: Australian Journal of Primary Health
Olga Szafran, Sandra L Kennett, Neil R Bell, Jacqueline M I Torti
BACKGROUND: In Canada, most patients with type 2 diabetes mellitus (T2DM) are cared for in the primary care setting in the practices of family physicians. This care is delivered through a variety of practice models ranging from a single practitioner to interprofessional team models of care. This study examined the extent to which family physicians collaborate with other health professionals in the care of patients with T2DM, comparing those who are part of an interprofessional health care team called a Primary Care Network (PCN) to those who are not part of a PCN...
March 13, 2019: BMC Family Practice
Susan F McLendon, Felecia G Wood, Nancy Stanley
OBJECTIVE: To provide a comprehensive evaluation of a grant-funded pilot diabetes care program. Rural adult patients living with poorly controlled diabetes were targeted for care. DESIGN AND SAMPLE: Retrospective study using a purposive sample of patients at select primary care sites with a glycated hemoglobin (A1C) greater than 8%. Interventions included nurse care management, telemedicine endocrinology consults, as well as diabetes self-management education (DSME), to enhance disease management and prevention of complications...
March 13, 2019: Public Health Nursing
Alex Bahar-Fuchs, Marjolein E A Barendse, Rachel Bloom, Ramit Ravona-Springer, Anthony Heymann, Hai Dabush, Lior Bar, Shirel Slater, Yuri Rassovsky, Michal Schnaider Beeri
BACKGROUND: To evaluate the effects of adaptive and tailored computerized cognitive training [CCT] on cognition and disease self-management in older adults with diabetes. METHODS: Single-blind trial. Eighty-four community-dwelling older adults with diabetes were randomized into a tailored and adaptive computerized cognitive training [TA-CCT] or a generic, non-tailored or adaptive CCT condition [GCCT]. Both groups trained for 8-weeks on the commercially-available CogniFit program and were supported by a range of behavior change techniques [BCTs]...
March 14, 2019: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
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