Understanding immunopathology of severe dengue: lessons learnt from sepsis

Endothelial dysfunction leading to vascular permeability and plasma leakage are characteristic features of severe dengue and sepsis. However, the mechanisms underlying these immune-pathologies remain unclear. The risk of severe dengue and sepsis development depend on patient-related and pathogen-related factors. Additionally, comorbidities increase the risk of severe disease and their incidence hampers correct diagnosis and treatments. To date, there is no efficient therapy to combat severe dengue and sepsis. Here, we discuss the differences and similarities between the pathogenesis of severe dengue and that of bacterial sepsis. We identify gaps in knowledge that need to be better understood in order to move towards the rational development and/or usage of therapeutic strategies to ameliorate severe dengue disease

Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus:a qualitative study

AIMS: Uptake of continuous subcutaneous insulin infusion (CSII) by people with diabetes (PwD) in Ireland is low and exhibits regional variation. This study explores barriers and facilitators to accessing CSII by adults with Type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS: A qualitative study employing focus groups with adults with Type 1 diabetes mellitus (n = 26) and semi-structured interviews with health care professionals (HCP) and other key stakeholders (n = 21) was conducted. Reflexive thematic analysis was used to analyze data, using NVivo. RESULTS: Four main themes comprising barriers to or facilitators of CSII uptake were identified. These included: (1) awareness of CSII and its benefits, (2) the structure of diabetes services, (3) the capacity of the diabetes service to deliver the CSII service, and (4) the impact of individuals' attitudes and personal characteristics-both PwD, and HCP. Each of these themes was associated with a number of categories, of which 18 were identified and explored. If the structure of the health-service is insufficient and capacity is poor (e.g., under-resourced clinics), CSII uptake appears to be impacted by individuals': interest, attitude, willingness and motivation, which may intensify the regional inequality in accessing CSII. CONCLUSIONS: This study identified factors that contribute to gaps in the delivery of diabetes care that policy-makers may use to improve access to CSII for adult PwD

Patient Web Portal Use Among Women with Gestational Diabetes

Background: The prevalence of gestational diabetes mellitus (GDM) continues to increase. Research suggests that adverse maternal and newborn outcomes increase in relation to the mother’s elevated blood glucose levels. Diabetes researchers discuss that utilizing information technology for self-management, particularly Internet-based modes of delivery, may result in individual improvements in diabetes outcomes. Scant research exists on the use of Internet-based tools such as patient web portals (PWPs) for GDM self-management and outcomes. Purpose: The purpose of this study was to examine PWP use in women with GDM. Specific aims of this study included: 1) compare the characteristics of nonusers and users of a patient web portal (PWP) for self-management including relationships between characteristics and PWP use, 2) in users of the PWP, describe the frequency and patterns of PWP use, and 3) compare glycemic control between PWP users and nonusers. Methods: A retrospective study was conducted using electronic health record (EHR) review of PWP users (n=91) and nonusers (n=67) who sought care in a diabetes and pregnancy clinic for GDM management. Results: PWP users were more likely to be employed fulltime than nonusers (p= .011). There were no statistically significant differences between users and nonusers for the other patient characteristics. Most users accessed the PWP each month in the third trimester but the number of days accessed varied greatly. The AVS [24.31 (SD 25.05)] and appointment reminders [15.44 (SD 17.00)] were accessed most frequently. Glycemic control did not differ significantly between users and nonusers (F (1.520, 191.474) = 184.428, p=.559). Discussion: This research provides insight into the patient characteristics of users and nonusers of a PWP for a non-chronic condition (GDM) and outlines the features of the PWP used. Patient web portals should be further stringently evaluated for their usability in this population of patients including facilitators and barriers to its use as well as dosage of utilization

An Evidence-Based Protocol for the Assessment and Management of Glucocorticoid-Induced Hyperglycemia.

D.N.P. Thesis. University of Hawaiʻi at Mānoa 2018

The Use of Self-Management, Group Education to Reduce Fear of Hypoglycaemia as a Barrier to Physical Activity in Adults Living with Type 1 Diabetes: A Feasibility Study.

A scoping review indicated the need for theory-driven interventions to address type 1 diabetes-specific barriers to physical activity, specifically fear of hypoglycaemia. Meta-inferences from a two-phase, explanatory sequential mixed methods study concluded that an intervention (Type 1 TACTICS for Exercise©) and the study methods used to evaluate it were feasible and acceptable, and revealed positive preliminary effects in favour of the intervention in reducing fear of hypoglycaemia as a barrier to physical activity

Factors that influence public engagement with eHealth: a literature review

Purpose: Public engagement with eHealth is generally viewed as beneficial. However, despite the potential benefits, public engagement with eHealth services remains variable. This article explores reasons for this variability through a review of published international literature. Methods: A focused search, conducted in January 2009, of three bibliographic databases, MEDLINE, CINAHL and EMBASE, returned 2622 unique abstracts. Results: Fifty articles met the inclusion criteria for the review. Four main types of eHealth service were identified: health information on the Internet; custom-made online health information; online support; and telehealth. Public engagement with these services appears to depend on a number of factors: characteristics of users; technological issues; characteristics of eHealth services; social aspects of use; and eHealth services in use. Conclusions: Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation

Stepping Up Telehealth: Using telehealth to support a new model of care for type 2 diabetes management in rural and regional primary care

Our proposal is to pilot the feasibility and acceptability of a telehealth intervention to enhance care in rural general practice for people with out-of-target Type 2 Diabetes (T2D). Our research program builds on the UK Medical Research Council framework in developing a model of care intervention that is well matched to the setting of General Practice and to the experiences and priorities of patients. We undertook an exploratory qualitative study, leading to the development of a practice-based intervention that we pilot tested for feasibility and acceptability before undertaking a larger pilot and a cluster RCT. We based our work on Normalisation Process Theory (NPT), a sociological theory of implementation, which describes how new practices become incorporated into routine clinical care as a result of individual and collective work. NPT suggested that our model of care intervention would need to be patient centred and include all members of the multidisciplinary diabetes team, including Endocrinologist, RN-CDE General Practitioners (GP), and generalist Practice Nurses (PNs). All of these groups are involved in the �work� of insulin initiation.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Sustaining Gains: Short Message Service (SMS)-Geographic Information Systems (GIS) Enabled Model for Diabetes Self-Care

Adherence to care and treatment of chronic conditions is a well-researched area. In the context of diabetes, many experts have identified self-care adherence as one of the major factors influencing patients’ health outcomes. Cases of non-adherence to self-care among diabetic patients have been well documented. The adverse effects of non-adherence are costly to both the patient and the healthcare industry. This proposed research attempts to mitigate the problem of non-adherence to care by incorporating mobile technology as a tool of support to promote care adherence. Specifically, the use of cellular phone Short Message Service (SMS) and Geographic Information System (GIS) technology to increase adherence to self-care amongst diabetes patients is investigated