Patient Knowledge Compared With National Guidelines for Diabetes Care

Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes Education Profile (DEP). Patient performance on these instruments was compared with corresponding items in the Ambulatory Care Facilities section of the Guide lines for Diabetes Care published by the American Diabetes Associ ation and the American Associ ation of Diabetes Educators. In general, insulin-dependent persons scored higher than noninsulin-dependent persons. Those taking insulin (whether insulin-dependent or not) scored higher than noninsulin-dependent persons whose regimen did not include insulin. The findings emphasize the need to subdivide any analysis of clinical diabetes or diabetes education into groups based on insulin use or nonuse.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69139/2/10.1177_014572178801400312.pd

Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72493/1/j.1399-5448.2008.00474.x.pd

Genetic Tracking of the Raccoon Variant of Rabies Virus in Eastern North America

AbstractTo gain insight into the incursion of the raccoon variant of rabies into the raccoon population in three Canadian provinces, a collection of 192 isolates of the raccoon rabies virus (RRV) strain was acquired from across its North American range and was genetically characterized. A 516-nucleotide segment of the non-coding region between the G and L protein open reading frames, corresponding to the most variable region of the rabies virus genome, was sequenced. This analysis identified 119 different sequences, and phylogenetic analysis of the dataset supports the documented history of RRV spread. Three distinct geographically restricted RRV lineages were identified. Lineage 1 was found in Florida, Alabama and Georgia and appears to form the ancestral lineage of the raccoon variant of rabies. Lineage 2, represented by just two isolates, was found only in Florida, while the third lineage appears broadly distributed throughout the rest of the eastern United States and eastern Canada. In New York State, two distinct spatially segregated variants were identified; the one occupying the western and northern portions of the state was responsible for an incursion of raccoon rabies into the Canadian province of Ontario. Isolates from New Brunswick and Quebec form distinct, separate clusters, consistent with their independent origins from neighboring areas of the United States. The data are consistent with localized northward incursion into these three separate areas with no evidence of east–west viral movement between the three Canadian provinces

Who Participates in an Internet-Based Research Program for Mothers of Infants? A Secondary Prevention Research Study Among Low-Income Families

Objective: The objective of this study was to evaluate the participation rates and factors associated with nonparticipation among mothers living in low-income households who were invited to join a parent-education and -support research program delivered via the Internet with professional support. Methods: Four hundred and seventy-seven mothers of infants were contacted via a variety of recruitment methods, including presentations at clinics/classes, direct mailings, print advertisement, and Internet posts. Research staff attempted to contact these mothers by phone, to assess their eligibility, and interest in participation. For those who were eligible but declined participation, we assessed reasons for declining and collected demographic information. Results: Seventy-four percent of those eligible agreed to participate in the program. Statistical tests comparing participants and decliners on demographic variables found no significant differences on mother’s age and marital status. There was a significant difference on baby’s age due to many decliners in the prenatal period. Mothers were an average age of 28 years and most were married (65.6%). Our sample of low-income participants was diverse with a large number of Latina mothers. Approximately half had a high-school diploma or less but 84% reported being moderately or very comfortable using a computer and half had a computer at home

Chimpanzees demonstrate individual differences in social information use

Studies of transmission biases in social learning have greatly informed our understanding of how behaviour patterns may diffuse through animal populations, yet within-species inter-individual variation in social information use has received little attention and remains poorly understood. We have addressed this question by examining individual performances across multiple experiments with the same population of primates. We compiled a dataset spanning 16 social learning studies (26 experimental conditions) carried out at the same study site over a 12-year period, incorporating a total of 167 chimpanzees. We applied a binary scoring system to code each participant’s performance in each study according to whether they demonstrated evidence of using social information from conspecifics to solve the experimental task or not (Social Information Score—‘SIS’). Bayesian binomial mixed effects models were then used to estimate the extent to which individual differences influenced SIS, together with any effects of sex, rearing history, age, prior involvement in research and task type on SIS. An estimate of repeatability found that approximately half of the variance in SIS was accounted for by individual identity, indicating that individual differences play a critical role in the social learning behaviour of chimpanzees. According to the model that best fit the data, females were, depending on their rearing history, 15–24% more likely to use social information to solve experimental tasks than males. However, there was no strong evidence of an effect of age or research experience, and pedigree records indicated that SIS was not a strongly heritable trait. Our study offers a novel, transferable method for the study of individual differences in social learning

Project #17: Impact of Pharmacist Generated Discharge Antimicrobial Cost Inquiry on Access and Patient Outcome

Identifying barriers to accessing and affording discharge antimicrobials early in the hospitalization course in order to facilitate discharge, enhance compliance, and reduce unnecessary length of stay. In 6/2018, a pharmacist initiated “cost-inquiry” workflow was developed to capture such obstacles. The study evaluated the process and safety of the discharge antimicrobial cost inquiry (DACI) workflow as well as the challenges to accessing discharge antimicrobials. It also assessed the differences in outcomes in patients discharged with (DACI group) and without (standard of care, SOC, group) a cost inquiry. Early identification of barriers to accessing discharge antimicrobials allows clinicians to mitigate the challenges by either discussing with patients regarding affordability or designing an alternative and affordable therapeutic regimen. This novel process provides an enhanced safety-net to assure accessibility and adds to person-centered care by involving patients to confirm affordability.https://scholarlycommons.henryford.com/qualityexpo2022/1001/thumbnail.jp

Optimizing preoperative antibiotics in patients with β-lactam allergies: A role for pharmacy

PURPOSE: Patients with a reported β-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting. METHODS: A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018. RESULTS: Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group. CONCLUSION: Implementation of a pharmacy-driven BLA reconciliation significantly increased β-lactam preoperative use without negative safety outcomes

Bayesian Spatiotemporal Pattern and Eco-climatological Drivers of Striped Skunk Rabies in the North Central Plains

Citation: Raghavan, R. K., Hanlon, C. A., Goodin, D. G., Davis, R., Moore, M., Moore, S., & Anderson, G. A. (2016). Bayesian Spatiotemporal Pattern and Eco-climatological Drivers of Striped Skunk Rabies in the North Central Plains. Plos Neglected Tropical Diseases, 10(4), 16. doi:10.1371/journal.pntd.0004632Striped skunks are one of the most important terrestrial reservoirs of rabies virus in North America, and yet the prevalence of rabies among this host is only passively monitored and the disease among this host remains largely unmanaged. Oral vaccination campaigns have not efficiently targeted striped skunks, while periodic spillovers of striped skunk variant viruses to other animals, including some domestic animals, are routinely recorded. In this study we evaluated the spatial and spatio-temporal patterns of infection status among striped skunk cases submitted for rabies testing in the North Central Plains of US in a Bayesian hierarchical framework, and also evaluated potential eco-climatological drivers of such patterns. Two Bayesian hierarchical models were fitted to point-referenced striped skunk rabies cases [n = 656 (negative), and n = 310 (positive)] received at a leading rabies diagnostic facility between the years 2007-2013. The first model included only spatial and temporal terms and a second covariate model included additional covariates representing eco-climatic conditions within a 4km(2) home-range area for striped skunks. The better performing covariate model indicated the presence of significant spatial and temporal trends in the dataset and identified higher amounts of land covered by low-intensity developed areas [Odds ratio (OR) = 3.41; 95% Bayesian Credible Intervals (CrI) = 2.08, 3.85], higher level of patch fragmentation (OR = 1.70; 95% CrI = 1.25, 2.89), and diurnal temperature range (OR = 0.54; 95% CrI = 0.27, 0.91) to be important drivers of striped skunk rabies incidence in the study area. Model validation statistics indicated satisfactory performance for both models; however, the covariate model fared better. The findings of this study are important in the context of rabies management among striped skunks in North America, and the relevance of physical and climatological factors as risk factors for skunk to human rabies transmission and the space-time patterns of striped skunk rabies are discussed