Outcomes for continuous subcutaneous insulin infusion users in young adults from lower socioeconomic backgrounds

OBJECTIVE: Diabetes technology is available and its efficacy and safety have been demonstrated; however, there is little evidence as to how this technology is being utilized and its effectiveness in vulnerable populations. This study evaluated differences in outcomes for young adults in the United States (U.S.) from lower socioeconomic (SES) backgrounds with type 1 diabetes (T1D) managed on continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) or fixed-dose insulin (FDI). RESEARCH DESIGN METHODS AND PARTICIPANTS: Utilizing the Optum® de-identified Electronic Health Record data set between 2008 and 2018 to perform a retrospective, cohort study, we identified 805 subjects with T1D aged 18-30 years with Medicaid. We evaluated median difference in HbA1c between CSII and MDI/FDI users for 24 months. Predictors of diabetic ketoacidosis (DKA)-associated hospitalizations by CSII use were evaluated using logistic regression. RESULTS: CSII users showed statistically significant lower median HbA1c values at 24 months of follow-up compared to individuals on MDI/FDI. Non-white individuals were at lower odds of receiving treatment with CSII. Subjects on CSII were not more likely to be hospitalized for DKA compared to subjects treated with MDI/FDI. Older subjects were at lower odds of being hospitalized for DKA. Males and subjects followed by Endocrinologists were at higher odds of being hospitalized for DKA. CONCLUSIONS: Young adults with T1D from lower SES backgrounds show improved glycaemic control when in CSII compared to MDI/FDI without increases in hospitalizations for DKA

Teaching Health Outcomes Research from an Interprofessional Perspective

Background: Considering the importance of interprofessional, collaborative practice and the ability to understand and evaluate health outcomes research in delivering efficient and quality care, health profession education curriculum should include a team-based, health outcomes research course. The ability to work collaboratively in assessing and interpreting health outcomes is an important next step. Purpose: We sought to determine the perceived effectiveness of a health outcomes research course to an interprofessional group of health profession students at the undergraduate level. Method: We offered and delivered a semester-long health outcomes research course. As part of this course, students completed critical reflections at the end of the semester which served as the qualitative data for our analyses. Students were instructed to reflect upon the course objectives and purpose as well as the overall structure of the course. Discussion: Students reported that the sequence of learning material, use of stable teams, and group projects and assignments helped facilitate learning as well as an increased awareness of the role of interprofessional teamwork in the health care process. Conclusion: An interprofessional health outcomes research course appears to improve learning and attitudes toward interprofessional collaborative practice and health outcomes research

Uniting Saint Louis University\u27s Interprofessional Education Program with Organizational Learning: A Theory-Based Model to Guide IP Education and Practice

Background: Strengthening the bridge between interprofessional education and interprofessional collaborative practice to expand the integration of effective team-based health care requires new models within the health care system. Recent calls in the literature have asked for interprofessional research to do a better job of incorporating theories and explanatory models. We propose the use of organizational learning theory as an approach to modeling and supporting interprofessional collaborative practice. Methods: The current paper applies the five disciplines of organizational learning to the organization of interprofessional education competencies and course objectives in a university interprofessional education program. Results: The model also provides a guide for healthcare administrators who may utilize organizational learning theory and who support the enhancement of interprofessional collaborative practice. Conclusion: Future research could work to evaluate these objectives and competencies of health professions graduates to see how individuals contribute to organizational learning and change once in the field

Prevalence and Predictors of Depression in Women with Osteoarthritis: Cross-Sectional Analysis of Nationally Representative Survey Data

Osteoarthritis (OA) is the most common joint disease in the US and can increase the risk of depression. Both depression and OA disproportionately affect women, yet this study is one of few on depression prevalence, treatment across age groups, and predictors in women with OA. Data were extracted from the 2011–March 2020 National Health and Nutrition Examination Survey (NHANES). Women aged ≥ 45 years with self-reported osteo- or degenerative arthritis were included. Outcomes were depression (assessed with PHQ-9) and treatment (self-reported pharmacotherapy and mental health services). Logistic regression was used to examine associations between age group, covariates, and outcomes. Overall, depression prevalence was 8%, with higher proportions among those 45–64 years old. Aging was associated with reduced odds of depression (Age 65–79: OR 0.68 (95% CI: 0.52–0.89); Age 80+: OR 0.49 (95% CI: 0.33–0.74); vs. Age 45–54). Of those with a positive depression screen, 21.6% documented some form of treatment. Age group was not statistically different between those treated and those not treated. Women aged 45–64 with osteoarthritis may be at increased risk of depression, and most are not treated. As depression is related to increased pain and risk of rehospitalization, future research should prioritize interventions to increase uptake of depression treatment

Palliative Care and Mental Health among Pancreatic Cancer Patients in the United States: An Examination of Service Utilization and Health Outcomes

Introduction: Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. Methods: Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum’s Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. Results: Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65–70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. Discussion: Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care’s role in addressing mental health concerns among pancreatic cancer patients

Realizing Promising Educational Practices in Academic Public Health: A Model for the Scholarship of Teaching and Learning

This paper presents a conceptual framework and critical considerations for the scholarship of teaching and learning (SoTL) in academic public health. Academic education for public health has undergone significant transformation over the last two decades as the demand for responsive and innovative public health pedagogy and training for preparing graduates to deploy an increasing array of skills has grown. The authors suggest that the role of schools, administrators, faculty, and educational staff in developing promising practices for teaching and learning in public health involves an articulated conceptual framework to guide the development and dissemination of scholarly, pedagogical innovations. Building on seminal philosophical foundations of SoTL, the authors conceptualize SoTL from the foundational belief that knowing and learning are communal tasks and that faculty are both scholars and learners in the practice of education. The paper advocates for SoTL as a form of engaged practice and scholarly inquiry that exists in contextually rich, diverse educational environments that abounds with uncertainty. SoTL is guided by an educational philosophy, values, and learning theories that envision educators critically examining themselves, their teaching practice, scholarly literature, and students\u27 learning to improve their teaching, enhance learning, and promote further inquiry. The authors suggest that SoTL involves the search for multiple forms of evidence and fosters dialogues on multiple interpretations and perspectives of the most promising practices of teaching and learning. The authors advocate for the term promising practices as an outcome of SoTL that supports and nurtures ongoing scientific discovery and knowledge generation, instead of supporting the search for best-ness in teaching and learning endeavors. SoTL should occur across formal, informal, and nonformal education