Barriers and Facilitators to Diabetes Self-Management in a Primary Care Setting – Patient and Physician Perspectives

OBJECTIVES: To identify patient- and physician-perceived barriers to self-management of type-2 diabetes (T2DM) and explore the challenges physicians face in managing these patients. METHODS: This cross-sectional study of T2DM patients and their physicians used a mixed-methods approach (combination of patient survey and electronic medical record (EMR) database). A random stratified sample of 2,100 patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250.xx) and having ≥2 physician visits was selected from a large physician group’s EMR database, and based on HbA1c level, was categorized into three groups: HbA1c\u3c7, 7–9, and \u3e9. Patients were administered a survey containing standardized instruments to collect information on demographics and diabetes self-care behaviors. Physician survey measured physician perceptions of patient barriers to self-management and their challenges in managing uncontrolled T2DM patients. RESULTS: 210 responses were received (10% response rate). Mean age was 63.68 years (+/-11.79), 102 (48.6%) were females, 197 were Caucasian (93.8%). Univariate analysis revealed that age (X2=15.73, p\u3c0.01), insurance status (X2=12.03, p\u3c0.05), referral to an endocrinologist (X2=6.17, p\u3c0.05), level of self-management (X2=12.01, p\u3c0.05), and willingness to take insulin (X2=9.8, p\u3c0.01) were associated with HbA1c control. Older age, lower willingness to take insulin, and less than graduate level education were significant determinants of glycemic control. Of the 21 physicians who responded (53.8% response rate), 71.2% were over the age of 50 years, 54.16% had ≥25 years of clinical experience, and 50% practiced in an urban setting. Barriers leading to clinical inertia as identified by the physicians include cost of medications, non-compliance with diet and medications, polypharmacy, lack of patient motivation, knowledge, time, and social support. CONCLUSIONS: Self-management behavior of T2DM patients is strongly associated with HbA1c control. Interventions directed towards improving self-management in T2DM population that take both physician and patient perspectives in to consideration may result in improved clinical outcomes

Dental professionals’ knowledge and behavior towards utilization of gloves: a cross-sectional survey

Introduction: The purpose of this study was to assess the perception and beliefs of dental healthcare providers towards usage of different type of gloves.Methods: A self-administered questionnaire was distributed among a total of 241 participants out of which 198 participants (77 interns, 58 dental post-graduate students (PG) and 63 dental faculty members) returned completed questionnaire (response rate of 82.15%). The questionnaire comprised of questions on dental professionals’ preferences for certain types of gloves and the reasons for these preferences, as well as determining their knowledge, beliefs and behavior concerning the use of dental gloves as a means of barrier protection.Results: Dental faculty members had a better knowledge regarding use of gloves as compared to dental PG students and interns. Most of the study participants preferred certain types of gloves for the purpose of better protection followed by comfort. Most of the participants believed that gloves provide full protection as long as there is no visible tear (interns 70.1%; PG students 50%; faculty members 60.3%). Most of the interns (42.9%) and PG students (41.4%) did not know about the fact that petroleum based products affect the integrity of the gloves. 2.6% interns, 29.3% PG students and 20.6% faculty members reported that they would not change gloves during an uninterrupted three-hour long procedure.Conclusion: Most of the interns and PG students had poor knowledge regarding usage of gloves which calls for an action on the part of educators to educate and train dental professionals regarding proper infection control practices

Effect of Reinforcement of Oral Health Education Message through Short Messaging Service in Mobile Phones: A Quasi-Experimental Trial

Objective. This paper aims to assess the effectiveness of reinforcement of oral health education message through short messaging service (SMS) in mobile phones. Material and Methods. 400 subjects from two colleges (200 from each college) belonging to 18-20 years age group possessing mobile phones were randomly selected and baseline examination of oral hygiene and gingival status was carried out using Oral Hygiene Index (OHI) and Gingival Index (GI). Oral health education was provided to all the subjects. Oral health education message was reinforced through short messaging service (SMS) in mobile phones for the subjects belonging to the intervention group. There was no such reinforcement for the control group. Follow-up examinations were done at the end of 1st, 2nd, 3rd, and 6th month. After the 3rd month, subjects of the intervention group did not receive oral health education message through short messaging service (SMS) and were followed up after next three months. Compiled data was analyzed using SPSS version 16 statistical software. Result. Mean OHI and GI scores in intervention group were significantly ( < 0.01) less than those of control group after the 2nd, 3rd, and 6th month. Conclusion. Reinforcement of oral health education message through short messaging service (SMS) is effective media to improve oral health

Barriers and Facilitators to Diabetes Self-Management in a Primary Care Setting - Patient and Physician Perspectives

OBJECTIVES: To identify patient- and physician-perceived barriers to self-management of type-2 diabetes (T2DM) and explore the challenges physicians face in managing these patients. METHODS: This cross-sectional study of T2DM patients and their physicians used a mixed-methods approach (combination of patient survey and electronic medical record (EMR) database). A random stratified sample of 2,100 patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250.xx) and having ≥2 physician visits was selected from a large physician group’s EMR database, and based on HbA1c level, was categorized into three groups: HbA1c9. Patients were administered a survey containing standardized instruments to collect information on demographics and diabetes self-care behaviors. Physician survey measured physician perceptions of patient barriers to self-management and their challenges in managing uncontrolled T2DM patients. RESULTS: 210 responses were received (10% response rate). Mean age was 63.68 years (+/-11.79), 102 (48.6%) were females, 197 were Caucasian (93.8%). Univariate analysis revealed that age (X2=15.73, p<0.01), insurance status (X2=12.03, p<0.05), referral to an endocrinologist (X2=6.17, p<0.05), level of self-management (X2=12.01, p<0.05), and willingness to take insulin (X2=9.8, p<0.01) were associated with HbA1c control. Older age, lower willingness to take insulin, and less than graduate level education were significant determinants of glycemic control. Of the 21 physicians who responded (53.8% response rate), 71.2% were over the age of 50 years, 54.16% had ≥25 years of clinical experience, and 50% practiced in an urban setting. Barriers leading to clinical inertia as identified by the physicians include cost of medications, non-compliance with diet and medications, polypharmacy, lack of patient motivation, knowledge, time, and social support. CONCLUSIONS: Self-management behavior of T2DM patients is strongly associated with HbA1c control. Interventions directed towards improving self-management in T2DM population that take both physician and patient perspectives in to consideration may result in improved clinical outcomes

Advance Traffic Signal Controlling System Using RFID Technique

An design for making intelligent systems for dominant road traffic is projected. The system relies on a straightforward principle of RFID pursuit of vehicles, will operate in period of time, improve traffic flow and safety, and totally machine-driven, saving pricey constant human involvement. these days the transportation systems show new challenges in management and management problems thanks to quantity of vehicles and therefore the variability and extension of the roads. New technologies are developed to induce data concerning Traffic in cities. however, new frameworks with completely different technologies applied to traffic observation haven't been well outlined. In this, frequency Identification technology (RFID) applied to road Traffic observation is exposed

Efficacy of herbal toothpastes on salivary pH and salivary glucose – A preliminary study

Due to dearth of literature on the effect of herbal toothpaste on saliva and salivary constituents, the present study was undertaken to evaluate and compare the effect of three different herbal toothpastes with the focus on on salivary pH and salivary glucose. Forty five subjects in the age group of 19–21 years were randomly divided into 3 groups (15 in each group) and were randomly intervened with three different herbal toothpastes (Dant Kanti, Himalaya Complete Care and Vicco Vajradanti). Unstimulated saliva samples were collected before and after brushing and salivary glucose and pH levels were assessed at an interval of one week each for a period of 4 weeks starting from day 1. All the three toothpastes were effective in reducing the overall (p < 0.05) levels as well as levels of salivary glucose from pre-brushing to post-brushing at each interval (p < 0.05) and in increasing the overall levels as well as levels of salivary pH (p < 0.05) from pre-brushing to post-brushing at each interval. Herbal toothpastes were effective in reducing salivary levels of glucose and improving pH of the saliva

Comparative assessment of Cranberry and Chlorhexidine mouthwash on streptococcal colonization among dental students: A randomized parallel clinical trial

Background: Chlorhexidine gluconate mouthwash has earned an eponym of the gold standard against oral infections, but with certain limitations. There is no effective alternative to Chlorhexidine. Cranberry is known to inhibit bacterial adhesion in various systemic infections and acts as a strong antioxidant. However, it is less explored for its dental use. Hence, there is a need to evaluate its effect against oral infections. Aim: The aim was to compare the efficacy of 0.2% Chlorhexidine mouthwash with 0.6% Cranberry mouthwash on Streptococcus mutans. Materials and Methods: This was a double-blind, randomized parallel group clinical trial. Total sample of 50 subjects, aged 18-20 years, were randomly divided into two groups, Group A (25) and Group B (25) were given 10 mL of Chlorhexidine mouthwash and Cranberry mouthwash twice daily, respectively, for 14 days each. The plaque samples, which were taken from the subjects on 1 st day and 14 th day, were inoculated on blood agar plates and incubated at 37΀C for 24-48 h. Number of streptococcal colony forming units were calculated using digital colony counter. The data were subjected to paired t-test and unpaired t-test at a 5% significance level. Results: (1) Chlorhexidine mouthwash showed 69% reduction whereas Cranberry mouthwash showed 68% reduction in S. mutans count. (2) No significant difference was seen between Chlorhexidine and Cranberry mouthwash on streptococci. Conclusion: Cranberry mouthwash is equally effective as Chlorhexidine mouthwash with beneficial local and systemic effect. Hence, it can be used effectively as an alternative to Chlorhexidine mouthwash

Effect of Reinforcement of Oral Health Education Message through Short Messaging Service in Mobile Phones: A Quasi-Experimental Trial

Objective. This paper aims to assess the effectiveness of reinforcement of oral health education message through short messaging service (SMS) in mobile phones. Material and Methods. 400 subjects from two colleges (200 from each college) belonging to 18–20 years age group possessing mobile phones were randomly selected and baseline examination of oral hygiene and gingival status was carried out using Oral Hygiene Index (OHI) and Gingival Index (GI). Oral health education was provided to all the subjects. Oral health education message was reinforced through short messaging service (SMS) in mobile phones for the subjects belonging to the intervention group. There was no such reinforcement for the control group. Follow-up examinations were done at the end of 1st, 2nd, 3rd, and 6th month. After the 3rd month, subjects of the intervention group did not receive oral health education message through short messaging service (SMS) and were followed up after next three months. Compiled data was analyzed using SPSS version 16 statistical software. Result. Mean OHI and GI scores in intervention group were significantly (p<0.01) less than those of control group after the 2nd, 3rd, and 6th month. Conclusion. Reinforcement of oral health education message through short messaging service (SMS) is effective media to improve oral health

Efficient Synthesis of Impurity-C of Antimigraine Agent Rizatriptan Benzoate

During the commercial manufacturing of antimigraine drug Rizatriptan benzoate, several impurities are reported to be formed. This present work demonstrates a convergent and short synthesis of the most critical impurity (C) of Rizatriptan, [2-(5-((1H-1,2,4-triazol-1-yl)­methyl)-1H-indole-2-yl)-<i>N</i>,<i>N</i>-dimethylethanamine (<b>1</b>)], recently reported in U.S. Pharmacopeia

Synthesis and Antimicrobial Activity of Some New 1, 4-Benzothiazine Containing Thiosemicarbazides and 1, 3, 4-Oxadiazole Derivatives

A series of novel 3- methyl-7-substituted-4H,4-benzothiazine-2-carbohydrazide (3a-e) and corresponding thiosemicarbazides (4-a-q); 2-[3-methyl-7-substituted- 4H -1, 4-benzothiazine-2-yl]-N-(aryl) hydrazine carbothiamide have been synthesized. The thiosemicarbazide when cyclized with iodine via intramolecular cyclisation gave benzothiazonyl oxadiazoles (5-a-q); 5-(3-methyl -7-substitued-4H- 1,4-benzothiazin-2-yl)- N —aryl- 1,3,4- oxadiazol -2-amine and the compounds were tested for antibacterial and antifungal activities against different microorganisms