Readability, User-Friendliness, and Key Content Analysis of Newborn Hearing Screening Brochures

Readability, user-friendliness, and key content are important components of newborn screening brochure design. Health information at a sixth grade or below reading level, designed for ease of navigation, with easily identifiable “action steps” can help adults with limited literacy skills find, understand, and use health information. The purpose of this study was to quantify the readability, user-friendliness, and key content components of newborn hearing screening brochures. Five readability formulae (FRE, F–K GL, FOG, FORCAST, and SMOG) were used to estimate reading levels of English language EHDI brochures (N = 48). Twenty-three participants assessed brochures for user-friendliness. Three participants assessed brochures to determine if key content elements were included and if so, the ease of locating them. Readers are provided with simple steps to follow during brochure design to maximize the message in parent education materials. This study forms the framework for quality improvement efforts and research-to-practice initiatives in the field

Implementation of Basal-Bolus Therapy in Type 2 Diabetes:A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Background: Barriers to mealtime insulin include complexity, fear of injections, and lifestyle interference. This multicenter, randomized controlled trial evaluated efficacy, safety, and self-reported outcomes in adults with type 2 diabetes, inadequately controlled on basal insulin, initiating and managing mealtime insulin with a wearable patch versus an insulin pen. Methods: Adults with type 2 diabetes (n = 278, age: 59.2 +/- 8.9 years), were randomized to patch (n = 139) versus pen (n = 139) for 48 weeks, with crossover at week 44. Baseline insulin was divided 1:1 basal: bolus. Using a pattern-control logbook, subjects adjusted basal and bolus insulin weekly using fasting and premeal glucose targets. Results: Glycated hemoglobin (HbA1c) change (least squares mean +/- standard error) from baseline to week 24 (primary endpoint) improved (P \u3c 0.0001) in both arms, -1.7% +/- 0.1% and -1.6% +/- 0.1% for patch and pen (-18.6 +/- 1.1 and -17.5 +/- 1.1 mmol/mol), and was maintained at 44 weeks. The coefficient of variation of 7-point self-monitoring blood glucose decreased more (P = 0.02) from baseline to week 44 for patch versus pen. There were no differences in adverse events, including hypoglycemia (three severe episodes per arm), and changes in weight and insulin doses. Subject-reported treatment satisfaction, quality of life, experience ratings at week 24, and device preferences at week 48 significantly favored the patch. Most health care providers preferred patch for mealtime insulin. Conclusions: Bolus insulin delivered by patch and pen using an algorithm-based weekly insulin dose titration significantly improved HbA1c in adults with type 2 diabetes, with improved subject and health care provider experience and preference for the patch

Peer role-play and standardised patients in communication training: a comparative study on the student perspective on acceptability, realism, and perceived effect

<p>Abstract</p> <p>Background</p> <p>To assess the student perspective on acceptability, realism, and perceived effect of communication training with peer role play (RP) and standardised patients (SP).</p> <p>Methods</p> <p>69 prefinal year students from a large German medical faculty were randomly assigned to one of two groups receiving communication training with RP (N = 34) or SP (N = 35) in the course of their paediatric rotation. In both groups, training addressed major medical and communication problems encountered in the exploration and counselling of parents of sick children. Acceptability and realism of the training as well as perceived effects and applicability for future parent-physician encounters were assessed using six-point Likert scales.</p> <p>Results</p> <p>Both forms of training were highly accepted (RP 5.32 ± .41, SP 5.51 ± .44, n.s.; 6 = very good, 1 = very poor) and perceived to be highly realistic (RP 5.60 ± .38, SP 5.53 ± .36, n.s.; 6 = highly realistic, 1 = unrealistic). Regarding perceived effects, participation was seen to be significantly more worthwhile in the SP group (RP 5.17 ± .37, SP 5.50 ± .43; p < .003; 6 = totally agree, 1 = don't agree at all). Both training methods were perceived as useful for training communication skills (RP 5.01 ± .68, SP 5.34 ± .47; 6 = totally agree; 1 = don't agree at all) and were considered to be moderately applicable for future parent-physician encounters (RP 4.29 ± 1.08, SP 5.00 ± .89; 6 = well prepared, 1 = unprepared), with usefulness and applicability both being rated higher in the SP group (p < .032 and p < .009).</p> <p>Conclusions</p> <p>RP and SP represent comparably valuable tools for the training of specific communication skills from the student perspective. Both provide highly realistic training scenarios and warrant inclusion in medical curricula. Given the expense of SP, deciding which method to employ should be carefully weighed up. From the perspective of the students in our study, SP were seen as a more useful and more applicable tool than RP. We discuss the potential of RP to foster a greater empathic appreciation of the patient perspective.</p

Evidence of regional differences in chlorine perception by consumers: sensitivity differences or habituation?

Chlorinous flavors are a leading cause of customers' dissatisfaction with drinking water. Potential differences in chlorine perception were investigated by conducting sensory testing experiments in France and Spain to assess consumers' sensory sensitivity (chlorine flavor detection threshold and supra-threshold intensity) as well as their liking of and acceptability for chlorinated solutions. In both countries, two groups of panelists were constituted based on their water drinking habits (tap vs. bottled water). Chlorine flavor detection threshold was found to vary depending on countries (0.17 mg/L Cl-2 in France and 0.56 mg/L Cl-2 in Spain). Taking into account that mean flavor detection thresholds were found in agreement with chlorine residuals delivered at tap, it is likely that habituation may explain sensitivity differences between countries. This hypothesis is supported by results showing no significant sensitivity difference at detection threshold levels, but significant differences between tap water and bottled water consumers at supra-threshold levels (flavor intensity). In addition, consumers' liking and acceptability for chlorinated water was found to be in agreement with sensitivity: the higher the sensitivity the lower the acceptability for chlorinated waters. Thus, French consumers or bottled water drinkers showed a lower appreciation of chlorinated water solutions and were especially less inclined to accept chlorinated water as drinking water delivered at tap

Optimising basal-bolus therapy in type 2 diabetes: A randomised, controlled trial comparing bolus insulin delivery using an insulin patch vs an insulin pen

Background and aims: This multicenter randomized, controlled trial compared efficacy, safety, and subject-reported outcomes for adults with type 2 diabetes on basal insulin (HbA1c 7.5-11% [58-97 mmol/mol]) initiating mealtime insulin (aspart) with a wearable bolus insulin delivery patch (Patch) vs an insulin pen (Pen). The Patch was applied at least every 3 days and delivered subcutaneous bolus insulin in 2-U increments per manual click. Materials and methods: Subjects (n = 278, mean age: 59 years, mean diabetes duration: 15 years) receiving 0.52 U/kg glargine on average, were randomized to Patch (n = 139) or Pen (n = 139). Baseline glargine dose was divided 1:1 into basal:bolus. Using a pattern-control logbook, subjects adjusted basal and bolus insulin weekly based on fasting and premeal glucose targets. Results: Change in HbA1c from baseline toWeek 24 (primary endpoint) for Patch was non-inferior (p \u3c 0.0001) to Pen (least squares mean change ± SEM: Patch, -1.7 ± 0.1% [-19 ± 1.0 mmol/mol] vs Pen, -1.6 ± 0.1% [-17 ± 1.0 mmol/mol]); this reduction was significant (p \u3c 0.0001) in both groups. HbA1c improvement was maintained at 44 weeks (Figure). At Week 24, 63% of Patch users and 56% of Pen users achieved HbA1c ≤7.0% (≤53 mmol/mol) (OR, 1.3; SEM, 0.25; 95% CI, 0.81, 2.14; p = 0.26). The proportions of Patch and Pen users who achieved HbA1c ≤7.0% (≤53 mmol/mol) at Week 44 rose to 65% and 63%, respectively (OR, 1.2; SEM, 0.28; 95% CI, 0.64, 1.93; p = 0.71). CVof 7-point selfmonitoring blood glucose decreased significantly more with Patch compared to Pen; change from baseline toWeek 44 was -1.2 ± 0.8% and 1.4 ± 0.8%, respectively (difference, -2.6 ± 1.1%; 95% CI, -4.8, -0.4; p = 0.022). Subjects in Patch and Pen arms, respectively, reported high adherence (mean ± SEM, %) to their insulin regimens atWeek 24 (79 ± 18% vs 78 ± 16%; p = 0.70) and Week 44 (81 ± 15% vs 81 ± 17%; p = 0.78). There were no significant differences in adverse events, including hypoglycemia (3 severe episodes/group). There were significantly greater improvements in subject-reported outcomes for Patch vs Pen. Conclusion: Bolus insulin with Patch or Pen and dosing algorithms improved HbA1c with better experience and preference for Patch. (Figure Presented

User-and health care provider-reported outcomes for a wearable bolus insulin delivery patch.

Background and aims: This multi-center randomized, controlled trial compared efficacy, safety, and User- /Health Care Providerreported outcomes for adults with type 2 diabetes (HbA1c: 7.5- 11% [58-97 mmol/mol]) on basal insulin initiating mealtime insulin (aspart) with a wearable bolus insulin delivery patch (Patch, n = 139) vs an insulin pen (Pen, n =139). Patch was applied at least every 3 days and delivered subcutaneous bolus insulin in 2- U increments per manual click. Materials and methods: Study durationwas 48 weeks with cross-over at Week 44; 88% of Patch Users and 86% of Pen Users completedWeek 24 assessments; 77% and 76%, respectively, completed Week 48 assessments. TreatingHealth Care Providers (n = 89) rated their experience with Patch at Week 24. Results: Change in HbA1c from baseline to Week 24 (primary endpoint) was significant (p \u3c 0.0001) in both groups (least squares mean change ± SEM: Patch, -1.7 ± 0.1% [-19 ± 1.0 mmol/mol] vs Pen, -1.6 ± 0.1% [-17 ± 1.0 mmol/mol]). Change in User satisfaction (measured by the Insulin Delivery System Rating Questionnaire) at Week 24 favored Patch over Pen for all measures; comparisons for convenience and overall satisfaction were significant (p \u3c 0.01). Change in User quality of life (measured by the Diabetes-Specific Quality of Life Survey) at Week 24 favored Patch over Pen for 6 of 7 measures; comparisons for daily functions and diet restrictions were significant (p \u3c 0.05). Comparisons of User experience ratings at Week 24 favored Patch over Pen for all 11 items; 7 of those showed a significant difference (Table). A User preference survey (Week 48) indicated a significant preference for Patch over Pen in those who used Patch for 44 weeks and those who crossed over to Patch for 4 weeks (p \u3c 0.0001); 69% in Patch group wanted to switch from Pen to Patch or had no preference (10%). Health Care Provider questionnaire ratings in favor of Patch at Week 24 ranged from 67% to 85% (p \u3c 0.0001). Additionally, 74% rated training for Patch use as “easy” and 89% reported that it took ≤30 minutes; 91% of Health Care Providers preferred Patch over Pen for initiating mealtime insulin (p \u3c 0.0001). Conclusion: The Patch is a viable alternative to Pen for mealtime insulin; both Users and Health Care Providers preferred patch to pen. (Table Presented