Diabetes Patient Education in The Office Setting

The diabetes patient education provided in ran domly chosen primary care physician offices in small and large com munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-de livered, informal, and in terwoven with the clinical care offered. They usually did not include a sys tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx imately 48 minutes per year per patient in the of fice setting. The study suggested several develop mental activities that might improve patient education in physician of fices where the majority of patients with diabetes receive most of their care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69027/2/10.1177_014572178601200307.pd

Nancy sue palchik, PhD Assistant Professor, University of Michigan Medical School.

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37789/1/1790040209_ftp.pd

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

Evaluating Medical Student Communication/Professionalism Skills from a Patient’s Perspective

Objective: Evaluate medical students’ communication and professionalism skills from the perspective of the ambulatory patient and later compare these skills in their first year of residency. Methods: Students in third year neurology clerkship clinics see patients alone followed by a revisit with an attending neurologist. The patient is then asked to complete a voluntary, anonymous, Likert scale questionnaire rating the student on friendliness, listening to the patient, respecting the patient, using understandable language, and grooming. For students who had completed 1 year of residency these professionalism ratings were compared with those from their residency director. Results: Seven hundred forty-two questionnaires for 165 clerkship students from 2007 to 2009 were analyzed. Eighty-three percent of forms were returned with an average of 5 per student. In 64% of questionnaires, patients rated students very good in all five categories; in 35% patients selected either very good or good ratings; and <1% rated any student fair. No students were rated poor or very poor. Sixty-two percent of patients wrote complimentary comments about the students. From the Class of 2008, 52% of students received “better than their peers” professionalism ratings from their PGY1 residency directors and only one student was rated “below their peers.” Conclusion: This questionnaire allowed patient perceptions of their students’ communication/professionalism skills to be evaluated in a systematic manner. Residency director ratings of professionalism of the same students at the end of their first year of residency confirms continued professional behavior

Gender Differences in Diabetes Attitudes and Adherence

This study focused on three questions: Is there a difference in men's and women's diabetes attitudes? Do health professionals give different recommendations to men and women? Is there a difference between men and women in care adherence? A total of 1201 patients with diabetes were surveyed; 65% of these patients were women. Differences in diabetes attitudes (three of seven attiticdes) were most evident between men and women with insulin-dependent diabetes mellitus (IDDM). No differences were found in the attitudes of men and women with non-insulin-dependent diabetes mellitus (NIDDM) using insulin, and only one attitude was different for patients with NIDDM not using insulin. Few differences were observed in the recommendations given by health professionals to men and women. Gender differences in adherence to the components of self-care also were minimal. These findings may indicate that there are many similarities in the reactions of men and women who have been diagnosed with diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69143/2/10.1177_014572179502100605.pd

Effects of grain by-products as supplements for stocker cattle grazing bermudagrass

Two experiments were conducted to compare corn, dried distillers’ grains (DDG), and pelleted soybean hulls (SH) as supplements for cattle grazing bermudagrass. In Exp. 1, 66 crossbred steers (306 ± 3.2 kg) were stratified by weight and allotted randomly to six 2.4-ha bermudagrass pastures for a 107-d study. One of three supplement treatments (corn, DDG, or SH) was assigned randomly to each pasture group and was offered at 0.5% (as fed) of body weight. Calves were weighed at 28-d intervals and supplement was adjusted after each weigh period. In Exp. 2, five ruminally cannulated steers grazed bermudagrass pasture and were individually fed supplements (corn, DDG, or SH) at 0.5% of body weight in a 3 x 3 replicated, incomplete Latin-square design with a 14-d adaptation and a 5-d sampling period. In Exp. 1, supplementation with DDG and corn increased (P \u3c 0.04) the average daily gain compared to supplementation with SH (0.89, 0.87, and 0.74 kg for DDG, corn, and SH, respectively). In Exp. 2, in situ dry-matter-disappearance kinetic measures of bermudagrass were not affected by type of supplementation. The potential extent of digestion for DDG (93%) was lower than for corn (97%, P = 0.01) and SH (96%, P = 0.06). Supplementation with corn or DDG at 0.5% of body weight improved the gain of stocker cattle grazing bermudagrass compared to supplementation with SH, but these differences were not explained by differences in bermudagrass degradation kinetic

A Diabetes Psychosocial Profile

An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com bined with demographic and clinical information, these scores form a com prehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individ ualized graphic profile that highlights possible prob lem areas to be consid ered when developing patient education and management plans.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68817/2/10.1177_014572178601200210.pd

Identification of Relationships Between Patients Through Elements in a Data Warehouse Using the Familial, Associational, and Incidental Relationship (FAIR) Initiative: A Pilot Study

BACKGROUND: Over the last several years there has been widespread development of medical data warehouses. Current data warehouses focus on individual cases, but lack the ability to identify family members that could be used for dyadic or familial research. Currently, the patient\u27s family history in the medical record is the only documentation we have to understand the health status and social habits of their family members. Identifying familial linkages in a phenotypic data warehouse can be valuable in cohort identification and in beginning to understand the interactions of diseases among families. OBJECTIVE: The goal of the Familial, Associational, and Incidental Relationships (FAIR) initiative is to identify an index set of patients\u27 relationships through elements in a data warehouse. METHODS: Using a test set of 500 children, we measured the sensitivity and specificity of available linkage algorithm identifiers (eg, insurance identification numbers and phone numbers) and validated this tool/algorithm through a manual chart audit. RESULTS: Of all the children, 52.4% (262/500) were male, and the mean age of the cohort was 8 years old (SD 5). Of the children, 51.6% (258/500) were identified as white in race. The identifiers used for FAIR were available for the majority of patients: insurance number (483/500, 96.6%), phone number (500/500, 100%), and address (497/500, 99.4%). When utilizing the FAIR tool and various combinations of identifiers, sensitivity ranged from 15.5% (62/401) to 83.8% (336/401), and specificity from 72% (71/99) to 100% (99/99). The preferred method was matching patients using insurance or phone number, which had a sensitivity of 72.1% (289/401) and a specificity of 94% (93/99). Using the Informatics for Integrating Biology and the Bedside (i2b2) warehouse infrastructure, we have now developed a Web app that facilitates FAIR for any index population. CONCLUSIONS: FAIR is a valuable research and clinical resource that extends the capabilities of existing data warehouses and lays the groundwork for family-based research. FAIR will expedite studies that would otherwise require registry or manual chart abstraction data sources

Familial, Associational, & Incidental Relationships (FAIR)

Identifying familial linkages in a phenotypic data warehouse can be valuable in cohort identification, and beginning to understand interactions of diseases among families. The goal of the Familial, Associational, & Incidental Relationships (FAIR) system is to identify an index set patients’ relationships through elements in a data warehouse. Using a test set of 500 children, we measured the sensitivity and specificity of available linkage algorithm (e.g.: insurance id and phone numbers) and validated this tool/algorithm through a manual chart audit. Sensitivity varied from 16% to 87%, and specificity from 70% to 100% using various combinations of identifiers. Using the “i2b2” warehouse infrastructure, we have now developed a web app that facilitates FAIR for any index population

Remodeling of the Intestinal Brush Border Underlies Adhesion and Virulence of an Enteric Pathogen

ABSTRACT Intestinal colonization by Vibrio parahaemolyticus—the most common cause of seafood-borne bacterial enteritis worldwide—induces extensive disruption of intestinal microvilli. In orogastrically infected infant rabbits, reorganization of the apical brush border membrane includes effacement of some microvilli and marked elongation of others. All diarrhea, inflammation, and intestinal pathology associated with V. parahaemolyticus infection are dependent upon one of its type 3 secretion systems (T3SS2); however, translocated effectors that directly mediate brush border restructuring and bacterial adhesion are not known. Here, we demonstrate that the effector VopV is essential for V. parahaemolyticus intestinal colonization and therefore its pathogenicity, that it induces effacement of brush border microvilli, and that this effacement is required for adhesion of V. parahaemolyticus to enterocytes. VopV contains multiple functionally independent and mechanistically distinct domains through which it disrupts microvilli. We show that interaction between VopV and filamin, as well as VopV’s previously noted interaction with actin, mediates enterocyte cytoskeletal reorganization. VopV’s multipronged approach to epithelial restructuring, coupled with its impact on colonization, suggests that remodeling of the epithelial brush border is a critical step in pathogenesis