A mixed method approach to understanding the factors surrounding delayed diagnosis of type one diabetes.

AIMS: This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS: 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS: 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39.8% vs. 24.6%), be transported by ambulance or life flight (30.7% vs. 15.3%), be hospitalized (93.7% vs. 83.9%), spend time in an Intensive Care Unit (42.2% vs. 21.3%), and be in diabetic ketoacidosis (DKA) (42.2% vs. 21.3%). Younger children were at increased risk, with higher rates of DKA and fewer days of symptoms. Many parents experienced frustration receiving a prompt diagnosis for their child, including an inability to schedule a physician appointment, proper glucose testing, and concerns being dismissed by professionals. CONCLUSION: More physician and parent education is needed. Doctors should conduct glucose screenings when diabetes symptoms are present. Parents need education to recognize excessive thirst and frequent urination as reasons to seek medical treatment.

The effects of a nutrition education intervention on vending machine sales on a university campus.

OBJECTIVE: To determine the effects of a nutrition information intervention on the vending machine purchases on a college campus. PARTICIPANTS AND METHODS: Five high-use vending machines were selected for the intervention, which was conducted in the fall of 2011. Baseline sales data were collected in the 5 machines prior to the intervention. At the time of the intervention, color-coded stickers were placed near each item selection to identify less healthy (red), moderately healthy (yellow), and more healthy (green) snack items. Sales data were collected during the 2-week intervention. RESULTS: Purchases of red- and yellow-stickered foods were reduced in most of the machines; moreover, sales of the green-stickered items increased in all of the machines. CONCLUSIONS: The increased purchases of healthier snack options demonstrate encouraging patterns that support more nutritious and healthy alternatives in vending machines.

Sonomammographic characteristics of invasive lobular carcinoma.

OBJECTIVE: The objective of our study was to identify characteristic features of invasive lobular carcinoma on mammography and ultrasound examinations. MATERIALS AND METHODS: This is a retrospective multicenter study of women with biopsy-proven invasive lobular carcinoma. All patients had undergone diagnostic sonomammography. The imaging findings were identified by experienced breast imagers. Final surgical pathology results were used as the reference standard. RESULTS: Thirty-two women ranging in age from 42 to 63 years old (mean age, 53 years), All had biopsy-proven invasive lobular carcinomas. Common features on mammogram included dense mass followed by architectural distortion; three cases showed breast asymmetry and one case was reported as normal. On ultrasound, common features included solid mass with spiculated margins, posterior shadowing, and perpendicular to the skin. CONCLUSION: Although no specific features could be linked to invasive lobular carcinoma, care should be directed to subtle signs such as architectural distortion and breast asymmetry in order not to miss any lesions. The combination of mammographic and sonographic helps to decrease the relatively high false negative diagnosis of this type of breast cancer.

How they cope: a qualitative study of the coping skills of hospice volunteers.

The purpose of this phenomenological study was to examine the coping techniques utilized by hospice volunteers. Individual semi-structured interviews were conducted with 15 hospice volunteers who had at least 1 year of experience, working as a hospice volunteer with direct patient care. The interviews were digitally recorded, transcribed, and analyzed utilizing qualitative research methods. The results indicated the volunteers used problem-focused coping (seeking advice from members of the hospice interdisciplinary team), emotion-focused coping (talking with others, going to funerals), meaning making through appraisal (religious beliefs, downward comparison), and physical techniques (walking, deep breathing). The most significant coping mechanism utilized for the volunteer was talking with the volunteer coordinator. Implications for hospice volunteer coordinators are also discussed.

The stresses of hospice volunteer work.

The purpose of this phenomenological study was to explore the interpretation of stress, the appraisal of the stressors, as well as the top stressors experienced by hospice volunteers. Individual semistructured interviews were conducted with 15 hospice volunteers. The interviews were digitally recorded, transcribed, and analyzed, using qualitative research methods. Although the results indicated that the hospice volunteers did not perceive their work as stressful, 2 main themes regarding challenging experiences did emerge. Hospice-related issues and personal issues were of concern to the volunteers. In addition, the timing of the stressors revealed that the most stress was felt at the beginning of their volunteer services, which has implications for hospice volunteer coordinators as they support their volunteers in the field.