Qualitative Exploration of Geospatially Identified Bright Spots and Priority Areas to Improve Diabetes Management.

BACKGROUND: Type 2 diabetes (T2DM) results in significant morbidity and mortality and is associated with disparities in prevalence, treatment, and outcomes. GIS can identify geographically based disparities. In the focused Rapid Assessment Process (fRAP)-a novel mixed-method study design-GIS is combined with qualitative inquiry to inform practice interventions and policy changes. METHODS: Using fRAP, areas with poor T2DM outcomes (priority areas) as well as areas with positive T2DM outcomes (bright spots) were identified, focus groups were conducted, and responses analyzed for intervention opportunities. Focus group participants were English- and Spanish-speaking patients with T2DM living in one of the identified areas. Qualitative analysis consisted of initial coding with a priori themes from the focus group question guide, followed by identification of emergent themes within each defined category. RESULTS: The a priori categories included Facilitators, Barriers, Strategies, and Impact of Diabetes Diagnosis. Emerging recurrent themes were Interactions with Medical Professionals, Medications, Lifestyle Management, Family Motivators and Support, Self-Efficacy, and Social Needs and Community Resources. CONCLUSIONS: Thematic results from focus groups can be used by practices to improve T2DM care through educating patients about chronic disease and nutrition, connecting them to diabetes-specific services, learning how diabetes fits in the context of patient lives, and eliciting patient values and motivations to improve diabetes self-management. Findings also may be used by health care professionals to inform community-based advocacy efforts, interventions, and future research.

Factors Associated with Clinician Adherence to USPSTF Diabetes Screening Recommendations.

INTRODUCTION/OBJECTIVES: Diabetes and prediabetes impact nearly half of the US adult population and are associated with significant health risks but may be underdiagnosed. Effective screening may improve diagnosis and give patients opportunity to manage their disease. The purpose of this study was to determine screening rates, identify characteristics predictive of screening, and evaluate correct diagnosis of diabetes and prediabetes. METHODS: Retrospective chart review of 71 433 patients eligible for diabetes screening, defined by completing A1c test within the 3-year study period. RESULTS: A total of 31.3% of eligible patients received diabetes screening. Factors associated with screening include older age, female sex, non-white race, Hispanic ethnicity, Medicare or Medicaid insurance, higher BMI, and having a medical comorbidity. History of prediabetes or gestational diabetes were the strongest predictors for diabetes screening, but history of gestational diabetes was under-documented. Of those screened, 10.4% had a result consistent with diabetes and 51.8% had a result consistent with prediabetes. However, 52.9% of these patients had a missed diagnosis. CONCLUSIONS: Findings of this study indicate the need for uniform coverage for diabetes screening for all insurances, increased documentation of gestational diabetes to improve screening for patients with this history, and improving accurate diagnosis after screening is completed.

Designing and Evaluating a Prediabetes Shared Decision Aid.

BACKGROUND: Prediabetes is increasing in prevalence and is associated with risk of developing diabetes, heart disease, stroke, and retinopathy. Clinicians have limited tools to facilitate prediabetes discussions within primary care visits. PURPOSE: 1) Develop a Patient and Stakeholder Advisory Committee (PASAC) to design, evaluate, and revise a prediabetes shared decision aid, and 2) evaluate the feasibility and experience of implementing the tool within primary care practice. METHODS: A prediabetes decision aid (double-sided infographic with decision questions) was created by a PASAC that included patients, primary care clinicians, diabetes educators, endocrinologists, and pharmacists. Five clinicians within 3 primary care practices tested the prediabetes tool with 50 adult patients with prediabetes. Patients completed 2 surveys immediately after the office visit and 6 weeks later. Clinicians and PASAC members completed a postintervention survey. RESULTS: The prediabetes shared decision aid was created through a deliberative process over 3 PASAC meetings. Ninety-six percent of patients felt the tool prepared them to decide on a diabetes prevention plan, and 100% of clinicians would use the tool again and felt the tool did not extend visit length. DISCUSSION: It was feasible to cocreate a prediabetes shared decision aid within a PASAC and implement the tool within a primary care setting. Patients and clinicians reported a prediabetes discussion, which may mitigate rates of progression to diabetes and associated complications. Future research should evaluate which of the intervention components most effectively promotes discussion of prediabetes within a primary care setting.

Peptoids advance multidisciplinary research and undergraduate education in parallel: Sequence effects on conformation and lipid interactions.

Peptoids are versatile peptidomimetic molecules with wide-ranging applications from drug discovery to materials science. An understanding of peptoid sequence features that contribute to both their three-dimensional structures and their interactions with lipids will expand functions of peptoids in varied fields. Furthermore, these topics capture the enthusiasm of undergraduate students who prepare and study diverse peptoids in laboratory coursework and/or in faculty led research. Here, we present the synthesis and study of 21 peptoids with varied functionality, including 19 tripeptoids and 2 longer oligomers. We observed differences in fluorescence spectral features for 10 of the tripeptoids that correlated with peptoid flexibility and relative positioning of chromophores. Interactions of representative peptoids with sonicated glycerophospholipid vesicles were also evaluated using fluorescence spectroscopy. We observed evidence of conformational changes effected by lipids for select peptoids. We also summarize our experiences engaging students in peptoid-based projects to advance both research and undergraduate educational objectives in parallel.

The effects of context in item-based directed forgetting: Evidence for "one-shot" context storage.

The effects of context on item-based directed forgetting were assessed. Study words were presented against different background pictures and were followed by a cue to remember (R) or forget (F) the target item. The effects of incidental and intentional encoding of context on recognition of the study words were examined in Experiments 1 and 2. Recognition memory for the picture contexts was assessed in Experiments 3a and 3b. Recognition was greater for R-cued compared to F-cued targets, demonstrating an effect of directed forgetting. In contrast, no directed forgetting effect was seen for the background pictures. An effect of context-dependent recognition was seen in Experiments 1 and 2, such that the hit rate and the false-alarm rate were greater for items tested in an old compared to a novel context. An effect of context-dependent discrimination was also observed in Experiment 2 as the hit rate was greater for targets shown in their same old study context compared to a different old context. The effects of context and directed forgetting did not interact. The results are consistent with Malmberg and Shiffrin's (Journal of Experimental Psychology: Learning, Memory, and Cognition, 31, 322-336, 2005) "one-shot" context storage hypothesis that assumes that a fixed amount of context is stored in the first 1 to 2 s of the presentation of the study item. The effects of context are independent of item-based directed forgetting because context is encoded prior to the R or F cue, and the differential processing of target information that gives rise to the directed forgetting effect occurs after the cue.

Recruitment challenges associated with a randomised controlled trial within a general telephone counselling service.

We investigated recruitment into a randomised controlled trial (RCT) following contact with a generalist telephone counselling service. Telephone counsellors were required to ask callers if they would be willing to receive a telephone call to discuss their possible involvement in a trial designed to evaluate the use of a web-based mental health intervention. The five centres involved answered a total of 34,722 counselling calls during the recruitment period. Only 9% of callers were invited by the telephone counsellor to receive the recruitment call and of all callers, only 2.6% agreed. Common reasons reported by the telephone counsellors for not referring eligible applicants to the trial included their view that it was inappropriate to ask the caller, feeling uncomfortable about asking the question, being concerned that the invitation might affect the counselling relationship and forgetting to ask. The presence of an on-site trial manager, regular encouragement and feedback, and tailored and specific recruiter training may improve rates of recruitment in future trials.

Mental health profile of callers to a telephone counselling service.

We studied the mental health profile of callers to a generalist helpline. A survey was conducted in a large telephone counselling centre over a four-week period in 2006. Telephone counsellors administered the survey at the completion of a user's call. The centre answered a total of 1404 calls in the study period. Of these, 439 calls met the inclusion criteria and 270 callers agreed to participate. The survey collected data from callers on demographic variables, anxiety, depression, panic and social phobia, alcohol use, frequency of help seeking from the service, sources of professional help, attitudes to help services and access to the Internet. Callers experienced high levels of anxiety and depression. More frequent callers were older, with very frequent callers more likely to be never married. More frequent callers were more likely to report concerns with loneliness, physical illness and anxiety. There was a significant difference on the Goldberg Anxiety Scale (P < 0.05), with more frequent callers having higher anxiety scores. However, there was no significant difference on the Goldberg depression scores as a function of call frequency (P > 0.05). Panic attacks were more common among more frequent callers. These results will be useful in developing new telephone-administered anxiety and depression treatment programmes.

Projections of future numbers of dementia cases in Australia with and without prevention.

OBJECTIVE: To produce projections of the number of dementia cases in Australia from 2000 to 2050. These projections examine the effects of an ageing population on number of dementia cases and also the potential impact of preventive strategies that delay age of dementia onset. METHOD: Data from several meta-analyses of dementia prevalence and incidence were combined with age-specific population projections to arrive at estimates of future numbers of cases. A statistical model of dementia incidence was developed and used to estimate the effects of delaying onset by up to 5 years. RESULTS: Without prevention, prevalence of dementia is estimated to increase from 172 000 in 2000 to 588 000 in 2050. Over the same period, the incidence of dementia is estimated to increase from 43 000 to 143 000 new cases a year. Delaying onset by 5 years would decrease prevalence in 2050 by 44%. Even a 6-month delay would reduce prevalence by 6%. CONCLUSIONS: Ageing of the population will lead to a rapid increase in number of dementia cases and an increasing burden for the working-age population. However, even modest prevention efforts could lessen the impact.