Impact of diabetes group visits on patient clinical and self-reported outcomes in community health centers.

BACKGROUND: Diabetes group visits (GVs) are a promising way to deliver high quality care but have been understudied in community health centers (CHCs), across multiple sites, or with a focus on patient-centered outcomes. METHODS: We trained staff and healthcare providers from six CHCs across five Midwestern states to implement a 6-month GV program at their sites. We assessed the impact of diabetes GVs on patient clinical and self-reported outcomes and processes of care compared to patients receiving usual care at these sites during the same period using a prospective controlled study design. RESULTS: CHCs enrolled 51 adult patients with diabetes with glycosylated hemoglobin (A1C) ≥ 8% for the GV intervention and conducted chart review of 72 patients receiving usual care. We analyzed A1C at baseline, 6, and 12 months, low-density lipoproteins (LDL), blood pressure, and patient-reported outcomes. GV patients had a larger decrease in A1C from baseline to 6 months (-1.04%, 95% CI: -1.64, -0.44) and 12 months (-1.76, 95% CI: -2.44, -1.07) compared to usual care; there was no change in blood pressure or LDL. GV patients had higher odds of receiving a flu vaccination, foot exam, eye exam, and lipid panel in the past year compared to usual care but not a dental exam, urine microalbumin test, or blood pressure check. For GV patients, diabetes distress decreased, diabetes-related quality of life improved, and self-reported frequency of healthy eating and checking blood sugar increased from baseline to 6 months, but there was no change in exercise or medication adherence. CONCLUSIONS: A diabetes GV intervention improved blood glucose levels, self-care behaviors, diabetes distress, and processes of care among adults with elevated A1Cs compared to patients receiving usual care. Future studies are needed to assess the sustainability of clinical improvements and costs of the GV model in CHCs.

Relationship between Mammographic Findings and Breast Abnormalities in a Nigerian Population.

PURPOSE: This study aims to describe the mammographic findings in a population of Nigerian women and to explore the relationships between abnormal mammographic findings, breast malignancy, and breast composition. METHODOLOGY: This was a retrospective study of consecutive mammograms carried out at Union Diagnostics and Clinical Services in Lagos, Nigeria from 2016 to 2018. Demographic information, indications for and findings on mammographic evaluation were obtained. A logistic regression fit model was used to establish the correlation between mammographic findings, breast density, and suspicion for breast malignancy (higher BIRADS scores). P ≤ 0.05 represented a statistically significant result. RESULTS: A total of 304 patients were involved in this study (age range 20-80 years, mean age 49.0 ± 10.5 years). The patients between 40 and 49 years formed the largest age group with 128 patients (42.4%). Most patients were referred for a breast mass/lump (115/304-38.6%); 56 patients (18.8%) presenting for routine screening. The most common finding on the mammograms was BIRADS 4 in both breasts in 96 patients (31.6%). Most patients had heterogeneous breast density (195 patients - 64.1%). Multivariate logistic regression analysis showed a significant correlation between history of mass, poorly defined margins, and suspicion of malignancy. There was no statistically significant association between abnormal mammographic findings and higher breast density. CONCLUSION: Poorly defined margins were positively correlated with BIRADS ratings suspicious for malignancy. The presence of a breast mass was positively correlated with a higher BIRADS score when other possible cofounding variables were not accounted for. Patient age did not correlate with breast density in this study.

The relationship between hysterosalpingography findings and female infertility in a Nigerian population.

PURPOSE: This study aims to explore the relationships between abnormal hysterosalpingography (HSG) findings and all types of infertility. MATERIAL AND METHODS: This retrospective study was carried out at a private radiodiagnostic centre in Lagos, Nigeria. The radiologist reports of all consecutive patients who had HSG evaluation from 2016 to 2018 were analysed. Biodemographic information and indications for HSG evaluation were also documented. Logistic regression was used to test correlations between the explanatory and outcome variables. P ≤ 0.05 represented a statistically significant result. RESULTS: A total of 450 patients were involved in this study, with ages ranging from 21 to 51 years and a mean age of 34.6 ± 5.56 years. The age group 31-35 years had the highest frequency of infertility. There were 299 patients referred for infertility. Secondary infertility was seen in 211 patients (46.9%), primary infertility was seen in 79 patients (17.6%), and subfertility was seen in nine patients (2%). There were 49 patients (10.9%) with cornual tubal blockage, while 57 patients (12.7%) had perifimbrial adhesion and/or blockage. There were 56 patients (12.4%) with hydrosalpinx and nine patients (2.0%) with tubal occlusion. Multivariate logistic regression analysis showed women with hydrosalpinx were 2.11 times more likely to be infertile than those without hydrosalpinx (95% CI: 1.02-4.36, p = 0.042). CONCLUSIONS: The presence of hydrosalpinx was a significant risk factor in developing all types of infertility. Understanding the HSG patterns and their correlations with infertility will help physicians across the world when evaluating infertility in patients of similar background to our patient population.