Implementing a Sodium-Glucose Cotransporter 2 Inhibitor Module With a Software Tool (Future Health Today): Qualitative Study.

BACKGROUND: Primary care plays a key role in the management of type 2 diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been demonstrated to reduce hospitalization and cardiac and renal complications. Tools that optimize management, including appropriate prescribing, are a priority for treating chronic diseases. Future Health Today (FHT) is software that facilitates clinical decision support and quality improvement. FHT applies algorithms to data stored in electronic medical records in general practice to identify patients who are at risk of a chronic disease or who have a chronic disease that may benefit from intensification of management. The platform continues to evolve because of rigorous evaluation, continuous improvement, and expansion of the conditions hosted on the platform. FHT currently displays recommendations for the identification and management of chronic kidney disease, cardiovascular disease, type 2 diabetes, and cancer risk. A new module will be introduced to FHT focusing on SGLT2 inhibitors in patients with type 2 diabetes who have chronic kidney diseases, cardiovascular diseases, or risk factors for cardiovascular disease. OBJECTIVE: The study aims to explore the barriers and enablers to the implementation of an SGLT2 inhibitor module within the Future Health Today software. METHODS: Clinic staff were recruited to participate in interviews on their experience in their use of a tool to improve prescribing behavior for SGLT2 inhibitors. Thematic analysis was guided by Clinical Performance Feedback Intervention Theory. RESULTS: In total, 16 interviews were completed. Identified enablers of use included workflow alignment, clinical appropriateness, and active delivery of the module. Key barriers to use were competing priorities, staff engagement, and knowledge of the clinical topic. CONCLUSIONS: There is a recognized benefit to the use of a clinical decision support tool to support type 2 diabetes management, but barriers were identified that impeded the usability and actionability of the module. Successful and effective implementation of this tool could support the optimization of patient management of type 2 diabetes in primary care.

Injury characteristics in professional modern dancers: A 15-year analysis of work-related injury rates and patterns.

We investigated work-related-musculoskeletal-injuries (WMSI) over 15-years in professional modern dancers to determine injury rate and pattern differences due to sex and professional-experience. Injuries were coded to allow analyses by tissue-type, body-region, severity, setting, mechanism, action-causation, and repertory-style. Injury prevalence (IP) was defined as average risk of injury/dancer. Injury incidence rate (IIR) was calculated per 1000-hrs exposure/block. Negative binomial logistic regression analyses were conducted with exposure-hrs to determine IIR, p < 0.05. Multinomial logistic regressions determined differences in tissue-type, body-region, action-causation and repertory-style; Poisson loglinear regressions determined differences in severity and mechanism, p < 0.05. Females were 15-times more likely to sustain bone-injuries, p = 0.016; males 8- and 15-times more likely to sustain muscle/tendon-injuries or lacerations/contusions, p ≤ 0.016. Females were more likely to sustain severe injury resulting in more lost-workdays and missed-performances, p < 0.001. In both sexes, more time-loss-injuries (TL-inj) occurred in performance , were traumatic in nature, with an action-causation of jumping/stomping/relevé. Dancers of moderate professional-experience were 1.3-times more likely to sustain TL-inj, p = 0.026;. Identifying context-specific activities and repertory-style relationships to injury can provide insight into casting and rehearsal scheduling. Comprehending sex-specific musculoskeletal health needs allows improved dancer health management and injury prevention planning.

Musculoskeletal injuries in professional modern dancers: a prospective cohort study of 15 years.

We analysed work-related musculoskeletal injuries (WMSI) in two modern dance companies to determine whether injury rates decreased and patterns altered compared to previous 3-yr and 6-yr audits (0.48 and 0.25/1000-hrs exposure respectively). In this prospectively designed 15-yr cohort study, data were collected in 30-dancer Company-1 and 12-dancer Company-2. In-house physical therapists tracked WMSI and time-loss-injuries for 159 dancers (42 dancers/yr). 15-yrs were grouped into five 3-yr blocks for comparison with prior audits. Negative binomial logistic regression analyses were conducted with exposure-hrs converted to the natural log and used as the offset variable. Block and company were categorical predictors for dependent variables: WMSI, time-loss-injuries, trauma-injuries and overuse-injuries (p < 0.05). 69% of dancers reported WMSI; 45% sustained at least one time-loss-injury. Company-1, with greater annual exposure, was 1.6-times more likely to sustain time-loss-injuries (p = 0.016, CI = 1.095-2.422) and 5.6-times more likely to sustain time-loss overuse-injuries (p = 0.003, CI = 1.812-17.327). Compared to Block-1, WMSI and time-loss-injuries decreased in Blocks-2, 3, and 5 (p ≤ 0.027). The ratio of time-loss overuse to trauma-injuries was reversed, with trauma-injuries accounting for over 80% of injuries by Block 5. Time-loss-injuries averaged 0.16 injuries/1000-hrs, lower than rates in ballet and sports. Decreased injury rates and changed injury patterns demonstrate efficacious injury management and prevention programming.