Subjective Experiences of Spanish-Speaking Patients Residing in the United States With Low English Proficiency Learning to Manage Their Diabetes: A Qualitative Study.

INTRODUCTION: Language discordance is a known barrier to diabetes care in patients with type 2 diabetes. This study aimed to better understand the subjective experiences of a group of Spanish-speaking study participants with low English proficiency who were learning to manage their diabetes using a language-concordant health coaching intervention. METHODOLOGY: This qualitative exploratory study used structured interview data to understand subjective experiences among participants. Thematic content analysis was conducted from a subset of health coaching phone transcripts (n = 17) performed during a language-concordant health coaching intervention study. RESULTS: Among the 17 participants included in the study, even with language-concordant coaching, participants had challenges in managing their diabetes care. Participants described internal and external factors, such as socioeconomic instability, that complicated their behavior changes and self-management abilities. DISCUSSION: A health coaching intervention in patients with low English proficiency can help to improve health outcomes. Findings from this study can guide the development of health care services and the management of chronic diseases in diverse populations.

Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.

Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = -.738, p < .001) and in thoracic expansion (r = .544, p = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.

Respiratory Muscle Strength Training in Patients Post-COVID-19: A Systematic Review.

Estimates of 10-49% of patients may experience ongoing symptoms after COVID-19, including dyspnea. Respiratory muscle strength training has been used to reduce dyspnea in other respiratory diseases, thus, it may be a viable option for individuals with post-COVID-19 symptoms. The objective of this review was to evaluate the evidence for the effectiveness of respiratory muscle strength training for individuals with post-COVID-19 dyspnea. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Web of Science, PubMed, EMBASE, Google Scholar, and Scopus databases were searched from 2020-2023. Eleven articles met the inclusion criteria. Pulmonary measures were improved in all but one study, and dyspnea, physical capacity and quality of life measures achieved statistical significance. Outcomes improved following respiratory muscle strength training as a standalone intervention, or with aerobic and peripheral muscle strength training.

Home-Based Pilot Pulmonary Program for Dyspneic Patients Post-COVID-19.

It is estimated that at least 10% of people who have had COVID-19 will experience ongoing symptoms such as shortness of breath, fatigue, and cognitive disturbances. Pulmonary exercise has demonstrated improved dyspnea outcomes in other respiratory conditions. Thus, the purpose of this study was to assess the efficacy of a home-based pulmonary rehabilitation program in post-COVID-19 survivors who continue to experience dyspnea. This was a longitudinal, single group pilot study in which 19 patients received a home-based expiratory muscle strength training program over 12 weeks. Outcomes measured at baseline, 6 weeks, and 12 weeks included pulmonary symptoms, functional performance, thoracic expansion, forced expiratory volume, and expiratory resistance measures. Significant improvements were found in pulmonary symptoms (p < .001), functional performance (p = .014), and progressive expiratory resistance capabilities (p < .001). A home-based pulmonary program may be an inexpensive strategy for post-COVID-19 survivors who continue to experience dyspnea.

Caregiver burden in caregivers of patients with advanced stage cancer: A concept analysis.

PURPOSE: Caregiver burden is a term used to describe the strain endured by the family member who is providing care for a patient and does not have formal training to do so. Caregiver burden is associated with a lack of self-efficacy, a decrease in the caregiver's quality of life, and high levels of anxiety and depression, that can worsen over time, impacting the well-being of the dyad. Due to the dynamic nature of caregiver burden, the precise understanding of this condition in relation to advanced stage cancer patients has not been fully conceptualized. Clarity of the nature of caregiver burden guides researchers, policy makers, and providers with a better understanding of what is needed to detect who the caregivers are and who is at most risk for severe caregiver burden. METHOD: An electronic search of the literature using PubMed, CINAHL, PsycINFO, and Cochrane Library databases informed the analysis. Quantitative and qualitative studies related to caregiver burden of the cancer patient, published in English between 2000 and 2021 were used. RESULTS: Of the over 20,000 articles initially identified, 19 ultimately met the inclusion criteria. Analysis identified the defining attributes of caregiver burden of the advanced stage cancer patient as: (1) decreased self-efficacy, (2) decreased quality of life, (3) increased anxiety, (4) increased depression, (5) and time sensitivity. Antecedents were identified as predictors of negative outcomes without intervention. Consequences were highlighted for those who are not supported. CONCLUSIONS: Caregiver burden impacts more than 2.8 million informal caregivers in the United States, who are providing complex care to patients with cancer without proper preparation. The conceptual understanding of caregiver burden guides the design of specific interventions to identify and prepare the caregiver for their critical role.

Cantharidin toxicosis in 2 alpacas.

Two adult alpacas were presented for recumbency and reluctance to rise. Cantharidin toxicosis was suspected based on clinical and ancillary diagnostic findings. The diagnosis was confirmed by gas chromatography-mass spectrometry of gastric contents and urine. Despite medical treatment, neither alpaca survived. Blister beetle toxicosis has not been previously described in camelids. Challenges in treatment of affected ruminants or pseudoruminants are noted.

Toxicose à la cantharidine chez 2 alpagas. Deux alpagas adultes ont été présentés pour décubitus et une réticence à se lever. La toxicose à la cantharidine a été soupçonnée en se fondant sur des résultats diagnostiques cliniques et auxiliaires. Le diagnostic a été confirmé par chromatographie en phase gazeuse et spectromètre de masse du contenu gastrique et de l'urine. Malgré un traitement médical, les deux alpagas n'ont pas survécu. La toxicose aux cantharides n'avait pas été décrite antérieurement chez les camélidés. Les difficultés du traitement des ruminants ou des pseudoruminants sont signalées.(Traduit par Isabelle Vallières).

Characterization of cardiac lesions in calves after ingestion of Japanese yew (Taxus cuspidata).

Plants of the genus Taxus are common ornamental shrubs that contain cardiotoxic alkaloids. Gross lesions consistent with heart failure are frequently reported in fatal cases; however, microscopic lesions in the heart have not been well characterized. The current report describes 2 related outbreaks in which 7 of 30, 250-kg calves died after confirmed exposure to clippings of Japanese yew (Taxus cuspidata). Three calves died 24 hr after initial exposure, with no significant gross or histologic lesions. Leaves of the yew plant were identified within the rumen contents, and Taxus alkaloids were confirmed by gas chromatography-mass spectrometry. Following the initial diagnosis, the yew clippings were burned. Two days later, the remaining calves were reintroduced to the enclosure. Within 24 hr, 3 additional calves began to show clinical signs of depression (3/3) or labored breathing (1/3), and by the fourth day, these 3 calves and an additional calf were found dead. Partially burnt yew leaves were found during close inspection of the enclosure. Two of 3 calves submitted for necropsy were severely autolyzed; the third had pulmonary edema and mild fibrinous pleural effusion. Histologic lesions in the latter included multifocal cardiac myocyte hypereosinophilia, sarcolemma fragmentation, pyknosis, karyolysis, myocyte loss, and a mild interstitial lymphoplasmacytic infiltrate with edema. Moderate fibrinosuppurative interstitial pneumonia was the only other significant finding. Cardiac changes were attributed to damage from the initial exposure to Taxus 6 days prior to death.

Pseudorabies virus infection in Oklahoma hunting dogs.

Pseudorabies is caused by Suid herpesvirus 1, a member of the Alphaherpesvirinae subfamily. Although pigs are the natural host of Pseudorabies virus (PRV), the virus has a broad host range and may cause fatal encephalitis in many species. The United States obtained PRV-free status in 2004 after the virus was eradicated from domestic swineherds, but the virus is still present in feral swine populations. The current report describes PRV infection in 3 dogs that were used to hunt feral swine. The dogs developed clinical signs including facial pruritus with facial abrasions, dyspnea, vomiting, diarrhea, ataxia, muscle stiffness, and death. Two were euthanized, and 1 died within approximately 48 hr after onset of clinical signs. The salient histologic changes consisted of neutrophilic trigeminal ganglioneuritis with neuronophagia and equivocal intranuclear inclusion bodies. Pseudorabies virus was isolated from fresh tissues from 2 of the dogs, and immunohistochemistry detected the virus in the third dog. Virus sequencing and phylogeny, based upon available GenBank sequences, revealed that the virus was likely a field strain that was closely related to a cluster of PRV strains previously identified in Illinois. Though eradicated from domestic swine in the United States, PRV is present in populations of feral swine, and should therefore continue to be considered a possible cause of disease in dogs and other domestic animals with compatible clinical history and signs. Continued surveillance is necessary to prevent reintroduction of PRV into domestic swine.

Water quality for cattle.

Water is often considered the most important livestock nutrient. It can carry both nutrients and toxic materials and can be a source of poisoning, although death losses are not common. More likely are questions of low-level contaminants or nutrient interactions that affect productivity. This article characterizes the major contaminants of water, their expected effects, and means to evaluate their presence.

Improving outcomes of coronary artery bypass graft infections with multiple interventions: putting science and data to the test.

In 2001, 7.58% of our coronary artery bypass graft (CABG) patients developed surgical-site infection (SSI) as compared with 3.57% in National Nosocomial Infections Surveillance System hospitals from January 1992 to June 2001. Seven new preventive measures were implemented and in 2002, the rate was 3.47%. Implementing evidence-based measures improved patient outcomes.

Shoulder work intensity with Six Sigma.

Follow one hospital system's efforts to reduce nurses' work intensity using the "Six Sigma" problem-solving approach.

Honey mesquite toxicosis in a goat.

Honey mesquite (Prosopis glandulosa) is distributed across a large portion of the southwestern United States. Ingestion of young leaves, pods, or beans can cause toxicosis in cattle and goats if they comprise a substantial portion of their diet. Goats, as browsers, are most likely to develolp mesquite toxicosis. Sheep appear to be more resistant to the plant's toxic effects. Consistent clinical signs include weight loss, ptyalism, mandibular tremors, tongue protrusion, and dysphagia. Diagnosis of mesquite toxicosis is largely made on the basis of history and clinical signs with exclusion of appropriate differentials. Laboratory findings are nonspecific but may reveal a mild anemia and hypoglycemia. Postmortem findings suggestive of mesquite toxicosis are limited to fine vacuolation of neurons in the trigeminal motor nucleus. Treatment consists of an alternative diet and supportive care. The disease is treatable in cattle and sheep but has a high case fatality rate in goats.

Effects of dietary sulfur concentrations on the incidence and pathology of polioencephalomalicia in weaned beef calves.

Fourteen heifer calves weighing 174.5+/-17.7 kg were used to evaluate the effects of 3 levels of dietary sulfur. Sodium sulfate added to basal diet made treatments designated moderate (3860 ppm sulfur), moderatey high (5540 ppm sulfur) and high (7010 ppm sulfur). Clinical polioencephalomalacia occurred in all calves assigned to the moderately high and high treatments. The calves did not acclimate to the dietary sulfur as polioencephalomalacia occurred in 4 animals on d 35 and in 1 calf on d 37. Microscopic lesions confirmed polioencephalomalacia in the calves on moderately high and high diets. Microscopic lesions also were present in 4 moderate diet calves although clinical signs were not seen. High dietary sulfur did not limit feed intake. Diets containing sulfur levels >4000 ppm sulfur produced polioencephalomalacia in 10 calves and sub-clinical brain lesions occurred in 4 calves consuming <4000 ppm sulfur.