Careful Choice Research Articles

Nueroprotection by Anesthetics in Brain Injury Models

The aim of the study was to compare the effect of sevoflurane and chloral hydrate on the neurological status and volume of brain damage after trauma and ischemia in experimental models of traumatic brain injury (TBI) and focal ischemic stroke (IS) induced by photothrombosis (PT).Materials and methods. The experiments were performed on mongrel Wistar rats weighing 250–300 g (N=43). There were 4 groups: the Ischemia + Sevoflurane group (ISSEV) (N=10), the Ischemia + Chloral hydrate group (ISCH) (N=10), TBI + Sevoflurane group (TBISEV) (N=13), and TBI+Chloral hydrate group (TBICH) (N=10). Ischemic brain damage was modelled using Rose Bengal (RB) dye-induced PT, and TBI was modelled using mechanical force-induced concussion.Results. MRI findings indicate lower volumes of brain damage (mm³) in rats from TBISEV group compared with the TBICH group (19±5 vs. 60±5, P<0.0001), and in the ISSEV group compared with the ISCH group (9.8±1.5 vs. 21.5±2, P=0.0016). Moreover, there was a significant difference between ISSEV and ISCH groups based on the protocol assessment of neurological status on day 14 with higher scores in ISSEV (11.4±1.8 vs. 4.9±2.6, P<0.0001).Conclusion. Taking into account the data obtained, we recommend a careful choice of anesthesia when modeling ischemic stroke and traumatic brain injury in animals. In particular, the neuroprotective effect of sevoflurane should be taken into account in the PT and TBI models.

User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study.

People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.

A Structured Template for Social Work Psychosocial Assessments and Formulations in Healthcare

ABSTRACT Previously, substantial inconsistencies existed in relation to social work documentation in medical records across Queensland Health. A structured, adaptable social work psychosocial assessment template, developed for use across Queensland Health, is introduced in this article. This template comprises six title headings and encompasses nine psychosocial domains. Importantly, a “Care Needs and Choice” domain encouraged promotion of the “patient voice”, while a Clinical Formulation section and matrix encouraged analysis and assessment of the presenting situation as conceptualised through the social work lens. We propose that, together with AASW guidelines and resources (e.g., AASW Practice Standards, 2023), utilisation of this template can help social workers articulate their professional identity and demonstrate their unique contributions to holistic, person-centred psychosocial healthcare. IMPLICATIONS A structured adaptable template can assist social workers to document psychosocial assessments in the medical record. Use of this template can help demonstrate the professional scope of social work practice and social workers’ unique contributions to person-centred care. The template promotes consideration and documentation of the “patient voice”, and the Formulation matrix encourages critical thinking and analysis to inform social work interventions.

The Impact of Kinlessness on Survival in Patients With Advanced Non-small Cell Lung Cancer: A Single-Center Retrospective Study.

Objectives Among patients with advanced non-small cell lung cancer (NSCLC), there are those who do not have a spouse, family members, or friends to support them in their cancer treatment and daily life: the kinless patients. Therefore, we designed an exploratory study of kinlessness and the prognosis of advanced NSCLC. Methods We retrospectively analyzed the prognosis of clinical factors and treatment and kinlessness in patients with advanced NSCLC with wild-type or unknown status for epidermal growth factor receptor/anaplastic lymphoma kinase (EGFR/ALK) and who visited our hospital from November 2018 to February 2023. In addition to the survival analysis by kinlessness, a multivariable analysis of survival was performed for all clinical factors. In a secondary analysis, a multivariable analysis of the choice of best supportive care (BSC) was performed for all clinical factors. Results One hundred forty-four patients are included in our cohort. There were 131 patients with kin, with a median survival of 1.34 years (95% CI of 1.01-1.79 years). There were 13 patients has no kin, with a median survival of 0.53 years (95% CI 0.23-0.76 years). The log-rank analysis showed that kinless patients had significantly shorter overall survival than patients who have kin. A Cox regression analysis showed that age, distant metastasis, performance status, and kinlessness were associated with overall survival. Secondary analysis showed that there was no statistical association between kinlessness and the choice of BSC in our cohort. Conclusions Kinless patients had shorter survival than patients who have kin in our single-center, retrospective study of patients with advanced NSCLC with wild-type or unknown status for (EGFR/ALK). Further research to evaluate the clinical impact of kinlessness in the treatment of advanced NSCLC is needed.

Physics-inspired transfer learning for ML-prediction of CNT band gaps from limited data

Recent years have seen a drastic increase in the scientific use of machine learning (ML) techniques, yet their applications remain limited for many fields. Here, we demonstrate techniques that allow overcoming two obstacles to the widespread adoption of ML, particularly relevant to nanomaterials and nanoscience fields. Using the prediction of the band gap values of carbon nanotubes as a typical example, we address the representation of the periodic data as well as training on extremely small datasets. We successfully showed that careful choice of the activation function allows capturing periodic tendencies in the datasets that are common in physical data and previously posed significant difficulty for neural networks. In particular, utilization of the recently proposed parametric periodic Snake activation function shows a dramatic improvement. Furthermore, tackling a typical lack of accurate data, we used the transfer learning technique utilizing more abundant low-quality computational data and achieving outstanding accuracy on a significantly expanded dataspace. This strategy was enabled by the use of a combination of the Snake and ReLU layers, capturing data periodicity and amplitude, respectively. Hence, retraining only ReLU layers allowed the transfer of the periodic tendencies captured from low-quality data to the final high-accuracy neural network. Those techniques are expected to expand the usability of ML approaches in application to physical data in general and the fields of nanomaterials in particular.

Unconventional Metaphor Use in the Writing of Chinese Learners of English

Metaphors are known to present both opportunities and challenges for second language learners, but relatively little is known about learners’ awareness of them. To investigate this, we analyzed 72 argumentative essays written in English by a group of 37 intermediate Chinese university students of English. We identified metaphors using an established identification procedure, and then used dictionary descriptions and corpus procedures to identify unconventional uses. Seeking to understand students’ thoughts about their uses of metaphor, we interviewed them within 2 days of the writing task. In this article, we explore the boundary between unconscious use of non-nativelike metaphors and deliberate choices. We argue that in many cases, our learners made conscious, careful language choices which they were able to articulate fluently and thoughtfully. Interview data show that sometimes they consciously decided to use a metaphor from their L1, fully aware that it was not a nativelike use in English, for one of various communicative functions. Our study extends thinking on deliberate metaphor, suggesting implications for its use in reframing research into second language metaphor use. Pedagogical implications are presented for developing learners’ metaphoric competence in L2 writing classrooms.

Ferromagnetic materials for Josephson π junctions

The past two decades have seen an explosion of work on Josephson junctions containing ferromagnetic materials. Such junctions are under consideration for applications in digital superconducting logic and memory. In the presence of the exchange field, spin–singlet Cooper pairs from conventional superconductors undergo rapid phase oscillations as they propagate through a ferromagnetic material. As a result, the ground-state phase difference across a ferromagnetic Josephson junction oscillates between 0 and π as a function of the thickness of the ferromagnetic material. π-junctions have been proposed as circuit elements in superconducting digital logic and in certain qubit designs for quantum computing. If a junction contains two or more ferromagnetic layers whose relative magnetization directions can be controlled by a small applied magnetic field, then the junction can serve as the foundation for a memory cell. Success in all of those applications requires careful choices of ferromagnetic materials. Often, materials that optimize magnetic properties do not optimize supercurrent propagation, and vice versa. In this review, we discuss the significant progress that has been made in identifying and testing a wide range of ferromagnetic materials in Josephson junctions over the past two decades. The review concentrates on ferromagnetic metals, partly because eventual industrial applications of ferromagnetic Josephson junctions will most likely start with metallic ferromagnets (either in all metal junctions or junctions containing an insulating layer). We will briefly mention work on non-metallic barriers, including ferromagnetic insulators, and some of the exciting work on spin–triplet supercurrent in junctions containing non-collinear magnetic inhomogeneity.

Kesehatan Mulut dan Nutrisi Optimal Dalam Membangun Kemandirian Kesehatan Generasi Emas di Sekolah Dasar (SD N Glagahwero 2 Jember)

Background: Oral health and optimal nutrition are pivotal in fostering the health autonomy of the golden generation, particularly among primary school-aged children. However, awareness regarding dental care and nutrition significance often lacks among children, especially within the primary school environment. Hence, an effective and innovative educational approach is imperative to instill awareness and healthy habits among young children. Purpose: This study aims to develop and execute a community engagement program focused on cultivating awareness of oral health and optimal nutrition among primary school children at Glagahwero Elementary School, Jember. Implementation: The program will entail employing interactive educational media, including dental and oral health games, and engaging learning materials that are accessible and comprehensible to children. Result: It is envisaged that through this program, there will be an augmentation in knowledge and comprehension among children regarding the importance of oral health and optimal nutrition, as well as the adoption of healthy habits in dental care and dietary choices. Suggestion: Sustainable and collaborative measures need to be undertaken between schools, communities, and local governments to ensure the long-term viability and success of this program.

Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations.

Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.

Are Individual Care Investments Affected by Past Accident Experiences?

Abstract In this paper, we analyze the impact of past accident experiences on individual care choices. By relying on standard economic theory and evidence of behavioral economics and psychology, we posit that individuals’ care investments should be affected by their past accidents as injurers or victims (accident-history effect hypothesis), or by their prior exposure to accident risks in the opposite role (role-reversal effect hypothesis). We test these two hypotheses using experimental data. We find that individuals’ accident history has no statistically significant effect on their care investments, but that care decisions vary with changes in the parties’ roles. Specifically, injurers with prior experience as victims invest statistically more in care than injurers without prior victim experience. By contrast, care investments are not sensitive to victims’ prior experience as injurers. Our research can be regarded as a preliminary study toward the understanding of the role of past accident experiences on individuals’ care behavior, and calls for both replication efforts and reconsideration of traditional economic models of torts.

A Study on Consumer Behavior in Selection of Personal Care Products based on their Financial Status

This research delves into the labyrinth of consumer behaviour, dissecting the nuanced preferences in the realm of personal care product selection. Focusing on the pivotal influence of financial status, our study seeks to unravel the intricate tapestry of choices made by individuals across diverse economic backgrounds. From essential grooming items to indulgent self-care commodities, the research delineates the spectrum of consumer decisions influenced by income brackets. Moreover, it uncovers potential shifts in consumer preferences amidst economic fluctuations and their implications for the personal care industry. As we navigate through the labyrinth of consumer behaviour, this study not only contributes valuable insights to marketers and policymakers but also prompts a re-evaluation of societal perceptions surrounding personal care choices. By understanding the symbiotic relationship between financial status and consumer behaviour, we hope to foster a more nuanced discourse on the intricate dynamics governing our daily grooming rituals.

Diverticulitis in the Under-40 Population.

As obesity and lifestyle factors become more prevalent in younger populations, we are diagnosing and treating diverticulitis in younger patients. In this study, the demographics, risk factors for the development, and treatment of acute diverticulitis were assessed focusing on patients under the age of 40. A retrospective review of the electronic medical records of a cohort of subjects diagnosed with diverticulitis was performed. Inclusion criteria included patients aged 18-40 who were treated for acute diverticulitis with or without any complications. Of the 109 patients, 40 patients required surgery, and 69 patients were managed conservatively. Analysis showed that the Hinchey classification (p<0.001) was the strongest predictor of treatment modality. As the incidence of diverticulitis has increased in recent decades, so too has the frequency with which elective surgical procedures are performed as treatment. While these procedures are vital components in the management of diverticulitis, the majority of research comparing conservative versus surgical treatments has been done in patients over 50 years old. Although diverticulitis has been classically thought of as a disease of the elderly, it has become more prevalent in younger populations due to the rise of obesity and lifestyle modification in the under-40 population. Although the prevalence of treatment and diagnosis of acute diverticulitis in younger patients has risen, there is a paucity of data surrounding treatment protocols for diverticulitis in association with patient symptoms for patients under the age of 40 years old. Our study has found that there is a higher incidence of complications in diverticulitis inpatients under the age of 40.Additionally, when considering the pattern of complication presentation in younger patients with complicated diverticulitis, surgical intervention might not be appropriate. The current treatment algorithm relates diverticulitis complications with surgical interventions. However, our data suggest that patients under the age of 40 presenting with abscesses or strictures may not need surgical intervention. This information could be particularly helpful in guiding physicians and younger patients in selecting the best choice of care and minimizing complications.Additionally, further research should help guide treatment protocol in this specific population of patients, as there is a lack of established guidelines pertaining to diverticulitis surrounding younger patients.

Families adapting to COVID-19 in urban Bangladesh: "It felt like the sky fell apart and we were in shock".

The COVID-19 epidemic has especially impacted the urban population in Bangladesh. Studies on COVID-19 have primarily focused on the patient's perspective. It is important to understand the experience of family members who adopt caregiving roles, as the experience of COVID-19 also impacts, and is impacted by, household members. This study aimed to explore the challenges, preventative practices, health-seeking behaviour, and perspectives of navigating the health care system from the perspective of family members of persons who had recovered from COVID-19 during its initial outbreak in Bangladesh. Participants of this qualitative study were family members (n = 7) of persons who had recovered from COVID-19 (either suspected or confirmed). Semi-structured in-depth interviews were conducted over telephone. Thematic analysis was used to analyse the data. Analysis revealed three key themes: changes in everyday practices and choice of health care, challenges and constraints, and unexpected positive outcomes. All the themes had temporal dimension to them with four distinct phases: early stage of COVID-19, strict lockdown phase, COVID-19 diagnosis and illness period and post COVID-19 recovery. The importance of maintaining social contact for psychological wellbeing during critical times was evident in the study. Online communication and social media enabled participants to remain 'socially connected' which further supported their mental health. Increased attention to hygiene practices both before, during and subsequent to COVID-19 infections within families was reported. Physical distancing in case of a suspected or confirmed COVID-19 case was found logistically and socially impractical in a densely populated city.

Hydrogel- and Nanocomposite-Based Drug-Delivery Strategies in the Treatment of Vaginal Infections.

The reproductive health of women is governed by an optimal balance in the host-microbiota interaction. Depletion of the beneficial vaginal microflora caused by depletion of Lactobacillus species and increased proliferation of pathogens results in gynaecological infections. Among women of reproductive age, vaginal infections are increasingly prevalent. Attaining therapeutic efficacy using conventional formulations remains a challenge as vaginal fluids quickly remove or dilute the therapeutic formulations. Hydrogels have been widely exploited for targeted delivery of therapeutics directly into the vaginal mucus. With a careful choice of polymers (natural, synthetic, or semisynthetic), hydrogels with specific properties, such as stimuli responsiveness, antimicrobial, and muco-adhesiveness, can be tailored for higher therapeutic efficacy. In this review, the advances in hydrogel strategies for the treatment of vaginal infections are presented with emphasis on the types and properties that play a significant role in vaginal drug delivery systems.

UNIVERSALITY, INTEGRALITY AND EQUITY IN CARE FOR THE DEAF PATIENTS PAIN PRIMARY CARE: A SYSTEMATIC REVIEW

This article aims to systematically identify scientific production regarding basic health care for deaf people. Through a systematic literature review, the search for published works using the SCIELO BR, BVS and PUBMED platforms as a database was carried out by two researchers, directing the selection and exclusion process, respectively, of data for analysis. In this sense, from a scope of careful and objective choices, original articles were sought, published in Portuguese, English and Spanish, and which addressed the perspective of care for deaf people in primary care. Dissertations, book chapters, case studies and editorials were excluded. From this, 508 articles were found, 396 were excluded by the filters applied, 03 were repeated, 75 were excluded by the title and 89 by reading the abstract. 04 were read in full and evaluated. Therefore, 04 articles were chosen for this review. The reality is that the care and experience experienced by deaf people in primary care require reformulations that occur quickly and effectively, both in communication, accessibility, care and research, and in the applicability of the right to health guaranteed by law.

The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness.

To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end-of-life care for Medicare beneficiaries from underserved groups-those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas. Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee-for-service beneficiaries nationwide. Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments. Using a matched comparison group, we estimated subgroup-specific effects on hospice use, days at home, and aggressive treatment and multiple emergency department visits in the last 30 days of life. The sample included decedent Medicare beneficiaries enrolled in MCCM and a matched comparison group from the same geographic areas who met model eligibility criteria at time of enrollment: having a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS; living in the community; not enrolled in the Medicare hospice benefit in the previous 30 days; and having at least one hospital stay and three office visits in the previous 12 months. Eligible beneficiaries from underserved groups were underrepresented in MCCM. MCCM increased enrollees' hospice use and the number of days at home and reduced aggressive treatment among all subgroups analyzed. MCCM also reduced disparities in hospice use by race and ethnicity and dual eligibility by 4.1 (90% credible interval [CI]: 1.3-6.1) and 2.4 (90% CI: 0.6-4.4) percentage points, respectively. It also reduced disparities in having multiple emergency department visits for rural enrollees by 1.3 (90% CI: 0.1-2.7) percentage points. MCCM increased hospice use and quality of end-of-life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.

What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia

BackgroundEnsuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries’ primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia.MethodsThe setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants’ choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses.ResultsBPJS-Health partners’ geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners’ services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities.ConclusionsSociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants’ primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners’ coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.

Compensating unknown speed of sound in learned fast 3D limited-view photoacoustic tomography

Real-time applications in three-dimensional photoacoustic tomography from planar sensors rely on fast reconstruction algorithms that assume the speed of sound (SoS) in the tissue is homogeneous. Moreover, the reconstruction quality depends on the correct choice for the constant SoS. In this study, we discuss the possibility of ameliorating the problem of unknown or heterogeneous SoS distributions by using learned reconstruction methods. This can be done by modelling the uncertainties in the training data. In addition, a correction term can be included in the learned reconstruction method. We investigate the influence of both and while a learned correction component can improve reconstruction quality further, we show that a careful choice of uncertainties in the training data is the primary factor to overcome unknown SoS. We support our findings with simulated and in vivo measurements in 3D.

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes.

The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

Assessing the effectiveness of membrane sweeping combined with cervical massage for term pre-induction cervical ripening: A single experimental study

Massage of the cervical region entails applying light pressure to the cervix to trigger the uterine contractions. Membrane sweeping, often called cervical sweeping or membrane stripping, releases hormones that may start labor by removing the amniotic sac from the uterine wall. Although membrane sweeping is helpful in several clinical trials, no studies have examined how effective cervical massage is when combined with membrane sweeping.This research compared the effectiveness of membrane sweeping and cervical massage as cervical ripening techniques in post-dated pregnancies before labor induction in specialized clinics. A total of 150 low-risk singleton pregnancies with a Modified Bishop Score (MBS) of fewer than five at 38 weeks of gestation were included. The experimental group received membrane sweeping with cervical massage, and the control group, which just received membrane sweeping, was randomly allocated to the participants. 48 hours after the intervention, changes in the MBS were used to gauge cervical favorability. Neonatal morbidity, membrane rupture, intrapartum and postpartum infections, and other complications were assessed.The mean ages and MBS of the primigravidae in the two research groups at induction were similar. After the intervention, the trial group's mean MBS was significantly higher than the control groups. Because of this, primigravidae observed a substantial change in the MBS after the operation. The experimental group's adverse effects and neonatal morbidity were comparable, except cardiotocographic abnormalities were observed more often in the control group.In some cases, when membrane sweeping cannot be conducted because of a closed cervical os, cervical massage combined with membrane sweeping appears successful and secure. A significant choice for obstetric care, this technique may aid cervical softening in post-dated pregnancies.