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The authors examine the electronic medical record requirements of obstetrics and gynecology which differ from other medical specialties. They cite several reasons for the unique requirements of electronic medical record systems in the medical specialty. They discuss obstetrician-gynecologist-specific functionality testing for electronic medical record systems, as well as the issues of clinical decision and guidelines support.

The article examines the Queensland Department of Education's Equal Opportunity Policy for Girls and Boys and the Implementing Guidelines for that policy within the context of the pedagogical practices of one secondary school. Most recent movement in sociology of education has been the recovery of human agency as a dynamic force within schools which had been previously seen as determining structures. This paper attempts to address this recovery of agency within a structural theory of education. The assumption of the individual as a passive recipient of society's message through institutions such as the school failed to account for the lived experience of the practitioners and students and precluded the possibility of transformative work. The theoretical purpose of this article is directly linked to attempt to understand gender relations as integral to the structure of schooling and the subjective positions made possible within such structure. There are a variety of difficulties associated with this work which are raised at appropriate places in the article.

Introduction: Efforts to lower glycosylated hemoglobin (A1c) in patients with type 2 diabetes (T2D) are intended to reduce the risk of diabetic complications, but A1c is not the only factor contributing to this risk. Consequently, we re-analyzed published data from a broad-spectrum lifestyle intervention that lowered A1c to assess its effectiveness in lowering the overall risk of two complications of T2D, namely, coronary heart disease (CHD) and stroke.Methods: Data from 37 adults who participated in a randomized clinical trial of a lifestyle intervention intended to reduce postprandial glucose (PPG) were re-analyzed for their pre- and post-treatment risk of CHD and stroke using the T2D-specific UK Prospective Diabetes Study (UKPDS) v2.0 risk algorithm.Results: Compared to participants who received routine care, those using the lifestyle intervention had a significantly greater reduction in 10-year risk for CHD, but not for stroke.Conclusion: These secondary analyses suggest that broad-spectrum lifestyle interventions that focus on lowering PPG may lower the risk of future CHD, which could guide future research.Trial Registration: ClinicalTrials.gov ID: NCT02432391. [ABSTRACT FROM AUTHOR]

Aims: This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters.Methods: Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires.Results: The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters.Conclusions: Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

The article discusses continuous glucose monitoring in the self-management of type 2 diabetes. It mentions the feasibility and efficacy of replacing systematic self-monitoring of blood glucose. It notes that those who monitored glucose with continuous glucose monitoring reported eating more low glycemic load foods.

Background: Weight loss (WL) is the initial treatment of choice for adults with t2d, but it is inappropriate for lean patients, unwanted/unsuccessful for some obese individuals, and unsustainable for others. An alternative is needed. Aim: Because post-prandial glucose (PPG) contributes strongly to A1c, we tested if a treatment focused on reducing PPG by reducing carbohydrate intake and increasing physical activity (Glycemic Excursion Minimization - GEM) would be equal or superior to WL for improving A1c and secondary benefits. We also hypothesized GEM would be enhanced by the quality and quantity of blood glucose (BG) feedback. Methods: Generally healthy adults (t2d ≤ 10 years, not on insulin, A1c ≥ 6.8) were randomized to WL (n = 36) or one of 3 GEM subgroups: 1) Didactic (GEMD, n = 35) taught participants how to choose low glycemic load foods, reduce sedentary time and increase moderate routine physical activity, 2) Didactic + systematic BG monitoring (GEMS, n =48) before and after meals and physical activity to educate, activate and motivate food and activity choices, or 3) Didactic + continuous glucose monitoring (GEMC, n = 43). WL treatment was led by diabetes nutritionists and followed the CDC Prevent T2 weight loss manual. GEM treatment was led by a diabetes nurse educator. All subjects received 6 hours of training, BG meters and wore activity monitors. A1c, weight, UKPDS, DDS, DES and PHQ-9 were assessed pre and 3 months post treatment. Results: The GEM subgroups did not differ, so they were combined. Both WL and GEM significantly reduced weight and diabetes distress (regimen). Only GEM significantly improved A1c (8.3 to 7.3, p <.001), cardiovascular risk (p <.001), empowerment (p <.001), and diabetes distress (emotional, p <.02). Discussion: Lifestyle interventions focused on minimizing PPG by reducing carbohydrates and increasing routine physical activity are effective alternatives to WL. Adding BG monitoring did not significantly enhance GEM's effectiveness. Disclosure: D. Cox: Research Support; Self; Dexcom, Inc. T. Banton: Research Support; Self; Dexcom, Inc. M.A. Moncrief: Research Support; Self; Dexcom, Inc. A. Diamond: Research Support; Self; Dexcom, Inc. V. Holmes: None. A. Wolf: None. K. Fang: None. A.L. McCall: None. Funding: Dexcom, Inc. (IIS-2017-047); National Institutes of Health (R01DK108957) [ABSTRACT FROM AUTHOR]

Carbohydrate (carb) ingestion strongly influences postprandial glucose (PPG). With recent interest in the role PPG plays in A1c and diabetic complications, there are research and clinical needs to quantify routine carb consumption. The 24-hour dietary recall is the gold standard for estimating carbs eaten, but it is tedious and narrowly focused. We developed a simple self-report to measure carbs routinely consumed (CRC). We hypothesized that the CRC would: 1) be reliable, 2) correlate with the 24-hour dietary recall, 3) be sensitive to a PPG-lowering intervention, and 4) reflect changes in A1c. Adults with type 2 diabetes (n = 116; mean age: 56 ± 11.6 years; mean disease duration: 5.3 ± 3 years; mean A1c: 8.2 ± 1.0) participated in a clinical trial comparing weight reduction to PPG reduction. At baseline and 3-month follow-up, participants completed the CRC, 3 days of ASA24 dietary recall, and A1c. The CRC score was the sum of the number of servings of 16 different high-carb food classes eaten (e.g., dried fruits) in an average week. The CRC mean was 35.9 ± 16.1. One-week test-retest reliability (r) was.96 (p =.02). Validity: At baseline, carbs eaten by CRC and ASA24 dietary recall were correlated (r =.43, p <.001). Change in CRC from baseline to follow-up was significantly lower for the PPG group (36.8 to 20.3, p <.001) but not for the weight-lowering group (33.0 to 34.4, p =.7). Correlation of pre-post change in A1c with CRC and ASA24 were r =.39 (p =.002) and r = -.03 (p =.8) respectively. Regression analysis indicated only the change in CRC predicted change in A1c. These data indicate the CRC is reliable and shows concurrent, discriminant and predictive validity - only changes in CRC reflected changes in A1c. The CRC may be useful to researchers in evaluating programs designed to lower carb intake. Clinicians might use it to evaluate a patient's routine consumption of carbs and responsiveness to lifestyle interventions. Limitation: the CRC is not a comprehensive nutritional analysis. Disclosure: D. Cox: None. M.A. Moncrief: None. T. Banton: None. V.M. Ngo: None. H. Singh: None. A.M. Diamond: None. A.L. McCall: None. Funding: National Institutes of Health (R01DK108957); Dexcom, Inc. (IIS-2016-047) [ABSTRACT FROM AUTHOR]