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This design case documents the reimagination of new faculty orientation for a mid-sized public university due to the COVID-19 global pandemic. This fully virtual iteration was facilitated during the summer of 2020 and is compared both to previous in-person iterations of new faculty orientation as well as a blended modality version of the orientation program offered in 2021. The redesign is explained using language from Puntedura’s (2006) Substitution- Augmentation- Modification- Redefinition (SAMR) model of technology application in distributed learning. Such terminology provided a helpful common vocabulary for a design team pressured to determine which elements of orientation needed to be fully reimagined for successful virtual implementation and where simple substitution would suffice. A description of synchronous elements from the fully virtual orientation as well as artifacts from the asynchronous portions is included. A lack of formal evaluation for the reimagined new faculty orientation space is shared as an element of design failure. The informal evaluation uncovered attendee appreciation of both flexibility and recursiveness, feedback our design team used to combat criticism of a lack of attention during virtual events. The paper concludes with a reflection on the need for transparent communication between event attendees, event designers, and other key invested partners (such as university administration) if the benefits of virtual orientation programming are to be adopted for our institution beyond emergency modalities.

Purpose: The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). Methods: A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists’ ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. Results: Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. Conclusion: To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.

We developed a 96-well plate assay which allows fast, reproducible and high-throughput generation of 3D cardiac rings around a deformable optically transparent hydrogel (PEG) pillar of known stiffness. Human induced pluripotent stem cell-derived cardiomyocytes, mixed with normal human adult dermal fibroblasts in an optimized 3:1 ratio, self-organized to form ring-shaped cardiac constructs. Immunostaining showed that the fibroblasts form a basal layer in contact with the glass, stabilizing the muscular fiber above. Tissues started contracting around the pillar at D1 and their fractional shortening increased until D7, reaching a plateau at 25±1%, that was maintained up to 14 days. The average stress, calculated from the compaction of the central pillar during contractions, was 1.4±0.4 mN/mm2. The cardiac constructs recapitulated expected inotropic responses to calcium and various drugs (isoproterenol, verapamil) as well as the arrhythmogenic effects of dofetilide. This versatile high-throughput assay allows multiple in situ mechanical and structural read-outs.

Introduction: Post-acute sequelae of SARS-CoV-2 infection (PASC), a constellation of disabling symptoms, persisting after COVID-19, is an emerging health issue affecting substantial number of persons globally and in the US. Cardiac PASC refers to the wide range of cardiovascular-specific PASC symptoms. The psychological impact of PASC, cardiac PASC is poorly characterized. Objective: To examine whether PASC and cardiac PASC symptoms are associated with depressive symptoms and high levels of perceived stress. Methods: We conducted cross-sectional analyses among persons with history of COVID-19. Exposures were self-reported PASC and cardiac PASC symptoms. Outcomes were depressive symptoms and perceived stress measured using Patient Health Questionnaire (PHQ8) and Perceived Stress Scale (PSS4), respectively. Scores on PHQ8 ranged from 0-24, and clinical cutoff for depressive symptoms was ≥10. Scores on PHQ8 were dichotomized as minimal-mild ( Results: Of 197 participants, mean age was 47.3 (±15.9) years, 74% were female, 77% were White. About 48% (95/197) reported PASC, 46% (90/197 participants) reported cardiac PASC. The odds for moderate-severe depressive symptoms (adjusted Odds Ratio [aOR]: 5.03, 95%CI: 2.43-10.41, Table ) and high perceived stress (aOR: 4.19, 95%CI: 2.17-9.08) were higher compared to those who did not report PASC. Similarly, the odds for moderate-severe depression (aOR: 2.42, 95%CI: 1.25-4.70) and high perceived stress (aOR: 2.68, 95%CI: 1.43-5.02) was higher compared to those who did not report cardiac PASC. Conclusion: PASC and cardiac PASC are associated with clinical depressive symptoms and high perceived stress. Psychological and mental health interventions should be integrated into PASC care models.

"Nature prescriptions" are increasingly being adopted by health sectors as an adjunct to standard care to attend to health and social needs. We investigated levels of need and interest in nature prescriptions in adults with cardiovascular diseases, psychological distress and concomitants (e.g. physical inactivity, sedentary behaviour, obesity, loneliness, burn-out).A nationally-representative survey of 3,319 adults across all states and territories of Australia was completed in February 2021 (response 84.0%). Participants were classified across 15 target groups using validated health indicators and surveyed on (1) time and frequency of visits to green and blue spaces (nature spaces), (2) interest in a nature prescription, and (3) potential confounders (e.g. age, income). Analyses were done using weighted logistic regressions.The sample was 50.5% female, 52.0% were aged ≥45 years, 15.2% were living alone and 19.3% were born overseas in non-English-speaking countries. Two-thirds of the sample spent 2 hours or more a week in nature, but these levels were generally lower in target groups (e.g. 57.7% in adults with type 2 diabetes). Most participants (81.9%) were interested in a nature prescription, even among those spending fewer than 2 hours a week in nature (76.4%). For example, 2 hours a week or more in nature was lowest among sedentary adults (36.9%) yet interest in nature prescriptions in this group was still high (74.0%). Lower levels of nature contact in target groups was not explained by differences in access to or preference for local nature spaces.High levels of interest in nature prescriptions amid low levels of nature contact in many target health groups provides impetus for developing randomised trials of interventions that enable people to spend more time in nature. These findings can inform intervention co-design processes with a wide range of community stakeholders, end-users in target health groups, and the health professionals who support them.

Background: There is growing recognition of the importance of involving patients and families with lived experiences of illness in healthcare service quality improvement, research and implementation initiatives. Ensuring input from people with palliative care needs is important, but how to enable this is not well understood. Aim: To seek the perspectives of Australian patients with palliative care needs, and their family members, to elicit their views on how to best contribute to inpatient palliative care quality improvement initiatives. Design: An exploratory qualitative study, using semi-structured interviews. Setting/participants: Eligible participants were adult patients with palliative care needs receiving care within a hospital setting, and their family members. Recruitment occurred through: five hospitals in New South Wales, Australia; and snowballing. Results: Fifty participants took part (21 patients and 29 family members). Results confirmed four themes: (1) Mechanisms for providing feedback about care quality need to be supportive and individualised; (2) The clinician-patient/family power imbalance makes real time feedback challenging to provide; (3) Willingness to contribute varies according to diagnosis, timing and role and (4) Face to face feedback is preferred for health service improvement work. Conclusions: Enabling meaningful consumer input to quality improvement requires careful consideration due to the unique requirements of the palliative care population. Embedding tailored outcome and experience measures to inform real-time care provision coupled with focussed opportunities for input into service improvement may best foster improvements in inpatient palliative care, founded in what matters most for people requiring this care.

Background/Objectives: Nurses in Lebanon are facing multiple crises and the severity of the situation calls for an empirical examination of their resilience status. Evidence indicates that resilience can buffer the negative effect of workplace stressors on nurses and is associated with favorable patient outcomes. The objective of this study was to test the psychometric properties of the Arabic Resilience Scale-14 that was utilized to measure resilience among Lebanese nurses, Methods Data was collected from nurses working in health care centers using a cross-sectional survey design. We estimated the confirmatory factor analysis using the Diagonally Weighted least Squares. Fit indices for the confirmatory factor analysis model included Model chi-square, root-mean squared error of approximation and Standardized Root Mean Square Residual. Statistical significance was set at p

Recent advances in immuno-oncology have significantly increased the therapeutic arsenal available for clinicians. However, being able to identify the responder to a given treatment remains difficult and time consuming. This is due to the lack of translational preclinical models that recapitulate the complete cellular and physical tumor-immune micro-environment (TME). We report for the first time a high throughput vascularized immunocompetent breast tumoroids model in standard multiwell culture plate (MW). The model uses micro physiological system (MPS) and microfabrication to recapitulate and precisely control the TME. The tumor model includes fibroblasts, tumor cells (MDA-MB-231), immune cells (CD81+, CD64+), endothelial cells (CD31+), and a collagen extra cellular matrix. These are essential for the TME and are often lacking in preclinical models, potentially biasing the observed therapeutic response. The physical microenvironment was recapitulated using Cherry Biotech’s MPS, CubiX, and 4DCell SmartSphero Plates (SSoP). A combined system, which to the best of our knowledge is the only one able to recreate the complete TME in a 24 MW with multiplexed and uniformized tumoroid sizes. The SSoP technology is based on microstructured hydrogels, where microwells with an anchoring point at the bottom, allow the formation of the tumoroids, and to keep them in place, making it easy to trace them. The non-adherent properties of the gels help maintain the tumoroids shape. The CubiX system allowed controlling the cell culture conditions: temperature (37°C) and medium perfusion (150 µL/min). The presence of an enriched gas mix with 5% CO2 and O2, was also provided to the tumoroids, and pH, lactate, glucose, O2 consumption were monitored along all culture periods. We focused on optimizing the recapitulation of the physiopathology of breast cancer in 3 aspects: growth rate; tumor cell migration; and oxygen gradient within the MW plate to mimic different depths of the tumor (normoxic to the hypoxic core). Those features are essential for accurate drug efficacy testing. We were able to grow and maintain up to 91 tumoroids per well in a 24MW. After tumoroids formation, we obtained a fully vascularized and immuno-competent model in 48h, the fastest to the best of our knowledge. The system enabled monitoring of the tumoroids growth rate, the differentiation of the endothelium cells (Kfl 2/4, Van Willebrand Factor, eNOS, -% actin fiber alignment), differentiation of CD81+ and CD64+ cells into Macrophage type 1 or 2. All cell types were kept viable for 7 days, and endothelial cells alignment was found physiological (80%). Furthermore, we were able to induce on demand the invasiveness phenotype of the tumoroids. We envision that this model will evolve into a vascularized immunocompetent patient derived tumor model that can be used routinely in precision oncology to predict the drug response of a given patient. Citation Format: Stijn Robben, Anais Peyron, Ana Rita Ribeiro, Divyasree Prabhakaran, Antoni Homs Corbera, Pierre Gaudriault, Patricia Davidson, Dario Fassini. A high throughput vascularized immunocompetent tumoroids model in a standard multiwell plate for precision oncology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 193.

Background: Caregivers of persons with heart failure must manage high levels of patient health care utilization, treatment complexity and often unpredictable stressors associated with intermittent symptom exacerbations and mortality. Interventions have often focused on the needs of the person with HF, not the caregiver. Therefore, we developed an intervention using human-centered design to provide caregiver-targeted support for this population. Objective: Pilot test the feasibility and gauge initial effect size of the Caregiver Support intervention to improve quality of life (mental and physical), caregiver burden, and self-efficacy among family caregivers from baseline to 16 weeks. Methods: The intervention includes five individualized, nurse-led sessions over 10 weeks conducted remotely (due to COVID-19). Intervention components focus on 1) nature of caregiving, 2) life purpose, 3) co-development of an action plan to address caregiver goals to reduce caregiver burden and improve caregiver well-being, 4) exploration of social and community resources to support unmet needs, and 5) building a sustainability plan for addressing future caregiver needs. We tested our approach in a randomized waitlist control pilot trial (N=35) from August 2020 through March 2022. We calculated enrollment and retention rates, described acceptability, and computed intervention effect sizes from baseline to 16 weeks. Results: 35 out of 101 (35%) eligible caregivers enrolled and were majority female (93.3%), White (60%) and spousal caregivers (63.3%). Average age was 59.4 ± 16.6 years. Overall retention was 69%. All intervention participants completed the five core components, reporting high levels of satisfaction and acceptability of activities. Between-group effect sizes (n=21) at 16 weeks suggest improvement in the mental health component of quality of life, caregiver burden, and self-efficacy (effect sizes 0.88, 0.31, and 0.63, respectively). Conclusion: Caregivers found Caregiver Support acceptable and study methods were feasible, despite challenges to engaging during the COVID-19 pandemic. Findings provide foundational evidence that this person-centered behavioral intervention can contribute to enhanced caregiver outcomes.

Introduction: Infection with the SARS-CoV-2 virus can lead to myocardial injury, with cardiac biomarker elevations. Objective: To quantify the association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients. Methods: Studies were identified from PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus, published between December 2019 to August 2021. Effect estimates for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using random-effects models. Odds Ratios (OR), Hazard Ratios (HR), and 95% Confidence Intervals (CI) were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions summarized pooled prevalence of co-morbidities. Results: We included 62 articles, with 41,013 patients. Pooled proportion of patients with hypertension history was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%), and cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.77, 95% CI: 1.42-2.18)] ( Figure ); also, separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-19 (OR: 1.93, 95% CI: 1.45-2.40). Elevated NT-proBNP were associated with higher odds for severe COVID-19/death (OR: 3.00, 95% CI: 1.58-5.70). Elevated D-dimer levels was significantly associated with critical/severe COVID-19 and death (OR: 1.38, 95% CI: 1.07-1.79). Conclusions: This meta-analysis synthesizes evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification.

Purpose: It is well documented that chronic conditions, such as diabetes, impact quality of life (QoL). QoL assessment is essential when developing and evaluating diabetes self-management education support interventions. The aim of this systematic review was to evaluate the evidence and gaps in the research and the impact of diabetes self-management education (DSME) on QoL outcomes in persons with type 1 diabetes mellitus (T1DM). Methods A systematic review of English language studies published between January 1, 2007, and March 31, 2020, was conducted using a modified Cochrane review method. Studies were included if they were randomized controlled trials (RCTs), participants had T1DM with or without caregivers, a DSME intervention alone or a component(s) of the ADCES7™ Self-Care Behaviors was described, and QoL was a primary or secondary outcome. A 3-tiered review process was utilized for selecting articles. Retained articles were assessed for risk of bias. Results: Nineteen articles, reporting on 17 RCTs, met inclusion criteria, of which 7 studies reported QoL as the primary outcome and 10 as a secondary outcome. Seven studies detected significant impact of DMSE on QoL outcomes in either the participants or family caregivers, which varied in participant populations, selection of QoL tools (generic vs diabetes-specific), intervention type, intervention length, and type of interventionist. Conclusion: DSME has the potential to influence QoL outcomes in people with T1DM. Research using more standardized methods are needed to delineate impact on a broader range of factors that influence QoL for those living with T1DM across the life span and their caregivers.

Over 50% of patients in intermediate care units (IMCU) present with multimorbidity, two or more chronic conditions. Balancing the effects of multimorbidity and their treatments with quality-of-life can be a challenge. This experience-based co-design project aimed to elicit experiences of patients, family caregivers, and healthcare professionals in IMCU, in the context of challenges and intricacies of multimorbidity management, to inform the development of a symptom management toolkit. Patients aged 55 years and older were recruited and interviewed in person. Healthcare professionals working in IMCU (i.e., physicians, nurses, respiratory therapists, social workers, etc.) were recruited and interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting quality of life, symptom burden and trajectory over time, and symptom management strategies that have and have not worked. An inductive thematic analysis approach was used for data analysis. Twenty-three interviews were conducted: 9 patients, 2 family-caregivers, and 12 healthcare professionals. Patients’ mean age was 67.5 (± 6.5) years, over half (n=5) were Black or Hispanic, and average number of multimorbidity was 3.67. Five major themes emerged: 1) importance of patient-provider relationship; 2) open and honest communication; 3) accessibility of resources during hospitalization and at discharge; 4) caregiver support, training, and education; and 5) care-coordination and follow-up care. Patients, caregivers, and healthcare professionals often have different priorities for multimorbidity management, treatment, and education. However, given the growing population of patients experiencing multimorbidity, it is imperative to identify shared priorities and target holistic interventions considering their experiences to enhance outcomes.

Heart disease is the leading cause of death in the developed world and causes significant morbidity and repeated hospitalization. Heart failure (HF) is the final common pathway for many cardiovascular diseases. Although optimal medical management and targeted use of devices improve survival and quality of life for people with HF, symptom distress and other types of illness burden are common. High illness burden and the risk of sudden death at every stage of HF means that palliative care treatments should be integrated into care for all patients. Palliative care should enhance communication among clinicians and with the patient and family, and should provide options for treatment of symptoms and deactivation of devices. Simultaneous care by a cardiologist and a palliative care specialist may optimize outcomes, and palliative care specialists must be aware that referral to HF specialists may be necessary for patients with advanced HF. Integrating palliative care alongside HF care can improve quality of life, decrease suffering and healthcare costs, and enhance quality of care.

Background Research has shown that among people with type 2 diabetes mellitus, reduction in hemoglobin A1c (HbA1c) prevents long term complications. Medically tailored meals (MTM) and telehealth-delivered medical nutrition therapy (tele-MNT) are promising strategies for patient-centered diabetes care. Objectives Project MiNT will determine whether provision of MTM with and without the addition of telehealth-delivered medical nutrition therapy improves HbA1c and is cost effective for patients with type 2 diabetes mellitus. Methods Patients with poorly controlled type 2 diabetes mellitus (HbA1c >8%) will be recruited from Jefferson Health. Eligible patients will be randomized to one of three arms: 1) usual care, 2) 12 weeks of home-delivered MTM, or 3) MTM + 12 months of tele-MNT. All participants (n = 600) will complete three follow-up assessments at 3, 6, and 12 months. The primary outcome is change in HbA1c at 6 months. Secondary outcomes include change in HbA1c at 3 and 12 months and cost-effectiveness of the intervention at 6 and 12 months. Conclusion Findings from Project MiNT will inform MTM coverage and financing decisions, how to structure services for scalability and system-wide integration, and the role of these services in reducing health disparities.

Background Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library's prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong. Objective Present the basis of systematic reviews for MNT and weight loss recommendations. Methods Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months. Main outcome measures Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated. Results For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure. Conclusions Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes.

INTRODUCTION: Sabbaticals were first offered by Harvard University in the late 17th century to provide “renewal” for faculty members. In this period of career development, a professor might learn new techniques, expand a research program, or finish off that book or pile of languishing manuscripts. This article tried to organize lived experiences of a visiting scholar from Isfahan University of Medical Sciences to Johns Hopkins University. The research aimed to study the context and conditions of the sabbatical in an alternative academic setting. METHODS: This article applies a narrative qualitative study integrated with Eisner critical and connoisseurship approach as a combined naturalistic methodology. Using narrative inquiry and reflective analysis in form of observations and audit reports, written dairy notes and memos, the content analyzed thematically and extracted the themes of lived experiences as well as lessons learned and then have been transformed into tables. RESULTS: Extracted themes from research sources are categorized into three main themes: organizational and professional experiences; teaching, instruction, and curricular experiences; and research and technology management experiences. These are resulted in the explanation of the field and events (description), discussion about them (interpretation), followed by concluding remarks (evaluation). . It also represents research questions and findings in descriptive and interpretation phases. DISCUSSION AND CONCLUSIONS: This article addresses some descriptions, interpretations, and evaluations extracted from the experiences through answering the research questions. It categorizes these practical lessons into three categories: (1) lessons about becoming a lifelong learner, (2) lessons about remaining a professor, and (3) innovative experiences.

An influential theory proposes that children learn words by initially relying on perceptual cues to identify referents, only later recruiting social or linguistic cues to acquire new words (Golinkoff and Hirsh-Pasek 2007). Here we ask whether a similar bias also characterizes children’s extensions of words to novel contexts. In order to establish relative preference for cues in different modalities, we focus on how children recruit auditory, visual, and lexical distributional cues in extending verbs to unfamiliar contexts involving missing or conflicting information regarding the referent of the verb. Four-year olds were taught two nonce verbs and subsequently asked to produce one of the two verbs in novel contexts involving conflicting cues (e.g., the linguistic cue associated with one verb is paired with the visual cue associated with the other verb). To assess relative cue preference, children’s responses in the ‘bimodal conflicting cues’ condition were compared with their responses in a ‘baseline unimodal’ condition in which only one of the three cues was presented. Four-year olds overwhelmingly prefer to produce verbs associated with visual cues versus auditory or linguistic cues. But there is no advantage for auditory over linguistic cues when they are placed in conflict. These findings demonstrate that children weight perceptual cues more heavily than linguistic cues during the process of verb generalization, but only if the cues are visual. The cue-weighting strategies that children recruit during verb generalization are similar in some respects to those proposed for the process of mapping word forms onto referents during word learning and additionally may be driven by visual dominance effects that characterize cognitive processing in other kinds of tasks (Colavita 1974).

There are 30.3 million people with diabetes and 86 million with prediabetes in the United States, underscoring the growing need for comprehensive diabetes care and nutrition for the management of diabetes and diabetes-related conditions. Management of diabetes is also critical for the prevention of diabetes-related complications such as cardiovascular and renal disease. The Diabetes Care and Education Dietetic Practice Group along with the Academy of Nutrition and Dietetics Quality Management Committee have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Diabetes Care. The SOP and SOPP for RDNs in Diabetes Care provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP utilizes the Nutrition Care Process and clinical workflow elements for care and management of those with diabetes and prediabetes. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with diabetes or specializing in diabetes care or practicing in other diabetes-related areas, including research. The SOP and SOPP are intended to be used for RDN self-evaluation for ensuring competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

Although nurses make up the largest group of professionals working in th healthcare field, they are often left out of the decisions that shape the restructuring of healthcare in Canada. A feminist philosophy guided this qualitative study, conducted in New Brunswick, to gain an in-depth knowledge of the impact of restructuring on nurses working in all types of healthcare facilities across the province. Sixty-five nurses were interviewed, and a number of themes, including "having a voice," emerged from the data. While many of the nurses interviewed reported that they were not invited to participate in decisions related to healthcare restructuring, others noted that when they did have an opportunity to participate, they were frequently not heard. However, a number of nurses also reported that they believed they had some influence and could continue to make a positive difference when they were asked to be involved at the outset of a change process.

I N 2001,THE INSTITUTEOFMEDICINE of the National Academy of Sciences published Crossing the Quality Chasm: A New Health System for the 21st Century, which promoted evidence-based practice as a prerequisite to quality health care. Implementation of evidence-based practice guidelines has become an integral component of the national health care quality strategy mandated by the Patient Protection and Affordable Care Act of 2010, with the goal of providing affordable care that leads to healthier communities. Evidence-based practice guidelines are essential to the delivery of quality care that is safe, effective, efficient, personalized, timely, and equitable. Despite this emphasis, it is challenging to ensure that registered dietitian nutritionists (RDNs) and other health care practitioners are following guidelines and that guideline use does in fact lead to quality care. This article describes a novel framework that uses the Nutrition Care Process (NCP) to link evidence-based practice guidelines and nutrition practice. The value of this framework for research measurement and clinical practice is also described.

Various hormone replacement regimens and delivery systems have been developed ; however, there is still a need for additional, easily controllable and biocompatible systems. We have developed and characterized biocompatible polycaprolactone-block-poly(ethylene oxide) (PCL-b-PEO) micelles for the delivery of 17beta-estradiol (E2) and investigated their loading and release properties using fluorescence spectroscopy. The micelles are spherical aggregates that range in size from 20 to 40 nm, as determined by both transmission electron microscopy and dynamic light scattering. A high loading efficiency for E2 of up to 96%, as well as a high drug loading capacity of up to 4000 molecules of E2 per micelle (equivalent to 190% (w/w)), is obtainable. In addition, the E2 loading and release can be controlled by modifying the block length of the polycaprolactone core and the initial estradiol concentration. The release of E2 from the micelles showed a biphasic profile under perfect sink conditions: there is an initial burst release, followed by a slow and prolonged release for up to 5 days, until complete release is achieved. The release of E2 from the micelles was shown to be diffusional, as shown by the linearity of the release as a function of the square root of time. Approximate diffusion coefficients of the order of 10(-17) cm2/s were obtained. In vitro and in vivo experiments confirmed that the biological activity of E2 was retained after preparation of the micelles. This micelle carrier could serve as a versatile and efficient nanodelivery system for steroids and other poorly water soluble drugs that require solubilizing agents for delivery.

Evaluation is an essential process that permits assessing the effectiveness and efficiency of planned programs. In implementing a new nurse-managed Community Health Clinic targeting services for the homeless and underserved, the stakeholders considered an evaluation process integral to the planning stage of the clinic as a whole as well as of all the different programs being offered. The program logic model was chosen and modified to guide evaluation. Work to develop the evaluation model and its components began before the clinic opened. This article describes the development of the modified program logic model, how it was modified, and the rationale for its modifications. We highlight the process of developing the evaluation model because we found limited descriptions of the process in the literature. The evaluation process itself will be evaluated on an ongoing basis to determine if it is capturing the evaluation needs of the clinic project accurately.

Primary health care has utility for policy development at all levels of organization in any nation, including policies influencing the health of persons living with severe and persistent mental illnesses. Using the primary health care framework, policies to improve health and housing for this population evolve from intersectoral collaboration. Active participation by those persons whose essential health is compromised by housing that is not acceptable, adequate, suitable, and affordable is required. Appropriate and affordable methods that address health challenges are identified. Access to services meeting essential health care needs of citizens has potential for healthy outcomes.

2016 will be an important year for women's health as we move into a new strategic process to achieve gender equality and improve the health of women and girls. On August 2, 2015, governments around...

This article describes the theoretical foundation of risk perception as a key component of changing deleterious health behaviours associated with cardiovascular disease (CVD). Furthermore, perception in increasing cardiovascular risk-reducing behaviours in a socio-cultural framework is discussed, and an empirical development conceptual model presented.Perception of risk is strongly linked with health-seeking behaviours. Understanding how to reduce risk and maximise cardiovascular health is an increasing focus of clinicians, researchers and policy makers. Increasing cultural diversity in contemporary society means that nurses need to develop and evaluate interventions in this context.An integrative literature review.An integrative literature review method was used to assess conceptual models relating to risk perception of developing CVD. On the basis of the findings, a model was developed to inform future intervention studies, considering individual, social and cultural factors.Studies examining CVD and health behaviours report that there is limited concordance between actual and perceived risk in people with CVD. This mismatch risk likely impedes the adoption of risk-reducing behaviours.There is a critical need to develop interventions for enhancing an accurate perception of CVD risk considering not only individual but social factors.There is limited correlation between knowledge and behaviours, and health behaviours are influenced by individual, social and cultural factors. Appraising the congruence between actual and perceived risk is an important step in developing effective care plans to reduce cardiovascular risk.

The aim of this study is to describe the experience of caregivers of individuals who have had a percutaneous coronary intervention (PCI).Decreased lengths of hospital stay and an increased emphasis on chronic disease self-management increase the importance of carers in assisting in recovery and lifestyle modification.Cross-sectional dual-moderated focus group design.Three focus groups using a dual facilitation approach were held in the cardiac rehabilitation setting of a tertiary referral hospital in metropolitan Sydney. All sessions were audio recorded, transcribed and thematically analysed.Four themes emerged from the data: (1) a gendered approach to health, illness and caring; (2) shock, disbelief and the process of adjustment following PCI; (3) challenges and changes of the carer-patient relationship and (4) the needs of the carer for support and information. Issues emerging from this study parallel other findings describing the experience, yet provide new insights into the issues surrounding PCI.These findings highlight the need for including carers in care planning and decision-making and providing them with support and resources.Emphasises the importance of preparing carers of the likely experience following a PCI. Demonstrates the degree to which vigilance, deferment of carer-health needs and role conflict impact on the carer's personal relationship. Demonstrates the need for formal support interventions for carers of patients who have had PCI.