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Rongchong Huang,1,* Xiantao Song,2,* Jian Wu,1 Wei Huang,2 Aaron L Leppin,3 Michael R Gionfriddo,3,4 Yongxian Liu,1 Kasey R Boehmer,3 Henry H Ting,5 Victor M Montori3,6 1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 2Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Knowledge and Evaluation Research Unit, 4Mayo Graduate School, Mayo Clinic, Rochester, MN, 5Value Institute, New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY, 6Division of Endocrinology, Mayo Clinic, Rochester, MN, USA *These authors contributed equally to this work Background: The aim of this study was to evaluate the feasibility of using the Statin Choice decision aid to have discussions about starting a statin medication for cardiovascular risk reduction in Chinese patients with stable coronary artery diseases.Methods: A prospective, pilot study of the Statin Choice decision aid in two teaching hospitals in Northern China was conducted. A total of seven clinicians were enrolled and underwent a 12-hour, group-based, in-person training on shared decision making (SDM) and the Statin Choice decision aid. Then, these clinicians used the Statin Choice decision aid in patients during a clinical encounter. A total of 86 patients aged 40-80 years, who had stable angina, were enrolled. All clinical encounters were video recorded. A team of three researchers viewed and scored all the encounter recordings to evaluate the SDM process and fidelity to the intervention using the OPTION scale and Fidelity scale, respectively. All the patients were followed up for 12 months to record adherence to statin and any major adverse cardiac events (MACEs).Results: The average scores on the OPTION normalized score and Fidelity scale were 21 (range, 3–32; out of a possible, 48) and 10 (range, 6–10; out of a possible, 10), respectively. This suggested that Chinese clinicians who were using Statin Choice in their patients were able to exhibit behaviors consistent with SDM at a level that is similar to that reported in Western countries. After SDM, the statin adherence was 94.5% (69/73), and the proportion of MACEs was 2.9% (2/69).Conclusion: Using an encounter decision aid developed in the US, it was feasible to implement SDM in a referral cardiology practice in Mainland China. Further work to ensure that the encounter aid is pertinent to the Chinese population and that SDM is tested in at-risk patients could contribute to the implementation of SDM across Mainland China. Keywords: Statin Choice, decision aid, stable angina, statin adherence, shared decision making, China

Abstract Background Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. Methods/Design We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Discussion Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. Trial registration NCT00388050

Objective: Previous in vitro and in vivo studies demonstrated a relevant role of vascular endothelial growth factor (VEGF) in experimental diabetic renal disease, whereas inhibition of VEGF ameliorated development of experimental diabetic nephropathy. Nevertheless, little information exists about the relevance of VEGF, VEGF receptor 2 (VEGF-R2), and VEGF mediated VEGF-receptor activation during diabetic nephropathy in man. Methods: In this study, we investigated expression profiles of VEGF and VEGF-R2, the receptor thought to be responsible for VEGFinduced angiogenesis, using specific antibodies in renal biopsies of 52 patients with type 2 diabetic nephropathy. Ten renal biopsies without evidence of kidney disease served as controls. VEGF-receptor bound VEGF (representing endothelial cells actively undergoing VEGFinduced angiogenesis) was detected using a monoclonal antibody specifically/exclusively recognizing the VEGF-VEGF-R complex. Glomerular expression of VEGF, VEGF-R2, and VEGF-receptor bound VEGF was quantified using computer assisted image analysis of the immunostaining. Due to the heterogeneity of the diabetic lesions, individual glomeruli were classified as mildly (a), moderately (b), or severely (c) injured according to cellularity, capillarisation and sclerosis. Immunostaining was compared between these three groups and to controls. Results: Control biopsies demonstrated glomerular expression of VEGF in a typical podocytic pattern (2.6 ± 2.2). Glomeruli of diabetic kidneys (n = 575 glomeruli) with mild, moderate and severe injury showed increased expression of VEGF (a = 8.7 ± 5; b = 10.4 ± 6; c = 10.1 ± 6.9; all P < 0.001), but no differentiation according to the degree of injury could be done. Surprisingly, VEGF-R2 was predominantly detected in podocytes of controls as well as diabetic kidneys. During diabetic nephropathy, VEGF-R2 was also found in different cell types including glomerular endothelial cells. Overall expression of VEGF-R2 was unchanged in glomeruli with mild injury compared to controls (3.3 ± 3.4 vs. 5 ± 2.7), but was significantly increased in moderately (8.1 ± 5.8; P < 0.05) and almost significantly increased in severely injured glomeruli (7.6 ± 7.1; P = 0.06). VEGF-receptor bound VEGF was exclusively distributed in a typical endothelial pattern (by immunostaining) in glomeruli of control and diabetic kidneys (n = 575). Expression of VEGF-receptor bound VEGF was significantly increased in glomeruli with mild injury (16.4 ± 6.9) compared to controls (12.7 ± 5.8; P < 0.01). In contrast, VEGF-receptor bound VEGF significantly decreased in moderately (b = 10.9 ± 5.8) and severely (c = 10.7 ± 6.9) injured glomeruli compared to controls (P ≤ 0.05) and to glomeruli with mild injury (P < 0.001). Conclusions: The VEGF and VEGF-receptor system is differentially regulated during diabetic glomerulopathy. VEGF-receptor bound VEGF representing endothelial cells actively undergoing VEGFinduced angiogenesis is markedly increased in early stages of diabetic glomerulopathy, while later stages are associated with a decreased activity of VEGF-mediated angiogenesis. [ABSTRACT FROM AUTHOR]

Objective: Increased renal nitric oxide production and/or activity has been associated with glomerular hyperfiltration, vascular permeability and modulation of glomerulosclerosis and tubulointerstitial fibrosis. Several studies demonstrated regulated expression of nitric oxide synthases (NOSes) in experimental diabetic nephropathy. However, the regulation of NOSes and its clinical relationship in diabetic nephropathy in man is still not yet specified. Methods: We investigated renal biopsies and clinical data of 36 patients with diabetic nephropathy, 10 renal biopsies without evidence of renal disease served as controls. Glomerular and cortical eNOS and iNOS expression were assessed by immunhistochemical staining and correlated with clinical data such as the duration of diabetes, creatinine clearance, duration of arterial hypertension, albuminuria/ proteinuria, HbA1c, duration of insulin therapy, presence of vascular complications or diabetic retinopathy and smoking. Results: Mean age of patients at biopsy was 59 years, mean duration of diabetes 13.6 years. Compared to normal biopsies, expression of cortical (14.2 ± 8 vs. 10.7 ± 5.5; P = 0.05) and glomerular (16.4 ± 8 vs. 4.6 ± 3.3; P < 0.001) eNOS was increased in type 2 diabetics, whereas no significant differences could be detected for iNOS. Expression of cortical eNOS related with duration of arterial hypertension (r = 0.55) and that of glomerular eNOS with the degree of microvascular complications (r = 0.43). Interestingly expression of glomerular iNOS was linked to the duration of insulin therapy (r = 0.65). In addition, patients treated with insulin for less than 1 year had significantly lower iNOS levels (same levels as healthy controls) compared to patients with insulin therapy for more than one year (1.4 ± 0.8 vs 3.3 ± 2.1; P < 0.05). No correlations could be detected for all other clinical parameters as mentioned above. Conclusions: This study demonstrates significantly increased eNOS expression in kidney biopsies from patients with histologically proven diabetic nephropathy. Expression of eNOS as well as iNOS were in addition related to clinical risk factors of disease progression. [ABSTRACT FROM AUTHOR]

Introduction: Students face difficult decisions when considering multiple opportunities for employment or continued training. When this happens, students may consider breaking a previous commitment to accept a more appealing offer. Societal trends toward decommitment may also influence students' perceptions of the importance of commitment., Perspective: Students must consider potentially serious professional repercussions that may result from dishonoring commitment before making such a decision., Implications: We challenge pharmacy faculty to reinforce the professional obligation of honoring commitment when guiding students in career decision-making. We emphasize the importance of helping students develop a specific plan to work toward career goals, entertain only those opportunities that help achieve these goals, and carefully weigh the potential impact of dishonoring commitment on their professional reputation., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cigarette smoking prevalence is higher for rural than urban adults, yet digital access to cessation programming is reduced. We aim to investigate digital access interventions to promote engagement with an online evidence-based cessation treatment (EBCT) program among rural adults., Methods: This pilot trial used a pragmatic, three-arm, randomized, parallel-group design (ClinicalTrials.gov: NCT05209451). Inclusion criteria included being aged ≥18, Mayo Clinic Midwest patient, rural residency, and currently smokes cigarettes. All participants received an online, 12-week EBCT program and were randomized to receive one of three digital access interventions: print materials (control, n = 30); print materials + loaner iPad device with data plan coverage (n = 30); or print materials + loaner device + up to six, 15-20-minute motivational interviewing-based coaching calls to support technology needs (n = 30). A composite score of trial engagement (primary outcome) and self-reported smoking abstinence and use of EBCT resources (secondary outcomes) were assessed online at 4 and 12 weeks. Qualitative interviews were used to assess patient experience. Neither participants nor outcome assessors were blinded to group assignment., Results: Results are reported for all 30 participants in each group. The average age of participants is 51.0 years and 61% are women. We show no significant arm differences for the trial engagement composite score (p = 0.30). We also find coaching support is significantly (p < 0.05) associated with enhanced smoking-related treatment response, including cigarette abstinence and use of EBCT resources, and participants reported positive experiences with the intervention., Conclusions: The coaching intervention to support technology needs is acceptable and shows preliminary evidence of its efficacy in smoking-related treatment response. Further studies could refine and implement the coaching intervention for trial engagement and long-term cessation., (© 2024. The Author(s).)

Background: Clinicians often hesitate to adjust antihypertensive medications based solely on clinic blood pressure (BP) readings. Limitations to obtaining home readings include access to sphygmomanometers and ability to provide accurate, reliable readings upon follow-up. Objective: This study examined whether an online platform linked to remote BP monitoring improved BP management and facilitated effective clinical interventions by pharmacists. Methods: Thirty patients with uncontrolled hypertension were enrolled and provided a remote BP monitor for home use. BP data downloaded to an online platform were monitored by two clinic pharmacists. Daily BP checks were requested (up to twice daily), and pharmacists called patients approximately weekly for 6 months. Through approved protocols, pharmacists individualized interventions to improve patient care. Descriptive statistics were used for demographic and clinical data. Results: The average systolic BP reduction was 39 mmHg (IQR = 17-52.5) for the 21 patients included in analysis. A target BP <140/<90 was achieved by 67%, and 76% had improved BP control. Patients utilized the cuff 2-4 times (n = 10) or >5 times weekly (n = 11). Through 261 patient contact attempts, the pharmacists requested more BP checks (n = 62), changed medications (n = 57), or provided non-pharmacologic counseling (n = 24) most often. Medication changes commonly included dose increases (n = 35) and additional agents (n = 17) for BP control. Spironolactone (n = 5) and thiazide diuretics (n = 5) were the most added medications. Conclusions: Most patients were willing to check their BP when provided with devices. The majority achieved a clinically significant decrease in home BP readings, demonstrating that pharmacist-driven home-monitoring programs can improve the optimization of hypertension regimens., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The aim of the present study is to determine similarities between patients with type 2 diabetes not on metformin therapy compared to patients on metformin therapy at a resident-led primary care clinic. Methods: An exploratory, single-center retrospective chart review was performed on patients 18 years and older with a documented diagnosis of type 2 diabetes seen at the University of Arkansas for Medical Sciences Family Medicine Clinic in Little Rock, Arkansas. Of the 2452 patients who met criteria for the study, 1085 patients did not have a documented metformin allergy. A subset of 216 patients who were not currently prescribed metformin and had no documented metformin allergy were further examined and compared to the 869 patients who were prescribed metformin. We sought to determine reasons for nonuse by evaluating their EPIC electronic health record. Information on these patients such as race, gender, hemoglobin A1c (A1c), kidney function, stated metformin intolerance, and comorbid disease states such as neuropathy, chronic kidney disease (CKD), ulcerative colitis, and irritable bowel syndrome were collected. Further examination was performed to determine why patients were not on metformin therapy and potential similarities between metformin intolerant patients. Results: The results of the study indicated a significant difference between metformin users and non-users in relation to body mass index (BMI) and diagnosis of CKD. Metformin non-users were found to have significantly lower mean BMI (30.87 vs. 35.43; p-value <0.0001), and significantly higher rates of CKD (25.93% vs 14.73%; p-value <0.0001) as compared to metformin users. BMI value of patients (coefficient: 0.2033, p value: <0.0001) was found to be significantly and positively correlated with metformin use, and CKD (coefficient: - 0.1191, p-value: <0.0001) was found to be significantly and negatively correlated with metformin use. A1c levels for patients not on metformin therapy were evaluated. Most non-metformin patients fell in prediabetic A1c levels ranging from 5-6.4% (84 patients; 38.89%), and 31 patients (14.35%) should be on insulin therapy according to guidelines. Conclusion: The results demonstrated that patients with lower BMI, CKD, or A1c in the prediabetic range were less likely to be prescribed metformin., (© Individual authors.)

Objective: To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy., Methods: PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution., Results: PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled., Conclusion: Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators., Competing Interests: Conflicts of interest The authors have no conflicts of interest to report., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

We aimed to identify the prevalence of comorbid depression, diabetes, and diabetes distress and assess glycemic control and rates of diabetes-related complications. While the presence of either depression or distress did not predict the level of glycemic control, certain macro- and microvascular complications were more prevalent with depression., Competing Interests: Conflicts of interest The authors have no conflicts of interest to disclose and certify that they have no affiliations with or involvement in any organization or entity with any personal or financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Obesity and gastric bypass surgery can complicate anticoagulation therapy. In general, patients post-bariatric surgery are considered to be at a moderate risk for deep venous thromboembolism or pulmonary embolism. American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists guidelines recommend chemical prophylaxis with unfractionated heparin or low molecular weight heparin after surgery until the patient is fully mobile, and for those who require chronic anticoagulation, the International Society of Thrombosis and Haemostasis recommend warfarin if body mass index (BMI) is above 40 kg/m 2 or weight is more than 120 kg. Clinical decision making regarding anticoagulation in the following patient case is complicated by multiple factors, most notably the combination of obesity and history of gastric bypass surgery. This patient failed multiple anticoagulation regimens, with apixaban and rivaroxaban therapies each ending in venous thromboemboli and warfarin leading to subtherapeutic International Normalized Ratio (INR)s despite dose adjustment. However, she is currently therapeutic on the combination of enoxaparin and warfarin as shown by INR and anti-Xa level monitoring. In this case and similar instances, there could be a need for anticoagulant dose adjustments, different INR goals, or a combination of different anticoagulants. Providers should take an individualized approach to patients who have had bariatric surgery with elevated BMI as a key factor in anticoagulant selection.

The goals of vascular composite allotransplantation (VCA) for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This study aimed to understand patients' knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: (1) knowledge and education around VCA as a treatment option; (2) adaptation of individuals with limb loss; (3) fear of risk associated with transplantation; (4) issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options-prosthetics, rehabilitative strategies, and VCA-can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Finnie, Griffin, Kennedy, Schaepe, Boehmer, Hargraves, Amer and Jowsey-Gregoire.)

Background: Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults., Methods: The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 1:1:1 allocation to one of three study groups: (1) Control Condition-no additional study intervention (n = 30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n = 30); (3) Loaner Digital Device + Coaching Support-loaner device plus up to six, 15-20 min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n = 30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience., Results: A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions., Conclusion: Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Diabetes is a chronic disease that is associated with many other health problems, but studies have shown that patient education can improve outcomes. The purpose of this project was to determine if a pharmacist-led group diabetes education class led to improvement in hemoglobin A1c levels., Methods: Pharmacists in a family medicine clinic conduct a group diabetes education class for patients seen within the health system. The once monthly, 90-minute education class includes content regarding pathophysiology, complications, monitoring, dietary and exercise recommendations, and common antidiabetic medications. Data were collected via retrospective chart reviews and included 66 patients. The primary outcome was change in A1c from pre-class measurement to first, post-class measurement at least 3 months after pre-class measurement. Secondary outcomes included pre-class to post-class changes in weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Outcome data were analyzed using a paired t-test and demographic data were presented with descriptive statistics., Results: The pharmacist-led diabetes education class was associated with statistically significant improvements on A1c lab values (mean decrease = 1.16%, p-value = 0.001) and weight (mean decrease = 1.8 kg, p-value = 0.03). However, SBP (mean decrease = 1.5 mmHg, p-value = 0.57) and DBP (mean decrease = 3.4 mmHg, p-value = 0.15) did not improve significantly., Implications: The results from this study support the idea that diabetes education classes are beneficial for the patient in learning how to properly manage this disease state. Pharmacists can play a vital role in diabetes management through counseling and patient education, which can improve patient outcomes.

Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity., Methods and Analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions., Registration Number: PROSPERO CRD42021236980., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Hanlon P et al.)

Background: Substance use disorder (SUD) is a known barrier to patient-self-management, which can hinder efforts to achieve treatment goals in type 2 diabetes (T2D) when the conditions coexist., Objective: Identify the association between SUD and glycemic control in patients with T2D treated in a primary care setting., Methods: This retrospective cohort study included patients with T2D treated by providers at family medicine clinics at an academic medical center and its affiliated regional sites from January 2014 to October 2019. Study index date was the first A1c recorded when T2D and SUD diagnoses had both been documented in the medical record. Glycemic control, measured by hemoglobin A1c (A1c), was identified at baseline and over a 12-month follow-up period and was compared between SUD and non-SUD patients., Results: Of 9568 included patients with T2D, 468 (4.9%) had a SUD diagnosis. In 237 SUD and 4334 non-SUD patients with A1c data, mean (SD) baseline A1c was 8.2% (2.5) and 7.9% (2.1), respectively (P = 0.043). A1c reduction was statistically greater in SUD patients than non-SUD patients (-0.31% versus -0.06%, respectively; P = 0.015), although the clinical significance is modest. In a multivariable linear regression analysis, follow-up A1c was lower in the SUD versus non-SUD patients (coefficient -0.184, 95% CI -0.358, -0.010; P = 0.038)., Conclusions: Patients with T2D and SUD had higher baseline A1c but this difference was minimized over a 12-month follow-up period. Additional research is warranted to determine long-term glycemic control and barriers to attaining and maintaining glycemic control in patients with T2D and SUD., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Background: Leadership Saves Lives (LSL) was a prospective, mixed methods intervention to promote positive change in organisational culture across 10 diverse hospitals in the USA and reduce mortality for patients with acute myocardial infarction (AMI). Despite the potential impact of complex interventions such as LSL, descriptions in the peer-reviewed literature often lack the detail required to allow adoption and adaptation of interventions or synthesis of evidence across studies. Accordingly, here we present the underlying design principles, overall approach to intervention design and core content of the intervention., Methods of Intervention Development: Hospitals were selected for participation from the membership of the Mayo Clinic Care Network using random sampling with a purposeful component. The intervention was designed based on the Assess, Innovate, Develop, Engage, Devolve model for diffusion of innovation, with attention to pressure testing of the intervention with user groups, creation of a think tank to develop a comprehensive assessment of the landscape, and early and continued engagement with strategically identified stakeholders in multiple arenas., Results: We provide in-depth descriptions of the design and delivery of the three intervention components (three annual meetings of all hospitals, four rounds of in-hospital workshops and an online community), designed to equip a guiding coalition within each site to identify and address root causes of AMI mortality and improve organisational culture., Conclusions: This detailed practical description of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals committed to understanding complex interventions across healthcare settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To use quantitative and qualitative methods to characterize the work patients with type 2 diabetes mellitus (T2DM) enact and explore the interactions between illness, treatment, and life., Patients and Methods: In this mixed-methods, descriptive study, adult patients with T2DM seen at the outpatient diabetes clinic at Mayo Clinic in Rochester, Minnesota, from February 1, 2016, through March 31, 2017, were invited to participate. The study had 3 phases. In phase 1, the Patient Experience with Treatment and Self-management (PETS) scale was used to quantify treatment burden. In phase 2, a convenience sample of patients used a smartphone application to describe, in real time, time spent completing diabetes self-management tasks and to upload descriptive digital photographs. In phase 3, these data were explored in qualitative interviews that were analyed by 2 investigators using deductive analysis., Results: Of 162 participants recruited, 160 returned the survey (phase 1); of the 50 participants who used the smartphone application (phase 2), we interviewed 17 (phase 3). The areas in which patients reported highest treatment burden were difficulty with negotiating health services (eg, coordinating medical appointments), medical expenses, and mental/physical exhaustion with self-care. Participants reported that medical appointments required about 2.5 hours per day, and completing administrative tasks related to health care required about 45 minutes. Time spent on health behaviors varied widely-from 2 to 60 minutes in a given 3-hour period. Patients' experience of a task's burden did not always correlate with the time spent on that task., Conclusion: The most burdensome tasks to patients with T2DM included negotiating health care services, affording medications, and completing administrative tasks even though they were not the most time-consuming activities. To be minimally disruptive, diabetes care should minimize the delegation of administrative tasks to patients., (© 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.)

Introduction: There are few research articles that give college faculty insight into how pharmacy residency programs evaluate applicants, and there is no data to indicate how residency program directors (RPDs) view pharmacy residency elective courses when evaluating applicants' transcripts. This study sought to describe post-graduate year 1 (PGY1) RPD perceptions of pharmacy residency electives., Methods: An online, 8-item survey was distributed to 1335 PGY1 RPDs, identified through the American Society of Health-System Pharmacists Online Residency Directory., Results: Two hundred thirty-two residency program directors participated in the survey. The majority of respondents (68.1%) stated that a residency elective would not change their perception of candidates, though 75.9% agreed that a residency elective is beneficial to the student and 53% responded that the elective would be beneficial to the residency program. Time management and research skills were the topics that were most often recommended to be included in such courses., Conclusions: Overall, responses were favorable toward pharmacy residency electives, though most stated completion of such a course would not change their assessment of candidates. These courses could be most beneficial if they include development in skills necessary for successful residency training., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier Inc. All rights reserved.)

A human immunodeficiency virus (HIV) infection is no longer an absolute contraindication for solid organ transplantation, yet such a setting is still challenging and little explored because of general reservations and medical difficulties. We describe a 51-year-old man with end-stage renal failure due to polycystic kidney disease who underwent an ABO-incompatible kidney transplantation from his 49-year-old male partner. Early postoperative course revealed an episode of suspected acute rejection, which was successfully managed with a steroid pulse. Both donor and recipient continued to have an undetectable viral load after adjusting antiretroviral medication to renal function. To the best of our knowledge, this is the first report of a successful ABO-incompatible living donor kidney transplantation from an HIV-positive donor in an HIV-positive recipient, and this case seems to be a valuable approach with favorable results., (Copyright © 2020 Elsevier Inc. All rights reserved.)

About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient's context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine-based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance., (©Thomas H Wieringa, Manuel F Sanchez-Herrera, Nataly R Espinoza, Viet-Thi Tran, Kasey Boehmer. Originally published in Journal of Participatory Medicine (http://jopm.jmir.org), 25.03.2020.)

Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.

Objectives: To summarise and synthesise published qualitative studies to characterise factors that shape patient and caregiver experiences of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)., Design: Meta-review of qualitative systematic reviews and metasyntheses. Papers analysed using content analysis., Data Sources: CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science were searched from January 2000 to April 2015., Eligibility Criteria for Selecting Studies: Systematic reviews and qualitative metasyntheses where the participants were patients, caregivers and which described experiences of care for CHF, COPD and CKD in primary and secondary care who were aged ≥18 years., Results: Searches identified 5420 articles, 53 of which met inclusion criteria. Reviews showed that patients' and caregivers' help seeking and decision-making were shaped by their degree of structural advantage (socioeconomic status, spatial location, health service quality); their degree of interactional advantage (cognitive advantage, affective state and interaction quality) and their degree of structural resilience (adaptation to adversity, competence in managing care and caregiver response to demands)., Conclusions: To the best of our knowledge, this is the first synthesis of qualitative systematic reviews in the field. An important outcome of this overview is an emphasis on what patients and caregivers value and on attributes of healthcare systems, relationships and practices that affect the distressing effects and consequences of pathophysiological deterioration in CHF, COPD and CKD. Interventions that seek to empower individual patients may have limited effectiveness for those who are most affected by the combined weight of structural, relational and practical disadvantage identified in this overview. We identify potential targets for interventions that could address these disadvantages., Systematic Review Registration Number: PROSPERO CRD42014014547., Competing Interests: CP declares consultancy payments from National Institute for Health and Care Excellence and the Department of Health., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)