How Does Regional Hypertrophy Affect Strain Measurements With Different Speckle-Tracking Methods?

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CA6-02: Collaborative Goal Setting and HbA1c Control Among Patients With Diabetes

Background/Aims Helping patients set and follow up on goals may be an effective way to help patients improve their confidence (self-efficacy) and commitment to improve diabetes self- management. We evaluate associations among patient-reported use of collaborative goal setting with clinicians, patient-reported self-efficacy, and clinical control (measured by HbA1c) among patients with diabetes. Methods A cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000-2005 was surveyed in 2008. The survey included the 3 collaborative goal-setting items from the Patient Assessment of Chronic Illness Care (PACIC), a 4-item measure of self-efficacy, measures of socio-demographics, age of diabetes onset, and height/weight. Survey data were joined with automated laboratory and encounter data for the 12 months prior to and following survey administration. A structural equation model (SEM), using path analysis and adjusting for baseline patient characteristics (including HbA1c and diabetes-related co-morbidities and complications), was fit to investigate relationships among collaborative goal setting, self-efficacy and HbA1c control. Results Completed surveys were available for 1070 patients (n=956 mail and n=114 telephone; 77% response rate). Survey respondents were on average 68 years, half were female, 60% white, 31% black, and 57% reported low self-efficacy. On average, patients reported engaging in collaborative goal setting with their clinicians 'sometimes' (mean = 3.1, range 1 [never]-5 [always]). At baseline, mean HbA1c was 7.2%, with 22% =8%. Results from the SEM did not support a direct relationship between the collaborative goal setting factor (Cronbach Alpha=0.83) and HbA1c control, but did support an indirect relationship (asymmetric distribution of products 95% CI = -0.02, -0.002) with increases in collaborative goal setting positively associated with a greater likelihood of average or high self-efficacy (beta, p<0.01), and average or high self-efficacy associated with lower follow-up HbA1cs level (-beta, p<0.01). These relationships persisted after controlling for baseline HbA1c and other patient characteristics. Discussion While collaborative goal setting between patients with diabetes and their clinicians is not directly associated with better clinical control, it is associated with improved self-efficacy, which in turn, is associated with improved clinical control.     

Counselling the Families Of Children With Learning Disorders

Learning disorders in children tend to disrupt the whole family. The physician can help parents to recognize realistic and unrealistic expectations, so that their attitude towards the child can be as positive as possible. Use of community services and appropriate medication are discussed.     

Engaging Families in the Residential Treatment Process Utilizing Family-Directed Structural Therapy

This article summarizes qualitative and quantitative literature specific to family involvement in children's residential treatment, highlighting the lack of specific types or methods of family therapy/interventions that might provide efficacious outcomes with this population. An overview of Family-Directed Structural Therapy (FDST) and corresponding assessment tools is presented, offering a means by which to begin to address this gap in the literature and practice knowledge. Finally, an interview with the Executive Director of a residential treatment facility successfully implementing FDST is summarized.     

Parents’ and Service Providers’ Perceptions of the Family Goal Setting Tool: A Pilot Study

Background This qualitative study describes parents’ and service providers’ experiences in using the Family Goal Setting Tool (FGST). This article looks specifically at the tool’s perceived clinical utility during annual, collaborative goal setting. Methods Participants included eight parents and ten service providers involved in a Family and Early Childhood Service in Queensland, Australia. Participants were interviewed individually (parents and one service provider) or in a focus group (service providers). The transcribed interviews were analysed using standard content analysis techniques. Results Four key themes emerged including: (i) the facilitation of goal setting, (ii) strengths‐based focus, (iii) family centred processes and (iv) family empowerment. Conclusions Both parents’ and service providers’ were positive about the FGST. Insights into barriers to holistic goal setting and the clinical utility of the tool are described. Further refinement of the tool and trial in a range of early intervention contexts is required.     

Caring for the Child With an Autism Spectrum Disorder in the Acute Care Setting

PURPOSE. This article explores the challenges that patients with autistic spectrum disorders (ASDs) face when hospitalized and provides assessment strategies and plan-of-care suggestions for nursing caregivers. CONCLUSIONS. With a high prevalence rate of medical comorbidities among this population, such as gastrointestinal complaints and seizures, nurses are likely to care for hospitalized patients with an ASD. PRACTICE IMPLICATIONS. For a child with an ASD, hospitalization can be an overwhelming sensory and cognitive experience. Nurses equipped with an understanding of the unique needs of a child with ASD can tailor the plan of care to reduce patient and family anxiety, optimize treatment goals, and reduce the stress of hospitalization.     

Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting

ObjectiveTo develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA).DesignProspective cohort study.SettingInpatients in a tertiary care hospital.ParticipantsA sample of patients (N=2300) who underwent primary TKA in 2016-2017.InterventionsNot applicable.Main Outcome MeasureCandidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome of interest was mobility limitations on post-TKA day 3, and this was determined a priori by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy.ResultsOn post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance index of 0.72 (95% confidence interval, 0.68-0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range of movement, low-volume surgeon, contralateral knee pain, higher body mass index, non-Chinese race, and greater self-reported walking limitations preoperatively.ConclusionWe have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning.     

Hyperlactation: How Left-brained ‘Rules’ for Breastfeeding Can Wreak Havoc With a Natural Process

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief.