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Mark Earnest Shale L. Wong Steve Federico Lilia Cervantes 《Journal of general internal medicine》2023,38(1):208
The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for. 相似文献
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Anne-Sophie Boureau MD PhD Béatrice Guyomarch MSc Pierre Gourdy MD PhD Ingrid Allix MD Cédric Annweiler MD PhD Nathalie Cervantes MD Guillaume Chapelet MD Isabelle Delabrière MD Sophie Guyonnet PhD Rachel Litke MD PhD Marc Paccalin MD PhD Alfred Penfornis MD PhD Pierre-Jean Saulnier MD PhD Matthieu Wargny MD PhD Samy Hadjadj MD PhD Laure de Decker MD PhD Bertrand Cariou MD PhD 《Journal of the American Geriatrics Society》2023,71(7):2107-2119
Background
There is a lack of real-life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin-treated T2D.Methods
This prospective multicenter study included 155 insulin-treated T2D patients aged 75 years and older with ≥2 self-monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am).Results
The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG-confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty-two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia.Conclusion
Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin-treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population. 相似文献808.
Henry W. Chen BS Emily E. Limmer MD Adrienne K. Joseph MD Kathryn Kinser MD Amanda Trevino BS Angel Valencia BS Rachel A. Weinheimer MD Sara Hassan Youssef MD Cecilia Cervantes CHW Maria Teresa Guzman CHW Ana Morales CHW Sandy Morales CHW Maurica Contreras APRN CNS FNP-C Faye Eifert MSN APRN FNP-C Darci LaMontagne RN CPNP Sarah Nouri MD MPH Fabiola Reyes MD Amit G. Pandya MD Arturo R. Dominguez MD 《Pediatric dermatology》2023,40(1):69-77