Diabetes Care and Outcomes: Disparities Across Rural America

We examined differences in receipt of diabetes care and selected outcomes between rural and urban persons living with diabetes, using nationally representative data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS). “Rural” was defined as living in a non-metropolitan county. Diabetes care variables were physician visit, HbA1c testing, foot examination, and dilated eye examination. Outcome variables were presence of foot sores and diabetic retinopathy. Analysis was limited to persons 18 and older self-reporting a diagnosis of diabetes (n = 29,501). A lower proportion of rural than urban persons with diabetes reported a dilated eye examination (69.1 vs. 72.4%; P = 0.005) or a foot examination in the past year (70.6 vs. 73.7%; P = 0.016). Conversely, a greater proportion of rural than urban persons reported diabetic retinopathy (25.8 vs. 22.0%; P = 0.007) and having a foot sore taking more than four weeks to heal (13.2 vs. 11.2%; P = 0.036). Rural residence was not associated with receipt of services after individual characteristics were taken into account in adjusted analysis, but remained associated with an increased risk for retinopathy (OR = 1.20, 95% CI = 1.02–1.42). Participation in Diabetes Self-Management Education (DSME) was positively associated with all measures of diabetes care included in the study. Availability of specialty services and travel considerations could explain some of these differences.     

The process of evidence-based practice in occupational therapy: Informing clinical decisions

As we move into the 21st century, there are increasing demands placed on occupational therapists to ensure their practice is based on sound evidence. Evidence-based practice is an approach to clinical decision making that has gained considerable interest and influence during the last decade. This article describes and explains the process of evidence-based practice and its application to clinical occupational therapy practice. Directions for resources that may assist therapists' self-directed learning are also provided. As health care becomes more evidence-based, awareness of the principles, skills, and resources for evidence-based practice is of relevance to all occupational therapists.     

Mechanisms of injury in unilateral testis torsion

We investigated the mechanisms of injury involved in unilateral testis torsion as well as the interventional effects of orchiectomy at 48 h and immunosuppression with corticosteroids in rats. Torsion was associated with abnormal contralateral testis histology and raised antilymphocytes and antisperm antibody titers. Both orchiectomy and steroid administration lessened these findings, suggesting that an immunological process underlies the abnormality seen in this experiment model.     

Prognostic implication and characterization of the blast cell population in the myelodysplastic syndrome

The bone marrow smears of 18 confirmed cases of MDS were analyzed carefully for the presence of “hypergranular type III blasts”, defined as more than 20 fine azurophil primary granules per cells. The concordance was close to 80% among 5 observers. Thirty-nine percent (7 cases) were reclassified as RAEB-t rather than RAEB. The presence of these hypergranular blasts was not suggestive of increased differentiation but rather leukemic cells. The reassignment of cases altered the median survival for the various subcategories, providing a clearer separation with the introduction of type III blasts than without utilizing these cells which were separated from the promyelocyte family. The introduction of this new blast cell definition in a larger series of patients is recommended to confirm these preliminary observations.     

Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents

Original Gianturco expandable stents and their modifications were used to create an experimental intrahepatic portacaval anastomosis (EIPCA) in 30 young domestic swine without portal hypertension. The study focused on the design of a suitable stent, the technique of its application, and the evaluation of short-term patency of the EIPCA. A stent with a 2.5-cm-long body and wire skirts on both ends was most suitable for EIPCA creation. Well-positioned stents shunted most of the portal blood in the inferior vena cava circulation and remained patent for 4-6 weeks. Ingrowth of liver parenchyma and abundant proliferation of the intima and connective tissue inside the stent lumen in these rapidly growing animals gradually decreased EIPCA patency, and thrombus formation with diminished blood flow closed them completely.     

Bullet wound of the heart,with coronary artery ligation

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1. Serial electrocardiograms, made after ligation of the anterior descending branch of the left cororary artery, which had been severed by a bullet, are reported. This is the third case in which chest leads were recorded after a heart wound in man.     

The drama of discharge: worker/supervisor perspectives

This paper examines the process of discharge planning in the framework of drama, as exemplified in one case. The thoughts and actions of the social worker and the social work supervisor are delineated in order to highlight four points, that: decision making in discharge planning impacts strongly on all the participants involved; the constraints of the hospital setting and regulatory mandates often result in dilemmas of choice for the patient and family; for social workers new to helping in such situations, supervisory guidance and support is an essential component for practice; and the values, knowledge and skill of the social work professionals ensure that discharge decisions and interventions are effected in a manner that is both humane and accountable.