Improving COVID-19 Research of University Hospitals in Germany: Formative Usability Evaluation of the CODEX Feasibility Portal

Background  Within the German “Network University Medicine,” a portal is to be developed to enable researchers to query on novel coronavirus disease 2019 (COVID-19) data from university hospitals for assessing the feasibility of a clinical study. Objectives  The usability of a prototype for federated feasibility queries was evaluated to identify design strengths and weaknesses and derive improvement recommendations for further development. Methods  In the course of a remote usability test with the thinking-aloud method and posttask interviews, 15 clinical researchers evaluated the usability of a prototype of the Feasibility Portal. The identified usability problems were rated according to severity, and improvement recommendations were derived. Results  The design of the prototype was rated as simple, intuitive, and as usable with little effort. The usability test reported a total of 26 problems, 8 of these were rated as “critical.” Usability problems and revision recommendations focus primarily on improving the visual distinguishability of selected inclusion and exclusion criteria, enabling a flexible approach to criteria linking, and enhancing the free-text search. Conclusion  Improvement proposals were developed for these user problems which will guide further development and the adaptation of the portal to user needs. This is an important prerequisite for correct and efficient use in everyday clinical work in the future. Results can provide developers of similar systems with a good starting point for interface conceptualizations. The methodological approach/the developed test guideline can serve as a template for similar evaluations.     

Design and Implementation of Patient Portal–Based Advance Care Planning Tools

Background

Electronic health record–based portal tools may help patients engage in advance care planning (ACP). We designed and implemented portal-based ACP tools to enable patients to create a medical durable power of attorney (MDPOA).

糖尿病患者合并感染及其危险因素

对１６１例住院糖尿病（ＤＭ）患者合并感染及其危险因素进行前瞻性监测研究。其中合并感染者５６例，１０５例患者未发生任何部位感染。应用成组病例对照研究方法，通过单因素分析发现：性别、血浆白蛋白、血红蛋白浓度、２４ｈ尿糖定量、使用胰岛素等因素与ＤＭ患者发生感染有显著的关系（Ｐ＜０．０５或Ｐ＜０．０１）。Ｌｏｇｉｓｔｉｃ回归分析筛选出３个相互独立的与ＤＭ合并感染有显著关系的因素，２４ｈ尿糖定量和住院时间与ＤＭ合并感染的发生呈正相关，血浆白蛋白浓度与ＤＭ感染的发生呈负相关，血浆蛋白低是感染的易发因素     

社区老年糖尿病患者使用胰岛素笔的调查分析与干预

目的了解社区老年糖尿病患者使用胰岛素笔的现状。方法对300例老年糖尿病患者采用问卷调查的方式,了解他们非住院期间使用胰岛素笔的注射方法及存在误区。结果20％的老年患者对疼痛有惧怕感;10％的老年患者对于在社交场所注射有窘迫感;30％的老年患者注射部位出现红肿、青紫或硬结;22％的老年患者遵医行为不强,随意调整注射剂量;33％的老年患者注射过程中,未按照无菌原则进行操作;28％的老年患者容易遗漏注射次数等。结论有针对性地加强社区老年糖尿病患者胰岛素知识的宣教,可以帮助老年患者正确掌握胰岛素的使用方法。     

Diabetes Distress: Assessment and Management of the Emotional Aspect of Diabetes Mellitus

Management of diabetes is well known to be a complex endeavor with many physical and psychological implications. Historically, primary focus has been on the physical complications of diabetes, with little attention being placed on the psychological repercussions. Patients with diabetes deal with intense psychological complications secondary to diabetes management, termed diabetes distress. Although related to emotions, this phenomenon differs from depression or anxiety. Management of diabetes distress includes a psychological approach with diabetes-specific care. Person-centered and positive strength-based language help build the clinician-patient relationship. Diabetes distress care is part of comprehensive diabetes management.     

New Vision for a Patient with Diabetes and Retinal Migraines

Retinal migraine is a chronic, disabling headache disorder that strikes sufferers with recurrent, transient episodes of monocular vision loss before the onset of a throbbing headache on the same side as the visual disturbance. The author discusses the experience of a patient with type 2 diabetes perceiving these frightening episodes of transient visual disturbances during the coronavirus disease 2019 pandemic in which stressors and missed meals precipitated and exacerbated these attacks. With an increased understanding of the characteristics of retinal migraines, nurse practitioners can work closely with other health care professionals to provide comprehensive and patient-centered care to these individuals.     

Ⅱ型糖尿病患者自我管理水平及其相关因素的研究

目的 研究Ⅱ型糖尿病患者自我管理水平及其相关因素。方法 采用自我管理量表和基本资料问卷,对198例门诊患者作一般资料、疾病资料、自我管理水平的调查。结果 从198例Ⅱ型糖尿病患者的自我管理总分来看,水平良好26％(51／198),一般69％(97／198),差25％(50／198);而从自我管理单项分值来看,良好的人数均在≤15％,中等水平则集中在饮食、药物、低血糖管理,管理水平差主要反映在运动、血糖监测、糖尿病足,总的来说,糖尿病患者自我管理水平较差。Ⅱ型糖尿病患者的自我管理能力与年龄、职业、文化程度、病程长短、经济状况、接受健康教育情况等因素有关。结论 Ⅱ型糖尿病患者自我管理水平总体偏低,并受诸多因素的影响,积极开展自我管理教育,充分地调动患者的主观能动性,让患者承担起管理自身疾病的责任和任务,提高治疗效果。     

Clinicians' Perspectives of Patient Engagement in Post-Acute Care: A Social Ecological Approach

Aims: To identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model. Methods: We conducted 13 focus groups in SNFs throughout Los Angeles County comprised of rehabilitation staff (n = 99). Focus groups were audio-recorded and transcribed. A secondary analysis of themes related to patient engagement were identified and organized within the social ecological model. Results: Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety). Conclusions: Examining barriers and facilitators to patient engagement has highlighted areas which need to be sustained and improved. Thus, these findings will inform future efforts to enhance patient engagement in order can to optimize patient healthcare decisions.     

Hypoglycemia in Diabetes: Challenges and Opportunities in Care

Optimal glycemic control, an A1c < 7% for most patients, is necessary to reduce the risk for diabetes complications. However, tight glucose control carries a risk for hypoglycemia. Hypoglycemia can be a frightening aspect of living with diabetes, causing harmful effects to the cardiovascular system and a decrease in quality of life. This article reviews the important aspects of hypoglycemia management from both the patient and provider perspective. Nurse practitioners (NPs) should understand the physiology behind glucose homeostasis and lead evidence-based discussions regarding medication timing and dose, physical activity/exercise, alcohol consumption, symptom management, treatment, and prevention of low blood glucoses. The management of special populations such as older adults, those with renal impairment, and pregnant women is included. In light of mounting evidence that hypoglycemia is harmful and should be avoided at all costs, NPs are well positioned to assist patients in identifying, managing, and preventing hypoglycemia.     

After Gestational Diabetes: An Overlooked Care Transition in Primary Care

Women with history of gestational diabetes mellitus (GDM) have significant risk for developing type 2 diabetes (T2D), especially within 6 years of giving birth. Children exposed to GDM-complicated pregnancies may also experience future metabolic abnormalities. Care transitions following GDM-complicated pregnancies are often fragmented resulting in missed opportunities to implement T2D prevention strategies. Primary care providers of women with history of GDM and their children have opportunities to deliver transgenerational health promotion interventions encompassing: T2D screening, reproductive life planning, lifestyle changes to support reduction of GDM-related metabolic risks, self-advocacy for lifelong T2D screening, weight management, and promotion of breastfeeding.     

Changes in alcohol consumption and related factors in diabetic Japanese men

Aim: The aim of the present study was to investigate changes in alcohol consumption and related factors in diabetic men. Methods: A cross‐sectional survey using a self‐administered questionnaire and a complementary interview about alcohol consumption was carried out among male diabetic outpatients at a university hospital in Japan (n = 126, 97.0% response rate). Results: Half of the eligible participants had reduced their alcohol consumption by more than 50% between the time of diagnosis of diabetes and the time of the investigation. Of the 65 subjects who consumed more than 200 g/week of alcohol at the time of diagnosis, 70.8% had reduced their alcohol consumption by more than 50% at the time of the investigation and 46.2% had reduced it by more than 80%. Factors related to the reduction in alcohol consumption at the time of the investigation by the 65 subjects whose alcohol consumption at the time of diagnosis was more than 200 g/week were: awareness of diabetic retinopathy (P < 0.01), the presence of acute symptoms at the time of diagnosis of diabetes (P = 0.03), and age <45 years at the time of diagnosis of diabetes (P = 0.07). Reasons for reducing alcohol consumption included ‘explanation by the medical team’, and ‘progression of diabetic retinopathy’. Reasons for maintaining high alcohol consumption included ‘absence of symptoms’. Conclusions: The results of this study suggest that approaches that support awareness of the patient's condition or vulnerability to disease are important for appropriate management of alcohol consumption.     

妊娠糖尿病孕妇健康教育干预的效果

目的探讨健康教育在控制妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇孕期血糖和改善妊娠结局中的作用,并摸索针对GDM孕妇的孕期教育模式。方法对干预组60例GDM孕妇进行糖尿病相关知识的问卷调查并实施糖尿病系统化教育和治疗,同时设60例常规产前护理的GDM孕妇为对照组,就其血糖变化和妊娠结局进行比较。结果实施糖尿病系统化教育前后,GDM孕妇的相关知识水平有了极大的提高(P<0.01),干预组的血糖控制与对照组相比有显著差异(P<0.01),其妊娠结局也明显优于对照组(P<0.01)。结论对GDM孕妇实施健康教育能使她们更好地控制血糖,改善妊娠结局,从而保证母婴健康。     

社区护理干预对老年糖尿病患者生活质量的影响

目的 研究护理干预对本社区老年糖尿病患者生活质量的影响。方法 采用康耐尔医学指数健康问卷设计的糖尿病知1只问卷,对95例社区老年糖尿病患者糖尿病知识、自我管理能力、糖尿病代谢控制指标、生活满意度进行干预前后评估,根据评估结果进行糖尿病知识讲座、个体针对性治疗、饮食、运动、药物、自我监测、并发症防治、足部护理、心理卫生指导等社区护理干预。结果 持续干预后患者的自我管理能力、糖尿病知识总评分、糖尿病代谢指标、对生活的满意度均明显优于干预前;干预前后比较均有显著性差异（P〈0．01或P〈0．001）。结论 针对性的社区护理干预能有效促进社区老年糖尿病患者病情的良性转归,提高生活质量。     

Empowering the Health and Well-Being of the Palliative Care Workforce: Evaluation of a Weekly Self-Care Checklist

BackgroundWorkplace interventions are needed to prevent burnout and support the well-being of the palliative care workforce.MeasuresWe conducted a survey of all palliative care clinical staff to evaluate the usefulness and feasibility of checklist items and the checklist itself. We collected demographics, perceptions of professional satisfaction and burnout, and qualitative feedback aimed at improving the checklist.InterventionWe implemented a 13-item self-care checklist, included in a handbook on palliative care carried in the laboratory coat of all clinical personnel, to remind them to care of their own well-being.OutcomesOf 39 personnel contacted, 32 (82%) responded. Most (20; 62%) found the checklist useful. Exercise was the most highly ranked item, whereas watching visual arts was the lowest ranked item.Conclusions/Lessons LearnedNumerous opportunities were identified to improve the checklist and facilitate achievement of checklist items. Survey data will be used in the next checklist version.     

患者安全文化测评问卷的构建

目的编制符合我国护理特点的患者安全文化测评问卷,并检验其信效度,确保问卷科学、可靠。方法参考国内外文献形成问卷初稿,经过反复的专家咨询及探索性因素分析筛选和修订条目,编制出适用于医院护理人员的患者安全文化测评问卷。采用分层随机法抽取上海市三级、二级医院临床护士211名进行测评,使用SPSS 13．0医学统计软件,应用主成分分析法、内在一致性信度等评价问卷信效度。结果形成适用于医院护理人员的患者安全文化测评问卷,其主要内容是医院护理人员的安全态度调查,共分为5个维度、24个条目。5个维度分别是团队氛围、对工作的满意、对压力的认知、单位安全的氛围、对管理的感受,累计贡献率为59．879％,数据经方差最大正交旋转后,根据各条目最大维度负荷值归因,5个维度的负荷值都在0．4以上,各条目的共同性在0．432～0．697之间;问卷各维度的Cronbach’s a系数为0．7234-0．8523,总体为0．8861;各维度两次测量得分的Pearson相关系数为0．701～0．833,总体为0．895;各条目与问卷总体的相关系数在0．661～0．843,且相关性均有显著统计学意义（P〈0．01）;各维度得分与问卷总体的相关系数为0．381～0．854,且相关性均有显著统计学意义（P〈0．01）。结论初步编制了适用于医院护理人员的患者安全文化测评问卷,信效度良好。