We investigated domains of spousal support among diabetic Korean seniors and their spouses. We conducted two focus groups with diabetic participants and three with their spouses from the greater Los Angeles Korean community asking participants to describe the spousal support given or received for diabetes self-management. Each group was composed of 4–9 participants. Focus groups were audiotaped, transcribed, translated; two independent coders identified domains of spousal support. Content analysis identified six domains: diet, exercise, emotional support, medical regimen, communication with clinicians, and information. Diet was the most frequently described domain across all groups. Gender differences were noted in domains of information, communication, and treatment among diabetic participants. Both diabetic and spouse participants identified individualizing spousal support and recognizing diabetes management as teamwork as important elements of successful spousal support. Spousal support education for Korean seniors might have the greatest impact by incorporating these six domains, addressing gender differences, providing tips on individualizing support, and cultivating teamwork.
Background: Primary open-angle glaucoma is a progressive optic neuropathy that can cause an irreversible loss of vision. A reduction in intraocular pressure (IOP) is beneficial in slowing or halting its progression. Once-per-day monotherapy glaucoma medications, such as prostaglandin analogues, are effective in lowering IOP while maintaining patients' adherence. Achieving the desired target IOP often requires multiple medications. The present study evaluates punctal occlusion of both the inferior and superior puncta as an adjunctive therapy to travoprost ophthalmic solution 0.004% for patients with primary open-angle glaucoma or ocular hypertension in order to reduce IOP. Methods: Thirteen patients who were using travoprost 0.004% ophthalmic solution for the treatment of open-angle glaucoma or ocular hypertension received silicone punctal plugs in the superior and inferior puncta of one eye. After one month, the IOP was remeasured. The percentage change of the IOP from the baseline was analysed by using a paired sample t-test. Results: The mean baseline IOP was 19.82 Ϯ 1.19 mmHg in the test eyes and 18.32 Ϯ 1.11 mmHg in the control eyes. The mean IOP at the one-month visit was 18.23 Ϯ 1.17 mmHg in the test eyes and 18.45 Ϯ 1.04 mmHg in the control eyes. The test eyes demonstrated a decrease in IOP of 1.59 (Ϯ 0.95) mmHg from the baseline, or a 6.82 per cent decrease in the IOP from the baseline. The control eyes had an increase in IOP of 0.14 Ϯ 0.77 mmHg from the baseline, or a 1.91 per cent increase in the IOP. The relative difference in the IOP between the test eyes and the control eyes at the one-month visit was 1.73 mmHg, or 8.74 per cent. Conclusion: Based on the results of this study, punctal occlusion offers a statistically and clinically significant decrease in IOP when it is used as an adjunctive therapy to travoprost 0.004% for patients who are suffering from open-angle glaucoma or ocular hypertension.
SummaryBackground/ObjectivesElectronic phenotyping is a method of using electronic‐health‐record (EHR) data to automate identifying a patient/population with a characteristic of interest. This study determines validity of using EHR data of children with overweight/obesity to electronically phenotype evidence of clinician ‘attention’ to high body mass index (BMI) and each of four distinct comorbidities.MethodsWe built five electronic phenotypes classifying 2‐18‐year‐old children with overweight/obesity (n = 17,397) by electronic/health‐record evidence of distinct attention to high body mass index, hypertension, lipid disorders, fatty liver, and prediabetes/diabetes. We reviewed, selected and cross‐checked random charts to define items clinicians select in EHRs to build problem lists, and to order medications, laboratory tests and referrals to electronically classify attention to overweight/obesity and each comorbidity. Operating characteristics of each clinician‐attention phenotype were determined by comparing comprehensive chart review by reviewers masked to electronic classification who adjudicated evidence of clinician attention to high BMI and each comorbidity.ResultsIn a random sample of 817 visit‐records reviewed/coded, specificity of each electronic phenotype is 99%–100% (with PPVs ranging from 96.8% for prediabetes/diabetes to 100% for dyslipidemia and hypertension). Sensitivities of the attention classifications range from 69% for hypertension (NPV, 98.9%) to 84.7% for high‐BMI attention (NPV, 92.3%).ConclusionsElectronic phenotypes for clinician attention to overweight/obesity and distinct comorbidities are highly specific, with moderate (BMI) to modest (each comorbidity) sensitivity. The high specificity supports using phenotypes to identify children with prior high‐BMI/comorbidity attention.
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