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Salgado TM, Radwan RM, Hickey Zacholski E, Mackler E, Buffington TM, Musselman KT, Irvin WJ, Perkins JM, Le TN, Dixon DL, Farris KB, Sheppard VB, Jones RM. Oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients with cancer undergoing chemotherapy: a cross sectional study. Support Care Cancer 2023; 31:450. [PMID: 37421495 DOI: 10.1007/s00520-023-07927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To assess oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients undergoing chemotherapy. METHODS In this cross-sectional study, a questionnaire collected oncologists' perceptions about professionals responsible for managing hyperglycemia during chemotherapy; comfort (score range 12-120); and knowledge (score range 0-16). Descriptive statistics were calculated including Student t-tests and one-way ANOVA for mean score differences. Multivariable linear regression identified predictors of comfort and knowledge scores. RESULTS Respondents (N = 229) were 67.7% men, 91.3% White and mean age 52.1 years. Oncologists perceived endocrinologists/diabetologists and primary care physicians as those responsible for managing hyperglycemia during chemotherapy, and most frequently referred to these clinicians. Reasons for referral included lack of time to manage hyperglycemia (62.4%), belief that patients would benefit from referral to an alternative provider clinician (54.1%), and not perceiving hyperglycemia management in their scope of practice (52.4%). The top-3 barriers to patient referral were long wait times for primary care (69.9%) and endocrinology (68.1%) visits, and patient's provider outside of the oncologist's institution (52.8%). The top-3 barriers to treating hyperglycemia were lack of knowledge about when to start insulin, how to adjust insulin, and what insulin type works best. Women (ß = 1.67, 95% CI: 0.16, 3.18) and oncologists in suburban areas (ß = 6.98, 95% CI: 2.53, 11.44) had higher comfort scores than their respective counterparts; oncologists working in practices with > 10 oncologists had lower comfort scores (ß = -2.75, 95% CI: -4.96, -0.53) than those in practices with ≤ 10. No significant predictors were identified for knowledge. CONCLUSION Oncologists expected endocrinology or primary care clinicians to manage hyperglycemia during chemotherapy, but long wait times were among the top barriers cited when referring patients. New models that provide prompt and coordinated care are needed.
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Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, and Massey Cancer Center, Virginia Commonwealth University, PO Box 98053, 410 N. 12th Street, Richmond, VA, 23298, USA.
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA.
| | - Rotana M Radwan
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Erin Hickey Zacholski
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Emily Mackler
- Michigan Oncology Quality Consortium (MOQC) and Michigan Institute for Care Management and Transformation (MICMT), 4251 Plymouth Road Arbor Lakes, Building 3, Floor 3, Ann Arbor, MI, 48105, USA
| | - Tonya M Buffington
- Bon Secours Mercy Health, 611 Watkins Centre Parkway, Suite 250, Midlothian, Richmond, VA, 23114, USA
| | - Kerri T Musselman
- Emcara Health and PopHealthCare, 113 Seaboard Lane, Suite B200, Franklin, TN, 37067, USA
| | - William J Irvin
- Bon Secours Cancer Institute, Bon Secours Mercy Health, 14051 St Francis Blvd Suite 2210, Midlothian, VA, 23114, United States
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, Endocrinology Clinic at Parnassus 400 Parnassus Ave., Suite A-550, San Francisco, CA, 94143, USA
| | - Trang N Le
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, 1101 E. Marshall St. Sanger Hall Suite 1-030, Richmond, VA, 23298, USA
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Population Health, and Massey Comprehensive Cancer Center, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23219, USA
| | - Resa M Jones
- Department of Epidemiology & Biostatistics, College of Public Health, and Fox Chase Cancer Center, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th Floor, Suite 917, Philadelphia, PA, 19122, USA
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Kreider KE. Endocrine Edition March 2023. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Tsai K, Long C, Liang TZ, Napolitano J, Khawaja R, Leung AM. Driving Factors to Pursue Endocrinology Training Fellowship: Empirical Survey Data and Future Strategies. J Clin Endocrinol Metab 2022; 107:e2459-e2463. [PMID: 35165741 DOI: 10.1210/clinem/dgac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There is a current and anticipated labor shortage of endocrinologists in the United States. Over the past decade, the number of applications to endocrinology fellowship programs has plateaued despite increased available positions, and interest in endocrinology has declined relative to other internal medicine subspecialty fields. The examination of driving factors for pursuit of endocrinology as a subspecialty career is needed. METHODS A 12-question online survey was developed to identify the primary reasons for current endocrinology fellows/trainees to pursue the field. This survey was sent to 152 U.S. endocrinology fellowship program directors for completion by their fellows between July and August 2021. RESULTS A total of 176 of 629 fellows (28.0%) completed the survey. The majority (57.4%) had decided to pursue endocrinology as a career during residency, while 27.3% had decided during medical school. The endocrinology rotation during residency was ranked by 79 fellows (44.9%) as the most influential factor, followed by having positive experiences with a clinical mentor (27.3%). Endocrinology exposure during medical school was sparse, with only 2.8% noting the availability of an endocrinology student interest group, while 59.7% reported inadequate endocrinology exposure during their medical school curriculum. CONCLUSION The majority of current endocrinology fellows/trainees report that exposure to the field during medical school was limited, and that their endocrinology elective and mentorship experiences during residency were the most influential factors for pursuing endocrinology as a subspecialty. Improved integration of endocrinology experiences between medical school and residency may enhance career interest in endocrinology.
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Affiliation(s)
- Karen Tsai
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Clarine Long
- The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Tom Z Liang
- Department of Pathology, Keck Medical Center of USC, Los Angeles, CA 90033, USA
| | - Jason Napolitano
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Raheela Khawaja
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, OH 43210, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
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Long C, Tsai K, Napolitano JD, Khawaja RA, Leung AM. The Current Status of Preclinical Endocrine Education in U.S. Medical Schools. Endocr Pract 2022; 28:744-748. [PMID: 35452814 DOI: 10.1016/j.eprac.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterize the current landscape of pre-clinical medical endocrine education in United States (U.S.) allopathic medical schools. METHODS U.S. endocrine curriculum directors were asked to voluntarily complete a 16-question emailed survey surveying the status of endocrine pre-clinical education at their medical school. RESULTS There were 69 of 155 (45%) endocrine block director respondents who completed the online survey between July to Sept 2021. A larger incoming class, a longer duration of an endocrine curriculum, and the offering of a separate endocrine curriculum (i.e. apart from the teaching of other organ systems) were each independently associated with an increased number of faculty teaching the course. Schools that used a gland/organ-based curriculum only and those that used a combination of gland/organ with topic based were differed significantly in their use of large lectures, small groups, and several curriculum components including point of care glucose testing, continuous glucose monitoring, and insulin pumps. CONCLUSION This survey study reports the current landscape of preclinical endocrine education in the U.S. and describes opportunities to improve interest in pursuing endocrinology as a career.
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Affiliation(s)
- Clarine Long
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen Tsai
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jason D Napolitano
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Raheela A Khawaja
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
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Lopes DF, Ramos AL, Castro EAD. The health workforce demand: a systematic literature review. CIENCIA & SAUDE COLETIVA 2021; 26:2431-2448. [PMID: 34133624 DOI: 10.1590/1413-81232021266.1.40842020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022] Open
Abstract
Understanding imbalances between the supply and demand of the human resour- ces for health (HRH) is essential for enhancing health outcomes. Addressing the HRH demand is particularly challenging, especially given the deficit of accurate data and surplus of unresolved methodological flaws. This study presents a systematic review of the literature surrounding HRH demand and answers the following key questions: How has HRH demand been addressed? What are the harms and barriers that accompany HRH demand modeling? This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Relevant keywords were used in a thorough search of the PubMed/MEDLINE, SCOPUS, and Web of Science databases. A total of 2,599 papers were retrieved and evaluated according to their title and abstract. Of these, the full-text of 400 papers was analyzed, 53 of which successfully met the inclusion criteria in our study. While the topic's relevance is widespread, it still lacks a validated approach to model HRH demand adequately. The main characteristics of the applied methods are presented, such as their application complexity by health policymakers. Opportunities and orientations for further research are also highlighted.
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Affiliation(s)
- Diana Fernandes Lopes
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal.
| | - Ana Luísa Ramos
- Departamento de Economia, Gestão, Engenharia Industrial e Turismo, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Abeiro Portugal
| | - Eduardo Anselmo de Castro
- Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal.
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Wu WC, Su DH, Chiu WY, Lin CH, Chen SC, Wang SY, Chou CK, Huang HJ, Tseng FY. Status of endocrinology and metabolism specialists in Taiwan. J Formos Med Assoc 2020; 120:588-593. [PMID: 32682703 DOI: 10.1016/j.jfma.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The literature emphasizes the importance of matching the demand and supply of endocrinology and metabolism (EM) specialists. This study analyzed the current status of EM specialists in Taiwan. The gender effects on the workplace of EM specialists were also evaluated. METHODS The number of internal medicine (IM) specialists was obtained from the websites of the Ministry of Health and Welfare. Data about EM specialists were retrieved from the database of the Endocrine Society of the Republic of China (ESROC; Taiwan). Differences in age distribution and workplace levels or locations between female and male EM specialists were analyzed. RESULTS Since 1988, 809 physicians were certified as EM specialists. The average age of 739 EM specialists (509 male, 230 female) who remained as active members of the ESROC was 49.9 ± 11.1 years. The age distribution (p < 0.001) and workplace location (p = 0.043) were significantly different between male and female EM specialists. Divided by decades, the ratio of female-to-male EM specialists revealed an increasing tendency (p < 0.001). The percentage of EM specialists among IM specialists, certified 2 years previously, declined from 14.0% in 2017 to 7.9% and 8.3% in 2018 and 2019, respectively. CONCLUSION The female-to-male ratio of EM specialists increased gradually. Compared to males, female EM specialists were relatively younger, and more of them had clinical practice in northern Taiwan. The percentage of IM specialists becoming EM specialists declined in the last 2 years. The equilibrium between the supply and demand of EM specialists deserves further investigation.
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Affiliation(s)
- Wan-Chen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Deng-Huang Su
- Department of Internal Medicine, Far-Eastern Polyclinic, Taipei, Taiwan
| | - Wei-Yih Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Chi Chen
- Department of Internal Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Shu-Yi Wang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Kai Chou
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Fen-Yu Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Garg SK, Rodbard D, Hirsch IB, Forlenza GP. Managing New-Onset Type 1 Diabetes During the COVID-19 Pandemic: Challenges and Opportunities. Diabetes Technol Ther 2020; 22:431-439. [PMID: 32302499 DOI: 10.1089/dia.2020.0161] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The current COVID-19 pandemic provides an incentive to expand considerably the use of telemedicine for high-risk patients with diabetes, and especially for the management of type 1 diabetes (T1D). Telemedicine and digital medicine also offer critically important approaches to improve access, efficacy, efficiency, and cost-effectiveness of medical care for people with diabetes. Methods: Two case reports are presented where telemedicine was used effectively and safely after day 1 in person patient education. These aspects of the management of new-onset T1D patients (adult and pediatric) included ongoing diabetes education of the patient and family digitally. The patients used continuous glucose monitoring with commercially available analysis software (Dexcom Clarity and Glooko) to generate ambulatory glucose profiles and interpretive summary reports. The adult subject used multiple daily insulin injections; the pediatric patient used an insulin pump. The subjects were managed using a combination of e-mail, Internet via Zoom, and telephone calls. Results: These two cases show the feasibility and effectiveness of use of telemedicine in applications in which we had not used it previously: new-onset diabetes education and insulin dosage management. Conclusions: The present case reports illustrate how telemedicine can be used safely and effectively for new-onset T1D training and education for both pediatric and adult patients and their families. The COVID-19 pandemic has acutely stimulated the expansion of the use of telemedicine and digital medicine. We conclude that telemedicine is an effective approach for the management of patients with new-onset T1D.
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Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado, USA
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, Maryland, USA
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado, USA
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Romeo GR, Hirsch IB, Lash RW, Gabbay RA. Trends in the Endocrinology Fellowship Recruitment: Reasons for Concern and Possible Interventions. J Clin Endocrinol Metab 2020; 105:5809736. [PMID: 32188983 PMCID: PMC7150610 DOI: 10.1210/clinem/dgaa134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Giulio R Romeo
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Irl B Hirsch
- Division of Endocrinology, Diabetes and Nutrition, University of Washington, Seattle, Washington
| | | | - Robert A Gabbay
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Robert A. Gabbay, MD, PhD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. E-mail:
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Upsher R, Allen-Taylor M, Reece I, Chamley M, Ismail K, Forbes A, Winkley K. Experiences of Attending Group Education to Support Insulin Initiation in Type 2 Diabetes: A Qualitative Study. Diabetes Ther 2020; 11:119-132. [PMID: 31732858 PMCID: PMC6965558 DOI: 10.1007/s13300-019-00727-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Type 2 diabetes is a progressive condition and many people require insulin therapy 5-10 years post diagnosis. Considering the global increase in type 2 diabetes, group education programmes to initiate insulin are beneficial as they are cost-effective and provide peer support. However, group education to initiate insulin has not been widely evaluated and there is a need to elicit the views and experience of people with type 2 diabetes who start insulin in groups. The aim of this study was to explore the perspectives of people with type 2 diabetes who receive nurse-led group-based insulin education. METHODS Qualitative, semi-structured interviews of people with type 2 diabetes in south London, UK, who had attended group education sessions to start insulin. Inductive thematic analysis identified themes within the data. RESULTS Fifteen people with type 2 diabetes were interviewed. Three main themes were identified: creating a supportive environment; facilitator skills; and effectiveness of group. Factors which created a supportive environment included peer support, providing reassurance and printed materials. Facilitator skills associated with positive experiences included addressing negative insulin beliefs and managing group dynamics. The effectiveness of the group was determined by ongoing self-management success, need for more peer support, and insulin concerns post insulin education group. CONCLUSION Positive experiences of insulin group education for people with type 2 diabetes were associated with sharing experiences with other people starting insulin, reassurance from healthcare professionals, appropriate supportive materials, and skill of the facilitator to address insulin concerns and manage group dynamics. People with type 2 diabetes may benefit more from education if healthcare professionals are skilled in psychological techniques to facilitate group education aimed at addressing concerns around insulin therapy. Further research needs to assess the effectiveness of structured insulin group education for people with type 2 diabetes.
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Affiliation(s)
- Rebecca Upsher
- Diabetes, Psychiatry, and Psychology, Department of Psychological Medicine, King's College London and Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Maya Allen-Taylor
- Florence Nightingale Faculty of Nursing and Midwifery and Palliative Care, King's College London, London, UK
| | - Ilse Reece
- Florence Nightingale Faculty of Nursing and Midwifery and Palliative Care, King's College London, London, UK
| | - Mark Chamley
- Lambeth Clinical Commissioning Group Diabetes Intermediate Care Team, South London, London, UK
| | - Khalida Ismail
- Diabetes, Psychiatry, and Psychology, Department of Psychological Medicine, King's College London and Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing and Midwifery and Palliative Care, King's College London, London, UK
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery and Palliative Care, King's College London, London, UK
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Rafiei S, Mohebbifar R, Hashemi F, Ezzatabadi MR, Farzianpour F. Approaches in Health Human Resource Forecasting: A Roadmap for Improvement. Electron Physician 2016; 8:2911-2917. [PMID: 27790343 PMCID: PMC5074749 DOI: 10.19082/2911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/30/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Forecasting the demand and supply of health manpower in an accurate manner makes appropriate planning possible. The aim of this paper was to review approaches and methods for health manpower forecasting and consequently propose the features that improve the effectiveness of this important process of health manpower planning. METHODS A literature review was conducted for studies published in English from 1990-2014 using Pub Med, Science Direct, Pro Quest, and Google Scholar databases. Review articles, qualitative studies, retrospective and prospective studies describing or applying various types of forecasting approaches and methods in health manpower forecasting were included in the review. The authors designed an extraction data sheet based on study questions to collect data on studies' references, designs, and types of forecasting approaches, whether discussed or applied, with their strengths and weaknesses. RESULTS Forty studies were included in the review. As a result, two main categories of approaches (conceptual and analytical) for health manpower forecasting were identified. Each approach had several strengths and weaknesses. As a whole, most of them were faced with some challenges, such as being static and unable to capture dynamic variables in manpower forecasting and causal relationships. They also lacked the capacity to benefit from scenario making to assist policy makers in effective decision making. CONCLUSIONS An effective forecasting approach is supposed to resolve all the deficits that exist in current approaches and meet the key features found in the literature in order to develop an open system and a dynamic and comprehensive method necessary for today complex health care systems.
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Affiliation(s)
- Sima Rafiei
- Ph.D. of Healthcare Management, Assistant Professor, Department of Health Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rafat Mohebbifar
- Ph.D. of Healthcare Management, Associate Professor, Department of Health Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fariba Hashemi
- M.Sc. in Nursing, Department of Operating Room, Faculty of Para medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Ranjbar Ezzatabadi
- Ph.D. of Health Policy, Health policy Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fereshteh Farzianpour
- Ph.D. of Healthcare Management, Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Keely E, Traczyk L, Liddy C. Patients’ Perspectives on Wait Times and the Referral-Consultation Process While Attending a Tertiary Diabetes and Endocrinology Centre: Is Econsultation an Acceptable Option? Can J Diabetes 2015; 39:325-9. [DOI: 10.1016/j.jcjd.2014.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/09/2014] [Accepted: 12/12/2014] [Indexed: 10/23/2022]
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Ishikawa T, Ohba H, Yokooka Y, Nakamura K, Ogasawara K. Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach. HUMAN RESOURCES FOR HEALTH 2013; 11:41. [PMID: 23981198 PMCID: PMC3765862 DOI: 10.1186/1478-4491-11-41] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 08/11/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND In Japan, a shortage of physicians, who serve a key role in healthcare provision, has been pointed out as a major medical issue. The healthcare workforce policy planner should consider future dynamic changes in physician numbers. The purpose of this study was to propose a physician supply forecasting methodology by applying system dynamics modeling to estimate future absolute and relative numbers of physicians. METHOD We constructed a forecasting model using a system dynamics approach. Forecasting the number of physician was performed for all clinical physician and OB/GYN specialists. Moreover, we conducted evaluation of sufficiency for the number of physicians and sensitivity analysis. RESULT & CONCLUSION As a result, it was forecast that the number of physicians would increase during 2008-2030 and the shortage would resolve at 2026 for all clinical physicians. However, the shortage would not resolve for the period covered. This suggests a need for measures for reconsidering the allocation system of new entry physicians to resolve maldistribution between medical departments, in addition, for increasing the overall number of clinical physicians.
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Affiliation(s)
- Tomoki Ishikawa
- Graduate School of Health Sciences, Hokkaido University, N12W5, Kita-ku, Sapporo 060-0812, Japan
| | - Hisateru Ohba
- Department of Medical Management and Informatics, Hokkaido Information University, Nishi Nopporo 59-2 Ebetsu, Hokkaido 069-8585, Japan
| | - Yuki Yokooka
- Medical Informatics, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kozo Nakamura
- Graduate School of Health Sciences, Hokkaido University, N12W5, Kita-ku, Sapporo 060-0812, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, N12W5, Kita-ku, Sapporo 060-0812, Japan
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Toledo FGS, Stewart AF. The academic and clinical endocrinology physician workforce in the U.S. J Clin Endocrinol Metab 2011; 96:942-4. [PMID: 21474691 DOI: 10.1210/jc.2011-0516] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Despite some progress in reducing the rate of diabetic complications, the epidemic rise in incidence of diabetes mellitus ensures that there will be an increasing number of patients in the coming decades with complex health care management issues who will need efficient and effective care. The management of patients with diabetes is an ever-challenging endeavor attributable to several factors. These include, among others, (1) limited provider expertise, (2) decreasing time of a patient visit, (3) increasing complexity of drug management, (4) limited use of self-monitoring of blood glucose by patients and/or providers, (5) clinical inertia, and (6) nonadherence. Technology-driven innovative solutions, including those using virtual reality, are desperately needed to assist both patients and their providers in overcoming the exigencies of this protean disease.
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Affiliation(s)
- Robert A Vigersky
- Diabetes Institute, Endocrinology Service, Walter Reed Health Care System, Washington, DC, USA.
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Barber P, López-Valcárcel BG. Forecasting the need for medical specialists in Spain: application of a system dynamics model. HUMAN RESOURCES FOR HEALTH 2010; 8:24. [PMID: 21034458 PMCID: PMC2987757 DOI: 10.1186/1478-4491-8-24] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 10/29/2010] [Indexed: 05/21/2023]
Abstract
BACKGROUND Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. METHODS We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. RESULTS In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. CONCLUSIONS The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.
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Affiliation(s)
- Patricia Barber
- University of Las Palmas de Gran Canaria, Campus Universitario de Tafira, 35017 Las Palmas de G.C., Canary Islands, Spain
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16
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Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 2009; 94:1853-78. [PMID: 19494161 PMCID: PMC5393375 DOI: 10.1210/jc.2008-2291] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT There has not been a comprehensive compilation of data regarding the epidemiology of all endocrine and metabolic disorders in the United States. EVIDENCE ACQUISITION We included 54 disorders with clinical and public health significance. We identified population-based studies that provided U.S. prevalence and/or incidence data by searching PubMed in December 2007 for English-language reports, hand-searching reference lists of six textbooks of endocrinology, obtaining additional resources from identified experts in each subspecialty, and searching epidemiological databases and web sites of relevant organizations. When available, we selected articles with data from 1998 or later. Otherwise, we selected the article with the most recent data, broadest geographical coverage, and most stratifications by sex, ethnicity, and/or age. Ultimately, we abstracted data from 70 articles and 40 cohorts. EVIDENCE SYNTHESIS Endocrine disorders with U.S. prevalence estimates of at least 5% in adults included diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, obesity, metabolic syndrome, osteoporosis, osteopenia, mild-moderate hypovitaminosis D, erectile dysfunction, dyslipidemia, and thyroiditis. Erectile dysfunction and osteopenia/osteoporosis had the highest incidence in males and females, respectively. The least prevalent conditions, affecting less than 1% of the U.S. population, were diabetes mellitus in children and pituitary adenoma. Conditions with the lowest incidence were adrenocortical carcinoma, pheochromocytoma, and pituitary adenomas. Certain disorders, such as hyperparathyroidism and thyroid disorders, were more common in females. As expected, the prevalence of diabetes mellitus was highest among ethnic minorities. Sparse data were available on pituitary, adrenal, and gonadal disorders. CONCLUSIONS The current review shows high prevalence and incidence of common endocrine and metabolic disorders. Defining the epidemiology of these conditions will provide clues to risk factors and identify areas to allocate public health and research resources.
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Affiliation(s)
- Sherita H Golden
- Johns Hopkins University School of Medicine, Division of Endocrinology and Metabolism, 2024 East Monument Street, Suite 2-600, Baltimore, Maryland 21205, USA.
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Roberfroid D, Leonard C, Stordeur S. Physician supply forecast: better than peering in a crystal ball? HUMAN RESOURCES FOR HEALTH 2009; 7:10. [PMID: 19216772 PMCID: PMC2671486 DOI: 10.1186/1478-4491-7-10] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 02/13/2009] [Indexed: 05/21/2023]
Abstract
BACKGROUND Anticipating physician supply to tackle future health challenges is a crucial but complex task for policy planners. A number of forecasting tools are available, but the methods, advantages and shortcomings of such tools are not straightforward and not always well appraised. Therefore this paper had two objectives: to present a typology of existing forecasting approaches and to analyse the methodology-related issues. METHODS A literature review was carried out in electronic databases Medline-Ovid, Embase and ERIC. Concrete examples of planning experiences in various countries were analysed. RESULTS Four main forecasting approaches were identified. The supply projection approach defines the necessary inflow to maintain or to reach in the future an arbitrary predefined level of service offer. The demand-based approach estimates the quantity of health care services used by the population in the future to project physician requirements. The needs-based approach involves defining and predicting health care deficits so that they can be addressed by an adequate workforce. Benchmarking health systems with similar populations and health profiles is the last approach. These different methods can be combined to perform a gap analysis. The methodological challenges of such projections are numerous: most often static models are used and their uncertainty is not assessed; valid and comprehensive data to feed into the models are often lacking; and a rapidly evolving environment affects the likelihood of projection scenarios. As a result, the internal and external validity of the projections included in our review appeared limited. CONCLUSION There is no single accepted approach to forecasting physician requirements. The value of projections lies in their utility in identifying the current and emerging trends to which policy-makers need to respond. A genuine gap analysis, an effective monitoring of key parameters and comprehensive workforce planning are key elements to improving the usefulness of physician supply projections.
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Kirsh S, Watts S, Pascuzzi K, O'Day ME, Davidson D, Strauss G, Kern EO, Aron DC. Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Qual Saf Health Care 2007; 16:349-53. [PMID: 17913775 PMCID: PMC2464960 DOI: 10.1136/qshc.2006.019158] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The epidemic proportions and management complexity of diabetes have prompted efforts to improve clinic throughput and efficiency. One method of system redesign based on the chronic care model is the Shared Medical Appointment (SMA) in which groups of patients (8-20) are seen by a multi-disciplinary team in a 1-2 h appointment. Evaluation of the impact of SMAs on quality of care has been limited. The purpose of this quality improvement project was to improve intermediate outcome measures for diabetes (A1c, SBP, LDL-cholesterol) focusing on those patients at highest cardiovascular risk. SETTING Primary care clinic at a tertiary care academic medical center. SUBJECTS Patients with diabetes with one or more of the following: A1c >9%, SBP blood pressure >160 mm Hg and LDL-c >130 mg/dl were targeted for potential participation; other patients were referred by their primary care providers. Patients participated in at least one SMA from 4/05 to 9/05. STUDY DESIGN Quasi-experimental with concurrent, but non-randomised controls (patients who participated in SMAs from 5/06 through 8/06; a retrospective period of observation prior to their SMA participation was used). INTERVENTION SMA system redesign. ANALYTICAL METHODS: Paired and independent t tests, chi(2) tests and Fisher Exact tests. RESULTS Each group had up to 8 patients. Patients participated in 1-7 visits. At the initial visit, 83.3% had A1c levels >9%, 30.6% had LDL-cholesterol levels >130 mg/dl, and 34.1% had SBP >or=160 mm Hg. Levels of A1c, LDL-c and SBP all fell significantly postintervention with a mean (95% CI) decrease of A1c 1.4 (0.8, 2.1) (p<0.001), LDL-c 14.8 (2.3, 27.4) (p = 0.022) and SBP 16.0 (9.7, 22.3) (p<0.001). There were no significant differences at baseline between control and intervention groups in terms of age, baseline intermediate outcomes, or medication use. The reductions in A1c in % and SBP were greater in the intervention group relative to the control group: 1.44 vs -0.30 (p = 0.002) for A1c and 14.83 vs 2.54 mm Hg (p = 0.04) for SBP. LDL-c reduction was also greater in the intervention group, 16.0 vs 5.37 mg/dl, but the difference was not statistically significant (p = 0.29). CONCLUSIONS We were able to initiate a programme of group visits in which participants achieved benefits in terms of cardiovascular risk reduction. Some barriers needed to be addressed, and the operations of SMAs evolved over time. Shared medical appointments for diabetes constitute a practical system redesign that may help to improve quality of care.
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Affiliation(s)
- Susan Kirsh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Farrell B. Microformats: three proposed standards for solving the need for standard data presentation. J Diabetes Sci Technol 2007; 1:245-50. [PMID: 19888413 PMCID: PMC2771476 DOI: 10.1177/193229680700100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The continuous glucose monitor market is just starting to develop. Current trends in the availability of diabetes information tools highlight the need for standard data presentation for continuous glucose monitors. These trends and their implications are discussed. This article proposes a set of standards for blood glucose data presentation. If device manufacturers adopt these standards, they will ensure that their continuous glucose monitors meet both the short-term and the long-term needs of users. This should increase the demand for these monitors and enable future device developments that appeal to a wider range of users.
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Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists : challenges to assuring access to oncology services. J Oncol Pract 2007; 3:79-86. [PMID: 20859376 PMCID: PMC2793740 DOI: 10.1200/jop.0723601] [Citation(s) in RCA: 402] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO. METHODS New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000-2002) of age- and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models. RESULTS Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists-roughly one-quarter to one-third of the 2005 supply. The baseline projections do not include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions. CONCLUSIONS ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery.
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Gebbie K, Merrill J, Sanders L, Gebbie EN, Chen DW. Public health workforce enumeration: beware the "quick fix". JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2007; 13:72-9. [PMID: 17149103 DOI: 10.1097/00124784-200701000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most common source of information on workforce in the United States is the Bureau of Labor Statistics (BLS), a branch of the Department of Labor. In 1998, 14 public health workforce titles were added to the BLS Standard Occupational Classification (SOC) system. While this was a constructive step, it is not a "quick fix," because these additional titles do not solve the longstanding problems inherent in capturing accurate PH workforce data. As is true for all currently available sources, BLS statistics capture a limited segment of public health's broadly defined and multidisciplinary workforce. A standard system of data collection is needed to guide planning to sustain the present and future workforce. Revision of the 1998 SOC in preparation for the 2010 Census is now underway. This presents an opportunity for the public health community to act on prior recommendations regarding workforce data and advocate for more inclusive enumeration of public health occupations that can inform policies and planning for the current and future workforce.
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Affiliation(s)
- Kristine Gebbie
- Center for Health Policy, Columbia University School of Nursing, New York, New York 10032, USA.
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Affiliation(s)
- Hossein Gharib
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA
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Ishikawa Y, Otsu K, Oshikawa J. Caveolin; different roles for insulin signal? Cell Signal 2005; 17:1175-82. [PMID: 15913956 DOI: 10.1016/j.cellsig.2005.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 03/09/2005] [Indexed: 11/30/2022]
Abstract
Caveolae, discovered by electron microscope in the 1950s, are membrane invaginations that accommodate various molecules that are involved in cellular signaling. Caveolin, a major protein component of caveolae identified in 1990s, has been known to inhibit the function of multiple caveolar proteins, such as kinases, which are involved in cell growth and proliferation, and thus considered to be a general growth signal inhibitor. Recent studies using transgenic mouse models have suggested that insulin signal may be exempted from this inhibition, which rather requires the presence of caveolin for proper signaling. Caveolin may stabilize insulin receptor protein or directly stimulate insulin receptors. Other studies have demonstrated that caveolae provide the TC10 complex with cellular microdomains for glucose transportation through Glut4. These findings suggest that caveolin plays an important role in insulin signal to maintain glucose metabolism in intact animals. However, the role of caveolin in insulin signal may differ from that in other transmembrane receptor signals.
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Affiliation(s)
- Yoshihiro Ishikawa
- Department of Physiology, Yokohama City University School of Medicine, 3-9 Fukuura Kanazawa, Yokohama 236-0004, Japan
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Zgibor JC, Rao H, Wesche-Thobaben J, Gallagher N, McWilliams J, Korytkowski MT. Improving the Quality of Diabetes Care in Primary Care Practice. J Healthc Qual 2004; 26:14-21. [PMID: 15352340 DOI: 10.1111/j.1945-1474.2004.tb00502.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The quality of care delivered to patients with diabetes has an impact on long-term outcomes. The purpose of this quality improvement project was to examine the effect of a Diabetes Disease Management Program (DDMP) on compliance with recommended process measures of care in primary care practice settings. Certified diabetes nurse educators visited five participating primary care practices biweekly for 1 year providing education to physicians and office staff on standards for diabetes management and to patients regarding self-management. Among 208 participants, 85.5% had >2 HbA1cs, 93.6% had lipid profiles, and 100% had foot examinations. Improvements in HbA1c (9.0% to 7.7%) were observed. Implementation of DDMP effectively promotes compliance with care standards in primary care practices.
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Affiliation(s)
- Janice C Zgibor
- Department of Epidemiology, University of Pittsburgh, PA, USA.
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