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Wood ST, Cuevas H, Kim J, Stuifbergen AK. Development and Use of a Tech-Based Data Management System for a Cognitive Rehabilitation Randomized Controlled Trial for People With Type 2 Diabetes. Comput Inform Nurs 2024; 42:252-258. [PMID: 38206176 PMCID: PMC11006582 DOI: 10.1097/cin.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Successful technology-based interventions to improve patients' self-management are providing an incentive for researchers to develop and implement their own technology-based interventions. However, the literature lacks guidance on how to do this. In this article, we describe the electronic process with which we designed and implemented a technology-based data management system to implement a randomized controlled trial of a comprehensive cognitive rehabilitation intervention to improve cognitive function and diabetes self-management in people with type 2 diabetes. System development included feasibility assessment, interdisciplinary collaboration, design mapping, and use of institutionally and commercially available software. The resulting framework offers a template to support the development of technology-based interventions. Initial development may be time-consuming, but the benefits of the technology-based format surpass any drawbacks.
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Affiliation(s)
| | | | - Jeeyeon Kim
- The University of Texas at Austin, School of Nursing
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Mukherjee S, McDonald AD, Kesler SR, Cuevas H, Swank C, Stevens A, Ferris TK, Danesh V. Driving among individuals with chronic conditions: A systematic review of applied research using kinematic driving sensors. J Am Geriatr Soc 2024; 72:1242-1251. [PMID: 38243756 PMCID: PMC11018482 DOI: 10.1111/jgs.18738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Kinematic driving data studies are a novel methodology relevant to health care, but prior studies have considerable variance in their methods, populations, and findings suggesting a need for critical analysis and appraisal for feasibility and methodological guidelines. METHODS We assessed kinematic driving studies of adults with chronic conditions for study feasibility, characteristics, and key findings, to generate recommendations for future study designs, and to identify promising directions for applications of kinematic driving data. PRISMA was used to guide the review and searches included PubMed, CINAHL, and Compendex. Of 379 abstract/titles screened, 49 full-text articles were reviewed, and 29 articles met inclusion criteria of analyzing trip-level kinematic driving data from adult drivers with chronic conditions. RESULTS The predominant chronic conditions studied were Alzheimer's disease and related Dementias, obstructive sleep apnea, and diabetes mellitus. Study objectives included feasibility testing of kinematic driving data collection in the context of chronic conditions, comparisons of simulation with real-world kinematic driving behavior, assessments of driving behavior effects associated with chronic conditions, and prognostication or disease classification drawn from kinematic driving data. Across the studies, there was no consensus on devices, measures, or sampling parameters; however, studies showed evidence that driving behavior could reliably differentiate between adults with chronic conditions and healthy controls. CONCLUSIONS Vehicle sensors can provide driver-specific measures relevant to clinical assessment and interventions. Using kinematic driving data to assess and address driving measures of individuals with multiple chronic conditions is positioned to amplify a functional outcome measure that matters to patients.
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Affiliation(s)
- Srijani Mukherjee
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA
| | - Anthony D. McDonald
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shelli R. Kesler
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Alan Stevens
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Thomas K. Ferris
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA
| | - Valerie Danesh
- Baylor Scott & White Research Institute, Dallas, TX, USA
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Edgar C, Young CC, Cuevas H. Adolescent Simulation in a Health Assessment Course for Advanced Practice Nursing Students. Nurs Educ Perspect 2024:00024776-990000000-00202. [PMID: 38227615 DOI: 10.1097/01.nep.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
ABSTRACT Advanced practice registered nurse (APRN) students face challenges transitioning to practice. They benefit greatly from simulated learning experiences that build confidence and increase competence in the skills needed to perform in an APRN role. The purpose of this quality improvement project was to evaluate the effectiveness of a simulated adolescent well visit in an advanced health assessment course. Using a pretest/posttest design, qualitative and quantitative data were collected from participants. Results included high learner satisfaction, an increase in both self-reported competence and confidence, and an appreciation for the "safe space" of learning.
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Affiliation(s)
- Carly Edgar
- About the Authors The authors are faculty at The University of Texas at Austin School of Nursing, Austin, Texas. Carly Edgar, DNP, APRN, CPNP-PC, is a clinical assistant professor. Cara C. Young, PhD, APRN, FNP-C, FAANP, FAAN, is an associate professor. Heather Cuevas, PhD, APRN, ACNS, FCNS, is an assistant professor. For more information, contact Dr. Edgar at
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Kim J, Cuevas H. The impact of musical reward responses on cognitive function in older adults with type 2 diabetes. Geriatr Nurs 2024; 55:327-332. [PMID: 38147787 PMCID: PMC11079956 DOI: 10.1016/j.gerinurse.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
Cognitive decline is prevalent in older adults with type 2 diabetes (T2DM). The use of music has emerged to improve cognitive health. Even though reward from music has been shown to improve cognitive function, no studies have focused on specific factors of musical reward. This study investigated which factors of musical reward impact cognitive function in older adults with T2DM. A secondary data analysis was conducted with 185 older adults with T2DM and subjective cognitive decline. Among the musical reward factors, mood regulation significantly influenced subjective cognitive function (β = 0.315; p < 0.001). The findings suggest that music interventions for older adults with T2DM may need to focus on managing their psychological states for the intervention to have beneficial effects on cognitive function. Future rigorous studies with larger sample sizes should be done to obtain robust evidence for optimal music interventions for older adults with T2DM.
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Affiliation(s)
- Jeeyeon Kim
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Heather Cuevas
- School of Nursing, University of Texas at Austin, Austin, TX, USA
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Kuo HJ, García AA, Huang YC, Zuñiga JA, Benner AD, Cuevas H, Fan KC, Hsu CY. Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis. Sci Diabetes Self Manag Care 2023; 49:438-448. [PMID: 37873569 DOI: 10.1177/26350106231205029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE The purposes of this study were to (1) examine the relationships between fatigue, its influencing factors, and diabetes self-management and (2) test the mediation effects of fatigue on the link between the influencing factors and diabetes self-management in adults with type 2 diabetes. METHODS This cross-sectional, correlational study was guided by the theory of unpleasant symptoms. Data were collected using structured questionnaires. Fatigue was measured by the Fatigue Symptom Inventory and the Multidimensional Fatigue Inventory. Diabetes self-management was measured by the Summary of Diabetes Self-Care Activities. From March to July 2021, a convenience sample of 150 participants was recruited from 2 diabetes outpatient clinics of a regional hospital in Taiwan. Data were analyzed using structural equation modeling. RESULTS A more recent diagnosis of diabetes, more depressive symptoms, and lower sleep quality were related to higher fatigue. Higher fatigue correlated with less performance in diabetes self-management. Fatigue mediated the relationship between depressive symptoms, sleep quality, and diabetes self-management. CONCLUSIONS Fatigue had a mediating effect on the link between psychological influencing factors and diabetes self-management. Future development of fatigue interventions integrating depressive symptoms and sleep management will likely increase the performance of diabetes self-management and improve the health outcomes in adults with type 2 diabetes. The study tested the theory of unpleasant symptoms using empirical data and will assist in building theory-guided fatigue interventions to improve diabetes self-management in people with type 2 diabetes.
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Affiliation(s)
- Hsuan-Ju Kuo
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | | | - Ya-Ching Huang
- School of Nursing, Texas A&M University, College Station, Texas
| | - Julie A Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Aprile D Benner
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Kang-Chih Fan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chih-Yao Hsu
- Taipei City Hospital Renai Branch, Taipei City, Taiwan
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Kim J, Cuevas H, Wood ST. Effect of Music Interventions on Cognitive Function in Older Adults With Mild Cognitive Impairment: A Systematic Review. Res Gerontol Nurs 2023; 16:259-268. [PMID: 37335894 DOI: 10.3928/19404921-20230609-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The purpose of the current systematic review was to examine the effects of music interventions on cognitive function in older adults with mild cognitive impairment (MCI). A systematic search of CINAHL, PubMed, PsycINFO, and Web of Science databases was performed. Studies examining the effects of music interventions on cognitive function in older adults with MCI were included. Narrative synthesis for cognitive outcomes postintervention was performed. A total of 11 articles met inclusion criteria. Music interventions significantly improved global cognitive function, verbal fluency, executive function, and spatial function in older adults with MCI. Included studies were heterogeneous in terms of the type of intervention, cognitive assessment tool, and intervention duration. Six studies were at risk of bias due to missing data and confounding factors. Our findings suggest that music interventions can be an effective strategy to improve cognitive function for older adults with MCI. However, findings should be interpreted with caution. More rigorous studies with various types of music interventions investigating cognitive domain-specific effects are needed. [Research in Gerontological Nursing, 16(5), 259-268.].
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Danesh V, Boehm LM, Cuevas H, Arroliga AC, Stevens AB. Peer-delivered motivational interviewing intervention for post-intensive care syndrome: A pilot of peer mentor training feasibility. PM R 2023; 15:805-807. [PMID: 35909367 PMCID: PMC9889566 DOI: 10.1002/pmrj.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/28/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Alejandro C Arroliga
- Baylor Scott & White Health, Dallas, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Alan B Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, Texas, USA
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Zuñiga JA, Huang YC, Bang SH, Cuevas H, Hutson T, Heitkemper EM, Cho E, García AA. Revision and Psychometric Evaluation of the Diabetes Knowledge Questionnaire for People With Type 2 Diabetes. Diabetes Spectr 2023; 36:345-353. [PMID: 38024222 PMCID: PMC10654121 DOI: 10.2337/ds22-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Objective Diabetes knowledge is associated with health, including lower A1C levels. The Diabetes Knowledge Questionnaire (DKQ-24), developed 30 years ago for Mexican Americans with type 2 diabetes and since used with diverse samples in many countries, contains outdated items that no longer accurately assess current knowledge needed for diabetes self-management. We revised the DKQ-24 and tested psychometric properties of the DKQ-Revised (DKQ-R) with a diverse sample. Methods We conducted a five-phase instrumentation study as follows: 1) DKQ-24 items were revised to reflect current diabetes care standards; 2) the Delphi method was used to evaluate the DKQ-R's content validity (n = 5 experts); 3) cognitive interviews were conducted with people with type 2 diabetes (n = 5) to assess their interpretations of DKQ-R items; 4) cross-sectional administration of the DKQ-R to adults with type 2 diabetes was carried out to assess internal consistency reliability and convergent validity; and 5) an item analysis was conducted using discrimination index and point biserial analysis. Results After receiving the experts' feedback and conducting the cognitive interviews, 39 items were administered to 258 participants with type 2 diabetes (42.2% women; 29.1% Latino, 42.6% Asian, mean age 55.7 years). To select the final items, we considered the item discrimination index, as well as item-to-total correlations, content area, and participant feedback. The final 22-item DKQ-R uses the same yes/no/I don't know response format as the DKQ-24. The DKQ-R is strongly correlated with the DKQ-24 (r = 0.71, P <0.01) and is weakly correlated with diabetes numeracy (r = 0.23, P <0.01), indicating adequate convergent validity; a Kuder-Richardson-20 coefficient of 0.77 indicated good reliability. Conclusion The DKQ-R is a reliable and valid updated measure of diabetes knowledge for diverse populations with type 2 diabetes.
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Affiliation(s)
- Julie A. Zuñiga
- School of Nursing, University of Texas at Austin, Austin, TX
| | - Ya-Ching Huang
- School of Nursing, Texas A&M University, College Station, TX
| | - So Hyeon Bang
- School of Nursing, University of Texas at Austin, Austin, TX
| | - Heather Cuevas
- School of Nursing, University of Texas at Austin, Austin, TX
| | - Tara Hutson
- School of Nursing, University of Texas at Austin, Austin, TX
| | | | - Emma Cho
- School of Nursing, University of Texas at Austin, Austin, TX
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Cuevas H, Stuifbergen AK, Hilsabeck RC, Sales A, Wood S, Kim J. The role of cognitive rehabilitation in people with type 2 diabetes: A study protocol for a randomized controlled trial. PLoS One 2023; 18:e0285553. [PMID: 37186584 PMCID: PMC10184896 DOI: 10.1371/journal.pone.0285553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).
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Affiliation(s)
- Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Alexa K. Stuifbergen
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Robin C. Hilsabeck
- Department of Neurology, Dell Medical School, Austin, Texas, United States of America
| | - Adam Sales
- Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, United States of America
| | - Shenell Wood
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jeeyeon Kim
- School of Nursing, The University of Texas at Austin, Austin, Texas, United States of America
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Heitkemper EM, Wilcox GB, Zuñiga J, Kim MT, Cuevas H. A Text-Mining Analysis to Examine Dominant Sources of Online Information and Content on Continuous Glucose Monitors. Sci Diabetes Self Manag Care 2023; 49:101-111. [PMID: 36896911 PMCID: PMC10084517 DOI: 10.1177/26350106231158828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE The purpose of this study is to use text-mining methods to examine the dominant sources of online information and content about continuous glucose monitors (CGMs). Because the internet is the most popular source for health information, it is important to understand what is being said about CGMs in online sources of information. METHODS A text miner, algorithmic-driven statistical program was used to identify the main sources of online information and topics on CGMs. Content was limited to English and was posted from August 1, 2020, to August 4, 2022. Using Brandwatch software, 17 940 messages were identified. After cleaning, there were 10 677 messages in final analyses conducted using SAS Text Miner V.12.1 software. RESULTS The analysis identified 20 topics that formed 7 themes. Results show that most online information comes from news sources and focuses on the general benefits of CGM use. Beneficial aspects ranged from improvements in self-management behaviors, cost, and glucose levels. None of the themes mentioned changes to practice, research, or policies related to CGM. CONCLUSIONS To improve diffusion of information and innovations going forward, novel ways of information sharing should be explored, such as diabetes specialist, provider, and researcher engagement in social media and digital storytelling.
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Affiliation(s)
| | - Gary B Wilcox
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, Texas.,Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, Austin, Texas
| | - Julie Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Miyong T Kim
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas
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Cuevas H, Muñoz E, Nagireddy D, Kim J, Ganucheau G, Alomoush F. The Association of Glucose Variability and Dementia Incidence in Latinx Adults with Type 2 Diabetes: A Retrospective Study. Clin Nurs Res 2023; 32:249-255. [PMID: 36472225 DOI: 10.1177/10547738221141232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Latinx adults with both cognitive dysfunction and type 2 diabetes mellitus (T2DM) are significantly more likely than Latinx adults with diabetes alone to have complications such as cardiovascular disease. Glucose variability may be a risk for dementia, but the course of glucose variability in the time before a dementia diagnosis for Latinx adults with T2DM has not been examined. We used a 10-year retrospective cohort of medical records of Latinx patients with T2DM who had at least one use of a continuous glucose monitor. The objective was to examine how glucose variability was associated with future dementia diagnoses. A total of 116 charts were included. Mean of daily differences and mean amplitude of glycemic excursions were more strongly associated with dementia diagnoses than other variability indices (p < .01). Understanding the relationships between cognitive function, glucose variability, and barriers to health care can translate into improved interventions to enhance diabetes care.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, USA
| | - Elizabeth Muñoz
- The University of Texas at Austin, College of Natural Sciences, USA
| | - Divya Nagireddy
- The University of Texas at Austin, College of Natural Sciences, USA
| | - Jeeyeon Kim
- The University of Texas at Austin, School of Nursing, USA
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Zuñiga JA, Cuevas H, Jones K, Adiele K, Cebulske L, Frost L, Sannigrahi S, García AA, Heitkemper E. Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19: A Qualitative Study. ANS Adv Nurs Sci 2022; 45:256-273. [PMID: 34966026 PMCID: PMC9237177 DOI: 10.1097/ans.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of this qualitative secondary analysis research was to describe the impact of the COVID-19 pandemic on self-management behaviors and practices for people living with the dual diagnoses of HIV/AIDS and type 2 diabetes mellitus and to identify early pandemic-specific disruptions or changes to their self-management practices. In-depth interviews conducted in May-June 2020 with 9 participants, and analyzed using content analysis, revealed 5 themes: adjusting to living with HIV/AIDS and diabetes impacts beliefs about COVID-19 risks; COVID-19 information seeking and accuracy; trade-offs in self-managing multiple chronic conditions; balance between safety, relationships, and the society at large; and discordant perceptions and actions. Some participants were resilient from previous experiences. Many received mixed messages about their risk for COVID-19, resulting in inaccurately or inconsistently applying guidelines for social isolation.
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Affiliation(s)
| | | | - Kristian Jones
- The University of Texas at Austin, School of Social Work
| | | | | | - Livia Frost
- The University of Texas at Austin, College of Natural Sciences
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Cuevas H, Heitkemper E, Haque B. Relationships Among Perception of Cognitive Function, Diabetes Self-Management, and Glucose Variability in Older Adults: A Mixed Methods Study. Res Gerontol Nurs 2022; 15:203-212. [PMID: 35708961 DOI: 10.3928/19404921-20220609-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the current study was to explore relationships among perceived cognitive function, glucose variability, and self-management in older adults with type 2 diabetes mellitus (T2DM). A mixed methods design was used with data from: (a) questionnaires on perceived cognitive function and diabetes self-management; (b) continuous glucose monitoring (CGM) reports; and (c) semi-structured interviews. Thirty adults with T2DM (47% female; mean age = 68.5 [SD = 5.2] years) participated. Those who exercised more days per week had more stable glucose. Those who reported fewer days of diet adherence had more hypoglycemia. Participants who reported higher levels of memory dissatisfaction exhibited higher levels of glucose variability. Findings point to the potential of glucose variability as a target to reduce the effect of diabetes on cognitive function. Instruction in recognition of glucose patterns found via CGM can be integrated into self-management education to improve self-management and subsequent glucose control and cognitive function. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Cuevas H, John-Miller L, Zuñiga J. Factors affecting cognitive dysfunction screening for Latinx adults with type 2 diabetes. J Clin Transl Endocrinol 2022; 27:100294. [PMID: 35386420 PMCID: PMC8978099 DOI: 10.1016/j.jcte.2022.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022] Open
Abstract
Aim To examine influences on screening of Latinx adults with type 2 diabetes for cognitive problems by identifying patient-, clinician-, and clinic-level factors. Methods This was a mixed methods study consisting of semi-structured interviews with Latinx adults with type 2 diabetes (n = 30; mean age = 68; 57% Mexican American) and surveys and interviews with health care providers (n = 15) in Central Texas. Data were examined with thematic analysis (interviews) and descriptive statistics (surveys and inventories). Results For the interviewed patients, screening was important, but inability to work related to a possible diagnosis of dementia was a concern. Both providers and patients agreed that other health issues (e.g., hyperglycemia) took precedence over cognitive screening. Providers (96.7%) were expected to screen patients but lacked clinic support and time; they relied on patients for initial prompts. Only one clinic required staff education on cognitive screening, with an emphasis on potential cultural differences in test results and adequate resources related to dementia for Latinx adults. Conclusions Clinics serving Latinx adults have a responsibility to deliver appropriate care. Leadership should consider innovative practices such as the creation, with patients, of educational materials for screening—a need highlighted by most participants.
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Cuevas H, Heitkemper E, Huang YC, Jang DE, García AA, Zuñiga JA. A systematic review and meta-analysis of patient activation in people living with chronic conditions. Patient Educ Couns 2021; 104:2200-2212. [PMID: 33610334 DOI: 10.1016/j.pec.2021.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objectives of this review are to (1) describe the state of the science of patient activation interventions for the self-management of chronic conditions; (2) identify effective intervention elements for improving patient activation; and (3) compare intervention effectiveness across chronic conditions. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). PubMed, CINAHL, and Web of Science databases were searched. RESULTS Thirty-two articles published between 2005 and 2019 were identified with intervention elements of self-management, disease management, and education. Meta-analysis of a subset of seven randomized controlled trials (n = 7) that used the 13-item version of the Patient Activation Measure with data collection points at 6 months demonstrated that patient activation did not change significantly in comparison with controls (MD = 0.25, 95 % CI = 0.02-0.47). CONCLUSION Most interventions reported significant improvement in patient activation and were linked to tasks such as regular exercise and monitoring glucose. However, the meta-analysis of RCTs did not confirm these findings. PRACTICE IMPLICATIONS Patient activation can be assessed and addressed uniformly across all chronic conditions to improve patient engagement in care.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, USA.
| | | | - Ya-Ching Huang
- Texas State University, St. David's School of Nursing, USA
| | - Dong Eun Jang
- The University of Texas at Austin, School of Nursing, USA
| | | | - Julie A Zuñiga
- The University of Texas at Austin, School of Nursing, USA
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Cuevas H, Carter S. Nurse-Talk Ratios as a Measure of Participation in a Cognitive Rehabilitation Intervention for People With Type 2 Diabetes. Res Theory Nurs Pract 2021; 35:67-81. [PMID: 33632923 DOI: 10.1891/rtnp-d-19-00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done. PURPOSE The purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory. METHODS Nineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios. RESULTS Talk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable. IMPLICATIONS FOR PRACTICE Talk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.
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Affiliation(s)
- Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Sharon Carter
- School of Nursing, The University of Texas at Austin, Austin, TX
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Zuñiga JA, Huang YC, Cuevas H, Vasquez L, García AA. An interdisciplinary approach using case management and clinical pharmacy improves results for people with diabetes. Res Social Adm Pharm 2020; 16:1387-1391. [DOI: 10.1016/j.sapharm.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
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Cuevas H, Carter S. Online Cognitive Training: An Adaptation of the Memory, Attention, and Problem Solving Skills for Persons With Diabetes Intervention. Comput Inform Nurs 2020; 39:162-169. [PMID: 32769625 DOI: 10.1097/cin.0000000000000663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research shows the risk for cognitive impairment and the rate of cognitive decline double after type 2 diabetes mellitus is diagnosed and can make self-management more difficult. Cognitive training has been found to be one way to improve self-management and cognitive function, and this article reports the adaptation of one such intervention to an online format. Ten adults with diabetes participated in an 8-week intervention that combined webinar classes with online computer game training. Perceived memory ability, executive function, self-management, and self-efficacy were measured. Evaluation of recruitment, data collection, and implementation demonstrated good feasibility and reduced barriers to engagement. Although the intervention did not result in significant changes in cognitive function, scores on all surveys improved. Adherence to diet, exercise, and foot care recommendations also improved. Most participants stated they preferred the intervention's online format to "traditional" in-person formats. Online technology in this 8-week intervention helped improve recruitment, retention, participant engagement, and use of cognitive strategies in people with type 2 diabetes mellitus. Overall, participants found the intervention helpful and said it reduced the time and travel burden associated with educational interventions. A larger randomized controlled trial is needed to further explore the intervention's potential impact over a longer period.
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Affiliation(s)
- Heather Cuevas
- Author Affiliations : School of Nursing, The University of Texas at Austin, Texas
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Cuevas H, Ward C. Application of cognitive screening guidelines by health care providers in diabetes care: A cross-sectional descriptive study. J Eval Clin Pract 2019; 25:800-805. [PMID: 30488518 DOI: 10.1111/jep.13085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population. In this study, we examined health care providers' knowledge of those recommendations and their application of them, as well as factors associated with guideline use. METHODS This study used a cross-sectional, descriptive correlational design with a convenience sample. All data were collected with a 20-question online survey sent to advanced practice nurses (APNs), medical doctors/doctor of osteopathic medicines (MDs/DOs), and physician assistants (PAs) in Central Texas. RESULTS One-hundred eighty-one health care providers responded. Participants most frequently said they were "moderately familiar" with guidelines for cognitive impairment screening (60.9%). Twenty-three per cent of physicians, 37.4% of APNs, and 8.3% of PAs indicated that they incorporated routine screening into daily practice. However, 64% did not use standardized tools to assess cognitive function. The most common clinical tasks related to cognitive screening were referral for more in-depth cognitive screening (44%) and education of families regarding cognitive problems (29%). Lack of time was the most common barrier to screening (57.7%). CONCLUSIONS Most respondents believed that there was a good rationale for assessing cognitive function in people with diabetes. However, despite some familiarity with guidelines for cognitive function screening, most respondents did not use standardized assessment tools. The results indicate variability in clinical practice regarding assessment and practices, such that there may be some variability in outcomes for patients.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, Austin, Texas
| | - Catherine Ward
- The University of Texas at Austin, School of Nursing, Austin, Texas
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Cuevas H, Stuifbergen A. Perceived cognitive deficits are associated with diabetes self-management in a multiethnic sample. J Diabetes Metab Disord 2017; 16:7. [PMID: 28239597 PMCID: PMC5312423 DOI: 10.1186/s40200-017-0289-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/25/2017] [Indexed: 12/30/2022]
Abstract
Background People with diabetes have almost twice the risk of developing cognitive impairment or dementia as do those without diabetes, and about half of older adults with diabetes will become functionally disabled or cognitively impaired. But diabetes requires complex self-management: patients must learn about the implications of their disease; manage their diets, physical activity, and medication; and monitor their blood glucose. Difficulties with cognition can hinder these activities. Methods The purpose of this study was to explore perceptions of cognitive ability in a multiethnic sample of persons with type 2 diabetes (T2DM). One hundred twenty participants completed surveys assessing perceived memory, executive function, diabetes self-management, and quality of life. Scores on the surveys were examined along with hemoglobin A1C levels and demographics. Results Scores for executive function were positively associated with self-reports of dietary adherence and blood glucose monitoring. Perceived memory ability was a significant predictor of quality of life, and executive function was a significant predictor of A1C. Conclusions Patients’ perceptions of their cognitive difficulties may assist health care providers in detection of patients’ deficiencies in performing diabetes self-management tasks. The relationships between cognitive difficulties and self-management found in this descriptive study suggest that research on the processes leading to cognitive changes in T2DM is needed, as are studies on how those processes affect diabetes self-management.
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Affiliation(s)
- Heather Cuevas
- The University of Texas, Austin School of Nursing, 1710 Red River, Austin, TX 78701 USA
| | - Alexa Stuifbergen
- The University of Texas, Austin School of Nursing, 1710 Red River, Austin, TX 78701 USA
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Zalapa JE, Staub JE, McCreight JD, Chung SM, Cuevas H. Detection of QTL for yield-related traits using recombinant inbred lines derived from exotic and elite US Western Shipping melon germplasm. Theor Appl Genet 2007; 114:1185-201. [PMID: 17294163 DOI: 10.1007/s00122-007-0510-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/12/2007] [Indexed: 05/06/2023]
Abstract
The inheritance of yield-related traits in melon (Cucumis melo L.; 2n = 2x = 24) is poorly understood, and the mapping of quantitative trait loci (QTL) for such traits has not been reported. Therefore, a set of 81 recombinant inbred lines (RIL) was developed from a cross between the monoecious, highly branched line USDA 846-1 and a standard vining, andromonoecious cultivar, 'Top Mark'. The RIL, parental lines, and three control cultivars ('Esteem', 'Sol Dorado', and 'Hales Best Jumbo') were grown at Hancock, WI and El Centro, CA in 2002, and evaluated for primary branch number (PB), fruit number per plant (FN), fruit weight per plant (FW), average weight per fruit (AWF), and percentage of mature fruit per plot (PMF). A 190-point genetic map was constructed using 114 RAPD, 43 SSR, 32 AFLP markers, and one phenotypic trait. Fifteen linkage groups spanned 1,116 cM with a mean marker interval of 5.9 cM. A total of 37 QTL were detected in both locations (PB = 6, FN = 9, FW = 12, AWF = 5, and PMF = 5). QTL analyses revealed four location-independent factors for PB (pb1.1, pb1.2, pb2.3, and pb10.5), five for FN (fn1.1, fn1.2, fn1.3, fn2.4, and fn8.8), four for FW (fw5.8, fw6.10, fw8.11, and fw8.12), two for AWF (awf1.3 and awf8.5), and one for PMF (pmf10.4). The significant (P </= 0.05) positive phenotypic correlations observed among PB, FN, and FW, and negative phenotypic correlations between PB and AWF and between FN and AWF were consistent with the genomic locations and effects (negative vs. positive) of the QTL detected. Results indicate that genes resident in highly branched melon types have potential for increasing yield in US Western Shipping type germplasm via marker-assisted selection.
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Affiliation(s)
- J E Zalapa
- US Department of Agriculture, Agricultural Research Service, Vegetable Crops Unit, Department of Horticulture, University of Wisconsin, 1575 Linden Dr., Madison, WI 53706, USA.
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