BACKGROUND:Most patients with asthma have mild asthma, but it has received less attention despite risks of exacerbation, lung function decline, and even death. Provider knowledge, practice patterns, and guidelines used to inform treatment decisions in mild asthma are not well described. OBJECTIVE:To evaluate provider behaviors in mild asthma and to identify differences between specialists and generalists. METHODS:An anonymous survey was distributed nationwide. It evaluated the definition and treatment of mild asthma and familiarity with the National Heart, Lung, and Blood Institute (NHLBI) and Global Initiative of Asthma guidelines. Respondents were categorized as asthma specialists (allergy and pulmonology) and generalists (internal medicine, medicine-pediatrics, and family medicine). RESULTS:A total of 172 providers participated in the survey, including 76 generalists and 96 specialists. Specialists felt that fewer exacerbations per year were consistent with a diagnosis of mild asthma compared with generalists (1.26 vs 1.58, P = .023). Compared with generalists, specialists were more familiar with asthma guidelines and used both NHLBI and Global Initiative of Asthma documents to guide their practice. In contrast, generalists were more likely to only use NHLBI guidelines. Specialists were more likely to use anti-inflammatory reliever or maintenance and rescue therapy, but both groups most frequently prescribed albuterol alone for reliever therapy in mild asthma (specialists, 57%; generalists, 68%). More specialists had patients with mild asthma use an asthma action plan than generalists (63.5% vs 43.4%, P = .030). CONCLUSION:Significant heterogeneity exists in the definition and treatment of mild asthma. Knowledge and use of asthma guidelines differ between generalists and specialists, further complicating management of mild asthma.
Introduction and Objective: Patients with diabetes have a 15-34% lifetime risk of foot ulcerations and complications from these ulcers are a leading cause of nontraumatic amputations in the United States. Elevated perioperative glucose (>140 mg/dL or A1c ≥8%) is associated with complications in elective surgeries, but limited data exists on its impact on nonelective amputations. This study aims to assess the effect of perioperative glucose levels on outcomes in patients with diabetes undergoing lower extremity amputations after infectious cases. Methods: This two-year retrospective chart review at a large tertiary health system identified 186 patients who underwent lower extremity amputations between January 1, 2021, and December 31, 2022. Glucose levels were measured preoperatively (120-30 minutes before incision), intraoperatively, and postoperatively (30-120 minutes after surgery). Non-eligible patients included non-diabetic related amputations, incomplete follow-up (<6 months), and missing glucose measurements. Outcomes such as healing time, postoperative infection, and hospital readmissions were assessed. Results: 65 patients met eligibility. Postoperative glucose >180 mg/dL significantly delayed healing by ~ 1.6 weeks (p= 0.0255). Healing time was also influenced by amputation level, with transmetatarsal amputations delaying healing by ~ 2.9 weeks (p<0.001). Postoperative infection and peripheral arterial disease (PAD) added ~2.1 weeks (p <0.001) and ~ 1.6 weeks (p = 0.0046) respectively to the average healing time. A1c levels and preoperative glucose levels were non-significant. Conclusion: Postoperative glucose levels >180 mg/dL delayed healing in diabetic patients undergoing amputations. Healing time was also influenced by amputation level, post operative infection, and PAD. These findings emphasize tight perioperative glucose control and lay the groundwork for future research to optimize glucose management in high-risk procedures. C. Girgis: None. S. Behme: None. I. Gaynanova: None. B.M. Schmidt: None.
Introduction and Objective: Low participation in Diabetes Self-Management Education and Support Programs (DSMES) among Black adults is attributed to unique barriers. To enhance DSMES reach and adoption, we co-designed a culturally tailored program and evaluated its feasibility, implementation and preliminary effectiveness. Methods: Two 6-week culturally tailored DSMES were delivered by trained Black facilitators. Using an embedded mixed methods design guided by RE-AIM, and Proctor Outcomes, we assessed implementation feasibility and effectiveness. Outcomes were measured at baseline and 6 months using Wilcoxon Signed-Rank tests. Qualitative content analysis of semi-structured interviews and focus groups explored participant and facilitator perceptions, and program adoption Results: Thirty-two Black adults participated, primarily female (87%) with a mean age of 57 (SD = 12). At 6 months, significant improvements (p <.05) were observed in self-reported health (12%), health engagement (83%), and diabetes empowerment (20%). Participants reported increased adherence to healthy eating (30%), glucose monitoring (17%), and foot care (54%) compared to baseline. Qualitative findings highlighted the importance of culturally relevant recommendations in diet, stress management, and provider communication for fostering engagement and adherence. High program satisfaction (4.2/5.0) rated by participants was related to an empowering facilitation and safe space. Facilitators found the tailored training to be feasible and acceptable (4.7/5.0). However, program providers noted that funding and leadership support posed barriers to broader implementation Conclusion: The culturally tailored DSMES program demonstrated feasibility and significant improvements in health engagement and self-care behaviors among Black adults, with participants and facilitators valuing the culturally relevant approaches to implementation O. Shiyanbola: None. M. Wen: None. M.A. Maurer: None. UW School of Medicine and Public Health from the Wisconsin Partnership Program, and NIH-NCATS Clinical and Translational Science Award (WPP 5129 and UL1TR002373)
Introduction Slipping Rib Syndrome (SRS) is caused by the hypermobility of costal cartilages that are attached to the false and floating ribs. This condition causes vague chest and upper abdominal pain that may be mistaken for other diagnoses. Here, we report a case of the rare condition presenting as a possible food allergy. Case Description A 30-year-old female was referred to Allergy for evaluation of food allergies given ongoing left upper quadrant abdominal pain. She reported developing urticaria, nausea, vomiting, and headache when ingesting dairy; and abdominal pain initially triggered by eating but then became constant. She underwent extensive evaluation and interventions by subspecialists with no relief or definitive diagnosis. Upon evaluation, skin prick testing to milk and casein were negative. She had tenderness in the left upper quadrant on abdominal examination. A hypermobile left rib was noted with increased pain on hooking maneuver. The patient underwent a dynamic ultrasound and was diagnosed with SRS. Symptoms resolved after surgical intervention. Discussion SRS is a rare condition that can cause a costal cartilage to slide behind a superior costal cartilage, resulting in pain from impingement of intercostal nerves. SRS is often caused by direct trauma, weakness of interchondral ligaments, or congenital rib deformities. The hooking maneuver is helpful in making the diagnosis. A dynamic ultrasound is used as a confirmatory tool. SRS is underdiagnosed and can lead to unnecessary testing and interventions. Awareness of SRS can lead to rapid diagnosis and interventions to improve a patient’s quality of life.
