Background: Diabetes management combined with housing instability intersects, forcing individuals to triage competing needs and critical stressors, such as safety and shelter, with fundamental diabetes self-management tasks like attending healthcare appointments to screen for the complications of diabetes, leaving individuals overwhelmed and overburdened. We aim to address this disjuncture found within our current healthcare delivery system by providing point-of-care screening opportunities in a more patient-centered approach. Method:We describe a pilot study of a novel clinical intervention which provides timely, comprehensive, and accessible screening for diabetes complications to people experiencing homelessness. We will assess the reach, effectiveness, adoption, implementation, and maintenance, as per the RE-AIM framework, of a SAFER model of care (i.e., screening for A1C, feet, eyes, and renal function). A trained nurse will provide this screening within a homeless shelter. During these encounters, eligible participants will be screened for microvascular complications (neuropathy, nephropathy, retinopathy) and have their A1C measured, all at the point of care, using bedside tools and novel technology. Effectiveness, our primary objective, will be evaluated using a pre-post design, by comparing the rate of completion of full microvascular screening during the study period with individuals' own historical screening in the 2-year period prior to enrollment. The other domains of the RE-AIM framework will be assessed using process data, chart reviews, patient surveys, and qualitative semi-structured interviews with service providers and participants. This study will be conducted in a large inner-city homeless shelter within a major urban Canadian city (Calgary, Canada). Discussion: Currently, screening for diabetes complications is often inaccessible for individuals experiencing homelessness, which places heavy burdens on individuals and, ultimately, on already strained emergency and acute care services when complications go undetected at earlier stages. The SAFER intervention will modify the current standard of care for this population in a way that is less fragmented, more person-focused, and timely, with the goal of ultimately improving the rate of screening in an acceptable fashion to identify those requiring specialist referral at earlier stages.

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Objectives: The objective of this study was to assess the effectiveness of ultrasound guided vs. conventional palpation method for radial artery cannulation in the operating room for patients undergoing elective open-heart operations. Methodology: This prospective observational study was carried at the National Institute of Cardiovascular Disease (NICVD) in Karachi and Sukkur. All cannulation procedures were performed by anesthesia residents (R-1). Two equal sized independent groups of patients based on radial artery cannulation technique, either ultrasound guided (USG) or conventional palpation method (CPM) were recruited. Artery cannulation success along with number of attempts, total duration, number of additional operators, need for change of site, and complications were recorded. Results: A total of 70 patients were recruited in each of the group, mean patient age was 52.43±13.53 years vs. 50.71 ± 14.1 years; p=0.605 with proportion of male patients as 65.7% (46) vs. 77.1% (54); p=0.290, for USG and CPM, respectively. Artery cannulation success rate was 74.3% (52) vs. 80% (56); p=0.569, mean number of attempts was 1.71±1.05 vs. 1.51±0.89; p=0.391, mean total duration was 7.76±3.78 minutes vs. 5.42 ± 8.2 minutes; p=0.131, mean number of additional operators was 0.74±0.44 vs. 0.89±0.32; p=0.128, need for change of site was 11.4% (8) vs. 2.9% (2); p=0.356, and complications were observed in 8.6% (6) vs. 2.9% (2); p=0.614 for USG and CPM, respectively. Conclusion: In this observational study, no significant differences were observed in the effectiveness of USG and CPM for radial artery cannulation when performed by newly inducted anesthesia residents.

Background - Diabetes management combined with housing instability intersect, forcing individuals to triage competing needs and critical stressors, such as safety and shelter, with fundamental diabetes self-management tasks like attending healthcare appointments to screen for the complications of diabetes, leaving individuals overwhelmed and overburdened. We aim to address this disjuncture found within our current healthcare delivery system by providing point-of-care screening opportunities in a more patient-centered approach.Method - We describe a pilot study of a novel clinical intervention which provides timely, comprehensive, and accessible screening for diabetes complications to people experiencing homelessness. We will assess the reach, effectiveness, adoption, implementation, and maintenance, as per the RE-AIM framework, of a SAFER model of care (i.e., Screening for A1C, Feet, Eyes, and Renal function). A trained nurse will provide this screening within a homeless shelter. During these encounters, eligible participants will be screened for microvascular complications (neuropathy, nephropathy, retinopathy) and have their A1C measured, all at the point-of-care, using bedside tools and novel technology. Effectiveness, our primary objective, will be evaluated using a pre-post design, by comparing the rate of completion of full microvascular screening during the study period with individuals’ own historical screening in the 2-year period prior to enrollment. The other domains of the RE-AIM framework will be assessed using process data, chart reviews, patient surveys and qualitative semi-structured interviews with service providers and participants. This study will be conducted in a large inner-city homeless shelter within a major urban Canadian city (Calgary, Canada).Discussion - Currently, screening for diabetes complications is often inaccessible for individuals experiencing homelessness, which places heavy burdens on individuals, and ultimately, on already strained emergency and acute care services when complications go undetected at earlier stages. The SAFER intervention will modify the current standard of care for this population in a way that is less fragmented, more person-focused, and timely, with the goal of ultimately improving the rate of screening in an acceptable fashion to identify those requiring specialist referral at earlier stages.