IntroductionThe primary objective of this work was to develop a diabetes education book, to pilot its use, and to evaluate its impact on patient care. The secondary objective was to compare the value of providing only the book to patients versus providing the book along with a brief tutorial given by a nurse on how to use the book.MethodsA diabetes education book was developed through a social marketing approach. The impact of the book was then tested in a pilot, prospective, randomized controlled trial evaluating diabetes knowledge, emotional distress, self-care behavior, and clinical outcomes in a primary care patient population. The three-arm study randomized one group to usual care (n=33), one group to receive the book alone (n=33), and one group to receive the book with a brief nurse tutorial (n=34). Patients completed surveys at baseline, 4 weeks, 3 months, and 6 months to assess knowledge (Knowledge Questionnaire), self-care behaviors (Summary of Diabetes Self Care Activities [SDSCA] survey), and disease-related distress (Problem Areas in Diabetes [PAID] scale).ResultsA patient advocacy committee identified a need for information on basic diabetes knowledge, diet, medications, complications, preparing for a visit, and plans for daily life. Using social marketing with a focus on low literacy, the Penn State Hershey Diabetes Playbook was created. The pilot study showed a trend towards improved knowledge, decreased distress, and improved self-care behaviors in patients who received the book. There was no difference in outcomes in patients who were provided the book alone versus those who received a brief nurse tutorial along with the book.ConclusionSocial marketing techniques and low literacy awareness are useful in developing diabetes educational materials.

Introduction: Studies have shown that patients with diabetes mellitus are at an increased risk for complications and higher episode-of-care costs after total hip (THA) and total knee arthroplasties (TKA), but the effect of poor glycemic control on episode-of-care costs has yet to be addressed in the literature. The purpose of this study was to determine whether patients with a higher preoperative hemoglobin A1c have increased episode-of-care costs in diabetic patients undergoing THA and TKA. Methods: We reviewed a consecutive series of 9,511 primary THA and TKA patients between 2015 and 2018. We recorded demographics, medical comorbidities, and hemoglobin A1c for patients with diabetes mellitus. We compared complications, readmissions, and 90-day episode-of-care costs from Medicare claims data across A1c levels. A multivariate logistic regression analysis was done to assess the independent effect of A1c on episode-of-care costs. Results: Diabetic patients (n = 1,042) had higher episode-of-care costs ($20,577 vs $19,414, P < 0.001) than patients without diabetes. Higher stratified A1c levels were associated with increasing mean episode-of-care costs (6.5% to 6.9% = $18,912; 7.0% to 7.49% = $19,832; 7.5% to 7.9% = $20,827; >8% = $21,169). In multivariate analysis, patients with hemoglobin A1c >7.5% had higher episode-of-care costs ($2,331, 95% confidence interval, $511-$4,151, P = 0.012). Those with a hemoglobin A1c >7.5% had increased rates of complications (7% vs 3%, P = 0.049) and readmissions (11% vs 5%, P = 0.020). Discussion: Hemoglobin A1c levels above 7.5% are associated with increased episode-of-care costs, complications, and readmissions after THA and TKA. Optimizing glycemic control before surgery may improve quality of care and lead to success in Medicare bundled payment models.

Some patients require emergent, urgent, or elective surgery in the time period immediately following diagnosis of concussion. However, changes in brain homeostatic mechanisms following a concussion and concern for secondary brain injury can complicate the decision as to whether or not a surgery should proceed or be postponed. Given the paucity of available evidence, further evaluation of the use of anesthesia in a patient with concussion is warranted. This article summarizes what is currently known about the relevant pathophysiology of concussion, intraoperative anesthesia considerations, and effects of anesthesia on concussion outcomes in an attempt to help providers understand the risks that may accompany surgery and anesthesia in this patient population. While most contraindications to the use of anesthesia in concussed patients are relative, there are nonetheless pathophysiologic changes associated with a concussion that can increase risk of its use. Understanding these changes and anesthetic implications can help providers optimize outcomes in this patient population.