Programs and Communities

Diabetes, a common chronic condition, effects many individuals causing poor quality of life, expensive medical bills, and devastating medical complications. While health care providers try to manage diabetes during short office visits, many patients still struggle to control their diabetes at home. Lack of diabetes self-management (DSM) is a potential barrier for people with diabetes having to maintain healthy hemoglobin A1cs (HgA1c).

In hopes of addressing this concern, an evidenced-based intervention; diabetic education and phone calls, using the chronic care model as its framework was implemented. The intervention targeted people with type II diabetes at a transitional care setting. Measured variables included HgA1c and DSM. Statistically significant improvements were seen in reported physical activity. Average improvements were seen in HgA1c and DSM after three months of diabetes self-management education (DSME). Attrition, cultural sensitivity, and increasing DSME hours should be further evaluated for future projects.

Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.

Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.

Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.

Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.

Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.

Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.

Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.

Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.

Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.

While the majority of the scholarship around surrealist relationships with fashion look at the era of the 1930s onwards, this article considers the first period of surrealism during the 1920s, including its prehistory in the mouvement flou as it emerged via Paris Dada and Littérature, asking two related questions: what was the presence and status of the discourse of fashion for surrealism during these formative years; and in what kinds of fashion practices did its members engage? In response to the first of these, an examination of the group’s journals, publications and documents suggests that fashion stands as a significant and abiding area of interest for the group and its members. Writings by André Breton, Louis Aragon, René Crevel and others are correlated with surrealist images and artworks to reflect upon this sustained and informed engagement with men’s and above all women’s fashion, and suggest a particularly keen awareness of the changes in clothing styles over the recent past. The second question has rarely been asked in a systematic way: how did the early Parisian surrealists reflect these interests in their own day-to-day fashion choices and preferences? Given that the majority of the early Parisian surrealist group was male, the focus here is predominantly on men’s fashion, and analysis of memoirs, correspondence and documents such as the photographs taken in the Bureau de recherches surréalistes provides evidence of collective and individual positions. The fashion choices of Simone and André Breton form a particular area of concern, revealing some nuanced developments and unorthodox moments in their day-to-day attitudes.

During his wartime exile in New York City, André Breton responded to the popular entrenchment of Surrealism as a language of shop window merchandising by leading a small group of artists and writers to take the publicity of Surrealism into their own hands. At Breton’s behest, Marcel Duchamp designed three shop windows to advertise texts released by the French publishing arm of the Fifth Avenue bookstore Brentano’s in 1943 and 1945. Although art historians have called attention to the relationship between these designs and the iconography of better-known works by Duchamp, this paper considers them as instantiations of Breton’s evolving thought within the context of a commercial environment already saturated with surrealist imagery. It places them within an iconographic web that includes, among others, Salvador Dalí’s famed fashion displays of the preceding decade, multiple iterations of Duchamp’s “twine,” and works by Kurt Seligmann, Roberto Matta, and Breton himself. The paper argues that, exemplifying the prewar surrealist motif of interior and exterior permeability and bringing it to a breaking point, these obscure windows for French-language texts became an important laboratory for the engaged critique of consumerism that would come to the forefront of the surrealist movement during the postwar period.