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  • ISSN: 2379-0547
    Volume 2, Issue 3
    Research Article
    Muna Alkhaifi1, Ghaigha Alkhussaib1, Thord Theodorson1, Michael A. Ward2,3* and A. Al Mazrou’I4
    Objective of the study: The goal of this qualitative study was to explore the barriers of initiating insulin for patients with Type II Diabetes among general practitioners and family physicians in primary care settings.
    Method: This qualitative study was composed of 3 focus groups of General Practitioners and Family Physicians (n=18) who had experience in treating patients with type 2 Diabetes. A semi -structured questionnaire was used to guide the interview in 3 focus group discussions held over 3 consecutive days. The discussion was then transcribed verbatim and analyzed.
    Result: Initiating insulin therapy was shown to be affected by physician, patient and system related factors. Each barrier was identified by highlighting the main categories. Physician factors which included physician knowledge, beliefs, fears and concerns. Patient factor included patient education, compliance and socio-economic status. System factors included short consultation time and lack of resources.
    Conclusion: Overcoming barriers to the initiation of insulin therapy will require further education amongst physicians regarding insulin initiation and preferably the use of standardized guidelines. Moreover, patient education and awareness of the benefits of insulin in preventing diabetic complications is indicated. A patient-centered approach with improved communication between physicians and patients may improve patient knowledge, address misconceptions of insulin, improve compliance and help overcome barriers. This may be partly achieved by reorganizing aspects of the health care delivery system. Further research is needed to investigate these recommendations and to assess patients’ perceptions and systems- related factors on initiating insulin therapy.
    Nabi Fatahi1,2* and Øyvind Økland3
    Objective: To study difficulties and possibilities in Kurdish refugees’ social relationship in the host country and its impact on refugee’s psychosocial well-being
    Method: Data was collected through group interviews with 23 Kurdish refugees from the Kurdistan regions in Iraq and Iran 10 women and 13men aged 32-54 years (mean age 47). Content analysis method was used for analyse and interpreting of collected data.
    Results: Kurdish refugees reported a number of difficulties and possibilities related to the social relationship in the host countries. Three main categories emerged from the analysis of the data. The first category reflects the hampering factors regarding refugees’ social relationship. The second category deals with factors that affect improving of refugees’ social relationship. The third category is about the importance of social relationship for psychosocial well-being.
    Conclusion: According to the participants’ experiences, there are both hampering and amplification factors regarding immigrants social relationship and psychosocial well-being in host countries. They stated that there is a strong association between social relationships and psychosocial well-being.
    Seema Jain1 and Michael A. Ward1,2*
    Lipid profiles are a part of the routine blood work ordered by many family physicians. For decades, manipulation of lipid levels has been a central theme in the effort to decrease the impact of cardiovascular disease. In particular, the high density lipoprotein (HDL) fraction has been the subject of much research and controversy. In the 1960’s, strong epidemiological evidence demonstrated an inverse relationship between HDL and the risk of cardiovascular disease. This paper sought to examine the risk reduction of such events by therapeutically targeting HDL with niacin, fibrates or the cholesteryl ester transfer protein (CETP) inhibitors. A literature search yielded 5 relevant articles which were then critically analyzed. Results demonstrated no benefit of increasing HDL with niacin, gemfibrozil, bezafibrate or fenofibratein those patients already treated with statins. However, patients not on statins were found to have a decreased risk of non-fatal MI with niacin and fibrate use. Niacin also reduced the incidence of strokes. Despite disappointing phase three trials with the CETP inhibitors, torcetrapib and dalcetrapib, trials for anacetrapib and evacetrapib are ongoing.
    Short Communication
    Surendra Bir Adhikari1, Rick R. Massatti1, Josephine F. Wilson2*, Jo Ann Ford2 and Jared Embree2
    The objective of this research was to explore whether increased exposure to E-Therapy results in more successful therapeutic outcomes for persons with disabilities and substance use disorders (SUD). A Mann-Whitney U test was used to analyze exit interview data on 48 persons who had successfully completed SUD treatment. Clients who received a higher percentage of SUD treatment as E-Therapy had better therapeutic outcomes and those who received fewer therapeutic sessions had less successful outcomes. E-Therapy has critical policy implications and should be promoted as a cost-effective way to provide SUD treatment to persons who are deaf or experience low-incidence disabilities.
    Case Repot
    Fatahi N*
    Background: Every day, tens of thousands of people are moving more or less involuntarily from their homelands to other countries, thus passing lingual and cultural borders. In this context, cross-cultural and cross-lingual clinical encounters are unavoidable issues for health care providers. Mutual understanding between patient and physician is essential for the patient’s satisfaction and health outcome.
    Case report: In healthcare contexts, diversities in language and culture have resulted in misunderstandings between patients and interpreters. The patients and their interpreters need to understand each other on a comparable level to the interpreter and physician. The assignment of an interpreter should be done in consultation with the patient and according to the patient’s mother tongue rather than patent’s citizenship. If patient and interpreter have different mother tounges, three languages are involved in the consultation process, which increases the risk for misunderstandings, as compared with settings involving only two languages.
    Conclusion: In order to minimize misunderstanding in clinical encounters, interpreters should be assigned according to the patient’s mother tongue rather than patient’s citizenship. Trilingual interpreting situations (patient and interpreter have different mother tongues) in clinical encounters should be avoided.
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