Management of labour

2017 ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Skills ◽  
Antenatal Clinic ◽  
Screening Tests ◽  
Medical Risk ◽  
Medical Risk Factors ◽  
Professional Person ◽  
Long Acting ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST5 doctor in the diabetic antenatal clinic. The clinic has been particularly busy today and is running 60 minutes late. There are several different clinics running simultaneously and no extra staff available to help in the diabetic clinic. You are asked to see Claire Potter, a 28- year- old lady with Type 1 diabetes who is 32 weeks in her first pregnancy. She has no other medical risk factors and her diabetes is well controlled with no complications. A recent HBA1c was 45. Ultrasound today shows normal liquor and normal symmetrical growth plotting on her established growth curve at 75th centile. Conduct a focused antenatal review and respond to her concerns. You have 10 minutes for this task (+ 2mins initial reading time). This task assesses the communication skills and application of knowledge regarding diabetes in pregnancy. Please do not interrupt or prompt. Record your overall clinical impression of the candidate for each domain (i.e. pass, borderline, or fail). There are marks for the actor to also assign at the end of the station You are Claire Potter, a 28- year- old solicitor, 32 weeks into your first pregnancy. You have Type 1 diabetes since you were 12 and are very confident in how best to control your diabetes. You are meticulous with checking your BM’s and adjusting your insulin accordingly and they are all within range (4– 6.5). You have no complications of diabetes and no other health problems. You take short and long acting insulin and have no allergies. You do not smoke or drink alcohol. You’re dating and anomaly ultrasound scans were normal and screening tests were low risk for Down’s syndrome. Your pregnancy has been uneventful with regular clinic reviews of your diabetes. Your last scan at 28/ 40 showed the baby was growing normally. Temperament: You are a very busy professional person and do not like to be kept waiting unnecessarily. You are annoyed the clinic is running late (yet again) but are not unreasonable provided you feel you are being listened to and your concerns addressed.

Diagnostic Accuracy of Serologic Screening Tests for Celiac Disease in Asymptomatic Adults and Children with Type 1 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1579-P
Author(s):  
MICHELLE GOULD ◽  
FARID H. MAHMUD ◽  
ANTOINE B. CLARKE ◽  
ESTHER ASSOR ◽  
AMISH PARIKH ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Diagnostic Accuracy ◽  
Screening Tests ◽  
Adults And Children ◽  
Serologic Screening

Management of delivery

2017 ◽  
Keyword(s):  
Reading Time ◽  
Clinical Skills ◽  
Breech Presentation ◽  
Antenatal Clinic ◽  
Information Gathering ◽  
Normal Vaginal Delivery ◽  
Clinical Impression ◽  
Safety Communication ◽  
Pregnancy And Delivery ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Rebecca Francis is a 34- year- old lady in her second pregnancy. She has had a normal vaginal delivery two years ago. Her pregnancy remained uneventful so far. At 36 weeks, her midwife detected that the baby was in breech presentation and has referred her to the antenatal clinic to discuss further management. You will then be given some information and asked questions by the examiner. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and actor. After the consultation with the actor patient (or in the last two minutes), tell the candidate that Rebecca underwent an unsuccessful ECV and was booked for an elective caesarean at 39 weeks. You performed her caesarean and to your surprise, you delivered a cephalic baby by caesarean section. What should you have done to prevent this? What will you do next to prevent this kind of incidence? What will you explain to Rebecca? Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). You are Rebecca Francis, a 34- year- old mother of two- year- old Lucy. You had a straight forward pregnancy and delivery with Lucy. You are currently 36 weeks pregnant. You were seen by your midwife yesterday for a routine check and she found the baby to be in breech position. You were sent to the antenatal clinic and have had a scan confirming that the baby is in breech position. You were told that rest of the scan, including the baby’s measurements, fluid volume around the baby and the position of the placenta are normal. You are healthy. You do not smoke and have had no alcohol in pregnancy. Your pregnancy has progressed without any problems so far. The screening test for the baby showed low risk for Down’s syndrome. Temperament: You think you are mostly a calm, level- headed woman, but you do like to be organised and in control of things.

scholarly journals Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

2019 ◽  
Vol 10 ◽  
pp. 204201881983086 ◽  
Author(s):  
Gesine van Mark ◽  
Stefanie Lanzinger ◽  
Ralf Barion ◽  
Michael Degenhardt ◽  
Simone Badis ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycosylated Hemoglobin ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Current Status ◽  
Metabolic Pattern ◽  
Oral Antidiabetic ◽  
Hba1c Control ◽  
Long Acting

Background: An understanding of the current status of patients with type 1 diabetes mellitus (T1DM) can help to provide appropriate treatment. Methods: This was a retrospective analysis of the DIabetes Versorgungs-Evaluation (DIVE) and the Diabetes-Patienten-Verlaufsdokumentation (DPV) databases for Germany. Results: The analysis included 56,250 people with T1DM (54.2% male), a median age of 36.8 years, and a median diabetes duration of 12.4 years. 15.3% were obese (body mass index ≥ 30kg/m2). Long-acting insulin analogs were used by 53.3%, short-acting analogs by 72.1%, and oral antidiabetic drugs by 4.7%. Patients had a median glycosylated hemoglobin (HbA1c) of 7.8%. There was a drop in HbA1c and an increase in the rate of hypertension, oral antidiabetic drug use, and in the rate of severe hypoglycemia (all p < 0.01) with age. Flash glucose monitoring (FGM) showed the best glucose values with fewer complications compared to other monitoring systems. HbA1c and FBG were lower in patients using a pump versus multiple daily injections (MDIs; 7.7 versus 7.9% and 7.8 versus 8.7 mmol/l; all adjusted p < 0.01). Patients had a lower risk of at least one severe hypoglycemic or DKA episode during the most recent treatment year with pump treatment compared to MDI (9.4% versus 10.5% and 4.7% versus 6.1%, both adjusted p < 0.01). Conclusion: The data demonstrated less-than-optimal glycemic control in the young, an increasing metabolic pattern in T1DM with increasing age, a benefit of FGM to improve HbA1c control and adverse effects, as well as benefits of pump treatment over MDIs.

Long-acting Insulin Analogs Effect on gh/igf Axis of Children with Type 1 Diabetes: a Randomized, Open-label, Two-period, Cross-over Trial

2016 ◽  
Vol 124 (05) ◽  
pp. 276-282 ◽  
Author(s):  
V. Cherubini ◽  
B. Pintaudi ◽  
A. Iannilli ◽  
M. Pambianchi ◽  
L. Ferrito ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Analogs ◽  
Open Label ◽  
Acting Insulin ◽  
Long Acting
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