One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes

Polydipsia is a disorder that has received little attention in the research literature. Treatment has been mainly confined to medical or pharmacological intervention. Few studies have reported the use of contingency management techniques and none have sought to encourage self-management. This study shows how such a procedure brought about a significant change in rates of water drinking in a thirty-one year old man with a mild learning disability.

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Evaluation of an Internet Diabetes Self-Management Training Program for Adolescents and Young Adults

Diabetes Technology & Therapeutics ◽

10.1089/dia.2006.0058 ◽

2007 ◽

Vol 9 (1) ◽

pp. 60-67 ◽

Cited By ~ 41

Author(s):

Ben S. Gerber ◽

Marla C. Solomon ◽

Tracie L. Shaffer ◽

Michael T. Quinn ◽

Rebecca B. Lipton

Keyword(s):

Young Adults ◽

Training Program ◽

Management Training ◽

Adolescents And Young Adults ◽

Self Management

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The internet‐based arthritis self‐management program: A one‐year randomized trial for patients with arthritis or fibromyalgia

Arthritis & Rheumatism ◽

10.1002/art.23817 ◽

2008 ◽

Vol 59 (7) ◽

pp. 1009-1017 ◽

Cited By ~ 263

Author(s):

Kate R. Lorig ◽

Philip L. Ritter ◽

Diana D. Laurent ◽

Kathryn Plant

Keyword(s):

Randomized Trial ◽

Management Program ◽

Self Management ◽

The Internet ◽

One Year

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Incidence of Severe Pain in Newly Diagnosed Ambulatory Patients with Stage IV Cancer

Pain Research and Management ◽

10.1155/2012/542354 ◽

2012 ◽

Vol 17 (5) ◽

pp. 347-352 ◽

Cited By ~ 5

Author(s):

Thomas Isaac ◽

Sherri O Stuver ◽

Roger B Davis ◽

Susan Block ◽

Jane C Weeks ◽

...

Keyword(s):

Head And Neck ◽

Severe Pain ◽

Stage Iv ◽

Initial Visit ◽

Newly Diagnosed ◽

Ambulatory Oncology ◽

Ambulatory Patients ◽

Stage Iv Cancer ◽

One Year ◽

Thoracic Malignancies

BACKGROUND: Pain is common among cancer patients.OBJECTIVE: To characterize the incidence of severe pain among newly diagnosed patients with stage IV cancer in ambulatory care.METHODS: A retrospective cohort of 505 ambulatory oncology patients with newly diagnosed stage IV solid tumours at a comprehensive cancer centre (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) was followed from January 1, 2004, to December 31, 2006. Pain intensity scores were extracted from electronic medical records. The incidence of severe pain was calculated using the maximum monthly pain scores reported at outpatient visits.RESULTS: Of the 505 patients included in the present study, 340 (67.3%) were pain-free at the initial visit, 90 (17.8%) experienced mild pain, 48 (9.5%) experienced moderate pain and 27 (5.4%) experienced severe pain. At least one episode of severe pain within one year of diagnosis was reported by 29.1% of patients. Patients with head and neck, gastrointestinal and thoracic malignancies were more likely to experience severe pain compared with patients with other types of cancer (52.6%, 33.9% and 30.5%, respectively). In the multivariable model, patients whose primary language was not English (OR 2.90 [95% CI 1.08 to 7.80]), patients who reported severe pain at the initial visit (OR 9.30 [95% CI 3.72 to 23.23]) and patients with head and neck (OR 10.17 [95% CI 2.87 to 36.00]) or gastrointestinal (OR 4.05 [95% CI 1.23 to 13.35]) cancers were more likely to report severe pain in the following year.CONCLUSIONS: The incidence of severe pain was high in ambulatory patients with newly diagnosed stage IV cancer.

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Abstract MP75: Geographic Variation in Stroke Rates and Oral Anticoagulation Use among Medicare Beneficiaries with Atrial Fibrillation

Circulation ◽

10.1161/circ.137.suppl_1.mp75 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Inmaculada Hernandez ◽

Samir Saba ◽

Yuting Zhang

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Geographic Variation ◽

Newly Diagnosed ◽

Medicare Beneficiaries ◽

The West ◽

North Central ◽

Census Division ◽

Adjusted Rate ◽

West North Central

Background: Recent studies have shown strong geographic variation in oral anticoagulation (OAC) use in atrial fibrillation (AF); however, it remains unknown how this contributes to the geographic variation in ischemic stroke observed across the US. The objective of the present study was to evaluate the relationship between the geographic variation in the initiation of OAC and the incidence of ischemic stroke in a cohort of Medicare beneficiaries newly diagnosed with AF. Methods: Using 2013-2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 and categorized them according to their initiation of OAC. Our sample included 21,226 OAC initiators and 20,068 patients who did not initiate OAC therapy. We assigned each patient to one of the 9 US Census Divisions using the zip code, and collected their medical claims with a diagnosis of ischemic stroke. We constructed logistic regression models to estimate the average adjusted probability of OAC initiation and Poisson models to estimate the average adjusted rate of ischemic stroke, in each Census Division. Both estimates were adjusted for demographics, eligibility for Medicaid coverage and for low-income subsidy, enrollment in a Medicare Advantage Part D plan, and a comprehensive list of clinical characteristics. We computed the correlation between the average adjusted probability of OAC initiation and the average adjusted rate of ischemic stroke at the Census Division level. Results: The probability of OAC initiation was lowest in the West South Central (0.47) and highest in the West North Central (0.54) and New England (0.54). The average adjusted rate of ischemic stroke was lowest in the West North Central (0.09) and highest in the South Atlantic (0.14) and South West Central (0.14). The average adjusted probability of OAC initiation at the Census Division level and the average adjusted rate of ischemic stroke were inversely correlated, with R=-0.576, p-value=0.10. This suggests that variation in OAC initiation likely explains at least a third of geographic variation in ischemic stroke [R 2 =(-0.576) 2 =0.332]. Conclusions: Our results suggest that geographic variations in OAC initiation within the U.S. explain, in part, variations in the incidence of ischemic stroke among AF patients. Further mechanistic research using advanced causal mediation models is warranted.

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P006: Characterizing patients with newly-diagnosed diabetes mellitus in the emergency department: A one-year health records review

CJEM ◽

10.1017/cem.2017.208 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S79

Author(s):

H. Ali Khan ◽

K. Gushulak ◽

M. Columbus ◽

I.G. Stiell ◽

J.W. Yan

Keyword(s):

Diabetic Ketoacidosis ◽

Type Ii Diabetes ◽

Type I ◽

Type Ii ◽

Newly Diagnosed ◽

Health Records ◽

The Mean ◽

One Year ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes

Introduction: Diabetes mellitus is an increasingly prevalent chronic condition that is usually managed in an outpatient setting. However, the emergency department (ED) plays a crucial role in the management of diabetic patients, particularly for those who are presenting with newly diagnosed diabetes. Little research has been done to characterize the population of patients presenting to the ED with hyperglycemia with no previous diagnosis of diabetes. The objective of this study was to describe the epidemiology, treatment, and outcomes of patients who were newly diagnosed with diabetes in the ED and to compare those with newly diagnosed type I versus type II diabetes. Methods: A one-year health records review of newly diagnosed diabetes patients ≥18 years presenting to one of four tertiary care EDs was conducted. All patients with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome were screened, but only those who did not have a previous history of diabetes were included. Trained research personnel collected data on patient characteristics, management, disposition, and outcome. Descriptive statistics were used to summarize the data where appropriate. Results: Of 645 patients presenting with hyperglycemia in the study period, 112 (17.4%) were newly diagnosed diabetes patients. Of these patients, 30 (26.8%) were later diagnosed with type I diabetes and 82 (73.2%) were diagnosed with type II diabetes. For the newly diagnosed type I patients the mean (SD) age was 27.6 (9.9) and the mean (SD) age for type II patients was 52.4 (14.1). Of all the new onset patients, 26.8% were diagnosed with diabetic ketoacidosis. The percentage of patients diagnosed with diabetic ketoacidosis was higher in type I than type II (63.3% vs 13.4%; P<0.01). A total of 49 (43.8%) patients were admitted to the hospital, and more patients with type I were admitted compared to those with type II (66.7% vs 35.4 %; P<0.01). Conclusion: Limited research has been done to describe patients newly diagnosed with diabetes in the ED. Patients with type I were found to be more likely to present to the ED with serious symptoms requiring admission to hospital. Our findings demonstrate that the ED may have a strong potential role for improving diabetic care, by providing future opportunities for education and follow-up in the ED to reduce complications, particularly in type I.

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Reliability and Validity A Quick Review

The Diabetes Educator ◽

10.1177/0145721707308172 ◽

2007 ◽

Vol 33 (5) ◽

pp. 775-780 ◽

Cited By ~ 34

Author(s):

Karen Fitzner

Keyword(s):

Construct Validity ◽

External Validity ◽

Diabetes Education ◽

Reliability And Validity ◽

Management Training ◽

Self Management ◽

Validity Testing ◽

Education Practice ◽

Rigorous Testing ◽

Diabetes Educators

The purpose of this article is to provide a brief review of reliability and validity testing. These concepts are important to researchers who are choosing techniques and/or developing tools that will be applied and evaluated in diabetes education practice. Several types of reliability and validity testing are defined, and an easy-to-use check sheet is provided for research purposes. Following testing for the basic aspects of reliability and validity such as face and construct validity, a tool may be appropriate for use in practice settings. Those conducting comprehensive outcomes evaluations, however, may desire additional validation such as testing for external validity. Diabetes educators can and should incorporate rigorous testing for these important aspects when conducting assessments of techniques and tools relating to diabetes self-management training.

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