Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis

Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources.Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA.Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model.Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P0.001).Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents.

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DIABETIC KETOACIDOSIS AS THE INITIAL PRESENTATION OF TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS: EPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL

Revista Paulista de Pediatria ◽

10.1590/1984-0462/2020/38/2018204 ◽

2020 ◽

Vol 38 ◽

Author(s):

Leonardo Calil Vicente Franco de Souza ◽

Gabriela de Carvalho Kraemer ◽

Adriana Koliski ◽

José Eduardo Carreiro ◽

Mônica Nunes Lima Cat ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Children And Adolescents ◽

Diabetic Ketoacidosis ◽

University Hospital ◽

Pediatric Endocrinology ◽

Altered Level ◽

Duration Of Symptoms ◽

The Impact

ABSTRACT Objective: To analyze the variables associated with the presence of diabetic ketoacidosis in type 1 diabetes mellitus (T1DM) diagnosis and its impact on the progression of the disease. Methods: We reviewed the records of 274 children and adolescents under 15 years, followed in a Pediatric Endocrinology clinic of a university hospital in Curitiba-PR. They had their first appointment between January 2005 and April 2015. Results: Most patients received their T1DM diagnosis during a diabetic ketoacidosis episode. The associated factors were: lower age and greater number of visits to a physician’s office prior to diagnosis; diabetic ketoacidosis was less frequent in patients who had siblings with T1DM and those diagnosed at the first appointment. Nausea and vomiting, abdominal pain, tachydyspnea, and altered level of consciousness were more common in the diabetic ketoacidosis group. There was no association with socioeconomic status, duration of symptoms before diagnosis, and length of the honeymoon period. Conclusions: Prospective studies are necessary to better define the impact of these factors on diagnosis and disease control. Campaigns to raise awareness among health professionals and the general population are essential to promote early diagnosis and proper treatment of diabetes mellitus in children and adolescents.

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Intracerebral Haemorrhages and Oral Anticoagulation in the North of Scotland

Scottish Medical Journal ◽

10.1177/003693300004500402 ◽

2000 ◽

Vol 45 (4) ◽

pp. 101-104 ◽

Cited By ~ 11

Author(s):

J. Berwaerts ◽

O.J. Robb ◽

T.A. Jeffers ◽

J. Webster

Keyword(s):

Oral Anticoagulation ◽

Oral Anticoagulant ◽

Intracranial Haemorrhage ◽

Absolute Risk ◽

Admission Rate ◽

Royal Infirmary ◽

The North ◽

Number Of Patients ◽

Average Annual Incidence ◽

The Impact

The aim of this study has been twofold: 1 - to examine the impact of oral anticoagulant (OAC) use on a possible recent rise in the admission rate of intracerebral haemorrhages to Aberdeen Royal Infirmary (ARI), and 2 - to estimate the absolute risk of intracranial haemorrhage for outpatients followed up in the OAC Clinic at AR1. The number of patients admitted to ARI with intracerebral bleedings increased by 60% between 1993 and 1998. A corresponding increase in the proportion of patients with concurrent OAC use (4.7% vs 15.7%, p=0.055) cannot sufficiently explain the increase in the total number of intracerebral haemorrhages. The average annual incidence of intracranial haemorrhages for the OAC Clinic at ARI is found to be acceptably low at 0.33% per year. Further audit of the large number of patients receiving warfarin outwith the supervision of the clinic is urgently required.

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Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.911 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Pinheiro ◽

B Nunes ◽

S Pereira da Silva ◽

C Caetano

Keyword(s):

Hospital Admission ◽

Economic Crisis ◽

Suicide Attempts ◽

Admission Rate ◽

Sudden Increase ◽

Hospital Admission Rate ◽

Crisis Period ◽

Increased Risk ◽

Self Harm ◽

The Impact

Abstract Background Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal. Methods A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality. Results A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued. Conclusions There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period. Key messages Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.

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Hospital admission rate in children and adolescents with mild persistent asthma

Pediatric Pulmonology ◽

10.1002/ppul.25363 ◽

2021 ◽

Author(s):

Eduardo Vieira Ponte ◽

Cintia Fernanda Bertagni Mingotti ◽

Ronei Luciano Mamoni ◽

Evaldo Marchi ◽

José Eduardo Martinelli ◽

...

Keyword(s):

Hospital Admission ◽

Children And Adolescents ◽

Persistent Asthma ◽

Admission Rate ◽

Hospital Admission Rate ◽

Mild Persistent Asthma

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The Impact of Murmur’s Severity on the Cardiac Variability

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/101 ◽

2020 ◽

Vol 3 (12) ◽

pp. 01-11

Author(s):

S.M Debbal

Keyword(s):

Cardiac Activity ◽

Common Disease ◽

Heart Activity ◽

Important Indicator ◽

Heart Murmurs ◽

Effective Factor ◽

Number Of Patients ◽

Life Threatening ◽

Cardiac Variability ◽

The Impact

Phonocardiogram (PCG) signal is one of the useful approach to explore cardiac activity, and extract many features to help researchers to develop technic that may serve medical stuff to the diagnosis of several cardiac diseases. For people when it comes to a heart activity problem it is a serious health matter that need special care. In this paper, the importance is given to heart murmurs to highlight their impact. Heart murmurs are very common disease in world and depend on their severity they could be life-threatening point; therefore, the purpose of this paper is focused on three essential steps: first is to design an algorithm to extract only heart murmurs from a pathological phonocardiogram signal (PCG) as a basic background to the whole work. Than calculate their severity based on energy ratio (ER) which is recommended by recent studies as an effective factor, in order to classify them to mild, medium and severe murmurs. In other hand, this classification will served to study the impact of severity of systolic and diastolic murmurs on cardiac variability, which is very important indicator on general health of human body. This study is done on consider number of patients and its reveal on very interesting results.

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Abstract 3221: Impact of Thienopyridines on Re-Operation Rates, Bleeding Outcomes and Hospitalization in ACS Patients Requiring CABG Surgery

Circulation ◽

10.1161/circ.116.suppl_16.ii_724-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jeffrey S Berger ◽

Carla B Frye ◽

Qing Harshaw ◽

Fred H Edwards ◽

Steven R Steinhubl ◽

...

Keyword(s):

Cross Section ◽

Cohort Analysis ◽

Exposed Group ◽

Cabg Surgery ◽

Preoperative Administration ◽

Number Of Patients ◽

Comparison Groups ◽

Life Threatening ◽

Broad Cross Section ◽

The Impact

Objective: The objective of this retrospective observational study is to examine the impact of preoperative administration of clopidogrel on re-operation rates, incidence of life-threatening bleeding, inpatient length of stay (LOS) and other bleeding-related outcomes in ACS patients requiring CABG in a broad cross-section of US hospitals. This is the first study designed with this objective to be conducted in multiple centers . Methods: A retrospective cohort analysis of ACS patients requiring CABG surgery during their index hospitalization was completed. Each site randomly selected 40–50 cases divided into the two comparison groups which consisted of patients exposed to clopidogrel versus those not exposed to clopidogrel within 5 days prior to surgery. Results: Data from the first 361 patients in 12 hospitals are reported. The two groups were comparable at baseline in terms of age, gender and co-morbidities. The rate of re-operation in the exposed group was 6.3% vs. 1.5% (p = 0.016) in those not exposed within 5 days. The number of patients who experienced excessive or life-threatening bleeding was higher in the exposed group; total inpatient LOS was not significantly different. Patients in the exposed group also required more blood product transfusions. Relationship between Clopidogrel Exposure and LOS, Markers for Life Threatening Bleeding, and Reoperation - Interim Analysis, 12 sites reporting Conclusion: Exposure to clopidogrel within 5 days before CABG surgery in ACS patients appears to significantly increase the need for re-operation and major bleeding outcomes in a broad cross-section of hospitals.

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Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Acta Endocrinologica ◽

10.1530/eje-15-0129 ◽

2015 ◽

Vol 173 (3) ◽

pp. 341-350 ◽

Cited By ~ 43

Author(s):

Beate Karges ◽

Joachim Rosenbauer ◽

Paul-Martin Holterhus ◽

Peter Beyer ◽

Horst Seithe ◽

...

Keyword(s):

Type 1 Diabetes ◽

Regression Analysis ◽

Hospital Admission ◽

Diabetic Ketoacidosis ◽

Young Patients ◽

Admission Rate ◽

Severe Hypoglycemia ◽

Diabetes Duration ◽

The Mean

ObjectiveTo investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes.DesignIn total, 31 330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included.MethodsAdmission rates for DKA (pH <7.3 or bicarbonate <15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis.ResultsThe mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51–5.14). The highest DKA rates were observed in patients with HbA1c ≥9.0% (15.83 (14.44–17.36)), age 15–20 years (6.21 (5.61–6.88)) and diabetes duration of 2–4.9 years (5.60 (5.00–6.27)). DKA rate was higher in girls than in boys (5.35 (4.88–5.86) vs 4.34 (3.95–4.77), P=0.002), and more frequent in migrants than in non-migrants (5.65 (4.92–6.49) vs 4.57 (4.23–4.93), P=0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30–1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72–2.65) vs 1.28 (1.12–1.47), P<0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63–20.03) vs patients without preceding hypoglycemia 0.42 (0.35–0.52), P<0.001). Differences remained significant after multivariable adjustment.ConclusionsThe identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.

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The Impact of Murmur’s Severity on the Cardiac Variability

10.52916/jmrs204030 ◽

2020 ◽

pp. 1-6

Author(s):

SM Debbal

Keyword(s):

Cardiac Activity ◽

Common Disease ◽

Heart Activity ◽

Important Indicator ◽

Heart Murmurs ◽

Effective Factor ◽

Number Of Patients ◽

Life Threatening ◽

Cardiac Variability ◽

The Impact

Phonocardiogram (PCG) signal is one of the useful approach to explore cardiac activity, and extract many features to help researchers to develop technic that may serve medical stuff to the diagnosis of several cardiac diseases. For people when it comes to a heart activity problem it is a serious health matter that need special care. In this paper, the importance is given to heart murmurs to highlight their impact. Heart murmurs are very common disease in world and depend on their severity they could be life-threatening point; therefore, the purpose of this paper is focused on three essential steps: first is to design an algorithm to extract only heart murmurs from a pathological Phonocardiogram (PCG) signal as a basic background to the whole work. Than calculate their severity based on Energy Ratio (ER) which is recommended by recent studies as an effective factor, in order to classify them to mild, medium and severe murmurs. In other hand, this classification will served to study the impact of severity of systolic and diastolic murmurs on cardiac variability, which is very important indicator on general health of human body. This study is done on consider number of patients and its reveal on very interesting results.

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Additive Effect of Periodontal Disease and Obesity on COVID-19 Outcomes

Journal of Dental Research ◽

10.1177/00220345211029638 ◽

2021 ◽

pp. 002203452110296

Author(s):

H. Larvin ◽

S. Wilmott ◽

J. Kang ◽

V.R. Aggarwal ◽

S. Pavitt ◽

...

Keyword(s):

Oral Health ◽

Periodontal Disease ◽

Hospital Admission ◽

Odds Ratio ◽

Admission Rate ◽

Mortality Rates ◽

Normal Weight ◽

Hazard Ratio ◽

Hospital Admission Rate ◽

The Impact

This study aims to examine the impact of periodontal disease in obesity on COVID-19 infection and associated outcomes. This retrospective longitudinal study included 58,897 UK Biobank participants tested for COVID-19 between March 2020 and February 2021. Self-reported oral health indicators (bleeding gums, painful gums, and loose teeth) were used as surrogates for periodontal disease. Body fat levels were quantified by body mass index (BMI) and categorized as normal weight (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (≥30 kg/m2). Multivariable logistic regression and Cox proportional hazard models were used to quantify risk of COVID-19 infection, hospital admission, and mortality, adjusted for participants’ demographics and covariates. Of 58,897 participants, 14,466 (24.6%) tested positive for COVID-19 infection. COVID-19 infection was higher for participants who were overweight (odds ratio, 1.18; 95% CI, 1.12 to 1.24) and obese (odds ratio, 1.33; 95% CI, 1.26 to 1.41) as compared with those of normal weight, but infection was not affected by periodontal disease. The hospital admission rate was 57% higher (hazard ratio, 1.57; 95% CI, 1.25 to 1.97) in the obese group with periodontal disease than without periodontal disease, and admission rates increased with BMI category (normal weight, 4.4%; overweight, 6.8%; obese, 10.1%). Mortality rates also increased with BMI category (normal weight, 1.9%; overweight, 3.17%; obese, 4.5%). In addition, for participants with obesity, the mortality rate was much higher (hazard ratio, 3.11; 95% CI, 1.91 to 5.06) in participants with periodontal disease than those without. Obesity is associated with higher hospitalization and mortality rates, and periodontal disease may exacerbate this impact. The results could inform health providers, policy makers, and the general public of the importance to maintain good oral health through seamless provision of dental services and public oral health prevention initiatives.

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The bimodal rise and fall acute coronary syndromes curves paralleling COVID-19 outbreaks

European Heart Journal ◽

10.1093/eurheartj/ehab724.1458 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Trabattoni ◽

G Teruzzi ◽

P M Ravagnani ◽

G Santagostino Baldi ◽

P Montorsi ◽

...

Keyword(s):

Cardiogenic Shock ◽

Hospital Admission ◽

Clinical Outcomes ◽

Acute Coronary Syndromes ◽

Hospital Admissions ◽

Admission Rate ◽

Nasopharyngeal Swab ◽

Admission Rates ◽

Coronary Syndromes ◽

The Impact

Abstract Introduction Preliminary reports from the early phase of COVID-19 epidemic in Italy reported a dramatic reduction in hospital admission rates for acute coronary syndromes (ACS) coupled with longer times from symptoms onset to hospital presentation. Purpose To assess the impact of COVID-19 on hospital admission rates and ACS patterns, as well as time to presentation and clinical outcomes, following the acute pandemic phase in 2020 compared to previous year. Methods We conducted a single institution retrospective analysis conducted in a cardiovascular hub serving a large metropolitan area in Italy. Number and monthly distribution of hospital admissions for ACS from January 1 to December 31, 2020 were compared to the respective figures in 2019. Baseline clinical features, time from symptoms onset to hospital admission and main clinical outcomes were collected. Results A total of 599 ACS cases were recorded in 2020 vs. 386 cases in 2019, with a net 55% increase. ACS presentation rate in 2020 showed a bimodal pattern, paralleling the most contagious outbreak periods (Figure 1). SARS-CoB-2 nasopharyngeal swab or specific antibody tests were positive in 34 (5.7%) patients. Time from symptoms onset to hospital presentation tended to be longer in 2020 than in 2019, being two-fold longer during the peak epidemic phase (February 21-May 3, 2020; median time 2.0 vs. 5.0 hours, p=0.030). The proportion of late-presenting STEMI (>8 hrs from symptoms onset) was higher in 2020 compared to 2019 (30% vs. 18%, p=0.003),as well as higher was in-hospital mortality (15% in 2020 vs 6% in 2019, p=0.001), partly due to a three-fold increase in cardiogenic shock on ACS presentation. Conclusions ACS admission rate significantly increased during the 2020 COVID-19 epidemic outbreak for several reasons only partially explained by a SARS-CoV-2 infection trigger effect on ACS. Longer presentation times and higher rates of cardiogenic shock and mortality were observed, urging the need health-care systems to keep a high priority on cardiovascular emergencies response networks. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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