Evaluation of quality indicators in hospital discharge reports in diabetic patients from an Internal Medicine Service: are we doing a good clinical practice?

Hyperglycaemic patients admitted to hospital have worse clinical outcomes with higher operational costs than normoglycaemic patients. Identifying, defining and treating hyperglycaemia promptly and appropriately is essential during hospitalization; adequate “continuity of care” must be assured after discharge. This requires a multidisciplinary clinical collaboration between the internist and the diabetes team, which plays a central role in the treatment course and should be involved soon after patient admission to the hospital. This document aims to establish guidelines and recommendations for good clinical practice in managing hyperglycaemic Internal Medicine patients, with or without previous diagnosis of diabetes. The Associazione Medici Diabetologi (AMD), Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) and Società Italiana di Diabetologia (SID) have decided to publish a document useful for internists in the management of hospitalised patients with hyperglycaemia. The Trialogue project, coordinated by the Board of Scientific experts from the three Scientific Societies, was initiated for this purpose. A questionnaire consisting of 16 multiple choice questions on the management of hyperglycaemia in hospital was answered by 660 physicians from over 250 internal medicine units distributed throughout Italy. Analysis of responses has yielded an overview of routine clinical practice and provided a wealth of ideas to better identify critical points in the treatment of hospitalized patients with hyperglycaemia. These recommendations were developed with the aim of providing mutually agreed practical guidance (instructions for use) that can be readily applied by healthcare professionals in routine clinical practice.

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Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

Primary Care Diabetes ◽

10.1016/j.pcd.2012.04.007 ◽

2012 ◽

Vol 6 (4) ◽

pp. 285-292 ◽

Cited By ~ 6

Author(s):

Abdulbari Bener ◽

Mariam Abdulmalik ◽

Mohammed Al-Kazaz ◽

Rahima Sanya ◽

Sara Buhmaid ◽

...

Keyword(s):

Primary Care ◽

Gender Differences ◽

Clinical Practice ◽

Good Clinical Practice ◽

Diabetic Patients

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Stakeholders’ recommendations for revising Good Clinical Practice

Contemporary Clinical Trials Communications ◽

10.1016/j.conctc.2021.100776 ◽

2021 ◽

pp. 100776

Author(s):

Amy Corneli ◽

Annemarie Forrest ◽

Teresa Swezey ◽

Li Lin ◽

Pamela Tenaerts

Keyword(s):

Clinical Practice ◽

Good Clinical Practice

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Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis

BMC Nephrology ◽

10.1186/s12882-021-02394-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Peter Bramlage ◽

Stefanie Lanzinger ◽

Sascha R. Tittel ◽

Eva Hess ◽

Simon Fahrner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Analysis Data ◽

Disease Diagnosis ◽

Diabetic Patients ◽

European Society Of Cardiology

Abstract Background Recent European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) guidelines provide recommendations for detecting and treating chronic kidney disease (CKD) in diabetic patients. We compared clinical practice with guidelines to determine areas for improvement. Methods German database analysis of 675,628 patients with type 1 or type 2 diabetes, with 134,395 included in this analysis. Data were compared with ESC/EASD recommendations. Results This analysis included 17,649 and 116,747 patients with type 1 and type 2 diabetes, respectively. The analysis showed that 44.1 and 49.1 % patients with type 1 and type 2 diabetes, respectively, were annually screened for CKD. Despite anti-diabetic treatment, only 27.2 % patients with type 1 and 43.5 % patients with type 2 achieved a target HbA1c of < 7.0 %. Use of sodium-glucose transport protein 2 inhibitors (1.5 % type 1/8.7 % type 2 diabetes) and glucagon-like peptide-1 receptor agonists (0.6 % type 1/5.2 % type 2 diabetes) was limited. Hypertension was controlled according to guidelines in 41.1 and 67.7 % patients aged 18–65 years with type 1 and 2 diabetes, respectively, (62.4 vs. 68.4 % in patients > 65 years). Renin angiotensin aldosterone inhibitors were used in 24.0 and 40.9 % patients with type 1 diabetes (micro- vs. macroalbuminuria) and 39.9 and 47.7 %, respectively, in type 2 diabetes. Conclusions Data indicate there is room for improvement in caring for diabetic patients with respect to renal disease diagnosis and treatment. While specific and potentially clinically justified reasons for non-compliance exist, the data may serve well for a critical appraisal of clinical practice decisions.

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Strategy for the Maximal Use of Native Arteriovenous Fistulae for Hemodialysis

The Scientific World JOURNAL ◽

10.1100/tsw.2006.171 ◽

2006 ◽

Vol 6 ◽

pp. 808-815 ◽

Cited By ~ 8

Author(s):

Marko Malovrh

Keyword(s):

Clinical Practice ◽

Vascular Access ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Significant Proportion ◽

Chronic Hemodialysis ◽

Diabetic Patients ◽

Term Survival ◽

Av Fistula ◽

Native Fistula

The long-term survival and quality of life of patients on hemodialysis is dependant on the adequacy of dialysis via an appropriately placed vascular access. The native arteriovenous fistula (AV fistula) at the wrist is generally accepted as the vascular access of choice in hemodialysis patients due to its low complication and high patency rates. It has been shown beyond doubt that an optimally functioning AV fistula is a good prognostic factor of patient morbidity and mortality in the dialysis phase. Recent clinical practice guidelines recommend the creation of a vascular access (native fistula or synthetic graft) before the start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. A multidisciplinary approach, including nephrologists, surgeons, interventional radiologists, and nurses should improve the hemodialysis outcome by promoting the use of native AV fistulae. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. This approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate, and a high maturation, even in risk groups such as elderly and diabetic patients. Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results also support clinical practice guidelines that recommend the preferential placement of a native fistula.

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