A Cloud-Based Solution to Support Patient Outreach and Engagement for Chronic Disease and Preventative Care-A Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Rubina Rizvi ◽  
Fernando Suarez ◽  
Suwei Wang ◽  
Anita Preininger ◽  
Karlis Draulis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
Response Rate ◽  
Diabetic Patients ◽  
Medical Group ◽  
Preventative Care ◽  
Chi Square ◽  
Patient Response ◽  
Patients With Diabetes ◽  
Patient Outreach

BACKGROUND Patients more actively engaged in their care have better clinical outcomes. OBJECTIVE To examine the performance of a widely adopted cloud-based patient engagement system for management of diabetes, hypertension, and preventative screenings at two large healthcare systems. METHODS We included patients with diabetes, hypertension, and those due for breast cancer screenings and/or bi-annual wellness visits and at Loudon Medical Group (LMG) in Virginia, and Basset Medical Group (BMG) in New York between 2019-2021. We examined outreach outcomes including successful contact rate (SCR), patient response rate (PRR), and adherent response rate (ARR). Associations between demographic characteristics and outcome measures were explored with Chi-square or Fisher’s exact tests. RESULTS Attempted contacts with patients with diabetes (N=2567) at LMG resulted in SCR of 87.1%, PRR of 47.2%, and ARR of 38.4%. At BMG, attempted contacts with patients with diabetes (N=3621), hypertension (N=10881), patients for breast cancer screening (N=2441), and wellness visits (N=9070) resulted in SCR values of 91.0%, 93.2%, 90.1%, and 92.1%; PRR of 57.0%, 59.8%, 50.8%, and 52.0%; and ARR of 45.2%, 39.8%, 6.8%, and 11.5% respectively. Outreach outcomes measures were significantly higher in patients with hypertension, and those carrying commercial or Medicare insurance vs. those who were self-insured or on Medicaid plans (SCR P<.0001, PRR P<.0001, and ARR P=.0013). Among diabetic patients, only SCR (P=.0008) was significantly associated with commercial or Medicare insurance. In general, rate of contact (SCR) had more favorable results as compared to the rate of follow-up visits (PRR, ARR), with higher PRR significantly associated with female sex (P<.0001), and a higher SCR seen among patients contacted by text (P<.0001). Age-stratified analysis showed that 60-69 years old diabetic patients had the highest SCR and ARR. Hypertensive patients between the ages of 70-79 had the highest SCR, PRR, and ARR. CONCLUSIONS This cloud-based patient outreach system demonstrated high rates of contact in patients with hypertension, diabetes and/or eligible for preventative screenings. Overall response rates were over 50%, with moderate adherence rates for diabetes and hypertension, but low adherence for preventative screenings. Older patients had higher adherence rates. Additional strategies are needed to translate successful patient contact into response and adherence. CLINICALTRIAL NA

Diabetes outcomes in patients with a history of breast cancer.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 8-8
Author(s):  
Leslie J. Hinyard ◽  
Martin W Schoen ◽  
Jiajing Chen ◽  
Yifan Tu ◽  
Miriam B. Rodin
Keyword(s):  
Breast Cancer ◽  
General Health ◽  
Multiple Chronic Conditions ◽  
Diabetic Patients ◽  
Chi Square ◽  
Diabetes Outcomes ◽  
Patients With Diabetes ◽  
History Of ◽  
Physical Limitations

8 Background: While diabetes is known to worsen breast cancer (BC) outcomes, little is known about the effect of BC on diabetes outcomes. This study examined differences in outcomes diabetic patients with and without a history of BC. Methods: Data from NHANES 2010 – 2016 was used to identify female patients self-reporting diabetes mellitus (DM). Comparisons of DM outcomes for persons reporting a history of BC versus without any cancer were made using Chi-Square and separate analyses were conducted for younger (less than 65) and older (65 and older) respondents. Analyses were conducted using SAS survey procedures (Cary, NC) and were weighted to account for the sampling scheme. Results: The analytic cohort consisted of 1347 patients, of which 80 (6.3%, weighted) reported a history of breast cancer. 785 (62.4%, weighted) of the full sample was under age 65. Of those under 65, 3% (weighted) reported history of BC and 11.8% (weighted) of those over 65% reported BC. In diabetics under 65, respondents with BC were more likely to report physical limitations keep them from working and physical, mental, and emotional limitations (p = .001, and p = 0.03, respectively) and were less likely to use insulin (p = .01) than respondents without BC. In respondents 65 and older, women with BC were more likely to report problems with memory and confusion (p = .002) and less likely to rate their general health as excellent or very good (p = .01) compared to those without BC. No differences were found for demographic characteristics, retinopathy, heart disease, or stroke for either age group. Conclusions: In this population of patients with diabetes, history of BC was associated with physical and emotional limitations in younger patients and general health status and memory and confusion in older patients. Understanding the intersection of multiple chronic conditions is important for improving quality of life and clinical outcomes in BC survivors.

scholarly journals Recent Advances in the Use of Metformin: Can Treating Diabetes Prevent Breast Cancer?

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Hatoum ◽  
Eileen M. McGowan
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Clinical Studies ◽  
Clinical Trial Data ◽  
The Elderly ◽  
Diabetic Patients ◽  
Positive Trend ◽  
Patients With Diabetes ◽  
Meta Analyses

There is substantial epidemiological evidence pointing to an increased incidence of breast cancer and morbidity in obese, prediabetic, and diabetic patients.In vitrostudies strongly support metformin, a diabetic medication, in breast cancer therapy. Although metformin has been heralded as an exciting new breast cancer treatment, the principal consideration is whether metformin can be used as a generic treatment for all breast cancer types. Importantly, will metformin be useful as an inexpensive therapy for patients with comorbidity of diabetes and breast cancer? In general, meta-analyses of clinical trial data from retrospective studies in which metformin treatment has been used for patients with diabetes and breast cancer have a positive trend; nevertheless, the supporting clinical data outcomes remain inconclusive. The heterogeneity of breast cancer, confounded by comorbidity of disease in the elderly population, makes it difficult to determine the actual benefits of metformin therapy. Despite the questionable evidence available from observational clinical studies and meta-analyses, randomized phases I–III clinical trials are ongoing to test the efficacy of metformin for breast cancer. This special issue review will focus on recent research, highlightingin vitroresearch and retrospective observational clinical studies and current clinical trials on metformin action in breast cancer.

scholarly journals In Hospital Frequency of Heart Failure in STEMI after Thrombolysis in Patient with Diabetes

2021 ◽  
pp. 66-71
Author(s):  
Abdul Mueed ◽  
Nandlal Rathi ◽  
Shazia Kazi ◽  
Raj Kumar Sachdewani ◽  
. Shahzad ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Heart Disease ◽  
Previous History ◽  
P Value ◽  
Diabetic Patients ◽  
Chi Square ◽  
St Segment Elevation ◽  
Patients With Diabetes ◽  
End Stage

Objective: To determine the frequency of heart failure after thrombolysis in STEMI patients with diabetes mellitus. Methodology: Through a prospective study we have enrolled all the diabetic patients who presented with acute ST-Segment Elevation Myocardial Infarction (STEMI) having age more than 35 years and less than 70 years who underwent pharmacological revascularization both males and females were included in this study. Patients with previous history of revascularization, end stage kidney, liver or heart disease, known advanced valvular heart disease, pregnant women, and those who develop serious complication related to streptokinase were excluded from our study. Echocardiography was done immediately after thrombolysis then after 3 days and then before discharge of the patients to determine the frequency of heart failure. Baseline and clinical data were entered and analysed using SPSS and a chi square test and p-value ≤0.05 was considered as significant. Results: A total of 175 patients were finally analysed and most of them were males as compared to females, 63.42% (N = 111) vs. 36.57% (N = 64), respectively. Mean age and SD of the patients was 55.90±10.49 years and mean duration of DM was 12.95±8.40 years. The overall frequency of heart failure in patients with post-STEMI was 56% (N = 98) and their mean ejection fraction was 38.46±8.20%. Frequency of heart failure in diabetic post-STEMI thrombolysed patients was significantly observed higher with increased age, increased duration of diabetes mellitus, hypertension, and smoking (p≤0.05). Conclusion: High prevalence of heart failure was observed in diabetic patients admitted with acute STEMI and underwent thrombolysis. The burden is even higher in males having age more than 55 years.

scholarly journals Hyperglycaemia-induced chemoresistance in breast cancer cells: role of the estrogen receptor

2015 ◽  
Vol 23 (2) ◽  
pp. 125-134 ◽  
Author(s):  
L Zeng ◽  
H A Zielinska ◽  
A Arshad ◽  
J P Shield ◽  
A Bahl ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Cancer Cells ◽  
Cancer Patients ◽  
Breast Cancer Cells ◽  
Diabetic Patients ◽  
Breast Cancer Patients ◽  
Patients With Diabetes ◽  
The Impact ◽  
Positive Breast Cancer

Breast cancer patients with diabetes respond less well to chemotherapy; in keeping with this we determined previously that hyperglycaemia-induced chemoresistance in estrogen receptor (ERα) positive breast cancer cells and showed that this was mediated by fatty acid synthase (FASN). More recent evidence suggests that the effect of metabolic syndrome and diabetes is not the same for all subtypes of breast cancer with inferior disease-free survival and worse overall survival only found in women with ERα positive breast cancer and not for other subtypes. Here we examined the impact of hyperglycaemia on ERα negative breast cancer cells and further investigated the mechanism underlying chemoresistance in ERα with a view to identifying strategies to alleviate hyperglycaemia-induced chemoresistance. We found that hyperglycaemia-induced chemoresistance was only observed in ERα breast cancer cells and was dependent upon the expression of ERα as chemoresistance was negated when the ERα was silenced. Hyperglycaemia-induced an increase in activation and nuclear localisation of the ERα that was downstream of FASN and dependent on the activation of MAPK. We found that fulvestrant successfully negated the hyperglycaemia-induced chemoresistance, whereas tamoxifen had no effect. In summary our data suggests that the ERα may be a predictive marker of poor response to chemotherapy in breast cancer patients with diabetes. It further indicates that anti-estrogens could be an effective adjuvant to chemotherapy in such patients and indicates the importance for the personalised management of breast cancer patients with diabetes highlighting the need for clinical trials of tailored chemotherapy for diabetic patients diagnosed with ERα positive breast cancers.

Antepartum Contraceptive Counseling in Women with Preterm Birth

2019 ◽  
Vol 36 (12) ◽  
pp. 1310-1316
Author(s):  
Marika Toscano ◽  
Dongmei Li ◽  
Timothy Dye ◽  
Courtney Olson-Chen
Keyword(s):  
New York ◽  
Preterm Birth ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Interpregnancy Interval ◽  
Postpartum Contraception ◽  
Chi Square ◽  
Patient Response ◽  
Contraceptive Counseling ◽  
Future Pregnancy

Objective To compare rates of antepartum contraceptive counseling among women with preterm birth (PTB) and term birth. Study Design This is a retrospective cohort study of patients with completed delivery records in New York from January 1, 2004, to December 31, 2014. Exposure was determined based on the timing of delivery. Exposed women delivered at <37 weeks, and nonexposed women delivered at ≥37 weeks. Primary outcome was patient response to questions regarding receipt of prenatal contraceptive counseling (PCC) by a health care provider. Secondary outcome was receipt of interpregnancy interval counseling. Chi-square tests and multivariate logistic regression were used for analysis. Results Of 724,723 delivery records, PTB rate was 7.9%. Women with PTB < 37 weeks were significantly less likely to receive PCC (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.89–0.93) or interpregnancy interval counseling (OR: 0.95; 95% CI: 0.94–0.97). The primary outcome remained significant after adjusting for confounders (adjusted OR: 0.91; 95% CI: 0.89–0.93). PTB < 34 weeks was associated with even lower odds of receiving contraceptive counseling (OR: 0.79; 95% CI: 0.76–0.83). Conclusion Postpartum contraception is an important tool for the prevention of recurrent PTB. Antepartum contraception counseling increases postpartum contraceptive uptake. Women with PTB have less exposure to antepartum contraceptive counseling. Lack of adequate counseling and decreased uptake of postpartum contraception may impact future pregnancy outcomes.

scholarly journals Assessment of periodontal status in adults with diabetes mellitus

2020 ◽  
Vol 8 (11) ◽  
pp. 3891
Author(s):  
Manish Deheriya ◽  
Anuj Bhargava ◽  
Dushyant Pippal ◽  
Anupama Ahirwar
Keyword(s):  
Diabetes Mellitus ◽  
Periodontal Disease ◽  
Age Groups ◽  
Diabetic Patients ◽  
Male Population ◽  
Chi Square ◽  
Periodontal Status ◽  
Periodontal Index ◽  
Patients With Diabetes ◽  
Study Population

Background: Diabetes mellitus is a group of chronic metabolic disorders known to exhibit a myriad of complications over a period of time. Periodontal disease is the sixth most common complication in diabetic patients. The aim of the study was to assess the periodontal status of adult diabetic patients.Methods: 100 diabetic patients in the age group of 25-80 years fulfilling the inclusion criteria were examined by a calibrated WHO CPI probe to assess their periodontal status as per the scoring criteria of the community periodontal index. Student t test, Chi square test and ANOVA F were applied for statistical analysis. p>0.05 was considered not significant and p<0.01 was considered highly significant.Results: A prevalence of 73% periodontitis was found in diabetic study population with statistically high significance (p=0.001) found according to age. A total of 52% Shallow pockets and 15% Deep pockets were reported respectively in middle (41-56 years) and older (57-80 years) age groups. Further, 47% male population was found to have statistically significant (p=0.027) more periodontitis (shallow and deep periodontal pockets) compared to female (26%) population.Conclusions: Within limitations of the study it may be safely concluded that assessment of periodontal status of DM patients revealed chronic periodontal destruction particularly in age groups beyond 40 years in majority of study population depicting that age is significantly associated with the increased prevalence and severity of periodontal disease in patients with diabetes.

scholarly journals Impact of Diabetes Mellitus on Complications and Outcomes of Adjuvant Chemotherapy in Older Patients With Breast Cancer

2009 ◽  
Vol 27 (13) ◽  
pp. 2170-2176 ◽  
Author(s):  
Tomasz P. Srokowski ◽  
Shenying Fang ◽  
Gabriel N. Hortobagyi ◽  
Sharon H. Giordano
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Diabetic Patients ◽  
Breast Cancer Outcomes ◽  
Kaplan Meier ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Multivariable Regression ◽  
Medicare Database

Purpose To evaluate whether diabetes affects patterns of adjuvant chemotherapy use, toxic effects of chemotherapy, and breast cancer outcomes. Patients and Methods By using the Surveillance, Epidemiology, and End Results–Medicare database, we identified patients aged 66 years or older who had stages I through III breast cancer that was diagnosed between 1992 and 2002. Multivariable regression analyses were performed to determine the effect of diabetes on use of chemotherapy, toxicities, and outcomes. The risks of all-cause mortality and breast cancer–specific (BCS) mortality were estimated with the Kaplan-Meier method. Results Our cohort had 70,781 men and women, of whom 14,414 (20.36%) had diabetes. Among people who received chemotherapy (n = 11,826), 21.0% were diabetics. In this group, diabetics had lower odds of receiving anthracyclines (odds ratio [OR], 0.78; 95% CI, 0.71 to 0.87) and taxanes (OR, 0.86; 95% CI, 0.75 to 0.99). Diabetes was associated with increased odds of being hospitalized for any chemotherapy toxicity (OR, 1.38; 95% CI, 1.23 to 1.56), for infection or fever (OR, 1.43; 95% CI, 1.2 to 1.7), for neutropenia (OR, 1.22; 95% CI, 1.03 to 1.45), for anemia (OR, 1.24; 95% CI, 1.05 to 1.47), and for any cause (OR, 1.32; 95% CI, 1.19 to 1.46). Patients with diabetes had higher all-cause mortality (hazard ratio [HR], 1.35; 95% CI, 1.31 to 1.39). There was a significant interaction between diabetes and chemotherapy use for BCS mortality. Diabetic and nondiabetic patients who did not receive chemotherapy had similar BCS mortality, but diabetic patients who did receive chemotherapy had higher BCS mortality than nondiabetic patients (OR, 1.20; 95% CI, 1.07 to 1.35). Conclusion In this observational, hypothesis-generating study, patients who have breast cancer and diabetes are at increased risk of chemotherapy-related toxicities compared with nondiabetic patients who are receiving chemotherapy and have higher all-cause mortality.

scholarly journals Frequency of deep infection of the sternal wound in diabetic patients utilizing skeletonized versus pedicled harvesting technique of internal thoracic artery after CABG surgery.

2019 ◽  
Vol 26 (11) ◽  
pp. 1866-1872
Author(s):  
Riffat Tanveer ◽  
Asad Khan ◽  
Muhammad Musharaf ◽  
Amina Nasreen
Keyword(s):  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Deep Infection ◽  
Diabetic Patients ◽  
Chi Square ◽  
Cabg Surgery ◽  
Harvesting Technique ◽  
Patients With Diabetes ◽  
Chi Square Test

Objectives: After coronary artery bypass graft (CABG) surgery, infection of the sternum is a serious issue as it would adversely affect the mortality of patient. Left internal thoracic artery (LITA) has significant benefits but after its utilization occurrence of sternal infection is documented especially in diabetic patients due to impairment in blood flow of sternum. Our objective was to document the frequency of deep infection of the sternal wound in patients with diabetes utilizing skeletonized versus pedicled harvesting technique of the left ITA after CABG Surgery in our population. Study Design: An observational study was retrospectively done. Setting: National Institute of Cardiovascular Diseases, Karachi. Period: January 2013 to October 2015. Material and Methods: The sample size of the study was determined to be a total of two hundred and twenty patients who had primary, isolated and elective CABG surgery. One hundred and ten patients were included in whom skeletonized left ITA was utilized and in one hundred and ten patients pedicled left ITA was utilized. We used the statistical Chi square test and p < 0.05 was considered significant. Results: Deep infection of the sternal wound occurred in 3.64% of the patients with diabetes in whom the pedicled left ITA was utilized and did not occur in any of the diabetic patients in whom the skeletonized left ITA was utilized. Post CABG surgery frequency of deep infection of the sternal wound was greater in those patients in whom the LITA was harvested utilizing the pedicled technique (p<0.05). Conclusion: There is decreased frequency of deep infection of the sternal wound in patients with diabetes utilizing the skeletonized harvesting technique of the left ITA after CABG Surgery.

scholarly journals Association Between Smoking and Foot Ulcer among Patients with Diabetes Mellitus, Wad Medani, Sudan

2021 ◽  
Author(s):  
Abeer AbdElrahman Elnour Eltilib
Keyword(s):  
Diabetes Mellitus ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Primary Data ◽  
Diabetic Patients ◽  
Chi Square ◽  
Patients With Diabetes ◽  
Negative Effect ◽  
Chi Square Test ◽  
The Relationship

Background: This study aimed to assess the relationship between smoking and diabetic foot ulcer (DFU) among adult diabetic patients presenting to Aldarga Diabetic Center, Wad Medani, Sudan in 2020. Methods: This comprehensive study is based on primary data obtained via a longitudinal cross-section random sample of 400 patients with diabetes mellitus who presented to Aldarga Diabetic Health Center in Wad Medani Town, Gezira State, Sudan between September and December 2020. Data were collected using a structured questionnaire. The core questions included two main dimensions: sociodemographic variables and smoking. Data were analyzed using the SPSS software, v.20, using descriptive and inferential statistics, namely, frequency tables and graphs, showing the Chi-square test of the relationship between the dependent and the independent variables. Results: Of the 400 participants, 96 were clearly diagnosed with foot ulcer giving a proportion of 33% in the sample. There was a statistically significant relationship between smoking and DFU. A Chi-square test was done to measure the relationship between smoking and foot ulcer, which was significant at P = 0.043. Conclusion: Extensive awareness programs to control the negative effect of smoking in accelerating DFU and amputation are necessary.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

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