Effectiveness of a diabetes focused electronic discharge orderset and post-discharge nursing support among poorly controlled hospitalized patients: A randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Audrey White ◽  
David Bradley ◽  
Elizabeth Buschur ◽  
Cara Harris ◽  
Jacob LaFleur ◽  
...  
Keyword(s):  
Diabetes Management ◽  
Hospitalized Patients ◽  
Post Discharge ◽  
Discharge Data ◽  
Phone Calls ◽  
Discharge Outcomes ◽  
Long Term Follow Up ◽  
Order Set

BACKGROUND While electronic order sets have become standard practice for inpatient diabetes management, there is limited decision support at discharge. OBJECTIVE This study assessed whether an electronic discharge order set (DOS) plus nurse follow up calls improves discharge orders and post-discharge outcomes among hospitalized patients with type 2 diabetes (T2D). METHODS This is a randomized open label single center study comparing an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with T2D. The primary outcome was change in HbA1c at 24 weeks post-discharge. Secondary outcomes included completeness and accuracy of discharge prescriptions related to diabetes. RESULTS The study was stopped early due to feasibility concerns related to long-term follow-up. However a total of 158 subjects were enrolled (DOS=82, ESC=76), 155 of whom had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (81% vs 44%; P=0.01), needles/syringes (95% vs 63%; P=0.03), and glucometers (86% vs 36%; P=0.0002). Clarity of orders was similar. HbA1c was available in 27 subjects in each arm at 12 weeks, and 20/21 subjects in the DOS/ESC arms at 24 weeks. The adjusted difference in change in HbA1c (DOS-ESC) was -0.5 ± 0.4% at 12 weeks (P = 0.20) and -0.7 ± 0.4% at 24 weeks (P= 0.09). Achievement of individualized HbA1c target was greater in the DOS group at 12 weeks but not 24 weeks. CONCLUSIONS A DOS resulted in more complete discharge prescriptions. Assessment of post-discharge outcomes was limited due to loss of long-term follow-up but suggests possible benefit in glucose control. CLINICALTRIAL NCT03455985 Effectiveness of a Diabetes Focused Discharge Order Set Among Poorly Controlled Hospitalized Patients Transitioning to Glargine U300 Insulin

Abstract TP378: Long Term Follow Up Telephone Evaluation of Post Stroke Quality of Life is Feasible and Effective

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Renata Miranda ◽  
Carla Ledo ◽  
Daisa Escobosa ◽  
Caren Cristina Giannotti Bizutti ◽  
Amanda Ruiz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Data Collection ◽  
Clinical Outcomes ◽  
Stroke Recurrence ◽  
Post Discharge ◽  
Phone Calls ◽  
Long Term Follow Up

Background: The long-term follow-up of clinical outcomes in patients admitted with acute stroke can identify relevant clinical data in the prevention of stroke recurrence as well as measure the quality of life of such patients. Follow-up after discharge in hospitals without stroke clinics can be a challenge. Therefore we created in our hospital an outcomes measurement nuclei characterized as a data collection center, with the main objective of periodically measuring clinical outcomes and quality of life of patients after hospital discharge.This sector works together with the different clinical specialties in providing information with a focus on outcome indicators, using questionnaires to estimate the parameters of evaluation of health states.Our objective was to describe data obtained from this data collection center evaluating post-discharge quality of life of patients treated in our stroke center 30, 90, 180 days and 01 years after the diagnosis. Methods: The study was conducted from January 2012 to March 2016, at a tertiary, general, private hospital in São Paulo, Brazil. Phone calls using the EuroQol instrument (EQ-5D) to measure quality of life were performed. The modified Rankin scale and a structured questionnaire to identify stroke recurrence, readmissions and medication failures were also applied. Results: We conducted 2184 telephone calls and obtained 1727 (79%) successful contacts. The mean EQ-5D at 30 days was: 0.732 +/-0.558; at 90 days: 0.722 +/- 0.358; at 180 Days: 0.781 +/- 0.326; and at 12 months 0.766 +/-0.349. During the follow-up, 31 patients (2%) died. The main reasons for censuring patients were unsuccessful contact after 3 attempts (51%); outdated registration data (3%) and refusals (9%). Conclusion: In conclusion, monitoring of standardized clinical outcomes after stroke is possible even in private non academic hospitals, allowing the acquisition of quality of care indicators and patient centered outcomes.

scholarly journals Occurrence of comorbidities in newly diagnosed type 2 diabetes patients and their impact after 11 years’ follow-up

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sophia Eilat-Tsanani ◽  
Avital Margalit ◽  
Liran Nevet Golan
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Newly Diagnosed ◽  
Risk Of Death ◽  
High Prevalence ◽  
Long Term Follow Up ◽  
New Onset

AbstractThe burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.

scholarly journals 35DETERMINANTS OF POST-DISCHARGE FALLS AND FRACTURES AFTER STROKE OVER LONG TERM FOLLOW UP

2017 ◽  
Vol 46 (suppl_2) ◽  
pp. ii11-ii13
Author(s):  
E J Foster ◽  
R S Barlas ◽  
A B Clark ◽  
J H Bettencourt-Silva ◽  
K M Bowles ◽  
...  
Keyword(s):  
Post Discharge ◽  
Long Term Follow Up

scholarly journals Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4698-4698
Author(s):  
Ruth Namazzi ◽  
Andrea L Conroy ◽  
Dibyadyuti Datta ◽  
Chandy C. John ◽  
Robert Opoka
Keyword(s):  
Severe Malaria ◽  
Malaria Episode ◽  
National Guidelines ◽  
Post Discharge ◽  
Increased Risk ◽  
Discharge Outcomes ◽  
The Mean ◽  
Complete Blood Counts

Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda Ruth Namazzi, Andrea Conroy, Dibyadyuti Datta, Gloria Kyarisiima Chandy John, Robert Opoka Background Children with severe malaria anaemia are at an increased risk of poor post discharge outcomes including frequent readmissions and clinic visits for malaria. How the post-discharge outcomes affect haematological recovery of children after severe malaria anaemia has not been evaluated. Methods We enrolled and followed up for 12 months 248 children with severe malaria anaemia (SMA) and 120 age matched asymptomatic community controls (CC). Complete blood counts, reticulocyte percentages and erythropoietin levels were done at baseline, 1 month and 12 months after the malaria episode. Children were treated according to national guidelines, which included blood transfusion and anti malarial therapy. We evaluated the relationship between recovery of haematological indices and multiple readmissions in the post-discharge period in SMA children. Results The mean age was 2.12 ± 0.9 and 2.2 ± 1.0 years (p=0.266) for SMA and CC respectively. The mean baseline haemoglobin (Hb), reticulocyte percentage and erythropoietin levels were 3.5 ± 0.9g/dL, 2.6±4.7% and 6843±5891 for SMA, compared to 10.8±1.5g/dL, 1.8±2.6% and 58.5 for CC, respectively. By 1-month, SMA children had made complete haematological recovery with mean Hb, reticulocyte percentage and erythropoietin levels of 11.2 ± 2.2g/dL, 1.8± 2.7% and 20.2 ± 58.3. The hematological recovery was sustained even by month12 follow up; mean Hb level was 10.7±2.1 and 11.6±2.1g/dL for SMA and CC, p =0.07. Reticulocyte percentages were comparable between SMA and CC, 2.5 ± 4.1vs 1.2±1.7,p=0.41. Amongst SMA group, more children who had multiple readmissions during the follow up period were still anemic at 12 months compared to those who did not have multiple readmissions, 7/64(10.9%) vs. 13/168(7.8%). The difference however was not statistically significant (p=0.438). Conclusion Children with SMA achieve hematological recovery by 1 month post-discharge. The hematological recovery was maintained until 12 months post-discharge. Amongst SMA children, multiple readmissions in the post-discharge period did not appear to adversely affect hematological recovery by 12 months. The effect of repeated malaria episodes on long term haematological recovery needs further study. Disclosures Conroy: ALC: Patents & Royalties: angiopoietin-1, angiopoietin-2.

Challenges for retrospective cohort studies: A profile of patients who refuse participation or are lost to follow-up

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6615-6615
Author(s):  
R. Patel ◽  
S. Kurian ◽  
C. Sun ◽  
L. Francisco ◽  
L. Wong ◽  
...  
Keyword(s):  
Hematopoietic Cell Transplantation ◽  
Targeted Interventions ◽  
Non Hodgkin Lymphoma ◽  
Phone Calls ◽  
High Participation ◽  
Long Term Follow Up ◽  
Retrospective Cohort Studies ◽  
Lost To Follow Up

6615 Background: As hematopoietic cell transplantation (HCT) has increasingly become a curative option for many diseases, studying long-term complications has assumed critical importance. A major issue in conducting scientifically rigorous long-term follow up studies with large cohorts is the ability to track patients, and obtain informed consents. High participation rates are critical to avoid selection bias and ensure generalizability. Methods: A mass consenting process was implemented to obtain informed consents from 1056 City of Hope HCT patients transplanted during 1976–2006 who were one+ year survivors and alive in June 2007. This process involved mailing consent forms followed by phone calls. Patients were classified as consented, refused, or lost-to-follow-up (LTFU). Sociodemographic and clinical characteristics indicative of higher risks for refusal or LTFU were identified. Results: Study patients comprised 58% males, and 53% Caucasians. Median age at HCT was 34 years (0.6–73); median age at study initiation was 47 years (6–81); and median time from HCT to study initiation was 10 years (1–30). Primary diagnoses included acute/chronic leukemia (43%), Hodgkin/non-Hodgkin lymphoma (36%), multiple myeloma (9%), and other miscellaneous diagnoses (12%). Fifty percent received allogeneic HCT. At the end of the process, 46% consented, 17% refused, and 37% were LTFU. Compared to consented patients, males, Asians, and younger patients were more likely to refuse consent. Patients LTFU were more likely to have lower SES, a longer time since HCT, in addition to being males, Asians and younger at HCT (Table). Conclusions: This study demonstrates the critical need for maintaining up-to-date contact information on patients after HCT in order to obtain valid long-term follow-up data. It also describes the characteristics of the sub-population that are more likely to refuse or be LTFU, information necessary for planning targeted interventions in long-term follow-up initiatives. [Table: see text] No significant financial relationships to disclose.

Abstract 13907: Patients With NSTEMI Are at Higher Risk, Have Worse Outcomes, but Less Intense Cardiology Follow-up 1-3 Years Post-discharge: Findings From the TIGRIS Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sibi N Krishnamurthy ◽  
Stuart Pocock ◽  
Prashant Kaul ◽  
Ruth Owen ◽  
Jiyan Chen ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Post Discharge ◽  
Relative Risks ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
St Elevation ◽  
The Mean ◽  
Long Term Prognosis

Introduction: Non-ST-elevation myocardial infarction (NSTEMI) patients have more comorbidities and extensive CAD than STEMI patients. However, there is a need for comparative data on the long-term prognosis and resource utilization of stable patients after these MI subtypes. Methods: TIGRIS enrolled 9027 stable patients 1-3 years post-MI (369 centers, 25 countries) with ≥1 risk factor (age ≥65 years, diabetes, 2nd prior MI, multivessel CAD, CKD). The incidence of cardiovascular (CV) events and deaths, and self-reported EQ-D5 score were recorded over 2 years. Multivariable Poisson regression models were used to compare STEMI and NSTEMI patients for relative risks, adjusting for prognostically relevant patient factors. Results: MI subtype was known in 8494 patients (STEMI: 56%; NSTEMI: 44%). At enrollment, NSTEMI patients were more likely to be older, have diabetes, hypertension, hyperlipidemia, and prior CAD compared with STEMI patients. NSTEMI patients had significantly poorer self-rated health and a lower use of dual antiplatelet therapy at discharge and 1-3 years later. NSTEMI patients had a higher incidence of the composite of MI, stroke and CV death over 2 years (5.6% vs 4.0%, p<0.001) and higher all-cause mortality (4.1% vs 2.6%, p<0.001) vs STEMI patients (Figure). These excess risks for the composite outcome attenuated after adjusting for baseline characteristics (adj RR 1.18, 95% CI 0.96-1.45, p=0.11), but remained significant for all-cause mortality (adj RR 1.31, 95% CI 1.02-1.68, p=0.03). Resource utilization over 2 years was higher in NSTEMI patients, although the mean number of cardiologist visits were higher for STEMI patients (4.2 vs 2.8, p<0.001). Conclusions: NSTEMI patients had a less favorable risk profile and experienced more adverse CV events during long-term follow-up than STEMI patients, but had less intense cardiology follow-up. Continued efforts are needed to optimize secondary prevention and care of stable patients after NSTEMI.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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