scholarly journals Perioperative Glycemic Management for Patients with and without Diabetes

2021 ◽  
Vol 16 (1) ◽  
pp. 17-23
Author(s):  
Shannon Marie Ruzycki ◽  
Tyrone Harrison ◽  
Anna Cameron ◽  
Karmon Helmle ◽  
Julie McKeen
Keyword(s):  
Best Practices ◽  
Diabetes Management ◽  
Surgical Patients ◽  
Preoperative Screening ◽  
Increased Risk ◽  
Nous Examinons ◽  
Poor Outcomes ◽  
Pour Cent ◽  
Risk Review ◽  
Glycemic Management

ABSTRACTPeople with diabetes are at an increased risk for worse postoperative outcomes, compared to people without diabetes. Notably, up to one in 10 people who undergo surgery have unrecognized diabetes and an additional 10% may have postoperative hyperglycemia without meeting the criteria for a diagnosis of diabetes. Management of postoperative hyperglycemia has been demonstrated to reduce the incidence of poor outcomes, but evidence demonstrates that postoperative hyperglycemia remains a quality gap for surgical patients. In this review, we will outline the evidence for preoperative screening for postoperative hyperglycemic risk, review the evidence for perioperative glycemic management, and examine the barriers to these best practices. RÉSUMÉLes personnes atteintes de diabète courent un risque accru de voir leurs résultats postopératoires moins bons que ceux des personne non atteinte de diabète. En particulier, près d’une personne sur dix qui subit une intervention chirurgicale présente un diabète non diagnostiqué et dix pour cent supplémentaires peuvent présenter une hyperglycémie postopératoire sans pour autant répondre aux critères de diagnostic du diabète. Il a été démontré que le traitement de l’hyperglycémie postopératoire réduit l’incidence des mauvais résultats, mais les données probantes montrent que l’hyperglycémie postopératoire demeure une lacune chez les patients opérés. Dans cette revue, nous présentons les données probantes relatives au dépistage préopératoire du risque d’hyperglycémie postopératoire, nous passons en revue les données probantes relatives à la gestion de la glycémie périopératoire et nous examinons les obstacles à ces meilleures pratiques.

The Role of Disordered Eating in Type 2 Diabetes: A Pilot Study

2021 ◽  
pp. 155982762110024
Author(s):  
Alyssa M. Vela ◽  
Brooke Palmer ◽  
Virginia Gil-Rivas ◽  
Fary Cachelin
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Disordered Eating ◽  
Lifestyle Intervention ◽  
Eating Behaviors ◽  
Diabetes Management ◽  
Behavioral Therapy ◽  
Exercise Stress ◽  
Increased Risk

Rates of type 2 diabetes mellitus continue to rise around the world, largely due to lifestyle factors such as poor diet, overeating, and lack of physical activity. Diet and eating is often the most challenging aspect of management and, when disordered, has been associated with increased risk for diabetes-related complications. Thus, there is a clear need for accessible and evidence-based interventions that address the complex lifestyle behaviors that influence diabetes management. The current study sought to assess the efficacy and acceptability of a pilot lifestyle intervention for women with type 2 diabetes and disordered eating. The intervention followed a cognitive behavioral therapy guided-self-help (CBTgsh) model and included several pillars of lifestyle medicine, including: diet, exercise, stress, and relationships. Ten women completed the 12-week intervention that provided social support, encouraged physical activity, and addressed eating behaviors and cognitions. Results indicate the lifestyle intervention was a feasible treatment for disordered eating behaviors among women with type 2 diabetes and was also associated with improved diabetes-related quality of life. The intervention was also acceptable to participants who reported satisfaction with the program. The current CBTgsh lifestyle intervention is a promising treatment option to reduce disordered eating and improve diabetes management.

scholarly journals Care for Patients with Type 2 Diabetes in a Random Sample of Community Family Practices in Ontario, Canada

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Gina Agarwal ◽  
Janusz Kaczorowski ◽  
Steve Hanna
Keyword(s):  
Best Practices ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Management Strategies ◽  
Chart Audit ◽  
Pressure Reading ◽  
International Data ◽  
One Year ◽  
Control And Management

Objective. Diabetes care is an important part of family practice. Previous work indicates that diabetes management is variable. This study aimed to examine diabetes care according to best practices in one part of Ontario. Design and Participants. A retrospective chart audit of 96 charts from 18 physicians was conducted to examine charts regarding diabetes care during a one-year period. Setting. Grimsby, Ontario. Main Outcome Measures. Glycemic screening, control and management strategies, documentation and counselling for lifestyle habits, prevalence of comorbidities, screening for hypertension, hyperlipidemia, and use of appropriate recommended preventive medications in the charts were examined. Results. Mean A1c was within target (less than or equal to 7.00) in 76% of patients (ICC = −0.02), at least 4 readings per annum were taken in 75% of patients (ICC = 0.006). Nearly 2/3 of patients had been counselled about diet, more than 1/2 on exercise, and nearly all (90%) were on medication. Nearly all patients had a documented blood pressure reading and lipid profile. Over half (60%) had a record of their weight and/or BMI. Conclusion. Although room for improvement exists, diabetes targets were mainly reached according to recognized best practices, in keeping with international data on attainment of diabetes targets.

scholarly journals UCH-L1 is induced in germinal center B cells and identifies patients with aggressive germinal center diffuse large B-cell lymphoma

Blood ◽  
2016 ◽  
Vol 127 (12) ◽  
pp. 1564-1574 ◽  
Author(s):  
Tibor Bedekovics ◽  
Sajjad Hussain ◽  
Andrew L. Feldman ◽  
Paul J. Galardy
Keyword(s):  
B Cell ◽  
Germinal Center ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Neuronal Marker ◽  
Large B Cell Lymphoma ◽  
Increased Risk ◽  
Key Points ◽  
Poor Outcomes ◽  
Large B Cell

Key Points The neuronal marker UCH-L1 is induced in, and specifically augments the oncogene-induced transformation of, GCB cells. High levels of UCHL1 identify patients with GC DLBCL with an increased risk for poor outcomes.

Abstract T P231: Does Intraventricular Hemorrhage Lead to a Normal Pressure Hydrocephalus-Like Syndrome?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Andrew J Kruger ◽  
Matthew Flaherty ◽  
Padmini Sekar ◽  
Mary Haverbusch ◽  
Charles J Moomaw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Normal Pressure Hydrocephalus ◽  
Barthel Index ◽  
Intraventricular Hemorrhage ◽  
Normal Pressure ◽  
Stroke Study ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Poor Outcomes

Background: Intracerebral hemorrhage (ICH) has the highest short and long-term morbidity and mortality rates of stroke subtypes. While increased intracranial pressure due to the presence of intraventricular hemorrhage (IVH) may relate to early poor outcomes, the mechanism of reduced 3-month outcome with IVH is unclear. We hypothesized that IVH may cause symptoms similar to normal pressure hydrocephalus (NPH), specifically urinary incontinence and gait disturbance. Methods: We used interviewed cases from the Genetic and Environmental Risk Factors for Hemorrhagic Stroke Study (7/1/08-12/31/12) that had 3-month follow-ups available. CT images were analyzed for ICH volume and location, and IVH presence and volume. Incontinence and dysmobility were defined by Barthel Index at 3 months. We chose a Barthel Index score of bladder less than 10 and mobility less than 15 to define incontinence and dysmobility, respectively. Multivariate analysis was used to assess independent risk factors for incontinence and dysmobility. ICH and IVH volumes were log transformed because of non-normal distributions. Results: Barthel Index was recorded for 308 ICH subjects, of whom 106 (34.4%) had IVH. Presence of IVH was independently associated with both incontinence (OR 2.7; 95% CI 1.4-5.2; p=.003) and dysmobility (OR 2.5; 95% CI 1.4-4.8; p=.003). The Table shows that increasing IVH volume was also independently associated with both incontinence and dysmobility after controlling for ICH location, ICH volume, age, baseline mRS, and admission GCS. Conclusion: Our data show that patients with IVH after ICH are at an increased risk for developing the NPH-like symptoms of incontinence and dysmobility. This may explain the worse long-term outcomes of patients who survive ICH with IVH than those who had ICH alone. Future studies are needed to confirm this finding, and to determine the effect of IVH interventions such as shunt or intraventricular thrombolysis.

scholarly journals Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. e011069 ◽  
Author(s):  
Nicholas Gregory Ross Bayfield ◽  
Adrian Pannekoek ◽  
David Hao Tian
Keyword(s):  
Cardiac Surgery ◽  
Smoking Status ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Neurological Complications ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Short Term ◽  
Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95%  CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95%  CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95%  CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

scholarly journals Promoting Team-Based Exercise Among African American Breast Cancer Survivors

2018 ◽  
Vol 40 (12) ◽  
pp. 1885-1902 ◽  
Author(s):  
Linda B. Piacentine ◽  
Karen M. Robinson ◽  
Leslie J. Waltke ◽  
Judy A. Tjoe ◽  
Alexander V. Ng
Keyword(s):  
Breast Cancer ◽  
African American ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Well Being ◽  
Walking Program ◽  
Increased Risk ◽  
Before And After ◽  
Mind Set ◽  
Poor Outcomes

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

scholarly journals Duke University Medical Center Perioperative Diabetes Management Program

2021 ◽  
Author(s):  
Tara A. Lenk ◽  
John Whittle ◽  
Solomon Aronson ◽  
Timothy E. Miller ◽  
Matthew Fuller ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Diabetes Management ◽  
Medical Center ◽  
Tertiary Care ◽  
Management Program ◽  
Surgical Patients ◽  
Tertiary Care Medical Center ◽  
Uncontrolled Diabetes ◽  
Duke University ◽  
Diabetes Management Program

The following article describes a project at an academic tertiary-care medical center aimed at identifying surgical patients with uncontrolled diabetes early in the preoperative process to improve their perioperative glycemic control and surgical outcomes.

scholarly journals Are cardiac surgical patients at increased risk of difficult intubation?

2017 ◽  
Vol 61 (8) ◽  
pp. 629
Author(s):  
DeepakPrakash Borde ◽  
SavaniSameer Futane ◽  
Vijay Daunde ◽  
Sujata Zine ◽  
Nayana Joshi ◽  
...  
Keyword(s):  
Difficult Intubation ◽  
Surgical Patients ◽  
Increased Risk

scholarly journals Protecting the vulnerable during COVID-19: Treating and preventing chronic disease disparities

2020 ◽  
Vol 4 ◽  
pp. 125
Author(s):  
Linda M. Mobula ◽  
David J. Heller ◽  
Yvonne Commodore-Mensah ◽  
Vanessa Walker Harris ◽  
Lisa A. Cooper
Keyword(s):  
Vulnerable Populations ◽  
Communicable Diseases ◽  
Non Communicable Diseases ◽  
Socioeconomic Groups ◽  
Policy Interventions ◽  
Vulnerable Patients ◽  
Increased Risk ◽  
Care Models ◽  
Key Policy ◽  
Poor Outcomes

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases – are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself – but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions – task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering emerging universal primary care models.

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