Biomedical subjects
Publications and source records attributed to M Cypress.
Critically high or low blood sugar in a patient with diabetes is a medical emergency. You'll need to be able to quickly identify and know how to manage the acute complications of diabetes to help a patient avoid a tragic outcome. Here's how.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The level of adherence with recommended standards for ophthalmic examinations was assessed in a purposive sample of diabetic patient charts (n = 350) from four clinics in medically underserved areas. All of the clinics referred patients with diabetes to off-site services for comprehensive eye examinations (dilation, visual acuity, and intraocular pressure); adherence with the standard of care was defined as a chart note indicating a referral for an ophthalmic examination. Overall, 86% of the patients were from high-risk minority groups (black or Hispanic) for diabetes and its complications. Mean age and duration of diabetes were 57.7 and 8.8 years, respectively. Referrals for ophthalmic exams were noted in 18% of the charts during the year preceding the review and in 28.6% of the charts during the 2 preceding years. Annual referrals in the preceding 2 years were noted in 3.1% of the charts. Eye disease was noted as a diagnosis in 22%. Patients who had a diagnosis of eye disease noted in their charts had a 7.5-fold increase in the odds of having a referral noted. The increased likelihood of being referred in patients with known eye disease may be due to follow-up of current eye problems.
A survey of 108 members of a local metropolitan AADE chapter was conducted to assess (1) current roles and responsibilities of diabetes educators with respect to medical management and patient education, and (2) the use of behavioral strategy techniques among diabetes educators. Nurses and dietitians specializing in diabetes care performed a range of responsibilities. Approximately 75% of the nurses performed standard patient education roles and 20% performed the majority of roles traditionally considered to be in the medical domain, including insulin adjustment. More than half of the respondents had not received formal training in the use of behavioral strategies. Formal training was positively associated with greater use of behavioral techniques. Training for diabetes educators should include behavioral intervention strategies. Nurses specializing in diabetes care may also need training regarding physical assessment for chronic complications, and knowledge regarding adjustment of insulin and oral hypoglycemic medications.
The Diabetes Quality Assurance (DQA) Checklist was developed to measure adherence to standards of diabetes care. Two raters simultaneously scored a convenience sample of 23 charts of patients with diabetes. These raters scored each chart again 5-7 weeks later. Data obtained were used to assess inter-rater and intra-rater reliability. Inter-rater reliability was estimated for basic assessment at Time 1 (r = 0.94, 95% CI 0.86-0.97) and at Time 2 (r = 0.91, 95% CI 0.81-0.96); and for high-risk assessment at Time 1 (r = 0.88, 95% CI 0.73-0.95). Intra-rater reliability for the basic assessment was estimated for Reviewer 1 (r = 0.84, 95% CI 0.65-0.93) and for Reviewer 2 (r = 0.75, 95% CI 0.49-0.89); the high-risk estimate for Review 1 was 0.60 (95% CI 0.25-0.81) and for Reviewer 2 0.97 (95% CI 0.94-0.99). The DQA Checklist is useful for monitoring and assessing diabetes care.
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OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes.