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Shields C, Conway NT, Allardice B, Wake DJ, Cunningham SG. Continuing the quality improvement of an electronic personal health record and interactive website for people with diabetes in Scotland (My Diabetes My Way). Diabet Med 2023:e15085. [PMID: 36924001 DOI: 10.1111/dme.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
AIMS eHealth applications have the potential to enable patients to take more control over managing their own health, helping to delay and prevent complications. My Diabetes My Way (MDMW) is an electronic personal health record/educational platform available to people with diabetes in Scotland. This study aims to assess user experience with respect to demographic subgroups, examine effectiveness of previous improvements made to the platform and inform its ongoing development. METHODS All active MDMW users (22,665) were invited to take part in a questionnaire combining Likert scale and free-response items relating to system utility. Likert responses were used to generate a 'utility score'. This was used in regression analyses to determine predictors of system utility scoring. Free-response answers were analysed thematically and themes were generated. RESULTS A total of 4713 (21%) MDMW users responded to the questionnaire. Most agreed that MDMW helps them to track changes over time, prepare for face-to-face consultations, remember information discussed in consultations and reduced the need to contact their general practitioner. Free-response answers showed that users valued earlier enhancements made to the site (e.g. linking Fitbit data), and highlighted areas needing further improvement. Evidence of the 'digital divide' was seen in respondent demographics, and some users mentioned 'lack of digital skills' as a barrier to engaging with the platform. CONCLUSIONS User experience of MDMW was positive. Users agreed with statements that MDMW facilitates diabetes self management. Several areas of potential improvement were identified, including linking more wearable device data, and assisting/directing users to gain the digital skills required to engage fully with MDMW.
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Affiliation(s)
- Cathy Shields
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Nicholas T Conway
- Tayside Children's Hospital, Ninewells hospital, MACHS Building, Dundee, DD1 9SY, UK
| | - Brian Allardice
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Deborah J Wake
- Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh, EH16 4UX, UK
| | - Scott G Cunningham
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
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Siddiqui MK, Hall C, Cunningham SG, McCrimmon R, Morris A, Leese GP, Pearson ER. Using Data to Improve the Management of Diabetes: The Tayside Experience. Diabetes Care 2022; 45:2828-2837. [PMID: 36288800 DOI: 10.2337/dci22-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
Tayside is a region in the East of Scotland and forms one of nine local government regions in the country. It is home to approximately 416,000 individuals who fall under the National Health Service (NHS) Tayside health board, which provides health care services to the population. In Tayside, Scotland, a comprehensive informatics network for diabetes care and research has been established for over 25 years. This has expanded more recently to a comprehensive Scotland-wide clinical care system, Scottish Care Information - Diabetes (SCI-Diabetes). This has enabled improved diabetes screening and integrated management of diabetic retinopathy, neuropathy, nephropathy, cardiovascular health, and other comorbidities. The regional health informatics network links all of these specialized services with comprehensive laboratory testing, prescribing records, general practitioner records, and hospitalization records. Not only do patients benefit from the seamless interconnectedness of these data, but also the Tayside bioresource has enabled considerable research opportunities and the creation of biobanks. In this article we describe how health informatics has been used to improve care of people with diabetes in Tayside and Scotland and, through anonymized data linkage, our understanding of the phenotypic and genotypic etiology of diabetes and associated complications and comorbidities.
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Affiliation(s)
- Moneeza K Siddiqui
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - Christopher Hall
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - Scott G Cunningham
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - Rory McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - Andrew Morris
- Usher Institute, College of Medicine and Veterinary Medicine, Edinburgh, U.K
| | - Graham P Leese
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
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Goldthorpe J, Allen T, Brooks J, Kontopantelis E, Holland F, Moss C, Wake DJ, Brodie D, Cunningham SG, Kanumilli N, Bishop H, Jones E, Milne N, Ball S, Jenkins M, Nicinska B, Ratto M, Morgan-Curran M, Johnson G, Rutter MK. Digital Interventions Supporting Self-care in People With Type 2 Diabetes Across Greater Manchester (Greater Manchester Diabetes My Way): Protocol for a Mixed Methods Evaluation. JMIR Res Protoc 2022; 11:e26237. [PMID: 35976184 PMCID: PMC9434385 DOI: 10.2196/26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/17/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) is common, with a prevalence of approximately 7% of the population in the United Kingdom. The quality of T2D care is inconsistent across the United Kingdom, and Greater Manchester (GM) does not currently achieve the National Institute for Health and Care Excellence treatment targets. Barriers to delivery of care include low attendance and poor engagement with local T2D interventions, which tend to consist of programs of education delivered in traditional, face-to-face clinical settings. Thus, a flexible approach to T2D management that is accessible to people from different backgrounds and communities is needed. Diabetes My Way (DMW) is a digital platform that offers a comprehensive self-management and educational program that should be accessible to a wide range of people through mobile apps and websites. Building on evidence generated by a Scotland-wide pilot study, DMW is being rolled out and tested across GM. OBJECTIVE The overarching objectives are to assess whether DMW improves outcomes for patients with T2D in the GM area, to explore the acceptability of the DMW intervention to stakeholders, and to assess the cost-effectiveness of the intervention. METHODS A mixed methods approach will be used. We will take a census approach to recruitment in that all eligible participants in GM will be invited to participate. The primary outcomes will be intervention-related changes compared with changes observed in a matched group of controls, and the secondary outcomes will be within-person intervention-related changes. The cost-effectiveness analysis will focus on obtaining reliable estimates of how each intervention affects risk factors such as HbA1c and costs across population groups. Qualitative data will be collected via semistructured interviews and focus groups and organized using template analysis. RESULTS As of May 10, 2021, a total of 316 participants have been recruited for the quantitative study and have successfully enrolled. A total of 278 participants attempted to register but did not have appropriate permissions set by the general practitioners to gain access to their data. In total, 10 participants have been recruited for the qualitative study (7 practitioners and 3 patients). An extension to recruitment has been granted for the quantitative element of the research, and analysis should be complete by December 2022. Recruitment and analysis for the qualitative study should be complete by December 2021. CONCLUSIONS The findings from this study can be used both to develop the DMW system and improve accessibility and usability in more deprived populations generally, thus improving equity in access to support for T2D self-management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26237.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | - Joanna Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Fiona Holland
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Charlie Moss
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Deborah J Wake
- My Way Digital Health, Dundee, United Kingdom.,Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Scott G Cunningham
- My Way Digital Health, Dundee, United Kingdom.,Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Naresh Kanumilli
- Northenden Group Practice, Manchester, United Kingdom.,Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Hannah Bishop
- Greater Manchester & Eastern Cheshire Strategic Clinical Networks, Greater Manchester Health & Social Care Partnership, Manchester, United Kingdom
| | - Ewan Jones
- Greater Manchester & Eastern Cheshire Strategic Clinical Networks, Greater Manchester Health & Social Care Partnership, Manchester, United Kingdom
| | - Nicola Milne
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Steve Ball
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | | | | | - Martina Ratto
- Beingwell Group, English Institute of Sport, Sheffield, United Kingdom
| | | | - Gemma Johnson
- Changing Health Limited, Newcastle upon Tyne, United Kingdom
| | - Martin K Rutter
- Diabetes, Endocrinology & Metabolism Centre, Manchester Royal Infirmary, Manchester, United Kingdom.,Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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Mackenzie SC, Cumming KM, Mehar S, Wilson L, Cunningham SG, Bickerton A, Wake DJ. Education at scale: Improvements in type 1 diabetes self-management following a massive open online course. Diabet Med 2022; 39:e14842. [PMID: 35426171 PMCID: PMC9540112 DOI: 10.1111/dme.14842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Scott C. Mackenzie
- School of Medicine and Veterinary MedicineThe University of EdinburghEdinburghUK
- MyWay Digital HealthDundeeUK
| | | | - Salma Mehar
- MyWay Digital HealthDundeeUK
- NHS North West London Collaboration of Clinical Commissioning GroupsLondonUK
| | | | | | - Alex Bickerton
- Dept Diabetes & EndocrinologyYeovil District Hospital NHS Foundation TrustYeovilUK
| | - Deborah J. Wake
- Centre for Medical InformaticsUsher InstituteUniversity of EdinburghEdinburghUK
- Edinburgh Centre for Endocrinology and DiabetesNHS LothianEdinburghUK
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Shields C, Cunningham SG, Wake DJ, Fioratou E, Brodie D, Philip S, Conway NT. User-Centered Design of A Novel Risk Prediction Behavior Change Tool Augmented With an Artificial Intelligence Engine (MyDiabetesIQ): A Sociotechnical Systems Approach. JMIR Hum Factors 2022; 9:e29973. [PMID: 35133280 PMCID: PMC8864521 DOI: 10.2196/29973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes and its complications account for 10% of annual health care spending in the United Kingdom. Digital health care interventions (DHIs) can provide scalable care, fostering diabetes self-management and reducing the risk of complications. Tailorability (providing personalized interventions) and usability are key to DHI engagement/effectiveness. User-centered design of DHIs (aligning features to end users’ needs) can generate more usable interventions, avoiding unintended consequences and improving user engagement. Objective MyDiabetesIQ (MDIQ) is an artificial intelligence engine intended to predict users’ diabetes complications risk. It will underpin a user interface in which users will alter lifestyle parameters to see the impact on their future risks. MDIQ will link to an existing DHI, My Diabetes My Way (MDMW). We describe the user-centered design of the user interface of MDIQ as informed by human factors engineering. Methods Current users of MDMW were invited to take part in focus groups to gather their insights about users being shown their likelihood of developing diabetes-related complications and any risks they perceived from using MDIQ. Findings from focus groups informed the development of a prototype MDIQ interface, which was then user-tested through the “think aloud” method, in which users speak aloud about their thoughts/impressions while performing prescribed tasks. Focus group and think aloud transcripts were analyzed thematically, using a combination of inductive and deductive analysis. For think aloud data, a sociotechnical model was used as a framework for thematic analysis. Results Focus group participants (n=8) felt that some users could become anxious when shown their future complications risks. They highlighted the importance of easy navigation, jargon avoidance, and the use of positive/encouraging language. User testing of the prototype site through think aloud sessions (n=7) highlighted several usability issues. Issues included confusing visual cues and confusion over whether user-updated information fed back to health care teams. Some issues could be compounded for users with limited digital skills. Results from the focus groups and think aloud workshops were used in the development of a live MDIQ platform. Conclusions Acting on the input of end users at each iterative stage of a digital tool’s development can help to prioritize users throughout the design process, ensuring the alignment of DHI features with user needs. The use of the sociotechnical framework encouraged the consideration of interactions between different sociotechnical dimensions in finding solutions to issues, for example, avoiding the exclusion of users with limited digital skills. Based on user feedback, the tool could scaffold good goal setting, allowing users to balance their palatable future complications risk against acceptable lifestyle changes. Optimal control of diabetes relies heavily on self-management. Tools such as MDMW/ MDIQ can offer personalized support for self-management alongside access to users’ electronic health records, potentially helping to delay or reduce long-term complications, thereby providing significant reductions in health care costs.
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Affiliation(s)
- Cathy Shields
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Scott G Cunningham
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Deborah J Wake
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Evridiki Fioratou
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | | | - Sam Philip
- Grampian Diabetes Research Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Cunningham SG, Stoddart A, Wild SH, Conway NJ, Gray AM, Wake DJ. Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years. J Diabetes Sci Technol 2022; 17:715-726. [PMID: 34986658 DOI: 10.1177/19322968211069172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS My Diabetes My Way (MDMW) is Scotland's interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. MATERIALS AND METHODS Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. RESULTS MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: -£118.72 (-£150.16 to -£54.16) over ten years. Increasing MDMW costs (10%): -£50.49 (-£82.24-£14.14). Decreasing MDMW costs (10%): -£186.95 (-£218.53 to -£122.51). CONCLUSIONS MDMW is "dominant" over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.
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Affiliation(s)
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Alastair M Gray
- Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Deborah J Wake
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Meza-Torres B, Cunningham SG, Heiss C, Joy M, Feher M, Leese GP, de Lusignan S, Carinci F. Adherence to General Diabetes and Foot Care Processes, with Prompt Referral, Are Associated with Amputation-Free Survival in People with Type 2 Diabetes and Foot Ulcers: A Scottish National Registry Analysis. J Diabetes Res 2022; 2022:7414258. [PMID: 35746918 PMCID: PMC9213182 DOI: 10.1155/2022/7414258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS To compare different packages of care across care providers in Scotland on foot-related outcomes. METHODS A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Proportional hazards were used for time-to-event univariate and multivariate analyses, adjusting for case-mix characteristics and care processes. Results were expressed in terms of hazard ratios with 95% confidence intervals. RESULTS 2,243 (32.7%) subjects had a major amputation or death. Exposure to all nine care processes at all ages (HR = 0.63; 95% CI: 0.58-0.69; p < .001) and higher foot care attendance in people aged >70 years (HR = 0.88; 0.78-0.99; p = .03) were associated with longer major amputation-free survival. Waiting time ≥ 12 weeks between ulceration and clinic attendance was associated with worse outcomes (HR = 1.59; 1.37-1.84; p < .001). In people > 70 years, minor amputations were associated with improved major amputation-free survival (HR = 0.69; 0.52-0.92; p = .01). CONCLUSIONS Strict adherence to a standardised package of general diabetes care before foot ulceration, timely foot care after ulceration, and specific treatment pathways were associated with longer major amputation-free survival among a large cohort of people with type 2 diabetes in Scotland, with a larger impact on older age groups.
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Affiliation(s)
- Bernardo Meza-Torres
- Department of Clinical and Experimental Medicine, University of Surrey, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Scott G. Cunningham
- Division of Population Health and Genomics, University of Dundee, Scotland, UK
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, UK
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Graham P. Leese
- Division of Population Health and Genomics, University of Dundee, Scotland, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Italy
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Carinci F, Štotl I, Cunningham SG, Poljicanin T, Pristas I, Traynor V, Olympios G, Scoutellas V, Azzopardi J, Doggen K, Sandor J, Adany R, Løvaas KF, Jarosz-Chobot P, Polanska J, Pruna S, de Lusignan S, Monesi M, Di Bartolo P, Scheidt-Nave C, Heidemann C, Zucker I, Maurina A, Lepiksone J, Rossing P, Arffman M, Keskimäki I, Gudbjornsdottir S, Di Iorio CT, Dupont E, de Sabata S, Klazinga N, Benedetti MM. Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe. Front Clin Diabetes Healthc 2021; 2:744516. [PMID: 36994337 PMCID: PMC10012140 DOI: 10.3389/fcdhc.2021.744516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
BackgroundRegistries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe.ObjectivesWe aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research.MethodsSurvey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017.ResultsThe 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years.ConclusionsThe heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes.
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Affiliation(s)
- Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Fabrizio Carinci,
| | - Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Scott G. Cunningham
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Tamara Poljicanin
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Ivan Pristas
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Vivie Traynor
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - George Olympios
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - Vasos Scoutellas
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - János Sandor
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Roza Adany
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Przemka Jarosz-Chobot
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, The Silesian University of Technology, Gliwice, Poland
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcello Monesi
- Diabetes Unit “Sant’Anna” Hospital Ferrara, Ferrara, Italy
- Associazione Medici Diabetologi (AMD), Rome, Italy
| | - Paolo Di Bartolo
- Associazione Medici Diabetologi (AMD), Rome, Italy
- Azienda Unità Sanitaria Locale (AUSL) Diabetes Unit Romagna, Ravenna, Italy
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Inbar Zucker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anita Maurina
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Jana Lepiksone
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | - Martti Arffman
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ilmo Keskimäki
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska Hospital, Gothenburg, Sweden
| | | | - Elisabeth Dupont
- International Diabetes Federation European Region, Brussels, Belgium
| | - Stella de Sabata
- International Diabetes Federation European Region, Brussels, Belgium
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Massimo Massi Benedetti
- International Diabetes Federation European Region, Brussels, Belgium
- Hub for International Health Research, Perugia, Italy
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Conway NT, Bluett M, Shields C, Taylor A, Wake DJ, Cunningham SG. A Longitudinal Perspective on User Uptake of an Electronic Personal Health Record for Diabetes, With Respect To Patient Demographics. J Diabetes Sci Technol 2021; 15:993-1004. [PMID: 33870755 PMCID: PMC8442201 DOI: 10.1177/19322968211005734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The growing prevalence of diabetes has increased the need for scalable technologies to improve outcomes. My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) available to all people with diabetes in Scotland since 2010, associated with improved clinical outcomes among users. MDMW pulls data from a national clinician-facing informatics platform and provides self-management and educational information. This study aims to describe MDMW user demographics through time with respect to the national diabetes population, with a view to addressing potential health inequalities. METHODS Aggregate data were obtained retrospectively from the MDMW database and annual Scottish Diabetes Survey (SDS) from 2010 to 2020. Variables included diabetes type, sex, age, socioeconomic status, ethnicity, and glycemic control. Prevalence of MDMW uptake was calculated using corresponding SDS data as denominators. Comparisons between years and demographic sub-groups were made using Chi- Squared tests. RESULTS Overall uptake of MDMW has steadily increased since implementation. By 2020, of all people with T1D or T2D in Scotland, 13% were fully enrolled to MDMW (39,881/312,326). There was proportionately greater numbers of users in younger, more affluent demographic groups (with a clear social gradient) with better glycemic control. As uptake has increased through time, so too has the observed gaps between different demographic sub-groups. CONCLUSIONS The large number of MDMW users is encouraging, but remains a minority of people with diabetes in Scotland. There is a risk that innovations like MDMW can widen health inequalities and it is incumbent upon healthcare providers to identify strategies to prevent this.
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Affiliation(s)
- Nicholas T Conway
- NHS Tayside, Dundee, UK
- University of Dundee, Dundee, UK
- Nicholas T Conway, MBChB, MRCPCH, MPH, MD,
Tayside Children’s Hospital, MACHS Building, Ninewells Hospital, Dundee, DD1
9SY, UK.
| | - Michael Bluett
- University of Dundee, Dundee, UK
- NHS Research Scotland Diabetes Network,
Dundee, UK
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10
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Mackenzie SC, Cumming KM, Garrell D, Brodie D, Wilson L, Mehar S, Cunningham SG, Bickerton A, Wake DJ. Follow-Up of a Massive Open Online Course in Type 2 Diabetes Self-Management Education. J Diabetes Sci Technol 2021; 15:976-977. [PMID: 33719593 PMCID: PMC8258537 DOI: 10.1177/1932296821997178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Salma Mehar
- MyWay Digital Health Ltd, Dundee, UK
- NHS North West London Collaboration of Clinical Commissioning Groups, London, UK
| | - Scott G Cunningham
- Department of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Alex Bickerton
- Department of Diabetes and Endocrinology, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Deborah J Wake
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
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11
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Mackenzie SC, Cumming KM, Garrell D, Brodie D, Wilson L, Mehar S, Cunningham SG, Bickerton A, Wake DJ. Massive open online course for type 2 diabetes self-management: adapting education in the COVID-19 era. BMJ Innov 2020; 7:141-147. [PMID: 37556268 PMCID: PMC7670558 DOI: 10.1136/bmjinnov-2020-000526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022]
Abstract
Introduction Type 2 diabetes self-management education is an essential component of type 2 diabetes care that is traditionally delivered in a face-to-face setting. In response to the recent COVID-19 pandemic, innovative solutions are urgently needed, allowing provision of self-management education that can be delivered in compliance with social distancing policies. Innovations that are self-service and can deliver education efficiently at low cost are particularly appealing to healthcare providers and commissioners. Methods We aimed to evaluate user uptake, dropout, acceptability, satisfaction, perceived short-term knowledge gain and health benefits/behaviour changes in relation to a free massive open online course (MOOC) in diabetes self-management education, created and delivered during the COVID-19 pandemic. This course, focusing on addressing knowledge and self-management needs for people with type 2 diabetes, made use of online interactive content including expert and patient videos, quizzes, moderated discussion boards and live social media that encouraged personal reflection and goal setting. User expectations and experiences were explored via survey-based methods. Here, we present our experience of developing the course and describe users' experiences. Results 1991 users registered interest in the course over a 2-week period, with 976 users starting the course and 640 (65.6%) users completing the course in full. Users engaged well, finding the course educational, user-friendly and motivating, demonstrating high completion rates and user satisfaction. A statistically significant (p<0.001) increase in self-reported self-management ability and health knowledge was observed among participants with type 2 diabetes. Discussion MOOCs in type 2 diabetes self-management education have great potential for delivering education efficiently at scale and low cost. Although engagement can be limited by digital literacy, benefits include flexible and remote access to up-to-date, evidence-based education delivered by a multidisciplinary team of healthcare professionals.
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Affiliation(s)
- Scott C Mackenzie
- Department of Acute
Medicine, Ninewells Hospital and Medical School,
Dundee, UK
| | | | | | | | - Lyn Wilson
- NHS Lanarkshire, Bothwell, South
Lanarkshire, UK
| | - Salma Mehar
- MyWay Digital Health Ltd, Dundee, UK
- NHS North West London Collaboration of Clinical
Commissioning Groups, London,
UK
| | - Scott G Cunningham
- Department of Population
Health & Genomics, University of Dundee,
Dundee, Dundee, UK
| | - Alex Bickerton
- Department of Diabetes
& Endocrinology, Yeovil District Hospital NHS Foundation
Trust, Yeovil,
UK
| | - Deborah J Wake
- Usher Institute of
Population Health Sciences and Informatics, The University of
Edinburgh, Edinburgh,
UK
- Edinburgh Centre for
Endocrinology and Diabetes, NHS Lothian,
Edinburgh, UK
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12
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McKnight JA, Ochs A, Mair C, McKnight O, Wright R, Gibb FW, Cunningham SG, Strachan M, Ritchie S, McGurnaghan SJ, Colhoun HM. The effect of DAFNE education, continuous subcutaneous insulin infusion, or both in a population with type 1 diabetes in Scotland. Diabet Med 2020; 37:1016-1022. [PMID: 31872473 DOI: 10.1111/dme.14223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effect of DAFNE and continuous subcutaneous insulin infusion in clinical practice. METHODS Within NHS Lothian, continuous subcutaneous insulin infusion started in 2004 and DAFNE education began in 2006. We extracted anonymized data from the national database for all those aged > 18 years with type 1 diabetes having a Dose Adjustment For Normal Eating course or continuous subcutaneous insulin infusion start date (n = 4617). RESULTS In total, 956 persons received DAFNE education, and 505 had received an insulin pump, 208 of whom had DAFNE education followed by insulin pump. Mean (SD) HbA1c before DAFNE education was 68 (15) mmol/mol (8.4% [1.4%]) and 66 (13) mmol/mol (8.2% [1.2%]) before continuous subcutaneous insulin infusion. In the year following DAFNE education, the mean fall in within-person HbA1c was 3.8 mmol/mol (95% CI 4.0 to 3.4; 0.3% [0.4% to 0.3%]). Those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]) experienced the largest decline (15.7 mmol/mol [1.4%]). Those in the lowest HbA1c band at initiation (< 53 mmol/mmol [7.0%]) experienced a rise. In the year following continuous subcutaneous insulin infusion initiation there was a mean fall in within-person HbA1c of 6.6 mmol/mol (6.8 to 6.4; 0.6% [0.6% to 0.6%]). In those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]), the mean fall in HbA1c was 22.2 mmol/mol (23 to 21; 2.0% [2.1% to 1.9%]). Continuous subcutaneous insulin infusion effectiveness was not different with or without DAFNE education. The effects of both interventions were sustained over 5 years. CONCLUSIONS Both DAFNE education and insulin pump therapy had the greatest effect on HbA1c in those with higher baseline values. There was little difference to attained HbA1c when Dose Adjustment For Normal Eating education was introduced before insulin pump therapy.
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Affiliation(s)
- J A McKnight
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - A Ochs
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Mair
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - O McKnight
- Forth Valley Royal Hospital, NHS Forth Valley, Scotland
| | - R Wright
- Department of Diabetes, St John's Hospital, Livingston, UK
| | - F W Gibb
- Edinburgh Centre for Diabetes and Endocrinology, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S G Cunningham
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - M Strachan
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S Ritchie
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S J McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Department of Public Health, NHS Fife, Kirkcaldy, UK
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Carinci F, Meza Torres B, Cunningham SG, Mainz J, Groene O, Massi Benedetti M, Klazinga NS, Kringos D, de Lusignan S. Using routine data to benchmark quality and outcomes of diabetes care in the EU HEALTHPROS project. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The EU-funded Marie Curie project HEALTHPROS aims to foster a new generation of “Healthcare Performance Intelligence Professionals” through a cohesive stream of 13 doctoral projects (www.healthpros-h2020.eu). Over 48 months, researchers will investigate key levers of healthcare improvement in 7 different countries, using methods drawn from the diverse fields of biostatistics, medical informatics and health services research.
Objectives
To describe barriers and enablers in the conduction of two doctoral projects aimed at exploring the impact of personal risk factors and organizational arrangements on lower extremity amputations in diabetes, through the use of large-scale databases from England, Scotland, Denmark and Germany.
Results
The research plan included a systematic review, structured comparison of data sources, predictive modelling and software development for automated international comparisons. Barriers encountered by researchers were: knowledge and access to data sources from different countries, dealing with data protection rules and the ability to carry out international comparisons when individual records are not easily allowed to leave national boundaries. Enabling factors included: a targeted educational process for risk modelling in diabetes and a multidisciplinary support team to help doctoral students overcoming the above barriers across different sites. Further clinical insight and contextual knowledge of data systems in place at different locations were needed in addition to the statistical, epidemiological and technical skills initially foreseen by the program.
Conclusions
The success of studies within a general educational program on health systems performance may depend from the continued support of a multidisciplinary team helping students in their educational process as well as with the practicalities of their research. International comparisons using routine data may require prioritisation to meet the tight timelines of doctoral theses.
Key messages
Academic programs for international comparisons in health care may be hampered by different type of barriers including technical aspects, legal regulations and a range of contextual factors. The establishment of multidisciplinary support teams may be essential for training doctoral students aiming to conduct international comparisons using routine data.
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Affiliation(s)
- F Carinci
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - B Meza Torres
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - S G Cunningham
- Clinical Technology Centre, University of Dundee, Dundee, UK
| | - J Mainz
- Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | | | | | - N S Klazinga
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - D Kringos
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - S de Lusignan
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
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Conway N, Adamson KA, Cunningham SG, Emslie Smith A, Nyberg P, Smith BH, Wales A, Wake DJ. Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System. J Diabetes Sci Technol 2018; 12:381-388. [PMID: 28905658 PMCID: PMC5851216 DOI: 10.1177/1932296817729489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users' reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. METHODS Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. RESULTS The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (-2.3 mmol/mol [-0.2%] versus -1.1 [-0.1%], P = .003). DISCUSSION AND CONCLUSIONS The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.
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Affiliation(s)
- Nicholas Conway
- NHS Tayside, Ninewells Hospital Dundee, Dundee, UK
- University of Dundee, Ninewells Hospital Dundee, Dundee, UK
- Nicholas Conway, MACHS building, Tayside Children’s Hospital, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Karen A. Adamson
- NHS Lothian, St John’s Hospital, Howden Road West, Howden, Livingston, UK
| | | | | | - Peter Nyberg
- Duodecim Medical Publications, Helsinki, Finland
| | - Blair H. Smith
- University of Dundee, Ninewells Hospital Dundee, Dundee, UK
| | - Ann Wales
- NHS Education for Scotland, Glasgow, UK
| | - Deborah J. Wake
- NHS Tayside, Ninewells Hospital Dundee, Dundee, UK
- University of Dundee, Ninewells Hospital Dundee, Dundee, UK
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15
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Walker GS, Cunningham SG, Sainsbury CAR, Jones GC. HbA 1c variability is associated with increased mortality and earlier hospital admission in people with Type 1 diabetes. Diabet Med 2017; 34:1541-1545. [PMID: 28833535 DOI: 10.1111/dme.13455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 01/21/2023]
Abstract
AIM Despite evidence of morbidity, no evidence exists on the relationship between HbA1c variability and mortality in Type 1 diabetes. We performed an observational study to investigate whether the association between HbA1c variability and mortality exists in a population of people with Type 1 diabetes. As a secondary outcome, we compared onset of first hospital admission between groups. METHODS People with Type 1 diabetes were identified for inclusion from the Scottish Care Information - Diabetes data set. This database includes data of all people known to have diabetes who live within Scotland. A survival analysis was carried out over a 47-month period comparing two groups; group 1 with a HbA1c coefficient of variation (CV) above the median CV value, and group 2 with a CV below the median value. Time to death or first admission was also analysed. A Cox proportional hazard model was used to compare time to death, adjusting for appropriate covariables. RESULTS Some 6048 individuals with Type 1 diabetes were included in the analysis. Median HbA1c CV was 7.9. The hazard ratio (HR) for mortality for those with an HbA1c CV above the median value is 1.5 over 47 months of follow-up (P < 0.001). HR for survival to either the first admission to hospital or death for those with an HbA1c CV above the median value was 1.35 (95% confidence interval 1.25-1.45) over 730 days of follow-up (P < 0.001). CONCLUSION Our results show that people with greater HbA1c variability have a higher rate of mortality and earlier hospital admission in Type 1 diabetes.
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Affiliation(s)
- G S Walker
- Diabetes Centre, Gartnavel General Hospital, Glasgow
| | - S G Cunningham
- Clinical Technology Centre, Ninewells Hospital, Dundee, UK
| | | | - G C Jones
- Diabetes Centre, Gartnavel General Hospital, Glasgow
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16
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Jones GC, Timmons JG, Cunningham SG, Cleland SJ, Sainsbury CAR. Hypoglycemia and Clinical Outcomes in Hospitalized Patients With Diabetes: Does Association With Adverse Outcomes Remain When Number of Glucose Tests Performed Is Accounted For? J Diabetes Sci Technol 2017. [PMID: 28627243 PMCID: PMC5588825 DOI: 10.1177/1932296816688012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hypoglycemia is associated with increased length of stay in hospital patients, but previous studies have not considered the confounding effect of increased hypoglycemia detection associated with increased capillary blood glucose (CBG) measurement in prolonged admissions. We aimed to determine the effect of recorded hypoglycemia on length of stay of hospital inpatients (LOS) when this mathematical association is subtracted. METHODS CBG data were analyzed for inpatients within our health board area (01/2009-01/2015). A simulated CBG data set was generated for each patient with an identical sampling frequency to the measured CBG data set. The mathematical component of increased LOS was determined using the simulated data set. Subtraction of this confounding mathematical association was used to provide measurement of the true clinical association between recorded hypoglycemia (CBG < 4 mmol [< 72mg/dl]) and LOS. RESULTS A total of 196 962 admissions of 52 475 individuals with known diabetes were analyzed. 68 809 admissions of 29 551 individuals had >4 CBG measurements made and were included in analysis. After subtraction of the mathematical association of increased sample number, the clinical effect of recorded hypoglycemia is reduced-but persists-compared to previous studies. 1-2 days with recorded hypoglycemia has a relatively minor effect on LOS. LOS increases rapidly if there are ≥3 days with recorded hypoglycemia, with an increase of 0.75 days LOS per additional day with hypoglycemia. CONCLUSIONS This technique increases accuracy of economic modeling of the impact of hypoglycemia on health care systems. This could assist study of the impact of hypoglycemia on other outcomes by factoring for bias of increased sample numbers.
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Affiliation(s)
- Gregory C. Jones
- Diabetes Centre, Gartnavel General Hospital, Glasgow, Scotland, UK
- Gregory C. Jones, MB ChB, Diabetes Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, Scotland G12 OYN, UK.
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17
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Timmons JG, Cunningham SG, Sainsbury CAR, Jones GC. Inpatient Glycemic Variability and Long-Term Mortality in Hospitalized Patients with Type 2 Diabetes. J Diabetes Complications 2017; 31:479-482. [PMID: 27343028 DOI: 10.1016/j.jdiacomp.2016.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS To determine the association between inpatient glycemic variability and long-term mortality in patients with type 2 diabetes mellitus. METHODS Capillary blood glucose (CBG) of inpatients from 8 hospitals was analysed. 28,353 admissions identified were matched for age, duration of diabetes and admission and median and interquartile range of CBG. 6year mortality was investigated for (i) those with CBG IQR in the top half of all IQR measurements (matched for all except IQR), vs those in the lower half and (ii) those with the lowest quartile median glucose (matched for all except median). RESULTS CONCLUSION: Higher inpatient glycemic variability is associated with increased mortality on long-term follow up. When matched by IQR, we have demonstrated higher median CBG is associated with lower long-term mortality. CBG variability may increase cardiovascular morbidity by increasing exposure to hypoglycaemia or to variability per se. In hospitalized patients with diabetes, glycemic variability should be minimised and when greater CBG variability is unavoidable, a less stringent CBG target considered.
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Affiliation(s)
- Joseph G Timmons
- Diabetes Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, Scotland, United Kingdom
| | - Scott G Cunningham
- Clinical Technology Centre, Ninewells Hospital, Dundee, DD2 1UB, Scotland, United Kingdom
| | - Christopher A R Sainsbury
- Diabetes Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, Scotland, United Kingdom
| | - Gregory C Jones
- Diabetes Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 OYN, Scotland, United Kingdom.
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Abstract
MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-management platform for diabetes patients in Scotland. This platform links multiple national institutional and patient-recorded data sources to provide a unique resource for patient care and self-management. This review considers the current evidence for online interventions in diabetes and discusses these in the context of current and ongoing developments for MDMW. Evaluation of MDMW through patient reported outcomes demonstrates a positive impact on self-management. User feedback has highlighted barriers to uptake and has guided platform evolution from an education resource website to an electronic personal health record now encompassing remote monitoring, communication tools and personalized education links. Challenges in delivering digital interventions for long-term conditions include integration of data between institutional and personal recorded sources to perform big data analytics and facilitating technology use in those with disabilities, low digital literacy, low socioeconomic status and in minority groups. The potential for technology supported health improvement is great, but awareness and adoption by health workers and patients remains a significant barrier.
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Affiliation(s)
- Deborah J Wake
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Jinzhang He
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Anna Maria Czesak
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Fezan Mughal
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Scott G Cunningham
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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19
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Cunningham SG, Carinci F, Brillante M, Leese GP, McAlpine RR, Azzopardi J, Beck P, Bratina N, Bocquet V, Doggen K, Jarosz-Chobot PK, Jecht M, Lindblad U, Moulton T, Metelko Ž, Nagy A, Olympios G, Pruna S, Skeie S, Storms F, Di Iorio CT, Massi Benedetti M. Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery. Methods Inf Med 2015; 55:166-76. [PMID: 26666452 DOI: 10.3414/me15-01-0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND A set of core diabetes indicators were identified in a clinical review of current evidence for the EUBIROD project. In order to allow accurate comparisons of diabetes indicators, a standardised currency for data storage and aggregation was required. We aimed to define a robust European data dictionary with appropriate clinical definitions that can be used to analyse diabetes outcomes and provide the foundation for data collection from existing electronic health records for diabetes. METHODS Existing clinical datasets used by 15 partner institutions across Europe were collated and common data items analysed for consistency in terms of recording, data definition and units of measurement. Where necessary, data mappings and algorithms were specified in order to allow partners to meet the standard definitions. A series of descriptive elements were created to document metadata for each data item, including recording, consistency, completeness and quality. RESULTS While datasets varied in terms of consistency, it was possible to create a common standard that could be used by all. The minimum dataset defined 53 data items that were classified according to their feasibility and validity. Mappings and standardised definitions were used to create an electronic directory for diabetes care, providing the foundation for the EUBIROD data analysis repository, also used to implement the diabetes registry and model of care for Cyprus. CONCLUSIONS The development of data dictionaries and standards can be used to improve the quality and comparability of health information. A data dictionary has been developed to be compatible with other existing data sources for diabetes, within and beyond Europe.
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Affiliation(s)
- S G Cunningham
- Dr Scott G. Cunningham, Clinical Technology Centre, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK, E-mail:
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20
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Abstract
Background: Diabetes prevalence in Scotland is increasing at approximately 4.6% annually, with figures currently at 247,278 (4.7%). Internet-based interventions have the potential to enhance self-management and shift the balance of power towards the patient. Electronic personal health records (ePHRs) have been identified as an ideal route to deliver these interventions, as outlined in the Department of Health Information Strategy. Methods: We developed a diabetes-focused, population-based ePHR for NHS Scotland. Data are sourced from primary, secondary and tertiary care via the national shared-electronic record, SCI-DC. Data are displayed alongside lay-descriptions and information links tailored to the patient’s needs. Results: 3,391 individuals have registered to access their clinical data. In this largely self-selecting group, 31% have type 1 diabetes and 61% are male. 2,015 have completed the enrolment process and 861 have successfully logged in. By the end of 2012, the number of distinct users per month had risen to nearly 300. Conclusions: The system is now a useful additional component for the self-management of diabetes. Although the system has been developed for, and by, stakeholders from across Scotland, it has the potential to connect to any electronic medical record. The current project is expected to reach over 5,000 patients by the end of 2013.
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Affiliation(s)
| | - Deborah J Wake
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Annalu Waller
- School of Computing, University of Dundee, Dundee, UK
| | - Andrew D Morris
- Medical Research Institute, University of Dundee, Dundee, UK
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21
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Abstract
In the UK, 85% of adults use the internet, yet digital technology and web based applications have been slow to realise their potential within health care. Diabetes, a chronic disease requiring extensive self-management, could particularly benefit from an e-health approach. Whilst there are a number of independent on-line diabetes communities, mobile apps, websites and networking opportunities, these operate in silos rather than integrating with mainstream health care. This review will explore the political drivers and barriers to eHealth, and review current digital opportunities for patients and health care professionals within diabetes care.
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Affiliation(s)
- Deborah J Wake
- Medical Education Institute/ Medical Research institute, Cardiovascular and Diabetes Division, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Scott G Cunningham
- Clinical Technology Centre, University of Dundee, Ninewells Hospital, Dundee, UK
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Foster TC, Fugger HN, Cunningham SG. Receptor blockade reveals a correspondence between hippocampal-dependent behavior and experience-dependent synaptic enhancement. Brain Res 2000; 871:39-43. [PMID: 10882780 DOI: 10.1016/s0006-8993(00)02379-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the involvement of N-methyl-D-aspartate receptors (NMDARs) in experience-dependent synaptic plasticity. Rats chronically received an NMDA receptor antagonist (AP5) or saline (SAL) and were exposed to individual cages (IC) or environmental enrichment (EC). AP5 impaired measures of hippocampal-dependent behavior and increased locomotor activity. Perforant path synaptic strength, measured in the in vitro hippocampal slice, was increased and long-term potentiation (LTP) was decreased for EC+SAL animals. The experience-dependent effects on synaptic function were inhibited by drug treatment. Measures of synaptic strength were correlated with hippocampal-dependent behavior and synaptic plasticity for EC animals. The results suggest a relationship between hippocampal-dependent behavior and experience-dependent modification of perforant path synaptic function through NMDAR activation.
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Affiliation(s)
- T C Foster
- University of Kentucky, College of Medicine, Department of Pharmacology, 40536, Lexington, KY, USA.
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23
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Abstract
This study investigated the role of the estrogen receptor alpha (ERalpha) in mediating performance on a spatial discrimination task, the Morris water maze. Spatial discrimination on this water escape task was examined in eight groups of gonadectomized mice. Male and female wild-type (WT) and littermate mice lacking functional copies of the ERalpha gene (ERalphaKO), were treated with estradiol benzoate (EB) or sesame oil vehicle. Subjects were trained on the water escape task over a 4-day period (four trials per block, three blocks per day). Latency to find the hidden platform was measured. Only female WT mice treated with EB failed to learn this spatial discrimination task. All males, WT and ERalphaKO treated with EB or oil exhibited decreased latencies across blocks of trials, WT females treated with oil, and ERalphaKO females, regardless of treatment, learned the spatial discrimination task. In order to eliminate motivational or sensory-motor impairments as a factor in describing the poor spatial discrimination performance of WT females treated with EB, the cue version of the water maze task was employed. Results from the cue phase of the task indicate that EB and oil-treated WT females exhibited a similar decrease in escape latencies across blocks of trials, indicating good cue discrimination performance. Taken together, the results indicate that ERalpha activation impairs acquisition of spatial discrimination of the water escape task, but not cue discrimination, in female mice. Because ligand-bound ERalpha appears to operate differently in male and female mice we hypothesize that the ability of ERalpha to affect learning is organized during development.
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Affiliation(s)
- H N Fugger
- Neuroscience Graduate Program, University of Virginia, Charlottesville, Virginia, 22903, USA.
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Cunningham SG. Women's heart health--an integrated approach to prevention. Can J Cardiovasc Nurs 1998; 9:28-37. [PMID: 10335140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The major causes of death and disability in women include in order: heart disease, cancer, stroke, fractures, pneumonia, osteoarthritis, and cataracts. This paper discusses common preventive approaches that have the potential to reduce women's risk of atherosclerotic cardiovascular disease as well as cancer, osteoporosis, and fractures. These preventive approaches include smoking cessation or prevention, physical activity, weight control and consuming a healthy diet.
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Affiliation(s)
- S G Cunningham
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle 98195-7266, USA
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Anderson FD, Cunningham SG, Maloney JP. Indirect blood pressure measurement: a need to reassess. Am J Crit Care 1993; 2:272-7; quiz 278-9. [PMID: 8358473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Indirect blood pressure measurement is the assessment tool used most frequently in epidemiological studies and hypertension management in the population at large. OBJECTIVE To review indirect blood pressure measurement within the context of nursing practice. RESULTS Nurses are not following recommended American Heart Association measurement guidelines. CONCLUSION A national program of certification in indirect blood pressure measurement, similar to that of basic and advanced cardiac life support, is needed. An initial approach to evaluating present practice is also suggested.
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26
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Abstract
BACKGROUND: Indirect blood pressure measurement is the assessment tool used most frequently in epidemiological studies and hypertension management in the population at large. OBJECTIVE: To review indirect blood pressure measurement within the context of nursing practice. RESULTS: Nurses are not following recommended American Heart Association measurement guidelines. CONCLUSION: A national program of certification in indirect blood pressure measurement, similar to that of basic and advanced cardiac life support, is needed. An initial approach to evaluating present practice is also suggested.
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27
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Cunningham SG. Nonpharmacologic management of high blood pressure. Cardiovasc Nurs 1987; 23:18-22. [PMID: 3650125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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28
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Davis-Rollans C, Cunningham SG. Physiologic responses of coronary care patients to selected music. Heart Lung 1987; 16:370-8. [PMID: 3647973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Hill MN, Cunningham SG. New recommendations for high blood pressure control: guidelines for all NPs. Nurse Pract 1985; 10:35. [PMID: 4022467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Sanders JB, Cunningham SG, Knowlton CG. A comparison of plasma renin activity levels in patients with and without congestive heart failure after myocardial infarction. Heart Lung 1985; 14:1-8. [PMID: 3881367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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31
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Cunningham SG. The Neuman systems model applied to a rehabilitation setting. Rehabil Nurs 1983; 8:20-2. [PMID: 6554840 DOI: 10.1002/j.2048-7940.1983.tb02352.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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32
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Cunningham SG. Fluid and electrolyte disturbances associated with cancer and its treatment. Nurs Clin North Am 1982; 17:579-93. [PMID: 6757872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Individuals with cancer are subject to fluid and electrolyte imbalances because of the original disease process, therapy, and complications resulting from both the disease process and from therapy. These imbalances are life threatening either when they become extreme or when they occur very rapidly. Although almost any fluid and electrolyte disorder or combination of disorders can occur in people with cancer, this article will focus on the following more common, potentially critical imbalances: water excess, decreased vascular volume, hypercalcemia, hypokalemia, and tumor lysis syndrome, which includes hypocalcemia, hyperphosphatemia, hyperuricemia, and hyperkalemia. These imbalances will each be reviewed with a focus on their causes, signs and symptoms, and treatment. Additional readings on fluid and electrolyte imbalances in patients with cancer can be found in several recent articles.
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Cunningham SG, Knowlton GG, Sanders JB. Plasma renin activity levels in two patients with impending cardiogenic shock. N Engl J Med 1982; 306:993-4. [PMID: 7038500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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35
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