Distribution, management and outcomes of AMI according to principal diagnosis priority during inpatient admission

Peer reviewedPostprin

Clinical, sociodemographic, and environmental factors associated with hospitalizations for acute complications in adults with type 1 diabetes mellitus

Bibliography: p. 92-100Includes copies of ethics approval. Original copies with original Partial Copright Licence.Objective: To identify factors associated with hospitalizations for acute complications in adults with type 1 diabetes. Within this thesis, three discrete studies were conducted which assessed 1) clinical and sociodemographic factors; 2) driving distance to diabetes care sites; and, 3) seasonality. Methods: This thesis used clinical, administrative, and geographic data. Analysis included descriptive statistics, logistic regression models, and Geographic Information Systems (GIS) methodology. Results: The results showed: 1) Diabetic ketoacidosis (DKA) hospitalization was associated with shorter duration of diabetes, higher hemoglobin Ale, gastroparesis, and psychiatric disorders. Hypoglycemia hospitalization was associated with longer duration of diabetes and neuropathy; 2) Driving distance to diabetes care sites overall was not associated with hospitalizations; and, 3) DKA and hypoglycemia hospitalizations had seasonal variation. Conclusions: This thesis identified unique factors associated with hospitalizations for acute complications. This information could inform specific initiatives to improve the health and well being of adults with type 1 diabetes

Sedentary behavior, gestational diabetes mellitus, and type 2 diabetes risk: where do we stand?

A substantial number of pregnancies are complicated by gestational diabetes mellitus (GDM) and up to 70 % of women with GDM go on to develop type 2 diabetes. Given the extensive body of research suggesting physical activity reduces the risk of type 2 diabetes, facilitating physical activity, and reducing sedentary time may be effective approaches to promote the health of women with a previous GDM diagnosis. Here, we discuss physical activity, exercise, and sedentary behavior, in the context of GDM and the potential for type 2 diabetes risk reduction

Women’s experience with peer counselling and social support during a lifestyle intervention among women with a previous gestational diabetes pregnancy

Purpose Women who are diagnosed with gestational diabetes mellitus have an increased risk of developing type 2 diabetes, but most receive little guidance regarding disease prevention. This study examined the role and usefulness of social support, including peer counselling in facilitating behaviour change as a part of a healthy eating and physical activity intervention among women with a previous gestational diabetes mellitus pregnancy. Methods We used a qualitative descriptive approach to investigate participants’ experiences with the social support they received during the intervention. We used purposeful sampling and invited women and peer counsellors to participate in semi-structured interviews. Data were analyzed using content analysis. Results We interviewed nine women and two peer counsellors. Participants received emotional, appraisal, and informational types of social support from the peer counsellor and exercise specialist that they reported as useful. Additionally, participants’ received informal emotional and instrumental support from family, friends, and colleagues that they found useful in supporting behaviour change. Conclusions Different types of social support are important to encourage behaviour change. These findings provide insight into the types of social support women with previous gestational diabetes mellitus find useful, in addition to practical ways that social support can be incorporated into future interventions

Exploring the reliability of inpatient EMR algorithms for diabetes identification

Introduction Accurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms.Materials and methods A chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms used or statements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV).Results The algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99.Discussion Free-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery

Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners’ perspectives on a facilitated relay intervention in Alberta, Canada

Objective The objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention.Design Qualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis.Setting Primary care providers and patients in Calgary, Alberta, Canada.Participants 17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups.Main outcome measures Exploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions.Results GPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries.Conclusions GPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs’ ability to successfully engage patients in cardiovascular risk reduction through statin therapy