Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

Background The prevalence of diabetes mellitus is increasing in the USA. However, control of intermediate outcome measures remains substandard. Recently, significant emphasis has been placed on the value of electronic medical records and informatics systems to improve the delivery of health care. Objective To determine whether a clinical informatics system improves care of patients with diabetes mellitus. Methods In this quality improvement pilot initiative, we identified 48 patients with diabetes mellitus who were due for their annual haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and microalbumin tests. Through our newly developed clinical informatics initiative, patients were reminded to schedule tests and a physician appointment. Seventy-five patients without reminders served as controls. Results A significant improvement in LDL control was achieved in the intervention group (35.4% vs 13.3%; P=0.004). The intervention group had a greater percentage of patients who underwent the three tests, and members of this group also showed greater control of haemoglobin A1c, but these differences were not statistically significant. Conclusions A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings

PM₁₀, PM_2.5, PM₁, number and surface of particles at the child’s seat when smoking a cigarette in a car

The exposure to particles was measured by a diffusion size classifier (10–300 nm) and an optical particle counter (300 nm–10 μm) at the child’s seat of a car during repeated drives on a fixed route from a suburban domestic area to a school and back. One single cigarette smoked in a car at the front seat during a 10 minute trip, lead to an increase of PM10 on the back seat by a factor of 10.5, for PM2.5 by a factor of 21.3 and for PM1 by a factor of 23.9. Concentrations dropped after opening the back door, but stayed elevated on the way back, compared to outdoor concentrations. Holding the cigarettes to the open window of the front seat did not reduce exposure on the back seat. When a second cigarette was smoked on the way back, PM10 concentrations rose again to 300 μg m−3. While background PM1 made up 19–39% of PM10, PM1 during smoking amounted to 78–89% of PM10. PM1 was highly correlated to particle number (mean 97,701 pt cm−3, SD 82,537) and lung deposited surface area (LDSA, mean 270 cm2 cm−3, SD 229). Positioning of the cigarette at the open window did not decrease the exposure to LDSA at the child’s seat. In conclusion, particles can reach exorbitant high levels at the back seat, when cigarettes are smoked in a small place like a car, even with a 2 inches open window next to the smoker at the front seat. Through smoking in cars parents can harm their or other’s children severely

Symbolic coping: Young people’s perspectives during the Covid-19 pandemic in three Central European countries

Soziale

Symbolic coping: Young people's perspectives during the COVID-19 pandemic in three central european countries

The aim of this study was to find out what interpretive repertoires young people use in the symbolic management of the pandemic. Qualitative research using several methods on a sample of 172 young people in three countries, Slovakia, the Czech Republic and Austria, and the subsequent discursive analysis showed that young people symbolically coped during the Covid-19 pandemic with the help of widespread concepts such as cutting off, closing sci-fi and panic. The interpretations used by young people to symbolically deal with the pandemic are close to those present in the public discourse the discourses of threat, loss, emotion but there was also a search for the concepts and language for use by experts and the general public in communicating about the pandemic. There were no significant differences in the interpretations of life during the Covid-19 pandemic in the three Central European countries.Slovak Research and Development AgencySlovak Research and Development Agency [APVV-18-0303]; VEGA grant Psychological, sociocultural and biological sources of love [1/0426/18]Agentúra na Podporu Výskumu a Vývoja, APVV: APVV-18-0303; Vedecká Grantová Agentúra MŠVVaŠ SR a SAV, VEGA: 1/0426/1

When the plot thickens: a rare complication of rheumatoid arthritis

Introduction: Rheumatoid arthritis (RA) is a common illness with many extraarticular manifestations. Rheumatoid pachymeningitis is a rare neurologic complication of this common disease. Here in we present a patient with longstanding RA who developed this uncommon complication. Case description: A 75-year-old woman with longstanding RA presented to the clinic with multiple seizure-like spells per day. Upon admission to the hospital, brain MRI showed enhancement of the meninges. After an extensive workup for possible other infectious or inflammatory causes, the patient was diagnosed with rheumatoid pachymeningitis. Conclusion: Rheumatoid pachymeningitis is a rare complication of RA that usually occurs late in the disease course. It may have many neurologic manifestations include mimicking seizure or stroke and must be considered in patients with RA presenting with neurologic symptoms. Pachymeningitis is treated distinctly from articular RA, so early recognition can lead to appropriate treatment