HEMOGLOBIN A1C IMPROVEMENTS AND BETTER DIABETES-SPECIFIC QUALITY OF LIFE AMONG PARTICIPANTS COMPLETING DIABETES SELF-MANAGEMENT PROGRAMS: A NESTED COHORT STUDY

Background: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA1c) and diabetes-specific quality of life among patients completing diabetes self-management programs. Methods: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA1c from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality of life measure) at one year. Results: HbA1c levels improved for the overall cohort from baseline to one-year follow-up (t (74) = 3.09, p = .0029). One-year follow up HbA1c was correlated with worse overall quality of life (r = 0.33, p = 0.004). Improvements in HbA1c from baseline to one-year follow-up were associated with greater D-39 diabetes control (β = 0.23, p = .04) and D-39 sexual functioning (β = 0.25, p = .03) quality of life subscales. Conclusions: Improvements in HbA1c among participants completing a diabetes self-management program were associated with better diabetes-specific quality of life. Innovations in primary care that engage patients in self-management and improve clinical biomarkers, such as HbA1c, may also be associated with better quality of life, a key outcome from the patient perspective

The Effect of Insurance Status and Race on Access to Care for Pediatric and Adolescent Patients With Anterior Cruciate Ligament Injury

BACKGROUND: Anterior cruciate ligament injuries (ACL) of the knee are becoming increasingly common in the pediatric and adolescent population with the rise in organized sports participation. This injury can be devastating to a young athlete’s ability to engage in physical activity as the knee is rendered unstable; leaving it susceptible to further degenerative changes. As a result, a delay in both the diagnosis and treatment of ACL injuries can lead to secondary joint damage in this highly active population. The purpose of this study was to analyze whether the insurance status and race of pediatric and adolescent patients with ACL injuries impacts the time from injury to diagnosis and treatment, and consequently secondary joint damage. MATERIALS AND METHODS: This was a retrospective review of 170 consecutive patients at a tertiary care pediatric hospital treated by a single surgeon from 2011 to 2015 for ACL ruptures. The institution at which the patients were treated was a safety-net hospital that provides a significant level of care to low-income, uninsured, and vulnerable populations with no care preference given based on insurance status. Patients were stratified into public insurance and private insurance groups. Race was also considered. Ability to access care was compared between the groups in regards to time from injury to magnetic resonance imaging (MRI) exam (the gold standard for diagnosis of ACL injury) as well time from injury to surgical reconstruction. In addition, the presence of secondary injury (meniscal / chondral injury) that may have stemmed from treatment delay and continued activity with an unstable knee was compared between groups. RESULTS: One hundred and two patients had public insurance and 68 patients had private insurance. Patients with private insurance received an MRI nearly 50% faster after their injury (p \u3c 0.001, 19 days vs. 38 days). In addition, time from injury to ACL reconstruction was also faster (p \u3c 0.001, 61 days vs. 96 days) for privately insured patients. An increased rate of meniscal tears and chondral injuries was not significantly seen in the public insurance group. Race did not impact timing to treatment or secondary injuries. CONCLUSIONS: The results of this study demonstrated that time from injury to MRI diagnosis, and surgical treatment was significantly shorter in privately insured pediatric and adolescent patients even in a safety-net hospital setting. Clinicians must be cognizant of this disparity and develop means to ensure timely access to care

Hemoglobin A1c improvements and better diabetes-specific quality of life among participants completing diabetes self-management programs: A nested cohort study

BACKGROUND: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA(1c)) and diabetes-specific quality of life among patients completing diabetes self-management programs. METHODS: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA(1c) from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality of life measure) at one year. RESULTS: HbA(1c) levels improved for the overall cohort from baseline to one-year follow-up (t (74) = 3.09, p = .0029). One-year follow up HbA(1c) was correlated with worse overall quality of life (r = 0.33, p = 0.004). Improvements in HbA(1c) from baseline to one-year follow-up were associated with greater D-39 diabetes control (β = 0.23, p = .04) and D-39 sexual functioning (β = 0.25, p = .03) quality of life subscales. CONCLUSIONS: Improvements in HbA(1c) among participants completing a diabetes self-management program were associated with better diabetes-specific quality of life. Innovations in primary care that engage patients in self-management and improve clinical biomarkers, such as HbA(1c), may also be associated with better quality of life, a key outcome from the patient perspective

Use of Posterior Hamstring Harvest During Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Population.

BackgroundPosterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference.PurposeTo describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications.Study designCase series; Level of evidence, 4.MethodsThis study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient's leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed.ResultsA total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest-no graft transections, neurovascular injuries, secondary procedures for wound healing or closure, cosmetic concerns, or limitations in return to activity due to the posterior incision.ConclusionThe posterior hamstring harvest is a safe and reliable technique to harvest autograft tendon in pediatric and adolescent anterior cruciate ligament reconstructions. The posterior technique entailed no complications related to harvest. No patients expressed any cosmetic concerns about their incision or had limitations in return to sport due to the posterior harvest

A longitudinal study to evaluate effect of surgically induced astigmatism after phacoemulsification clear corneal incision placed in the steepest meridian on eyes with preexisting astigmatism

Context: Surgically induced astigmatism (SIA) is the cause of poor postoperative vision even after uneventful cataract surgery. Aims: (1) To evaluate the effect of SIA after phacoemulsification clear corneal incision in the steepest meridian on the magnitude of preexisting astigmatism (PEA). (2) To map the magnitude of SIA by incisions in superior (S) and temporal (T) positions. Settings and Design: KLES Dr. Prabhakar Kore Hospital and Medical Research Centre (MRC), Belagavi, Karnataka. Longitudinal study. Subjects and Methods: The present 1-year study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, on patients undergoing cataract surgery during the period of January 1, 2014,-December 31, 2014. The patients undergoing phacoemulsification with PEA ranging from 0.5 D to 1.5 D were selected for the study to evaluate SIA after phacoemulsification clear corneal incision in the steepest meridian on the magnitude of the PEA. Statistical Analysis Used: Paired t-test was used to calculate mean SIA. Results: The result showed average SIA recorded was 0.54 ± 0.34 D with P < 0.001 (statistically significant). The SIA through temporal incision was 0.70 ± 0.35 D and through superior incision was 0.84 ± 0.49 D. This difference of SIA comparison between temporal and superior incision was not statistically significant (P = 0.145). On taking temporal incision, the mean keratometric difference was 1.03 ± 0.96, which was statistically significant. On taking superior incision, the mean keratometric difference was 0.92 ± 0.95, which was statistically significant. Conclusions: Choosing the clear corneal incision site based on the preoperative steepest meridian significantly decreased keratometric astigmatism at the temporal and superior locations. As well as, temporal incision is evidently better than superior incision in minimizing SIA

Prevalence of ocular trauma in KLES Hospital: A 1-year cross-sectional study

Context: People affected by eye injury often have to face loss of career opportunities, major lifestyle changes, and occasionally permanent disfigurement. Aims: (1) To find the prevalence of ocular trauma in patients attending our hospital. (2) To find the clinical profile of ocular trauma patients and the cause of trauma in them. Settings and Design: This was a cross-sectional study conducted at KLE Hospital, Belagavi, Karnataka. Subjects and Methods: The present 1-year study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, on 2308 trauma patients presenting to the ophthalmology outpatient department and casualty from January 1, 2014, to December 31, 2014. Out of 2308 patients, 217 patients were identified to have ocular trauma and were examined in a systematic fashion. Statistical Analysis Used: None. Results: The prevalence rate of ocular trauma was found to be 9.40%. Maximum patients (27.19%) were in the age group of 21-30 years. A total of 182 (83.87%) patients were male and 35 (16.13%) patients were female. Conclusions: Most common cause of ocular trauma was found to be road traffic accidents (RTAs), seen most commonly among males in the age group of 21-30 years. Males are commonly injured in RTA which is probably related to both exposure and risk-taking behavior. Several human and environmental risk factors were found to be associated with increased risk of RTA. Apart from RTA, occupational hazard was the next major cause of ocular trauma. Certain laws and legislations and their strict enforcement can curb these two major causes of ocular trauma