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Hernar I, Cooper JG, Nilsen RM, Skinner TC, Strandberg RB, Iversen MM, Graue M, Ernes T, Løvaas KF, Madsen TV, Lie SS, Richards DA, Ueland GÅ, Haugstvedt A. Diabetes Distress and Associations With Demographic and Clinical Variables: A Nationwide Population-Based Registry Study of 10,186 Adults With Type 1 Diabetes in Norway. Diabetes Care 2024; 47:126-131. [PMID: 37922320 PMCID: PMC10733651 DOI: 10.2337/dc23-1001] [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: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.
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Affiliation(s)
- Ingvild Hernar
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - John G. Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Roy M. Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Timothy C. Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Ragnhild B. Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M. Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes Data, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tony Ernes
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V. Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Silje S. Lie
- Department of Health, VID Specialized University, Stavanger, Norway
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe Å. Ueland
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Slåtsve KB, Claudi T, Lappegård KT, Jenum AK, Larsen M, Nøkleby K, Tibballs K, Cooper JG, Sandberg S, Buhl ES, Løvaas KF, Berg TJ. Level of education is associated with coronary heart disease and chronic kidney disease in individuals with type 2 diabetes: a population-based study. BMJ Open Diabetes Res Care 2022; 10:10/5/e002867. [PMID: 36171015 PMCID: PMC9528574 DOI: 10.1136/bmjdrc-2022-002867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/11/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To study the relationship between education level and vascular complications in individuals with type 2 diabetes in Norway. RESEARCH DESIGN AND METHODS Multiregional population-based cross-sectional study of individuals with type 2 diabetes in primary care. Data were extracted from electronic medical records in the period 2012-2014. Information on education level was obtained from Statistics Norway. Using multivariable multilevel regression analyses on imputed data we analyzed the association between education level and vascular complications. We adjusted for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration. Results are presented as ORs and 95% CIs. RESULTS Of 8192 individuals with type 2 diabetes included, 34.0% had completed compulsory education, 49.0% upper secondary education and 16.9% higher education. The prevalence of vascular complications in the three education groups was: coronary heart disease 25.9%, 23.0% and 16.9%; stroke 9.6%, 7.4% and 6.6%; chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) 23.9%, 16.8% and 12.6%; and retinopathy 13.9%, 11.5% and 11.7%, respectively. Higher education was associated with lower odds for coronary heart disease (OR 0.59; 95% CI 0.49 to 0.71) and chronic kidney disease (OR 0.75; 95% CI 0.60 to 0.93) compared with compulsory education when adjusting for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration. CONCLUSIONS In a country with equal access to healthcare, high education level was associated with lower odds for coronary heart disease and chronic kidney disease in individuals with type 2 diabetes.
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Affiliation(s)
- Kristina B Slåtsve
- Department of Medicine, Nordlandssykehuset HF, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Claudi
- Department of Medicine, Nordlandssykehuset HF, Bodø, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordlandssykehuset HF, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Karen Jenum
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Marthe Larsen
- Clinical Research Department, UNN Tromsø, Tromsø, Norway
| | - Kjersti Nøkleby
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Katrina Tibballs
- Department of General Practice, University of Oslo, Oslo, Norway
| | - John G Cooper
- Department of Medicine, Medical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Medicine, NOKLUS, Haraldsplass Diakonale Sykehus, Bergen, Norway
| | - Sverre Sandberg
- Department of Medicine, NOKLUS, Haraldsplass Diakonale Sykehus, Bergen, Norway
| | | | | | - Tore Julsrud Berg
- Norwegian Quality Improvement of Laboratory Examinations, (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Prigge R, McKnight JA, Wild SH, Haynes A, Jones TW, Davis EA, Rami-Merhar B, Fritsch M, Prchla C, Lavens A, Doggen K, Chao S, Aronson R, Brown R, Ibfelt EH, Svensson J, Young R, Warner JT, Robinson H, Laatikainen T, Rautiainen P, Delemer B, Souchon PF, Diallo AM, Holl RW, Schmid SM, Raile K, Tigas S, Bargiota A, Zografou I, Luk AOY, Chan JCN, Dinneen SF, Buckley CM, Kgosidialwa O, Cherubini V, Gesuita R, Strele I, Pildava S, Veeze H, Aanstoot HJ, Mul D, Jefferies C, Cooper JG, Løvaas KF, Battelino T, Dovc K, Bratina N, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Globa E, Zelinska N. International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med 2022; 39:e14766. [PMID: 34890078 DOI: 10.1111/dme.14766] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 05/11/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes. METHODS Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA1c (IQR) and proportions of individuals with HbA1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA1c category compared to previous estimates were calculated. RESULTS Median HbA1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women compared to men, 1.68 (1.65-1.71) for people aged <15 years and 0.81 (0.79-0.82) aged15-24 years compared to those aged ≥25 years. Differences between populations persisted after adjusting for sex, age and data source. In general, compared to our previous analysis, the proportion of people with an HbA1c < 58 mmol/l (<7.5%) increased and proportions of people with HbA1c ≥ 75 mmol/mol (≥9.0%) decreased. CONCLUSIONS Glycaemic control of type 1 diabetes continues to vary substantially between age groups and data sources. While some improvement over time has been observed, glycaemic control remains sub-optimal for most people with Type 1 diabetes.
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Affiliation(s)
- Regina Prigge
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John A McKnight
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Metabolic Unit and Acute Receiving Unit, Western General Hospital, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Birgit Rami-Merhar
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christine Prchla
- Klinik Donaustadt, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | | | | | | | | | - Ruth Brown
- LMC Diabetes & Endocrinology, Toronto, Canada
| | | | - Jannet Svensson
- Department of Paediatrics, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | | | - Holy Robinson
- Royal College of Paediatrics and Child Health, London, UK
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Päivi Rautiainen
- Joint municipal authority for North Karelia social and health services (Siunsote), Joensuu, Finland
| | - Brigitte Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Pierre François Souchon
- Department of Paediatrics, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Alpha M Diallo
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Reims, Reims, France
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Sebastian M Schmid
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetology, University Medicine Berlin, CharitéBerlin, Germany
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Volos, Greece
| | - Ioanna Zografou
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Andrea O Y Luk
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Juliana C N Chan
- The Chinese University of Hong Kong, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
- NUI Galway, Galway, Ireland
| | | | - Oratile Kgosidialwa
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | | | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy, Italy
| | - Ieva Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - Santa Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Henk Veeze
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Dick Mul
- Diabeter, National Centre for Paediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - Craig Jefferies
- Department of Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - John G Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Centre of Registers in Region VästraGötaland, Göteborg, Sweden
| | - Evgenia Globa
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Nataliya Zelinska
- Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
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Tran AT, Berg TJ, Mdala I, Gjelsvik B, Cooper JG, Sandberg S, Claudi T, Jenum AK. Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA 1c in type 2 diabetes in norwegian general practice. Diabet Med 2021; 38:e14500. [PMID: 33354827 PMCID: PMC8359382 DOI: 10.1111/dme.14500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
AIMS To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured. METHODS A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. RESULTS Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs' use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed. CONCLUSION Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.
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Affiliation(s)
- Anh T. Tran
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Tore J. Berg
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Ibrahimu Mdala
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Bjørn Gjelsvik
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - John G. Cooper
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of MedicineStavanger University HospitalStavangerNorway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory ExaminationsHaraldsplass Deaconess HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department of Clinical Biochemistry and PharmacologyHaukeland University HospitalBergenNorway
| | - Tor Claudi
- Department of MedicineNordland HospitalBodøNorway
| | - Anne K. Jenum
- Department of General PracticeInstitute of Health and SocietyUniversity of OsloOsloNorway
- General Practice Research Unit (AFE)Department of General PracticeInstitute of Health and Society, University of OsloOsloNorway
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Nøkleby K, Berg TJ, Mdala I, Buhl ES, Claudi T, Cooper JG, Løvaas KF, Sandberg S, Jenum AK. High adherence to recommended diabetes follow-up procedures by general practitioners is associated with lower estimated cardiovascular risk. Diabet Med 2021; 38:e14586. [PMID: 33876447 DOI: 10.1111/dme.14586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
AIMS To explore whether the general practitioners' (GPs') performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. METHODS A cross-sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP's average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10-year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. RESULTS The mean total and modifiable estimated 10-year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest-performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17-2.60) and 1.78 (1.14-2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest-performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27-2.46) times higher than that for patients with a GP in the highest quintile. CONCLUSIONS We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.
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Affiliation(s)
- Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tore J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Esben S Buhl
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Bodø, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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6
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Slåtsve KB, Claudi T, Lappegård KT, Jenum AK, Larsen M, Nøkleby K, Cooper JG, Sandberg S, Berg TJ. Factors associated with treatment in primary versus specialist care: A population-based study of people with type 2 and type 1 diabetes. Diabet Med 2021; 38:e14580. [PMID: 33834523 DOI: 10.1111/dme.14580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/29/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022]
Abstract
AIMS The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. METHODS Population-based cross-sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed-effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. RESULTS Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c , use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners' use of a structured form and a diabetes nurse were negatively associated with specialist care. CONCLUSIONS Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow-up in primary care.
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Affiliation(s)
- Kristina B Slåtsve
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Bodø, Norway
| | - Knut T Lappegård
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marthe Larsen
- Clinical Research Department, University Hospital of North Norway, Tromsø, Norway
| | - Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
- Department of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Tore J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Nøkleby K, Berg TJ, Mdala I, Tran AT, Bakke Å, Gjelsvik B, Claudi T, Cooper JG, Løvaas KF, Thue G, Sandberg S, Jenum AK. Variation between general practitioners in type 2 diabetes processes of care. Prim Care Diabetes 2021; 15:495-501. [PMID: 33349599 DOI: 10.1016/j.pcd.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 08/20/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022]
Abstract
AIMS To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. METHODS Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. RESULTS We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37-4.92). GPs' age >60 years and heavier workload were associated with poorer performance. CONCLUSION We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.
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Affiliation(s)
- Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Tore Julsrud Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anh Thi Tran
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Åsne Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Gjelsvik
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tor Claudi
- Nordland Hospital, Department of Medicine, Bodø, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway; Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Geir Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sverre Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Iversen MM, Igland J, Smith-Strøm H, Østbye T, Tell GS, Skeie S, Cooper JG, Peyrot M, Graue M. Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo). BMC Endocr Disord 2020; 20:157. [PMID: 33087074 PMCID: PMC7580005 DOI: 10.1186/s12902-020-00637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer-Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants' health, well-being and quality of life. TRIAL REGISTRATION Clinicaltrials.gov , NCT01710774 . Registered October 19th, 2012.
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Affiliation(s)
- Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway.
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hilde Smith-Strøm
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Mark Peyrot
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
| | - Marit Graue
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
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Xiao N, Cooper JG, Godbe JM, Bechel MA, Scott MB, Nguyen E, McCarthy DM, Abboud S, Allen BD, Parekh ND. Chest radiograph at admission predicts early intubation among inpatient COVID-19 patients. Eur Radiol 2020; 31:2825-2832. [PMID: 33051736 PMCID: PMC7553374 DOI: 10.1007/s00330-020-07354-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/14/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023]
Abstract
Objective The 2019 Coronavirus (COVID-19) results in a wide range of clinical severity and there remains a need for prognostic tools which identify patients at risk of rapid deterioration and who require critical care. Chest radiography (CXR) is routinely obtained at admission of COVID-19 patients. However, little is known regarding correlates between CXR severity and time to intubation. We hypothesize that the degree of opacification on CXR at time of admission independently predicts need and time to intubation. Methods In this retrospective cohort study, we reviewed COVID-19 patients who were admitted to an urban medical center during March 2020 that had a CXR performed on the day of admission. CXRs were divided into 12 lung zones and were assessed by two blinded thoracic radiologists. A COVID-19 opacification rating score (CORS) was generated by assigning one point for each lung zone in which an opacity was observed. Underlying comorbidities were abstracted and assessed for association. Results One hundred forty patients were included in this study and 47 (34%) patients required intubation during the admission. Patients with CORS ≥ 6 demonstrated significantly higher rates of early intubation within 48 h of admission and during the hospital stay (ORs 24 h, 19.8, p < 0.001; 48 h, 28.1, p < 0.001; intubation during hospital stay, 6.1, p < 0.0001). There was no significant correlation between CORS ≥ 6 and age, sex, BMI, or any underlying cardiac or pulmonary comorbidities. Conclusions CORS ≥ 6 at the time of admission predicts need for intubation, with significant increases in intubation at 24 and 48 h, independent of comorbidities. Key Points • Chest radiography at the time of admission independently predicts time to intubation within 48 h and during the hospital stay in COVID-19 patients. • More opacities on chest radiography are associated with several fold increases in early mechanical ventilation among COVID-19 patients. • Chest radiography is useful in identifying COVID-19 patients whom may rapidly deteriorate and help inform clinical management as well as hospital bed and ventilation allocation. Electronic supplementary material The online version of this article (10.1007/s00330-020-07354-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Xiao
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. .,Division of Vascular and Interventional, Department of Radiology, 676 N. St. Clair, Suite 800, Chicago, IL, USA.
| | - John G Cooper
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Jacqueline M Godbe
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Meagan A Bechel
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Michael B Scott
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Edward Nguyen
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | | | - Samir Abboud
- Department of Radiology, Division of Emergency Radiology, Northwestern University, Chicago, IL, USA
| | - Bradley D Allen
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nishant D Parekh
- Department of Radiology, Division of Chest and Cardiovascular Imaging, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
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10
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Slåtsve KB, Claudi T, Lappegård KT, Jenum AK, Larsen M, Cooper JG, Sandberg S, Julsrud Berg T. The total prevalence of diagnosed diabetes and the quality of diabetes care for the adult population in Salten, Norway. Scand J Public Health 2020; 50:161-171. [PMID: 32854596 PMCID: PMC8873303 DOI: 10.1177/1403494820951004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the total prevalence of types 1 and 2 diabetes and to describe and compare cardiovascular risk factors, vascular complications and the quality of diabetes care in adults with types 1 and 2 diabetes in Salten, Norway. Research design and methods: Cross-sectional study including all patients with diagnosed diabetes in primary and specialist care in Salten, 2014 (population 80,338). Differences in cardiovascular risk factors, prevalence of vascular complications and attained treatment targets between diabetes types were assessed using regression analyses. Results: We identified 3091 cases of diabetes, giving a total prevalence in all age groups of 3.8%, 3.4% and 0.45% for types 2 and 1 diabetes, respectively. In the age group 30–89 years the prevalence of type 2 diabetes was 5.3%. Among 3027 adults aged 18 years and older with diabetes, 2713 (89.6%) had type 2 and 304 (10.0%) type 1 diabetes. The treatment target for haemoglobin A1c (⩽7.0%/53 mmol/mol) was reached in 61.1% and 22.5% of types 2 and 1 diabetes patients, respectively. After adjusting for age, sex and diabetes duration we found differences between patients with types 2 and 1 diabetes in mean haemoglobin A1c (7.1% vs. 7.5%, P<0.001), blood pressure (136/78 mmHg vs. 131/74 mmHg, P<0.001) and prevalence of coronary heart disease (23.1% vs. 15.8%, P<0.001). Conclusions: The prevalence of diagnosed type 2 diabetes was slightly lower than anticipated. Glycaemic control was not satisfactory in the majority of patients with type 1 diabetes. Coronary heart disease was more prevalent in patients with type 2 diabetes.
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Affiliation(s)
- Kristina B. Slåtsve
- Department of Medicine, Nordland Hospital, Norway
- Kristina B. Slåtsve, Department of Medicine, Nordland Hospital, Prinsens gate 164, 8005 Bodø, Norway.
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordland Hospital, Norway
- Department of Clinical Medicine, The Arctic University of Norway, Norway
| | - Anne K. Jenum
- General Practice Research Unit (AFE), University of Oslo, Norway
| | - Marthe Larsen
- Clinical Research Department, University Hospital of North Norway, Norway
| | - John G. Cooper
- Department of Medicine, Stavanger University Hospital, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Norway
- Department of Clinical Biochemistry, Haukeland University Hospital, Norway
| | - Tore Julsrud Berg
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
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11
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Cooper JG, Bakke Å, Dalen I, Carlsen S, Skeie S, Løvaas KF, Sandberg S, Thue G. Factors associated with glycaemic control in adults with Type 1 diabetes: a registry-based analysis including 7601 individuals from 34 centres in Norway. Diabet Med 2020; 37:828-837. [PMID: 31469928 DOI: 10.1111/dme.14123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 08/28/2019] [Indexed: 01/22/2023]
Abstract
AIMS To use data from the Norwegian Diabetes Registry for Adults and Statistics Norway to assess factors associated with glycaemic control in type 1 diabetes. METHODS The analyses included all individuals aged ≥18 years who had a type 1 diabetes duration of >2 years and a recorded value in the registry between 2013 and 2015 (n=7601). Predicted mean HbA1c levels for subgroups of participants were assessed using linear regression analysis. RESULTS Young age (18-25 years), low education levels, smoking, living alone, exercising infrequently, monitoring glucose infrequently, high insulin requirements, low frequency of symptomatic hypoglycaemia, history of ketoacidosis and a BMI <18.5 kg/m2 were associated with a 2-12-mmol/mol (0.2-1.1%) higher HbA1c level. Those with 10-15 years of diabetes duration had 5-mmol/mol (0.5%) higher HbA1c level than those who had a diabetes duration of 2-5 years. Sex, participation (ever) in a diabetes education course, or ever experiencing serious hypoglycaemia were not associated with glycaemic control. CONCLUSIONS We present representative national data on factors that were associated with glycaemic control. A better understanding and awareness of these factors, together with technological advances in diabetes management, could lead to more personalized management strategies, better glycaemic control and a lower risk of diabetes complications.
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Affiliation(s)
- J G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Å Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - I Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - S Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - S Skeie
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - K F Løvaas
- Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - S Sandberg
- Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- The Norwegian Porphyria Centre (NAPOS) Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - G Thue
- Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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12
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Tollånes MC, Jenum AK, Berg TJ, Løvaas KF, Cooper JG, Sandberg S. Availability and analytical quality of hemoglobin A1c point-of-care testing in general practitioners’ offices are associated with better glycemic control in type 2 diabetes. ACTA ACUST UNITED AC 2020; 58:1349-1356. [DOI: 10.1515/cclm-2020-0026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Background
It is not clear if point-of-care (POC) testing for hemoglobin A1c (HbA1c) is associated with glycemic control in type 2 diabetes.
Methods
In this cross-sectional study, we linked general practitioner (GP) data on 22,778 Norwegian type 2 diabetes patients to data from the Norwegian Organization for Quality Improvement of Laboratory Examinations. We used general and generalized linear mixed models to investigate if GP offices’ availability (yes/no) and analytical quality of HbA1c POC testing (average yearly “trueness score”, 0–4), as well as frequency of participation in HbA1c external quality assurance (EQA) surveys, were associated with patients’ HbA1c levels during 2014–2017.
Results
Twenty-eight out of 393 GP offices (7%) did not perform HbA1c POC testing. After adjusting for confounders, their patients had on average 0.15% higher HbA1c levels (95% confidence interval (0.04–0.27) (1.7 mmol/mol [0.5–2.9]). GP offices participating in one or two yearly HbA1c EQA surveys, rather than the maximum of four, had patients with on average 0.17% higher HbA1c levels (0.06, 0.28) (1.8 mmol/mol [0.6, 3.1]). For each unit increase in the GP offices’ HbA1c POC analytical trueness score, the patients’ HbA1c levels were lower by 0.04% HbA1c (−0.09, −0.001) (−0.5 mmol/mol [−1.0, −0.01]).
Conclusions
Novel use of validated patient data in combination with laboratory EQA data showed that patients consulting GPs in offices that perform HbA1c POC testing, participate in HbA1c EQA surveys, and maintain good analytical quality have lower HbA1c levels. Accurate HbA1c POC results, available during consultations, may improve diabetes care.
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Affiliation(s)
- Mette C. Tollånes
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
| | - Anne K. Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Tore Julsrud Berg
- Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - Karianne F. Løvaas
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
| | - John G. Cooper
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Medicine , Stavanger University Hospital , Stavanger , Norway
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus) , Haraldsplass Deaconess Hospital , Bergen , Norway
- Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
- Department of Medical Biochemistry and Pharmacology , Haukeland University Hospital , Bergen , Norway
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Sharma S, Ifergan I, Kurz JE, Linsenmeier RA, Xu D, Cooper JG, Miller SD, Kessler JA. Intravenous Immunomodulatory Nanoparticle Treatment for Traumatic Brain Injury. Ann Neurol 2020; 87:442-455. [PMID: 31925846 PMCID: PMC7296512 DOI: 10.1002/ana.25675] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Received: 06/10/2019] [Revised: 12/29/2019] [Accepted: 01/05/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There are currently no definitive disease-modifying therapies for traumatic brain injury (TBI). In this study, we present a strong therapeutic candidate for TBI, immunomodulatory nanoparticles (IMPs), which ablate a specific subset of hematogenous monocytes (hMos). We hypothesized that prevention of infiltration of these cells into brain acutely after TBI would attenuate secondary damage and preserve anatomic and neurologic function. METHODS IMPs, composed of US Food and Drug Administration-approved 500nm carboxylated-poly(lactic-co-glycolic) acid, were infused intravenously into wild-type C57BL/6 mice following 2 different models of experimental TBI, controlled cortical impact (CCI), and closed head injury (CHI). RESULTS IMP administration resulted in remarkable preservation of both tissue and neurological function in both CCI and CHI TBI models in mice. After acute treatment, there was a reduction in the number of immune cells infiltrating into the brain, mitigation of the inflammatory status of the infiltrating cells, improved electrophysiologic visual function, improved long-term motor behavior, reduced edema formation as assessed by magnetic resonance imaging, and reduced lesion volumes on anatomic examination. INTERPRETATION Our findings suggest that IMPs are a clinically translatable acute intervention for TBI with a well-defined mechanism of action and beneficial anatomic and physiologic preservation and recovery. Ann Neurol 2020;87:442-455.
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Affiliation(s)
- Sripadh Sharma
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago
| | - Igal Ifergan
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago
| | - Jonathan E Kurz
- Davee Pediatric Neurocritical Care Program, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago
| | - Robert A Linsenmeier
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Neurobiology, Northwestern University, Evanston, IL
| | - Dan Xu
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago
| | - John G Cooper
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago
| | - Stephen D Miller
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago
| | - John A Kessler
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago
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14
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Cooper JG, Sicard D, Sharma S, Van Gulden S, McGuire TL, Cajiao MP, Tschumperlin DJ, Kessler JA. Spinal Cord Injury Results in Chronic Mechanical Stiffening. J Neurotrauma 2020; 37:494-506. [PMID: 31516087 PMCID: PMC6978780 DOI: 10.1089/neu.2019.6540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gliosis and fibrosis after spinal cord injury (SCI) lead to formation of a scar that is thought to present both molecular and mechanical barriers to neuronal regeneration. The scar consists of a meshwork of reactive glia and deposited, cross-linked, extracellular matrix (ECM) that has long been assumed to present a mechanically "stiff" blockade. However, remarkably little quantitative information is available about the rheological properties of chronically injured spinal tissue. In this study we utilize atomic force microscopy microindentation to provide quantitative evidence of chronic mechanical stiffening after SCI. Using the results of this tissue characterization, we assessed the sensitivity of both mouse and human astrocytes in vitro and determined that they are exquisitely mechanosensitive within the relevant range of substrate stiffness observed in the injured/uninjured spinal cord. We then utilized a novel immune modifying nanoparticle (IMP) treatment as a tool to reveal fibrotic scarring as one of the key drivers of mechanical stiffening after SCI in vivo. We also demonstrate that glial scar-forming astrocytes form a highly aligned, anisotropic network of glial fibers after SCI, and that IMP treatment mitigates this pathological alignment. Taken together, our results identify chronic mechanical stiffening as a critically important aspect of the complex lesion milieu after SCI that must be considered when assessing and developing potential clinical interventions for SCI.
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Affiliation(s)
- John G. Cooper
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Delphine Sicard
- Department of Physiology and Biomedical Engineering, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Sripadh Sharma
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie Van Gulden
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tammy L. McGuire
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Miguel Pareja Cajiao
- Department of Anesthesiology, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Daniel J. Tschumperlin
- Department of Physiology and Biomedical Engineering, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - John A. Kessler
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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15
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Bakke Å, Tran AT, Dalen I, Cooper JG, Løvaas KF, Jenum AK, Berg TJ, Madsen TV, Nøkleby K, Gjelsvik B, Claudi T, Skeie S, Carlsen S, Sandberg S, Thue G. Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway. Diabet Med 2019; 36:1431-1443. [PMID: 30343522 DOI: 10.1111/dme.13842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/18/2018] [Indexed: 12/30/2022]
Abstract
AIMS To assess population, general practitioner (GP) and practice characteristics associated with the performance of microvascular screening procedures and to propose strategies to improve Type 2 diabetes care. METHODS A cross-sectional survey in Norway (281 GPs from 77 practices) identified 8246 people with a Type 2 diabetes duration of 1 year or more. We used multilevel regression models with either the recording of at least two of three recommended screening procedures (albuminuria, monofilament, eye examination) or each procedure separately as dependent variable (yes/no), and characteristics related to the person with diabetes, GP or practice as independent variables. RESULTS The performance of recommended screening procedures was recorded in the following percentages: albuminuria 31.5%, monofilament 27.5% and eye examination 60.0%. There was substantial heterogeneity between practices, and between GPs within practices for all procedures. Compared with people aged 60-69 years, those aged < 50 years were less likely to have an albuminuria test performed [odds ratio (OR) 0.75, 95% CI 0.61 to 0.93] and eye examination (OR 0.79, 95% CI 0.66 to 0.95). People with macrovascular disease had fewer screening procedures recorded (OR 0.68, 95% CI 0.59 to 0.78). Use of an electronic diabetes form was associated with improved screening (OR 2.65, 95% CI 1.86 to 3.78). GPs with high workload recorded fewer procedures (OR 0.59, 95% CI 0.39 to 0.90). CONCLUSIONS Performance of screening procedures was suboptimal overall, and in people who should be prioritized. Performance varied substantially between GPs and practices. The use of a structured diabetes form should be mandatory.
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Affiliation(s)
- Å Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - A T Tran
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo
| | - I Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger
| | - J G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
| | - K F Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
| | - A K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo
| | - T J Berg
- Institute of Clinical Medicine, University of Oslo, Oslo
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo
| | - T V Madsen
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
| | - K Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo
| | - B Gjelsvik
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo
| | - T Claudi
- Nordland Hospital, Department of Medicine, Bodø
| | - S Skeie
- Department of Medicine, Stavanger University Hospital, Stavanger
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
| | - S Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - G Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen
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16
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Tran AT, Bakke Å, Berg TJ, Gjelsvik B, Mdala I, Nøkleby K, Shakil Rai A, Cooper JG, Claudi T, Løvaas K, Thue G, Sandberg S, Jenum AK. Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014. Scand J Prim Health Care 2018; 36:170-179. [PMID: 29717939 PMCID: PMC6066292 DOI: 10.1080/02813432.2018.1459238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM). DESIGN Cross-sectional survey. SETTING AND SUBJECTS The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified. MAIN OUTCOME MEASURES Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics. RESULT Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p < 0.01), a larger proportion of their patients achieved good glycaemic control (HbA1c = 6.0%-7.0%) (49.1% vs. 44.4%, p = 0.018) and lower mean systolic blood pressure (133.0 mmHg vs. 134.7 mmHg, p < 0.01) compared with non-specialists. GPs who graduated in Western Europe achieved lower diastolic blood pressure than their counterparts (76.6 mmHg vs. 77.8 mmHg, p < 0.01). CONCLUSION Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice. Key Points Research on associations between General Practitioners (GPs) characteristics and quality of care for patients with type 2 diabetes is limited. Specialists in General Practice performed recommended procedures more frequently, achieved better HbA1c and blood pressure levels than non-specialists. GPs who graduated in Western Europe performed screening procedures more frequently and achieved lower diastolic blood pressure compared with their counterparts. There were few significant differences in the quality of care between GP groups according to their gender and country of birth.
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Affiliation(s)
- Anh Thi Tran
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- CONTACT Anh Thi TranDepartment of General Practice, Institute of Health and Society, University of Oslo, Pb 1130 Blindern, 0317Oslo, Norway
| | - Åsne Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Tore J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway;
- Department of Endocrinology, Morbid Obestiy and Preventive Medicine, Oslo University Hospital, Oslo, Norway;
| | - Bjørn Gjelsvik
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Anam Shakil Rai
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway;
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Tor Claudi
- Department of Endocrinology, Nordlandssykehuset, Bodø, Norway;
| | - Karianne Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Geir Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Sverre Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Anne K Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
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Cooper JG, Jeong SJ, McGuire TL, Sharma S, Wang W, Bhattacharyya S, Varga J, Kessler JA. Fibronectin EDA forms the chronic fibrotic scar after contusive spinal cord injury. Neurobiol Dis 2018; 116:60-68. [PMID: 29705186 DOI: 10.1016/j.nbd.2018.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/19/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 11/27/2022] Open
Abstract
Gliosis and fibrosis after spinal cord injury (SCI) lead to formation of a scar that is an impediment to axonal regeneration. Fibrotic scarring is characterized by the accumulation of fibronectin, collagen, and fibroblasts at the lesion site. The mechanisms regulating fibrotic scarring after SCI and its effects on axonal elongation and functional recovery are not well understood. In this study, we examined the effects of eliminating an isoform of fibronectin containing the Extra Domain A domain (FnEDA) on both fibrosis and on functional recovery after contusion SCI using male and female FnEDA-null mice. Eliminating FnEDA did not reduce the acute fibrotic response but markedly diminished chronic fibrotic scarring after SCI. Glial scarring was unchanged after SCI in FnEDA-null mice. We found that FnEDA was important for the long-term stability of the assembled fibronectin matrix during both the subacute and chronic phases of SCI. Motor functional recovery was significantly improved, and there were increased numbers of axons in the lesion site compared to wildtype mice, suggesting that the chronic fibrotic response is detrimental to recovery. Our data provide insight into the mechanisms of fibrosis after SCI and suggest that disruption of fibronectin matrix stability by targeting FnEDA represents a potential therapeutic strategy for promoting recovery after SCI.
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Affiliation(s)
- John G Cooper
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Su Ji Jeong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Tammy L McGuire
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sripadh Sharma
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Wenxia Wang
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Swati Bhattacharyya
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - John Varga
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - John A Kessler
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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18
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Smith-Strøm H, Igland J, Østbye T, Tell GS, Hausken MF, Graue M, Skeie S, Cooper JG, Iversen MM. The Effect of Telemedicine Follow-up Care on Diabetes-Related Foot Ulcers: A Cluster-Randomized Controlled Noninferiority Trial. Diabetes Care 2018; 41:96-103. [PMID: 29187423 DOI: 10.2337/dc17-1025] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/10/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether telemedicine (TM) follow-up of patients with diabetes-related foot ulcers (DFUs) in primary health care in collaboration with specialist health care was noninferior to standard outpatient care (SOC) for ulcer healing time. Further, we sought to evaluate whether the proportion of amputations, deaths, number of consultations per month, and patient satisfaction differed between the two groups. RESEARCH DESIGN AND METHODS Patients with DFUs were recruited from three clinical sites in western Norway (2012-2016). The cluster-randomized controlled noninferiority trial included 182 adults (94/88 in the TM/SOC groups) in 42 municipalities/districts. The intervention group received TM follow-up care in the community; the control group received SOC. The primary end point was healing time. Secondary end points were amputation, death, number of consultations per month, and patient satisfaction. RESULTS Using mixed-effects regression analysis, we found that TM was noninferior to SOC regarding healing time (mean difference -0.43 months, 95% CI -1.50, 0.65). When competing risk from death and amputation were taken into account, there was no significant difference in healing time between the groups (subhazard ratio 1.16, 95% CI 0.85, 1.59). The TM group had a significantly lower proportion of amputations (mean difference -8.3%, 95% CI -16.3%, -0.5%), and there were no significant differences in the proportion of deaths, number of consultations, or patient satisfaction between groups, although the direction of the effect estimates for these clinical outcomes favored the TM group. CONCLUSIONS The results suggest that use of TM technology can be a relevant alternative and supplement to usual care, at least for patients with more superficial ulcers.
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Affiliation(s)
- Hilde Smith-Strøm
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Duke Global Health Institute, Duke University, Durham, NC
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marie F Hausken
- Section of Endocrinology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Marit Graue
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Section of Endocrinology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Marjolein M Iversen
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Section of Endocrinology, Department of Medicine, Stavanger University Hospital, Stavanger, Norway
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Jeong SJ, Cooper JG, Ifergan I, McGuire TL, Xu D, Hunter Z, Sharma S, McCarthy D, Miller SD, Kessler JA. Intravenous immune-modifying nanoparticles as a therapy for spinal cord injury in mice. Neurobiol Dis 2017; 108:73-82. [PMID: 28823935 DOI: 10.1016/j.nbd.2017.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 04/21/2017] [Revised: 07/17/2017] [Accepted: 08/16/2017] [Indexed: 01/16/2023] Open
Abstract
Intravenously infused synthetic 500nm nanoparticles composed of poly(lactide-co-glycolide) are taken up by blood-borne inflammatory monocytes via a macrophage scavenger receptor (macrophage receptor with collagenous structure), and the monocytes no longer traffic to sites of inflammation. Intravenous administration of the nanoparticles after experimental spinal cord injury in mice safely and selectively limited infiltration of hematogenous monocytes into the injury site. The nanoparticles did not bind to resident microglia, and did not change the number of microglia in the injured spinal cord. Nanoparticle administration reduced M1 macrophage polarization and microglia activation, reduced levels of inflammatory cytokines, and markedly reduced fibrotic scar formation without altering glial scarring. These findings thus implicate early-infiltrating hematogenous monocytes as highly selective contributors to fibrosis that do not play an indispensable role in gliosis after SCI. Further, the nanoparticle treatment reduced accumulation of chondroitin sulfate proteoglycans, increased axon density inside and caudal to the lesion site, and significantly improved functional recovery after both moderate and severe injuries to the spinal cord. These data provide further evidence that hematogenous monocytes contribute to inflammatory damage and fibrotic scar formation after spinal cord injury in mice. Further, since the nanoparticles are simple to administer intravenously, immunologically inert, stable at room temperature, composed of an FDA-approved material, and have no known toxicity, these findings suggest that the nanoparticles potentially offer a practical treatment for human spinal cord injury.
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Affiliation(s)
- Su Ji Jeong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - John G Cooper
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Igal Ifergan
- Department of Microbiology-Immunology and the Interdepartmental Immunobiology Center, Northwestern University Medical School, Chicago, IL 60611, USA
| | - Tammy L McGuire
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Dan Xu
- Department of Microbiology-Immunology and the Interdepartmental Immunobiology Center, Northwestern University Medical School, Chicago, IL 60611, USA
| | - Zoe Hunter
- Department of Microbiology-Immunology and the Interdepartmental Immunobiology Center, Northwestern University Medical School, Chicago, IL 60611, USA
| | - Sripadh Sharma
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Derrick McCarthy
- Department of Microbiology-Immunology and the Interdepartmental Immunobiology Center, Northwestern University Medical School, Chicago, IL 60611, USA
| | - Stephen D Miller
- Department of Microbiology-Immunology and the Interdepartmental Immunobiology Center, Northwestern University Medical School, Chicago, IL 60611, USA.
| | - John A Kessler
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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20
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Carlsen S, Skrivarhaug T, Thue G, Cooper JG, Gøransson L, Løvaas K, Sandberg S. Glycemic control and complications in patients with type 1 diabetes - a registry-based longitudinal study of adolescents and young adults. Pediatr Diabetes 2017; 18:188-195. [PMID: 26875589 DOI: 10.1111/pedi.12372] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 08/06/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The main aims of this study were to assess longitudinal glycemic control and the prevalence of retinopathy and nephropathy in young people (aged 14-30 yr) with type 1 diabetes in Norway. METHOD Data on 874 patients were obtained by linking two nationwide, population-based medical quality registries: The Norwegian Diabetes Register for Adults and The Norwegian Childhood Diabetes Registry. RESULTS Median age was 23 yr, median diabetes duration 9 yr and 51% were male. Median HbA1c increased through adolescence to peak at ages of 17 yr for females and 19 yr for males, females had higher HbA1c than males: 9.3% (78 mmol/mol) vs. 9.1% (76 mmol/mol). Subsequently, median HbA1c declined but was still >8% (>64 mmol/mol) for patients approaching 30 yr. Half of the patients aged 14-17 yr and 40% of patients aged 18-25 yr had HbA1c >9% (75 mmol/mol). Retinopathy was found in 16% and nephropathy in 13% of the population. Patients transferring from the pediatric department to adult care between the ages of 14 and 17 yr had higher median HbA1c and prevalence of late complications than those transferring at ages 18-22 yr. Less than 40% of patients with albuminuria were treated with ACE inhibitors or angiotensin II receptor blocker. CONCLUSION Our results demonstrate that treatment of adolescents and young adults with type 1 diabetes in Norway is not optimal, especially for patients in their late teens. We suggest that pediatricians and endocrinologists should critically assess the care offered to this group and consider new approaches to help them improve glycemic control.
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Affiliation(s)
- Siri Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Torild Skrivarhaug
- Department of Paediatrics, Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Thue
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway.,Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Lasse Gøransson
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karianne Løvaas
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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Gjelberg HK, Hoem D, Verbeke CS, Eide J, Cooper JG, Molven A. Hypoglycemia and decreased insulin requirement caused by malignant insulinoma in a type 1 diabetic patient: when the hoof beats are from a zebra, not a horse. Clin Case Rep 2017; 5:761-768. [PMID: 28588806 PMCID: PMC5457997 DOI: 10.1002/ccr3.927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/05/2017] [Indexed: 12/30/2022] Open
Abstract
Insulinomas are uncommon tumors, and in patients with diabetes mellitus they are extremely rare. We describe a patient with type 1 diabetes who developed malignant insulinoma. When hypoglycemic episodes persist in a patient with diabetes and treatment‐induced and other causes of hypoglycemia have been ruled out, an insulin‐producing tumor should be considered.
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Affiliation(s)
- Hilde K Gjelberg
- Department of Pathology Haukeland University Hospital Bergen Norway
| | - Dag Hoem
- Department of Gastrointestinal Surgery Haukeland University Hospital Bergen Norway
| | - Caroline S Verbeke
- Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Pathology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Johan Eide
- Department of Pathology Haukeland University Hospital Bergen Norway
| | - John G Cooper
- Department of Medicine Stavanger University Hospital Stavanger Norway
| | - Anders Molven
- Department of Pathology Haukeland University Hospital Bergen Norway.,Gade Laboratory for Pathology Department of Clinical Medicine University of Bergen Bergen Norway.,KG Jebsen Center for Diabetes Research Faculty of Medicine and Dentistry University of Bergen Bergen Norway
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22
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Bakke Å, Cooper JG, Thue G, Skeie S, Carlsen S, Dalen I, Løvaas KF, Madsen TV, Oord ER, Berg TJ, Claudi T, Tran AT, Gjelsvik B, Jenum AK, Sandberg S. Type 2 diabetes in general practice in Norway 2005-2014: moderate improvements in risk factor control but still major gaps in complication screening. BMJ Open Diabetes Res Care 2017; 5:e000459. [PMID: 29177051 PMCID: PMC5687527 DOI: 10.1136/bmjdrc-2017-000459] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/29/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the status of type 2 diabetes care in general practice and changes in the quality of care between 2005 and 2014, and to identify areas of diabetes care requiring improvement. RESEARCH DESIGN AND METHODS Two cross-sectional surveys were performed that included patients with type 2 diabetes in selected areas (n=9464 in 2014, n=5463 in 2005). Quality of care was assessed based on key recommendations in national guidelines. Differences in clinical performance between 2005 and 2014 were assessed in regression models adjusting for age, sex, counties and clustering within general practices. RESULTS Treatment targets were achieved in a higher proportion of patients in 2014 compared with 2005: hemoglobin A1c ≤7.0% (≤53 mmol/mol) in 62.8% vs 54.3%, blood pressure ≤135/80 mm Hg in 44.9% vs 36.6%, and total cholesterol ≤4.5 mmol/L in 49.9% vs 33.5% (all adjusted P≤0.001). Regarding screening procedures for microvascular complications, fewer patients had recorded an eye examination (61.0% vs 71.5%, adjusted P<0.001), whereas more patients underwent monofilament test (25.9% vs 18.7%, adjusted P<0.001). Testing for albuminuria remained low (30.3%) in 2014. A still high percentage were current smokers (22.7%). CONCLUSIONS We found moderate improvements in risk factor control for patients with type 2 diabetes in general practice during the last decade, which are similar to improvements reported in other countries. We report major gaps in the performance of recommended screening procedures to detect microvascular complications. The proportion of daily smokers remains high. We suggest incentives to promote further improvements in diabetes care in Norway.
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Affiliation(s)
- Åsne Bakke
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - John G Cooper
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Geir Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Siri Carlsen
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Karianne Fjeld Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone Vonheim Madsen
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Ellen Renate Oord
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Tore Julsrud Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Bodø, Norway
| | - Anh Thi Tran
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bjørn Gjelsvik
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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Vliegenthart A, Kimmitt RA, Seymour JH, Homer NZ, Clarke JI, Eddleston M, Gray A, Wood DM, Dargan PI, Cooper JG, Antoine DJ, Webb DJ, Lewis SC, Bateman DN, Dear JW. Circulating acetaminophen metabolites are toxicokinetic biomarkers of acute liver injury. Clin Pharmacol Ther 2016; 101:531-540. [PMID: 27770431 PMCID: PMC6099202 DOI: 10.1002/cpt.541] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/15/2016] [Accepted: 10/17/2016] [Indexed: 02/07/2023]
Abstract
Acetaminophen (paracetamol-APAP) is the most common cause of drug-induced liver injury in the Western world. Reactive metabolite production by cytochrome P450 enzymes (CYP-metabolites) causes hepatotoxicity. We explored the toxicokinetics of human circulating APAP metabolites following overdose. Plasma from patients treated with acetylcysteine (NAC) for a single APAP overdose was analyzed from discovery (n = 116) and validation (n = 150) patient cohorts. In the discovery cohort, patients who developed acute liver injury (ALI) had higher CYP-metabolites than those without ALI. Receiver operator curve (ROC) analysis demonstrated that at hospital presentation CYP-metabolites were more sensitive/specific for ALI than alanine aminotransferase (ALT) activity and APAP concentration (optimal CYP-metabolite receiver operating characteristic area under the curve (ROC-AUC): 0.91 (95% confidence interval (CI) 0.83-0.98); ALT ROC-AUC: 0.67 (0.50-0.84); APAP ROC-AUC: 0.50 (0.33-0.67)). This enhanced sensitivity/specificity was replicated in the validation cohort. Circulating CYP-metabolites stratify patients by risk of liver injury prior to starting NAC. With development, APAP metabolites have potential utility in stratified trials and for refinement of clinical decision-making.
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Affiliation(s)
- Adb Vliegenthart
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - R A Kimmitt
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - J H Seymour
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - N Z Homer
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - J I Clarke
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Eddleston
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - A Gray
- Emergency Medicine Research Group, Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - P I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - J G Cooper
- Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - D J Antoine
- MRC Centre for Drug Safety Science, Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - D J Webb
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S C Lewis
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - D N Bateman
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | - J W Dear
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
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Iversen MM, Espehaug B, Hausken MF, Graue M, Østbye T, Skeie S, Cooper JG, Tell GS, Günther BE, Dale H, Smith-Strøm H, Kolltveit BCH, Kirkevold M, Rokne B. Telemedicine Versus Standard Follow-Up Care for Diabetes-Related Foot Ulcers: Protocol for a Cluster Randomized Controlled Noninferiority Trial (DiaFOTo). JMIR Res Protoc 2016; 5:e148. [PMID: 27430301 PMCID: PMC4969550 DOI: 10.2196/resprot.5646] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/13/2016] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 01/15/2023] Open
Abstract
Background This paper presents the protocol for an ongoing study to evaluate a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Diabetes-related foot ulcers represent challenges for patients and the health services. The large increase in the prevalence of diabetes, combined with the aging population, means that the absolute number of patients with diabetes-related foot ulcers is likely to continue to increase. Health care services therefore need to provide close clinical follow-up care for people with diabetes both in primary and specialist care. Information and communication technologies may enable more integrated treatment and care pathways across organizational boundaries. However, we lack knowledge about the effect of telemedicine follow-up and how such services can be optimally organized. Objective To present the design and methods of a study evaluating a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Methods The study is designed as a cluster randomized controlled trial (noninferiority trial) involving municipalities or municipality districts (clusters) belonging to one clinical site in Western Norway. The study includes patients with type 1 and type 2 diabetes presenting with a new foot ulcer at the initial visit to the clinic. Patients in the intervention group receive telemedicine follow-up care in the community. The key ingredient in the intervention is the close integration between health care levels. The intervention is facilitated by the use of an interactive wound platform consisting of a Web-based ulcer record combined with a mobile phone, enabling counseling and communication between nurses in the community and specialist health care. Patients in the control group receive standard hospital outpatient care. The primary endpoint in the trial is healing time; secondary outcomes include amputation and death, patient-reported outcome measures, and follow-up data on the recurrence of foot ulcers. In addition, qualitative substudies are being performed to provide a more comprehensive evaluation of the ongoing processes during the trial with the patients in the intervention and control groups and those health care professionals either working in primary care or in specialist care delivering the intervention. Results The project has been funded. The inclusion of patients started in September 2012. Because recruitment goals were not met in the initial period, two more clinical sites have been included to meet sample size requirements. Patient recruitment will continue until June 2016. Data collection in the qualitative substudies has been completed. Conclusions This telemedicine trial operates in a novel setting and targets patients with diabetes-related foot ulcers during a 12-month follow-up period. The trial addresses whether integrated care using telemedicine between primary and specialist health care can be an equivalent alternative to standard outpatient care. Trial Registration ClinicalTrials.gov NCT01710774; https://clinicaltrials.gov/ct2/show/NCT01710774 (Archived by WebCite at http://www.webcitation.org/6im6KfFov).
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Affiliation(s)
- Marjolein M Iversen
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
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Rodbard HW, Cariou B, Pieber TR, Endahl LA, Zacho J, Cooper JG. Treatment intensification with an insulin degludec (IDeg)/insulin aspart (IAsp) co-formulation twice daily compared with basal IDeg and prandial IAsp in type 2 diabetes: a randomized, controlled phase III trial. Diabetes Obes Metab 2016; 18:274-80. [PMID: 26592732 PMCID: PMC5066701 DOI: 10.1111/dom.12609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 01/12/2023]
Abstract
AIMS To evaluate the efficacy and safety of two insulin intensification strategies for patients with type 2 diabetes previously treated with basal insulin--insulin degludec (IDeg) and insulin aspart (IAsp)--administered as a co-formulation (IDegAsp) or as a basal-bolus regimen (IDeg and IAsp in separate injections). METHODS This 26-week, open-label, treat-to-target, phase IIIb, non-inferiority trial randomized patients (1 : 1) to IDegAsp twice daily with main meals (n = 138; IDegAsp group) or IDeg once daily and IAsp 2-4 times daily (n = 136; IDeg+IAsp group). RESULTS After 26 weeks, the mean glycated haemoglobin (HbA1c) level was 7.0% (53 mmol/mol) for the IDegAsp group and 6.8% (51 mmol/mol) for the IDeg+IAsp group (Δ%HbA1c from baseline -1.31 and -1.50%, respectively). The non-inferiority of IDegAsp versus IDeg+IAsp was not confirmed for mean change in HbA1c [estimated treatment difference (ETD) 0.18, 95% confidence interval (CI) -0.04, 0.41; p = non-significant]. No significant differences were observed in the proportion of patients achieving HbA1c <7.0% (56.5 and 59.6%, respectively). IDegAsp treatment resulted in a significantly lower total daily insulin dose, a smaller change in body weight, numerically lower rates of confirmed hypoglycaemia (self-reported plasma glucose <3.1 mmol/l; rate ratio 0.81; p = non-significant), and nocturnal confirmed hypoglycaemic episodes (rate ratio 0.80; p = non-significant) versus IDeg+IAsp. Patient-reported outcome scores for social functioning were significantly higher for IDegAsp versus IDeg+IAsp (ETD 2.2; 95% CI 0.3, 4.1; p < 0.05). CONCLUSIONS Both intensification strategies effectively improved glycaemic control. Although non-inferiority was not confirmed, there were no significant differences between the groups that could affect clinical utility.
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Affiliation(s)
- H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | - B Cariou
- Department of Endocrinology, l'Institut du Thorax, Nantes University Hospital, Nantes, France
| | - T R Pieber
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | | | - J Zacho
- Novo Nordisk A/S, Søborg, Denmark
| | - J G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
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Løvaas KF, Cooper JG, Sandberg S, Røraas T, Thue G. Feasibility of using self-reported patient data in a national diabetes register. BMC Health Serv Res 2015; 15:553. [PMID: 26666413 PMCID: PMC4678468 DOI: 10.1186/s12913-015-1226-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 12/10/2015] [Indexed: 11/12/2022] Open
Abstract
Background In order to improve recruitment of patients to the Norwegian diabetes register for adults, a questionnaire was designed to collect data directly from patients. The main aim of this study was to assess the agreement of questionnaire data with data reported to the Register from health care personnel during routine consultations. Methods Patient data were obtained by sending a questionnaire with 27 of the 41 Register variables to 3714 members of the Norwegian Diabetes Association. Questionnaire data were compared with data already in the Register. Paired t-tests, percentages of total agreement, percentages of “positive” answers and kappa coefficients (k) were used for comparing data. Results Of the 1645 replies (44.3 %), the Register already had data on 324 patients for comparison. Response rate for most variables was better from patients (ranging from 76–100 %) compared with health care professionals (33–100 %). For 17 of 25 assessable variables including diabetes duration, height, weight, HbA1c, drug treatment and several diabetes complications, agreement was substantial or better with kappa >0.60. Data on family history of premature heart disease (k–0.59), foot examination (k = 0.26), foot ulcer (k = 0.32) and arterial surgery (k = 0.24) seemed to be difficult to answer by patients, whereas data on physical activity and self-monitoring of glucose seemed to be better when reported by patients. Conclusions Patient response rate was acceptable, and data had good concordance with data from health care professionals for most variables. However, registers using patient questionnaires should compare questionnaire data with data from professionals at regular intervals.
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Affiliation(s)
- Karianne Fjeld Løvaas
- Norwegian Diabetes register for adults, Norwegian Center for Quality Improvement of Primary Care Laboratories (NOKLUS), Boks 6165, 5892, Bergen, Norway.
| | - John G Cooper
- Norwegian Diabetes register for adults, Norwegian Center for Quality Improvement of Primary Care Laboratories (NOKLUS), Boks 6165, 5892, Bergen, Norway.
| | - Sverre Sandberg
- Norwegian Diabetes register for adults, Norwegian Center for Quality Improvement of Primary Care Laboratories (NOKLUS), Boks 6165, 5892, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5018 Bergen, Norway. .,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway.
| | - Thomas Røraas
- Norwegian Diabetes register for adults, Norwegian Center for Quality Improvement of Primary Care Laboratories (NOKLUS), Boks 6165, 5892, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5018 Bergen, Norway. .,Haraldsplass Deaconess Hospital, Postboks 6165, Postterminal, 5892 Bergen, Norway.
| | - Geir Thue
- Norwegian Diabetes register for adults, Norwegian Center for Quality Improvement of Primary Care Laboratories (NOKLUS), Boks 6165, 5892, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5018 Bergen, Norway.
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McKnight JA, Wild SH, Lamb MJE, Cooper MN, Jones TW, Davis EA, Hofer S, Fritsch M, Schober E, Svensson J, Almdal T, Young R, Warner JT, Delemer B, Souchon PF, Holl RW, Karges W, Kieninger DM, Tigas S, Bargiota A, Sampanis C, Cherubini V, Gesuita R, Strele I, Pildava S, Coppell KJ, Magee G, Cooper JG, Dinneen SF, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Veeze H, Aanstoot HJ, Khalangot M, Tamborlane WV, Miller KM. Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015; 32:1036-50. [PMID: 25510978 DOI: 10.1111/dme.12676] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [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: 12/11/2014] [Indexed: 11/29/2022]
Abstract
AIMS Improving glycaemic control in people with Type 1 diabetes is known to reduce complications. Our aim was to compare glycaemic control among people with Type 1 diabetes using data gathered in regional or national registries. METHODS Data were obtained for children and/or adults with Type 1 diabetes from the following countries (or regions): Western Australia, Austria, Denmark, England, Champagne-Ardenne (France), Germany, Epirus, Thessaly and Thessaloniki (Greece), Galway (Ireland), several Italian regions, Latvia, Rotterdam (The Netherlands), Otago (New Zealand), Norway, Northern Ireland, Scotland, Sweden, Volyn (Ukraine), USA and Wales) from population or clinic-based registries. The sample size with available data varied from 355 to 173 880. Proportions with HbA1c < 58 mmol/mol (< 7.5%) and ≥ 75 mmol/mol (≥ 9.0%) were compared by age and sex. RESULTS Data were available for 324 501 people. The proportions with HbA1c 58 mmol/mol (< 7.5%) varied from 15.7% to 46.4% among 44 058 people aged < 15 years, from 8.9% to 49.5% among 50 766 people aged 15-24 years and from 20.5% to 53.6% among 229 677 people aged ≥ 25 years. Sex differences in glycaemic control were small. Proportions of people using insulin pumps varied between the 12 sources with data available. CONCLUSION These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.
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Affiliation(s)
- J A McKnight
- Metabolic Unit, Western General Hospital, Edinburgh and University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M J E Lamb
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - T W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - E A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - S Hofer
- Department of Pediatrics, Medical University of Innsbruck, Austria
- German/Austria DPV database
| | - M Fritsch
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - E Schober
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - J Svensson
- Department of Pediatrics, Copenhagen University Hospital Herlev, Denmark
| | - T Almdal
- Department of Medicine F, Copenhagen University Hospital, Hellerup, Denmark
| | - R Young
- Salford Royal Foundation NHS Trust, Salford, UK
| | - J T Warner
- Children's Hospital for Wales, Cardiff, UK
- National Pediatric Diabetes Audit and the Royal College of Paediatrics and Child Health
| | - B Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Rheims, France
| | - P F Souchon
- Department of Pediatrics, American Memorial Hospital, University Hospital of Rheims, France
- CARéDIAB Network
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
- German/Austria DPV database
| | - W Karges
- Division of Endocrinology, RWTH Aachen University, Germany
- German/Austria DPV database
| | - D M Kieninger
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Germany
- German/Austria DPV database
| | - S Tigas
- Department of Endocrinology, University of Ioannina, Greece
| | - A Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Greece
| | - C Sampanis
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - V Cherubini
- Department of Women's and Children's Health, SalesiHospital, Ancona, Italy
- RIDI Study Group
| | - R Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Italy
| | - I Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - S Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - K J Coppell
- Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - G Magee
- Daisy Hill Hospital, Newry, County Down, UK
| | - J G Cooper
- Norwegian Adult Diabetes Register, Noklus, Bergen, Norway
| | - S F Dinneen
- Galway University Hospitals, Galway, Ireland
- NUI Galway, Galway, Ireland
- Galway University Hospitals Department of Diabetes, Endocrinology and Metabolism
| | - K Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - A-M Svensson
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - S Gudbjornsdottir
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - H Veeze
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - H-J Aanstoot
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - M Khalangot
- Shupyk National Medical Academy of Postgraduate Education and Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine
- Ukrainian Diabetes Register Team
| | - W V Tamborlane
- Yale University, New Haven, CT, USA
- T1D Exchange Clinic Network
| | - K M Miller
- Jaeb Centre for Health Research, Tampa, FL, USA
- T1D Exchange Clinic Network
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Teo AIC, Cooper JG. The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department. Scott Med J 2014; 58:149-53. [PMID: 23960053 DOI: 10.1177/0036933013496951] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The emergency department of Aberdeen Royal Infirmary receives around 68,000 new adult admissions annually. All poisoning cases are admitted to a 14-bedded short-stay ward, except those admitted to intensive care or immediately discharged. This study aimed to analyse epidemiological trends and management of short-stay ward admissions for poisonings. METHOD AND RESULTS Adult (>13 years) poisoning presentations admitted to the emergency department short-stay ward of Aberdeen Royal Infirmary from 1 January-31 December 2009 were retrospectively reviewed using patient discharge summaries. During 2009, there were 1062 poisoning cases, of which repeat episodes were responsible for 15%. The mean age of presentation was 33.9 years (SD 14.4) and there was a female preponderance (62%). Almost half of poisonings were polypharmacy, alcohol was involved in 40% of cases and overdoses most commonly involved paracetamol (43%). Management involved basic observations only (66%), N-acetylcysteine (24%), naloxone (4%) and activated charcoal (1%). Liaison psychiatry reviewed 84% presentations and admitted 9% to the psychiatric unit. CONCLUSIONS The short-stay ward is important for acute management of poisonings and the data gained from this study should help to direct patient services appropriately.
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Affiliation(s)
- A I C Teo
- Emergency Department, Aberdeen Royal Infirmary, UK.
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Cooper JG, Claudi T, Thordarson HB, Løvaas KF, Carlsen S, Sandberg S, Thue G. Treatment of type 1 diabetes in the specialist health service--data from the Norwegian Diabetes Register for Adults. Tidsskr Nor Laegeforen 2014; 133:2257-62. [PMID: 24226332 DOI: 10.4045/tidsskr.13.0153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The Norwegian Diabetes Register for Adults was established in 2005. The aim of the study is to assess the quality of treatment for adult patients with type 1 diabetes in the specialist health service based on register data. MATERIAL AND METHOD We included patients ≥ 18 years with type 1 diabetes in the specialist health service for whom the register has data for the period from 1 July 2010-to 31 December 2011. The patients were asked to consent to the transfer of data to the register when they attended a routine consultation. As of 31 December 2011, 95% of the patients asked gave their consent. It is not known how large a proportion of patients were asked. RESULTS We included the last registered data for 3,697 patients (46.8% women) from 24 outpatient clinics and specialist centres. The average age was 41.8 years and the average duration of diabetes was 20.8 years. Median HbA1c, systolic blood pressure and LDL cholesterol were 8.0%, 126 mm Hg and 2.8 mmol/l respectively. 9.8% achieved all treatment targets set out in the national guidelines for diabetes. 18% had HbA1c ≤ 7.0%, while 22% had HbA1c ≥ 9%. 39% of patients on statin therapy achieved the treatment target for LDL cholesterol. 19.6% smoked on a daily basis. 14.9% had received treatment for retinopathy and 5.8% had experienced coronary heart disease. There was no record of foot examination or ophthalmoscopy being performed in 33% and 29% of patients. INTERPRETATION The preliminary register data indicate that diabetes treatment should be improved both with respect to the implementation of recommended procedures and the proportion of patients who achieve the treatment targets.
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Cooper JG, Thue G, Claudi T, Løvaas K, Carlsen S, Sandberg S. The Norwegian Diabetes Register for Adults – an overview of the first years. Nor J Epidemiol 2013. [DOI: 10.5324/nje.v23i1.1599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Norwegian Diabetes Register for Adults (NDR-A) was granted status as a consent-based National Quality Register by the Ministry of Health and Care Services and approved by the Data Inspectorate in 2005. The main aim of the register is to improve the quality of the treatment of people with diabetes in hospitals and primary care. NDR-A is the first national quality register in Norway to capture all data electronically, and it is also the first register to collect data from both primary health care and hospital/specialist services. We therefore think that experiences gained from developing and promoting the register will be of general interest. In this paper we describe the reasons for establishing the register, the register population and dataset, the electronic tools used for data capture, how recruitment is progressing, how we think the register can improve the care of patients with diabetes, and possibilities for future epidemiological research.
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Tran AT, Straand J, Dalen I, Birkeland KI, Claudi T, Cooper JG, Meyer HE, Jenum AK. Pharmacological primary and secondary cardiovascular prevention among diabetic patients in a multiethnic general practice population: still room for improvements. BMC Health Serv Res 2013; 13:182. [PMID: 23688317 PMCID: PMC3664587 DOI: 10.1186/1472-6963-13-182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnic minority groups have higher prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). We assessed general practitioners' (GPs') performance with respect to the pharmacological prevention of CVD in patients with T2DM from different ethnic backgrounds in Oslo. METHODS Of 1653 T2DM patients cared for by 49 GPs in 2005, 380 had a diagnosis of CVD. Ethnicity was categorized as Norwegian, South Asian and other. Risk factor levels, medication use, achievement of treatment targets (HbA1c ≤ 7.5%, systolic blood pressure (SBP) ≤ 140 mmHg, total cholesterol/HDL-cholesterol < 4) and therapeutic intensity (number of drugs targeting each risk factor) were recorded. Chi-square, Wald tests and multiple linear regression analyses were used. RESULTS Of the 1273 patients receiving primary prevention, 1.5% had their Hb1Ac, 4.8% SBP and 12.7% lipids levels above treatment thresholds without relevant prescriptions. Among patients on pharmacological therapy, 66% reached the HbA1c, 62% SBP and 62% lipid target. Proportions not achieving the HbA1c target were 26% in Norwegians, 38% in South Asians and 29% in others (p = 0.008). Proportions not achieving the SBP target were 42% in Norwegians, 22% in South Asians and 25% in others (p ≤ 0.001). Of those not achieving the HbA1c and SBP targets, 43% and 35% respectively, used only one agent. CONCLUSIONS Norwegian GPs comply reasonably well with guidelines for pharmacological prevention of CVD in T2DM patients across ethnic groups. However, lipid-lowering therapy was generally underused, and the achievement of treatment targets for HbA1c in ethnic minorities and for BP in Norwegians could be improved.
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Mathieu C, Hollander P, Miranda-Palma B, Cooper JG, Franek E, Bain SC, Larsen J, Rana A, Russell-Jones DL. Insulin Degludec Allows for Flexible Daily Dosing in Type 1 Diabetes, Providing Equal Glycemic Control with Less Nocturnal Hypoglycemia than Insulin Glargine Over 52 Weeks. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.07.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
In 2002 it was highlighted that sledging results in serious injuries in the paediatric population and safety recommendations were made. The aim of this study was to re-examine the number, severity and aetiology of sledging-related trauma. This was a retrospective study performed in the Paediatric Emergency Department (PED) of the Royal Aberdeen Children's Hospital (RACH) during two periods totalling 12 days, when there was continuous snow ground cover. Records of all attendances were scrutinized to identify patients with sledging injuries. The nature, mechanism and severity of injury, and subsequent management were then analysed. Of 403 PED attendances, 45 (11%) were sledging related with 16 (36%) fractures and 13 (29%) head injuries. Eight patients (18%) were admitted to hospital and three (7%) required an operation. Collision with a stationary object was the most common reason for injury (51%), followed by the adoption of a dangerous sledging position or use of a stationary jump. No patients were wearing a helmet. In conclusion, there has been little change in the epidemiology and aetiology of paediatric sledging injuries since 2002. Work is needed to inform parents of the previously recommended safety measures that could reduce the morbidity of this activity without detracting from the enjoyment.
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Affiliation(s)
- L A Regan
- Emergency Department, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK.
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Affiliation(s)
- Richard A. Bunce
- a Department of Chemistry , Oklahoma State University Stillwater , Oklahoma , USA
| | - Nicholas R. Cain
- a Department of Chemistry , Oklahoma State University Stillwater , Oklahoma , USA
| | - John G. Cooper
- a Department of Chemistry , Oklahoma State University Stillwater , Oklahoma , USA
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Tran AT, Diep LM, Cooper JG, Claudi T, Straand J, Birkeland K, Ingskog W, Jenum AK. Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo, Norway. BMC Health Serv Res 2010; 10:145. [PMID: 20507647 PMCID: PMC2887836 DOI: 10.1186/1472-6963-10-145] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 05/28/2010] [Indexed: 11/17/2022] Open
Abstract
Background In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM) patients from these ethnic minority groups compared with the care received by Norwegians. Methods In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients). 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used. Results Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA): mean age 44.9 years, Middle East/North Africa (MENA): 47.2 years, East Asians (EA): 52.0 years, others: 49.0 years) compared with Norwegians (59.7 years, p < 0.001). HbA1c, systolic blood pressure (SBP) and s-cholesterol were measured in >85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (≥79% vs. 72%, p < 0.001). After adjusting for age, gender, diabetes duration, practice and physician unit, HbA1c (geometric mean) for Norwegians was 6.9% compared to 7.3-7.5% in the minority groups (p < 0.05). The proportion with poor glycaemic control (HbA1c > 9%) was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p < 0.001. No significant ethnic differences were found in the proportions reaching the combined target: HbA1c ≤ 7.5%, SBP ≤ 140 mmHg, diastolic blood pressure (DBP) ≤ 85 mmHg and total s-cholesterol ≤5.0 mmol/L (Norwegians: 25.5%, SA: 24.9%, MENA: 26.9%, EA: 26.1%, others:17.5%). Conclusions Mean age at the time of diagnosis of T2DM was 8-15 years younger in minority groups compared with Norwegians. Recording of important processes of care measures is high in all groups. Only one in four of most patient groups achieved all four treatment targets and prescribing habits may be sub-optimal. Patients from minority groups have worse glycaemic control than Norwegians which implies that it might be necessary to improve the guidelines to meet the needs of specific ethnic groups.
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Affiliation(s)
- Anh T Tran
- Section of General Practice, Institute of Health and Community, University of Oslo, Oslo, Norway.
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Claudi T, Ingskog W, Cooper JG, Jenum AK, Hausken MF. [Quality of diabetes care in Norwegian general practice]. Tidsskr Nor Laegeforen 2008; 128:2570-2574. [PMID: 19023353] [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: 05/27/2023] Open
Abstract
BACKGROUND The prevalence of diabetes is increasing. Good diabetes care reduces macro and microvascular complications. Quality of care was assessed against predefined review criteria based on key recommendations in national guidelines MATERIAL AND METHODS A cross-sectional study from four geographical areas in Norway, with electronic identification of all patients with diabetes mellitus and extraction of data from electronic patient records. All data were manually validated. RESULTS 6892 patients with diabetes were identified, 5817 were cared for by the GPs and included in the study. 354 (6.0%) were classified as having type 1 diabetes and 5463 (94.0%) as type 2. For patients with type 1 mean Hb A1c was 7.8% and mean blood pressure 129/76 mm Hg; for type 2 the results were 7.1% and 139/79 mmHg. Among patients with type 2 diabetes and known cardiovascular disease, 69.7% were treated with statins and 60.6% with acetylsalicylic acid. About 90% of the study population had measured Hb A1c , blood pressure and lipids annually. 71% of patients with type 2 diabetes were referred to eye examination, smoking habits and weight were recorded in 57 and 54 % and urine albumin in 40% of the patients. INTERPRETATION The quality of care had improved substantially in 2005 from five and 10 years ago (when similar studies were performed), although 80 % of patients did not reach the combined treatment targets for Hb A1c , systolic blood pressure and total cholesterol.
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Affiliation(s)
- Tor Claudi
- Medisinsk avdeling, Nordlandssykehuset, 8092 Bodø.
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Carlsen SM, Lund-Johansen M, Schreiner T, Aanderud S, Johannesen O, Svartberg J, Cooper JG, Hald JK, Fougner SL, Bollerslev J. Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab 2008; 93:2984-90. [PMID: 18492760 DOI: 10.1210/jc.2008-0315] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [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] [Indexed: 02/05/2023]
Abstract
CONTEXT Surgery is the primary treatment of acromegaly. However, it often fails to cure the patient. New strategies that improve surgical outcome are needed. OBJECTIVE Our objective was to investigate whether 6-month preoperative treatment with octreotide improves the surgical outcome in newly diagnosed acromegalic patients. PATIENTS During a 5-yr period (1999-2004), all newly diagnosed acromegalic patients between 18 and 80 yr of age in Norway were screened and invited to participate in the study. A total of 62 patients was included in the Preoperative Octreotide Treatment of Acromegaly study. RESEARCH DESIGN AND METHODS After a baseline evaluation, patients were randomized directly to transsphenoidal surgery (n = 30) or pretreatment with octreotide (n = 32) 20 mg im every 28th day for 6 months before transsphenoidal surgery. Cure was evaluated 3 months postoperatively primarily by IGF-I levels. RESULTS According to the IGF-I criteria, 14 of 31 (45%) pretreated patients vs. seven of 30 (23%) patients with direct surgery were cured by surgery (P = 0.11). In patients with microadenomas (< or = 10 mm), one of five (20%) pretreated vs. three of five (60%) with direct surgery were cured (P = 0.52). In patients with macroadenomas, 13 of 26 (50%) pretreated vs. four of 25 (16%) with direct surgery were cured (P = 0.017). CONCLUSIONS Six-month preoperative octreotide treatment might improve surgical cure rate in newly diagnosed acromegalic patients with macroadenomas. These results have to be confirmed in future studies.
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Affiliation(s)
- Sven M Carlsen
- Department of Endocrinology, St. Olavs Hospital, University Hospital of Trondheim, 7006 Trondheim, Norway.
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Øyen N, Nygård O, Igland J, Tell GS, Nordrehaug JE, Irgens LM, Cooper JG, Langørgen J, Vollset SE. [Hospital admission rates for cardiovascular diseases in Western Norway, 1992-2001]. Tidsskr Nor Laegeforen 2008; 128:17-23. [PMID: 18183051] [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: 05/25/2023] Open
Abstract
BACKGROUND The Regional Register of Cardiovascular Diseases of the Regional Health Authority of Western Norway was established to enable epidemiologic research on a national level before the recent advent of the Norwegian health register with personal identification. Hospital admission rates, and case-fatality were compared with regional mortality rates for cardiovascular diseases. MATERIAL AND METHODS The register contains data on 231,857 patients with cardiovascular diseases or diabetes mellitus admitted to hospitals in Western Norway (Rogaland, Hordaland and Sogn og Fjordane) 1972-2002. The hospital data were supplemented with data from the national cause of death register (national identification number was used to link up the information). RESULTS The admission rates for cardiovascular diseases increased moderately in Western Norway from 1992 through 2001. At the same time a marked reduction was seen in mortality rates for these diseases. For acute myocardial infarction, the admission rates decreased slightly from 1992 through 2000, and then increased in 2001. Case-fatality from acute infarction was substantially reduced throughout the decade, most notably for those aged 65 years or more. Among those who died of acute infarction the first 24 hours, the fraction who died outside of hospital was high (78.3%). INTERPRETATION Hospital admission rates for cardiovascular diseases do not parallel the simultaneous decrease in mortality rates. The Regional Register of Cardiovascular Diseases demonstrates the possibilities for etiological research and the limitation of mortality statistics alone.
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Affiliation(s)
- Nina Øyen
- Institutt for samfunnsmedisinske fag, Universitetet i Bergen, Postboks 7804 5020 Bergen.
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40
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Claudi T, Cooper JG, Jenum AK. [Should follow up of patients with type 2 diabetes be performed at outpatient clinics?]. Tidsskr Nor Laegeforen 2007; 127:2125; author reply 2125. [PMID: 17717586] [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: 05/16/2023] Open
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Abstract
OBJECTIVE To determine the accuracy of references in Emergency Medicine Journal during 2003. MATERIALS AND METHODS All references cited in Emergency Medicine Journal during 2003 were examined carefully, and the accuracy of the citations was checked against reliable electronic and manual resources. References were categorised as correct or incorrect. The errors were classified as minor if the integrity of the reference was not greatly compromised and major if the error severely detracted from the quality of the reference. RESULTS Overall, errors were found in 19% of all citations checked (n = 2561), and in 8% the errors were major and markedly detracted from the quality of the reference. CONCLUSIONS Citation errors reflect badly on authors and the publishing journal and may reflect underlying flaws in other areas of the research published. It is hoped that identification of this problem will lead to attempts to improve the accuracy of reference citation in the emergency medicine literature and to an improvement in the credibility of research in our specialty.
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Affiliation(s)
- U Y Raja
- Leeds General Infirmary, Leeds, UK
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42
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Specktor P, Cooper JG, Indelman M, Sprecher E. Hyperphosphatemic familial tumoral calcinosis caused by a mutation in GALNT3 in a European kindred. J Hum Genet 2006; 51:487-490. [PMID: 16528452 DOI: 10.1007/s10038-006-0377-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 01/10/2006] [Indexed: 11/24/2022]
Abstract
Hyperphosphatemic familial tumoral calcinosis (HFTC) is an autosomal recessive metabolic disorder characterized by extensive phenotypic and genetic heterogeneity. HFTC was shown recently to result from mutations in two genes: GALNT3, coding for a glycosyltransferase responsible for initiating O-glycosylation, and FGF23, coding for a potent phosphaturic protein. All GALNT3 mutations reported so far have been identified in patients of either Middle Eastern or African-American extraction, corroborating numerous historical reports of the disorder in Africa and in the Middle East. In the present study, we describe a patient of Northern European origin displaying typical features of HFTC. Mutation analysis revealed that this patient carries a homozygous novel nonsense mutation in GALNT3 predicted to result in the synthesis of a significantly truncated protein. The present results expand the spectrum of known mutations in GALNT3 and demonstrate the existence of HFTC-causing mutations in this gene outside the Middle Eastern and African-American populations.
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Affiliation(s)
- Polina Specktor
- Department of Dermatology, Laboratory of Molecular Dermatology, Rambam Medical Center, POB 9602, 31096, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Margarita Indelman
- Department of Dermatology, Laboratory of Molecular Dermatology, Rambam Medical Center, POB 9602, 31096, Haifa, Israel
| | - Eli Sprecher
- Department of Dermatology, Laboratory of Molecular Dermatology, Rambam Medical Center, POB 9602, 31096, Haifa, Israel.
- The Rappaport Family Institute for Research in the Medical Sciences, 31096, Haifa, Israel.
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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43
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Affiliation(s)
- John G Cooper
- Department of Medicine, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway.
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Claudi T, Cooper JG, Hausken MF, Michaelsen T, Harboe K, Ingskog W, ØStrem A. [Risk intervention in persons with diabetes mellitus in general practice]. Tidsskr Nor Laegeforen 2004; 124:1508-10. [PMID: 15195153] [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: 04/29/2023] Open
Abstract
BACKGROUND Intervention against cardiovascular risk factors such as hypertension, dyslipidaemia and smoking is necessary to reduce the increased mortality associated with diabetes mellitus. METHODS The case notes of 2003 patients with diabetes in general practice in Rogaland, Salten and Aker were reviewed in order to assess the quality of diabetes care including the treatment of risk factors for cardiovascular disease. RESULTS 287 out of 1417 patients below the age of 76 had known cardiovascular disease. Of these, 57.5% were treated with a statin and 61 % were taking aspirin. 118 patients had had a myocardial infarction, 69.5% were on a statin and 60.2% were taking aspirin. 776 (38.7%) of the patients in the study had been diagnosed as suffering from hypertension, 40.3% were on therapy with one anti-hypertensive agent, 28.6% received two agents and 12.1% were on three or more anti-hypertensive agents. Only 57.5% of patients, who according to current national guidelines ought to be on a statin as secondary prevention, received such a treatment. Smoking habits were recorded in 35.1% and weight in 45 % of the patients. INTERPRETATION There is considerable room for improvement with regard to intervention against known risk factors for cardiovascular disease in patients with diabetes treated in primary care.
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45
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Affiliation(s)
- J G Cooper
- Department of Accident and Emergency, Aberdeen Royal Infirmary, Aberdeen, UK
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46
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Abstract
Kaposiform haemangioendothelioma (KHE) is a rare vascular tumour, predominantly of infancy and early childhood, that has a close association with Kasabach-Merritt syndrome. Despite benign histology, this tumour frequently behaves aggressively, causing significant morbidity and mortality as a result of the compression and invasion of surrounding structures as well as from associated haematological and lymphoproliferative syndromes. There is a need for a high index of suspicion when presented with large, enlarging or abnormal vascular lesions in infancy and, less commonly, in adulthood. An early diagnosis of KHE can lead to prompt treatment, which may be life saving. To date, there have been only four reported cases of KHE occurring in patients over the age of 18 years. We report an otherwise well 26-year-old woman who presented with a KHE of the left thigh, and briefly review the literature. We believe this to be the second reported case of KHE in the UK and the first in an adult patient.
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Affiliation(s)
- J G Cooper
- Department of Plastic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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Claudi T, Cooper JG. Comparison of urinary albumin excretion rate in overnight urine and albumin creatinine ratio in spot urine in diabetic patients in general practice. Scand J Prim Health Care 2001; 19:247-8. [PMID: 11822649 DOI: 10.1080/02813430152706774] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To evaluate whether measurement of albumin creatinine ratio (ACR) on a spot urine specimen can replace a timed overnight collection of urine albumin excretion rate (UAER) in patients with diabetes in primary care. DESIGN Patients with diabetes attending Rønvik Health Centre were asked to bring a timed overnight collection of urine for measurement of UAER. They were also asked to void a urine specimen for measurement of albumin creatinine ratio. SETTING Primary health care. SUBJECTS One-hundred-and-six persons with diabetes (47 women, 59 men) aged 13 to 78 years. RESULTS The sensitivity and specificity of ACR with cut-off values of 2.5 mg/mmol for men and 3.5 mg/mmol for women compared to UAER with cut-off value of 20 mg/24 h was 90%. CONCLUSIONS Spot urine ACR analysed on a DCA 2000 can replace a timed (overnight) collection of urine and measurement of UAER when diabetic patients are reviewed in general practice. This simplifies procedures for the patient as a timed urine collection is no longer necessary. Another advantage is that the results are available after 7 min.
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Affiliation(s)
- T Claudi
- Rønvik Health Centre, Bodø, Norway.
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48
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Liu GC, Cooper JG, Schoeffler KM, Hammond WE. Standards for the electronic health record, emerging from health care's Tower of Babel. Proc AMIA Symp 2001:388-92. [PMID: 11825216 PMCID: PMC2243285] [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: 02/23/2023] Open
Abstract
This paper considers the standardization of an Electronic Health Record (EHR). Relations between several distinct medical datasets and information systems are mapped in order to derive a more precise definition of the EHR. Two international efforts to establish standards for the EHR are presented and critiqued. Strategies for standardizing the EHR are analyzed and recommendations are provided for approaching the standardization process.
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Affiliation(s)
- G C Liu
- Division of Medical Informatics, University of North Carolina, Chapel Hill, NC, USA
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Flottorp S, Oxman AD, Cooper JG, Hjortdahl P, Sandberg S, Vorland LH. [A reply: our guidelines are useful also for Swedish throats]. Lakartidningen 2000; 97:5145-8. [PMID: 11116896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- S Flottorp
- Seksjon for helsetjenesteforskning, Statens institutt for folkehelse, Postboks 4404 Torshov, 0403 Oslo
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Flottorp S, Oxman AD, Cooper JG, Hjortdahl P, Sandberg S, Vorland LH. [Guidelines for diagnosis and treatment of sore throat]. Lakartidningen 2000; 97:4437-42, 4445-6, 4448. [PMID: 11068399] [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: 02/18/2023]
Abstract
BACKGROUND Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines. MATERIAL AND METHODS We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants. RESULTS Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt. INTERPRETATION Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision/making if they want antibiotics.
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Affiliation(s)
- S Flottorp
- Seksjon for helsetjenesteforskning Statens institutt for folkehelse, Oslo
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