scholarly journals P144: Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S126-S126
Author(s):  
J. Yan ◽  
K. Gushulak ◽  
M. Columbus ◽  
A. Hamelin ◽  
I.G. Stiell
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Blood Glucose ◽  
Tertiary Care ◽  
Clinical History ◽  
Future Research ◽  
Warning Sign ◽  
Discharge Diagnosis ◽  
Discharge Instructions ◽  
Hyperosmolar Hyperglycemic State

Introduction: Patients with poorly controlled diabetes mellitus (DM) often visit the emergency department (ED) for management of hyperglycemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Many of these patients have a “sentinel” ED visit for other medical conditions prior to their hyperglycemic visit, which may worsen their glucose control. The objective of this study was to describe the epidemiology and outcomes of patients presenting with a sentinel ED visit prior to their visit for a hyperglycemic emergency. Methods: This was a health records review of patients ≥18 years presenting to one of four tertiary care EDs (combined annual census 300,000) with a discharge diagnosis of DM, hyperglycemia, DKA or HHS in a one-year period. Visits for hypoglycemia were excluded. Trained research personnel collected data from medical records including demographics, clinical history and results of investigations. Electronic charts were reviewed to determine if the patient came to the ED within the prior 14 days of their index hyperglycemia visit, and the details and outcomes surrounding both visits. Descriptive statistics were used where appropriate to summarize the data. Results: From January-December 2014, 609 ED visits had a discharge diagnosis of hyperglycemia. Mean (SD) age was 50.4 (19.5) years, and 343 (56.3%) were male. 101/609 visitors (16.6%) had an ED presentation within the previous 14 days from their hyperglycemia visit. 71 (70.3%) of these were discharged from this initial visit and 49/71 (69.0%) were discharged either without their blood glucose checked or with an elevated blood glucose (>11.0 mmol/L). Of the sentinel visits, 58 (57.4%) were for hyperglycemia and 15 (14.9%) were for infection. Upon returning to the ED, 45/101 (44.6%) visitors were subsequently admitted for management of severe hyperglycemia, DKA or HHS. Conclusion: This unique ED-based study demonstrates that patients with DM presenting with hyperglycemia or infection often return and may ultimately require admission. Clinicians should be vigilant in checking blood glucose when these patients present to the ED and provide clear discharge instructions for follow-up and glucose management. Future research should focus on improving glycemic control in these patients in order to prevent further hyperglycemic emergencies from occurring.

scholarly journals Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 230-237 ◽  
Author(s):  
Justin W. Yan ◽  
Katherine M. Gushulak ◽  
Melanie P. Columbus ◽  
Alexandra L. Hamelin ◽  
George A. Wells ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Blood Glucose ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Warning Sign ◽  
Diabetic Patients ◽  
Discharge Instructions ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State

ABSTRACTObjectivesPatients with poorly controlled diabetes mellitus may have a sentinel emergency department (ED) visit for a precipitating condition prior to presenting for a hyperglycemic emergency, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). This study’s objective was to describe the epidemiology and outcomes of patients with a sentinel ED visit prior to their hyperglycemic emergency visit.MethodsThis was a 1-year health records review of patients≥18 years old presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, DKA, or HHS. Trained research personnel collected data on patient characteristics, management, disposition, and determined whether patients came to the ED within the 14 days prior to their hyperglycemia visit. Descriptive statistics were used to summarize the data.ResultsOf 833 visits for hyperglycemia, 142 (17.0%; 95% CI: 14.5% to 19.6%) had a sentinel ED presentation within the preceding 14 days. Mean (SD) age was 50.5 (19.0) years and 54.4% were male; 104 (73.2%) were discharged from this initial visit, and 98/104 (94.2%) were discharged either without their glucose checked or with an elevated blood glucose (>11.0 mmol/L). Of the sentinel visits, 93 (65.5%) were for hyperglycemia and 22 (15.5%) for infection. Upon returning to the ED, 61/142 (43.0%) were admitted for severe hyperglycemia, DKA, or HHS.ConclusionIn this unique ED-based study, diabetic patients with a sentinel ED visit often returned and required subsequent admission for hyperglycemia. Clinicians should be vigilant in checking blood glucose and provide clear discharge instructions for follow-up and glucose management to prevent further hyperglycemic emergencies from occurring.

scholarly journals LO28: Emergency department gastrointestinal presentations related to marijuana ingestion: a single centre retrospective study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S17
Author(s):  
J. Teefy ◽  
J. Blom ◽  
K. Woolfrey ◽  
M. Riggan ◽  
J. Yan
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clinical History ◽  
Cannabis Use ◽  
Future Research ◽  
Discharge Diagnosis ◽  
Marijuana Consumption ◽  
The Impact

Introduction: Cannabis Hyperemesis Syndrome (CHS) is a poorly understood phenomenon with a subset of patients presenting to the emergency department (ED) for symptomatic control of refractory nausea and vomiting. As legalization of marijuana commenced on October 2018, it is important to recognize the presentation of patients related to marijuana consumption. The objective of this study was to describe demographic and ED visit data of patients presenting to the ED with cannabis-related sequelae. Methods: This was a health records review of patients ≥18 years presenting to one of two tertiary care EDs (annual census 150,000 visits) with a discharge diagnosis including cannabis use with one of abdominal pain or nausea/vomiting using ICD-10 codes. Trained research personnel collected data from medical records including demographics, clinical history, results of investigations within the ED. Descriptive statistics including means and standard deviations are presented where appropriate. Results: From April 2014 to June 2016, 203 unique ED patients had a discharge diagnosis including cannabis use with abdominal pain or nausea/vomiting. Mean (SD) age was 30 (13.04) years and 120 (59.1%) were male. Patients presented to the ED independently 84 (41.4%), via EMS with 104 (51.23%) and 15 (7.39%) by police. The majority of patients were triaged as CTAS-2 in 27 (33%) and CTAS-3 in 106 (52.2%) of all cases. Of patients disclosing their method of consumption, 31 (15.3%) had used combustion methods and 30 (14.8%) had edible marijuana. Mean (SD) serum potassium was 3.71 (0.48) mmol/l. 162 (79.8%) were discharged home and 9 (4.4%) were given follow up (all psychiatric). Twenty-nine (14.3%) were admitted to hospital with 28 (13.8%) admitted to psychiatry and 1 (0.5%) admitted to medicine. Conclusion: This ED-based retrospective chart review reports a description of cannabis-related presentations to the ED. Clinicians should be aware of CHS in patients presenting to the ED, especially as Canada enters the era of legalization. Future research should focus on the impact of federal legalization of marijuana on ED utilization for CHS-related presentations.

scholarly journals P161: Emergency department visits for hyperglycemia in emerging adults with diabetes: a health records review

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S114-S114
Author(s):  
J. W. Yan ◽  
A. L. Hamelin ◽  
K. M. Gushulak ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emerging Adults ◽  
Life Stage ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Emergency Department Visits ◽  
Future Research ◽  
Health Records ◽  
Hyperosmolar Hyperglycemic State

Introduction: Patients with diabetes who are in emerging adulthood, defined as the life stage between 18-29 years, have unique challenges in managing their illness and are at risk of acute complications and loss to follow-up. The studys objective was to describe emergency department (ED) utilization for hyperglycemia in emerging adults with diabetes and to characterize 30-day outcomes including return visits and admission for hyperglycemia. Methods: This was a health records review of emerging adults presenting over a one-year period to four tertiary care EDs with a diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Research personnel collected data on patient characteristics, treatment, disposition, and determined if patients returned to the ED for hyperglycemia within 30 days. Descriptive statistics were used to summarize the data where appropriate. Results: There were 185 ED encounters for hyperglycemia, representing 116 unique emerging adult patients. Mean (SD) age was 23 (3.5) years and 50.9% were female. 80 (69.0%) had known type 1 diabetes, 11 (9.5%) had type 2, and 25 (21.5%) were newly diagnosed in the ED. Of 185 visits, 98 (53.0%) resulted in hospital admission. 56 (30.3%) returned to the ED for hyperglycemia within 30 days of their initial encounter, and 21 (11.4%) resulted in admission on this subsequent visit. Conclusion: We characterized ED utilization and 30-day outcomes of emerging adults with diabetes for hyperglycemia. Future research should focus on earlier identification of those at higher risk for recurrent ED visits or admission and the efficacy of interventions to prevent these adverse outcomes.

scholarly journals LO48: Pediatric cannabinoid hyperemesis syndrome in the emergency department: a 5-year retrospective review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S24-S24
Author(s):  
D. Foster ◽  
K. Van Aarsen ◽  
J. Yan ◽  
J. Teefy ◽  
T. Lynch
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Venous Blood ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Cannabis Use ◽  
Discharge Diagnosis ◽  
Cannabinoid Hyperemesis Syndrome

Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.

A Prospective Study of the Clinical and Demographic Profile of Type 2 Diabetes Mellitus Patients Receiving Antidiabetic Drug Combinations

2020 ◽  
Vol 16 (5) ◽  
pp. 503-508
Author(s):  
Akash Gadgade ◽  
Ashok S. Kudgi ◽  
Ashwin Kamath ◽  
Priyanka Kamath ◽  
Prabha Adhikari ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Dose Escalation ◽  
Tertiary Care ◽  
Postprandial Blood Glucose ◽  
Antidiabetic Treatment

Background: The specific treatment recommendations for type 2 diabetes mellitus (T2DM) differ based on a particular guideline. The goal of pharmacotherapy is to achieve the target HbA1c and fasting and postprandial blood glucose levels to avoid disease complications. Objective: To evaluate the profile of T2DM patients on different antidiabetic treatment regimens and the factors leading to dose escalation in these patients. Methods: A prospective descriptive study was conducted at Kasturba Medical College Hospital, Mangalore, a tertiary care teaching hospital, over a period of one year. The study population comprised of patients with T2DM for ≥5 years. The demographic and clinical data were collected during the baseline and follow-up visits. Results: Of the 119 patients studied, 59.7% were males; 32.8% were ≥65 years of age. A significant decrease in the fasting blood glucose (FBG) on follow-up was seen (p = 0.028) in patients on sulfonylurea and metformin combination. A significant decrease in the glycated haemoglobin (HbA1c) was seen in patients on sulfonylurea with metformin and pioglitazone (p = 0.011); sulfonylurea with metformin, pioglitazone, and sitagliptin (p = 0.026); and metformin with insulin (p = 0.001). Patients who received dose escalation had a longer duration of the disease (p = 0.042), higher FBG (p = 0.039) and HbA1c (p = 0.05). Conclusion: A combination of metformin with sulfonylurea was the preferred first-line treatment; insulin was added when HbA1c was >9. Patients who received dose escalation had a longer duration of the disease and higher FBG and HbA1c.

scholarly journals An Automated Tobacco Cessation Intervention for Emergency Department Discharged Patients

2021 ◽  
Vol 22 (4) ◽  
pp. 1010-1013
Author(s):  
David Chiu ◽  
Ronald Lavoie ◽  
Larry Nathanson ◽  
Leon Sanchez
Keyword(s):  
Emergency Department ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Discharge Instructions ◽  
Exact Test ◽  
Instruction System ◽  
Implementation Period

Introduction: Nearly 14% of US adults currently smoke cigarettes. Cigarette smoking causes more than 480,000 deaths each year in the United States. Emergency department (ED) patients are frequently asked for their use of tobacco. Manual selection of pre-formed discharge instructions is the norm for most ED. Providing tobacco cessation discharge instructions to ED patients presents another avenue to combat the tobacco use epidemic we face. The objective of the study is to evaluate the effectiveness of an automated discharge instruction system in increasing the frequency of discharging current tobacco users with instructions for tobacco cessation. Methods: The study was done at an urban academic tertiary care center. A before and after study was used to test the hypothesis that use of an automated discharged instruction system would increase the frequency that patients who use tobacco were discharged with tobacco cessation instructions. Patients that were admitted, left against medical advice, eloped or left without being seen were excluded. The before phase was from 09/21/14-10/21/14 and the after phase was from the same dates one year later, 09/21/15-10/21/15. This was done to account for confounding by time of year, ED volume and other factors. A Fisher’s Exact Test was calculated to compare these two groups. Results: Tobacco cessation DC instructions were received 2/486 (0.4%) of tobacco users in the pre-implementation period compared to 357/371 (96%) in the post-implementation period (p < 0.05). Conclusions: The automated discharge instructions system increases the proportion of tobacco users who receive cessation instructions. Given the public health ramifications of tobacco use, this could prove to be a significant piece in decreasing tobacco use in patients who go to the emergency department.

scholarly journals Readability of patient discharge instructions with and without the use of electronically available disease-specific templates

2015 ◽  
Vol 22 (4) ◽  
pp. 857-863 ◽  
Author(s):  
Stephanie K Mueller ◽  
Kyla Giannelli ◽  
Robert Boxer ◽  
Jeffrey L Schnipper
Keyword(s):  
Tertiary Care ◽  
Patient Discharge ◽  
Care Hospital ◽  
Discharge Diagnosis ◽  
Discharge Instructions ◽  
Flesch Reading Ease ◽  
Grade Levels ◽  
Large Tertiary Care ◽  
Specific Discharge ◽  
The Impact

Abstract Objective Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. Materials and Methods We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based “discharge module,” which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0–100 scale, with higher scores indicating greater readability) and the Flesch–Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). Results Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P &lt; .001) and lower FKGL scores (5.6 vs. 7.6, P &lt; .001), compared to clinician-generated discharge instructions. Discussion The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient’s specific discharge diagnosis. Conclusions Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.

scholarly journals A mapping study on blood glucose recommender system for patients with gestational diabetes mellitus

2019 ◽  
Vol 8 (4) ◽  
Author(s):  
Shuhada Mohd Rosli ◽  
Marshima Mohd Rosli ◽  
Rosmawati Nordin
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Recommender System ◽  
Future Research ◽  
Systematic Mapping Study ◽  
Mapping Study ◽  
Hybrid Filtering ◽  
Filtering Technique

Blood glucose (BG) prediction system can help gestational diabetes mellitus (GDM) patient to improve the BG control with managing their dietary intake based on healthy food. Many techniques have been developed to deal with blood glucose prediction, especially those for recommender system. In this study, we conduct a systematic mapping study to investigate recent research about BG prediction in recommender systems. This study describes an overview of research (2014-2018) about BG prediction techniques that has been used for BG recommender system. As results, 25 studies concerning BG prediction in recommender system were selected. We observed that although there is numerous studies published, only a few studies took serious discussion about techniques used to incorporate the BG algorithms. Our result highlighted that only one study discusses hybrid filtering technique in BG recommender system for GDM even though it has an ability to learn from experience and to improve prediction performance. We hope that this study will encourage researchers to consider not only machine learning and artificial intelligent techniques but also hybrid filtering technique for BG recommender system in the future research.

scholarly journals Opportunistic screening for random blood glucose level among adults attending a rural tertiary care centre in Haryana during world health day observation activity

2017 ◽  
Vol 4 (6) ◽  
pp. 1951 ◽  
Author(s):  
Jai Pal Majra ◽  
Ramesh Verma
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Tertiary Care ◽  
World Health ◽  
Opportunistic Screening ◽  
Care Providers ◽  
Random Blood Glucose ◽  
Study Participants

Background: Diabetes mellitus is one of the most common non-commu­nicable diseases worldwide and major global risks for morbidity and mortality. The total burden of deaths from high blood glucose in 2012 has been estimated to 3.7 million which includes 1.5 million diabetes deaths, 2.2 million deaths from cardiovascular diseases, chronic kidney disease, and tuberculosis. Various studies reported that population-based screening of blood glucose level will result in low yield but higher cost. However, opportunity screening at earlier stage had good prognosis. Hence opportunistic screening for raised random blood glucose level was planned.Methods: During observation of World Health Day 2016 activity based on theme, “Beat diabetes: Scale up prevention, strengthen care, and enhance surveillance” this present cross-sectional study was conducted. Attendants of the patients having age >30 years; visiting this institute on that day enrolled as study participants. Information gathered regarding their socio-demographic parameters and doing regular physical activity. A brief clinical examination regarding anthropometric measurements and random blood glucose was done using standard procedures by trained personnel.Results: Out of 215 opportunistic screened participants, 14 (6.51%) participants were known diabetic and having random blood glucose level <200 mg%. However among rests 201 study participants whose diabetic status was unknown, 8 (4%) participants had random blood glucose level >200 mg%. BMI status of 48 (22%) and 103 (48%) study participants were recorded as pre-obese and obese respectively.Conclusions: It was concluded that after every 7 cases of known diabetes mellitus there were 4 unknown cases identified as raised random blood glucose level. Hence in tertiary care settings, individuals more than 30 years should get priority for opportunistic screening of random blood glucose estimation. Health-care providers should be sensitized on practicing opportunistic screening in outpatient department. 

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