scholarly journals Individualizing treatment targets for elderly patients with type 2 diabetes: factors influencing clinical decision making in the 24-week, randomized INTERVAL study

Aging ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 769-777 ◽  
Author(s):  
W. David Strain ◽  
Abhijit S. Agarwal ◽  
Päivi M. Paldánius
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Elderly Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Treatment Targets ◽  
Factors Influencing

Virtual Simulation Improves Clinical Decision-Making in Managing Type 2 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 688-P ◽  
Author(s):  
AMY LARKIN ◽  
KELLY L. HANLEY ◽  
MARTIN WARTERS ◽  
GWEN S. LITTMAN
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Virtual Simulation

scholarly journals Point-of-care HbA1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045511
Author(s):  
Jennifer A Hirst ◽  
Kirsten Bobrow ◽  
Andrew Farmer ◽  
Jennie Morgan ◽  
Naomi Levitt
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Decision Making ◽  
Blood Glucose ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Glucose Testing

IntroductionMonitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa.Subjects185 adults aged 19–88 years with type 2 diabetes.Materials and methodsParticipants recruited to this mixed methods cohort study received a point-of-care HbA1c test. Doctors were asked to use the point-of-care HbA1c result for clinical decision-making. Qualitative interviews were held with clinical staff.ResultsPoint-of-care HbA1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA1c, 64 mmol/mol). Medical officers reported using a combination of HbA1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA1c result to help with decision-making.DiscussionOur results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA1c test result to help them make treatment decisions.

An overview of decision making in veterinary nursing

2019 ◽  
Vol 10 (9) ◽  
pp. 460-464
Author(s):  
Mary Fraser
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Communication Skills ◽  
Clinical Evidence ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Past Experience ◽  
Factors Influencing ◽  
Standard Operating ◽  
Work Up

Decision making takes place in all aspects of veterinary care. Throughout any consultation, work up, hospitalisation or ongoing home care, decisions need to be made about the next step to be taken. Clinical decision making is influenced by many different factors including past experience, emotions, owner wishes, financial concerns and communication skills. Within the veterinary team, it is important that everyone understands the factors influencing decisions. Decision making can follow a paternalistic, guardian or shared approach, which tends to be dominant in veterinary practice. Where practices adopt standard operating procedures, the use of clinical evidence and clear non-biased decisions need to be made.

scholarly journals Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities

2021 ◽  
Vol 12 ◽  
Author(s):  
Rajan Nathan ◽  
Mark Gabbay ◽  
Sean Boyle ◽  
Phil Elliott ◽  
Clarissa Giebel ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Contextual Factors ◽  
Clinical Decision ◽  
Personal Factors ◽  
Liaison Psychiatry ◽  
Acute Admission ◽  
Factors Influencing ◽  
Wide Range

Background: Human decision-making involves a complex interplay of intra- and inter-personal factors. The decisions clinicians make in practise are subject to a wide range of influences. Admission to a psychiatric hospital is a major clinical intervention, but the decision-making processes involved in admissions remain unclear.Aims: To delineate the range of factors influencing clinicians' decisions to arrange acute psychiatric admissions.Methods: We undertook six focus groups with teams centrally involved in decisions to admit patients to hospital (crisis resolution home treatment, liaison psychiatry, approved mental health practitioners and consultant psychiatrists). The data were analysed using qualitative thematic analysis.Results: Our analysis of the data show a complex range of factors influencing decision-making that were categorised as those related to: (i) clinical and risk factors; (ii) fear/threat factors; (iii) interpersonal dynamics; (iv) contextual factors.Conclusions: Decisions to arrange acute admission to hospital are not just based on an appraisal of clinical and risk-related information. Emotional, interpersonal and contextual factors are also critical in decision-making. Delineating the breadth of factors that bear on clinical decision-making can inform approaches to (i) clinical decision-making research, (ii) the training and supervision of clinicians, and (iii) service delivery models.

scholarly journals Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Juraj Koska ◽  
Daniel S. Nuyujukian ◽  
Gideon D. Bahn ◽  
Jin J. Zhou ◽  
Peter D. Reaven
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Severe Hypoglycemia ◽  
Clinical Decision ◽  
Veterans Affairs ◽  
Cvd Risk ◽  
C Peptide ◽  
Increased Risk ◽  
Control Patterns

Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (< 0.50 nmol/l, HR 1.30 [95%CI 1.05–1.60], p = 0.02) and with rising levels in the high range (> 1.23 nmol/l, 1.27 [1.00–1.63], p = 0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60–0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate − 0.12 [SE 0.01]; ARV, − 0.10 [0.01]) (p < 0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17–1.87, p = 0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.

Sign in / Sign up

Export Citation Format

Share Document