Experience of coronary care in diabetes.

During 1968-1973, 94 patients with diabetes were admitted to a coronary care unit (CCU) on 99 occasions with proved myocardial infarction. Altogether 24 of them (25-5%) died, giving an overall mortality at the time of discharge of 24% for the total admissions. This was just significantly higher than the 19% mortality recorded among non-diabetics treated in the same period but was much lower than that among diabetics treated for myocardial infarction before the advent of CCUs. No definite correlation was found between the type of anti-diabetic treatment and either mortality or the incidence of primary ventricular fibrillation. Patients with "poor" control of the diabetes before admission showed a significantly higher mortality than those with "good" control, but there was no significant difference in mortality between those with previous good control and non-diabetics.     

Problems of comprehensive shared diabetes care.

In its first year 747 diabetics were entered into a comprehensive shared care scheme in which general practitioners agreed to follow up their own patients. After two years patients were recalled to hospital for review through a computer based recall system. Analysis of the first 209 patients reviewed showed that the recall system worked well with failure to trace only eight patients. Six new cases of foot ulcer, 15 of retinopathy, 14 of macular degeneration, and 15 of raised blood pressure requiring treatment were detected at review. Sixty four patients appeared to have had no check on their diabetes during the two years. Of the 117 with written evidence in their cooperation books that they had received some diabetic supervision, many had had no measurement of weight (32), blood pressure (49), or urine (68) or blood glucose (70), and only 55 had had foot and 65 eye examination. This erratic and generally poor standard of supervision suggests that much tighter organisation is required within each practice, with time being set aside specifically for care of diabetics. Practice nurses could have an important role in the delivery and organisation of care.     

Shared care provides time-budgeting advantages for female eiders

Shared parental care resulting from brood amalgamation is often considered beneficial to parents. However, the benefit of grouping (a decline in individual vigilance despite an increase in collective vigilance, with a concomitant increase in individual feeding time) has not been evoked as a factor promoting shared care. Eider females, Somateria mollissima, are subject to substantial energetic costs during breeding, and sometimes share brood-rearing duties. We compared the activity budgets and feeding behaviour of lone tenders and multifemale tenders. We also measured the collective vigilance of multifemale tenders and examined whether the coordination of feeding activity among females changes with time. As expected, the proportion of time spent feeding increased, and the proportion of time spent vigilant decreased, as the number of females attending the brood increased. None the less, the collective vigilance of multifemale tenders was at least 20% higher than the vigilance of lone tenders. Furthermore, multifemale tending allowed females to feed more optimally, as dive duration increased with the number of females tending the brood. The level of parental investment by individual females after hatching of the eggs is therefore related to the number of tending females and, based on previous work, a female's body condition when the eggs hatch is also logically connected with the number of tending females. Whether females sharing brood care on a permanent basis coordinate their feeding activity, so as to increase the potential protection of ducklings against predation, remains equivocal. Copyright 2002 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.     

Retrospective assessment of the quality of diabetes care in a rural diabetes clinic in Western Kenya

Background

Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya.

Methods

To provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines.

Results

A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18?months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6?months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF.

Conclusion

This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region.