XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Objective:To provide an update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008.Design:A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at ke

Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

/pdf/2017-esc-guidelines-for-the-management-of-acute-myocardial-14hhjrfylv.pdf

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).

Cardiac arrest (CA) survivors often suffer physical and cognitive deficits. Unlike survivors of myocardial infarction or stroke, CA survivors are inconsistently referred to rehabilitation services. Social and structural determinants of health affects access to care. We investigated if rehabilitation referral rates for CA survivors differed across race, ethnicity, sex and socioeconomic status (SES) based on median income of patient’s zip code of residence. We included consecutive CA survivors discharged from a single academic medical center 2014-2019. We performed a structured chart review to identify referrals to inpatient or outpatient rehabilitation. Outpatient services included cardiac rehabilitation, PT/OT, and speech therapy. We used Census data to determine median household income for each patient’s zip code of residence. We used Fisher’s Exact test and Kruskal Wallis tests to investigate the difference in referral rates based on income brackets identified from Census data, age, sex, race, and ethnicity. We included 674 CA patients, of whom 367 (54%) arrested out of hospital, 418 (62%) were male, median age was 60 (IQR 49-69) years, 526 (78%) were white, 553 (82%) were non-Hispanic or Latin-x. Overall 387 (57%) were referred to rehabilitation ( n=316 (47%) inpatient-only, n=42 (6%) outpatient-only, n=29 (4%) both). Rehabilitation referral differed across categories of income (p=0.023) (Figure) but showed no consistent trend across consecutive categories. Age was positively associated with referral (odds ratio per decade 1.33; 95% CI 1.21-1.47, p=0.015). There was no association of race, ethnicity or sex with rehabilitation referral. In our single center data, referral to rehabilitation increased with age and was less frequent for patients from neighborhoods with the lowest median income. It did not differ based on sex, race or ethnicity. Future studies should investigate rehabilitation attendance rates in comparison to SES.
 
 


Abstract 224: Rate Of Rehabilitation Referral After Cardiac Arrest Based On Socioeconomic Status


 Introduction:
 Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions.
 
 
 Methods:
 Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics.
 
 
 Results:
 Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p<0.01). In a multivariable model, acute inpatient rehabilitation was significantly associated with a good recovery pattern when compared to other discharge dispositions (home with out-patient rehabilitation services (odds ratio (OR), 0.3; CI, 0.1-0.8; p = 0.02), and skilled nursing facility (OR, 0.2; CI, 0.1-0.6; p<0.01). SDOH including minority race/ethnicity, poor insurance, premorbid unemployment, no carepartner or spouse, and patients with longer hospital length of stay had independent and significant associations with poor functional recovery patterns.
 
 
 Conclusions:
 Acute inpatient rehabilitation was associated with a good functional recovery pattern 12 months after hospital discharge from CA. Social determinants of health have an independent effect on the functional recovery patterns and should be systematically collected for future outcome-based studies.


Abstract 227: Acute Inpatient Rehabilitation And Social Determinants Of Health Are Associated With Functional Recovery Patterns At 12 Months Relative To Hospital Discharge From Cardiac Arrest.

Evaluating Novel Methods of Outcome Assessment following Cardiac Arrest.

Methode und gerät mit einem skalierungsexponenten zur selektiven defibrillation eines patienten

Coma is common following resuscitation from cardiac arrest. Few data describe the trajectory of recovery the first days following resuscitation. The objective of this study is to describe the evolution in neurological examination during the first 5 days after resuscitation and test if subjects who go on to awaken have different patterns of early recovery.Prospective study of adult subjects resuscitated from out-of-hospital cardiac arrest. We abstracted demographic information and trained clinicians completed daily neurologic examinations using the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness brainstem (FOUR-B) and motor (FOUR-M) scores during daily sedation interruption. The change in scores between Day 1 and Day 5 was analyzed using the Kruskal-Wallis Test and logistic regression models. The relationship of FOUR-B, FOUR-M, and GCS with time to death was estimated by fitting cox proportional hazard models.FOUR-M and GCS did not differ over time (p = 0.10; p = 0.07). FOUR B increased over time (p < 0.01). Time to recovery of brainstem or motor function differed between those treated at 33 °C and 36 °C (p = 0.0023 and p = 0.0032, respectively). FOUR-B, FOUR-M, and GCS differed between survivors and non-survivors (p < 0.01). Time to recovery of brainstem and motor function differed between survivors and non-survivors. FOUR-M and FOUR-B differed between those with good outcome and poor outcome.The brainstem clinical examination improved during the first 5 days following resuscitation. Brainstem recovery was common in entire cohort and did not differentiate between survivors and non-survivors. Recovery of motor function, however, was associated with survival. 

https://doi.org/10.1016/j.resplu.2022.100332

Clifton W. Callaway

Papers

Abstract 224: Rate Of Rehabilitation Referral After Cardiac Arrest Based On Socioeconomic Status

Abstract 227: Acute Inpatient Rehabilitation And Social Determinants Of Health Are Associated With Functional Recovery Patterns At 12 Months Relative To Hospital Discharge From Cardiac Arrest.

Evaluating Novel Methods of Outcome Assessment following Cardiac Arrest.

Methode und gerät mit einem skalierungsexponenten zur selektiven defibrillation eines patienten

The association of brainstem and motor recovery with awakening after out-of-hospital cardiac arrest