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

This article is a review of the literature on classroom formative assessment. Several studies show firm evidence that innovations designed to strengthen the frequent feedback that students receive about their learning yield substantial learning gains. The perceptions of students and their role in self‐assessment are considered alongside analysis of the strategies used by teachers and the formative strategies incorporated in such systemic approaches as mastery learning. There follows a more detailed and theoretical analysis of the nature of feedback, which provides a basis for a discussion of the development of theoretical models for formative assessment and of the prospects for the improvement of practice.

Assessment and Classroom Learning

Prospective Cohort Study

Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease, which is autoimmune in origin and is characterized by the presence of autoantibodies directed against nuclear antigens. It is a multi-system disease, and patients can present in vastly different ways. Prevalence varies with ethnicity, but is estimated to be about 1 per 1000 overall with a female to male ratio of 10:1. The clinical heterogeneity of this disease mirrors its complex aetiopathogenesis, which highlights the importance of genetic factors and individual susceptibility to environmental factors. SLE can affect every organ in the body. The most common manifestations include rash, arthritis and fatigue. At the more severe end of the spectrum, SLE can cause nephritis, neurological problems, anaemia and thrombocytopaenia. Over 90% of patients with SLE have positive anti-nuclear antibodies (ANA). Significant titres are accepted to be of 1:80 or greater. SLE is a relapsing and remitting disease, and treatment aims are threefold: managing acute periods of potentially life-threatening ill health, minimizing the risk of flares during periods of relative stability, and controlling the less life-threatening, but often incapacitating day to day symptoms. Hydroxychloroquine and non-steroidal anti-inflammatory drugs are used for milder disease; corticosteroids and immunosuppressive therapies are generally reserved for major organ involvement; anti-CD20 monoclonal antibody is now used in patients with severe disease who has not responded to conventional treatments. Despite enormous improvements in prognosis since the introduction of corticosteroids and immunosuppressive drugs, SLE continues to have a significant impact on the mortality and morbidity of those affected.

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Systemic lupus erythematosus

Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Standards for educational and psychological testing

A-21 Examining Suicidal Ideation in Adolescents Who Have Sustained Concussions

Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure--Reply.

American-style football (ASF) players experience repetitive head impacts which may result in chronic traumatic encephalopathy neuropathologic change (CTE-NC). At present, a definitive diagnosis of CTE-NC requires the identification of localized hyperphosphorylated Tau (p-Tau) after death via immunohistochemistry. Some studies suggest that positron emission tomography (PET) with the radiotracer (18F)-Flortaucipir (FTP) may be capable of detecting p-Tau and thus establishing a diagnosis of CTE-NC among living former ASF players. To assess associations between FTP, football exposure, and objective neuropsychological measures among former professional ASF players, we conducted a study that compared former professional ASF players to age-matched male control participants without repetitive head impact exposure. Former ASF players and male controls underwent structural magnetic resonance imaging and PET using FTP for p-Tau and [11C]-PiB for amyloid-β. Former players underwent neuropsychological testing. ASF exposure was quantified as age at first exposure, professional career duration, concussion signs and symptoms burden, and total years of any football play. Neuropsychological testing included measures of memory, executive functioning, and depression symptom severity. P-Tau was quantified as FTP standardized uptake value ratios (SUVR) and [11C]-PiB by distribution volume ratios (DVR) using cerebellar grey matter as the reference region. There were no significant differences in [18F]-FTP uptake among former ASF players (N=27, age=50±7 years) compared to control participants (N=11, age=55±4 years), nor did any participant have significant amyloid-β burden. Among ASF participants, there were no associations between objective measures of neurocognitive functioning and [18F]-FTP uptake. However, there was a marginally significant difference between [18F]-FTP uptake isolated to the entorhinal cortex among players in age-, position-, and race-adjusted models (p=0.05) which may represent an area of future investigation. The absence of increased [18F]-FTP uptake in brain regions previously implicated in CTE among former professional ASF players compared to controls questions the utility of [18F]-FTP PET for clinical evaluation in this population.

Tau Positron Emission Tomography and Neurocognitive Function Among Former Professional American-Style Football Players.

Objective: To develop and evaluate psychometric criteria for identifying cognitive impairment in adults with mood disorders. Participants & Methods: Participants were adults between the ages of 20 and 54, including 659 healthy control subjects, 84 unmedicated outpatients diagnosed with depression, 59 outpatients diagnosed with depression who were on medications at the time of the evaluation, and 43 outpatients with bipolar disorder. All completed the CNS Vital Signs computerized battery. This battery of seven tests yields five domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility). Results: Base rates of low domain scores were calculated, using different cut-offs, for the healthy control subjects and the patients with mood disorders. Having two scores at or below the 5 th percentile occurred in 31.2% of the patients and only 8.2% of the control subjects [χ 2 (1)=66.67, p<.0001; Odds Ratio=5.1, 95% CI=3.4–7.7]. This low false positive rate was maintained across age groups, sexes, and education levels. African Americans (N=49) had higher false positive rates (i.e., 14.3%) than Caucasians (N=570; 7.0%). A larger proportion of patients with bipolar disorder (41.9%) than patients with depression (27.1-28.6%) met criteria for cognitive impairment. Conclusion: A substantial minority of adults with mood disorders appear to have cognitive impairment. The psychometric criterion for cognitive impairment on this computerized test battery has a low false positive rate.

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Identifying Cognitive Impairment in Adults with Mood Disorders Using Computerized Testing

Author Notes: The authors thank Drs. C. Thomas Gualtieri and Lynda G. Johnson for providing all the data used in this study. Drs. Gualtieri and Johnson are the two developers of the CNS Vital Signs battery used in this study. Please address correspondence to Grant Iverson, Ph.D., Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, B.C., Canada V6T 2A1. Phone: (604) 822-7588; Fax: (604) 822-7756; Email: giverson@interchange.ubc.ca.

https://www.cnsvs.com/Publications/dep%202008%20ab%20-%20ins%20a%20short%20form%20of%20cns%20vital%20signs%20for%20use%20in%20depression.pdf

Grant L. Iverson

Papers

A-21 Examining Suicidal Ideation in Adolescents Who Have Sustained Concussions

Attribution of Concussion-Like Symptoms and History of Collision Sports Exposure--Reply.

Tau Positron Emission Tomography and Neurocognitive Function Among Former Professional American-Style Football Players.

Identifying Cognitive Impairment in Adults with Mood Disorders Using Computerized Testing

A Short Form of CNS Vital Signs for Use in Depression