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Using blood glucose meter downloads to improve the accuracy of verbal self-reported blood glucose in teenagers with type I diabetes at ski campA Sjoeholm1, A Gray2, J Rayns3, P Tomlinson4, B Wheeler1,3.1Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand. 2Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. 4Department of Women's and Children's Health, University of Otago, Invercargill, New Zealand.Despite advances in diabetes management, self-monitoring of blood glucose (SMBG) remains fundamental. A number of studies have confirmed that logbook entries of SMBG are prone to common errors. A single recent study reveals similar findings for verbally reported SMBG. As verbal SMBG is crucial for safety at diabetes camps worldwide, we aimed to assess whether adolescent awareness of a planned meter download at diabetes ski camp conclusion, would improve the overall accuracy of camp verbal SMBG.Twenty-six adolescents with diabetes attended a three-day ski camp. Verbally reported SMBG values were reported to, and recorded by, camp supervisors at multiple time points throughout the camp, as per safety protocols. The intervention involved ensuring all participants (at camp commencement) were aware of a planned meter download and SMBG review at camp conclusion. This data was then compared with historical camp data from 2012, collected using identical methodology, as part of a prior research study, in which participants were unaware of the planned meter download. Blood glucose (BGL) data was classified as: accurate, absent/phantom, or modified – verbally reported value> / < meter downloaded value.Dual-data from verbal SMBG and download was obtained for 527 instances of BGL testing. This was compared to dual-data for 394 historical tests. Following intervention, error rate was 4.5%, over 34% of participants. There was a statistically significant improvement in accuracy compared to historical non-intervention data, in which the error rate was 13.5% over 70% of participants (P < 0.001). There was also a significant decrease in phantom readings at 2%, from 8.6% in 2012 (P < 0.001).This study demonstrates an improvement in accuracy and reliability in verbally reported SMBG, following a simple intervention. Meter download could be easily incorporated into camp safety protocols worldwide, and may provide an easy, low cost way of improving safety on camp. Predicting outcomes in acute severe Ulcerative Colitis; comparison of the Travis and Ho severity scoresA Churchhouse1, R Lynch2, A. Protheroe3, I Arnott2.1Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 2GI Unit, Western General Hospital, Edinburgh, UK, 3CEEu, Royal College of Physicians, London, UK.Patients with severe Ulcerative Colitis (UC) are commonly identified using the Truelove and Witts criteria. The Travis and Ho scores are subsequently used to identify patients with severe UC who are at high risk of failing medical therapy and needing second line therapy or colectomy. There has been no direct comparison between Travis and Ho scores to determine which is superior.We analysed data from 3049 patients with UC collected during the national UK Inflammatory Bowel Disease audit. Those with acute severe UC that failed steroid therapy were scored using both Travis and Ho criteria and allocated into either a Travis "high" or "low" risk group and either a Ho "high", "medium" or "low" risk group. We assessed whether further medical or surgical intervention varied between groups.Patients requiring surgery did not differ between the high risk groups (Travis 51%, n = 88 and Ho 50%, n = 63, respectively). However, only 33% (n = 39) in the medium risk Ho group, 34% (n = 16) in the low risk Ho group and 25% (n = 30) in the low risk Travis group underwent surgery. A similar trend was seen in patients receiving second line treatment with ciclosporin. Resistance to ciclosporin correlated with increasing risk stratification, although this failed to reach statistical significance for all groups. The use of anti-TNFs was the same across all three groups, although like ciclosporin, the tendency to TNF resistance also increased with increasing risk group.The Travis and Ho scores are equally able to identify patients who are at high risk of failing medical therapy and needing colectomy or second line medical therapy. The Ho score also has an intermediate response to second line therapy. Both scores are useful tools to aid clinical decision making but do not replace timely multidisciplinary care for these patients.

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Using blood glucose meter downloads to improve the accuracy of verbal self-reported blood glucose in teenagers with type I diabetes at ski campA Sjoeholm1, A Gray2, J Rayns3, P Tomlinson4, B Wheeler1,3.1Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand. 2Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. 4Department of Women's and Children's Health, University of Otago, Invercargill, New Zealand.Despite advances in diabetes management, self-monitoring of blood glucose (SMBG) remains fundamental. A number of studies have confirmed that logbook entries of SMBG are prone to common errors. A single recent study reveals similar findings for verbally reported SMBG. As verbal SMBG is crucial for safety at diabetes camps worldwide, we aimed to assess whether adolescent awareness of a planned meter download at diabetes ski camp conclusion, would improve the overall accuracy of camp verbal SMBG.Twenty-six adolescents with diabetes attended a three-day ski camp. Verbally reported SMBG values were reported to, and recorded by, camp supervisors at multiple time points throughout the camp, as per safety protocols. The intervention involved ensuring all participants (at camp commencement) were aware of a planned meter download and SMBG review at camp conclusion. This data was then compared with historical camp data from 2012, collected using identical methodology, as part of a prior research study, in which participants were unaware of the planned meter download. Blood glucose (BGL) data was classified as: accurate, absent/phantom, or modified – verbally reported value> / < meter downloaded value.Dual-data from verbal SMBG and download was obtained for 527 instances of BGL testing. This was compared to dual-data for 394 historical tests. Following intervention, error rate was 4.5%, over 34% of participants. There was a statistically significant improvement in accuracy compared to historical non-intervention data, in which the error rate was 13.5% over 70% of participants (P < 0.001). There was also a significant decrease in phantom readings at 2%, from 8.6% in 2012 (P < 0.001).This study demonstrates an improvement in accuracy and reliability in verbally reported SMBG, following a simple intervention. Meter download could be easily incorporated into camp safety protocols worldwide, and may provide an easy, low cost way of improving safety on camp. Predicting outcomes in acute severe Ulcerative Colitis; comparison of the Travis and Ho severity scoresA Churchhouse1, R Lynch2, A. Protheroe3, I Arnott2.1Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 2GI Unit, Western General Hospital, Edinburgh, UK, 3CEEu, Royal College of Physicians, London, UK.Patients with severe Ulcerative Colitis (UC) are commonly identified using the Truelove and Witts criteria. The Travis and Ho scores are subsequently used to identify patients with severe UC who are at high risk of failing medical therapy and needing second line therapy or colectomy. There has been no direct comparison between Travis and Ho scores to determine which is superior.We analysed data from 3049 patients with UC collected during the national UK Inflammatory Bowel Disease audit. Those with acute severe UC that failed steroid therapy were scored using both Travis and Ho criteria and allocated into either a Travis "high" or "low" risk group and either a Ho "high", "medium" or "low" risk group. We assessed whether further medical or surgical intervention varied between groups.Patients requiring surgery did not differ between the high risk groups (Travis 51%, n = 88 and Ho 50%, n = 63, respectively). However, only 33% (n = 39) in the medium risk Ho group, 34% (n = 16) in the low risk Ho group and 25% (n = 30) in the low risk Travis group underwent surgery. A similar trend was seen in patients receiving second line treatment with ciclosporin. Resistance to ciclosporin correlated with increasing risk stratification, although this failed to reach statistical significance for all groups. The use of anti-TNFs was the same across all three groups, although like ciclosporin, the tendency to TNF resistance also increased with increasing risk group.The Travis and Ho scores are equally able to identify patients who are at high risk of failing medical therapy and needing colectomy or second line medical therapy. The Ho score also has an intermediate response to second line therapy. Both scores are useful tools to aid clinical decision making but do not replace timely multidisciplinary care for these patients.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Using blood glucose meter downloads to improve the accuracy of verbal self-reported blood glucose in teenagers with type I diabetes at ski campA Sjoeholm1, A Gray2, J Rayns3, P Tomlinson4, B Wheeler1,3.1Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand. 2Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. 4Department of Women's and Children's Health, University of Otago, Invercargill, New Zealand.Despite advances in diabetes management, self-monitoring of blood glucose (SMBG) remains fundamental. A number of studies have confirmed that logbook entries of SMBG are prone to common errors. A single recent study reveals similar findings for verbally reported SMBG. As verbal SMBG is crucial for safety at diabetes camps worldwide, we aimed to assess whether adolescent awareness of a planned meter download at diabetes ski camp conclusion, would improve the overall accuracy of camp verbal SMBG.Twenty-six adolescents with diabetes attended a three-day ski camp. Verbally reported SMBG values were reported to, and recorded by, camp supervisors at multiple time points throughout the camp, as per safety protocols. The intervention involved ensuring all participants (at camp commencement) were aware of a planned meter download and SMBG review at camp conclusion. This data was then compared with historical camp data from 2012, collected using identical methodology, as part of a prior research study, in which participants were unaware of the planned meter download. Blood glucose (BGL) data was classified as: accurate, absent/phantom, or modified – verbally reported value> / < meter downloaded value.Dual-data from verbal SMBG and download was obtained for 527 instances of BGL testing. This was compared to dual-data for 394 historical tests. Following intervention, error rate was 4.5%, over 34% of participants. There was a statistically significant improvement in accuracy compared to historical non-intervention data, in which the error rate was 13.5% over 70% of participants (P < 0.001). There was also a significant decrease in phantom readings at 2%, from 8.6% in 2012 (P < 0.001).This study demonstrates an improvement in accuracy and reliability in verbally reported SMBG, following a simple intervention. Meter download could be easily incorporated into camp safety protocols worldwide, and may provide an easy, low cost way of improving safety on camp. Predicting outcomes in acute severe Ulcerative Colitis; comparison of the Travis and Ho severity scoresA Churchhouse1, R Lynch2, A. Protheroe3, I Arnott2.1Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 2GI Unit, Western General Hospital, Edinburgh, UK, 3CEEu, Royal College of Physicians, London, UK.Patients with severe Ulcerative Colitis (UC) are commonly identified using the Truelove and Witts criteria. The Travis and Ho scores are subsequently used to identify patients with severe UC who are at high risk of failing medical therapy and needing second line therapy or colectomy. There has been no direct comparison between Travis and Ho scores to determine which is superior.We analysed data from 3049 patients with UC collected during the national UK Inflammatory Bowel Disease audit. Those with acute severe UC that failed steroid therapy were scored using both Travis and Ho criteria and allocated into either a Travis "high" or "low" risk group and either a Ho "high", "medium" or "low" risk group. We assessed whether further medical or surgical intervention varied between groups.Patients requiring surgery did not differ between the high risk groups (Travis 51%, n = 88 and Ho 50%, n = 63, respectively). However, only 33% (n = 39) in the medium risk Ho group, 34% (n = 16) in the low risk Ho group and 25% (n = 30) in the low risk Travis group underwent surgery. A similar trend was seen in patients receiving second line treatment with ciclosporin. Resistance to ciclosporin correlated with increasing risk stratification, although this failed to reach statistical significance for all groups. The use of anti-TNFs was the same across all three groups, although like ciclosporin, the tendency to TNF resistance also increased with increasing risk group.The Travis and Ho scores are equally able to identify patients who are at high risk of failing medical therapy and needing colectomy or second line medical therapy. The Ho score also has an intermediate response to second line therapy. Both scores are useful tools to aid clinical decision making but do not replace timely multidisciplinary care for these patients.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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