Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol

Objective

Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system.

Design

Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods.

Measurements

Percentage of glucose readings in ideal range of 70–109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay.

Results

The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for ≥24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups.

Conclusion

The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients.     

Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels

Background

Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels.

Methods

Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA.

Results

Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group.

Conclusion

Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.     

Prevalence and Determinants of Hypertension in a Rural Community

Background

There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community.

Methods

A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors.

Result

Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects.

Conclusion

Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.Key Words: Hypertension, Prevalence, Determinants, Rural community     

Alexithymia,emotion processing and social anxiety in adults with ADHD

Objective

Given sparse research on the issue, this study sought to shed light upon the interactions of alexithymia, emotion processing, and social anxiety in adults with attention-deficit hyperactivity disorder (ADHD).

Subjects and methods

73 German adults with ADHD according to DSM-IV diagnostic criteria participated. We used the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) to assess different features of social anxiety, and we applied the German ''Experience of Emotions Scale'' (SEE) to measure emotion processing.

Results

40% of the sample were found to meet the DSM-IV criteria of social anxiety disorder, and about 22% were highly alexithymic according to a TAS-20 total score ≥ 61; however, the mean TAS-20 total score of 50.94 ± 9.3 was not much higher than in community samples. Alexithymic traits emerged to be closely linked to emotion processing problems, particularly ''difficulty accepting own emotions'', and to social anxiety features.

Discussion/conclusion

Our findings suggest interactions of alexithymia, emotion processing dysfunction, and social anxiety in adults with ADHD, which may entail the therapeutic implication to thoroughly instruct these patients to identify, accept, communicate, and regulate their emotions to aid reducing interaction anxiety.     

A clinical study to evaluate the efficacy of intravitreal Anti-VEGF therapy in treating macular edema due to retinal venous occlusions

Background

A non-randomized, interventional study was carried out various types of retinal venous occlusions with significant macular edema who required an Anti-VEGF injection.

Method

One hundred and one consecutive patients diagnosed as a case of CRVO/HCRVO/BRVO were enrolled in the study provided they had significant macular edema. Atleast three intra-vitreal injections of Anti-VEGFs were given and both the pre and post injections BCVA and CMT on OCT were observed and analyzed.

Results

87 patients (86.14%) showed a significant improvement of vision of atleast two lines on the Snellen''s and mean BCVA improved from log MAR +1.084 to log MAR +0.455. CMT on OCT showed reduction in thickness after Anti-VEGF therapy in 99 patients out of 101 and mean CMT decreased from 586.30 μ at baseline to 329.50 μ. Both of these findings were statistically very significant.

Conclusions

Anti-VEGF therapy had a marked improvement in BCVA along with a dramatic reduction in CMT in the vast majority of RVOs patients with no serious ocular or systemic side effects.     

“Not all my friends need to know”: a qualitative study of teenage patients,privacy, and social media

Background

The literature describes teenagers as active users of social media, who seem to care about privacy, but who also reveal a considerable amount of personal information. There have been no studies of how they manage personal health information on social media.

Objective

To understand how chronically ill teenage patients manage their privacy on social media sites.

Design

A qualitative study based on a content analysis of semistructured interviews with 20 hospital patients (12–18 years).

Results

Most teenage patients do not disclose their personal health information on social media, even though the study found a pervasive use of Facebook. Facebook is a place to be a “regular”, rather than a sick teenager. It is a place where teenage patients stay up-to-date about their social life—it is not seen as a place to discuss their diagnosis and treatment. The majority of teenage patients don''t use social media to come into contact with others with similar conditions and they don''t use the internet to find health information about their diagnosis.

Conclusions

Social media play an important role in the social life of teenage patients. They enable young patients to be “regular” teenagers. Teenage patients'' online privacy behavior is an expression of their need for self-definition and self-protection.     

Health Professionals Expose TB Patients to Stigmatization in Society: Insights from Communities in an Urban District in Ghana

Objectives

To determine how the activities and attitudes of health professionals expose TB patients to stigmatization in the community.

Design

Qualitative research approach using individual interviews and focus groups

Setting

Shama Ahanta East Metropolitan district in the western region of Ghana

Participants

Members in nine communities in the district

Outcome measures

Words and statements that depict how activities and attitudes of health professionals may expose TB patients to stigmatization

Results

Five interrelated ways by which activities and attitudes of health professionals may expose TB patients to stigmatization in the community were identified in data: TB control practices; fear-based responses to TB; inappropriate health education messages; medical licensing for sellers; and prohibition of burial rites.

Conclusions

The findings may explain the diagnostic delay and low TB case detection rate in Ghana. This calls for intensification of education on TB and regular organization of refresher courses and possibly retraining of health professionals in TB control and management. When health professionals are seen to be treating TB patients as ‘normal’ individuals, it has the potential of changing the society''s perception about the disease.     

Modifications to Norman's procedure for hypermobility of the TMJ

Background

Norman''s procedure is a well known surgical technique for the hypermobility of temporomandibular joint. In this procedure after performing glenotemporal osteotomy the augmentation of the zygomatic root of the temporal bone is done by placing a bone graft from the iliac crest to prevent forward movement of the condyle beyond the eminence. This paper describes the clinical outcome of two modifications added to Norman''s procedure. In addition to the conventional procedure inferiorly based pedicled flap from the temporal fascia was sutured to the antero-lateral aspect of the capsule. Intraorally pterygoid disjunction was carried out only in those case in which hypermobility was associated with painful temporomandibular joint disorder.

Methods

Modified Norman’s procedure was performed in 10 patients (4 females & 6 males), 7 of them were bilateral and 3 cases were unilateral under general anesthesia.

Results

After one year follow up in none of the cases graft failed or rejected though recurrence along with TMJ pain was noticed in 2 cases.

Conclusion

This technique is versatile but long-term follow up on a larger number of patients is necessary to be able to draw definitive conclusions.     

The mediastinal staging accuracy of 18F-Fluorodeoxyglycose Positron Emission Tomography / Computed Tomography in non-small cell lung cancer with variable time intervals to surgery.

Background

PET/CT scanning can determine suitability for curative therapy and inform decision making when considering radical therapy in patients with non-small cell lung cancer (NSCLC). Metastases to central mediastinal lymph nodes (N2) may alter such management decisions. We report a 2 year retrospective series assessing N2 lymph node staging accuracy with PET/CT compared to pathological analysis at surgery.

Methods

Patients with NSCLC attending our centre (excluding those who had induction chemotherapy) who had staging PET/CT scans and pathological nodal sampling between June 2006 and June 2008 were analysed. For each lymph node assessed pathologically, the corresponding PET/CT status was determined. 64 patients with 200 N2 lymph nodes were analysed.

Results

Sensitivity of PET/CT scans for indentifying involved N2 lymph nodes was 39%, specificity 96% and overall accuracy 90%. For individual lymph node analysis, logistic regression demonstrated a significant linear association between PET/CT sensitivity and time from scanning to surgery (p=0.031) but not for specificity and accuracy. Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥9 weeks, p=0.007). Differences in specificity were not seen (97% <9 weeks, 91% ≥9 weeks, p=0.228). No significant difference in specificity was found at any time point.

Conclusions

We recommend that if a PET/CT scan is older than 9 weeks, and management would be altered by the presence of N2 nodes, re-staging of the mediastinum should be undertaken.     

Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance

Objective

To determine characteristics and effects of nurse dosing over-rides of a clinical decision support system (CDSS) for intensive insulin therapy (IIT) in critical care units.

Design

Retrospective analysis of patient database records and ethnographic study of nurses using IIT CDSS.

Measurements

The authors determined the frequency, direction—greater than recommended (GTR) and less than recommended (LTR)— and magnitude of over-rides, and then compared recommended and over-ride doses'' blood glucose (BG) variability and insulin resistance, two measures of IIT CDSS associated with mortality. The authors hypothesized that rates of hypoglycemia and hyperglycemia would be greater for recommended than over-ride doses. Finally, the authors observed and interviewed nurse users.

Results

5.1% (9075) of 179 452 IIT CDSS doses were over-rides. 83.4% of over-ride doses were LTR, and 45.5% of these were ≥50% lower than recommended. In contrast, 78.9% of GTR doses were ≤25% higher than recommended. When recommended doses were administered, the rate of hypoglycemia was higher than the rate for GTR (p=0.257) and LTR (p=0.033) doses. When recommended doses were administered, the rate of hyperglycemia was lower than the rate for GTR (p=0.003) and LTR (p<0.001) doses. Estimates of patients'' insulin requirements were higher for LTR doses than recommended and GTR doses. Nurses reported trusting IIT CDSS overall but appeared concerned about recommendations when administering LTR doses.

Conclusion

When over-riding IIT CDSS recommendations, nurses overwhelmingly administered LTR doses, which emphasized prevention of hypoglycemia but interfered with hyperglycemia control, especially when BG was >150 mg/dl. Nurses appeared to consider the amount of a recommended insulin dose, not a patient''s trend of insulin resistance, when administering LTR doses overall. Over-rides affected IIT CDSS protocol performance.     

Hip Fractures: The St Ann's Bay Regional Hospital Experience

Objectives:

To study the outcome of hip fractures in a cohort of patients from two different time periods (2002–2003 and 2006–2008).

Methods:

Patients treated for hip fractures at the St Ann''s Bay Regional Hospital, which provides orthopaedic care for the parishes of St Ann, St Mary and Portland, were retrospectively analysed between 2002–2003 and 2006–2008.

Results:

A significant increase in the recorded incidence of hip fractures, from 19 in the 2002–2003 time period to 101 in the 2006–2008 time period was noted. There was a drastic fall in the in-hospital mortality rate (43% in the 2002–2003 time period compared to 4.5% in the 2006–2008 time period). In the 2006–2008 period, 82.9% of patients were ambulant at discharge compared to 36% from the 2002–2003 time period.

Conclusion:

Early surgical fixation is necessary to allow rapid mobilization in these patients for whom the consequences of bed rest would otherwise be devastating.     

Influenza surveillance using electronic health records in the American Indian and Alaska Native population

Objective

Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed.

Materials and methods

The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system''s results were compared with those of the traditional US ILI Surveillance Network.

Results

The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day.

Discussion

EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance.     

Use of population health data to refine diagnostic decision-making for pertussis

Objective

To improve identification of pertussis cases by developing a decision model that incorporates recent, local, population-level disease incidence.

Design

Retrospective cohort analysis of 443 infants tested for pertussis (2003–7).

Measurements

Three models (based on clinical data only, local disease incidence only, and a combination of clinical data and local disease incidence) to predict pertussis positivity were created with demographic, historical, physical exam, and state-wide pertussis data. Models were compared using sensitivity, specificity, area under the receiver-operating characteristics (ROC) curve (AUC), and related metrics.

Results

The model using only clinical data included cyanosis, cough for 1 week, and absence of fever, and was 89% sensitive (95% CI 79 to 99), 27% specific (95% CI 22 to 32) with an area under the ROC curve of 0.80. The model using only local incidence data performed best when the proportion positive of pertussis cultures in the region exceeded 10% in the 8–14 days prior to the infant''s associated visit, achieving 13% sensitivity, 53% specificity, and AUC 0.65. The combined model, built with patient-derived variables and local incidence data, included cyanosis, cough for 1 week, and the variable indicating that the proportion positive of pertussis cultures in the region exceeded 10% 8–14 days prior to the infant''s associated visit. This model was 100% sensitive (p<0.04, 95% CI 92 to 100), 38% specific (p<0.001, 95% CI 33 to 43), with AUC 0.82.

Conclusions

Incorporating recent, local population-level disease incidence improved the ability of a decision model to correctly identify infants with pertussis. Our findings support fostering bidirectional exchange between public health and clinical practice, and validate a method for integrating large-scale public health datasets with rich clinical data to improve decision-making and public health.     

Medical Abortion-An Alternative to Surgical Abortion

Background

Termination of early pregnancy has traditionally been done surgically, but agents are now available which can terminate pregnancy if taken orally, vaginally or parenterally. We have used a combination of mifepristone and misoprostol for termination of early pregnancy.

Material and Method

Fifty patients having amenorrhoea of upto 56 days with confirmed intrauterine pregnancy, were selected for medical termination of pregnancy. The patients were given tablet mifepristone (200mg) on day 1 and tablet misoprostol (400mcg) on day 3. On day 14, an ultrasound was done to confirm complete abortion.

Result

Majority 35 (70%) patients had amenorrhoea between 40 – 50 days. The duration of bleeding was less than 5 days in 12%, between 5 -10 days in 56%, 10 -13 days in 16% and greater than 14 days in 16%. In all patients with bleeding of more than 14 days ultrasonography confirmed intrauterine products & a suction evacuation was done. In this series there were no failures.

Conclusion

The combination of mifepristone and misoprostol is an effective method for termination of early pregnancy up to 56 days of amenorrhoea.Key Words: Medical abortion     

Design and development of an international clinical data exchange system: the international layer function of the Dolphin Project

Objective

At present, most clinical data are exchanged between organizations within a regional system. However, people traveling abroad may need to visit a hospital, which would make international exchange of clinical data very useful.

Background

Since 2007, a collaborative effort to achieve clinical data sharing has been carried out at Zhejiang University in China and Kyoto University and Miyazaki University in Japan; each is running a regional clinical information center.

Methods

An international layer system named Global Dolphin was constructed with several key services, sharing patients'' health information between countries using a medical markup language (MML). The system was piloted with 39 test patients.

Results

The three regions above have records for 966 000 unique patients, which are available through Global Dolphin. Data exchanged successfully from Japan to China for the 39 study patients include 1001 MML files and 152 images. The MML files contained 197 free text-type paragraphs that needed human translation.

Discussion

The pilot test in Global Dolphin demonstrates that patient information can be shared across countries through international health data exchange. To achieve cross-border sharing of clinical data, some key issues had to be addressed: establishment of a super directory service across countries; data transformation; and unique one—language translation. Privacy protection was also taken into account. The system is now ready for live use.

Conclusion

The project demonstrates a means of achieving worldwide accessibility of medical data, by which the integrity and continuity of patients'' health information can be maintained.     

A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias

Background

Bassini''s repair and the Lichtenstein''s tension free mesh hernioplasty are commonly used hernia repair techniques. A prospective randomized controlled study of Lichtenstein''s tension free versus modified Bassini repair in the management of groin hernias was undertaken to compare the technique and postoperative course in the two procedures.

Methods

A prospective study was conducted on patients reporting to Command Hospital (SC) Pune with inguinal hernia. One hundred and ninety six patients were included in the study, operated upon by either of technique and followed up.

Results

Study involved 196 patients with 216 primary inguinal hernias, studied over a period of 24 months. A total of 118 Bassini repair and 98 Lichtenstein''s repair were done. Of the 196 patients, four were females. Bassini Repair took more time than Lichtenstein''s repair, though the difference was not statistically significant (p>0.05). Direct hernias took lesser time to operate than the indirect hernias. Pain on the operative day, in the evening, was similar in both the groups. The commonest complication in both the groups was scar tenderness followed by erythema, scrotal swelling, neuralgia, superficial wound infection, funiculitis and seroma formation in the order of frequency. The average hospital stay was 5.74 days for Bassini''s repair as compared to 4.97 days for Lichtenstein''s repair. Patients undergoing Bassini''s repair took longer (mean 28.4 days) to return to work as compared to those who underwent Lichtenstein''s repair (mean 21.4 days) and the difference was statistically significant (p < 0.05). The recurrence rate was similar in Bassini''s (6.78%) and Lichtenstein''s repair (5.10%).

Conclusion

The Lichtenstein''s tension free mesh hernioplasty was comparatively better than modified Bassini''s repair due to its simplicity, less dissection and early ambulation in the postoperative period. Surgeons in training found the technique easier to master than the Bassini''s repair.Key Words: Inguinal hernia, Lichtenstein''s tension free mesh repair, Modified Bassini''s repair     

Laparoscopic Cardiomyotomy for Achalasia: A Single Unit study

Aims

Achalasia is a rare incurable neuromuscular disorder of the oesophagus. A number of treatment options are available. We reviewed our results of laparoscopic cardiomyotomy over a 30 month period.

Methods

18 patients with manometric features of achalasia underwent surgery between 2004 and 2006. Pre and postoperative weight and dysphagia scores were recorded (maximum score 45=normal, 0=complete dysphagia). Change in the Body Mass Index (BMI) was measured. Other symptoms (heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance) were scored on a 0–4 scale of increasing severity.

Results

At mean follow up of 16.2 months the mean dysphagia score was significantly improved from 7.5 to 33.9 (p<0.005). BMI was significantly increased from 22.3 to 25.8 kg/m² (p<0.05). Scores for heartburn, epigastric pain, regurgitation, odynophagia and sleep disturbance were also significantly improved. The average inpatient stay was 3.1 days and average operating time 111 minutes. One mucosal perforation occurred which was repaired intraoperatively. No patients required secondary operative intervention.

Conclusions

Laparoscopic cardiomyotomy is a safe, highly effective, minimally invasive treatment for achalasia.     

A Study of Psychological Correlates after Amputation

Background

Amputation of a limb affects almost all aspects of an individual''s life. Psychological aspects are important factors for adjustment with the disability.

Methods

The present study was carried out on 50 consecutive male patients admitted to the Artificial Limb Centre. Base line and post therapy psychological assessment was carried out on Hospital Anxiety and Depression Scale (HADS). Trauma Symptom Inventory (TSI) was administered along with Millon Index of personality styles (MIPS). Psychological intervention was given to them on a therapy module proposed by authors. Data was analyzed with the help of SPSS.

Result

Findings revealed significant differences in scores on HADS, before and after therapy (p<0.05). On Trauma symptom Inventory defensive avoidance and depression were noted to be above cut off level of (>65). Predominant personality styles were self indulgence and internally focused in motivating styles (mean prevalence score <50) and thought guided in thinking styles, dominating and controlling in behaving styles. The analysis of prevalence score of above 50 and less than 50 indicated Confident/Asserting (9B), Submissive / Yielding (11A), having significant change after therapy on score of anxiety (P<0.05). The personality dimension of dutiful and conforming had shown significant influence after therapy (P<0.05) on score of depression.

Conclusion

The findings indicated psychological assessment and intervention is to be included as a part of the management after amputation.Key Words: Amputation, Psychological correlates, Personality     

High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events

INTRODUCTION

Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder associated with multisystemic organ involvement. The STOP-BANG questionnaire is a concise, validated questionnaire that is used to screen for OSA. This study aimed to establish the use of the STOP-BANG questionnaire for perioperative patient risk stratification.

METHODS

In this retrospective cohort study, we extracted the demographic, medical and perioperative outcome data of all patients who underwent elective surgery, excluding ophthalmic surgeries, from January to December 2011. Multivariate regression analysis was used to predict independent risk factors for intraoperative and early postoperative adverse events.

RESULTS

Of the 5,432 patients analysed, 7.4% had unexpected intraoperative and early postoperative adverse events. We found that the risk of unexpected intraoperative and early postoperative adverse events was greater in patients with STOP-BANG scores ≥ 3 compared to those with a STOP-BANG score of 0 (score 3: odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1–6.3, p < 0.001; score 4: OR 3.4, 95% CI 1.8–6.5, p < 0.001; score 5: OR 6.4, 95% CI 2.7–15.0, p < 0.001; score ≥ 6: OR 5.6, 95% CI 2.1–15.4, p < 0.001). Patients with STOP-BANG scores ≥ 5 had a fivefold increased risk of unexpected intraoperative and early postoperative adverse events, while patients with STOP-BANG scores ≥ 3 had a ‘one in four’ chance of having an adverse event. Other independent predictors included older age (p < 0.001), American Society of Anesthesiologists class ≥ 2 (p < 0.003) and uncontrolled hypertension (p = 0.028).

CONCLUSION

STOP-BANG score may be used as a preoperative risk stratification tool to predict the risk of intraoperative and early postoperative adverse events.     

Social but safe? Quality and safety of diabetes-related online social networks

Objective

To foster informed decision-making about health social networking (SN) by patients and clinicians, the authors evaluated the quality/safety of SN sites'' policies and practices.

Design

Multisite structured observation of diabetes-focused SN sites.

Measurements

28 indicators of quality and safety covering: (1) alignment of content with diabetes science and clinical practice recommendations; (2) safety practices for auditing content, supporting transparency and moderation; (3) accessibility of privacy policies and the communication and control of privacy risks; and (4) centralized sharing of member data and member control over sharing.

Results

Quality was variable across n=10 sites: 50% were aligned with diabetes science/clinical practice recommendations with gaps in medical disclaimer use (30% have) and specification of relevant glycosylated hemoglobin levels (0% have). Safety was mixed with gaps in external review approaches (20% used audits and association links) and internal review approaches (70% use moderation). Internal safety review offers limited protection: misinformation about a diabetes ‘cure’ was found on four moderated sites. Of nine sites with advertising, transparency was missing on five; ads for unfounded ‘cures’ were present on three. Technological safety was poor with almost no use of procedures for secure data storage and transmission; only three sites support member controls over personal information. Privacy policies'' poor readability impedes risk communication. Only three sites (30%) demonstrated better practice.

Limitations

English-language diabetes sites only.

Conclusion

The quality/safety of diabetes SN is variable. Observed better practice suggests improvement is feasible. Mechanisms for improvement are recommended that engage key stakeholders to balance autonomy, community ownership, conditions for innovation, and consumer protection.