To examine the efficacy of clinical practice strategies in improving clinical outcomes and reducing length of hospital stay for inpatients with Type 1 and Type 2 diabetes.
People living with diabetes ...are at increased risk of being admitted to hospital and to stay in hospital longer than those who do not have the condition. Diabetes and its complications cause substantial economic loss to those living with the condition, their families, to health systems and national economies through direct medical costs and loss of work and wages. Length of stay is a major factor driving up hospitalisation costs relating to those with Type 1 and Type 2 diabetes with suboptimal blood glucose management, hypoglycaemia, hyperglycaemia, and co-morbidities shown to considerably impact upon length of stay. The identification of attainable evidence-based clinical practice strategies is necessary to inform the knowledge base and identify service improvement opportunities that could lead to improved clinical outcomes for these patients.
A systematic review and narrative synthesis.
A systematic search of CINAHL, Medline Ovid, and Web of Science databases was carried out to identify research papers reporting on interventions that have reduced length of hospital stay for inpatients living with diabetes for the period 2010-2021. Selected papers were reviewed, and relevant data extracted by three authors. Eighteen empirical studies were included.
Eighteen studies spanned the themes of clinical management innovations, clinical education programmes, multidisciplinary collaborative care and technology facilitated monitoring. The studies demonstrated improvements in healthcare outcomes such as glycaemic control, greater confidence with insulin administration and reduced occurrences of hypoglycaemia and hyperglycaemia and decreased length of hospital stay and healthcare costs.
The clinical practice strategies identified in this review contribute to the evidence base for inpatient care and treatment outcomes. The implementation of evidence-based research can improve clinical practice and show that appropriate management can enhance clinical outcomes for the inpatient with diabetes, potentially leading to reductions in length of stay. Investment in and commissioning of practices that have the potential to afford clinical benefits and reduce length of hospital stay could influence the future of diabetes care.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204825, identifier 204825.
People with diabetes often have difficulty maintaining optimal blood-glucose levels, risking progressive complications that can lead to unscheduled care. Unscheduled care can include attending ...emergency departments, ambulance call outs, out-of-hours care and non-elective hospital admissions. A large proportion of non-elective hospital admissions involve people with diabetes, with significant health and economic burden.
To identify precipitating factors influencing diabetes-related unscheduled hospital admissions, exploring potential preventative strategies to reduce admissions.
Thirty-six people with type 1 (n=11) or type 2 (n=25) diabetes, admitted to hospital for unscheduled diabetes-related care across three hospitals in Scotland, Northern Ireland and the Republic of Ireland were interviewed. Participants were admitted for peripheral limb complications (n=17), hypoglycaemia (n=5), hyperglycaemia (n=6), or for comorbidities presenting with erratic blood glucose levels (n=8).
Factors precipitating admissions were examined using Framework analysis.
Three aspects of care influenced unscheduled admissions: inadequate knowledge; restricted provision; and complexities in engagement. Limited specialist professional knowledge of diabetes by staff in primary and community care, alongside inadequate patient self-management knowledge, led to inappropriate treatment and significant delays. This was compounded by restricted provision of care, characterised by poor access to services, in time and proximity, and poor continuity of care. Complexities in patient engagement, help-seeking, and illness-beliefs, further complicated the progression to unscheduled admissions.
Dedicated investment in primary care is needed to enhance provision of and access to services, promoting increased and earlier diabetes specialist team involvement, alongside training and use of technology and telemedicine to enhance existing care.
Background. In many children with unilateral spastic cerebral palsy (USCP), the corticospinal tract to the affected hand atypically originates in the hemisphere ipsilateral to the affected hand. Such ...ipsilateral connectivity is on average a predictor of poor hand function. However, there is high variability in hand function in these children, which might be explained by the complexity of motor representations of both hands in the contralesional hemisphere. Objective. To measure the link between hand function and the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of children with USCP. Methods. We used single-pulse transcranial magnetic stimulation to measure the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of 50 children with USCP. We correlated these measures with manual dexterity of the affected hand, bimanual performance, and mirror movement strength. Results. The main and novel findings were (1) the large overlap in contralesional motor representations of the 2 hands and (2) the moderate positive associations of the size and excitability of such shared-site representations with hand function. Such functional associations were not present for overall size and excitability of representations of the affected hand. Conclusions. Greater relative overlap of the affected hand representation with the less-affected hand representation within the contralesional hemisphere was associated with better hand function. This association suggests that overlapping representations might be adaptively “yoked,” such that cortical control of the child’s less-affected hand supports that of the affected hand.
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