Evaluating antenatal breastmilk expression outcomes: a scoping review.

Background: Antenatal breastmilk expression (aBME) is recommended by some healthcare providers to improve lactation, breastfeeding, and newborn outcomes, particularly for women with diabetes as they face unique challenges with breastfeeding. However, there is limited evidence of the potential harms and benefits of this practice. Our objective was to conduct a scoping review to map the literature describing maternal and newborn outcomes of aBME.

Maternal and newborn outcomes of antenatal breastmilk expression: a scoping review protocol.

Introduction: Mothers with diabetes face unique challenges associated with breastfeeding initiation and maintenance. Antenatal breastmilk expression (BME) may be suggested to mothers, including mothers with diabetes, to improve breastfeeding, maternal, and infant outcomes postpartum. However, there have been few evaluations of the potential harms and benefits of this practice.

Patient Perspectives on Managing Type 1 Diabetes During High-Performance Exercise: What Resources Do They Want?

Objective: Athletes with type 1 diabetes face unique challenges that make it difficult for health care providers to offer concise recommendations for diabetes management. Moreover, little is known about patient preferences for diabetes management during high-level and competitive exercise. We undertook a qualitative study to understand patient perspectives on managing type 1 diabetes during exercise.

Evaluation of an electronic consultation service in psychiatry for primary care providers.

Background: This study explores the effectiveness of an electronic consultation (eConsult) service between primary care providers and psychiatry, and the types and content of the clinical questions that were asked.

Methods: This is a retrospective eConsult review study. All eConsults directed to Psychiatry from July 2011 to January 2015 by Primary care providers were reviewed.

Using Clinical Questions Asked by Primary Care Providers Through eConsults to Inform Continuing Professional Development.

Introduction: Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults.

Offering eConsult to Family Physicians With Patients on a Pain Clinic Wait List: An Outreach Exercise.

Wait times for many chronic pain programs in Canada range from 6 months to 2 years. This project sought to determine the interest of primary care providers (PCPs) in using an electronic consult system for patient(s) waiting for a pain consultation. This cross-sectional study was conducted at the pain clinic of a Canadian tertiary academic health sciences center.

Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby.

Obesity is common in women of childbearing age, and management of this population around the time of pregnancy involves specific challenges. Weight and medical comorbidities should be optimized both before and during pregnancy. During pregnancy, gestational weight gain should be limited, comorbidities should be appropriately screened for and managed, and fetal health should be monitored.

Unique Educational Opportunities for PCPs and Specialists Arising From Electronic Consultation Services.

Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.

eCONSULTS TO ENDOCRINOLOGISTS IMPROVE ACCESS AND CHANGE PRIMARY CARE PROVIDER BEHAVIOR.

Objective: To describe the impact of an eConsult service on access to endocrinologists along with its influence on changing primary care provider (PCP) course of action and referral behaviors.

Methods: Established in 2011, the Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to endocrinologists by PCPs between April 15, 2011 and January 31, 2015.

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes.

Background: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery.

Methods: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009.

Obstetric healthcare providers' perceptions of communicating gestational weight gain recommendations to overweight/obese pregnant women.

Background: Gestational weight gain (GWG) is a major risk factor of poor pregnancy outcomes. Obese pregnant women frequently report bias and discrimination when dealing with healthcare providers (HCPs). Effective communication of GWG recommendations may impact risks.

An assessment of patient information channels and knowledge of physical activity and nutrition during pregnancy.

Background: Excessive weight gain during pregnancy increases the risk for obesity in mother and child. Healthy eating and physical activity may help prevent excessive gestational weight gain and minimize offspring risk of developing obesity, diabetes and cardiovascular disease. Our goal was to determine the information channels used by pregnant women to obtain information on nutrition and exercise.

Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health.

Postpartum thyroiditis is a potentially destructive lymphocytic thyroiditis occurring in approximately 8% of the pregnant population, making it the most common endocrine disorder associated with pregnancy. This autoimmune thyroid disorder is precipitated by the postpartum immunological rebound that follows the partial immunosuppression of pregnancy, in individuals already at risk of autoimmune thyroid disease. The manifestations of postpartum thyroiditis are usually not present at the six-week postpartum visit and thus it is important that all physicians be aware of the risks, presentation and intervention required for this common disorder.

Pregnancy outcomes in diabetes subtypes: how do they compare? A province-based study of Ontario, 2005-2006.

Objective: To ascertain differences in pregnancy outcomes between women with diabetes subtypes (type 1 [DM1], type 2 [DM2], women with gestational [GDM])] and non-diabetic women within a large Canadian population.

Methods: We performed a retrospective multi-cohort analysis of all obstetrical deliveries that occurred in the province of Ontario between April 1, 2005, and March 31, 2006. Data were extracted from the Ontario Niday Perinatal Database.

Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial.

Objective: Women with previous gestational diabetes mellitus rarely receive the recommended 2-hour oral glucose tolerance test (OGTT) after delivery. We sought to determine whether postal reminders to be sent after delivery to a patient, her physician, or both would increase screening rates.

Study Design: Patients were assigned randomly to 4 groups: reminders sent to both physician and patient, to physician but not patient, or to patient but not physician or no reminders were sent.

Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies.

In utero hyperglycemia has been associated with insulin resistance (IR) in children; however, there are limited data in low-risk populations. The purpose of this study was to describe the prevalence of metabolic markers of IR in a primarily Caucasian cohort of gestational diabetes mellitus (GDM) offspring aged 7-11 yr (mean 9.1) and to correlate offspring with maternal indexes.

Use of low molecular weight heparin in acute venous thromboembolic events in pregnancy.

Objective: To compare the maternal and neonatal outcomes arising from the use of low molecular weight heparin (LMWH) or unfractionated heparin (UFH) in the treatment of acute venous thromboembolism (VTE) in pregnancy.

Study Design: A retrospective review of the charts of all women treated for acute VTE in pregnancy at the Ottawa Hospital from January 1990 to December 1999.

Results: Twenty-three cases were identified, of which 11 were treated with LMWH and 12 with UFH.