Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking.

Preoperative optimization has not been explored comprehensively in the surgical literature, as this responsibility has often been divided among surgery, anesthesia and medicine. We developed an evidence-based clinical practice guideline to summarize existing evidence and present diagnostic and treatment algorithms for use by surgeons caring for patients scheduled to undergo major elective surgery. We focus on 3 common comorbid conditions seen across surgical specialties - anemia, hyperglycemia and smoking - as these conditions increase complication rates in patients undergoing major surgery and can be optimized successfully as soon as 6-8 weeks before surgery.

Assessing the validity of an OSCE developed to assess rare, emergent or complex clinical conditions in endocrinology & metabolism.

Background: Assessment of emergent, rare or complex medical conditions in Endocrinology and Metabolism (E&M) is an integral component of training. However, data is lacking on how this could be best achieved. The purpose of this study was to develop and administer an Objective Structured Clinical Examination (OSCE) for E&M residents, and to gather validity evidence for its use.

Improving Glycemic Control in Adults and Children With Type 1 Diabetes With the Use of Smartphone-Based Mobile Applications: A Systematic Review.

Objectives: Management of type 1 diabetes is often challenging. Smartphone mobile applications (apps) may provide additional support and help to improve glycemic control and clinical outcomes. The objectives of this study were to examine the literature evaluating the use of mobile apps (stand-alone and text messaging/feedback) in type 1 diabetes and to review top-rated mobile apps applicable to type 1 diabetes.

Using a Structured Discharge Letter Template to Improve Communication During the Transition from a Specialized Outpatient Diabetes Clinic to a Primary Care Physician.

Objective: Transition from specialists to primary care physicians is dependent on clear communication by means of a discharge letter. Primary care physicians have indicated that letters from specialists rarely contain the details they require. As part of a quality-improvement project to improve the transition from diabetes clinics to primary care physicians, a structured discharge letter template was developed to facilitate the dictation of useful letters by specialists.

The Usefulness of the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) in Predicting Dysglycemia in Women with Histories of Gestational Diabetes.

Objectives: In Canada, approximately 20% of women with gestational diabetes (GDM) are diagnosed with type 2 diabetes by 9 years postpartum; therefore, regular screening for type 2 diabetes is recommended. Diabetes risk assessment questionnaires, such as the Canadian Diabetes Risk Assessment Questionnaire (CANRISK), may be used to inform screening strategies. However, CANRISK was developed to estimate personal diabetes risk for individuals >40 years old.

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.

Implementation of a screening program to detect previously undiagnosed dysglycemia in hospitalized patients.

Objective: Many people with dysglycemia are unaware that they have the condition. We conducted a study to determine whether a screening program for hospitalized patients could identify new cases of unrecognized dysglycemia and affect the actions of attending care providers during hospitalization.

Methods: We measured A1C in 466 participants with no history of diabetes who had been admitted to hospital for coronary heart disease or elective joint replacement surgery.

An unusual case of malignancy-related hypercalcemia.

Objective: To report the case of a 28-year-old woman who presented with hypercalcemia (total calcium =4.11 mmol/L), elevated parathyroid hormone (PTH) 24.6 pmol/L, normal parathyroid hormone-related peptide 7.

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic.

Background: Continuity of care is essential for good quality diabetes management. We recently found that 46% of patients defaulted from care (had no contact with the clinic for 18 months after a follow-up appointment was ordered) in a Canadian multidisciplinary tertiary care diabetes clinic. The primary aim was to compare characteristics, diabetes processes of care, and outcomes from referral to within 1 year after leaving clinic or to the end of the follow-up period among those patients who defaulted, were discharged or were retained in the clinic.

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.