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Medical Education - Research Publications
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ItemNo Preview AvailableIn-hospital hyperglycaemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysisBarmanray, R ; Cheuk, N ; Fourlanos, S ; Greenberg, P ; Colman, P ; Worth, L (University of Melbourne, 2022)
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ItemNo Preview AvailablePregnancy planning in a woman with diabetes secondary to familial partial lipodystrophy due to a rare PPAR gamma gene variantGong, J ; Barmanray, R ; Nankervis, A ; Price, S ; Trainer, A ; Conn, J (International Association of the Diabetes and Pregnancy Study Groups, 2022)
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ItemNo Preview AvailableDiabetes Digital Phenotyping to Improve Documentation of Diabetes in Hospital InpatientsBarmanray, R ; Fazio, T ; Sharma, A ; Grundy, L ; KITT-THOMPSON, T ; Coote, A ; Bode, G ; PLUMB, S (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableThe Specialist Treatment of Inpatients: Caring for Diabetes (STOIC-D) Surgery Randomised Controlled Trial – Proactive Electronic-based Care Reduces Glucose and Healthcare-Associated InfectionsBarmanray, R ; Kyi, M ; Colman, P ; Rowan, L ; Raviskanthan, M ; Collins, L ; Donaldson, L ; Tsan, J ; Sun, E ; Le, M ; Worth, L ; Fourlanos, S (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableThe Diabetes IN hospital – Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19) study: the 2020 Melbourne hospital experience prior to vaccination programs and the delta variantBarmanray, R ; Gong, J ; Kyi, M ; Kevat, D ; Islam, M ; Galligan, A ; Manos, G ; Perera, N ; Adams, N ; Nursing, A ; Warren, A ; Hamblin, P ; MacIsaac, R ; Ekinci, E ; Krishnamurthy, B ; Nair, I ; Karunajeewa, H ; Buising, K ; Visvanathan, K ; Kay, T ; Fourlanos, S (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableOvernight hospital admission is associated with healthcare-associated infection but not adverse glycaemia in patients undergoing glucose monitoring in the DINGO studySun, E ; Hazara, A ; Barmanray, R ; Kyi, M ; Fourlanos, S (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableLower socioeconomic status is not associated with adverse glycaemia in hospital inpatients, The Diabetes IN-hospital: Glucose and Outcomes and Socioeconomic Status (DINGO-SES) studyHazara, A ; Sun, E ; Barmanray, R ; Kyi, M ; Fourlanos, S (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableIn-hospital hyperglycaemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysisBarmanray, R ; Cheuk, N ; Fourlanos, S ; Greenberg, P ; Colman, P ; Worth, L (Australian Diabetes Society, 2022)
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ItemNo Preview AvailableGlycaemic outcomes in hospital with IDegAsp vs. BIAsp30 premixed insulinsWalt, J ; Loughran, J ; Fourlanos, S ; Barmanray, R ; Zhu, J ; Varadarajan, S (Australian Diabetes Society, 2022)BACKGROUND AND AIMS: IDegAsp (Ryzodeg 70/30), a unique premixed formulation of long-acting insulin degludec and rapid-acting insulin aspart, is increasing in use. Management of IDegAsp during hospitalisation is challenging because of degludec's ultra-long duration of action. We investigated inpatient glycaemia in patients treated with IDegAsp compared to biphasic insulin aspart (BIAsp30; Novomix30). METHODS: We performed a retrospective observational study at two hospitals assessing inpatients with type 2 diabetes treated with IDegAsp or BIAsp30 prior to and during hospital admission. Standard inpatient glycaemic outcomes were analysed based on capillary blood glucose (BG) measurements. RESULTS: We assessed 88 individuals treated with IDegAsp and 88 HbA1c-matched individuals treated with BIAsp30. Patient characteristics, including insulin dose at admission, were well matched, but the IDegAsp group had less frequent twice-daily insulin dosing than the BIAsp30 group (49% vs 87%, P < 0.001). Patient-days with BG <4 mmol/L were not different (10.6% vs 9.9%, P = 0.7); however, the IDegAsp group had a higher patient-day mean BG (10.4 (SD 3.4) vs 10.0 (3.4) mmol/L, P < 0.001), and more patient-days with mean BG >10 mmol/L (48% vs 38%, P < 0.001) compared to the BIAsp30 group. Glucose was higher in the IDegAsp group in the evening (4 PM to midnight) (11.6 (SD 4.0) vs 10.9 (4.6) mmol/L, P = 0.004), but not different at other times during the day. CONCLUSIONS: Inpatients treated with IDegAsp compared to BIAsp30 had similar hypoglycaemia incidence, but higher hyperglycaemia incidence, potentially related to less frequent twice-daily dosing. With the increasing use of IDegAsp in the community, development of hospital management guidelines for this insulin formulation is needed.
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ItemNo Preview AvailableAutomated Best Practice Alerts Improved Treatment Initiation Post Hip FractureChiang, C ; Barmanray, R ; Fazio, T ; Reijnierse, E ; Maier, A ; Sim, I-W ; EBELING, P ; Yates, C (Australian and New Zealand Bone and Mineral Society, 2021)Background: An initial fragility fracture increases risk of subsequent fracture two- to three-fold; the highest risk is evident within the first two years (1). Despite the known benefit in prompt treatment post-fracture, underutilisation of anti-resorptive medications is widespread (2). The Australian & New Zealand Hip Fracture Registry shows hip fractures, the fracture with the highest morbidity and mortality, remain sub optimally managed (3, 4). After consultation with stakeholders, Best Practice Alerts (BPA) were implemented with a built-in treatment pathway to improve Vitamin D testing, inpatient Vitamin D treatment, and pre-discharge anti-resorptive treatment initiation in patients with hip fracture. Methods: Hip fracture admission pre-BPA implementation was captured via the REStORing health of acutely unwell adulTs cohort (May 2019 – March 2020), and via electronic medical record post-BPA implementation (March - July 2021). Three BPAs were implemented: 1) order for Vitamin D testing triggered by inpatient hip fracture diagnosis, 2) order for colecalciferol triggered by vitamin D result ≤50 nmol/L AND vitamin D not already charted, 3) order for anti-resorptive treatment triggered by the discharge summary. The introduction of BPAs was supported by targeted education of stakeholders. Patient discharge medications were compared pre- and post-BPA implementation. Results: BPA fired 572 times in 75 hip fracture patients [age (mean ± SD) 79.5±8.9yrs, 61.3% female]. Parameters which did not differ pre- (n=58) and post-implementation were vitamin D testing (96.6% vs 97.3%), vitamin D level (62.5 vs 68.3 nmol/L), vitamin D treatment at discharge (75.9% vs 88%) and anti-resorptive treatment on admission (15.5% vs 20%). Anti-resorptive treatment rate on discharge increased 3-fold post-BPA implementation (21% vs 68%, p=<0.001). Conclusion: Automated BPA with an incorporated evidence-based treatment pathway provides a powerful tool to assist medical staff in overcoming the secondary fracture prevention care gap. Further fine-tuning will reduce redundant firing of BPA and avoid “alert fatigue”.