Medicine (RMH) - Research Publications

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    Longitudinal Digital Glucometric Benchmarking to Evaluate the Impact of Institutional Diabetes Care Initiatives in Adults With Diabetes Mellitus Over the 2016-2020 Period.
    Barmanray, RD ; Kyi, M ; Colman, PG ; Fourlanos, S (SAGE Publications, 2022-11-22)
    BACKGROUND: While glucometric benchmarking has been used to compare glucose management between institutions, the value of longitudinal intra-institution benchmarking to assess quality improvement changes is not established. METHODS: A prospective six-month observational study (October 2019-March 2020 inclusive) of inpatients with diabetes or newly detected hyperglycemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Networked blood glucose (BG) meters were used to collect capillary BG levels. Outcomes were measures of glycemic control assessed by mean and threshold glucometric measures and comparison with published glucometric benchmarks. Intra-institution comparison was over the 2016-2020 period. RESULTS: In all, 620 admissions (588 unique individuals) met the inclusion criteria, contributing 15 164 BG results over 4023 admission-days. Compared with the 2016 cohort from the same institution, there was increased BG testing (3.8 [SD = 2.2) vs 3.3 [SD = 1.7] BG measurements per patient-day, P < .001), lower mean patient-day mean glucose (PDMG; 8.9 mmol/L [SD = 3.2] vs 9.5 mmol/L [SD = 3.3], P < .001), and reduced mean and threshold measures of hyperglycemia (P < .001 for all). Comparison with institutions across the United States revealed lower incidence of mean PDMG >13.9 or >16.7 mmol/L, and reduced hypoglycemia (<3.9, <2.8, and <2.2 mmol/L), when compared with published benchmarks from an earlier period (2009-2014). CONCLUSIONS: Comprehensive digital-based glucometric benchmarking confirmed institutional quality improvement changes were followed by reduced hyperglycemia and hypoglycemia in a five-year comparison. Longitudinal glucometric benchmarking enables evaluation and validation of changes to institutional diabetes care management practices.
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    In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): systematic review and meta-analysis of observational studies prior to COVID-19
    Barmanray, RD ; Cheuk, N ; Fourlanos, S ; Greenberg, PB ; Colman, PG ; Worth, LJ (BMJ PUBLISHING GROUP, 2022-07)
    The objective of this review was to quantify the association between diabetes, hyperglycemia, and outcomes in patients hospitalized for community-acquired pneumonia (CAP) prior to the COVID-19 pandemic by conducting a systematic review and meta-analysis. Two investigators independently screened records identified in the PubMed (MEDLINE), EMBASE, CINAHL, and Web of Science databases. Cohort and case-control studies quantitatively evaluating associations between diabetes and in-hospital hyperglycemia with outcomes in adults admitted to hospital with CAP were included. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale, effect size using random-effects models, and heterogeneity using I2 statistics. Thirty-eight studies met the inclusion criteria. Hyperglycemia was associated with in-hospital mortality (adjusted OR 1.28, 95% CI 1.09 to 1.50) and intensive care unit (ICU) admission (crude OR 1.82, 95% CI 1.17 to 2.84). There was no association between diabetes status and in-hospital mortality (adjusted OR 1.04, 95% CI 0.72 to 1.51), 30-day mortality (adjusted OR 1.13, 95% CI 0.77 to 1.67), or ICU admission (crude OR 1.91, 95% CI 0.74 to 4.95). Diabetes was associated with increased mortality in all studies reporting >90-day postdischarge mortality and with longer length of stay only for studies reporting crude (OR 1.50, 95% CI 1.11 to 2.01) results. In adults hospitalized with CAP, in-hospital hyperglycemia but not diabetes alone is associated with increased in-hospital mortality and ICU admission. Diabetes status is associated with increased >90-day postdischarge mortality. Implications for management are that in-hospital hyperglycemia carries a greater risk for in-hospital morbidity and mortality than diabetes alone in patients admitted with non-COVID-19 CAP. Evaluation of strategies enabling timely and effective management of in-hospital hyperglycemia in CAP is warranted.
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    Assistive technology for diabetes management: A toolkit
    Barmanray, RD ; Kyi, M ; Fourlanos, S (Mark Allen Group, 2022-05-02)
    This article provides an up-to-date guide to the types of assistive technology designed for patients with diabetes.
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    Sex steroids and gender differences in muscle, bone, and fat
    Barmanray, RD ; YATES, CJ ; Duque, G ; Troen, BR (Elsevier, 2022)
    Sex steroids, comprising of the androgens, estrogens, and progestogens, are fundamentally important to the development of muscle, bone, and fat across the life course. Each has roles that differ between these tissues, the male and female sexes, and developmental stage. It is the differential production of sex steroids and expression of their receptors that mediates much of the pubertal development in muscle, bone, and fat, which in turn determines the typical dimorphic sexual phenotypes. It is similar to how this differential production changes over time that is responsible for much of the typical sex-specific changes seen with normal aging. This chapter considers the sex-specific production of sex steroids and their effects upon each muscle, bone, and fat. It additionally covers the developmental changes in sex steroid production, and how this contributes to age-related changes in these three tissues.
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    Optimising diabetes in hospital: the integral role of an inpatient diabetes team
    Barmanray, RD ; Kyi, M ; Fourlanos, S (WILEY, 2022-02)
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    Nursing perceptions of the importance of blood glucose monitoring in hospital wards
    Barmanray, RD ; Rowan, LM ; Tsan, J ; Dodds, AE ; Long, K ; Heinjus, D ; Kyi, M ; Fourlanos, S (MA Healthcare, 2020-07-02)
    Background/Aims: Diabetes mellitus is increasingly prevalent among hospital inpatients. Management requires regular blood glucose monitoring by nurses, yet research into nurse perceptions of glucose management importance is lacking. Methods: A 5-point Likert-scale survey was administered to 718 nurses at an Australian tertiary centre. Nurses were predominantly from acute medical wards (57%) and in the first decade of their career (66%). Results The six tested aspects of glucose monitoring were perceived as important by the majority, but the importance of timely management of abnormal glucose was rated lower by clinical nurse educators (4.33 vs 4.70, P=0.019) and by nurses with 5 or more years of experience compared with first-year nurses. Both predictors remained significant following multivariable adjustment (educator status odds ratio 0.51, P=0.043, years of nursing experience odds ratio 0.84, P=0.018). Conclusions These findings imply that concurrent nurse (re-)education in glucose management should be considered in the design and implementation of future glucose management programmes.
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    The storm that was delayed: The deterioration of an in-hospital diabetes process-of-care metric during the COVID-19 pandemic
    Barmanray, RD ; Tsan, J ; Kyi, M ; Gorelik, A ; Fourlanos, S (Mark Allen Group, 2021-07-02)
    Background/Aims Networked glucose blood monitoring has been demonstrated as a useful process of care for improving glycaemia and clinical outcomes in hospital inpatients. However, these benefits are partly reliant on the accurate entry of patients' medical record numbers by healthcare staff. This study assessed the accuracy of such data entry, comparing the periods before and after the onset of the COVID-19 pandemic. Methods This retrospective observational study analysed glucose meter medical record number entries at a large hospital in Victoria, Australia. The study period spanned from September 2019, when the networked blood glucose monitoring system was introduced, to July 2020. The proportion of inaccurate entries were presented as a percentage of the total number of entries and comparisons were made between the pre-COVID-19 and post-COVID-19 onset periods. Data were analysed using an interrupted time series methodology and presented using a Quasipoisson distribution. Results A gradual decrease in the percentage of accurate medical record number entries was observed following the introduction of the networked blood glucose monitoring system. This decline in accuracy decreased further following the onset of COVID-19, despite the hospital serving a relatively low number of patients with the virus. Conclusions The ongoing decrease in accuracy of data entry into the networked blood glucose monitoring system is thought to be a result of insufficient training and time constraints, which were exacerbated by the COVID-19 pandemic because of protocol changes and furloughed staff. It is recommended that accurate use of the networked blood glucose monitoring system is allocated more regular training in hospital wards.
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    End-of-Life Care Requires Caution with Use of Continuous Glucose Monitoring
    Wang, R ; Foskey, R ; Barmanray, R ; Le, B ; Fourlanos, S (MARY ANN LIEBERT, INC, 2022-03-01)
    Use of medical device technologies for diabetes mellitus, including continuous glucose monitoring devices, is becoming more frequently encountered in end-of-life care. Good communication is paramount to determine patient and carer preferences for if, when, and how blood glucose monitoring should occur in the end-of-life setting. We present two differing cases of how continuous glucose monitoring in an Australian setting impacted end-of-life care for the patients and their carers.
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    The Queensland Inpatient Diabetes Survey (QuIDS) 2019: the bedside audit of practice
    Barmanray, RD ; Kyi, M ; Fourlanos, S (WILEY, 2022-02-07)
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    Ambiguous medical abbreviation study: challenges and opportunities
    Holper, S ; Barmanray, R ; Colman, B ; Yates, CJ ; Liew, D ; Smallwood, D (WILEY, 2020-09)
    BACKGROUND: Healthcare workers often abbreviate for convenience, but ambiguous abbreviations may cause miscommunication, which jeopardises patient care. Robust large-scale research to quantify abbreviation frequency and ambiguity in medical documents is lacking. AIMS: To calculate the frequency of abbreviations used in discharge summaries, the proportion of these abbreviations that are ambiguous and the potential utility of auto-expansion software. METHODS: We designed a software programme to extract all instances of abbreviations from every General Medical Unit discharge summary from the Royal Melbourne Hospital in 2015. We manually expanded abbreviations using published inventories and clinical experience, logging multiple expansions for any abbreviation if identified. Abbreviations were classified based on well defined criteria as standardised and likely to be well understood, or ambiguous. Outcome measures included the range and frequency of standardised and ambiguous abbreviations, and the feasibility of electronic auto-expansion software based on these measures. RESULTS: Of the 1 551 537 words analysed from 2336 documents, 137 997 (8.9%) were abbreviations with 1741 distinct abbreviations identified. Most abbreviations (88.7%) had a single expansion. The most common abbreviation was PO (per os/orally), followed by BD (bis in die/twice daily) and 68.1% of abbreviations were standardised, largely pertaining to pathology/chemicals. This meant, however, that a large proportion (31.9%) of abbreviations (2.8% of all words) were ambiguous. The most common ambiguous abbreviation was Pt (patient/physiotherapy), followed by LFT (liver function test/lung function test). CONCLUSIONS: Close to one-third of abbreviations used in general medical discharge summaries were ambiguous. Electronic auto-expansion of ambiguous abbreviations is likely to reduce miscommunication and improve patient safety.