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1.
Diabetic Medicine ; 40(Supplement 1):102, 2023.
Article in English | EMBASE | ID: covidwho-20244547

ABSTRACT

The Royal College of Obstetrics and Gynaecology advocated replacing OGTT with HbA1c for gestational diabetes (GDM) screening for women with risk factors during the Covid-19 pandemic. HbA1c >=48mmol/mol/random plasma glucose (RPG) >=11.1mmol/l at booking indicated diabetes, and 41-47mmol/ mol/9-11mmol/ l prediabetes or possible GDM. Testing was repeated at 26 weeks if normal previously, with HbA1c >=39mmol/mol, fasting PG >=5.6mmol/l, or RPG >=9mmol/l diagnostic for GDM. A) At her clinic booking visit at 10 weeks gestation, 36 year-old South Asian female had HbA1c 55mmol/mol/RPG 9.5mmol/l suggesting undiagnosed type 2 diabetes. Initially managed with dietary advice and home blood glucose monitoring, metformin was added when self-monitored glucose above pregnancy targets (fasting and pre-meal <5.3mmol/l or 1 h post meal <7.8mmol/l) but insulin was required later. Metformin and insulin were stopped after delivery at 38 weeks with HbA1c 50mmol/mol three months postpartum, supporting the earlier diagnosis of type 2 diabetes. B) 32 year-old White Caucasian female was screened for GDM on booking at 11 weeks as BMI 38 kg/m2. HbA1c 44mmol/mol and RPG 6.9mmol/l confirmed GDM which was managed by dietary/lifestyle changes with glucose and pregnancy targets achieved until 28 weeks when metformin added. Normal delivery at 40 weeks with HbA1c 40mmol/mol three months postpartum triggered advice on long-term dietary/lifestyle changes and annual HbA1c checks. HbA1c was useful during the pandemic but most centres reverted to OGTT for GDM screening due to a significant fall in diagnoses using HbA1c >=39mmol/mol at 26 weeks. But, HbA1c testing was advantageous at booking to diagnose type 2 diabetes earlier.

2.
Diabetic Medicine ; 40(Supplement 1):99-100, 2023.
Article in English | EMBASE | ID: covidwho-20240054

ABSTRACT

HbA1c measurement is widely used for diagnosis/ management/remission of diabetes with international schemes certifying comparability. A) 75 year-old Chinese female with type 2 diabetes was admitted in April 2020 with Covid-19 and diabetic ketoacidosis. Glucose was 35mmol/l and HbA1c 150mmol/mol with previous HbA1c of 45mmol/mol on metformin and alogliptin. She was treated for ketoacidosis and once-daily Lantus introduced along with supportive management of viral illness. B) 68 year-old Afro-Caribbean with type 2 diabetes on metformin before admission, presented with new onset, jerky ballistic movements of high amplitude in right arm, 10-15 movements every 5 min. Admission glucose was >33mmol/l, ketones 1.8mmol/l and HbA1c >217mmol/ mol. Hemichorea-hemiballism, a hyperglycaemia related movement was diagnosed and insulin commenced. Glucose decreased to 8-20mmol/ l, reaching 5-15mmol/ l by time of discharge. Ballistic movements resolved when glycaemic control improved with HbA1c 169mmol/mol, 25 days after discharge. C) Several days before admission, a female with diabetes over 20 years required attention from paramedics on four occasions for hypoglycaemia. Months beforehand metformin was replaced by gliclazide due to chronic kidney disease with HbA1c 50mmol/mol, and she was transfused six weeks before admission for microcytic anaemia. Gliclazide was discontinued and her diet modified which prevented further hypoglycaemic episodes. Variant haemoglobin, beta-thalassaemia which can overestimate glycaemia;undetected by HbA1c HPLC method, invalidated HbA1c as did the blood transfusion. These cases highlight that inadequate understanding of HbA1c can lead to acute presentations of dysglycaemia. As HbA1c accuracy can be affected by multiple factors, clinical assessment and triangulation are key to the management of such patients.

3.
Cmes-Computer Modeling in Engineering & Sciences ; 2023.
Article in English | Web of Science | ID: covidwho-20231127

ABSTRACT

The lack of modern technology in healthcare has led to the death of thousands of lives worldwide due to COVID19 since its outbreak. The Internet of Things (IoT) along with other technologies like Machine Learning can revolutionize the traditional healthcare system. Instead of reactive healthcare systems, IoT technology combined with machine learning and edge computing can deliver proactive and preventive healthcare services. In this study, a novel healthcare edge-assisted framework has been proposed to detect and prognosticate the COVID-19 suspects in the initial phases to stop the transmission of coronavirus infection. The proposed framework is based on edge computing to provide personalized healthcare facilities with minimal latency, short response time, and optimal energy consumption. In this paper, the COVID-19 primary novel dataset has been used for experimental purposes employing various classification-based machine learning models. The proposed models were validated using k cross-validation to ensure the consistency of models. Based on the experimental results, our proposed models have recorded good accuracies with highest of 97.767% by Support Vector Machine. According to the findings of experiments, the proposed conceptual model will aid in the early detection and prediction of COVID-19 suspects, as well as continuous monitoring of the patient in order to provide emergency care in case of medical volatile situation.

4.
British Journal of Dermatology ; 185(Supplement 1):151, 2021.
Article in English | EMBASE | ID: covidwho-2286423

ABSTRACT

Biological therapies are increasingly being used in dermatology to treat conditions such as psoriasis and eczema. These medications are prescribed and dispensed in secondary care;however, it is important that they are present in the patient's primary care record, as this is often used by both the primary care provider and the hospital clerking doctor when the patient presents with other health concerns. Biologics are immunosuppressive medications, and it is thus important that any practitioner treating a patient who has been prescribed them is aware of this. Using a departmental record, all patients prescribed biological therapies or subcutaneous methotrexate were identified (n = 157). Their primary care medication record was then interrogated to assess whether the biological therapy was recorded. Forty-five (29%) patients on biological therapies or subcutaneous methotrexate did not have this recorded on their general practitioner (GP) record. The most common medications not recorded were ustekinumab (n = 14) and dupilumab (n = 13). There was no clear pattern indicating that a particular GP surgery was recording these medications poorly, and the patients were cared for evenly between the dermatology consultants in the department. This brief piece of work demonstrates that there is a problem with these prescriptions being accurately recorded on the GP record. Almost one-third of patients in the department did not have their biological therapy listed on their primary care record. Practitioners must be aware that a patient is on an immunosuppressive medication, especially when diagnosing and treating infections and assessing patient priority for COVID-19 vaccination, as well as including the need to avoid live vaccines. Furthermore, the GP record was used by Welsh Government agencies to identify patients needing to shield during the COVID-19 pandemic. These 45 patients recognized in the study would not necessarily have been identified as potentially high risk (depending on other comorbidities) and may therefore not have been advised to shield (in line with British Association of Dermatologists guidance for self-isolation and immunosuppressed patients). To rectify this problem in the short term, each GP surgery was contacted regarding the particular patients identified and were advised to add their biological therapy to their primary care record. Discussions between primary and secondary care and pharmacy are ongoing in order to identify how to prevent this problem from continuing.

5.
Trauma Counseling Theories and Interventions for Managing Trauma, Stress, Crisis, and Disaster: Second Edition ; : 572-591, 2022.
Article in English | Scopus | ID: covidwho-2089546

ABSTRACT

This chapter describes a range of techniques and strategies to facilitate trauma recovery. Included are examples from emotional, somatic, neurobiological, relational, and cognitive approaches to trauma-informed treatment. The chapter discusses techniques that are based on Herman’s (1992/2015) three-phase model of safety/stabilization, working through, and reconnection, as well as integrative techniques based on a holistic approach to trauma recovery. These tools both empower survivors to self-regulate and to avoid retraumatization, with or without processing the trauma story through talk- or narrative therapy. Finally, individualized tools for addressing client and counselor self-care and self-regulation, shared trauma, and traumatic grief are discussed, with a special focus on trauma treatment during the global pandemic of COVID-19. © 2023 Springer Publishing Company, LLC and 2012. All rights reserved.29

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