ABSTRACT
Members of the College of Physicians and Surgeons of Ontario Endocrinology and Metabolism Peer Review Network have been involved in a quality improvement project to help standardize the peer assessment of physicians practicing in endocrinology and metabolism. This has included developing state-of-the-art summaries of common endocrine problems by Canadian experts in endocrinology and metabolism. These tools have been developed in response to the educational needs, as identified by peer reviewers, of practicing endocrinologists in Ontario. These pedagogical tools aim not only to standardize the documentation of the clinical performance of endocrinologists but also to make the process more transparent and to improve the quality of patient care in Ontario. This article summarizes the project and also provides the tools developed for the endocrinology and metabolism section of the College of Physicians and Surgeons of Ontario.
Subject(s)
Critical Care/standards , Endocrine System Diseases , Endocrinology/methods , Metabolic Diseases , Peer Review/standards , Quality Improvement , Diagnosis, Differential , Endocrine System Diseases/diagnosis , Endocrine System Diseases/therapy , Endocrinology/standards , Humans , Metabolic Diseases/diagnosis , Metabolic Diseases/therapySubject(s)
Accidents, Traffic/legislation & jurisprudence , Automobile Driving , Hypoglycemia/complications , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Liability, Legal , Accidents, Traffic/prevention & control , Adult , Diabetes Complications , Diabetes Mellitus/drug therapy , Diabetes Mellitus/physiopathology , Humans , Hypoglycemia/etiology , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Male , Risk Factors , Risk-TakingABSTRACT
BACKGROUND: Complications from diabetes mellitus can compromise a driver's ability to safely operate a motor vehicle, yet little is known about whether euglycemia predicts normal driving risks among adults with diabetes. We studied the association between glycosylated hemoglobin (HbA1c) and the risk of a motor vehicle crash using a population-based case control analysis. METHODS AND FINDINGS: We identified consecutive drivers reported to vehicle licensing authorities between January 1, 2005 to January 1, 2007 who had a diagnosis of diabetes mellitus and a HbA1c documented. The risk of a crash was calculated taking into account potential confounders including blood glucose monitoring, complications, and treatments. A total of 57 patients were involved in a crash and 738 were not involved in a crash. The mean HbA1c was lower for those in a crash than controls (7.4% versus 7.9%, unpaired t-test, p = 0.019), equal to a 26% increase in the relative risk of a crash for each 1% reduction in HbA1c (odds ratio = 1.26, 95% confidence interval 1.03-1.54). The trend was evident across the range of HbA1c values and persisted after adjustment for measured confounders (odds ratio = 1.25, 95% confidence interval 1.02-1.55). The two other significant risk factors for a crash were a history of severe hypoglycemia requiring outside assistance (odds ratio = 4.07, 95% confidence interval 2.35-7.04) and later age at diabetes diagnosis (odds ratio per decade = 1.29, 95% confidence interval 1.07-1.57). CONCLUSIONS: In this selected population, tighter glycemic control, as measured by the HbA1c, is associated with an increased risk of a motor vehicle crash.
