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INTRODUCTION: Standardized diabetes monitoring checklists is an efficient registry collection tool and diabetes care improvement aid. Aim of this study was to improve the management of diabetes according to international standards and based on Joint Action CHRODIS Recommendations and Criteria, and to improve general practitioners (GPs) awareness of importance of monitoring via diabetes checklists. POPULATION AND METHODS: Twenty-eight GPs and 1242 diabetic patients were included. GPs were divided in groups regarding the intensity of education and information provided. Quantitative analyses of diabetes quality indicators and their availability as well as qualitative study in intensive group were performed. RESULTS: Average number of patients with fulfilled checklists per GP increased from 20.2 to 30.8 (52.30%). Most GPs had positive attitude towards checklists but there is still a room for further improvement. DISCUSSION AND CONCLUSIONS: Checklists are perceived as positive initiatives by GPs; however, there are areas for further improvements. General practitioners education and feedback regarding the checklists may contribute to better monitoring of patients with diabetes.
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Checklist/standards , Diabetes Mellitus , Registries , Croatia , Humans , Practice Guidelines as TopicABSTRACT
Aim: The study aims to investigate the effects of the COVID-19 pandemic on diabetes management and diabetes patients' healthcare utilization patterns in Croatia. Methods: Using data contained in the Croatian diabetes registry (CroDiab), Central Health Information System of the Republic of Croatia (CEZIH), and the Croatian hospitalization database (BSO), indicators including the total number of registered diabetes patients, number of newly diagnosed diabetes cases, number of diabetes-related primary care visits and hospitalizations, and key diabetes control indicators were analyzed. Yearly values from 2017 until 2020 were compared. Results: The age-adjusted prevalence rate increased significantly from 2017 until 2019 (2017: 6,858/100,000; 2018: 7,053/100,000; 2019: 7,160/100,000). In 2020 the age-adjusted prevalence rate was 7,088/100,000, but the decrease was insignificant compared to 2019. The age-adjusted rate of new cases decreased from 2017 until 2019 (2017: 910/100,000; 2018: 876/100,000; 2019: 845/100,000), with a significant decrease in 2020 (692/100,000) compared to 2019. The number of diabetes panels increased from 2017 (117,676) to 2018 (131,815), with a slight decrease in 2019 (127,742) and a sharp decrease in 2020 (104,159). A similar trend was observed regarding the numbers of diabetes patients with panels, visits to primary healthcare providers for diabetes-related problems and diabetes patients who visited their primary healthcare provider. A slightly different trend was observed regarding diabetes-related hospitalizations. In 2017 there were 91,192 diabetes-related hospitalizations; the number decreased to 83,219 in 2018, increased again to 102,087 in 2019 and decreased to 85,006 in 2020. The number of hospitalized diabetes patients displayed a similar tendency. Conclusion: The COVID-19 pandemic has had a negative effect on the utilisation of healthcare by diabetes patients, which may have long-term consequences for their general health.
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Clinical trials designed to answer treatment-related questions typically compare an intervention group that receives a drug or other intervention to a control group that serves as a standard against which results of the intervention are evaluated. An observed divergence from this trend in research papers on breastfeeding led us to hypothesize that the majority of breastfeeding research designs assign breastfed children to an intervention group rather than the control group, although breastfeeding is a physiological way of feeding infants that may be considered as a general standard. Headlines and abstracts of 760 publications identified in 2 databases were checked, and a total of 68 systematic reviews were included in our review with the goal to see if breastfed children were mostly considered as the intervention or control group. Our review showed that in 79,41% of papers breastfed children were regarded as the intervention group. The results of these papers were usually presented in a manner to show breastfeeding was beneficial in comparison to formula-feeding - as if breastfeeding was a health intervention. This way of data presentation probably helps to form attitude that formula-feeding is the norm and breastfeeding an optional choice, a "superstandard" with certain health benefits. Therefore, all available studies that regard breastfeeding should be interpreted with caution. We suggest that authors, while conducting and reporting clinical trials, regard breastfed children as the control group, and non-breastfed children as the intervention group.
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Breast Feeding , Child , Female , Humans , Infant , Systematic Reviews as TopicABSTRACT
AIM: To determine the prevalence of common somatic comorbidities among coronavirus disease 2019 (COVID-19) positive patients in Croatia in the first pandemic wave, and assess the differences in clinical outcomes depending on the presence of comorbidities. METHODS: We analyzed data from patients confirmed to be SARS-CoV-2-positive from February through May 2020. The data were obtained from clinical laboratories, primary health care providers, and hospitals. Previously recorded comorbidities, including diabetes, cancer, circulatory diseases, chronic pulmonary, and kidney disease, were analyzed. RESULTS: Among 2249 patients, 46.0% were men (median age 51 years; median disease duration 27 days). Hospitalization was required for 41.8% patients, mechanical ventilation for 2.5%, while 4.7% of all patients died. Patients who died were significantly older (median 82 vs 50 years, P<0.001) with a higher prevalence of all investigated comorbidities (all p's <0.001), more frequently required mechanical ventilation (34% vs 1%, P<0.001), and had shorter length of hospital stay (median 13 vs 27 days, P<0.001) with no sex preponderance. Patients requiring mechanical ventilation were significantly older (median age 70 vs 51 years, P<0.001), more frequently men (59.6% vs 45.7%, P=0.037), showed a higher prevalence of all comorbidities except ischemic heart and chronic kidney disease (all p's <0.001), and demonstrated a higher case-fatality rate (63.2% vs 3.2%, P<0.001). CONCLUSION: COVID-19 patients who died in the first pandemic wave in Croatia were more likely to suffer previous somatic comorbidities. This corroborates the findings of similar studies and calls for further research into the underlying disease mechanisms, hence providing ground for more efficient preventive measures.
