International Perception of Perioperative Risk for Arthroplasty-Experience of the Colombian Health System.

BACKGROUND: Following a recent publication of the American Association of Hip and Knee Surgeons (AAHKS) which found that 95% of respondents address risk factors before surgery and the challenges in the ultimate access to care, the authors proposed an international collaboration in order to gain insight on how performance measures affect access to care as well as what medical and/or socioeconomic factors are considered obstacles to good outcomes from an international perspective. The aim of this study was to poll Colombia's arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. METHODS: The survey used in the AAHKS study was adapted for use in the Colombian context and distributed to the members of the Colombian Society of Hip and Knee Surgeons (SOCCAR) via a collaborative format online, and it was completed by 109 out of 163 members, a response rate of 67%. RESULTS: Overall, 67% limit or restrict surgery in patients with specific modifiable risk factors. Those factors most likely to delay or restrict treatment were malnutrition/hypoalbuminemia (95.9%), poor diabetic control (89%), and active smoking (61.6%). Limited social support was considered a liability by 82.2% of surgeons. Over 80% of respondents decide based on personal experience or literature review. Low socioeconomic status was considered a factor for limiting access by 53.4% of polled surgeons. 91.8% believe some patient populations would benefit with better access to care if payment systems provided better risk adjustment. CONCLUSION: Only 67% of Colombian arthroplasty surgeons limit or restrict elective surgery in patients with modifiable risk factors, mainly considering malnutrition and poorly controlled diabetes as a cause for restriction, and half of the surgeons consider low socioeconomic status as a limitation to arthroplasty surgery. These findings contrast dramatically to the practice patterns of American AAHKS members.

Depression and diabetic control amongst a chronic disease clinic in Trinidad

Objectives: The goals of this study were to evaluate the relationship between two outcomes; depression and uncontrolled diabetes as well as to determine the prevalence and associated factors of these two main outcomes amongst diabetics attending a chronic disease clinic in Trinidad. Research Design and Methods: A cross-sectional study utilizing a researcher-administered questionnaire with a sample of 239 diabetic patients from the St Joseph Enhanced Health Centre. The Patient Health Questionnaire was used to determine the presence of depression whilst history from patients and laboratory data from the files were used to determine the HbA1C and other factors. Results: Depressed patients had increased odds for uncontrolled diabetes (OR 8.24 95%CI 3.37-20.17 p <0.000). Mann-Whitney U testing showed significant differences between the median and variance of the HbA1C between the depressed and non-depressed group, with the depressed group having a median HbA1C 9.0% and the non-depressed group a median of 7.1%. Prevalence of depression was 23.4% in this population and 59.4% of patients had HbA1C >7.0%. Factors associated with increased odds for depression were females, unemployment, no exercise and treatment with insulin. Decreased odds for depression was associated with religious participation, frequent exercise, compliance with medication and Afro-Trinidadian ethnicity. With respect to uncontrolled diabetes, housewives and those on insulin had increased odds whilst single persons and those who comply with medications had decreased odds for uncontrolled diabetes. Conclusions: The presence of depression is associated with 8x increased odds of uncontrolled diabetes, with depressed persons having higher average HbA1Cs than non-depressed. Persons treated with insulin had increased odds of both depression and uncontrolled diabetes whilst those compliant with medication had lowered odds for both.

Diabetic retinopathy and its risk factors at the university hospital in Jamaica.

PURPOSE: To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies (UHWI). MATERIALS AND METHODS: This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus (DM), type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. RESULTS: There were 104 patients (208 eyes) recruited for this study. There were 58.6% (61/104) females (mean age 53.6 ± 11.9 years) and 41.4% (43/104) males (mean age 61.7 ± 12.1 years). Type II DM was present in 68.3% (56% were females) of the patients and Type I DM was present in 31.7% (69.7% were females). Most patients (66%) were compliant with their diabetic medications. The mean blood glucose was 11.4 ± 5.3 mmol/L. Elevated blood pressure (<130/80) was present in 82.7% of patients. The mean visual acuity was 20/160 (logMAR 0.95 ± 1.1). The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy (PDR) of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 (95% confidence intervals (CI): 1.02-3.3) for Type I DM compared to 0.74 (95% CI: 0.55-0.99) for Type II DM. PDR was more prevalent in females (χ(2), P = 0.009) in both Type I and II DM. CONCLUSIONS: Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control.