Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis Complications Of Diabetes Mellitus: An Examination Or Hospital-Acquired Diabetic Ketoacidosis And Severe OutpatientHypoglycemiaChloe ZimmermanFollow this and additional works at: https://elischolar.library.yale.edu/ynitdlRecommended CitationZimmerman, Chloe. ’Iatrogenic Complications Of Diabetes Me Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis tlitus: An Examination Of Hospital-Acquired Diabetic Ketoacidosis .And Severe Outpatient Hypoglycemia" (2019). yule .Medicine Uteris Digital Library.Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
3S46.https:y/elischolar.hbrar}-.yale.edu/ymtdl/3546Ihis Open Access Ihcsts IS brought to you tor free and open access by the School of xtedcinc at EllYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis ed administrator of EliSchohr - A Digital Platform for Scholarly Publishing at Yale. For more information, please contact elischdirvSytde.edu.Iatrogenic Complications of Diabetes Melhtus: All Examination of Hospital'Acquired Diabetic Ketoacidosis and Severe Outpatient HypoglycemiaA Thesis Submitted Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis to the Yale University School of Medicine 111 Partial Fulfillment of the Requirements for the Degree ofDoctor of MedicinebyChloe Olivia Zimmerman2019ALuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
bstractPatients with diabetes me Hilus aie at risk for two acute metabolic complications: severe hyperglycemia and hypoglycemia. These acute complicatYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis s vv ork IS to focus OU a subset of these complications winch arc iatrogenic, Ĩ.C., caused by medical treatment. Hospital-acquired diabetic ketoacidosis (DKA) is an iatrogenic complication as it occurs when a patient with known diabetes experiences DKA while hospitalized for other reasons. Hypoglyce Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis mia is an adv CISC effect of treatment and thus, by definition, all hypoglycemia resulting horn the use of glucose-lowering medications in rhe outpatiLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
ent setting is iatrogenic. Reducing the occurrence of these iatrogenic complications of diabetes can improve patient health outcomes and reduce costs.Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis complications, we performed two analyses to examine factors driving their occurrence.The first analysis is a retrospective chart review of hospitalized adults with diabetes who developed DKA during a hospital admission al a single local hospital. Twenty-seven patients were included m tins analysis Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis over 5 years, rhe patients were predominantly White (70.4%) and middle-aged (average age 53.4 years). Most had a documented diagnosis of type 1 diabetLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
es (59.3%) and all but 1 patient were on insulin at home. At the tune of DKA. 51.9% were on medicine or neurology services. 33.3% on surgery or ob gynYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis nsulin (11=7, 25.9%) and insulin dose reductions of 50° 0 01 gieater (n=8. 29.6%). The remaining cases were caused by steroids (11=4. 13.8%), infection (11=4. 13.8%), and acute stress associated with surgery 01 shock (11=4.13.8%).The second analysis is a retrospective analysis of factors that mediat Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis e severe hypoglycemia requiring an F.D visit or hospitalization in an insured population in California. A total of 305.310 adults with diabetes were iLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
ncluded in this analysis. Among the full cohort, the rate of severe hypoglycemia requiring an JLD V isil or hospitalization was 7.1 pci 1.000 person-yYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis he significance of these racial disparities, factors mediating these disparities were further explored. Differences in insulin use by race were not significant, and racial disparities persisted among patients on insulin. Rates of hypoglycemia among Black vs White patients on insulin were 34.72 195% Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis CT 30.09. 38.87J vs 27.14 125.38, 28.98] per 1000 pci son-years, respectively. factors mediating the racial differences in 1ÍD visits and hospitalizatLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
ions for sev ere hypogly ccrnia were investigated using literature review and clinical expert inpul and a directed acyclic graph (DAG) was created to Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis the causal impact of each proposed mediator variable by using inverse probability weighting lo estimate countcrfactual disparity measures.Together, these projects demonstrate the importance of thorough analysis of factors that mediate and precipitate iatrogenic complications, hl the case of hospita Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis l-acquired DKA, interventions targeting inappropriate insulin dosing among hospitalizedpatients with diabetes could potentially prevent over 50° Ó ofLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
cases. For severe outpatient hypoglycemia, quantifying the causal unpact of each proposed mediator variable in the DAG will reveal high-yield opportunYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis ilitate implementation of targeted prevention strategiesAcknowledgementsI would like to thank Dr Kasia Lipska for her support and mentorship over the past four years. She has generously welcomed my contributions to her research, facilitated relationships with her collaborators, and encouraged me to Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis pursue my own independent projects. I will continue to look to her for inspiration and guidance as I move forward in my medical trainingI would also lLuận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
ike to thank Dr. Andrew Karter and Margaret Wharton for then essential input on the clinical assumptions and statistical analyses in the severe outpatYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis this thesis to the patience and unwavering support of my friends and family, without whom I would not liave made it to this point.Finally. I would like to thank Yale School of Medicine for the opportunity to explore my research interests during my time hereResearch reported in this publication was s Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis upported by the National Institute on Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T35DK104689.'Luận văn thạc sĩ iatrogenic complications of diabetes mellitus an examination of hospital acquired diabetic ketoacidosis
Table of ContentsIntroduction..........................................................................1Diabetes and its Complications................Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466Iatrogenic Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine 'lhesis Digital LibrarySchool of Medicine43466IatrogenicGọi ngay
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