Effi cient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, signifi cant and sustained improvement is often diffi cult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specifi c targets (primary drivers: fl uid prescription, fi xed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit. Interventions (secondary drivers) were developed to improve these targets and included monthly feedback to departments of emergency medicine, acute medicine, and diabetes. Following our intervention, the mean average duration of DKA reduced from 22.0 hours to 10.2 hours. We demonstrate that regular audit cycles with interventions introduced through the plan-do-study-act model is an effective way to improve the management of DKA. KEYWORDS : Causes , diabetic ketoacidosis , duration till resolution , length of stay , quality improvement ABSTRACT Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis
A radicular variant of dens invaginatus (DI) is a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed. This report involves successful management of a case with guided tissue regeneration and describes the cone beam computed tomography (CBCT) characteristics of true radicular DI. A 20-year-old woman reported with recurrent swelling and pus discharge associated with her maxillary left central incisor (#21). Cone beam computed tomography (CBCT) of the region revealed #21 had an invagination in the mesial aspect of the coronal third of the root with a para radicular low-density region perforating both the cortices. A diagnosis of true radicular variant of DI was made by exclusion. The case was managed with Biodentine ® , platelet-rich fibrin and freeze-dried demineralised bone graft. A 2-year review showed that the tooth was functional with normal periodontal parameters and normal response to electric pulp sensibility test.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.