Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa

Thomas, Sarah Ε.; Mohamed, Nazeer Ahmed; Bhana, Sindeep

doi:10.7196/samj.2019.v109i6.13700

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…This is most likely due to the heightened hormonal response with increased insulin resistance that predisposes pregnant woman with diabetes to the development of DKA. Contrary to the findings of a recent South African audit of DKA in the general population by Thomas et al, 17 reporting that DKA mostly presented with moderate severity, the study found that the majority of the patients presented with mild DKA in pregnancy and 14.2% patients presented with euglycemic DKA.…”

Section: Discussioncontrasting

confidence: 99%

“…In low-to middle-income countries there are patient and healthcare system factors that are associated with a negative impact on management of diabetes, especially DKA. [14][15][16][17][18][19][20][21] Poor compliance with insulin therapy, poor prenatal attendance, and poor recognition of sick days are identifiable patient factors, but these should not influence the emergency inpatient management of DKA. [12][13][14][15][16][17][18][19][20][21] Healthcare systems are overburdened with the ever-increasing numbers of women with high-risk pregnancies, including DKA in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…In low‐ to middle‐income countries there are patient and healthcare system factors that are associated with a negative impact on management of diabetes, especially DKA 14‐21 . Poor compliance with insulin therapy, poor prenatal attendance, and poor recognition of sick days are identifiable patient factors, but these should not influence the emergency inpatient management of DKA 12‐21 .…”

Section: Discussionmentioning

confidence: 99%

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A 10‐year audit of pregnancies affected by diabetic ketoacidosis at the Pretoria Academic Complex

Maseko

Zyl

Adam

2022

Intl J Gynecology & Obste

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In the general population, 46-50 per 10 000 patients per year will experience diabetic ketoacidosis (DKA). 1 In the pregnant population, the incidence of DKA is estimated to be even lower, at 0.3 to 5 per 10 000 patients per annum. 2 DKA occurring in pregnancy is a medical emergency and is associated with increased rates of maternal and perinatal mortality and morbidity. It is a complication that is commonly seen in patients with type 1 diabetes mellitus, although it has also been reported in up to 25% of patients with type 2 diabetes mellitus and rarely in patients with gestational diabetes mellitus. 1,2 Diabetes mellitus may present with DKA for the first time in pregnant women with undiagnosed diabetes mellitus. Pregnancy is a potent risk factor for DKA because of the normal physiologic

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A 10‐year audit of pregnancies affected by diabetic ketoacidosis at the Pretoria Academic Complex

Maseko

Zyl

Adam

2022

Intl J Gynecology & Obste

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“…The recovery time was delayed by 76% among severe DKA adult patients as compared with mild DKA adult patients. This finding is supported by the study conducted in South Africa identifies severe DKA was correlated with a longer time to resolution (28). The possible reason in this study could be due to the disease pathophysiology, patients with severe DKA had more electrolyte abnormalities compared with the mild and moderate forms of the disease(48) which is supported with a study conducted in Australia showed that higher admission potassium levels are independent predictors of a slower time to resolution of DKA(30).…”

Section: Discussionsupporting

confidence: 65%

“…Even though DKA patients with appropriate treatment are expected to make a full recovery within 24 hours (9, 11, 14, 15) the resolution time of DKA is longer in African countries. For example in South Africa the average time to resolution of DKA was 21 hours; excluding severe DKA, mild and moderate DKA had an average time to resolution of 20 hours (28) and in Kenya, the median time to resolution was 59 hours(29).…”

Section: Introductionmentioning

confidence: 99%

Time to Recovery from Diabetic Ketoacidosis and its Predictors among Adult Diabetic Ketoacidosis Patients in DEBRE MARKOS Referral Hospital, North West Ethiopia, 2021: Retrospective Cohort Study

Temesgen

Miskir

Dessie

et al. 2022

Preprint

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Introduction : Diabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. With appropriate treatments, diabetic ketoacidosis patients are expected to make a full recovery within 24 hours. Previous studies did not address variables such as duration of diabetic ketoacidosis symptoms, and blood glucose level. In addition, the recovery time and its predictors of diabetic ketoacidosis in adult patients are not well known in Ethiopia. Objective : To assess time to recovery from diabetic ketoacidosis and its predictors among adult diabetic ketoacidosis patients in Debre Markos referral hospital, North West Ethiopia, 2021 Methods: A retrospective cohort study was employed among 452 records of adult diabetic ketoacidosis patients who were admitted starting from January 1, 2016 to January 1, 2021 using their medical registration number. Data were entered into Epi-data version 4.6 and analyzed using Stata version 14. A Kaplan Meier survival curve was used to estimate diabetic ketoacidosis-free survival time. In addition, a generalized log-rank test was utilized to compare diabetic ketoacidosis-free survival time between different categorical explanatory variables. Cox proportional hazards model was used to identify predictors of time to diabetic ketoacidosis recovery time. Variables with a P-value < 0.25 in the bivariable analysis were entered into a multivariable Cox proportional hazards model to identify predictors of recovery time at p<= 0.05. Result: The median time to recovery from diabetic ketoacidosis for all observations was 24 hours. Severity of diabetic ketoacidosis (AHR=0.24, 95%CI=0.16-0.35), duration of diabetic ketoacidosis (AHR=0.46, 95%CI 0.33-0.64), diabetes duration (AHR=1.74, 95%CI 1.35-2.25), and random blood sugar level (AHR=0.64, 95%CI= (0.51-0.79) were significant predictors of recovery time. Conclusion and recommendation: The median time to recovery from diabetic ketoacidosis was relatively prolonged. The hospital shall give special attention to patients with the identified predictors. Further study using a prospective design by including admission pH and admission serum potassium level is advised.

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Occupational Stress, Strain, and Coping among Nursing Personnel: A Hospital-Based Cross-sectional Study

Kowshik,

HN,

Shil

2024

Journal of Health and Allied Sciences NU

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Background Nurses are the backbone of the health care system and the largest health care force in the world. They work in multidisciplinary areas in hospitals, nursing homes, government and private sectors, and research and development, which makes them the most stressful personnel in clinical areas. Objectives This paper aims to explore occupational stress, strain, and coping among nurses working in a hospital in Bengaluru. Methodology A nonexperimental hospital-based cross-sectional study was conducted from November 2, 2022, to December 2, 2022, using a purposive sampling technique. A total of 77 nurses from different areas participated in the study. Data were collected by the researcher himself through the revised version of the Occupational Stress Inventory scale. Descriptive statistics were used with the mean, standard deviation, frequency, and percentage. To check the association, chi-square analysis was used. Results The research shows that the majority of the nurses had maladaptive stress in terms of role insufficiency, role ambiguity, role boundary, and physical environment (PE). It was observed that there was a high level of vocational strain (VS) and interpersonal strain with an average social support system (SS) among nurses. A significant association was found between gender and occupational role questionnaire (ORQ) factors like PE, designation of the nurse and ORQ in the area of responsibility, and PE of the working area. In the personal strain questionnaire factor, VS was significantly associated with gender. Furthermore, a significant association was also found between gender and personal resources questionnaire factors like self-care coping and SS coping skills. Conclusion Our data suggested a moderate to high level of occupational stress with less SS among nurses. Consequently, it is imperative for health care organizations to acknowledge the existence of occupational stress and collaborate toward devising a resolution, enabling nurses to provide patients with optimal care.

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Audit of diabetic ketoacidosis management at a tertiary hospital in Johannesburg, South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 5 publications

References 18 publications

A 10‐year audit of pregnancies affected by diabetic ketoacidosis at the Pretoria Academic Complex

A 10‐year audit of pregnancies affected by diabetic ketoacidosis at the Pretoria Academic Complex

Time to Recovery from Diabetic Ketoacidosis and its Predictors among Adult Diabetic Ketoacidosis Patients in DEBRE MARKOS Referral Hospital, North West Ethiopia, 2021: Retrospective Cohort Study

Occupational Stress, Strain, and Coping among Nursing Personnel: A Hospital-Based Cross-sectional Study

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