Fifteen-minute consultation: Practical use of continuous glucose monitoring.

Type 1 diabetes is a self-managed condition. Regular monitoring of blood glucose (BG) levels has been the cornerstone of diabetes management. Finger prick BG testing traditionally has been the standard method employed. More recently, rapid advancements in the development of continuous glucose monitoring devices have led to increased use of technology to help children and young people with diabetes manage their condition. These devices have the potential to improve diabetes control and reduce hypoglycaemia especially if used in conjunction with a pump to automate insulin delivery. This paper aims to provide an update on main CGM devices available and practical considerations for doctors if they come across a child with diabetes who is using one of these devices.

Management of children with type 1 diabetes during illness: a national survey.

AIM: Adequate sick-day management at home can reduce the risk of progression to diabetic ketoacidosis and admission to hospital. The aim of this project was to review the management of diabetes during illness. METHOD: The Association of Children's Diabetes Clinicians (ACDC) carried out a questionnaire survey of all paediatric diabetes units. In addition, parents of children with type 1 diabetes completed an online questionnaire. RESULTS: The survey of 127 units had a 73% response rate. Sick-day management guidelines were in place in 93%. All guidelines advised giving extra insulin during illness. In 67%, the extra dose was based on a fraction of total daily dose. 22% used units per kg body weight (U/kg). 21% used locally derived formulae to calculate extra dose of insulin. 3% of units advised only blood ketone monitoring. Although all units had an out-of-hours access policy for the families, 45% received advice from the general paediatric registrar. Only in 15%, the advice was directly from a member of the paediatric diabetes team. 680 parents completed the questionnaire. 86% reported receiving training on managing sick days. The majority (52.2%) receiving an informal session at diagnosis. 40% did not know what to do in the presence of raised blood glucose and high blood ketones. CONCLUSIONS: There was a wide variation in the practice of monitoring and advice given during illness. Both surveys highlight need for national guidance as well and to improve quality of sick-day rule education programmes for parents of children with type 1 diabetes.

Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey.

In the UK, there have been reports of significant reductions in paediatric emergency attendances and visits to the general practitioners due to COVID-19. A national survey undertaken by the UK Association of Children's Diabetes Clinicians found that the proportion of new-onset type 1 diabetes (T1D) presenting with diabetes ketoacidosis (DKA) during this COVID-19 pandemic was higher than previously reported, and there has been an increase in presentation of severe DKA at diagnosis in children and young people under the age of 18 years. Delayed presentations of T1D have been documented in up 20% of units with reasons for delayed presentation ranging from fear of contracting COVID-19 to an inability to contact or access a medical provider for timely evaluation. Public health awareness and diabetes education should be disseminated to healthcare providers on the timeliness of referrals of children with T1D.

Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003.

OBJECT: Neurosurgeons are a high-risk group for allegations of malpractice. To determine the kinds of cases and the neurosurgical practice patterns associated with the highest proportion of litigation, the authors examined the experience over a 5-year period of a major physician-owned and -administered insurance company dealing with this issue, the Medical Liability Mutual Insurance Company (MLMIC) of New York. With the MLMIC cases as a basis, the authors also analyzed areas of physician vulnerability and determined the steps neurosurgeons can take to reduce potential litigation. METHODS: All cases closed against MLMIC-insured neurosurgeons from January 1, 1999, through December 30, 2003, were reviewed. Variables examined included allegation, anatomical site, and the ultimate resolution of the case. Of the 280 cases against neurosurgeons that were closed during the study period, 156 (56%) involved the spine, 109 (39%) involved the head and/or brain, and 15 (5%) reflected miscellaneous allegations. These proportions are relatively similar to the 1999 procedural statistics for neurosurgical practices. Of the cases examined, 98 were closed with a total loss indemnity of approximately $50 million, and 182 resulted in no indemnity payment. CONCLUSIONS: A neurosurgeon's chances of being sued for malpractice are not necessarily related to the medical complexity of a particular case but rather to the types of cases with which the physician is involved. Elective spinal surgery cases constitute the majority of litigation. Neurosurgeons can take steps to reduce their vulnerability to potential litigation and to increase the odds of a successful defense.