Variation in Care of Well-Appearing Hypothermic Young Infants: A Multisite Study.

BACKGROUND AND OBJECTIVES: Numerous decision tools have emerged to guide management of febrile infants, but limited data exist to guide the care of young infants presenting with hypothermia. We evaluated the variation in care for well-appearing hypothermic young infants in the hospital and/or emergency department setting between participating sites. METHODS: This is a retrospective cohort study of well-appearing infants ≤90 days old across 9 academic medical centers from September 1, 2016 to May 5, 2021. Infants were identified via billing codes for hypothermia or an initial temperature ≤36.0°C with manual chart review performed. Primary outcomes included assessment of variation in diagnostic evaluation, disposition, empirical antimicrobial therapy, and length of stay. RESULTS: Of 14 278 infants originally identified, 739 met inclusion criteria. Significant interhospital variation occurred across all primary outcomes. Across sites, a full serious bacterial illness evaluation was done in 12% to 76% of hypothermic infants. Empirical antibiotics were administered 20% to 87% of the time. Performance of herpes simplex viral testing ranged from 7% to 84%, and acyclovir was empirically started 8% to 82% of the time. Hospital admission rates ranged from 45% to 100% of patients. CONCLUSIONS: Considerable variation across multiple aspects of care exists for well-appearing young infants presenting with hypothermia. An improved understanding of hypothermic young infants and their risk of infection can lead to the development of clinical decision tools to guide appropriate evaluation and management.

Associations between diabetes-related distress and predicted cardiovascular complication risks in patients with type 2 diabetes.

CONTEXT: Diabetes-related distress (DRD) is experienced by nearly 50% of people with diabetes at any given time in their diagnosis. The effects of low socioeconomic status (SES) and lacking access to resources can increase DRD. In addition, cardiovascular (CV) complications associated with diabetes are associated with higher DRD scores. OBJECTIVES: This study evaluated the associations between DRD and predicted CV risks in participants with type 2 diabetes. METHODS: This cross-sectional study included 234 individuals with low SES who were Medi-Cal (California version of Medicaid) beneficiaries and sought medical care at a safety-net clinic system. The Problem Areas in Diabetes (PAID) questionnaire assessed DRD levels. The United Kingdom Prospective Diabetes Study Risk Engine was utilized to predict 10-year risks for coronary heart disease (CHD), fatal CHD, stroke, and fatal stroke. A multivariate linear regression model was constructed between the two variables, including other variables to control for potential confounding factors, for assessing the associations. RESULTS: After controlling for potential confounders, participants' total PAID questionnaire scores were significantly associated with their 10-year predicted fatal CHD risks (B=0.060, 95% CI: [0.00084, 0.12], p=0.047). CONCLUSIONS: After controlling for covariates, DRD levels exhibited a significant association with increased 10-year predicted fatal CHD risks in patients with type 2 diabetes and lower SES. Screening for DRD and provision of appropriate psychosocial interventions may reduce the risks of CHD in those with type 2 diabetes.

Navigating travel with diabetes.

As the number of people who travel continues to increase, so too will the number of travelers with diabetes. This increase will come with new and more frequent requests for medical travel advice. This article equips clinicians with the tools to address patient concerns about travel and to empower patients to be prepared for emergency situations both abroad and at home. This includes encouraging patients to obtain a travel letter, bring enough supplies for the trip, and have a plan to manage time-zone changes.