P3. p 81 - 86

Question 1

Concerning C-peptide

1) Comment on what it represents
2) What is it used for
3) What information does it give the clinician

BR 87

Diabet Med 2017:30(7):803-817

Answer 1

1) C-peptide is made in the body in equal amounts to insulin and is the best endogenous measure of insulin secretion.
2) It is used to assess endogenous insulin production and see how well the beta cells are functioning to meet the demands of insulin production.
3) In addition it helps to determine whether the patient has type 1 or type 2 diabetes. Absence of C-peptide at any time confirms absolute insulin requirement and the appropriatenesss of IDDM management strategies regardles of apparent etiology.

Question 2

What is HOMA-IR ?

BR 87

Answer 2

HOMA-IR stands for homeostatic model assessment for insulin resistance.

• it is an estimate of insulin sensitivity and beta cell function based on the fasting plasma [glucose] & fasting plasma [insulin] or [c-peptide]

Question 3

What is a physical shared medical appointment ?
BR 87

Answer 3

A physical shared medical appointment is a shared medical appointment (ie >1 patient present at a time) that include the opportunity for a private physical.

Question 4

What is the Chronic Care Model ?
Who developed it ?

What two things does it center on ?
BR 87

Answer 4

The Chronic Care Model (developed by Dr Ed Wagner) is helpful in explaining the involvement of the community and health care system in chronic disease care.

It centers on:

1) An informed, activated and engaged patient and
2) A Prepared, pro-active practice team.

Question 5

What is the P-D-S-A cycle ?

What are the 4 components ?

BR 87

Answer 5

P - Plan

D - Do

S - Study

A - Act

• it is a method for creating change that includes planning, doing, studying and actiing on each incremenatal change.
• The method involves several cycles of small-scale improvments.

Question 6

What is Root cause analysis ?

When is it used ?

What does it involve ?

What tool may it use ?

BR 87, Wikipedia

Answer 6

Root cause analysis is a tool used when something goes wrong, or a “near-miss” occurs.

• it involves repeatedly asking ‘why’ to get to the root cause of an inicident and then asking ‘so what ?’ to determine the consequences of what occurred and to help reframe what’s important.
• it may use a fishbone diagram and look at categories leading to the problem including: people, methods, machnes, material, environment, measurment systems, communications, policies, and paitents/customers.