Objective To assess the relationship between vitamin D status and diabetic retinopathy Methods A clinic-based, cross-sectional study was conducted at Emory University. A total of 221 subjects were classified into five groups based on diabetes status and retinopathy findings: no diabetes or ocular disease (n = 47), no diabetes with ocular disease (n = 51), diabetes with no background diabetic retinopathy (No BDR; n = 41), nonproliferative diabetic retinopathy (NPDR; n = 40), and proliferative diabetic retinopathy (PDR; n = 42). Key exclusion criteria included type 1 diabetes and those taking > 1000 IU vitamin D daily. Subjects underwent dilated fundoscopic examination and were tested for hemoglobin A1c, serum creatinine, and 25-hydroxy-vitamin D (25(OH)D) between December 2009 and March 2010. Results Between the groups, there was no statistical difference in age, race, sex, or multivitamin use. Diabetic subjects had lower 25(OH)D levels than non-diabetic subjects (22.9 ng/ml versus 30.3 ng/ml, p<0.001). The mean 25(OH)D levels were as follows: No diabetes or ocular disease = 31.9 ng/ml, No diabetes with ocular disease = 28.8 ng/ml, No BDR = 24.3 ng/ml, NPDR = 23.6 ng/ml, PDR = 21.1 ng/ml. Univariate analysis of the 25(OH)D levels demonstrated statistical significance between the study groups, race, body mass index, multivitamin use, hemoglobin A1c, serum creatinine, and estimated glomerular filtration rate. In a multivariate linear model with all potential confounders, only multivitamin use remained significant (p<0.001). Conclusions This study suggests that diabetic subjects, especially those with PDR, have lower 25(OH)D levels than those without diabetes.

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Background Communication failures are a key cause of medical errors and are particularly prevalent during handovers of patients between services. Objective To explore current perceptions of effectiveness in communicating critical patient information during admission handovers between emergency medicine (EM) residents and internal medicine (IM) residents. Methods Study design was a survey of IM and EM residents at a large urban hospital. Residents were surveyed about whether critical information was communicated during patient handovers. Measurements included comparisons between IM and EM residents about their perceptions of effective communication of key patient information and the quality of handovers. Results Ninety-three percent of EM residents (50 of 54) and 80% of IM residents (74 of 93) responded to the survey. The EM residents judged their handover performance to be better than how their IM colleagues assessed them on most questions. The IM residents reported that one-half of the time, EM residents provided organized and clear information, whereas EM residents self-reported that they did so most of the time (80%–90%). The IM residents reported that 25% of handovers were suboptimal and resulted in admission to an inappropriate level of care, and 10% led to harm or delay in care. The EM residents reported suboptimal communication was less common (5%). On the global assessment of whether the admission handover provided the information needed for good patient care, IM residents rated the quality of the handover data lower than did responding EM residents. Conclusions There are gaps in communicating critical patient information during admission handovers as perceived by EM and IM residents. This information can form the basis for efforts to improve these handovers.

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