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Diabetes in long term care

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https://www.readbyqxmd.com/read/29019269/the-burden-of-severe-hypoglycemia-in-type-1-diabetes
#1
Jieruo Liu, Rosa Wang, Michael L Ganz, Yurek Paprocki, Doron Schneider, James Weatherall
AIMS: Approximately 1.25 million people in the United States have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body's inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study's objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin...
October 11, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29018299/provision-of-medication-therapy-management-by-pharmacists-to-patients-with-type-2-diabetes-mellitus-in-a-federally-qualified-health-center
#2
Uche Anadu Ndefo, Aisha Morris Moultry, Portia N Davis, Raven Askew
BACKGROUND: Type-2 diabetes mellitus is a complex condition for which pharmacists are well suited to improve patient outcomes by delivering medication therapy management (MTM) services. When diabetes is well controlled, patients can avoid its long-term complications, such as cardiovascular and renal diseases. This article describes an MTM pilot program that was implemented at a federally qualified health center (FQHC). METHODS: This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8%...
October 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/29017368/the-burden-of-severe-hypoglycemia-in-type-2-diabetes
#3
Jieruo Liu, Rosa Wang, Michael L Ganz, Yurek Paprocki, Doron Schneider, James Weatherall
AIMS: More than 29 million people in the United States have type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterised by a progressive deterioration of glucose control, which eventually requires insulin. Abnormally low levels of blood glucose, a feared side effect of insulin treatment, may cause severe hypoglycemia (SHO), leading to emergency department (ED) admission, hospitalization, and long-term complications; these, in turn, drive up the costs of T2DM. This study's objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impact on patients with T2DM using insulin...
October 11, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28982652/short-and-long-term-prognosis-of-patients-with-acute-heart-failure-with-and-without-diabetes-changes-over-the-last-three-decades
#4
Jan C van den Berge, Alina A Constantinescu, Hendrik J Boiten, Ron T van Domburg, Jaap W Deckers, K Martijn Akkerhuis
OBJECTIVE: We studied differences in long-term (i.e., 10 year) prognosis among patients with acute heart failure (HF) with and without diabetes over the last three decades. In addition, we investigated whether the degree of prognostic improvement in that period was comparable between patients with and without diabetes. RESEARCH DESIGN AND METHODS: This prospective registry included all consecutive patients aged 18 years and older admitted to the Intensive Coronary Care Unit with acute HF in the period of 1985-2008...
October 5, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28979104/examining-the-health-related-quality-of-life-using-eq-5d-5l-in-patients-with-four-kinds-of-chronic-diseases-from-specialist-outpatient-clinics-in-hong-kong-sar-china
#5
Richard Huan Xu, Annie Wai Ling Cheung, Eliza Lai-Yi Wong
BACKGROUND: Health-related quality of life (HRQoL) measures have been increasingly employed in the evaluation of health utility. The aim of this study was to evaluate the impact of four different kinds of chronic diseases on the HRQoL of patients from specialist outpatient clinics in Hong Kong (HK) using the 5-level EQ-5D (EQ-5D-5L) value set. PATIENTS AND METHODS: Patients who attended one of the 26 Hospital Authority's specialist outpatient clinics and met inclusion criteria were potentially sampled...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28978217/strategies-for-addressing-the-cost-of-nonadherence-in-diabetes
#6
Candis M Morello, Jan D Hirsch
Diabetes accounts for the second largest amount of avoidable healthcare costs in the United States-an estimated $24.6 billion in wasteful and avoidable spending. Diabetes is a lifelong disease that is highly dependent on patient self-management. Unfortunately, studies demonstrate that almost 50% of patients with diabetes fail to reach the glycemic goal of glycated hemoglobin <7%. Patient nonadherence poses a significant barrier to effective management of diabetes and can place a significant burden on the patient and the healthcare system, resulting in even greater increases in costs, morbidity, and mortality...
August 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28976397/-cardiac-rehabilitation-in-the-elderly-patient
#7
Bahar Boydak
As it is the case globally, cardiovascular diseases (CVD) make up the most frequent cause of death in Turkey also. Due to this fact, cardiac rehabilitation (CR) has gained a highly important role in the treatment of coronary artery diseases. In Turkey, mortality and morbidity rates among the elderly patients are significantly high. Disability due to coronary artery diseases is more frequent in the elderly compared to young patients. So, it is clear that CR has a considerable importance in this special group of patients...
September 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28973526/association-of-glycemic-control-with-reduced-risk-of-large-vessel-disease-after-more-than-50-years-of-type-1-diabetes
#8
Liane J Tinsley, Varant Kupelian, Stephanie A D'Eon, David Pober, Jennifer K Sun, George L King, Hillary A Keenan
Context: Previously we demonstrated in individuals with 50 or more years of type 1 diabetes (Medalists) that glycemic control was unrelated to diabetic complications with the exception of cardiovascular disease (CVD), contrary to what has been documented in registry-based studies. Objective: The purpose of this study is to validate these initial findings, and identify contributors to mortality on an individual level basis in a large cohort. Design: Cross-sectional and longitudinal design...
July 26, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28971631/intravitreal-ziv-aflibercept-clinical-effects-and-economic-impact
#9
Sumit Randhir Singh, Avantika Dogra, Michael Stewart, Taraprasad Das, Jay Chhablani
During the past decade, drugs that inhibit the actions of vascular endothelial growth factor (VEGF) have become standard-of-care treatment for a variety of chorioretinal vascular conditions. The off-label, intravitreal use of ziv-aflibercept (Zaltrap) has provided clinicians with an additional cost-effective drug. The commercial preparation of ziv-aflibercept contains the same aflibercept (VEGF-trap) molecule as Eylea but has a much higher osmolarity (1000 mOsm/kg vs 300 mOsm/kg). Initial concerns regarding cytotoxicity and long-term safety of intravitreal ziv-aflibercept have been largely negated after a series of publications failed to identify adverse ocular and systemic side effects...
October 3, 2017: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/28968353/long-term-effects-of-pancreas-transplantation-on-diabetic-retinopathy-and-incidence-and-predictive-risk-factors-for-early-worsening
#10
Yoon Jeon Kim, Sung Shin, Duck Jong Han, Young Hoon Kim, Joo Yong Lee, Young Hee Yoon, June-Gone Kim
BACKGROUND: Limited data are available regarding the long-term effects of pancreas transplantation on the progression of diabetic retinopathy (DR) and the incidence of and associated risk factors for early worsening of DR. METHODS: Patients who underwent successful pancreas transplantation between January 2007 and October 2015 and were followed for ≥ 1 year were consecutively enrolled. Variables regarding demographic, systemic, metabolic, and surgical factors were reviewed for each patient...
September 29, 2017: Transplantation
https://www.readbyqxmd.com/read/28966319/coronary-artery-bypass-grafting-with-arterial-conduits-in-the-elderly
#11
Francesco Nicolini, Antonella Vezzani, Giorgio Romano, Davide Carino, Matteo Ricci, Maria Vincenza Di Chicco, Tiziano Gherli
Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues...
September 30, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28964481/pediatric-pancreas-transplantation-including-total-pancreatectomy-with-islet-autotransplantation
#12
Alexander J Bondoc, Maisam Abu-El-Haija, Jaimie D Nathan
Unlike other solid-organ transplants, whole pancreas transplantation in children is relatively rare, and it occurs more frequently in the context of multivisceral or composite organ transplantation. Because children only infrequently suffer severe sequelae of type 1 diabetes mellitus, pancreas transplantation is rarely indicated in the pediatric population. More commonly, pediatric pancreas transplant occurs in the setting of incapacitating acute recurrent or chronic pancreatitis, specifically islet autotransplantation after total pancreatectomy...
August 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28959048/health-amongst-former-rugby-union-players-a-cross-sectional-study-of-morbidity-and-health-related-quality-of-life
#13
Madeleine A M Davies, Andrew D Judge, Antonella Delmestri, Simon P T Kemp, Keith A Stokes, Nigel K Arden, Julia L Newton
In the general population, physical activity is associated with improved health outcomes. However, long-term sports participation may be associated with adverse outcomes, particularly at the elite level. The aims of this study were to assess morbidity and health-related quality of life (HrQoL) amongst former rugby players, compared to an age-standardised general population sample. A cross-sectional study of former elite, male, rugby players (n = 259) was undertaken, and standardised morbidity ratios (SMR) calculated, assessing morbidity prevalence relative to English Longitudinal Study of Aging participants (ELSA, n = 5186)...
September 28, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28958013/fracture-risk-assessment-in-long-term-care-frail-development-and-validation-of-a-prediction-model
#14
Sarah D Berry, Andrew R Zullo, Yoojin Lee, Vincent Mor, Kevin W McConeghy, Geetanjoli Banerjee, Ralph B D'Agostino, Lori Daiello, David Dosa, Douglas P Kiel
Background: Strategies used to predict fracture in community-dwellers may not be useful in the nursing home (NH). Our objective was to develop and validate a model (Fracture Risk Assessment in Long-term Care [FRAiL]) to predict the 2-year risk of hip fracture in NH residents using readily available clinical characteristics. Methods: The derivation cohort consisted of 419,668 residents between May 1, 2007 and April 30, 2008 in fee-for service Medicare. Hip fractures were identified using Part A diagnostic codes...
August 31, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28955429/clinical-characteristics-and-outcomes-of-patients-with-stroke-admitted-to-three-tertiary-hospitals-in-zimbabwe-a-retrospective-one-year-study
#15
Farayi Kaseke, Aimee Stewart, Lovemore Gwanzura, James Hakim, Vasco Chikwasha
BACKGROUND: Epidemiological data on stroke in Zimbabwe are scarce and few clinical studies have been performed to date. METHODS: A retrospective review of the medical records of patients admitted for stroke during the year 2012 was performed at three tertiary hospitals. Sociodemographic data were recorded alongside with comorbidities and outcomes. Scoping over a period of one year using records of patients admitted for stroke helped to quantify and qualify the stroke problem...
June 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/28948952/efficacy-of-metformin-in-improving-glycaemic-control-perinatal-outcome-in-gestational-diabetes-mellitus-a-non-randomized-study
#16
Neeta Singh, Malti Madhu, Perumal Vanamail, Nisha Malik, Sunesh Kumar
BACKGROUND & OBJECTIVES: Gestational diabetes mellitus (GDM) can cause adverse perinatal outcome if not treated. Although insulin therapy has been the main treatment modality over decades but considering its cost and parenteral mode of administration, it does not seem to be appropriate, especially in low-resource settings. The objective of this study was to evaluate the role of metformin in GDM and know its efficacy as well as adverse effect on foetus and mother. METHODS: All pregnant women with GDM who were not controlled on medical nutrition therapy and required metformin therapy were included in the study...
May 2017: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/28948451/a-diagnostic-approach-to-stroke-in-young-adults
#17
REVIEW
Christopher A Stack, John W Cole
Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28947621/the-role-of-the-quality-and-outcomes-framework-in-the-care-of-long-term-conditions-a-systematic-review
#18
Lindsay Jl Forbes, Catherine Marchand, Tim Doran, Stephen Peckham
BACKGROUND: Improving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients. AIM: To examine the evidence that the QOF has improved quality of care for patients with long-term conditions. DESIGN AND SETTING: This was a systematic review of research on the effectiveness of the QOF in the UK...
September 25, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28943384/infection-and-malignancy-outweigh-cardiovascular-mortality-in-kidney-transplant-recipients-post-hoc-analysis-of-the-favorit-trial
#19
Larry A Weinrauch, John A D'Elia, Matthew R Weir, Suphamai Bunnapradist, Peter V Finn, Jiankang Liu, Brian Claggett, Anthony P Monaco
INTRODUCTION: Now that long term survival after successful renal transplantation is no longer limited by excessive cardiovascular risk, the primary care physician should consider that infection and malignancy are leading non-cardiovascular causes of death even in the recipient with diabetes. METHODS: We accessed the NIH sponsored FAVORIT study population (4010 renal transplant recipients with elevated homocysteine levels) studied to determine whether folate and B12 supplementation would reduce cardiovascular endpoints...
September 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28942790/glucagon-like-peptide-1-receptor-agonists-a-class-update-for-treating-type-2-diabetes
#20
REVIEW
Julie A Lovshin
Current management options for treating type 2 diabetes are diverse. Many different classes of antidiabetes therapies are used in clinic, and several new candidates are in late-phase clinical trial. This therapeutic abundance is a windfall for patients because it facilitates individualized patient care. Evidence-based positioning of these agents is challenging, however, requiring comprehensive and balanced familiarity with each drug class. In this review, I provide a clinical update of glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of incretin-based, injectable antidiabetes therapies which improve fasting and postprandial blood glucose control through glucose-dependent pancreatic islet cell hormone secretion without significant risks for hypoglycemia...
October 2017: Canadian Journal of Diabetes
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