Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
- A survey of 600 Ontarians found that 43% were familiar with naturopathic medicine, with most having a positive impression. 24% had seen a naturopathic doctor, primarily seeking a natural approach to health. 41% said they were likely to see a naturopathic doctor in the next few years. 57% agreed naturopathic medicine leads to better outcomes.
Depression Involved in the Chemotherapy Induced Event-based Prospective Memor...IJEAB
The aim of this study was to investigate the relationships between depression and occurrence of chemotherapy induced prospective memory impairment in patients with breast cancer (BC).The 63 BC patients before and after chemotherapy were administered with the self-rating depression scale (SDS) and a battery of cognitive neuropsychological tests including event-based and time-based prospective memory (EBPM and TBPM, respectively) tasks. The changes in their prospective memory and cognitive neuropsychological characteristics before and after chemotherapy were compared. Compared with the scores before chemotherapy, the EBPM score exhibited a statistically significant difference after chemotherapy (t = 6.069, P < 0.01), while the TBPM score showed no significant difference (t = 1.087, P > 0.05). Further, compared with the patients without depression, the patients with depression exhibited a statistically significant difference in the EBPM score (t = -4.348, P < 0.01), while the TBPM scores did not show a statistically significant difference between the two groups (t = -1.260, P > 0.05). Post-chemotherapy, EBPM and overall cognitive functions in BC patients merged with depression were found to decline, while TBPM did not show a significant change, suggesting that the combination of chemotherapy and depression might be related with the occurrence of post-chemotherapy EBPM impairment.
This document discusses the application of precision medicine to Alzheimer's disease. It begins with background on the history and concepts of precision medicine and Alzheimer's disease. Precision medicine aims to personalize treatment based on individual characteristics like genetics and biomarkers. For Alzheimer's, precision medicine could help identify at-risk groups, understand the disease process, and develop targeted treatments. The role of genetics in precision medicine for Alzheimer's is discussed. Future directions include incorporating precision medicine into clinical trials to further advance personalized prevention and treatment of Alzheimer's disease.
Ethical issues in adult and child neurologyNeurologyKota
The document discusses various ethical issues in adult and child neurology. It begins by defining ethics and clinical ethics. It then covers subdisciplines like biomedical ethics and neuroethics. It discusses ethical theories like consequentialism, deontology, and virtue ethics. It also discusses ethical principles like respect for autonomy, non-maleficence, beneficence, justice, and more. The document covers ethical issues like informed consent, privacy, conflicts of interest, medical errors, euthanasia, and more. It also discusses ethical considerations specifically in pediatric neurology.
Dr Alison Young, Consultant Medical Oncology, Leeds Teaching Hospitals Trust
Dr Andrew Stewart, Haematologist and Lead for Acute Oncology, University Hospitals of the North Midlands
Ceri Stubbs, Clinical Lead, Velindre NHS Trust
This survey of physicians found:
- Around 5% of patients were estimated to have Intermittent Explosive Disorder (IED)
- IED was most common in younger patients aged 16-45
- Physicians want legal immunity if reporting IED patients, but are wary of legal hassles
- The majority want more patient/public education on IED from their Medical Association
This document summarizes the current best practices for the management of incidental gallbladder cancer discovered after cholecystectomy. It reviews the available literature on pathology and staging, timing and type of re-resection, and the role of adjuvant therapies. The key findings are that early stage T1a cancers often do not require additional surgery and have a very low risk of recurrence. For T1b or higher cancers, preoperative imaging and restaging is recommended followed by extended resection with lymphadenectomy. While the optimal approach remains controversial, re-resection within 4-8 weeks of initial surgery tends to have the best outcomes. Adjuvant chemotherapy may provide a benefit for higher stage or node-positive cancers but requires
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
- A survey of 600 Ontarians found that 43% were familiar with naturopathic medicine, with most having a positive impression. 24% had seen a naturopathic doctor, primarily seeking a natural approach to health. 41% said they were likely to see a naturopathic doctor in the next few years. 57% agreed naturopathic medicine leads to better outcomes.
Depression Involved in the Chemotherapy Induced Event-based Prospective Memor...IJEAB
The aim of this study was to investigate the relationships between depression and occurrence of chemotherapy induced prospective memory impairment in patients with breast cancer (BC).The 63 BC patients before and after chemotherapy were administered with the self-rating depression scale (SDS) and a battery of cognitive neuropsychological tests including event-based and time-based prospective memory (EBPM and TBPM, respectively) tasks. The changes in their prospective memory and cognitive neuropsychological characteristics before and after chemotherapy were compared. Compared with the scores before chemotherapy, the EBPM score exhibited a statistically significant difference after chemotherapy (t = 6.069, P < 0.01), while the TBPM score showed no significant difference (t = 1.087, P > 0.05). Further, compared with the patients without depression, the patients with depression exhibited a statistically significant difference in the EBPM score (t = -4.348, P < 0.01), while the TBPM scores did not show a statistically significant difference between the two groups (t = -1.260, P > 0.05). Post-chemotherapy, EBPM and overall cognitive functions in BC patients merged with depression were found to decline, while TBPM did not show a significant change, suggesting that the combination of chemotherapy and depression might be related with the occurrence of post-chemotherapy EBPM impairment.
This document discusses the application of precision medicine to Alzheimer's disease. It begins with background on the history and concepts of precision medicine and Alzheimer's disease. Precision medicine aims to personalize treatment based on individual characteristics like genetics and biomarkers. For Alzheimer's, precision medicine could help identify at-risk groups, understand the disease process, and develop targeted treatments. The role of genetics in precision medicine for Alzheimer's is discussed. Future directions include incorporating precision medicine into clinical trials to further advance personalized prevention and treatment of Alzheimer's disease.
Ethical issues in adult and child neurologyNeurologyKota
The document discusses various ethical issues in adult and child neurology. It begins by defining ethics and clinical ethics. It then covers subdisciplines like biomedical ethics and neuroethics. It discusses ethical theories like consequentialism, deontology, and virtue ethics. It also discusses ethical principles like respect for autonomy, non-maleficence, beneficence, justice, and more. The document covers ethical issues like informed consent, privacy, conflicts of interest, medical errors, euthanasia, and more. It also discusses ethical considerations specifically in pediatric neurology.
Dr Alison Young, Consultant Medical Oncology, Leeds Teaching Hospitals Trust
Dr Andrew Stewart, Haematologist and Lead for Acute Oncology, University Hospitals of the North Midlands
Ceri Stubbs, Clinical Lead, Velindre NHS Trust
This survey of physicians found:
- Around 5% of patients were estimated to have Intermittent Explosive Disorder (IED)
- IED was most common in younger patients aged 16-45
- Physicians want legal immunity if reporting IED patients, but are wary of legal hassles
- The majority want more patient/public education on IED from their Medical Association
This document summarizes the current best practices for the management of incidental gallbladder cancer discovered after cholecystectomy. It reviews the available literature on pathology and staging, timing and type of re-resection, and the role of adjuvant therapies. The key findings are that early stage T1a cancers often do not require additional surgery and have a very low risk of recurrence. For T1b or higher cancers, preoperative imaging and restaging is recommended followed by extended resection with lymphadenectomy. While the optimal approach remains controversial, re-resection within 4-8 weeks of initial surgery tends to have the best outcomes. Adjuvant chemotherapy may provide a benefit for higher stage or node-positive cancers but requires
The goal of this webinar is to educate physicians and healthcare professionals about hospice eligibility and benefits for patients with advanced cardiac disease (ACD) who have a prognosis of ≤6 months. Through evidence-based data and a review of case studies, attendees understand the benefits of advance care planning, complex modalities for high-acuity cardiac patients, how to manage symptoms, address pain and provide comfort and dignity near the end of life.
This document discusses managing care for dual eligible patients through appropriate use of hospice and palliative care. Dual eligible patients are covered by both Medicare and Medicaid and have high medical needs. Hospice provides end-of-life care through a team approach focused on comfort. It reduces costs by decreasing hospitalizations. Palliative care extends hospice principles earlier in illness for relief of symptoms. Both hospice and palliative care improve quality of life for dual eligible patients.
Rare Disease Disorders and CNS Drug Development – Paving the Way for Precisio...Medpace
This document discusses the changing landscape of clinical trials for rare central nervous system (CNS) diseases. It notes that many common CNS diseases have genetic components and can now be subdivided based on new genetic findings. Conducting clinical trials for rare CNS diseases presents challenges in identifying and enrolling small patient populations. New approaches are targeting disease pathways and mechanisms at a genetic or molecular level. Advances in delivery and monitoring of therapeutics to the CNS are also improving clinical research efforts. Successful identification and engagement of referral networks is key to recruitment and retention in rare disease studies.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Eisai developed the drug BANZEL to treat Lennox-Gastaut Syndrome, a rare and severe form of epilepsy. To effectively communicate information about appropriate use of BANZEL, Eisai used physician-level data to identify the small population of neurologists who treat LGS patients. In New Hampshire, where a data restriction law was passed, Eisai struggled to identify these neurologists and faced delays in disseminating important safety information about BANZEL. The experience demonstrated how such laws can negatively impact patient care by reducing the effectiveness and efficiency of information sharing regarding new treatment options.
February 9, 2018
In the past several years, the United States has struggled to respond to viral outbreaks, such as Ebola and Zika. There is now an awareness of the need to rapidly develop vaccines and treatments for epidemics that can quickly spread from country to country. But questions remain as how to best conduct clinical trials and development of vaccines in the context of an epidemic or outbreak.
At this panel discussion, two health policy experts examined the appropriate conduct of clinical trials during public health emergencies.
Learn more at: http://petrieflom.law.harvard.edu/events/details/clinical-trials-during-public-health-emergencies
This document discusses cardiovascular risk and adherence to treatment. It defines key terms like adherence, compliance, persistence, and non-adherence. It notes that poor adherence is a major reason for suboptimal clinical benefits. It also discusses factors that influence adherence like the medication, patient, and healthcare system. Non-adherence can increase risks of stroke, death, hospitalizations and costs. Long-term adherence to medications for conditions like hypertension and statins is often low, around 50%. Improving adherence requires addressing multiple barriers and ensuring patients are involved in treatment decisions.
The document provides an overview of psycho-oncology. It discusses the mental health consequences of cancer at diagnosis, during active treatment, and for survivors. It covers common issues like maladaptation, mental disorders, suicide, and impact on quality of life and compliance. It also reviews psychiatric side effects of cancer treatments and management approaches.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Determining Prognosis in Cancer and Non-cancer DiagnosisVITAS Healthcare
This helps physicians, nurses, case managers and social workers understand the trajectories of dying from cancer and non-cancer diagnoses, including heart, lung, kidney and liver disease, stroke, HIV/AIDS, dementia and neurodegenerative diseases. Aided by a better grasp of the decline-related domains involved in poor prognosis, disease progression and disease end stages, attendees will be better positioned to identify patients and residents who are appropriate for hospice care.
This study examined antidepressant use among 3,226 elderly patients receiving home healthcare. Over one-third of patients were taking antidepressants, including 29.15% without a documented depression diagnosis. Blacks used antidepressants less than whites even after controlling for other factors. Increased antidepressant use was associated with younger age, more disabilities, use of other psychotropics like benzodiazepines, and higher overall medication counts. The high rates of antidepressant use without depression raise questions about appropriate prescribing in this vulnerable population.
| Jose Poulose | Preventive health services by Dr jose poulose |Dr. Jose Poulose
Doctors of internal medicine concern on adult medicine and also had special study and best training focusing on the prevention and treatment of adult diseases or sickness
This randomized clinical trial compared the effects of 20% mannitol versus 3% hypertonic saline on controlling intracranial pressure in children with raised ICP due to acute CNS infection. The study found that 3% hypertonic saline was more effective at achieving the target ICP < 20 mmHg within 72 hours and resulted in better neurological outcomes, shorter duration of mechanical ventilation and PICU stay, and less severe disability compared to 20% mannitol. While hypernatremia was more common with hypertonic saline, both treatments had a similar safety profile otherwise. The study demonstrated that 3% hypertonic saline is superior to 20% mannitol for managing raised ICP in pediatric CNS
Don't miss our upcoming webinars. Subscribe today!
In part 2 of our empowerment series: Oncologist Rob Rutledge provides an overview of cancer, its treatment and how to get the best medical care in this empowering presentation. He follows with practical advice about diverse complementary treatments and techniques, and how to integrate them into your healing journey.
View the video:
https://youtu.be/8IM-okz7PSY
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
A 38-year-old woman presents with abnormally heavy menstrual bleeding. Her periods are now 10 days long compared to her normal 5 days. She has lower abdominal cramping and mild dizziness. Exam is normal. Initial testing shows a hemoglobin of 10.5 (down from 12 six months ago). Pelvic ultrasound reveals a left-sided submucosal fibroid. The patient is prescribed a course of progesterone which does not fully resolve her bleeding. She is referred for hysteroscopic or laparoscopic myomectomy to treat her symptomatic submucosal fibroid.
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
The who, what, where, why and how of end-of-life care. A continuing education webinar presented by VITAS Healthcare on March 15, 2018. For more information or future webinars, please visit: https://www.vitas.com/partners/continuing-education
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
The goal of this webinar is to educate physicians and healthcare professionals about hospice eligibility and benefits for patients with advanced cardiac disease (ACD) who have a prognosis of ≤6 months. Through evidence-based data and a review of case studies, attendees understand the benefits of advance care planning, complex modalities for high-acuity cardiac patients, how to manage symptoms, address pain and provide comfort and dignity near the end of life.
This document discusses managing care for dual eligible patients through appropriate use of hospice and palliative care. Dual eligible patients are covered by both Medicare and Medicaid and have high medical needs. Hospice provides end-of-life care through a team approach focused on comfort. It reduces costs by decreasing hospitalizations. Palliative care extends hospice principles earlier in illness for relief of symptoms. Both hospice and palliative care improve quality of life for dual eligible patients.
Rare Disease Disorders and CNS Drug Development – Paving the Way for Precisio...Medpace
This document discusses the changing landscape of clinical trials for rare central nervous system (CNS) diseases. It notes that many common CNS diseases have genetic components and can now be subdivided based on new genetic findings. Conducting clinical trials for rare CNS diseases presents challenges in identifying and enrolling small patient populations. New approaches are targeting disease pathways and mechanisms at a genetic or molecular level. Advances in delivery and monitoring of therapeutics to the CNS are also improving clinical research efforts. Successful identification and engagement of referral networks is key to recruitment and retention in rare disease studies.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Eisai developed the drug BANZEL to treat Lennox-Gastaut Syndrome, a rare and severe form of epilepsy. To effectively communicate information about appropriate use of BANZEL, Eisai used physician-level data to identify the small population of neurologists who treat LGS patients. In New Hampshire, where a data restriction law was passed, Eisai struggled to identify these neurologists and faced delays in disseminating important safety information about BANZEL. The experience demonstrated how such laws can negatively impact patient care by reducing the effectiveness and efficiency of information sharing regarding new treatment options.
February 9, 2018
In the past several years, the United States has struggled to respond to viral outbreaks, such as Ebola and Zika. There is now an awareness of the need to rapidly develop vaccines and treatments for epidemics that can quickly spread from country to country. But questions remain as how to best conduct clinical trials and development of vaccines in the context of an epidemic or outbreak.
At this panel discussion, two health policy experts examined the appropriate conduct of clinical trials during public health emergencies.
Learn more at: http://petrieflom.law.harvard.edu/events/details/clinical-trials-during-public-health-emergencies
This document discusses cardiovascular risk and adherence to treatment. It defines key terms like adherence, compliance, persistence, and non-adherence. It notes that poor adherence is a major reason for suboptimal clinical benefits. It also discusses factors that influence adherence like the medication, patient, and healthcare system. Non-adherence can increase risks of stroke, death, hospitalizations and costs. Long-term adherence to medications for conditions like hypertension and statins is often low, around 50%. Improving adherence requires addressing multiple barriers and ensuring patients are involved in treatment decisions.
The document provides an overview of psycho-oncology. It discusses the mental health consequences of cancer at diagnosis, during active treatment, and for survivors. It covers common issues like maladaptation, mental disorders, suicide, and impact on quality of life and compliance. It also reviews psychiatric side effects of cancer treatments and management approaches.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Determining Prognosis in Cancer and Non-cancer DiagnosisVITAS Healthcare
This helps physicians, nurses, case managers and social workers understand the trajectories of dying from cancer and non-cancer diagnoses, including heart, lung, kidney and liver disease, stroke, HIV/AIDS, dementia and neurodegenerative diseases. Aided by a better grasp of the decline-related domains involved in poor prognosis, disease progression and disease end stages, attendees will be better positioned to identify patients and residents who are appropriate for hospice care.
This study examined antidepressant use among 3,226 elderly patients receiving home healthcare. Over one-third of patients were taking antidepressants, including 29.15% without a documented depression diagnosis. Blacks used antidepressants less than whites even after controlling for other factors. Increased antidepressant use was associated with younger age, more disabilities, use of other psychotropics like benzodiazepines, and higher overall medication counts. The high rates of antidepressant use without depression raise questions about appropriate prescribing in this vulnerable population.
| Jose Poulose | Preventive health services by Dr jose poulose |Dr. Jose Poulose
Doctors of internal medicine concern on adult medicine and also had special study and best training focusing on the prevention and treatment of adult diseases or sickness
This randomized clinical trial compared the effects of 20% mannitol versus 3% hypertonic saline on controlling intracranial pressure in children with raised ICP due to acute CNS infection. The study found that 3% hypertonic saline was more effective at achieving the target ICP < 20 mmHg within 72 hours and resulted in better neurological outcomes, shorter duration of mechanical ventilation and PICU stay, and less severe disability compared to 20% mannitol. While hypernatremia was more common with hypertonic saline, both treatments had a similar safety profile otherwise. The study demonstrated that 3% hypertonic saline is superior to 20% mannitol for managing raised ICP in pediatric CNS
Don't miss our upcoming webinars. Subscribe today!
In part 2 of our empowerment series: Oncologist Rob Rutledge provides an overview of cancer, its treatment and how to get the best medical care in this empowering presentation. He follows with practical advice about diverse complementary treatments and techniques, and how to integrate them into your healing journey.
View the video:
https://youtu.be/8IM-okz7PSY
To learn more about CCSN, visit us at survivornet.ca
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
A 38-year-old woman presents with abnormally heavy menstrual bleeding. Her periods are now 10 days long compared to her normal 5 days. She has lower abdominal cramping and mild dizziness. Exam is normal. Initial testing shows a hemoglobin of 10.5 (down from 12 six months ago). Pelvic ultrasound reveals a left-sided submucosal fibroid. The patient is prescribed a course of progesterone which does not fully resolve her bleeding. She is referred for hysteroscopic or laparoscopic myomectomy to treat her symptomatic submucosal fibroid.
Addiction Medicine: Closing the Gap between Science and PracticeCenter on Addiction
These slides accompany CASAColumbia's report, Addiction Medicine: Closing the Gap between Science and Practice, published in June 2012, which found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment.
The who, what, where, why and how of end-of-life care. A continuing education webinar presented by VITAS Healthcare on March 15, 2018. For more information or future webinars, please visit: https://www.vitas.com/partners/continuing-education
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
This document provides information about hospice care, including statistics on where people die, myths about hospice, eligibility criteria, levels of care under the Medicare hospice benefit, and considerations for choosing a quality hospice provider. It notes that while most people hope to die at home, approximately 50% die in hospitals, but hospice allows three out of four patients to die at home. It aims to educate healthcare professionals about the benefits of hospice to provide timely, quality end-of-life care for terminally ill patients and their families.
This document provides an overview of medication safety and medication errors. It defines key terms like medical error, adverse drug events, and near misses. It discusses the scale of medication errors, estimating they occur in 5-14% of doses dispensed and 1 in 100 result in an adverse drug event. Preventable medical errors occur in over 3 million hospital admissions and outpatient visits annually in the US, resulting in over 7,000 deaths each year. Factors that contribute to medication errors include complex medication regimens and lack of communication between healthcare providers. Strategies to improve safety include using generic drug names, tailoring prescriptions to each patient, thorough medication histories, awareness of high-risk medications, and encouraging patient involvement.
This document summarizes a symposium on evidence-based medicine (EBM) focusing on diabetes care, screening, and prevention. It provides an overview of key EBM principles and resources, including the Cochrane Database of Systematic Reviews, ACP Journal Club, and MEDLINE. Measures of risk reduction like relative risk reduction, absolute risk reduction, and number needed to treat are discussed. The document also presents a hypothetical patient case of a woman newly diagnosed with diabetes and addresses related questions on screening, treatment, and prevention from an EBM perspective.
OCD and Substance Use Disorder IOCDF Conference 2020StaceyConroy3
The document discusses obsessive compulsive disorder (OCD) and substance use disorders (SUD). Around 25% of people with OCD also have a co-occurring SUD. Effective treatment of OCD and SUD requires concurrent, integrated treatment that addresses both disorders. Cognitive behavioral therapy, twelve step programs, and medication can all be part of an effective treatment plan for individuals with OCD-SUD. Assessment for SUD should be included when treating OCD patients to identify potential co-occurrence and need for integrated treatment.
PYA Principal Kent Bottles, MD, who is also Chief Medical Officer of PYA Analytics, presented before healthcare information technology (IT) professionals at the Summit of the Southeast—Driving the Future of Technology held at Nashville Music City Center, September 16-17, 2014. Dr. Bottles’ presentation covered population health.
This document discusses strategies to curb prescription drug abuse, specifically opioid abuse, in West Virginia. It notes that West Virginia has the highest drug overdose mortality rate in the US and clinicians there write a high number of opioid prescriptions. It explores reasons for high prescribing rates and discusses solutions like improving education for patients and doctors, changing financial incentives, using prescription drug monitoring programs, and following CDC guidelines for safer opioid prescribing. Alternative therapies for pain management and the role of EDIE in monitoring patients and interfacing with PDMPs are also covered. The document advocates for internal referrals to pain specialists and multidisciplinary approaches to pain care.
A presentation by Brian D Sites at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document discusses integrative oncology and comprehensive care for cancer patients. It defines integrative medicine as combining biomedical care with complementary therapies to heal the whole person - body, mind and spirit. The document notes high rates of complementary and alternative medicine use among cancer patients and barriers to discussing these therapies with oncologists. It emphasizes treating the individual patient and their disease, and the importance of lifestyle factors like diet, exercise and weight in cancer prevention and survival.
Physical monitoring in Mental Illness - Dr Sadgun BhandariDr Sadgun Bhandari
Physical monitoring in Mental Illness - Dr Sadgun Bhandari is a recognized member of the Royal College of Psychiatrists, UK and also a Fellow of the Royal College of Psychiatrists, UK.
From “Big Data” to Digital Medicine--PYA Explores Innovations in HealthcarePYA, P.C.
With reform in healthcare and advancements in technology, the future of medicine is in a state of flux. What it all means can be heard in discussions from coast-to-coast, in the halls of hospitals, at conferences, and in board rooms.
Among the thought leaders who have broached this timely subject is PYA Principal Kent Bottles, MD, who is also PYA Analytics’ Chief Medical Officer. He recently spoke at The North American Menopause Society Annual Meeting on the topic: “The Perils and Prospects of Practicing Medicine in a Digital Era.”
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
- Pharmacoepidemiology is the study of the use and effects of medications in large populations. It applies epidemiological methods to study drug effects and usage patterns in human populations.
- Several drug safety events throughout history led to the evolution and increased importance of pharmacoepidemiology, including the Elixir Sulfanilamide tragedy in 1937 and the Thalidomide crisis in the 1960s.
- Pharmacoepidemiology utilizes various study designs like case reports, case series, cross-sectional studies, cohort studies, and case-control studies to generate and test hypotheses about medication risks and benefits at a population level.
1) Electronic medical records have the potential to transform medicine by serving as a platform for clinical decision support, personalized medicine, and precision medicine approaches through integration of diverse data sources.
2) Registries built from EMR data can be used to study conditions, compare treatment effectiveness, and recruit for clinical trials, with the goal of reducing the lag time between research and practice.
3) Advances in predictive modeling, diagnostic and treatment algorithms, and artificial intelligence may help optimize clinical decision making if effectively integrated into clinical workflow and EMRs.
Personalized Medicine: Are we there yet?Reid Robison
Slides on the future of healthcare, entitled "Personalized Medicine: Are we there yet?" form a lecture given by Reid Robison, MD MBA at Brigham Young University in the College of Life Sciences in December 2014. The presentation covers the arrival of genome-guided precision medicine as well as the digital health movement and the shift towards a patient-centric, consumer-driven healthcare system.
This document summarizes key facts about hospice and palliative care in Missouri and the United States more broadly. It notes that 90 million Americans have serious illnesses that are expected to double in 25 years. Palliative care focuses on symptom control and communication to address gaps in care for these patients. Hospice represents a team approach to palliative care. Studies show hospice reduces costs and improves outcomes by focusing on patients' goals of care. The document calls for increased access to palliative care programs in Missouri through policies like training and quality programs.
A primary care physician is important for cancer survivors for several reasons:
1) Primary care physicians can provide whole person care beyond just cancer, including preventative care, management of other health conditions, and annual checkups.
2) Oncologists focus narrowly on cancer care while primary care physicians take a broader view of patient health.
3) More patients have access to primary care physicians than oncologists, and primary care physicians can help coordinate care between specialists like oncologists.
4) Establishing care with a primary care physician and having a survivorship care plan facilitates smooth transitions in care after cancer treatment is completed.
1) The document discusses challenges in end-of-life care including an aging population with complex medical needs, lack of advance care planning, and misalignment between patient values and treatment.
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2018: Ucsd choosing wisely in healthcare
1. Choosing Wisely in
Healthcare
Makes you healthy wealthy and wise.
Aboo Nasar, M.D., MPH, MBA
Medical Director Revive Rejuvenation Center, La Jolla
2. Talking Points
• 47 Million Americans 1/6 under age 65 has no health insurance
• Unpaid medical bills leading cause of personal bankruptcy
• Clinton Administration health care reform
• 2006 Healthcare cost $2.1 Trillion according to CMS 2016 $4.1 Trillion or 20%
GDP
• Life expectancy is 77 years just matching with Costa Rica, Chile
• Infant mortality rate behind Cuba
• 1/3rd of cost Administrative. Canada 16%
• It’s the Price Stupid. High administrative cost, malpractice, labor
3. Talking Points
• Average cost per day in US Hospital is $1,666
• 1/3rd to 1/5th in waste that equals to 500-700 Billion
• 1/3rd of medicine is unnecessary that leads to increase cost
• Eradication of small pox, Vaccines, Antibiotics, Nutrition, Organ Transplant
• National Survey 34% Americans believe any disease is curable with Modern
Medicine
• Cutting edge technology High tech CT, MRI, PET Scans have given us the
extra eye
• Unnecessary care 30,000 lives a year
4. • 1990 Evidence based Medicine concepts
• 1980 there were 600,00 physicians
• More doctors means more procedures
• Patients and doctors attracted to specialized care
• Medicare cost per capita $500 in 1965 to $5000 in 1995
• In 1996 Miami cost Medicare $8,414 in Minneapolis $3,341
• Last 6 months of their life highest spending region spent $14,644 to
$9,074 in lowest spending regions
• Elliott Fisher in 2000 published study showing Medicare recipients in
higher cost areas were not better off health wise
• Had increased risk of mortality
• I. Infection
• C. Complications
• E. Errors
5. • Wennberg quoted " Medical license is like a hunting license. They go out and find
enough patients to bag their limit, and their limit is set by some income target"
• " Surgical signature persists over time like a cultural transmission .like from Tampa
to Fort Myers FL back surgery up by 60%
• MI, Colorectal Cancer and Hip fracture followed for 2 yrs
• Dr. Donald Berwick published study in Annals of Internal Medicine. Highest
spending regions received 60% more care than lowest spending regions. Highest
spending areas patients were 2-6% more likely to die than least spending areas.
• IOM Report To Err is Human 98,000 deaths from medication errors. Another 90-400
K patients are harmed or killed by incorrect use of drug
• Institute of Medicine IOM 1999 report 4% of 33 Million hospital admissions that is
1.3 Million complications a year. 1/3 errors are actual negligence.
• Hospital based errors are the 8th leading cause of death.
• ADR 90,000 to 400,000
• Human Error authored by UK Psychologist James Reason complex system that
depends upon everyone body doing everything right all the time are inevitably
faced with "latent errors" accidents just waiting to happen.
• Atul Gandhi Complications, " Stakes are high, the liberties taken tremendous "
6. Fishers Paradox
• Medicare patients with the same well defined medical conditions, the same
chances of survival, and even the same socio economic status are most likely to die
in parts of the country which spends the highest Medicare dollars. Spending more
means doing more increases the chance of errors and patients hit with
complication. More days a patient stays in hospital more complex treatment he
receives the higher likelihood of adverse events.
• High spending Hospitals 75% of patients with MI received ASA
• Low spending area hospitals 83% sent home with baby ASA
• High spending hospitals 48% received flu vaccines
• Low spending hospitals 60% received flu vaccines
• Primary care physicians met better quality health indicators and less mortality rates
•
• 2003 NEJM. RAND Corporation looked at 439 Quality Indicators by Elizabeth
McGlynn
• Patients received recommended care 55% time
• Cataracts corrected 80%
• DM had appropriate test done 24%
• 1/5 patients with COPD advised to quit smoking, 1/10 received counseling
7. A Tale of Two Cities
• LA had 2.5 times more ICU beds per capita compared to Rochester Minnesota
home of Mayo Clinic
• Roemer’s Law is " A built hospital bed is a filled hospital bed"
• Boston Massachusetts 3,000 beds,
• Yale in New Haven Connecticut 978 beds
• Elderly spent 40% more time in Boston vs New Haven and 40% more likely to be
admitted to hospital
• Los Angeles elder is likely to spend 11 days in ICU vs 3.3 days in San Francisco
• Los Angeles 50 ICU beds per 1000 Medicare beneficiaries
• San Francisco 12 ICU beds per 1000 Medicare beneficiaries
• Los Angeles Medicare beneficiary $104,000 in the last 2 yrs of life and 23 days in
hospital
• San Francisco Medicare beneficiary spent $57,000 in last 2 yrs of life and 11 days in
hospital
8. Drug Disease Burden in Elderly
• Average US Senior is on 14+ drugs and medications
• 8 or more medications elevates risk for ADR by 100%
• Lower education level higher probability of 3+ psychotropics.
• Chairman of Geriatrics at Harvard Medical School, “ Any new Geriatric Syndrome
is an adverse drug reaction unless proven otherwise”
• 27% of ADE in primary care and 42% in LTC were preventable
• 2000/2001 Medical Expenditure Panel Survey PIM was $7.2 Billion
• List of PIM was published by Beers in 1991
• Non pharmacologic approach is considered superior, “ less is more approach”
• IDT approach is paramount
• Older adults are largest consumers but they are often underrepresented in clinical
trials.
9. PTSD
• P Procedures Feeding Tubes, Foley Caths
• T Tests Lipid Panels, U/A,
• S Screenings/Surveillance SSIC, PSA, PAPs
• D Smart Drugs, Antipsychotics, Statins
10. Antipsychotics and Dementia: A Time
for Restraint
Objectives:
• Estimate mortality risk associated with commonly prescribed antipsychotics
by Rebecca Rossom, et al.
Design: 5 year retrospective study.
Setting: Veteran National Healthcare Data
Participants: predominantly male, 65 years or older with diagnosis of dementia
and no other indication of antipsychotic drugs.
End Point: mortality.
11. Conclusion: Commonly prescribed doses of Haldol, Olanzapine, and
Risperidone, but not quietapine, increase 30 day mortality risk.
Results in first 30 days
Haloperidol n
= 2217 dose: 1
mg OR: 3.2
Olanzapine n
= 3384 Dose:
2.5 mg OR: 1.5
Quietapine n
= 4277 Dose: >
50 mg OR: 1.2
Risperidone n
= 8245 Dose: 1
mg OR: 1.6
12. Discussion
• No FDA approval for treatment for
behavioral symptoms.
• 60% of the VA patients were prescribed
antipsychotics, and 20% had organic
brain syndrome.
• 2005 FDA offered black box warning
(JAGS: Vol 58 June 2010).
13. • Design: population based case control study.
• Setting: U.S. general practice research database (GPRD).
• Participants: dementia with age > 65 years.
• Measurements:
• OR of CVA users vs. non users.
• Users of typical vs. atypical antipsychotics.
• Results: Adjusting confounding variables OR on CVA.
• Typical vs. no antipsychotics: 1.16
• Atypical vs. no antipsychotics: 0.62
• Conclusion: Typical antipsychotics increases the risk for CVA and the risk abates
when drugs are discontinued.
14. ADAMS Study: Aging demographics
and memory study (2002 – 2004)
• Study design: Retrospective cohort study
• Assess dementia severity
• Frequency of psychotropics
• Antipsychotics: 19.1 %
• Antidepressants: 29.1%
• Anticonvulsants: 8.8%
• Benzodiazepines: 9.8%
• 307 ADAMS participants:
• Alzheimers: 69.3%
• Vascular dementia: 17.7%
• Others 12.4%
• Findings:
• Older adults with dementia likely psychotropic use OR = 7.4
• Older adults with dementia having caregivers OR = 0.19
15. Drug-Disease Interaction: Beers Criteria
(AGS 2012 Beers Criteria, Vol 63 Jan 2015)
• Study Design: Cross-sectional study
• Settings: 15 VA community living centers
• Participants: 65 or older, with diagnosis of dementia/MCI
• History of falls, hip fracture, heart failure, PUD, CKD stage 4-5.
• Measurements: Drug-disease interaction (DDI)
• Results: 361/696 or 51.9% DDI (1 or more)
• 540 residents with dementia with DDI, antipsychotics use: 35.4%, benzodiazepines
:14.9%
• 267/696 or 67.8%.
• 50.7% who took psychoactive medications, antipsychotic use: 30.7%, SSRI 33.1%,
Anticonvulsants 25.1%
16. Regulation Agencies Impact on
Prescription Practice
• OBRA Act 87 studied on 485 bed nursing home
• Design: 12 month retrospective cohort study with review
of medications and view administrative records and
pharmacy recommendations.
• 75% of the times attempt was made to discontinue the
drugs.
17. Strategy: Reducing Antipsychotic Drugs
(SHELTER Study: Services in Health for Elderly
LTC)
• Public health policy needs to dictate decreased use of antipsychotics.
• There is no LTA recommendation for use.
• Antidepressants only if non-pharmacological measures fail (data limited).
• Algorithms: DICE
• Describe
• Investigate
• Create
• Evaluate
• Sudden changes in living condition triggers agitated behavior.
• Transitioning to adult daycare programs
• Discussion: Emotional support to patients and caregivers.
• Creative engagement program/Psychosocial activities
18. Strategy: Reducing Antipsychotic Drugs
(SHELTER Study: Services in Health for Elderly
LTC)
• Pan European INTERDEM/psychosocial intervention in 179 randomized
control trials review.
• Cognitive training and stimulation, exercise, music, reminiscence, massage,
and recreational therapy.
• Aggressive agitation stems from personal care.
• Person-centered care DVD on (eg. bathing without battle).
• Primary goal: Holistic model of well-being for patients, families and
caregivers (reduced caregiver burden).
19. Famous Business Quotes in Health care
• Henry Gadsden CEO of Merck told Fortune Magazine that he
wanted Merck to be more like chewing gum maker
Wrigley’s.” It is long to be my dream to make drugs for
healthy people so that Merck could sell to everyone”. Today
Gadsden’s dream is the major driver behind this mammoth
half a trillion drug making industry.
• Dr. Walter Willett, Professor of Epidemiology and Nutrition at
Harvard School of Public Health said” Drug companies are
extremely powerful. They put huge efforts into promoting the
benefits of these drugs. Its easier for everyone to go in this
direction. There’s no huge industry promoting smoking
cessation or healthy food”
20. Cholesterol, Statins and Longevity from Age
70-90 Years Jerusalem Longitudinal Study
• Cholesterol as a risk factor among elderly Is highly controversial
• Role of statins is also controversial
• All cause mortality data studied
• Survival was increased with Cholesterol>200mg/dl vs <200mg/dl
• Survival increased among subjects treated with statins mostly in the 80 yr range category.
• Jeremy Jacobs et al
21. PROSPER Study Prospective Study of Pravastatin in
Elderly at Risk of Vascular disease
• Evaluate the study of Pravastatin in older adults with known Vascular
disease or prevalent CV Risk factors, enrolled 5,804 patients aged
70-82 and f/u 3 years
• Pravastatin reduced the primary endpoint of CV death by 15%
• No history of CAD no reduced risk of CAD or Stroke
• No effect on all cause mortality
• Increase risk of developing cancer. By 4 years 1 extra case of
cancer for every 100 people taking a statin drug
22. Heart Protection Study
• Randomized 20,536 high risk individuals
• 5,806 were aged 70-80
• Simvastatin 40 mg/day vs placebo
• F/U period 5 yrs
• 17.8% reduction in fatal or non fatal vascular events aged
75-80
23. JUPITER Justification for the Use of Statins in Primary
Prevention, An Intervention Trial Evaluating
Rosuvastatin
• 5,695 patients aged 70 and older( mean age 74) with LDL-C<130
mg/dl, HS-CRP of 2 mg/L or greater and no prior history of CV
disease
• Rosuvastatin was associated with 39% reduction in primary
composite endpoint of first CV event, hospitalizations for USA, but
the absolute benefit was small, and the Number Needed to Treat
NNT for 1 year to prevent 1 event was 130 individuals $$$237K
• Rosuvastatin had no significant effect on all-cause mortality
24. AMDA Statement on Lipid
management in Elderly
• There is no evidence that Hypercholesterolemia or low
HDL is an important risk factor for all cause mortality,
coronary heart disease mortality, hospitalization for MI or
Unstable Angina in person older than 70 yrs. In fact,
studies show that elderly patients with lower cholesterol
have the highest mortality after adjusting other risk
factors. In addition, a less favorable risk-benefit ratio
may be seen in patients older than 85, where benefit
may be more diminished and risks from statin drugs
more increased ( cognitive impairment, falls,
neuropathy and muscle damage
25. Cholesterol Myth and Statin Dilemma
• Cholesterol and its role in Neuro transmitters, Sex hormone
• Sexual dysfunction on men by 50%
• Framingham Heart Study published in Archives of Internal
Medicine in 1993 shows higher total cholesterol correlates
with death from CVD only through age 60
• Risk of death from causes other than CAD increases with
lower Total Cholesterol after they reach 50
• Lack of Physical Activity is highly correlated with overall
mortality
26. Framingham Heart Study
• Author concludes:” Physicians should be
cautious about initiating cholesterol lowering
medications above 65-70 yrs of age
• Archives of Internal Medicine in 1999” None of
the lipid measures was associated with the risk
of MI in this population aged 65 and older”
27. 4S and LIPID Studies and CARE Studies
• Treatment with statins significantly reduced the incidence of future
MI, CAD Mortality and overall Mortality
• CARE Study average LDL 139mg/dl significant decrease in risk of
heart disease but no significant decrease in risk of death from heart
disease or overall mortality risk
• 4S Study treatment with statin in women overall mortality 12% higher
compared to placebo
• CARE Study statins in women reduces risk of heart disease but not
overall mortality
• LIPID Study failed to show protection in women
28. ALLHAT Study The Antihypertensive and Lipid
Lowering Treatment to Prevent Heart Attack Trial
• Tripling the number of people on statins neither prevented CAD nor
decreased overall mortality.
• It applies not for people age 55 to 65, with or without Diabetes, with or
without heart disease and not for LDL Cholesterol higher or lower than 130.
The only group that benefited are the African Americans who had fewer
episodes of heart disease but no fewer deaths.
• Dr. Richard Pasternak Cardiologist who wrote the editorial in JAMA
concluded, “ Physicians might be tempted to conclude that this large study
demonstrates that statins do not work; how ever it is well known they do” He
is one of the 14 authors of the NCEP Cholesterol guidelines.
• http://www.nhbli.nih.gov/guidelines/cholesterol/atp3upd04_disclose.htm
• accessed Nov,16,2004)
29. When to obtain urine cultures.
• Asymptomatic Bacteriuria: To treat or not to treat.
• Objectives: prevalence of asymptomatic bacteriuria patients
• Settings: Hem Shohen Center
• Urine cultures obtained and second cultures obtained after one week if initial cultures show 10/5 CFU/mL.
• Subjects were followed up after one year
• Asymptomatic bacteriuria repeat urine cultures every 2 months.
• Results:
• 85/196 or 43.3% Asymptomatic bacteriuria
• More bedridden 91.7 % vs. 82.1%
• Dementia 78.8% vs. 59.8%
• Incontinence of bladder 93% vs. 71.4%
• 1 year prospective observation shows bacteriuria mortality rate is 25.9% vs. 7,1 % for non-bacteriuria
• Increased functional impairment has increased mortality risk
• Increased mortality is not attributable to urinary infection.
30. Asymptomatic Bacteriuria in Elderly
Male JAGS Nov 1990
• Prospective Longitudinal Study Ambulatory men followed for
1 to 4.5 years
• Prevalence of CIB was 12%
• Gram +ve organism
• 29 men with bacteriuria and 105 non bacteriuric patients
followed with serial urine cultures
• Spontaneous resolution 22/29 or 76%
• Bacterial persistence 38%
• Bacterial Treatment no benefits
31. Asymptomatic Bacteriuria in Older
Ambulatory Women JAGS Mar 1996
• Study Design- Controlled Clinical Trial
• Objectives- Determine whether treatment of asymptomatic bacteriuria in
older ambulatory women affects subsequent UTI
• Measurements- Urine cultures every 6 months
• Results- 23 initially culture positive participants receiving antibiotic
treatment for Asymptomatic bacteriuria 9/27 were culture +ve at 6 mos
contrast to 18/27 who received no treatment or placebo. However
symptoms of UTI were more common in Antibiotic treated group.
• Conclusion- Abx therapy reduced subsequent occurrence of +ve urine
cultures, but symptoms were not reduced. Based on the study of morbidity,
studies showing no reduction in mortality, complications of abx therapy and
its cost, treatment of asymptomatic bacteriuria in older women is
contraindicated.
32. When to obtain urine cultures.
• Septicemia 83/100,000 patients in 1979 and 240/100,000 in 2000.
• 65% of the cases are patients 65 years or older.
• Antibiotics do not improve outcomes related to morbidity and mortality.
• Increased risk for:
• Drug interactions
• Adverse drug reactions (ADRs)
• Colonization with resistant bacteria
• Geriatric syndromes with chronic incontinence, lethargy, anorexia, invasive infections (No relationship)
• 11/96 or 12% patients who received antibiotics for UTI developed C. difficile colitis 3 weeks post-treatment (Rot
Janapan et al.)
• Quinolone therapy for 6 months led to febrile UTI with quinolone resistant organisms 17.5%.
• Treatment with trimethoprim/sulfamethoxazole prophylaxis for one month on post-menopausal women increased
prevalence of resistant E. coli in stool from 20% to 85%.
• Even antibiotic treatment in asymptomatic bacteriuria in young women increased risk of subsequent UTI 3 times.
• Benign colonizers transform into virulent bacteria.
• Selection of resistant pathogens increase risk for fatal outcomes and healthcare costs.
33. CDC Report on Clostridium difficile
• USA Today reports that CDC published in NEJM nearly half a million
Americans suffer from life threatening C Difficile infections
• 29,000 deaths last year
• Number of infections doubled from 2000-2010
• “ C diff infections cause immense suffering and deaths for thousands
of Americans each year” CDC Director Tom Friedman
• Colectomy done because of permanent damage to colon, per
CDC Michael Bell
• 1/3 patients had outside of hospital but 80% of them visited OP
doctors or dentist office
• Fecal Transplant for recalcitrant diarrhea.
34. Reduction of antibiotics in asymptomatic
bacteriuria (Katherine Evans Feb 2014/AMDA)
• Objective: Decrease antibiotic use of UTI by 25%
• Setting: 4 SNFs
• Two practice algorithms developed based on published guidelines.
• Clinicians ordered UA and treatment of UTI based on algorithms.
• Not meeting UTI algorithm criteria nursing staff monitored for hydration and
nonspecific changes.
• With the change of urine color and composition resident behavior was monitored.
• Results:
• ¾ facilities had at least a 25% reduction
• Conclusion: Multifactorial interventions by facility MD, patient and family education,
decrease antibiotic initiation for asymptomatic bacteriuria by more than 25%.
Continued education and support is needed.
35. Sliding scale insulin coverage (SSIC) in
long-term diabetics
• Diabetes affects 18 million Americans.
• Diabetes prevalence in nursing homes is 15-18%.
• SSIC is a reactive way in treating diabetes, increases patients’
discomfort and nursing times.
• Potential to cause hyperglycemia/hypoglycemia
• Meals are erratic
• Basal insulin/Basal + rapidly acting insulin
• Dangers of hypoglycemia: falls and falls-related injuries and
hospitalization
36. AMDA Clinical practice guidelines for
elderly diabetics
• Individualized therapy in nursing home patients
• “Although intensive treatment to control blood glucose levels is shown to reduce
diabetic complications, such treatment may not be appropriate for all individuals in
a long-term care setting.”
• To maintain the highest quality of life consideration of therapeutic and diagnostic
mortalities must be taken into account.
• Cognitive and functional status
• Severity of the disease
• Coexisting medical conditions
• Express preference
• Life expectancy
• “Clinicians caring for older adults with diabetes must involve heterogeneity into
consideration in an institutional setting and privatizing treatment goals.
37. Wise man’s sayings:
• “As you ought not to attempt to care the eyes
without the head or the head without the body,
so neither ought to attempt to cure the body
without the soul. For the part will never be well
unless the whole is well.” Plato