diabetic foot case presentation ppt

If hyperglycemia is detected, then a decision can be made about whether treatment is required. Natural experiment with comparison group; 11 participating providers had 698 patients; 19 nonparticipating providers had 1,300 patients. Activate your 30 day free trialto continue reading. Layerthorpe, York (UK): York Publishing Services Ltd; 2009. Manuscript selection for systematic review on the Chronic Care Model (CCM) and diabetes management in US primary care settings. When pillows are being shaken the nurse should turn away from the patient. Higher insulin doses may be needed with marked hyperglycemia due to underlying glucose toxicity. For older populations of chronic disease patients (the age group sampled in most of the reviewed studies), training programs on the use of digital technologies for diabetes self-management may reduce the anxiety and barriers to access that may currently exist (23,34). Team approach to care delivery used clinicians, nurses, and medical assistants. Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Patients used a home computer or their Nintendo Wii game system to review their electronic medical record through the My Health Record interface. Severe hypoglycemia (glucose levels < 40 mg/dL and/or with mental status changes and/or myocardial or cerebral ischemic symptoms) requires urgent management. Tokuda Y, Omata F, Tsugawa Y, et al. The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. Luna B, Feinglos MN. Although the original CCM has been critiqued for not adequately meeting the needs of diverse patient populations with diabetes (7), our systematic review supports the idea that CCM-based interventions are generally effective for managing diabetes in US primary care settings. These patients require referral to an ER for further management and likely hospital admission. Exercise is important for people with diabetes, as it is for everybody else. The model represents a well-rounded approach to restructuring medical care through partnerships between health systems and communities. Staff received training for new roles in chronic care. Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes knowledge, empowerment, quality of well-being, frequency of blood glucose self-monitoring. Process outcomes (eg, self-efficacy for disease management and clinical decision making, perceived social support, knowledge of diabetes self-care practices) are all indicators that need to be assessed. Diabetes is common, often unrecognized and associated with important adverse outcomes. Diabetes Care 2009;32(4):55966. Stress-induced hyperglycemia can result from an acute process, such as infection, pain, trauma, or vascular accident, or can be associated with pre-existing diabetes mellitus (DM) or previously unknown DM (new onset or undiagnosed). collaborate with clients These messages had links to relevant references for more in-depth information. A meta-analysis of interventions to improve care for chronic illnesses. Obstetrical Emergency in details this plan of clinical teaching. Figure. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. There is a growing literature on screening for diabetes or prediabetes in the acute care setting. At the other extreme, in an insulin-resistant patient, BG levels may fall 5 to 10 mg/dL per unit or rapid-acting insulin can be used. professional development Instituting these programs in PCP offices allowed for better communication between CDEs, PCPs, and patients, which contributed to lower HbA1c levels (1012,18,20,24); better adherence to medication and adjustment processes; and stronger support networks located in more personalized settings (10,11,1517,19,20,24). Modified Diabetes Care Profile; World Health Organization (Ten) Quality of Well-Being Index. Mean (SD) age, 65.4 (12.9) y; 99% white, 46% male. Diabetes is a major cause of heart disease and stroke among adults in the United States and is the leading cause of nontraumatic lower-extremity amputations, new cases of blindness, and kidney failure (13). In several studies, organizational leaders in health care systems initiated system-level reorganizations that facilitated more comprehensive and coordinated diabetes care. McNemar test for dichotomous data, Wilcoxon signed rank test for ordinal data, and paired, Mean change in lowering HbA1c levels was significant (. These changes improved the quality of diabetes care and rates of eye examinations, and were associated with improved HbA1c levels, blood pressure, cholesterol, and weight (19,20). Standardized Glycemic Management and Perioperative Glycemic Outcomes in Patients with diabetes mellitus who undergo same-day surgery. Interaction with the health care professional is an opportunity to recommend improving DM behaviors (avoidance of excess simple carbohydrates and calories) and adherence to pharmacologic therapy to decrease the future risk of diabetic microvascular complications, heart attack, or stroke. The same author (K.D.) Fat people always develop type 2 diabetes eventually - this is not true. Stroebel RJ, Gloor B, Freytag S, Riegert-Johnson D, Smith SA, Huschka T, et al. NICE study investigators, Finfer S, Chitlock DR, et al. The rate of fall of BG can be factored into the decision about whether a repeat insulin bolus (or boluses) is needed and how much to provide. Endocrinologists provided the telemedicine intervention, delivering these tailored messages to the primary care team for review 48 hours before the patients next scheduled visit. 2010; 87: 366-371. Diabetes Educ 2010;36(2):3019. A 2- to 3-fold greater proportion of patients reached when DSME was available at primary care practices compared to hospital-based programs. 3 In type I cryoglobulinemia, the cryoglobulins are monoclonal immunoglobulins (Igs), usually of the IgG or IgM isotypes and rarely IgA or Each issue contains a mix of peer-reviewed clinical and practice management articles that address the distinct clinical and practice management needs of those who are working in todays busy urgent care centers. N Engl J Med. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP officebased diabetes self-management education improved patient outcomes. Positive clinical outcomes have been cited as indicators of CCMs success in diabetes management (924). Diabetes is becoming more common in children and adolescents (32); Rapley and Davidson (33) have advocated for the adoption of CCM programs aimed at adolescent patients with diabetes to help bridge the gap between pediatric and adult care. Telephone: 352-217-6050. Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence, Breathlessness in pregnancy ---respiratory resasons, Resuscitation in pregnancy dr.krushna patel, Medical management of Post Partum Haemorrhage, Anesthesia for ANTEPARTUM HAEMORHHAGE (APH), Preeclampsia in pregnancy etiopathogenesis and management, Anaesthetic management of obstetric emergencies, No public clipboards found for this slide. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. Registry was used to identify patients who had not been seen in 6 months or had HbA1c levels >8%. 2011; 4: 4253-4261. Being Accessed June 12, 2012. University of Pittsburgh Medical Center provided educators with access to funding, information systems, PCPs, and hospital administration. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. This article is based on extrapolation of the most relevant literate derived from guidelines applicable to the emergency room, outpatient, perioperative, inpatient, and intensive care settings.8-18 The Endocrine Society recently published a Clinical Practice Guideline for management of hyperglycemia in hospitalized patients in the non-critical care setting.3 A detailed review of these issues is beyond the scope of this article. ], probable new onset or undiagnosed DM (type 2, type 1 or other) or confirmed new-onset or newly dehydration or electrolyte disturbance); identify patients at high risk for adverse outcomes (marked stress hyperglycemia, major co-morbid event (stroke, myocardial infarction, severe infection) and potentially identify high-risk patients with poorly controlled DM or new-onset DM who warrant arrangements for appropriate follow up. J Clin Endocrinol Metab. Enough of the problem: a review of time for health care transition solutions for young adults with a chronic illness. Treatment of diabetic ketoacidosis is beyond the scope of this article and often requires hospital admission, unless it is mild. 1. Patients from Vermont and New York primary care practices in the Vermont Diabetes Information System (VDIS). DM affects 25.8 million people in the United States, more than 7 million of whom are undiagnosed.1 The observed incidence of DM in hospitalized patients ranges from 32% to 38%, including more than 40% of patients admitted with acute coronary syndrome or congestive heart failure.2 Incidence of hyperglycemia in hospitalized patients without a history of DM is estimated to be 33% on the general medical/surgical ward and as high as 80% in patients in intensive care units (ICUs).3 Stress hyperglycemia (in nondiabetic patients) historically was felt to be physiologic and part of the natural course of acute illness not treated unless glucose levels exceeded 200mg/dL or a patient was symptomatic. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. Diagnostic records /certified fixed orthodontic courses by Indian dental acad Case Report: Heparin Induced Thrombocytopenia (HIT), PTERYGOID HAMULUS SYNDROME- A CASE REPORT, Planning,implementation and evaluation of education program on diabetes, Symptoms of Pre-Diabetes and Diabetes Prevention Tips, Eating Disorders and Type 1 Diabetes Mellitus, Dr Vivek Baliga - Chronic Disease Management In Heart Failure And Diabetes, Alphabet strategy for Diabetes Care for those Living with Diabetes, From renal failure to renal transplant updated oct 13. S.Y. WebBright light therapy has been found effective in manipulating melatonin production and the timing, effectively re-setting the circadian rhythm "body clock", and exposure to light also helps increase serotonin production.Bright light therapy is just like it sounds - exposure to intense levels of light!Green or green-blue light to be specific.Light therapy, also known as Hemoglobin A1C as a Screen for Previously Undiagnosed Prediabetes and Diabetes in an Acute-care Setting. Clinic space was modified to provide services. Assessment Of Pancreatic Hormones In Diabetes Mellitus & Non-diabetes Mellitu 14. a case study on diabetes mellitus type 1 with diabetic ketoacidosis cp in Case Presentation: Hypertension (A case on refusal of Evidence Based Medicine), Diabetes mellitus - a case presentation for SPM, R.C patel institute of pharmacutical education and research, shirpur. Delivery system design was identified as an important strategy for integrating DSME into primary care settings through addressing patient barriers to care such as accessibility to DSME and availability of staff to assist with diabetes care (10). As noted above, a normal fasting BG level is less than 100 mg/dL in a non-diabetic individual. Each database was separately searched. Objectives of Case study PresentationObjectives of Case study Presentation To share experience and knowledge with friends and supervisors. In 2010, the Centers for Disease Control and Prevention reported that 25.6 million, or 11.3%, of US adults aged 20 or older had diagnosed or undiagnosed diabetes (1). By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. Patients with known insulin-treated or -dependent DM (type 1 DM, post pancreatectomy, chronic pancreatitis, cystic fibrosis and other causes) are a special case. WHO/NMC/CCH/0201). Hello, and welcome to Protocol Entertainment, your guide to the business of the gaming and media industries. We, therefore, propose involving patients in the decision whether to provide insulin and/or IV hydration. Medical reasons to consider not checking a BG level in patients with pre-existing DM would include clinical futility and associated unnecessary expense. National standards for self-management education. Use of long-acting insulin such as NPH, detemir (Levimir, Novo, Nordisk), glargine (Lantus, Sanofi) will likely be done les soften and selectively. We recommend that patients who do not have an established provider be given by the urgent care center a list of local facilities that can provide suitable follow up. Number of ADA-recognized programs grew from 3 to 21 through decision support. Centers for Disease Control and Prevention. Using the Nintendo Wii to access electronic medical records was not useful (unfamiliar technology). SEMINAR WebMaria Montessori - Free download as Word Doc (.doc), PDF File (.pdf), Text File (.txt) or read online for free. Drug-induced hyperglycemia. If the correction factor for glucose lowering is known to the patient, an urgent care provider can use that correction factor as a reference point for dosing. GPS coordinates of the accommodation Latitude 438'25"N BANDOL, T2 of 36 m2 for 3 people max, in a villa with garden and swimming pool to be shared with the owners, 5 mins from the coastal path. Training PCPs on evidence-based guidelines and methods for implementing CCM resulted in improved PCP adherence to clinical guidelines, including the American Diabetes Association (ADA) Standards of Care (1012,14,16,17) and Institute for Clinical Systems Improvement (ICSI) Clinical Guidelines for Hypertension, Diabetes, and Hyperlipidemia (18). Med Care Res Rev 2007;64(5 Suppl):101S56S. Simple clinical signs can be helpful.22 Patients at low risk of an acute glucose metabolic disturbance will have BG levels below 400 mg/dL, systolic blood pressure greater than 100, pulse less than 90/minute and respiratory rate less than 20/minute. In patients with insulin pumps there may be problems with the infusion tubing or insertion sites that led to hyperglycemia and it may be preferable to use SQ insulin in the urgent care setting as the default. MacLean CD, Littenburg B, Gagnon M, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Activate your 30 day free trialto continue reading. Executive Director Perinatal HIV Research Unit, Wits Health Consortium, University of Witwatersrand; Associate Professor, Department of Paediatrics, University of Witwatersrand, South Africa; HVTN Director of International Programmes; HVTN Co-Principal Investigator; Chair of the standing committee on Health, Activate your 30 day free trialto unlock unlimited reading. For example, the Medical Archival Retrieval System (MARS) stored data and generated robust reports for providers on laboratory results, visits, medications, health insurance, comorbid conditions, medical procedures, and billing charges (12). Used ADA diabetes education content areas. However, the authors proposed this target range to minimize the risk of hypoglycemia (< 70 mg/dL) while being clinically effective. Stuckey HL, Dellasega C, Graber NJ, Mauger DT, Lendel I, Gabbay RA. Mortality and morbidity from common conditions needing surgery have grown in the world's poorest regions, both in real terms and relative to other health gains. Our review supports the idea that DSME improves psychosocial and clinical outcomes. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. 2011; 17: 370-375. 2009; 32(7): 1327-1334. Diabetes Educ 2005;31(2):22534. Blood glucose readings were remotely uploaded to providers for interactive feedback through a wireless Bluetooth device connecting a glucometer and a smartphone. 2012; 97: 49-58. The objective of this study was to determine how CCM has been applied in US primary care settings to provide care for people who have diabetes and also to describe outcomes of CCM implementation. Sustained outcomes in quality of well-being, self-monitoring of blood glucose. 30-Minute interactive group sessions focused on dietary choices, exercise, weight loss, and self-monitoring. BG levels in excess of 600 mg/dL will likely require a higher initial insulin dose. HbA1c, blood pressure, LDL cholesterol, urine protein, rates of eye and foot examinations, acetylsalicylic acid intake for patients age >40 y, and provider satisfaction. Now customize the name of a clipboard to store your clips. Diabetes Passport served as patients personal record of blood pressure, HbA1c levels, weight, and cholesterol, along with their goals and plans. Msc. Amor B, Harrison D, Rawler F. Assessment of the Clinical Outcome of a Symptom-Based Outpatient Hyperglycemia Protocol. Process measures: glucose readings and uploads, patientprovider e-mails. Umpierrez GU, Hellman R, Korytskowski MT, et al. Hall AK, Stellefson M, Bernhardt JM. VoiceThread Universal lets you browse threads and hear comments in Contemp Clin Trials 2009;30(4):36674. Effects of Intensive Glucose Lowering in Type 2 Diabetes (The Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD). JAMA 2002;288(14):17759. Hollingdal M, Juhl CB, Dall E, et al. In insulin-sensitive patients, BG levels may fall 100 mg/dL (or more) with each 1 unit of rapid-acting insulin used. Percentage of patients achieving goals for HbA1c, blood pressure, and LDL cholesterol. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. A reasonable starting quantity would be sufficient for 1 week. The available rapid-acting insulin agents are sufficiently similar that all are reasonable choices. PICK, MD, CDE, DAVID L. PICK, MD, FAAFP, and LOWELL R. SCHMELTZ, MD Hyperglycemia is common in acute care settings such as emergency rooms (ERs) or urgent care centers. Diabetes is common, often unrecognized and associated with important adverse outcomes. A urinalysis may also be helpful because a high urine specific gravity may indicate volume depletion and strongly positive urine ketones may indicate the presence of DKA. It is also noteworthy that none of the reviewed studies addressed the needs of pediatric patients diagnosed with either type 1 or type 2 diabetes. PCPs were trained by CDEs on ADA standards of care and implementation of guidelines. CCM is used as the framework; laboratories provide daily data feeds; algorithms provide automatic test interpretation; fax and mail are used for providers not easily reached by electronic networks; reports are formatted for accessibility and usability by patients and providers. Kitabchi AE, Umpierrez GE, Murphy MB, et al. How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? BHARTI HOSPITAL AND RESEARCH CENTRE STATISTICAL DATA(2015-2016 Cord Presentation- 02/1764 Deliveries. Patients had either interactive weekly automated telephone self-management support with nurse follow-up or monthly group medical visits with physician and health educator facilitation. sales and marketing, replace text-only discussions The authors suggest avoiding initiation on insulin therapy in the urgent care setting. We therefore suggest an initial bolus of 0.3 u/kg. Other models have sought to improve the community resources and policies component of the CCM. Diabetes days scheduled; on these days, a CDE was present in PCP offices. Providers need to place the level in the appropriate context (probable stress hyperglycemia, known type 2 DM, known insulin-treated or type 1 DM, known alternative cause of DM [steroids, post pancreatic surgery, chronic pancreatitis, etc. We recommend a low threshold for hospital admission in children with DKA with known Type 1 DM, unless the condition is mild, because they are at increased risk of cerebral edema. J Hosp Med. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Baseline chart audit was conducted to establish benchmark for adherence to ADA standards of care and enhance provider feedback. Multilevel, cluster-design, randomized controlled trial (n = 119). General, family, and internal medicine practices (n = 24) in Pittsburgh, Pennsylvania. In a recent study at an inner-city hospital in Detroit, HbA1c levels were checked on all patients who presented to the ER for any reason. Baseline survey scores of the patient population showed a high level of depression and a slightly positive effect of diabetes on self-confidence and that diabetes had most negative effect on enjoyment of vacations and on enjoyment of food and drinks. Offered weekly afternoon snack club to teach participants about healthful snack preparation and reinforce problem-solving and self-management skills. These assessments could enable health care administrators and professionals to determine how CCM could become further integrated into primary health care initiatives in diabetes. 1. Created patient registry to track clinical measures and generate patient performance reports for patients and providers. Patients received folders that included information about their disease, disease-specific self-management skills, and doctor-patient communication skills. Tap here to review the details. Copyright 2021 VoiceThread LLC | Activate your 30 day free trialto continue reading. Presented By:- Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. DM is often undiagnosed and has serious long-term complications, so it is reasonable to consider near universal BG testing in adults. Maerz LL, Akhtar S. Perioperative glycemic management in 2011: paradigm shifts. Accessed June 12, 2012. professional development, student presentations NEPHROTIC SYNDROME DR. ABHAY MANGE 2. Rockwood Clinic Foundation mission was refocused toward efforts to support and promote research in new systems of health care delivery. pages specially designed for screen readers. Participants showed a decrease in HbAlc levels (mean HbA1c decreased from 8.6 to 8.0) after an average of 20.6 months of participation in self-management activities. The 6 components (4,5) are 1) health system organization of health care (ie, providing leadership for securing resources and removing barriers to care), 2) self-management support (ie, facilitating skills-based learning and patient empowerment), 3) decision support (ie, providing guidance for implementing evidence-based care), 4) delivery system design (ie, coordinating care processes), 5) clinical information systems (ie, tracking progress through reporting outcomes to patients and providers), and 6) community resources and policies (ie, sustaining care by using community-based resources and public health policy). Comprehensive models of care, such as the original Chronic Care Model (CCM) (4,5), advocate for evidence-based health care system changes that meet the needs of growing numbers of people who have chronic disease. Diabetes Care. Unique challenges in the urgent care arena include the high likelihood that most patients will be discharged home and that care is designed to be problem-focused, episodic and delivered without continuity of care, even in the event of a return visit to the same facility. The maximum effective dose is 2 g daily. and then repeated by the same author to ensure accurate selection; any discrepancies were analyzed and resolved on the basis of the inclusion and exclusion criteria. 2001; 24(1): 131-153. OBSTETRICA Assuming a drop of 10 mg/dL per unit of rapid-acting insulin, that would predict the need for a bolus of 20 units of rapid-acting insulin to lower a BG level of 350 to 150 mg/dL. CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Mangement of hyperglycemia in type 2 diabetes: a patient-centered approach. Ms.Lisa Chadha 2002; 45(1): 49-55. Improved CDE referral system; gave clinical teams monthly reports to track patient performance; clinical teams meet quarterly to review results and receive clinical information updates. BG levels should be rechecked 1 to 2 hours after the insulin bolus is provided. If needed, the insulin can be rebolused, with or without dose adjustment based on the response. Diabetes Metab Syndr Obes. American Diabetes Association. Practical clinical trial with 3 arms: interactive weekly automated telephone self-management support with nurse follow-up (ATSM), group medical visits with physician and health educator facilitation (GMV), and usual care; random assignment to groups (n = 339). Future studies should examine the effects of continuing education for ADA Standards of Care and ICSI clinical guidelines on CCM decision support among providers. Diabetes Public Health Resource; 2012. http://www.cdc.gov/diabetes/projects/cda2.htm. Prospective single cohort study (n = 1,098). Prevalence of hypertension and its associated risk factors among school age c Case study hypertension presentation show, Ectodermal Dysplasia: a case report and overview, Case Report: Prostate Cancer/Septic Shock, Renal Tumour Angiomyolipoma - Bizarre Presentation. Diabetologia. no-schedule office hours Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, et al. Individual patient reports were also provided to health care teams for reviewing clinical trends (eg, HbA1c, blood pressure, lipids) and initiating clinical responses to laboratory results (eg, medication adjustments) (9,10,20,23). UL1 TR000064 and KL2TR00065. The most common side effect is gastrointestinal (GI) disturbance. Nurse case managers were integrated into a primary care setting to work with study participants, PCPs, endocrinologist, diabetes educator, and dietitian. Pick is on the Speakers Bureaus for Takeda (pioglitazone), Novo Nordisk (liraglutide, analog insulins) and Eli Lilly (linagliptin, analog insulins). You can read the details below. Children and diabetes more information. Ongoing tracking and documentation of patients needs and care process. WebWith our money back guarantee, our customers have the right to request and get a refund at any stage of their order in case something goes wrong. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. Factors requiring consideration of lower insulin dosing include low body weight, known insulin sensitivity, and underlying renal and liver disease. Free access to premium services like Tuneln, Mubi and more. STROKE. Cultural factors (eg, food preparation, views of illness) should be considered when designing, implementing, and evaluating DSME for these underserved groups (31). 76 female patients; mean age, 51.9 y; 47.7% Hispanic. Hosted planned visits every 3 months for PCPs to focus primarily on patients with diabetes; organized group visits with 10 to 12 patients and 3 care team members per session; revised team roles to include greater focus on proactive involvement in patients care. Barriers to Diabetes Care Instrument, Diabetes Empowerment Scale, and the World Health Organization (Ten) Quality of Well-Being Index. Seven studies (11,12,1618,20,24) specified strategies for using community resources and forming public policy. Project was fully supported by the governing board of the Salvation Army Free Clinic. The risk should be minimized by using a suitable protocol with BG monitoring (using meters appropriate for the urgent care setting). This type of culturally appropriate self-management support was associated with a greater number of participants who had an HbA1c measurement of less than 7% and a fewer number of participants who had an HbA1c measurement of greater than 10% (24). PCPs received training on ADA standards of care for people with diabetes. Diabetes Ther. Salvation Army Free Clinic was a product of community collaboration and the volunteer efforts of professionals and community laypersons. The low-cost and time-efficient interventions used in this study (ie, developing a protocol for foot examinations, training patients and medical assistants in foot examination, and tracking patients for follow-up appointments) improved clinical outcomes (blood glucose, lipid, blood pressure, and foot examinations) of patients who had both diabetes and cardiovascular disease. 2001; 286(16): 1945-1948. Blood pressure; HbA1c levels; documentation and follow-up of goal setting; eye and foot examinations; medical residents receiving/reviewing/discussing registry reports; medical residents learning and demonstrating self-management support strategies. The University of Pittsburgh Medical Center supported the implementation of ADA standards of care, covered fees for the application for ADA recognition, supported the development of a central coordination center for educators, supported seminars for training and certification, supported the development of a central advisory committee, which included representatives from hospital sites, the community, and physician practices. Offering DSME in primary care settings, rather than solely hospital settings, enhances the reach of such programs in a more intimate, socially supportive venue. Above this BG level there can be polyuria followed by osmotic shifts and electrolyte disturbances as BG levels rise further. Curr Opin Cfrit Care. However, it is important to determine the combination of components that will likely produce optimal patient and provider outcomes. For all patients with a history of DM, it is logical and reasonable to check aBG level to detect significant hypoglycemia or hyperglycemia. World Health Organization; 2002. Released in 1996 and featuring songs from Lynyrd Skynyrd, Waylon Jennings, Alabama, Tanya Tucker, and Hank Williams Jr, among others, this 32-minute, 11-song album was an album ode to NASCAR by some of country's biggest stars. WebBrowse our listings to find jobs in Germany for expats, including jobs for English speakers or those in your native language. Our review suggested that incorporating multiple components together in the same intervention can help facilitate better CCM implementation (eg, using the decision-support component to train providers on guidelines such as the ADA Standards of Care and using the delivery system design component to remodel the care delivery process to provide self-management support through DSME in PCP offices). Educational materials were developed for patients with diabetes. 1-year change in self-management behavior. Diabetes Care 2009;32(Suppl 1):S8794. The SlideShare family just got bigger. Another factor is patient waiting time. Ginde AA, Cagliero E, Nathan DM, Carnargo CA Jr. Point-of-care Glucose and Hemoglobin A1C in Emergency Department Patients without Known Diabetes: Implications for Opportunistic Screening. One approach is to never initiate DM therapy because there will be limited or no opportunity to provide suitable follow up. Medical Archival Retrieval System was used to track reimbursement, DSME service rates, and HbA1c levels. We've updated our privacy policy. PCPs completed routine examination and assessed complications during each visit. Clipping is a handy way to collect important slides you want to go back to later. professional development Silverman RA, Thakker U, Ellman T, et al. Patients treated with insulin may have knowledge of an adjustment algorithm for management of hyperglycemia. It appears that you have an ad-blocker running. Gerstein HC, Miller ME, __ et al. The system also generates population reports so that physicians can view the progress of their patients with diabetes. Finally, community-level partnerships pooled human and fiscal resources to provide diabetes management services (11,12,1618,20,24). CDE provided individual diabetes counseling, including nutritional counseling. Lyles et al (23) found that the use of a secure e-mail connection and a smartphone to upload glucose readings via a wireless Bluetooth device allowed some participants to feel better connected with their nurse case manager. Telephone and e-mail communication facilitated interaction between nurses, volunteer physicians and specialists (eg, endocrinologists). Curr Diab Rep. 2012; 12(1): 101-107. Ketones can be detected by their characteristic odor on the breath. Centre for Reviews and Dissemination. Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. Nurses followed up with telephone calls to monitor progress toward goals. Free medical clinic for uninsured patients. Tsai AC, Morton SC, Mangione CM, Keeler EB. By accepting, you agree to the updated privacy policy. STROKE PRESENTATION ON: Presentation on : STROKE o Stroke is defined as Abrupt onset of neurological deficit Persists more than 24 hour. Khan MA, Evans AT, Shah S. Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care. Improving chronic illness care: translating evidence into action. The Innovative Care for Chronic Conditions (ICCC) model espoused by the World Health Organization (33,37) is comparable to the Expanded Chronic Care Model proposed by Barr and colleagues (7); it introduces prevention efforts, social determinants of health, and enhanced community participation as core components of chronic disease care. No significant changes in HbA1c were found in ATSM, GMV, and usual-care groups. Exclusion of diabetic ketoacidosis (DKA) can be a consideration regardless of BG level. Provided access to electronic shared medical record for patients and providers; included secured e-mail for interactive feedback with case managers. Stellefson M, Chaney B, Chaney D. The digital divide in health education: myth or reality? There is currently no evidence-based literature to guide the goal of treatment, once undertaken. J Clin Nurs 2010;19(3-4):31323. We therefore recommend checking a basic chemistry panel that includes sodium, potassium, urea, and creatinine in all patients with marked hyperglycemia (>400 mg/dL), especially those taking diuretics, patients with evidence of volume depletion and those with a history of renal dysfunction. We collected articles from the Cochrane database of systematic reviews by using 2 distinct searches for chronic care model and diabet*, which were combined by using the word and. We also collected articles via EBSCOhost from the CINAHL database and the Health Source: Nursing/Academic Edition database by using the Boolean phrase search function for chronic care model (and) diabet*. These databases are all repositories for original health science research studies. It appears that you have an ad-blocker running. Clipping is a handy way to collect important slides you want to go back to later. Some organizations have already begun to do so. Circ Res. One meta-analysis (27) determined that no single component of the CCM was imperative for improved outcomes. Offered weekly diabetes education classes for 11 weeks using the curriculum developed by the Midwest Latino Health Research Center and including a supermarket tour. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Patients who have symptomatic improvement after treatment for hyperglycemia with hydration and/or insulin may be motivated to improve glucose control at home and intervention may have been worthwhile. Structured DSME was based on ADA education content areas. Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Provider-perceived barriers to care, adherence to ADA standards of care, patient HbA1c, blood pressure, and cholesterol; patient knowledge and empowerment levels. However, strategies for using community resources and developing policies were described in only 7 studies. In conclusion, our study provides evidence that CCM is effective in improving the health of people who have diabetes and receive care in primary care settings. ATSM group had significant decreases in days restricted to bed compared with usual care group (1.7 days per month, rate ratio 0.5 [95% CI, 0.31.01]). The volunteer physicians and specialists were available for consultation to manage challenging cases and questions (eg, difficult medication issues, questions directed to the physicians). Diabetes nurse case manager and motivational interviewing for change (DYNAMIC): Study design and baseline characteristics in the chronic care model for type 2 diabetes. Degree of structure of care alignment with CCM; process of care alignment with CCM; patient weekly self-care, quality of life, days spent in bed because of health problems; effect of diabetes on activities of daily living. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. interactive lectures To get feedback from the supervisors and friends for further improvement. Suburban and urban primary care practices. Piatt GA, Songer TJ, Brooks MM, Anderson RM, Simmons D, Orchard TJ, et al. Midico-legally an argument can be made for not checking a BG level in patients with preexisting DM so as to avoid the risk of the urgent care facility becoming directly responsible for glucose-related issues in the event of detection of marked hyperglycemia that could be transient or preexisting. If an urgent care provider is uncertain about the degree of a patients insulin resistance, a correction dose of 0.1 to 0.15 units/kg of rapid-acting insulin given SQ should be sufficient to return the glucose to a more acceptable range. Management of acute hyperglycemia emergencies is beyond the scope of this article.21 However, it is very important in the urgent care arena to recognize patients with hyperglycemia metabolic emergencies, that is, DKA and non-ketotic hyperosmolar syndrome. What level of glucose elevation in the urgent care setting, should be treated, why, and to what level? Physicians and patients were nonblinded, and outcome assessors and data analysts were blinded to allocation (n = 639). DiNardo M, Donihi AC, Forte P, et al. However, marked hyperglycemia in a child could reflect underlying type 1 DM. Presentation on : The goal is to confirm that the patients hyperglycemia has resolved, and if not, to provide information to allow suitable follow up of the newly diagnosed DM. CCM comprises 6 components that are hypothesized to affect functional and clinical outcomes associated with disease management. An urgent care provider should always be encouraged to add his or her own clinical judgment and experience to the insulin protocol being used. JPMorgan Chase has reached a milestone five years in the making the bank says it is now routing all inquiries from third-party apps and services to access customer data through its secure application programming interface instead of allowing these services to collect data through screen scraping. BELOW ARE SOME DIABETES MYTHS: People with diabetes should not exercise not true!! Use of rapid-acting insulin correction at a dose of 0.1-0.15 units/kg given SQ should be sufficient to return the glucose to a more acceptable range. Vital Sign triage to rule out diabetic ketoacidosis and non-ketotic hyperosmolar syndrome in hyperglycemia patients. Looks like youve clipped this slide to already. You can read the details below. HbA1c improvements observed at 1-year follow-up were sustained in 8 of 12 participants in CCM group at 3-year follow-up, whereas the provider-educationonly group and usual-care group remained constant from baseline. Abbreviations: CDE, certified diabetes educator; ADA, American Diabetes Association; PCP, primary care physician; DSME, diabetes self-management education.a The 6 components of the CCM are 1) health system organization of health care, 2) self-management support, 3) decision support, 4) delivery system design, 5) clinical information systems, and 6) community resources and policies. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Mean age, 58 y; 57% female; 39% Hispanic. Number of patients with depression; rates of eye and foot examinations; nephropathy assessment; cost-effectiveness; psychological and behavioral outcomes. Click here to review the details. Author Affiliations: Michael Stellefson, Christine Stopka, University of Florida, Gainesville, Florida. Patient registry was a major advancement for identifying patients, generating individual and private reports, and developing Plan-Do-Study-Act (PDSA) cycles for diabetes care. Protecting People., National Center for Chronic Disease Prevention and Health Promotion. For example 2 extra units of rapid-acting insulin would be predicted to lower the glucose from 350 mg/dL to 150 mg/dL. One option would be to provide IV hydration without insulin because that may significantly lower BG and there should be no risk of inducing hypoglycemia. Unger J. Insulin initiation and intensification in patients with T2DM for the primary care physician. CCM group mean (SD) age, 69.7 (10.7) y; 50% male; 13% nonwhite; 50% less than a high school diploma; 44% income <$20,000/year. A low-cost decision support and information system based on the CCM is feasible in primary care practices, especially practices that lack sophisticated electronic information systems. Patients with BG levels above 400 mg/dL or systolic blood pressure less than 100 may be at higher risk of DKA. Accessible to patients on a personal computer or a Nintendo Wii, it provided clinical reminders and patient performance summaries. Offered weekly breakfast club focused on nutrition and cooking skills and healthful modifications for traditional Puerto Rican recipes. In diabetic patients who provide a history of having stopped their prescribed DM medications for beyond a few days, states of metabolic decompensation, such as diabetic ketoacidosis and hyperosmolar non-ketotic syndrome, should be identified if present. Case management, evidence-based care, cultural competency, improved provider interactions. The SlideShare family just got bigger. 2009; 360: 129-130. The PCP then answered yes or no if the message was helpful and if it was used in developing patient plans. Easy to use - start for free! Lifestyle school session included a model grocery store so participants could practice reading food labels, learn and apply skills to choose more healthful options during grocery shopping and when considering fast food options. Provider-perceived patient barriers to care; adherence to ADA standards of care; patient HbA1c, blood pressure, non-HDL cholesterol levels; height and weight; knowledge and empowerment levels; diabetic, lipid and blood pressure treatment intensification. Core physicians were advocates of guideline-based management. However, hypoglycemia can occur with sulfonylureas, therefore, patient education is required about detection and management of hypoglycemia. Support from health care leaders stimulated organizational changes (912,14,1622,24). One potential downside to treatment of acute hyperglycemia with insulin is the possibility of causing hypoglycemia 2 to 4 hours after the dose is given (duration of action of rapid-acting insulin is 4 hours). NURSING Multilevel, cluster-design, randomized controlled trial (n = 104). A survey of leading chronic disease management programs: are they consistent with the literature? Smith SA, Shah ND, Bryant SC, Christianson TJ, Bjornsen SS, Giesler PD, et al. The SlideShare family just got bigger. The precise dose selected can be modified based on the possible predicted degree of underlying insulin sensitivity or possibly based on a history of the patients insulin doses or response to insulin, if he or she is already on an insulin regimen. Mean (SD) age, 51 (12) y; 59% male, 42% African American. design discussions We found that diabetes self-management education (DSME) generally improved psychosocial and clinical outcomes in patients with diabetes. Used Institute for Clinical Systems Improvement Clinical Guidelines for Hypertension, Diabetes, and Hyperlipidemia. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Curr Treat Opt Neurol. Standards of medical care in diabetes. Diabetes health disparities: a systematic review of health care interventions. Hosp Q 2003;7(1):7382. JAMA. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Problem-based learning sessions were used to demonstrate implementation of guidelines into a plan of care. A suggested protocol for marked hyperglycemia (above 400 mg/dL) in patients without known insulin-deficient DM such as type 2 DM is to provide a SQ bolus of rapid-acting insulin, starting with 0.1 to 0.15 units/kg. In several studies (1012,14,1618), providing administrative support to train PCPs in implementing evidence-based care was associated with improved patient engagement that led to positive health outcomes. In the non-diabetic population of 5,372 individuals, 7% had an elevated HbA1c of 6.5% indicating a new diagnosis of diabetes. DSME initially delivered on an individual basis; group visits were facilitated later in the study as office space became available. Qualitative evaluation of a mobile phone and web-based collaborative care intervention for patients with type 2 diabetes. Diabetes Care. Providers should inquire about the timing of last insulin administration and dose and type of insulin being used and that information should be factored in to treatment decisions. 2008; 358: 2545-2559. Developed the Vermont Diabetes Information System to collect clinical information and provide flow sheets, reminders, and alerts to physicians and their patients with diabetes. The Medical Archival Retrieval System allowed for reimbursement and usability monitoring. Sea on foot. Laboratory results, self-reported dietary habits and health beliefs, patient satisfaction with clinic rated on scale of 1 to 10. Process delivery (HbA1c, lipid panel, blood pressure, urinalysis, dilated eye referral, foot examination, and use of monofilament) were to be recorded by PCPs. The authors recommend avoiding use of glyburide because that agent may be associated with adverse cardiovascular outcomes and can cause prolonged hypoglycemia (especially in the elderly). Their hyperglycemia may be stress-induced, underlying pre-existing DM (type 1, type 2 or other) or gestational. We excluded studies that took place outside of the United States, reported secondary data, or represented an editorial, commentary, or a literature review. Unrecognized diabetes among hospitalized patients. Monthly support groups focused on foot care, healthful cooking and recipe modification, alternative treatments, and problem-solving skills. Group educational sessions consisting of 5 to 25 patients motivated patients to engage in positive behavior change and to apply problem-solving skills. Process of diabetes care, metabolic and vascular risk factor control with a 10-year estimated risk of cardiovascular disease; cost of care; participants functional health status. Each resident practiced a planned visit with a patient. A meta-analysis (27) also found that few studies addressed the community resources and policies component of CCM. Factors suggesting a need for higher insulin dosing than the starting protocol would be high body mass index (BMI > 35), features of insulin resistance (acanthosis nigricans on skin examination, known PCOS, steroid treatment, significant stress). Liebman J, Heffernan D, Sarvela P. Establishing diabetes self-management in a community health center serving low-income Latinos. Participants had an established diagnosis of type 2 diabetes (age and sex were not reported). This study had several limitations. Classification, Pathophysiology and management of Brain Stroke for Pharm.D (P Stroke I Incidence, Types, Causes, Risk Factors & Management - Dr Rohit Bhaskar, Neurology 9th vascular diseases of the nervous system, Brain stroke by Roel Tolentino Makati Philippines, Approach to a patient with stroke - Pathophysiology of stroke, Mrs. Duru Onyinye Ann Ph.D Power Point i.pptx, No public clipboards found for this slide. We've encountered a problem, please try again. Physicians and their patients were randomized to the control or intervention group (clustered randomization). Interactive feedback using the Web-based My Diabetes Daily Diary self-management tool focused on nutrition, medications, and exercise. Vaccinations, medications (statin use, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, aspirin), microalbuminuria. An electronic library of messages was developed according to best available research on the use of aspirin, angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers and management methods for glycemic control, diet and exercise, dyslipidemia, hypertension, chronic heart failure, and nicotine dependence. Accessed October 7, 2012. Clin Trials 2004;1(6):53244. Audit of Diabetes Dependent Quality of Life survey, Problem Areas in Diabetes scale, Diabetes Treatment Satisfaction Questionnaire, Summary of Diabetes Care Activities, and the Provider Satisfaction Inventory. Medical Outcomes Trust SF-12 Health Survey, Audit of Diabetes-Dependent Quality of Life questionnaire, Self-Administered Comorbidity Questionnaire, Short Test of Functional Health Literacy in Adults, Primary Care Assessment Survey, Patient Health Questionnaire-9. Provided bilingual/bicultural community health workers services, including home visits, accompanying patients on medical visits, and telephone and in-person counseling and support. Used empowerment approach during patient visits. The lists do not show all contributions to every state ballot measure, or each independent expenditure committee Inclusion criteria specified that studies 1) be published after the formal inception of the original CCM (1999) (5); 2) use the original CCM (4,5) instead of the expanded CCM (7); and 3) describe CCM-based interventions to manage and treat diabetes in US primary care settings. We then reviewed the full articles; 43 articles were retained, and 33 were excluded. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. For example, the Rockwood Clinic Foundation revised its mission statement to include fundraising for research and development in new methods of chronic care delivery, which has resulted in increased funding for training materials, glucometers, blood pressure monitors, and laboratories (20). Web27. However, the facility may be at increased risk legally from failing to detect or exclude hyperglycemia in the urgent care setting. Future DSME for primary care patients should continue to cover the ADA content areas (28) for diabetes self-management, and strategies for delivering DSME should be evaluated by assessing the comparative effectiveness of group- and individual-level DSME approaches. We recommend a treatment goal of 150 mg/dL (120-180 mg/dL). 1997; 314(7093): 1512-1515. Corresponding Author: Krishna Dipnarine, MS, Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, PO Box 118210, FLG 5, Gainesville, FL 32611-8210. The model accounts for health services at various levels in the diabetes care process. B.V CON , Pune. Activate your 30 day free trialto continue reading. Tap here to review the details. There patients should understand that they need to promptly follow up with their DM care providers to obtain an ongoing supply of medications under supervision and the decision to prescribe can be individualized. More personalized, patient-centered interactions (eg. BG level at or above 600 mg/dL are markedly abnormal, often associated with dehydration and metabolic emergencies, and often require electrolyte measurement, IV hydration, insulin administration, more than brief observation and possibly require hospital admission. Extra assistance should be available and, if necessary, one should be called upon to help lift the patient. critiqued the data to identify any inconsistencies between data presented in the studies and the data extracted for the review, posed questions for further clarification on all extracted content, and then reviewed and synthesized the extracted data for accurate presentation within the context of the CCM. No more guesswork - Rank On Demand Job descriptions of the medical director and quality improvement coordinator were altered to include improvement in the care of patients with chronic illnesses. Pregnant patients are another special category of patients who present to urgent care with hyperglycemia. Other culturally tailored non-CCM interventions (29) have demonstrated larger absolute reductions in HbA1c than nontailored interventions. Patients reported comfort with location and ease of approaching CDEs. WebGRAY, Prof Glenda MBBCH, FCP (Paeds) SA. By accepting, you agree to the updated privacy policy. Detection of Undiagnosed Diabetes and Prediabetes States in High-Risk Emergency Depertment Patients. Implementing the chronic care model in an academic setting: a residents perspective. MARS also served as a tool for administrators to gauge fiscal outcomes associated with placing CDEs in primary care sites to deliver DSME (12). J Am Geriatr Soc 2007;55(10):165662. Click here to review the details. WebManagement Business and Economics Marketing Case Study +59. Acad Emerg Med. Mesotten D, Van den Berghe G. Glycemic targets and approaches to management of the patient with critical illness. CDE worked with staff to schedule DSME; CDE served as a clinical resource; PCPs hosted diabetes days; PCPs made direct referrals to CDEs. Int J Telemed Appl 2010;2010:450418. As recommended by the Centre for Reviews and Dissemination systematic review guidelines (8), we created the following categories to systematically assess the 16 studies and gain an understanding of the methods used and the outcomes associated with CCM application: study design, sample size, setting, participant demographics, primary and secondary outcomes measured, data collection instruments used, statistical tests used, and major findings. Insulin-treated patients will often use rapid-acting insulin to treat hyperglycemia, so it is logical to provide similar therapy while in an urgent care center. At the end of the study, nearly half of the centers patients with diabetes reached the target goal of an HbA1c less than 7.0. E-mail: Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B. Caruso LB, Clough-Gorr KM, Silliman RA. Activate your 30 day free trialto unlock unlimited reading. Long-acting insulin preparations are used by patients with type 1 and insulin-deficient type 2 DM to provide a low level of background insulin to suppress hepatic gluconeogenesis and prevent hyperglycemia due to excess endogenous glucose production. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, et al. [A Insulin is the logical choice for acute management. Medications were reviewed in group setting; discussion focused on adherence. Far less emphasis has been placed on measuring the process outcomes of CCM that help lead to functional and clinical improvements. STROKE J Eval Clin Pract 2010;16(4):7006. We've updated our privacy policy. J Clin Endocrinol Metab. Healthy Aging 2.0: the potential of new media and technology. This information was used to create single-line, positively framed messages (information was presented as gains, not losses), which were shown to elicit a better response from physicians. We then qualitatively assessed the outcomes of each component that was applied in each study. BG monitoring every 1 to 4 hours may be required for patients with prolonged stays in urgent care facilities who are on medications with risk of causing hypoglycemia, such as insulin or sulfonylurea. 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