When is medication needed for type 2 diabetes genetic,5s online facebook,glycerin 14 - PDF 2016

A recent medication error that occurred in an Indiana hospital received nationwide publicity when three premature infants died as a result.
In the last issue of FootNotes, we focused on what I consider to be the essential components in the assessment of patients presenting with diabetic foot infections.
So now let us focus on the management of established diabetic foot infections that have been appropriately evaluated. They may or may not be sick (IDSA Grade 4 or 3), but the severity of their infection is signified by recalcitrant hyperglycemia, leukocytosis, and failure to resolve cellulitis with broad spectrum antimicrobial therapy.  These important clinical clues should indicate that, very likely, surgical debridement or partial foot amputation is necessary.
Equally important is the necessity for detecting and treating peripheral ischemia (PAD) when present.
Once the acute infection has been managed, the bone infection can be definitively treated as appropriate for the circumstances. I have not specifically addressed antimicrobial therapy thus far, because I think that we need to place a good deal of emphasis on the surgical management of limb threatening infections. The Mayer Institute specializes in delivering world-class, evidence-based diabetic foot wound care and education. A colleague of mine recently told me of an encounter with a new elderly patient referred to her practice. The American Geriatrics Society (AGS) is hoping to help influence this type of behavior with a newly released 2012 Updated Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adult.
I do want to highlight one of my favorite new additions to the 53 medications and classes of medications listed as potentially problematic - the insulin sliding scale.
Yes, the venerable insulin sliding scale is on the chopping block thanks to this new Beers criteria.
So in honor of the new Beers criteria, I’m asking all the GeriPal readers to submit their craziest medication cocktails that they have seen in the comment section of this blog post. We definitely need to reiterate the need for physicians to keep from going overkill with their medical prescriptions.
GeriPal (Geriatrics and Palliative care) is a forum for discourse, recent news and research, and freethinking commentary. Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes.
Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. People with diabetes must take responsibility and keep blood glucose levels from going too low or too high.
The infants mistakenly received overdoses of heparin because the wrong strength was used to prepare flush solutions for umbilical lines.
Although I concentrated on severe or limb threatening foot infections, the principles remain the same for even mild or moderate infections: always be suspicious, always look for ischemia, and always obtain appropriate laboratory tests and imaging procedures as essential parts of your evaluation. 1. Necrotizing soft tissue infection- no gas on x-rays but note the severe cellulitis, edema, and necrotic dorsal skin.
Several procedures are often required prior to eventual control of infection and definitive closure. Many patients with pre-existing PAD have a foot infection as their first presenting sign of ischemia. While this is a matter of debate around the Globe, surgical debridement or bone resection (and sometimes local amputation) with adjunctive systemic antimicrobial therapy seems to more predictably affect a cure than treatment with just antibiotics. Nonetheless, in our next issue, we will discuss my approach to antimicrobial management of diabetic foot infections – from a clinician’s viewpoint. We welcome your opinions, concerns, and suggestions.  If you have an interesting case or a troubling circumstance that you would like to share with fellow PRESENT Diabetes members,  please feel free to comment on eTalk. To solve the problem, I created a system that is so easy to maintain I knew I had to share it with you!1) Circle expiration dates with a sharpie.Take the time to check expiration dates on all of your vitamins and medicine. This document and the website that is associated with the updated Beers criteria is a wealth of both clinical and teaching resources, so I encourage you all to check it out the AGS website.
They should realize that even just one drug off (or too much) of a patient's usual meds could cause serious repercussions.


In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
But progress is being made in all areas and the researching a cure for Diabetes is always being researched. Edward Jacobson Patients who have found The Greenwich Center for Restorative Vaginal Surgery consider themselves fortunate to have worked with experienced gynecological surgeon Dr. Also important, please recognize that just having a wound does not imply that it is infected; most, if not all, wounds are contaminated. Although infection somewhat improved, further necrosis and persistent cellulitis required further debridement. A large soft tissue and osseous defect remained with residual necrosis at the midfoot, placing the limb at risk.
This is the course of treatment followed by most US surgeons until prospective studies can definitively identify those sites or patients best suited to medical therapy alone.  Nonetheless, osteomyelitis very rarely, if ever, presents as an acute problem – it usually comes associated with an acute soft tissue infection.
Properly dispose of old medicine and use a sharpie to circle the expiration dates on all medicine and vitamins that you’re keeping. Click Here Bioidentical Hormone Therapy helps millions of people take charge of their health. While nothing can erase the grief experienced by the families and hospital workers in the wake of this tragic incident, it does serve as a reminder of the need to take a closer look at heparin utilization in our facilities.1Heparin is an anticoagulant and one of the oldest drugs still in widespread clinical use. Infection is a clinical diagnosis based on those classical signs we are all familiar with: rubor, tumor, dolor, and calor. A final, definitive procedure such as a closed amputation or skin graft should follow the revascularization and restoration of perfusion to the foot. Your categories may need to be different than mine, but having your medicine categorized will help you to find the needed medicines quickly.3) Use sandwich bags if needed.If any medicine tends to fall out of its package or to leak, put it inside a zip-top sandwich bag!
For this reason, heparin is considered a high-alert medication that requires special safeguards to reduce the risk of errors.3Errors associated with heparin use are as multifaceted as its indications.
Exceptional personalized care offered in Greenwich, CT Share and Enjoybioidentical estrogen, it is essential to determine your breast cancer risk. Examples of medication error reports submitted to PA-PSRS include the following:Nurse was approached by a technician and asked if patient was still on lidocaine.
The nurse stated “yes.” The technician then informed the nurse that a heparin bag was hanging on the patient’s IV pump, not lidocaine. Come on in and join me for a few minutes, then roll up your sleeves and get to work because learning to become clutter-free is about more than getting rid of stuff.
It’s about creating room for life to happen, for memories to be made, and for loved ones to gather.Subscribe Via Email Sign up for free e-mail updates as well as a FREE copy of "101 Time-Saving Tips for Busy Moms" Email Address First Name Last Name * = required field powered by MailChimp!
Many errors have occurred when nurses have retrieved heparin from an ADC in which heparin and HESPAN were stored, and where both names appeared as choices on the machine’s computer screen. Since HESPAN, a plasma expander, is sometimes used in patients who are actively bleeding, administering heparin instead can be very hazardous. These levels led to consideration of a hemorrhagic event, and several hours later, to discovery of the medication error. Given patient's unexplained bleeding, another set of labs were drawn which found   an INR of 10.9 and aPTT of greater than 160. Subsequently, patient was treated with additional blood products and returned to a hemodynamically stable state. The patient did not receive the wrong medication.In an error reported to the MERP, a physician asked for heparin 2,000 units during a procedure. The patient received heparin 20,000 units, but the nurse quickly noticed the mistake, and the patient received protamine sulfate with no resulting harm.
5Concomitant TherapiesOther tragic errors occur when low molecular weight heparin products, such as Fragmin (dalteparin sodium), Lovenox (enoxaparin sodium), and Innohep (tinzaparin sodium), are inadvertently initiated in patients that are concurrently being administered heparin infusions or vice versa. Many of these errors result from poor communication of a patient’s medication regimen to caregivers. Many times, low molecular weight heparin is prescribed and administered in the emergency department (ED).


Consequently, those orders are rarely communicated to the pharmacy or screened for safety.6 Additionally, breakdowns in the medication reconciliation process can leave personnel on the nursing unit without knowledge of what was administered in the ED. Reports of concomitant heparin and low molecular weight heparin products submitted to PA-PSRS include the following:Patient was given LOVENOX in the ED.
Another physician, unaware of FRAGMIN therapy, ordered weight-based heparin protocol at 1,500.
Patient received bolus of heparin, and drip was administered for three hours before the error was discovered.
Nursing had not seen the discontinue order.In a case reported to the MERP, a hospitalized 86-year-old woman with a history of atrial fibrillation was prescribed Lovenox (enoxaparin) 60 mg every 12 hours subcutaneously by her cardiologist. Later in the week, a gastroenterologist recommended a colonoscopy to rule out colorectal cancer. However, enoxaparin administration continued every 12 hours, and the heparin order was never faxed to the pharmacy. To administer the bolus and begin the infusion, the nurse borrowed a vial of heparin and a premixed solution that the pharmacy had dispensed for another patient. The heparin infusion was decreased, but by the next morning, the patient’s aPTT was still elevated, her hemoglobin and hematocrit had dropped, and she exhibited evidence of internal bleeding.
Heparin and enoxaparin were discontinued immediately, but the patient died despite aggressive treatment. 6Potential SolutionsThe case reports in this article and many others that have been reported to PA-PSRS emphasize that heparin is a high-alert medication that is prescribed, dispensed, and administered via error-prone processes.  To protect patients who are at risk for an adverse outcome if an error occurs, this high-alert medication warrants unique handling. The following strategies may help reduce the incidence of heparin-related errors: 1,4-6Reviewing the medication record. It is important for prescribers, pharmacists, and nurses to consider recent drug therapy before ordering, dispensing, and administering any anticoagulants or antithrombotic agents.
Protocols, guidelines, and standard order forms can feature prominent reminders to asses all drug therapy (including medications administered in the ED) and avoid unintentional use of more than one anticoagulant in a patient.Improving access to information. Instituting a process for immediate communication with the pharmacy, upon a patient’s admission to the hospital, of all medications administered in the ED or other outpatient settings will enable pharmacy to enter the medications into the pharmacy computer system and screen for duplicate therapy or interactions with medications prescribed upon admission.
Testing computer systems.  Testing both computerized prescriber order entry systems and pharmacy computer systems can help to ensure that staff are alerted when heparin and low molecular weight heparin products are ordered on the same patient. Segregating look-alike products.  Store products with look-alike packaging in different locations in pharmacies, patient care units, and other settings.
Remedy problems by repackaging medications, affixing auxiliary labels to products, or switching manufacturers to improve distinction and clarity of labeling and packaging.Reducing access. Whenever possible, allow only one concentration for bolus doses, and use pre-filled syringes for all heparin flushes. Avoid stocking items on nursing units that require further preparation by nurses before administration.
Having an independent double-check of heparin products before they leave the pharmacy can prevent mistakes. Consider having a pharmacist (or a technician, if necessary) check all products pulled for restocking of ADCs before they leave the pharmacy.
In addition, many facilities have instituted a double-check by nursing staff before heparin administration.Implementing bar-code technology. Bar-code technology can be employed for selecting and stocking medications in ADCs and before administering medications to patients. Bar-coding is valuable for bedside scanning to confirm the accuracy of the patient, drug and dose of medication.Even if these problems with heparin use are not obvious in your facility today, every facility can proactively anticipate and focus on problems with heparin use by discussing heparin errors that have happened at other facilities and incorporating the risk reduction strategies presented above.



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