XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

A high rate of polypharmacy is, in part, a consequence of the increasing proportion of multimorbidity in the ageing population worldwide. Our understanding of the potential harm of taking multiple medications in an older, multi-morbid population, who are likely to be on a polypharmacy regime, is limited. This is a narrative literature review that aims to appraise and summarise recent studies published about polypharmacy. We searched MEDLINE using the search terms polypharmacy (and its variations, e.g. multiple prescriptions, inappropriate drug use, etc.) in titles. Systematic reviews and original studies in English published between 2003 and 2018 were included. In this review, we provide current definitions of polypharmacy. We identify the determinants and prevalence of polypharmacy reported in different studies. Finally, we summarise some of the findings regarding the association between polypharmacy and health outcomes in older adults, with a focus on frailty, hospitalisation and mortality. Polypharmacy was most often defined in terms of the number of medications that are being taken by an individual at any given time. Our review showed that the prevalence of polypharmacy varied between 10% to as high as around 90% in different populations. Chronic conditions, demographics, socioeconomics and self-assessed health factors were independent predictors of polypharmacy. Polypharmacy was reported to be associated with various adverse outcomes after adjusting for health conditions. Optimising care for polypharmacy with valid, reliable measures, relevant to all patients, will improve the health outcomes of older adult population.

https://journals.sagepub.com/doi/pdf/10.1177/2042098620933741

An overview of prevalence, determinants and health outcomes of polypharmacy:

Chronic pain is highly prevalent among older adults where it is associated with significant suffering, disability, social isolation, and greater costs and burden to health care systems. Pharmaceutical treatment of chronic pain in older adults is usually only partially effective and is often limited by side effects including urinary retention, constipation, sedation, cognitive impairment, and increased risk of falls. Since older adults are underrepresented in clinical trials testing treatments for chronic pain, the potential impacts of polypharmacy and frailty on reported outcomes and side effect profiles are largely unknown. Thus, for current treatments, providers and patients must balance anticipated benefits of pain reduction with the known and unknown risks of treatment. Chronic pain is also a risk factor for premature death as well as accelerated cognitive decline, suggesting potential shared mechanisms between persistent pain (or its treatment) and dementia. Cognitive decline and dementia may also impact pain perception and the ability to report pain, complicating treatment decisions. Associations between persistent pain and the risks of premature death and accelerated cognitive decline make estimates for chronic pain in these populations particularly challenging. Future research is needed to improve estimates for chronic pain in older adults, to elucidate underlying mechanisms of pain with aging, and to develop and advance safer, more effective treatment options for chronic pain in older adults.

/pdf/the-silent-epidemic-of-chronic-pain-in-older-adults-4075kn7rsn.pdf

The silent epidemic of chronic pain in older adults.

Due to the threat of a radiological or nuclear incident that could impact citizens, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early- to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries. Given that the body's natural response to radiation exposure includes production of growth factors and cytokines, and that the only drugs approved by the U.S. Food and Drug Administration to treat acute radiation syndrome are growth factors targeting either the granulocyte (Neupogen® or Neulasta®) or granulocyte and macrophage (Leukine®) hematopoietic cell lineages, there is interest in understanding the role that these factors play in responding to and/or ameliorating radiation damage. Furthermore, in an environment where resources are scarce, such as what might be expected during a radiation public health emergency, availability of growth factor or other treatments may be limited. For these reasons, the NIAID partnered with the Radiation Injury Treatment Network (RITN), whose membership includes medical centers with expertise in the management of bone marrow failure, to explore the use of growth factors and other cytokines as MCMs to mitigate/treat radiation injuries. A workshop was convened that included government, industry and academic subject matter experts, with presentations covering the anticipated concept of operations during a mass casualty incident including triage and treatment, growth factors under development for a radiation indication, and how the practice of medicine can inform other potential approaches, as well as considerations for administration of these products to diverse civilian populations. This report reviews the information presented, and provides an overview of the discussions from a guided breakout session.

https://bioone.org/journals/radiation-research/volume-192/issue-1/RR15363.1/Use-of-Growth-Factors-and-Other-Cytokines-for-Treatment-of/10.1667/RR15363.1.pdf

Use of Growth Factors and Other Cytokines for Treatment of Injuries During a Radiation Public Health Emergency.

Background Drug-drug interactions (DDIs) are one of the most common drug-related problems. Recently, electronic databases have drug interaction tools to search for potential DDIs, for example, Micromedex and Drugs.com. However, Micromedex and Drugs.com have different abilities in detecting potential DDIs, and this might cause misinformation to occur between patients and health care providers. Methods and findings The aim of this study was to compare the ability of Micromedex and Drugs.com to detect potential DDIs with metabolic syndrome medications using the drug list from the U-central database, King Chulalongkorn Memorial Hospital in April 2019. There were 90 available drugs for the treatment of the metabolic syndrome and its associated complications, but six were not found in the Micromedex and Drugs.com databases; therefore, only 84 items were used in the present study. There were 1,285 potential DDI pairs found by the two databases. Micromedex reported DDIs of 724 pairs, while, Drugs.com reported 1,122 pairs. For the severity of the potential DDI reports, the same severity occurred between the two databases of 481 pairs (37.43%) and a different severity for 804 pairs (62.57%). Conclusion Drugs.com had a higher sensitivity to detect potential DDIs by approximately 1.5-fold, but Micromedex supplied more informative documentation for the severity classification. Therefore, pharmacists should use at least two databases to evaluate potential DDIs and determine the appropriate drug regimens for physician communications and patient consultations.

/pdf/comparison-of-potential-drug-drug-interactions-with-191b10v91a.pdf

Comparison of potential drug-drug interactions with metabolic syndrome medications detected by two databases.

Continue or stop applying wet cupping therapy (al-hijamah) in migraine headache:A randomized controlled trial.

Investigation of wet cupping therapy’s effect on oxidative stress based on biochemical parameters

OBJECTIVE To investigate the rates of polypharmacy (PP) and its relations with accessibility to health services in chronic patients in a primary care setting. STUDY DESIGN A cross-sectional study. PLACE AND DURATION OF STUDY Melekhatun Family Health Center, Istanbul, Turkey, from January 2014 to January 2017. METHODOLOGY Chronically ill older adults were enrolled in the study. Patients were seen either at home or at health centre. Threshold for PP was five medications daily. Chi-square tests were applied for group comparisons of PP. Continuous variables were examined by Student's t-test. Logistic regressions followed. RESULTS Study population (n=707) consisted of 442 female (62.5%) and 265 male (37.5%) subjects. Mean age was 73.6 ±7.1 years. Mean number of medicine used per day was 4.7 ±3.5. Polypharmacy rate was 32.8%.Although the number of chronic diseases, that at home patients had, was significantly higher, outpatients had 1.92 times higher risk for PP. Similarly, risk for PP was found 2.57-fold higher in insured patients. CONCLUSION Univariate results of this study suggests that accessibility to health services also increases PP risk, in addition to known risk factors such as female gender, depression and chronic diseases. Same results draw our attention to the risk of inadequate treatment in those who lack health insurance. Longitudinal studies in larger scale are needed for further assessment of these relationships.

/pdf/accessibility-to-healthcare-and-risk-of-polypharmacy-on-2nob0jpxdw.pdf

Accessibility to Healthcare and Risk of Polypharmacy on Chronically ill Patients.

Amac:  Tukenmislik konusunda yapilmis bircok tanim olmasina ragmen gunumuzde kabul goren en yaygin tukenmislik tanimi Maslach ve arkadaslari tarafindan yapilan ve tukenmisligi uc boyutlu olarak algilayan tanimdir. Acil servis (AS) personeli is ortaminin yogunlugu, bakim verilen hastalarin ciddiyeti, vardiya seklinde calisma programi nedeniyle surekli stres altindadir. Bu calismada Tip Fakulteleri (TFH) ile Saglik Bakanligi Egitim ve Arastirma Hastanelerinde (EAH) gorev yapmakta olan Acil Tip Asistanlarinin (ATA) tukenmislik duzeylerinin karsilastirilmasi amaclanmistir. Gerec ve Yontemler:  Bu calisma Ankara Numune Egitim ve Arastirma Hastanesi etik kurulundan onay alinarak Mayis-Agustos 2011 tarihleri arasinda anket yontemiyle yapilmistir. Calismaya EAH’den 116 ATA, TFH’den 90 ATA olmak uzere toplam 206 ATA alinmistir. Anket yontemiyle elde edilen verilerin istatistiksel analizleri SPSS 15 programi ile yapilmistir. Istatistiksel analizlerde ki-kare, Independent Sample T testi ve Oneway Anova testi kullanilmistir. p 0.05) Sonuc:  EAH’lerinde calisan ATA’larin, TFH’de calisan ATA’lara oranla daha fazla tukenmeye maruz kaldiklari bulundu

/pdf/tip-fakultesi-hastaneleri-ve-saglik-bakanligi-egitim-ve-1rjwbushk6.pdf

Tıp Fakültesi Hastaneleri ve Sağlık Bakanlığı Eğitim ve Araştırma Hastanelerinde Çalışan Acil Tıp Asistanlarının Tükenmişlik Düzeylerinin Karşılaştırılması

leneksel tıp sistemlerinin birçoğu beden temizliğinden (detoks) ve bunun hastalıkların tedavisindeki öneminden bahsetmektedir. Örneğin; ayurveda da “pancha karma” olarak adlandırılan kusturma (vamana), ishal (virechana), aromatik yağların nazal yolla inhalasyonu (nasya), bitkisel içerikli lavman (basti) ve kan almadan (raktamokshana) müteşekkil beşli prosedür kollektif bir detoks yöntemi olarak geleneksel Hint Tıbbı’nın tedavi basamaklarının ilkini temsil etmektedir.1

Osmanlı Tıbbı'nın Geleneksel Detoks Yöntemi: İstifra

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