A NARRATIVE REVIEW OF OPTIMAL CARE FOR PATIENTS WITH CARDIOVASCULAR DISEASE AND TYPE 2 DIABETES: COLLABORATIVE RESPONSIBILITIES OF CARDIOLOGISTS AND DIABETOLOGISTS.

Diabetes and cardiovascular disease are linked, putting diabetics at higher risk of cardiovascular events and death. Comprehensive cardiovascular risk mitigation includes blood glucose management. Diabetes vascular protection includes hypertension, dyslipidemia, and lifestyle changes. Optimizing diabetic vascular protection requires cardiologists and diabetologists to work together. This narrative review examines type 2 diabetes' complex association with cardiovascular disease. Glycemic control and vascular protection methods in diabetics are crucial for early detection and therapy of coronary artery disease (CAD). It also highlights the difficulties of selecting diabetes patients for cardiac tests and the importance of interdisciplinary care. This narrative review underlines the substantial link between type 2 diabetes and cardiovascular disease and that glucose control is only one part of cardiovascular risk management in diabetics. Since improper glucose regulation is common in coronary artery disease, early glycemic control is crucial. Regular diabetes and glucose intolerance screening is advised for cardiac patients. Determining who needs non-invasive cardiac testing is difficult. A multidisciplinary team of cardiologists and diabetologists is needed to treat diabetic and cardiac patients. Further research should refine risk stratification approaches to identify diabetic people who might benefit most from CAD tests. Novel therapies to improve diabetic glucose control and cardiovascular outcomes are also needed. Long-term studies on interdisciplinary care teams and patient outcomes are needed. Clinicians should prioritize comprehensive vascular protection strategies for type 2 diabetics due to their complex cardiovascular risk. Identifying diabetic cardiac patients should be simplified. In this high-risk group, multidisciplinary care teams improve patient management and outcomes. To improve diabetes and cardiovascular disease care, policymakers should develop recommendations that encourage cardiologists and diabetologists to work together

An intervention program to reduce the number of hospitalizations of elderly patients in a primary care clinic

<p>Abstract</p> <p>Background</p> <p>The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations.</p> <p>Objectives</p> <p>To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care.</p> <p>Methods</p> <p>A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program.</p> <p>Results</p> <p>As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%). The number of adjusted hospitalization days dropped from 132 to 82 (37.9%) and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%). The adjusted hospitalization cost ($/1,000 patients) dropped from$32,574 to $18,624 (42.8%). The overall clinic expense, for all age groups, dropped by 9.9%.</p> <p>Conclusion</p> <p>Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.</p

Preventing stroke at door step– need for a paradigm shift in delivery of preventive healthcare

Although stroke is a preventable disease, it is increasing globally. Only few risk factors are responsible for much of the leading noncommunicable diseases, yet those remain poorly controlled, despite being the most affordable way of promoting health and preventing disease [1]. Lifestyle modification including cessation of smoking, making aerobic physical activity a routine, certain changes in diet, and aggressive management of risk factors are all part of stroke prevention strategies [2]

The impact of statin use on outcomes of Diabetic adult patients hospitalized for community acquired pneumonia.

BACKGROUND: Statins, a class of drugs that treat hyperlipidemia, may have an immunosuppressive effect for patients with community acquired pneumonia (CAP). Retrospective and in vitro studies have suggested an immunomodulatory, antioxidative and anticoagulant effects from statin use in patients with Type 2 Diabetes Mellitus (T2DM) hospitalized for CAP. Prospective studies that have tested any effect of statin therapy on patients with T2DM and CAP have not been found literature. To date, prospective studies showing of the effects statin therapy may have on T2DM patients hospitalized for CAP are not available. METHODS: This dissertation is a secondary analysis using deidentified data collected from the HAPPI Study, a prospective CAP observational study conducted in nine adult acute-care hospitals in Louisville, Kentucky, from 2014-2017. HAPPI patients were grouped by T2DM, prior statin exposure, and age. Decision tree analyses were performed to indicate how strongly the T2DM and statin interaction is related to outcomes of mortality (after one, six, and 12 months) and CAP rehospitalization (after one, six, and 12 months). Multivariate logistic regression analyses were used to identify potential covariables. Propensity score matching (PSM) and the McNemar test were used to compare the odds ratios of outcomes on paired statin users (cases) and non-statin users (controls) based on age and T2DM. RESULTS: From 10052 CAP patients, 1265 of 2734 T2DM patients were on statins (46.3%) and 2340 of 7318 non-T2DM patients were on statins (32.0%). The decision tree analysis, logistic regression analysis, and survival analysis indicated that statin use in T2DM patients age \u3c 65 years was significantly associated (OR = 0.55, p \u3c 0.01) with a decreased likelihood for all-cause mortality at one, six, and 12 months. Analysis after PSM found statin use in T2DM patients age \u3c 65 was associated with non-significantly decreased odds for one, six, and 12 month mortality (OR = 0.70, p = 0.09). The logistic regression analysis and PSM analysis showed no significant difference in mortality likelihood between T2DM patients age ≥ 65 with statin use and those without statin use. No significant difference was seen in rehospitalization between T2DM cases and controls in either age groups. CONCLUSIONS: Decision tree analysis, logistic regression analysis, and Cox regression analysis showed that the T2DM and statin interaction was significantly associated with decreased mortality at one, six, and 12 months for T2DM patients age, but not in T2DM patients age ≥ 65. A prospective case control study with a larger sample size to account for PSM may validate these findings to be significant. This dissertation emphasized the continued study of statin therapy for the attenuation of CAP severity and improved outcomes

A person with diabetes as a patient - basic rules of conduct

BACKGROUND: Diabetes is very widespread disease. More and more patients suffer from hyperglycaemia and low levels of insulin because of obesity, aging and wrong diet. The most important in treatment based on health condition is to normalize glucose level. It is recommended to treat patients to avoid many complications of hyperglycaemia, e.g. cardiovascular diseases, stroke episodes, neuropathy or nephropathy. The most common cause of death are cardiovascular problems and renal failure. MATERIAL AND METHODS: A proper review of published literature provide to define laboratory indexes, risk factors, complications to precise methods of treatment among patients with diabetes. RESULTS: The problem of growing number of people suffering from diabetes is an important issue to find solutions to conduct their treatment. Basic method is a change of diet and body loss. The most important medicament in treatment is metformin. To achieve the best results of conducting therapy should be extended by pioglitazone or liraglutide. Also addition of aspirin lower dyslipidemia problems. Such a combination provides to minimise side effects of sickness. CONCLUSIONS: Number of people suffering from DM is still and will be growing over the next years. It is significant to diagnose these people because untreated diabetes provides to many complications e.g. stroke or acute coronary syndrome. It is important to examine patients correctly what allows to turn on correct treatment. Basic standards in treatment should contain lower glucose levels, avoid complications to enhance life quality. . Expanded therapy is also concentrated on hypertension, acidosis and ketoacidosis coma to obtain beneficial effects

Effectiveness of Education on Diabetes Control

The purpose of this study was to examine the effect of a diabetes education intervention strategy on the clinical and biochemical status of patients in the Diabetes Complications Prevention Study (DCPS) at Candler County Hospital in Metter, Georgia. The participants in this study were all active members in the DCPS program. This intervention group was paired to control group members of a similar age and race. A sample size of 18 participants and an equal number of controls was chosen for this evaluative study. The sampling method utilized for participants in the study was non-probability quota sampling. Medical records were used to obtain clinical data that included type of diabetes, sex, race, age, weight, high blood pressure, use of medication (insulin, high blood pressure and glucose pills), diabetes mellitus diet, and whether the patient was hospitalized. The variables glucose, HbAlc, blood pressure, weight recorded in the medical records were included in a Pearson correlation, t-test, one way Analysis of Variance (ANOVA), and multiple regression analysis. The t-tests and one way ANOVA revealed no statistically significant differences in means between the DCPS and control group. Bivariate analysis revealed a significant relationship between the variables average glucose (0.52, p Recommendations originating from the study include sustaining the essential, collaborative and integrated team approach to diabetes management. In other words, diabetes educators and other health professionals should continue to emphasize the health benefits of diabetic diet, regular exercise and other aspects of the diabetes care regimen. Additionally, it is important that diabetics assume an active role in their care. Education interventions increase patient involvement which in turn improves compliance. Directing resources to educational programs seems a wise allotment of funds compared to the more costly expense of treating diabetic complications

International Liver Transplantation Consensus Statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation

Nonalcoholic steatohepatitis (NASH)-related cirrhosis has become one of the most common indications for liver transplantation (LT), particularly in candidates over the age of 65 years. Typically, NASH candidates have concurrent obesity, metabolic and cardiovascular risks, which directly impact patient evaluation and selection, waitlist morbidity and mortality and eventually posttransplant outcomes. The purpose of these guidelines is to highlight specific features commonly observed in NASH candidates and strategies to optimize pretransplant evaluation and waitlist survival. More specifically, the working group addressed the following clinically-relevant questions providing recommendations based on the GRADE system supported by rigorous systematic reviews and consensus: (1) Is the outcome after LT similar to that of other etiologies of liver disease? (2) Is the natural history of NASH-related cirrhosis different from other etiologies of end-stage liver disease? (3) How should cardiovascular risk be assessed in the candidate for LT? Should the assessment differ from that done in other etiologies? (4) How should comorbidities (hypertension, diabetes, dyslipidemia, obesity, renal dysfunction, etc.) be treated in the candidate for LT? Should treatment and monitoring of these comorbidities differ from that applied in other etiologies? (5) What are the therapeutic strategies recommended to improve the cardiovascular and nutritional status of a NASH patient in the waiting list for LT? (6) Is there any circumstance where obesity should contraindicate LT? (7) What is the optimal time for bariatric surgery: before, during, or after LT? and (8) Donor steatosis: how much relevant is it for LT in NASH patients

Cardiovascular risk assessment - From individual risk prediction to estimation of global risk and change in risk in the population

Cardiovascular disease is the most common cause of death and risk prediction formulae such as the Framingham Risk Score have been developed to easily identify patients at high risk that may require therapeutic interventions. Using cardiovascular risk formulae at a population level to estimate and compare average cardiovascular risk among groups has been recently proposed as a way to facilitate surveillance of net cardiovascular risk and target public health interventions. Risk prediction formulas may help to compare interventions that cause effects of different magnitudes and directions in several cardiovascular risk factors, because these formulas assess the net change in risk using easily obtainable clinical variables. Because of conflicting data estimates of the incidence and prevalence of cardiovascular disease, risk prediction formulae may be a useful tool to estimate such risk at a population level

IMPLEMENTING A PRESCREENING PROCESS TO FULLY ASSESS RISK FACTORS AND OUTCOMES ASSOCIATED WITH OBESITY AND HEPATIC STEATOSIS TO PREVENT CIRRHOSIS

Fatty liver disease can be treated if is identified in the initial stages of the disease. Once the disease progresses to fibrosis and/or cirrhosis, there is irreversible damage. The leading cause of non-alcoholic fatty liver disease is obesity. Obesity has reached epidemic proportions, with most obese individuals not fully cognizant of the repercussions of prolonged obesity. Other risk factors for fatty liver disease are uncontrolled diabetes mellitus, hyperlipidemia, and hypertension. Certain medications can also increase the risk of fatty liver disease. Currently, there is no prescreening tool to identify patients who are at risk for fatty liver disease. The researchers developed a prescreening tool in a written format to aid in identifying individuals at risk for fatty liver disease. Once identified as being at risk, the individuals can be instructed on ways to decrease that risk. The prescreening tool was utilized in a primary clinic setting. Patients who attended the clinic and consented to participate in the study were screened with this tool. Fifteen patients who attended the clinic agreed to participate in the study. The researchers eliminated participants who had already been diagnosed with fatty liver disease or had a history of drug or alcohol abuse. No one under 18 was permitted to participate in the study. Out of the 15 participants, 10 were at risk for developing fatty liver disease. Those 10 participants were then educated on methods to reduce the risk of developing fatty liver disease, including weight loss and the importance of taking prescription medications directed to control any disease processes. The participants were followed up over four weeks, either in person at the clinic or via telehealth visits. The results show that, out of the 10 participants, three lost four pounds, five lost two pounds, and two did not lose any weight. Out of 10 participants, two took medication for diabetes and four took medication for hyperlipidemia. They all demonstrated compliance with taking the medication regularly and were knowledgeable about the medication. The results showed that most of the participants were able to demonstrate knowledge of methods to decrease their risk for fatty liver disease