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4461. Prevention, identification and management of foot complications in diabetes

Copyright Administration, Attorney-General’s Department, Robert Garran Of? ces, National Circuit, Barton ACT 2600 or posted at ISBN Print: 978-0-9871410-0-2 Electronic document This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, noncommercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests

2011 Clinical Practice Guidelines Portal

4462. Diagnosis, management and prevention of occulational contact dermatitis: concise guidelines

-Stokes FRCP and Bernard Higgins FRCP Copyright: All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s permission should be addressed to the publisher. © 2011 Royal College of Physicians. All rights reserved. Citation: Royal (...) . Occupational CD is notifiable to the Health and Safety Executive under the Reporting of Incidents, Diseases, and Dangerous Occurrences Regulations (RIDDOR). The employer is responsible for reporting work-related CD when the diagnosis has been confirmed by a doctor or other health professional. Therefore, physicians have an important role in alerting a patient’s employer if they think that a new case of CD has been caused by work. Dermatitis is a prescribed disease for the purpose of Industrial Injuries

2011 British Association of Dermatologists

4464. More Pills, More Problems: The Polypill Revisited

with cardiovascular disease results in an . [6] Treatment complexity is a [7,8] Patients with multiple prescriptions are more prone to misuse medications, with an increased risk of adverse reactions. Because polypharmacy is a contributing factor to medication noncompliance, there has been a growing trend toward simplifying drug regimens and combining medications into single pills. [1] Fixed-dose combinations (FDCs) of 2-3 medications in one pill are already in widespread use. Some common cardiovascular FDCs (...) . 1998;21(1):87–92. 5. Dezii CM. Medication noncompliance: what is the problem? Manag Care. 2000;9(9 Suppl):7–12. 6. US Department of Health and Human Services. Medication regimens: causes of noncompliance. 7. , , , Tang SS, Rosenberg N, Schwartz JS. Association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy. 8. Clax to n AJ, Cramer J, Pierce C. A systematic review of the associati on s between dose regimens and medicati

2011 Clinical Correlations

4465. Tales of Survival: Physical Exam

were often told that we would always remember every patient we helped to take care of. In my experience, this prediction has come true. Patients are memorable because each one seems to teach a new lesson. In our preclinical years we had been lectured endlessly about medications prescribed for congestive heart failure, but it was only after I followed a 66-year-old homeless man with CHF for three weeks, watching him gasp for air as he shuffled to the bathroom, that I finally understood how (...) it as he experienced it. Thanx Comments are closed. Sites We Follow: Useful Links: Questions? Comments? Contact us! © New York University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2011 Clinical Correlations

4466. Guidelines for the Management of Iron Deficiency Anaemia

:// CG027quickrefguide). 13. Hamilton W, Lancashire R, Sharp D, et al. The importance of anaemia in diagnosing colorectal cancer: a case-control study using electronic primary care records. Br J Cancer 2008;98:323e7. 14. Lewis SM, Bain BJ, Bates I. Dacie and Lewis Practical Haematology. 9th edn. London: Churchill Livingstone, 2001. 15. Jolobe OM. Prevalence of hypochromia (without microcytosis) vs microcytosis (without hypochromia) in iron de?ciency. Clin Lab Haematol 2000;22:79e80. 16. Guyatt GH (...) . A prospective audit of patients presenting with iron de?ciency anaemia and faecal occult blood loss. Gut 1992;33(Suppl 1):S31. (abstract). 44. Moses PL, Smith RE. Endoscopic evaluation of iron de?ciency anemia. A guide to diagnostic strategy in older patients. Postgrad Med 1995;98:213e26. 45. Smith AG. Prescribing iron. Prescribers’ J 1997;37:82e7. 46. Crosby WH, O’Neil-Cutting MA. A small dose iron tolerance test as an indicator of mild iron de?ciency. JAMA 1984;251:1986e7. 47. Joosten E, Vander-Elst B

2011 British Society of Gastroenterology

4467. Transrectal Ultrasound Guided Biopsy of the Prostate

individual EAUN members, both electronically and in print. The full text can be accessed on the EAU website ( nursing-guidelines/) and the EAUN website ( Hard copies can be ordered through the EAU website via the web shop ( or by e-mail ( Transrectal Ultrasound Guided Biopsy of the Prostate – March 2011 Table of contents Introduction 2 1. Methodology, disclosures 7 1.1 Guidelines

2011 European Association of Urology Nurses

4469. How to ease your transition home from the hospital

the house. A utensil holder with handle works great for medications and syringes, etc. Also, make sure to organize and order any equipment (like a breathing/heart rate monitor, kangaroo with a stand, or a car seat) ahead of time. 2. Make sure you are well stocked with over the counter first aid supplies and gadgets. Sometimes when the focus is on prescription medications and complex medical conditions, we forget the simple things. Baby friendly thermometers, diaper rash cream, band-aids and batteries (...) rely on. You have come this far relying on teams of people in the hospital and, hopefully, in your family and the wider community. Don’t underestimate how emotionally and physically exhausting this journey has been, and make sure you have paper or electronic lists of how to contact the people you can rely on for the next days and weeks — on your own terms. You may want to arrange your own “support staff” whether it’s family, friends, a night nurse, nanny, or babysitter to come help. Be ready

2017 KevinMD blog

4470. Concept Clearance » HIV Healthcare Systems Approaches to Improve Viral Suppression (HH-SAIVS)

interventions with structural interventions in healthcare systems or healthcare delivery. Structural interventions seek to improve the health of populations or groups, rather than individuals. They may be directed at healthcare practice, providers, systems, or policy. This initiative would target a gap in scientific knowledge on HIV healthcare delivery factors that may improve viral suppression. Research related to this initiative may include: Research testing the impact of prescription-based strategies (...) such as synchronization of medication refill dates, extended refill intervals, and co-packaging of individual medicines on HIV viral suppression; Research testing whether reduced medication co-pays or value-based insurance designs can improve rates of ART medication refills and viral suppression; Research testing clinic-level interventions that target clinic or provider practice to promote ART adherence and viral suppression, including electronic medical record practices; Research on “test and start” HIV care models

2017 NIMH blog

4471. Once upon a time, being a doctor was great. Not anymore.

and people didn’t wring their hands all the time about rules and lawyers. Sometimes, old Grandpa Leap and his friends felt like cowboys, trying new things in the ER whether we had done them before or not. Yessiree, it was a time. We didn’t live by a long list of letters and rules — we knew what was important. And we were trusted to use our time well, without being tracked like Caribou with electronic badges. Those were the salad days. When I was a young pup of a doctor, we took notes with pen and paper (...) and wrote orders on the same. It wasn’t perfect, and it wasn’t always fast. But it didn’t enslave us to the clipboard. We didn’t log-into the clipboard or spend twenty minutes trying to figure out how to write discharge instructions and a prescription. We learned in grade school. EMR has brought great things in information capture and storage, but it isn’t the same — or necessarily as safe — as the way humans conveyed information for hundreds, nay thousands of years. Back then, kids, the hospital

2017 KevinMD blog

4472. Evidence-based guidelines for treating bipolar disorder

be noted that of the BAP 2016 authors, only two were on the NICE 2014 development group. Confusingly, one of the authors of both guidelines has argued for the in the National Health Service (Morriss, 2015). Patient choice/prescribers choice In perhaps their most confrontational mode, the authors state: [D]rug choice is an important clinical freedom… While NICE 2014 is at pains to emphasize the need to respect patient choice, as are we, they are less liberal in what choices they actually sanction (...) ), Lurasidone (not licenced for use in bipolar depression in Europe) and lamotrigine have evidence of efficacy Antidepressants may be effective [italics authors own] but require co-prescription of a mood stabilising agent Risk of a switch to mania is higher in tricyclic antidepressants and other duel-action medications (e.g. venlafaxine) than in SSRI Lithium, valproate and carbamazepine have poor evidence for acute efficacy Consider ECT in severe or refractory depression Consider family focused, cognitive

2016 The Mental Elf

4473. Psychotropic medication in pregnancy: new evidence may help achieve a safe balance Full Text available with Trip Pro

treatment increased by more than 50% before and during pregnancy and prescriptions of anticonvulsant mood stabilisers to women with a record of psychosis or depression almost doubled. In contrast, lithium prescribing after delivery almost halved, in fact so few women were prescribed lithium no further analyses could be conducted. Descriptive studies Prescribing of psychotropic medication decreased in early pregnancy and then increased after delivery to equal or above pre-pregnancy levels. Rates (...) effects of psychotropic medication? The National Institute for Health Research has commissioned research to address the question: What are the risks and benefits of psychotropic drugs in women treated for psychosis who become pregnant? (Peterson et al, 2016). Stacey Slater from BBC EastEnders. Women with severe mental illness can face incredibly difficult treatment decisions when they become pregnant. Methods The researchers used data from two existing electronic health records sources: The Health

2016 The Mental Elf

4474. STEADI-ing our older patients against falls

for falls in the United States along with relevant Choosing Wisely recommendations. They provide an algorithm from the STEADI toolkit to identify patients at risk for falls using a and the . Incorporating these 2 screening instruments into the . Recommending physical therapy, reviewing medications, and ensuring home safety, visual correction, and appropriate footwear have been found to benefit patients at moderate to high risk of falling. Prescribing vitamin D is also recommended for some older adults (...) , though Dr. Lin has written previously on the blog about the . The accompanying reviews the costs for caring for older adults after a fall ($31 billion a year from Medicare alone) along with the development and components of the STEADI initiative: screen, assess, and intervene. A 2016 Community Blog . Plans to integrate STEADI screens and interventions in electronic health records (EHR) should assist physicians with incorporating falls assessment into our everyday workflow; while waiting

2017 The AFP Community Blog

4475. Want to change medicine? Work in finance.

are still largely absent from traditional medical education. This summer, I interned at a hedge fund that invests in the health care space. I found learning how other major players impact the health care system far more valuable than pipetting small volumes of clear liquids or data mining electronic health records. I don’t mean to downplay the value of such projects; I took two years off before school to do wet lab research and absolutely loved it. Just know that basic and clinical research aren’t going (...) money and lots of it. The saying “bench to bedside” skips a few critical steps. Now back at school, the drugs we’re learning about in class, and will one day prescribe, suddenly have narratives — stories of development, hitting clinical endpoints and eventually receiving a price tag. Asking patients about their insurance coverage and out-of-pocket costs is no longer a superficial checkbox. Slowly, but surely, the puzzle pieces come together. While learning about how these various moving parts

2017 KevinMD blog

4476. Literacy is a health care problem no one talks about

to complete forms in English when they primarily speak another language. When language is considered, the number with below basic literacy or worse is over 30 million. With so many people having low or limited literacy, one would think health care does a good job at providing health care instructions in the preferred language. After all, most electronic health records (EHRs) have patient instructions in different languages. However, it may take extra clicks or extra time to load so it doesn’t happen (...) as often as needed. In addition, many pharmacies are able to dispense medication instructions in other languages only if requested by the prescriber. When basic instructions aren’t understood, errors are bound to occur. Low literacy and limited English proficiency have been known to affect hospitalizations, readmissions, morbidity and mortality. If we don’t do this right in health care where the stakes are high, why should other industries care? Fortunately, most adults are literate, but they can also

2017 KevinMD blog

4477. Do quality metrics really improve patient care?

quality of the care our patients receive? That’s a lot of questions all at once, and I’m not sure we’re ever going to get the answers to all of them, but it is reflective of the environment we are practicing in. Here are some examples: Behavioral health, ADHD medication management, follow-up care for children prescribed ADHD medicines — initiation phase, continuation phase. So someone’s going to have to review the charts of children with ADHD, and make sure that there is follow-up. Whatever that means (...) , we are pouring endless effort and energy and the work of all the people who used to help us take care of patients, into creating an electronic documentation behemoth, this huge space that used to be called the patient’s medical record, that is now becoming a lumbering collection of boxes that needed to be clicked to satisfy a never-ending thirst for compliance and unproven metrics. Are all these things, these metrics, really just the things we used to do, the things we were trying to do

2017 KevinMD blog

4478. A psychiatrist’s perspective on the digital pill

A psychiatrist’s perspective on the digital pill A psychiatrist's perspective on the digital pill A psychiatrist’s perspective on the digital pill | | December 2, 2017 60 Shares One of my readers, Natalie, wondered about my thoughts about the . My initial reactions were similar to several of those who were interviewed for the article. The digital pill, which provides electronic information to confirm whether someone has ingested the medication, has great potential to become a tool of coercion (...) . Aripiprazole (Abilify) is classified as an antipsychotic medication, which is often prescribed to people who have beliefs that machines and other surveillance tools are in their bodies. Why would the nascent technology of a digital pill make its debut for this population? I have several other concerns about this digital pill: 1. The purported mechanism of action for aripiprazole (Abilify) involves hand-waving, which is yet another reason why its debut as a digital pill is perplexing. To the manufacturer’s

2017 KevinMD blog

4479. When EMRs crash: It’s time to push back

When EMRs crash: It’s time to push back When EMRs crash: It's time to push back When EMRs crash: It’s time to push back | | December 3, 2017 77 Shares The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era. The paper medical chart I used during most of my career never “crashed.” Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed. Although I appear (...) to the patients as a breathing and willing medical practitioner, I might as well be a storefront mannequin who appears lifelike, but cannot function. We cannot access the patients’ records, write a prescription or enter a new office visit. Of course, like any business who faces this crisis, we expect instantaneous rescue from our IT professionals, as if we are their only client and they are permanently stationed in our waiting room just waiting for us to sound the alarm. This is among one of the most

2017 KevinMD blog

4480. How the nurse makes it possible

. Physicians prescribe a series of treatments, medications, and suggestions they feel will help you improve. The nurse follows orders of priority to carry these out thru the course of their shift. This means fighting with intravenous lines, tubing, and pumps to carry out that Cipro order your doctor wants you to have every 12 hours. The nurse must make sure the line going into your vein is healthy and not causing you additional problems. While doing this, the nurse helps you get in and out of bed to walk (...) to the restroom, sit in the chair, and prepare your lunch. Blood work results are in, and the nurse looks them up in the electronic medical record that is on the computer screen at the nurse’s station. Your potassium level is very low and must be corrected. The nurse pages the physician and obtains orders to replace it. This order is entered, sent to a pharmacist who ensures it is an accurate dose. The nurse enters into the medication record in the electronic medical record and again will follow a series

2017 KevinMD blog

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