...Energy Laser as a Treatment for Refractory Diabetic Leg Ulcers By Wendy Price Wake Forest University Department of Physician Assistant Studies 4/10/2009 I would like to thank everyone at Coy C. Carpenter library help and reference desks. To Ekatrina Zachry who translated the Russian research papers, thank you is the very least I can say for such an excellent job. I would like to tell my girls how proud I am of them and thank them for their patience, pictures, and prayers. You make it all worth the while. I would also like to thank my mother for her support, coming to help with the girls while I have been in school, and her motherly faith in me that never waivers. Most of all I want to thank my husband Clay Price for being an amazing pillar of strength, encouragement, patience, understanding, and love. I know I COULD NOT have done it without you. UA&F Low Energy Laser as a Treatment for Refractory Diabetic Leg and Foot Ulcers ABSTRACT BACKGROUND: Diabetic leg and foot ulcers often lead to immobility, infection, and amputation, cost $7,000 to $40,000 per ulcer, and erode mental health and QOL. Lasers have been effectively utilized in medicine since the 60’s, from various surgical uses to the treatment of diseases. Although low-energy (also called low-power, low-level, and cold) laser therapy for “biostimulation” (or biomodulation) of ulcer healing has been studied extensively, quality data on diabetic wound healing is rare. This review seeks to...
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...Diabetic Mellitus –Type 2 Reason of admission-Chief Complaint: A 55-year-old Caucasian man presented with polyuria, polydipsia, and "feeling dry" during the past 2 months. History of Present Illness: Physical examination revealed a height of 5'11", weight of 240 lb (body mass index [BMI] of 34.4 kg/m2), blood pressure of 150/88 mm Hg, and pulse of 80/min. There was no abdominal tenderness or organomegally. Laboratory evaluation showed a serum glucose of 397 mg/dl. Urinalysis revealed 3+ glucose and negative ketones. His medical history was remarkable for a 3-year history of poorly controlled hypertriglyceridemia. His initial fasting serum cholesterol was 299 mg/dl, triglycerides were 928 mg/dl, and high-density lipoprotein (HDL) cholesterol was 30 mg/dl before treatment. Past medical history: He was treated with gemfibrozil (Lopid) 600 mg twice daily and told to watch his diet and exercise. No referral was made to a registered dietitian. Current medications: A fasting triglyceride level of 570 mg/dl prompted further increase of gemfibrozil to 600 mg three times daily (this exceeds usual recommended dosing). The patient was started on 5 mg glyburide [Micronase] daily. He was also given a referral to a dietitian. That evening, the patient complained of abdominal pain, nausea, vomiting and flu-like symptoms. He collapsed at home and died a short time later. At autopsy, it was found that he died of acute hemorrhagic pancreatitis. The patient was also found to have severe...
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...Single-component products – Cost comparison of selected oral anti-diabetic products Introduction: Fixed-dose combination products (FDCs) are drugs which contain two or more drugs in fixed proportions in the same formulation. Fixed-dose combinations are becoming increasingly important because they offer several advantages to the patients. General advantages include lower costs of manufacture, improved patient adherence and decreased distribution costs. Advantages like increased efficacy and increased safety may be possible with certain cases. Combinations are being used in the treatment of various conditions and are specifically useful in the management of HIV, Malaria, Tuberculosis, diabetes and hypertension to name few. A few irrational combinations came to the market place due to certain loopholes existed in the drug regulatory system in India. Certain steps have been taken by Drugs Controller General of India to stop such irrational combinations. However, still the debate is on between the manufacturers and drug regulatory authorities. Objective: It is a general belief among the prescribers and other stakeholders of healthcare that FDCs are less costly than their single-component products. However, it cannot be generalised to all FDCs. The present study was taken up with an objective to find out FDCs which are costlier than their single-component counterparts. For which certain oral anti-diabetic drugs were selected and studied. Methodology: Data was collected...
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...Diabetes Education Community Teaching Due: April 13, 2014 Diabetes Power Point at QCP This diabetes power point was presented at an adult community center in Queens, New York called QCP. This power point highlights the importance of educating yourself on disease and more specifically diabetes. Unlike other diseases that can be managed using only medication, diabetes requires day to day knowledge of the disease including nutrition, exercise and different levels of medication. Type II diabetes can also come on later in life based on diet and exercise or lack thereof. Therefore this power point presentation was important to help people understand how to deal with diabetes and how to prevent diabetes. This teaching plan includes education for both prevention and management of the disease. The power point presentation first describes what type of disease that diabetes is and what exactly the symptoms are. The teaching plan goes on to discuss the three different types of diabetes including Type I, Type II and gestational diabetes. Following along the teaching plan teaches how diabetes is diagnosed and what type of symptoms people have when they have diabetes. This helps people better understand the disease and what their symptoms mean and what causes it. The teaching plan is careful to differentiate between pre-diabetes and diabetes to make sure that people understand the difference before they experience the full blown disease. My teaching plan includes simple learning devices...
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...Study Skills Essay I have chosen to study about Diabetes as I think it is important that everyone is aware of this disease. In the past year the amount of people diagnosed with Diabetes has risen to 2.8 million people, an increase of more than 150,000 people in a year. This means that one in twenty of the UK population now has Diabetes. (Diabetes UK, 2010). From my experience, working as a health care assistant on a ward in a local hospital trust, I have first hand knowledge that you could be caring for a number of patients with Diabetes at one time. In this essay I shall be exploring different methods of study skills for my chosen topic. For each study skill that I have chosen, I shall explain why that method was selected, what I found useful and what did not help in increasing my knowledge of this subject. I shall demonstrate how I used a learning styles questionnaire to determine what type of learner I am. I will do this by describing the questionnaire and I shall explain how I used the information to increase my learning. How I managed my time to study effectively around university and placement will also be discussed. To prepare myself for writing this essay, I decided to discover what my learning style was in a study skills guide recommended by the university. There were four different learning styles and to help you decide which one you were there was a list of the characteristics, learning strengths and the areas that the individual needed to develop...
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...Part 1 For the first part of your research project for the course, you will start to identify the topic you will research in the literature. The difference between a research problem and an Evidence-Based Practice (EBP) problem (which we will discuss in more depth later in the module) is that a research problem typically helps define a study or experiment that will be undertaken, while an EBP question often has an answer already, we just need to identify it. It is important, however, to have an understanding of the process that is involved in developing a research question. It’s also important to discuss the problem and purpose of the study – after all, we need to understand why what we’re researching matters! When working as a bachelors prepared nurse you will be asked to be on committees and may even take another job in a quality/process improvement. Within this role you will need to be able to identify new solutions to clinical problems within the health setting. In order to do this you will go to the published literature and identify quality literature and see if the results found in that literature would apply to your setting and population. Problem Statement: The first thing you will do is identify your problem statement. That is, what problem do you want to address. You might discuss the high cost, mortality, and morbidity associated with Type I diabetes in children, for example. This lets us know why it is important that we research this issue further. Identifying...
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...Diabetic Athletes Your Name Your School After learning more about disease from someone with Type 1 diabetes it made me wonder how someone can be active with diabetes. First we must understand what Diabetes is, here is a definition I found was that is very simply and understanding. “Diabetes is disease that affect how your body uses blood sugar also known as glucose. Glucose is beneficial to one’s health because it is an important source of energy for the cells that make up your muscles and tissues.” There are two types of diabetes there is Type 1 and Type 2 diabetes. The main difference between the two is Type 1 your body is unable to produce insulin, in Type 2 it can be cured through diet and exercise. Hypoglycemia is a major fear for among diabetics this is when you are low on blood sugar and this triggers symptoms such as: rapid/fast heartbeat, fatigue, headaches, shakiness, blurred vision, weakness, unconsciousness, etc. I did some research and found that there are actually people who are athletes that still are able to play a sport or even stay active. Team Novo Nordisk is a group diabetic athletes that compete each year in triathlons, cycling, and runners. They have competed in more than 500 events worldwide in 2014. Team Novo Nordisk started back in 2006 with only eight members now it is composed of 100 athletes from 20 different countries. The reason why the compete each year is not only to educate people about diabetes but also to inspire people...
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...Education on Wound Care for Diabetic Patients Education on Wound Care for Diabetic Patients Abstract Non-compliance of wound care management has increased the risk of infection and amputations. Diabetes wound care management is an important and fundamental aspect when it comes to diabetes teaching and education. Assessment of the feet daily and at a primary care office will provide information such as noncompliance, risks for neuropathy, peripheral vascular disease, macro-vascular disease, and possible amputation. Education provided by health care practitioners to the diabetic population will promote decrease in risk for further complications and the patient to be involved in their own care. Assessment, treatment, and education on wound care management with the involvement of the patient will increase the patient’s quality of life and be very beneficial to both the practitioner and the patient. Keywords: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, diabetic care management Introduction Working in a primary care setting will involve a multitude of disease processes- diabetes mellitus being one of them. Diabetes is a disease that is characterized by high levels of blood glucose with a defect in insulin secretion and cell resistance. Without proper management, diabetes may lead to other issues in health. Examples of such, would be, delay in wound healing, leading to foot ulcerations, which thus increases the risk for amputations...
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...Diabetic Nephropathy Introduction My grandmother means the world to me even though she may not know it. When my grand mother reached her early 40’s she was diagnosis with diabetes. My grand mother today is now 70 years of age. Through out the years of her having diabetes it has made her mentally strong but physically weak. From day to day, and through all the years my grandmother’s body broke down slowly but surely. Along with her diabetes my grand mother has also been diagnosis with high blood pressure and high cholesterol. But like I stated earlier she became mentally strong and more capable to deal with whatever life had in store for her. Unfortunately 1 year ago my grandmother once again was diagnosed with another disease called Diabetic Nephropathy. This disease became very dangerous to my grandmother’s life and thank God that she is the person that she is because she continues to fight. Definition Diabetic Nephropathy is a disease that damages the kidneys. The damages that are done to the kidneys are usually the result of complications that come from having diabetes. Diabetic Nephropathy can also be called Kimmelstiel-Wilson disease or diabetic glomerulosclerosis. But regardless what name you give this disease it still takes the same toll on a person’s body by damaging their kidney. Etiology According to www.medlineplus.com , the exact cause of Diabetic Nephropathy is unknown. But through different studies the caused is believed to be caused by high uncontrolled...
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...demonstrated improved wound healing. Its use has been extended to other types of wounds, such as surgical wounds from abdominal, chest and cardiac (heart) surgical procedures. Currently VAC can be used on all types of wounds: acute, subacute or chronic. Introduction Diabetes is becoming a common problem in most of the countries all over the world. About 1.8 million people are affected by diabetes and with rapidly increasing diabetic patients the count is estimated to go up to 2.7 million in next 25 years (Speak K, 2007). Diabetic foot complications are more frequent in males individuals aged over 60 years. The life expectancy of the diabetic patients has increased due different treatments, which in turn increases the number of complications as the disease progresses. Prolonged uncontrolled diabetes leads to complications like neuropathy and peripheral arterial disease (PAD), which are the risk factors for diabetic foot ulcers (Speak K, 2007). Nearly, 15%-20% of diabetic patients suffer from diabetic foot ulcer and 85% suffer amputations because of diabetic foot ulcer (Bergin S, 2006). Amputations not only responsible for social,...
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...Introduction Diabetes is on the rise in the United States and the resultant health problems are leading to visits to physicians’ offices and hospitals more than ever before. Diabetic neuropathy, a debilitating nerve disorder which can affect almost any part of the nervous system, occurs in nearly 50 percent of patients with diabetes. Diabetic peripheral neuropathy is found in 12 percent of insulin dependent diabetics and 32 percent of those who are not, equaling approximately 3 million people in the United States. (Chen et al. 2007) The number of patients with other neuropathies, such as autonomic, proximal, and focal, comprises the other 1 million diabetic neuropathy patients, most of whom suffer in pain from the dysfunction of the nervous system. (Chen et al. 2007) This disorder’s elusive nature is such that it can not only present in any part of the body but it can be completely without symptoms that the average patient would report to their physician. Since the patients themselves are less likely to naturally disclose their suffering through their assumption that their symptoms are not relevant to their diabetic condition, the physician’s role in the diagnosis and recognition of this disorder is even more critical. II. Definition and Types of Diabetic Neuropathy The most common type of diabetic neuropathy is peripheral, considered, more generally, sensorimotor. Peripheral neuropathy causes pain or loss of feeling in the toes, feet, legs, hands, and arms. (NIDDKD...
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...Arab American Unversity Faculty of Allied Medical Sciences Pediatric Health Nursing Diabetic & Obesity in Children Student Name: 1-Fuad Sa’ed Maraw’a 2-Suzan Sammar 3- Amera Mohamad Zaed 4-Madlen Adnan Ateeq Instructor: D.R.Ahmad Ayed 1 Diabetic & Obesity for children Introduction Diabetes is a major cause of mortality globally, and it has been estimated that 400 million people worldwide will suffer from it by 2030. Obesity has reached epidemic proportions throughout the global, and this has affected on people of the world, especially those in higher-income, oil-producing countries. The importance of this subject the relationship between diabetes and obesity and how to control and prevent it. An important factor contributing to obesity is the imbalance between energy intake and energy expenditure. In ancient obesity was identified as a worldwide health care problem affecting the wellbeing of populations. Now The WHO (World Health Organization) defines obesity as a BMI (body mass index) of 25 kg/m2 or more and considers obesity as a visible but neglected health issue that has only received recognition during the last 15 years. The prevalence of obesity has risen in both developed and underdeveloped countries and has been particularly problematic in children. Excess weight is the sixth most important risk factor for worldwide disease burden and is associated with diabetes mellitus is defined by WHO is a chronic disease, which occurs when...
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...World Wide Wounds Negative Pressure Wound Therapy Augusta Ogwu Chamberlain College of Nursing Foreword: Negative Pressure Wound Therapy better known as Topical Negative Pressure (TNP), stands to be a vacuum assisted procedure for the treatment of ulcer by employing a negative pressure of 60-125 mm Hg on the bed of the wound. The procedure has been employed ever since the year 1995 for the treatment of surgical wounds, severe wounds and more rarely for the ulcers that are hard to heal. Treatment with TNP is employed within the departments of high technology like the department of cardiothoracic surgery, wherein the procedure has been widely assessed for mediastintis post heart surgery (Sjögren J. Vacuum, 2005). The experiences of patients of treatment with TNP for mediastintis has been elucidated in one Swedish doctoral thesis (Swenne C.L., 2006). Plurality of research rest upon the V.A.C. therapy, that was brought forth in the American market in the year 1995 and in Europe in the year 1997(Argenta L.C, Morykwas M.J. Vacuum, 1997). The objective of this research was to assess if the negative pressure would be a clinically feasible alternative for the management of wound in primary care, when taking into consideration the time for the healing of ulcer (gauged in weeks), change in the size of the ulcer (measured in cm² using a digital planimeter) and formulation of the granulation tissue (examined by visual observation). Albeit the calculation costs was...
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...XXXX-XXXXX XXXXXXXXX RECOGNIZING AND ACTING ON CLINICAL DETERIORATION Assignment NUR2100 Due date: April 29, 2013 Computer word count: 1,913 XXXX-XXXXX XXXXXXXXX RECOGNIZING AND ACTING ON CLINICAL DETERIORATION Introduction Nursing has always been a profession that embraces diversity towards rendering holistic patient care. However, with the constant changes in nursing practice; patient safety has been at risk due to nurse’s competence towards detecting impending patient deterioration that may lead to further complications or even death. It is said that the most important practical lesson that can be given to nurses, is to teach them what to observe (Nightingale 1969). Having the ability to observe and interpret critical situations are the essential key features applied in clinical practice. Effective observation of ward patients is the first step in identifying the deteriorating patient and effectively managing their care (Odell, Victor & Oliver 2009, p. 1993). Studies have shown that poor vital sign recording, lack of knowledge, failure to respond to abnormal signs, lack of knowledge, lack of supervision and failure to report deterioration or seek advice, have all contributed to the suboptimal care of ward patients (Odell, Victor & Oliver, cited in McGloin et al. 1999; McQuilla et al. 1998; Smith & Wood 1998; Hodgetts et al. 2002, p. 1993). With constant observation established, patient safety is implemented and surveillance is then incorporated to be able to...
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...Ketoacidosis is hyperglycemia, ketosis, and metabolic acidosis (Mattson Porth, 2015). This condition can be life threatening. Ketones are developed in the blood because of there being not enough insulin. Often, with type 1 DM a patient is diagnosed because of being in Diabetic Ketoacidosis (DKA). DKA happens when there is no insulin or the use of insulin is inadequate. When there is not the right amount of insulin or no insulin this leads to the rapid breakdown of energy stores. The energy stores that are broken-down are fat and muscle. With the body turning to the energy stores, amino acids are moved to the liver to convert to glucose and fatty acids are converted to ketones. Often times this is how type 1 patients are diagnosed, especially...
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