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L. Alima, M.A., M.D.

Program Director, University of Michigan Medical School

The burden of physical demands treatment questionnaire purchase glucophage sr 500 mg with mastercard, complications and the self-care regimen can exert a toll and impact the trajectory of patient care symptoms for strep throat buy glucophage sr 500mg online. This symposium draws on mixed methods studies to examine specific aspects of the physical burden of diabetes medicine 123 purchase glucophage sr 500mg online, perceptions of efforts to follow physical activity and dietary recommendations and the patient experience of and response to provider focus on their diabetes complications symptoms bladder infection buy glucophage sr 500 mg with amex. The first examines findings from a clinical study of physiological and perceptual responses to physical activity exertion in overweight, sedentary older women with and without Type 2 diabetes (T2D). The second presentation focuses on a clinical study of multidimensional aspects of fatigue and associations with well-being and self-care in a clinic sample of adults with T2D. The third draws on qualitative data from indepth interviews of adults with T2D, examining their perceptions of and approach to food and fast food culture. The discussant will address the diagnostic overlap between lethargy, poor sleep, diet and inactivity, medical conditions and depression. In total, these presentations suggest that people with diabetes experience an abnormal situation with high burden of physical and psychological challenges that create uncertainty for the future. Patient centered care that approaches perceived burden and depressive and anxious symptoms as appropriate responses to be managed may promote optimal diabetes self-care. Beverly, PhD Health is a key value that individuals use to negotiate everyday food choices, but the meaning of food in relationship to health, specifically type 2 diabetes, has not been examined extensively. The purpose of this qualitative study was to explore the meaning of food among adults with type 2 diabetes. Qualitative analysis revealed three themes: 1) Food and the Demands of Diabetes Management: Participants described the role of food as operational; however, the diagnosis of diabetes changed how they approached food. Since their diabetes diagnosis, most described a negative or ambivalent relationship with food. These participants often expressed a sense of guilt or personal failure if they indulged in "bad" foods. Participants felt that the social, celebratory aspect of food coupled with the perceived fast food American culture was in direct conflict with the demands of diabetes. Participants struggled to follow a healthful diet in a culture that advertised the opposite. In conclusion, diabetes patients may benefit from education that addresses socioculturally embedded norms that guide food choices. Ritholz, PhD Despite advancements in diabetes technology and management, eye, kidney, and nerve complications remain major health risks with significant psychosocial impact for people with diabetes. When recalling their first discussion of complications, patients described providers giving: 1) clinical suggestions to avoid complications, 2) only factual information, or 3) warnings/ threats. Patients recommended improving communication (65%) by providers communicating honestly (13%) but positively (11%), knowing their patients (11%), promoting active participation (13%), and avoiding blame/fear (8%). They also suggested providers detail specific actions to prevent complications (50%) and provide hope and reassurance (40%). Our findings suggest patients want to know about complications and apply preventative strategies as early as possible. Notably, they value positive, honest and non-blaming communication, active patient participation and specific treatment options to enhance their hope, efficacy and motivation to improve self-care. Further, understanding the implications of discussing complications at different stagesin the lifespan will have a significant impact on clinical care. Diabetes can be physically and behaviorally demanding, requiring multiple daily self-care activities. Frequently reported symptoms include visual problems, recurrent infections, and persistent fatigue. Fatigue is a common, overlapping symptom of both diabetes and depression, making this an important consideration for providers working within this population. Fatigue is studied in cancer and other chronic diseases as a multidimensional construct. Fatigue levels in participants were comparable to fatigue levels observed in cancer and orofacial pain patients.

Improving patient safety by repeating (read-back) telephone reports of critical information symptoms 5dp5dt fet purchase 500 mg glucophage sr overnight delivery. Ensuring safe and efficient communication of medication prescriptions in community and ambulatory settings medicine 5325 discount glucophage sr 500 mg on line. Pilot responsibility for compliance with air traffic control clearances and instructions; rules treatment plant discount 500 mg glucophage sr. Data link communication between controllers and pilots: a review of the simulation literature xanax medications for anxiety purchase glucophage sr 500mg free shipping. The Problem Medication reconciliation is the practice of comparing medication orders to the medications the patient has been taking. When nonprescription drugs were included, the frequency was 27% to 83%; and when information on drug allergies and prior adverse events was included, the frequency was 34% to 95%. For the 700-bed teaching hospital studied, annual costs for adverse drug events and preventable adverse drug events were $5. In 2007, the Joint Commission hosted a one-day Summit on Medication Reconciliation with the goal to discuss the challenges associated with reconciling medications in various health care settings, to identify best practices, and to bring forth potential refinements to medication reconciliation practices. The consensus of the Summit was that the process of medication reconciliation, obtaining an accurate medication list from the patient, and assuring its accuracy throughout the care continuum, improves patient safety; however, more guidance on implementation is required. The 2009 Joint Commission National Patient Safety Goals have been updated to include more guidance and are cross-walked with this practice. Safe Practice 17: Medication Reconciliation the healthcare organization must develop, reconcile, and communicate an accurate patient medication list throughout the continuum of care. Two out of every three patients who visit a doctor leave with at least one prescription for medication, leading to a record volume of nearly 3. Deleted: At a minimum, reconciliation must occur any time the organization requires that orders be rewritten, any time the patient changes service, setting, provider, or level of care and new medication orders are written. For transitions that do not involve new medications or the rewriting of orders, the organization should determine whether reconciliation must occur. The reason for referring back to the "home" medication list is that some "home" medications may be held when a patient is admitted or goes to surgery. At the time of transfer, the transferring organization informs the next provider of service how to obtain clarification on the list of reconciled medications. Deleted: this practice is applicable in hospitals, including critical access hospitals-ambulatory care, assisted living, behavioral health care, disease-specific care, home care, longterm care, and office-based surgery centers. Example Implementation Approaches Develop and use a template medication reconciliation form to gather information about current medications and medication allergies, standardize care, and prevent errors. Identify internal champions to lead implementation of the practice within the organization. Opportunities for Patient and Family Involvement Encourage patient and family members to ask questions regarding medication use. Engage patient and family members to carry accurate medication lists and share list with healthcare professionals during office visits, hospitalizations and community pharmacy encounters. Patient and family members should be instructed how to identify and manage routine side effects, and to know when and whom to contact if they believe they are experiencing any serious adverse effects of drug therapy. Consider including patients or families of patients who have experienced medication related adverse events to serve on appropriate patient safety or performance improvement committees. A reasonable goal for an organization is to reduce the percentage of unreconciled medications in an area of focus (admission, transfer, or discharge) by 75 percent or more. Furthermore, the accuracy of the reconciliation can be measured if it has occurred. Documentation of medication list in the outpatient record (Ambulatory): Percentage of patients having a medication list in the medical record. Documentation of allergies and adverse reactions in the outpatient record (Ambulatory): Percentage of patients having documentation of allergies and adverse reactions in the medical record. Measures of patient participation in maintaining their medication lists may also be undertaken. Settings of Care Considerations Rural Healthcare Settings: All requirements of the practice are applicable to small and rural healthcare settings as specified.

The cells of the table contain the frequencies of occurrence of all possible pairs of values of the two variables: (1 symptoms 6 days post iui cheap glucophage sr 500 mg amex, 1) symptoms 5 dpo purchase 500mg glucophage sr, (1 medicine descriptions 500 mg glucophage sr mastercard, 0) nioxin scalp treatment 500mg glucophage sr free shipping, (0, 1), and (0, 0). An objective of the analysis of data that meet these criteria is a statistic known as the odds ratio. The odds ratio is a measure of how much greater (or less) the odds are for subjects possessing the risk factor to experience a particular outcome. For example, when the outcome is the contracting of a disease, the interpretation of the odds ratio assumes that the disease is rare. Suppose, for example, that the outcome variable is the acquisition or nonacquisition of skin cancer and the independent variable (or risk factor) is high levels of exposure to the sun. Analysis of such data collected on a sample of subjects might yield an odds ratio of 2, indicating that the odds of skin cancer are two times higher among subjects with high levels of exposure to the sun than among subjects without high levels of exposure. Computer software packages that perform logistic regression frequently provide as part of their output estimates of b0 and b1 and the numerical value of the odds ratio. Thus, we estimate that the odds of finding a case of obstructive coronary artery & disease to be almost six times higher among men than women. Logistic Regression: Continuous Independent Variable Now let us consider the situation in which we have a dichotomous dependent variable and a continuous independent variable. Our discussion, consequently, will focus on an evaluation of the adequacy of the model as a representation of the data at hand, interpretation of key elements of the computer printout, and the use of the results to answer relevant questions about the relationship between the two variables. We wish also to know if we may use the results of our analysis to predict the likelihood of participation by a woman if we know her age. The regression equation, then, is ^i ј 1:8744 А:0379xi y ^ where ^i ј lnЅ^i р1 А ^i Ю and pi is the predicted probability of attending y p p cardiac rehabilitation for a woman aged xi. Test of H 0 that b1 ј 0 We reach a conclusion about the adequacy of the logistic model by testing the null ^ ^ hypothesis that the slope of the regression line is zero. The test statistic is z ј b1 =sb1 where ^ z is the standard normal statistic, b1 is the sample slope (А. The square of z is chi-square with 1 degree of freedom, a statistic that is shown in Figure 11. Suppose, for example, that we wish to estimate the probability that a woman who is 50 years of age will participate in a rehabilitation program. We can see the estimated probabilities of attending cardiac rehabilitation programs for the age range of the subjects enrolled in the study in Figure 11. Since the slope was negative, we see a decreasing probability of attending a cardiac rehabilitation program for older women. These independent variables may be either continuous or discrete or a combination of the two. Subjects were classified as having either early (< 25 years) or late (> 25 years) onset of excessive alcohol use. Test of H0 that b1 ј 0 Tests for significance of the regression coefficients can be obtained directly from Figure 11. Assessing Goodness of Fit A natural question that arises when doing logistic regression is: "How good is my model? Given the nature of the response variable in logistic regression, a coefficient of determination does not provide the same information as it does in linear regression. This is because in logistic regression values of the parameters are not derived to minimize sums of squares, but rather are iterative estimates; hence, there is no equivalent measure of R2 in logistic regression. Below, we provide an explanation of some commonly used approaches to evaluate logistic regression models, and follow these explanations with two illustrative examples. Many authors have attempted to develop what are known as "pseudo-R2" values that range from 0 to 1, with higher values indicating better fit. In other words, they are comparative measures designed to indicate "how much better" a model with predictor variables is when compared to a model with no predictors. Two commonly used pseudo-R2 statistics were developed by Cox and Snell (4) and Nagelkerke (5). The value of these measures is the fact that they may be useful for comparing models with different predictor variables, but provide little relative use for examining a single model. Both of these approaches are based on the idea of using a measure of fit known as the log-likelihood statistic. The log-likelihood for the intercept-only model is used to represent the total sum of squares, while the log-likelihood for the model with predictor variables is used to represent the error sum of squares. Interested readers may find an explanation of the loglikelihood statistic in Hosmer and Lemeshow (2).