Doron Schneider

Practice Guidelines for the Treatment of Patients With Delirium

In general, the treatment of delirium is broken down into three parts—psychiatric management, environmental and supportive interventions, and somatic interventions. In the broadest terms, the underlying cause of the delirium should be sought and treated if possible. Behavioral and environmental intervention should be optimized and instituted first. If necessary, to prevent patient distress or harm, pharmacological interventions should be instituted, the mainstay of which is haloperidol therapy.

A look into the future: improving diabetes care by 2015

Abstract Insulin initiation, which was traditionally the province of specialists, is increasingly undertaken by primary care. However, significant barriers to appropriate and timely initiation still exist. Whilst insulin is recognized as providing the most effective treatment in type 2 diabetes, it is also widely considered to be the most challenging and time consuming. This editorial identifies that the organization of existing healthcare services, the challenges faced by patients, and the treatments themselves contribute to suboptimal insulin management. In order to improve future diabetes care, it will be necessary to address all three problem areas: (1) re-think the best use of existing human and financial resources to promote and support patient self-management and adherence to treatment; (2) empower patients to participate more actively in treatment decision making; and (3) improve acceptance, persistence and adherence to therapy by continuing to refine insulin therapy and treatment regimens in terms of safety, simplicity and convenience. The principles discussed are also applicable to the successful management of any chronic medical illness.

The burden of severe hypoglycemia in type 1 diabetes

Abstract Aims: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body’s inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin. Methods: Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts. Results: We identified 8,734 patients, of which 4.2% experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. of those in the inpatient and outpatient SHO groups), 31% experienced at least one SHO-related hospitalization, while 9% were treated in the ED without subsequent hospitalization. Approximately 79% of patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. The inpatient SHO patients stayed in the hospital, including time in the ED, for 1.7 days and incurred

Call for Submissions: New Clinical Diabetes Department Focuses on Quality Improvement and Practice Transformation Initiatives

3551 in costs. About one-third of patients were hospitalized again for SHO. Inpatient SHO patients incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the two other groups (

Antithrombotic Therapy for Atrial Fibrillation, Valvular Heart Disease, Management of Elevated INRs, and Perioperative Management

2084 vs

Management of Newly Diagnosed Atrial Fibrillation

1313 and

Prevention of Bacterial Endocarditis

1372), corresponding to 59% or 52% higher monthly costs for inpatient SHO patients. Limitations: These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders. Conclusions: The burden associated with SHO is not negligible. About 4% of T1DM patients using basal-bolus insulin regimens are hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incur red at least

Health Care Provider Management of Patients With Type 2 Diabetes Mellitus: Analysis of Trends in Attitudes and Practices

712 (52%) more in costs per month after their hospitalization than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T1DM.

Current Practice Patterns and Identified Educational Needs of Health Care Providers in Managing Patients With Type 2 Diabetes

EDITOR’S NOTE: Quality Improvement Success Stories, a new Clinical Diabetes department developed in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program, will feature articles and a searchable online collection of information about quality improvement and practice transformation initiatives in the area of diabetes care. This article provides the rationale and article submission process for this new offering.

Urinary Incontinence in an Elderly Woman

This chapter will concisely summarize the following sections of the anticoagulation guidelines (for management of deep vein thrombosis [DVT]/pulmonary embolism [PE], see chapter on DVT/PE): 1. Prevention of venous thromboembolism (VTE). 2. Antithrombotic therapy in atrial fibrillation (AF). 3. Antithrombotic therapy in valvular heart disease—native and prosthetic. 4. Management of elevated international normalized ratios (INRs) or bleeding in patients receiving vitamin K antagonists (VKA). 5. Managing anticoagulation therapy in patients requiring invasive procedures (1).