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The Etiquette of Help

The Etiquette of Help

“Any surgeon to OR 6 STAT. Any surgeon to OR 6 STAT.” No surgeon wants to hear or respond to a call like that. It means someone is in deep kimchee and needs help right away. I was in the locker room, just about to strip off my scrubs and dress to go out with my wife for the evening. We had finished a full day of routine surgery—two gallbladders and a colon resection—and had plans for dinner. Our older son was home from college and had offered to watch his younger brother for us. I closed my locker and walked back out to the OR control desk. Michele, my wife and first assistant, was already there. A glance at the control board showed me that Dr. S was in room 6. She was a gynecologist, and according to the board, was doing a routine diagnostic laparoscopy. The bustle of technicians and nurses running in and out of the room indicated that it was anything but routine. We made our way to the room, and I stuck my head in. My friend Jon was the anesthesiologist. He was squeezing a bag of packed red blood cells to make them run into the IV faster. “We could use some help,” he said, calmly as ever. But he rolled his eyes toward the table. Dr S. stood there, blood coating her arms and chest, her eyes looking at me but somehow also looking far away, the thousand yard stare of someone out of their depth and very afraid. “Hey, Lou,” I said, using her first name as I stepped into the...

Dealing With Diabetes & Depression

Rates of depression are significantly higher for patients with diabetes, especially those who are elderly, when compared with people without diabetes. About 20% to 30% of patients with diabetes suffer from clinically relevant depressive disorders. “Depression can worsen glycemic control in those with diabetes,” says Jason C. Baker, MD. Research suggests depression is associated with a higher risk of developing diabetes complications and adverse outcomes. Conversely, improving depressive symptoms has been shown to lead to better glycemic control. “Depression can result in reduced physical activity and a greater need for medical care and prescriptions, which in turn can increase healthcare costs and worsen quality of life,” Dr. Baker says. “In order to improve the management of patients with these two conditions, it’s imperative that healthcare providers be aware of this link and its consequences.” He adds that effective pharmacologic and non-pharmacologic treatments are available and may be of benefit in some situations. Routine Screening The stress of managing diabetes on a daily basis and the effects of the disease on the brain may contribute to depression, according to Dr. Baker. “There are multiple factors that may be at play, but one of the most important things clinicians can do is screen patients with diabetes for depression,” he says. “Oftentimes, physicians focus solely on the chief complaint or on A1C, blood pressure, and cholesterol numbers. We need to take a more holistic approach and be vigilant about seeking out depression or other mental health problems. This should become a routine part of all diabetes care.” Dr. Baker says that it can be challenging to address depression when managing patients with...

Treatment Trends for Type 2 Diabetes

The burden of diabetes is expected to increase over the next few decades in the United States, with about one in three American adults projected to be at risk for developing the disease by 2050. Diabetes has also been linked to a considerable economic burden, with annual direct medical expenditures for treating and managing the disease totaling nearly $250 billion in 2012. Most of the medical expenditures for diabetes are attributable to hospitalizations and physician services, but the costs of prescription therapies are also significant. With the high prevalence and burden of diabetes, the disease has become a ripe target for pharmaceutical development. “During the past decade, several important changes in the diabetes marketplace have occurred,” explains G. Caleb Alexander, MD, FACP. For example, in the early 2000s, glitazones were rapidly adopted for use, but subsequent evidence suggested that these agents were associated with cardiovascular risks. In turn, this led to substantial declines in the use of glitazones during the latter half of the decade.  In addition, new long-acting insulins and several new classes of therapies have emerged to treat type 2 diabetes, including injectable incretin mimetics such as glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium glucose cotransporter 2 (SGLT-2) inhibitors. The costs of these medications can be high, but clinicians appear to be interested in using them because of their novel mechanisms of action and potential promise in helping to improve glycemic control among those with type 2 diabetes.   Examining Recent Patterns Over the past 2 decades, clinical investigations have examined changes in the treatment of diabetes. These analyses identified several important trends,...
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