Impact In Terms Of Mortality Research Articles

Hypoglycemia in Type 2 Diabetes—Consequences and Risk Assessment

Although hypoglycemia has traditionally been considered a significant complication of the treatment of type 1 diabetes, the greater incidence of type 2 diabetes compared with type 1, the intensive treatment strategies currently employed, and the longer life expectancy of patients with diabetes, give rise to a large number of type 2 patients at risk for hypoglycemia. This number is likely to rise in an aging population with the increasing use of insulin to treat diabetes. The highest incidence of hypoglycemia is seen in older patients with poor glycemic control and is associated with the use of antidiabetic agents that increase blood insulin concentrations independently of blood glucose concentration (oral antidiabetic drugs or exogenous insulin). Hypoglycemia has a substantial clinical impact in terms of mortality, morbidity, and quality of life. The economic impact of severe hypoglycemic events owing to direct hospital costs and the indirect costs of the inability to work are considerable. Furthermore, both patients’ and physicians’ fear of hypoglycemia reduces adherence to therapeutic regimens and limits the ability of current diabetes medications to achieve the level of glycemic control required to prevent disease progression. Newer therapies and improvements in patient education may help patients achieve improved glucose control by safely reducing glycosylated hemoglobin (HbA1c) with a lower risk of hypoglycemia.

International Perspectives

Humanitarian efforts by a large number of groups have provided care in many developing countries around the world, including southeast Asia. Beginning around 2000, Project Vietnam, a humanitarian organization supported, in part, by California Chapter 4 of the American Academy of Pediatrics, expanded its already established presence within Vietnam to include a focus that specifically addressed efforts to improve neonatal care and reduce mortality in that country. I became a part of this effort and joined the expanding team devoted to this mission. Part of the impetus for this change by the organization was the establishment of goals by the Vietnamese Ministry of Health (MoH) and the leaders of pediatrics within the country. These goals, stimulated by the millennium goals of the World Health Organization, were aimed at improving the care of newborns and developing systems of care to accomplish sustainable results in this important area of health care. Over the past 9 years, much progress has been made and many lessons have been learned in Vietnam. The improvements have led to reductions in mortality and to the expanded availability of higher-quality modern care for increasing numbers of patients. Such advances have come about through the hard work and dedication of individuals and several organizations such as Project Vietnam as well as the partnership with key leaders within the country. Perhaps as important as these tangible improvements is the information learned from successes and failures that may serve as the foundation of an organizational structure or paradigm that can be used to guide similar efforts elsewhere in the world. The following discussion is a compilation of experiences and descriptions of some of the centrally important events in which we have been involved. The models that have grown out of this include important generalizations with utility elsewhere. Although related by a …

Hospital-acquired pneumonia

<h3>Key points</h3> Hospital-acquired pneumonia has a major impact in terms of mortality and morbidity. Empirical treatment approach is still the best course of action. Prevention is of critical importance. <h3>Educational aims</h3> To improve knowledge of HAP management. To better understand the epidemiological basis for the correct empirical therapy of HAP <h3>Summary</h3> HAP still has a major impact in terms of mortality and morbidity among hospitalised patients. Early appropriate antibiotic therapy is associated with a reduction in mortality and improved outcome. Although, in most cases, an empirical approach is still the rule, taking into account the risk factors, the severity of illness and length of stay before the pneumonia onset can better target antibiotic therapy. The patient9s follow-up course, in terms of microbiological, clinical and radiological monitoring, is important. Prevention strategies are of critical importance and are based on the understanding of the epidemiology and pathogenesis of HAP. Routine efforts for the prevention of HAP should be directed towards obtaining effective surveillance and infection-control programmes, including staff education, use of proper isolation techniques and infection-control practices. This review aims to increase understanding of these points to allow improved knowledge and treatment of HAP.