Diabetes Treatments

Please explain yes’ answers Circle your choice. 1. Have you ever been hospitalized? your heart, blood pressure, diabetes, or seizures? …

admin — Mon, 17 Nov 2008 05:26:08 +0000

LAWRENCE UNIVERSITY

ATHLETIC MEDICAL QUESTIONNAIRE

Please print clearly

Name __________________________________________ Date
_________________________
Sport __________________________________________ DOB
_____/_____/________
Class Year Fr ____ So ____ Jr ____ Sr ____ LU
ID______________________
School address _____________________________ Home Address
__________________________
_____________________________
__________________________
Cell phone____________________ Home phone
_________________________

Please explain yes answers Circle
your choice

1 Have you ever been hospitalized?____________________________________
Yes No
2 Have you ever had surgery? ________________________________________
Yes No
3 Are you presently taking any over-the-counter medications or
supplements? Yes No
____________________________________________________
Are you presently taking any prescription medications?
__________________ Yes No
4 Do you have any
allergies medicine, food, etc
________________________ Yes No
_______________________________________________________________
5 Have you ever passed out or nearly fainted during exercise?
Yes No
Have you ever had chest discomfort or chest pain during exercise?
Yes No
Do you tire quicker than your friends during exercise?
Yes No
Have you ever been told you have a heart murmur?
Yes No
Have you ever had high blood pressure?
Yes No
Have you ever had racing of your heart or skipped beats?
Yes No
Has anyone in your family died of heart problems or sudden death
before age 50? Yes No
Have you been told you have sickle-cell anemia?
Yes No
Do you have a close relative under age 50 with disability from heart
disease? Yes No
Do you or any of your family have knowledge of cardiac conditions?
Marfans syndrome, cardiomyopathy, long QT syndrome
Yes No
Are you presently taking any prescription medications on a regular
basis for Yes No
your heart, blood pressure, diabetes, or seizures?
_______________________
6 Do you have any skin problems itching,
moles, etc
____________________ Yes No
7 Have you ever had a concussion? ___________________________________
Yes No
If yes, how many and when? ____________________________________
Have you ever had a seizure? _______________________________________
Yes No
Have you ever had a stinger or burner?
____________________________ Yes No
8 Have you ever injured sprained, dislocated, fractured, etc one of
the following
structures indicate R or L:
_____hand _____wrist _____forearm _____elbow _____arm
_____shoulder
_____neck _____chest _____back _____hip _____thigh _____knee
_____shin _____calf _____ankle _____foot

Please indicate type of injury, date of injury, and any limitations or
continuing problems:

____________________________________________________________________________
__

____________________________________________________________________________
__
9 Have you ever had heat cramps?
Yes No
Have you ever been dizzy or passed out in the heat?
Yes No

10 Have you ever had one of the following in the last 12 months note
ones you have or have had with a
check mark:
_____mononucleosis _____hepatitis _____asthma
_____tuberculosis
_____diabetes _____headaches freq _____eye injury
_____stomach ulcer
11 Have you been advised by a physician or by your parents not to
participate
in athletic events?
Yes No
12 Have you been treated for a disease or illness during the past 12
months? Yes No
______________________________________________________________
13 Are you currently under the care of a physician?
_______________________ Yes No
______________________________________________________________
14 Have you been found to have only one organ of usually paired organs
Yes No
ex: kidney, eye? _______________________________________________
15 Do you wear ____ Glasses ____ Contacts
Do you wear ____ Dental bridges ____ Plates ____ Braces
16 Do you use ____Special pads ____ Braces __________________________
17 When was your last tetanus shot date? ______________________

Confidential Health Questionnaire

Have you ever been treated for anemia?
Yes No
How many meals do you eat each day? _____ How many snacks? _____
Are there certain
food groups you refuse to eat ex: meats, breads
____________________________
Have you ever been on a diet?
Yes No
What is your present weight? __________ Are you happy with this weight?
Yes No
If not, what would you like to weigh? __________
Have you ever tried to control your weight by the following methods? check
all that apply:
_____vomiting _____diuretics _____diet pills _____using
laxatives
Have you ever expressed a concern that you might have an eating disorder
like
bulimia or anorexia? Yes
No
Has anyone ever expressed a concern that you might have an eating disorder?
Yes No
Have you been treated for an eating disorder?
Yes No
Do you have questions about healthy ways to control weight?
Yes No

For Men Only

Do you perform testicular exams on a regular basis?
________________________ Yes No

For Women Only

How old were you when you had your first menstrual period?
___________________
How often do you have a period? __________________________________________
How long do your periods last? ___________________________________________
How many periods have you had in the last 12
months?
________________________
Do you ever experience cramps during your period?
Yes No
If so, how do you treat them? _____________________________________________
Do you perform self breast exams on a regular basis?
_________________________ Yes No

With my signature, I, the undersigned, assure that the above is correct to
the best of my knowledge

______________________________________________
___________________________

Signature of Athlete Date

5/08

American Diabetes Ana Gonzalez. Ana shared statistical information and graphs on Latino diabetes. Step Out to Fight Diabetes - Shelby Dopp. …

admin — Mon, 17 Nov 2008 05:26:08 +0000

Chula Vista Community Collaborative
Minutes
October 9, 2007
9:00-11:00 AM
Health and Human Services Agency
690 Oxford, Chula Vista

Welcome and Introductions -Margarita Holguin welcomed everyone New
members were introduced
Margarita noted that CVCC continues its commitment to connect resources to
needs - CVCC is working on development of a Promotora Training Curriculum
and is reaching out to partners for existing training topics and material

CVCC is also looking for ways to visibly show the effectiveness of the CVCC
monthly meetings and is looking for creative ways to show partner agencies
the successes and connections at CVCC

South Bay Childrens Museum - Erica Newton Fessia Erica is the Co-founder
and Executive Director of the South Bay Childrens Museum, which was
established in June 2007 Erica discussed the museums mission, planning
and why the South Bay was selected They have just received their 501c3
status Development will be in three phases: Mini-Mobile launched in Sept
2007 this phase is designed to expose the community to
what a childrens
museum has to offer There are 1 - 3 interactive exhibits that are
designed to be set up for one day or less Mobile, launch goal is Sept
2008 This phase will expand the offerings by displaying more complex
exhibits designed to be set up on a semi-permanent basis using community
venues such as school auditoriums, centers, libraries, etc Museum Home,
goal is to open October 2010 This will be a permanent facility in which
the museum will operate full-scale exhibits and ongoing programs, while
continuing the mini-mobile and mobile units For more information check
out their web site: wwwsouthbaycmorg or e-mail
info@southbaycmorg

American Diabetes - Ana Gonzalez Ana shared statistical information and
graphs on Latino diabetes The goal of the Latino campaign, which began in
2005, is to find a cure for diabetes and improve the lives of all people
affected with diabetes In 2005 ADAs Latino Initiatives health campaign
was named Por tu familia — or for your family, and was developed to
provide community based activities in Spanish Educational models are
brief and interactive Feria de Salud pro tu familia is scheduled for
Saturday, March 1, 2008 at Kimball Park in
National City Ana invited
organizations interested in participating to contact her For more
information call 1-800-DIABETES or log on to wwwdiabetesorg

Step Out to Fight Diabetes - Shelby Dopp Step Out to Fight Diabetes is a
5K walk to raise money to fight diabetes The walk in San Diego will be
Sunday, October 28th at Liberty Station beginning at 8 am A 15 per
step gift is requested There will be live music, a flat route and
barbecue For more information call Ana at 234-9897 x 513 or log on to
wwwdiabetesorg and go to local events and activities to register

CVCC - Margarita announced that presentations are booked through January
and weve had to limit presentations to 15 minutes Those still interested
in making presentations should call 498-8044 or e-mail
mholguin@cvesdk12caus
CVCC is participating in SHOP FOR A CAUSE, with the Macys Chula Vista
store For a 500 donation you will receive a ticket for 20 -10 off all
day The event will be Saturday, October 13th Tickets were available
during the break

Neat AT2 Project - Carolyn Scholl Chula Vista Elementary School District
is partnering with UCSD for a nutrition program targeting families with
children 2 - 4 years old
The sessions are 10 weeks long and are 15
hrs/week and include free childcare Five sessions are devoted to
nutrition and 5 are devoted to physical activity For more information
call 425-9600 x 1529 or 1532

Thank you - Family Health Centers of San Diego for the snack HHSA has
signed up for November Agencies wishing to volunteer for January, April,
May or June can contact Chris Ross at cross@cvesdk12caus or call 498-
8044

Volunteer San Diego - Debbie Krakauer Jose Rubio Volunteer San Diego
links volunteers with organizations, groups, and agencies needing
volunteers Volunteer projects can be short term or long term There is a
shortage in the South Bay region of registered organizations, groups and
agencies To register log on to wwwvolunteersandiegoorg

Energy Drinks - James Marcelino Presentation was made on the dangers and
marketing strategies of Energy Drinks James explained how marketing is
geared to youth using a 3 point plan 1 Create confusion 2 Offer a cheap
alternative 3 Marketing The presentation showed how deceptive marketing
can be The easiest way is to look for nutritional information on the can
If there isnt any theres alcohol in the drink Info will be
posted on
the CVCC website: wwwchulavistaccorg James is also available to give
presentation, just call 427-0376 or e-mail policyadvocate@earthlinknet

Healthy Eating Active Communities HEAC - Margarita Holguin CVCC is
partnering with the HEAC initiative in Chula Vista One of the primary
focuses of CVCC is the neighborhood sector The goal is to improve
nutrition and physical activity CVCC has three Promotoras who are
available to provide interactive presentations - Please let CVCC of any
potential venues for presentations Margarita also noted that tomorrow,
Oct 10th, they will be walking Lauderbach park area to identify conditions
that positively and/or negatively impact access for families

Announcements:
1 Martha Garcia, Public Health Nurse - Provided information on the
West Nile Virus West Nile Virus is passed from bird to mosquitoes
to humans Three mosquitoes have tested positive in the Chula Vista
area - there have been 5 new cases since August 31st The County is
encouraging everyone to get rid of standing water Call 888 551-
INFO Handouts on the resource table You can also visit
wwwSDFightTheBitecom
2 Margarita Holguin,
CVCC - Strategic Planning There are three
remaining community conversations planned A Youth - tomorrow at
New Directions, B School Personnel - Oct 24th, 4:00 pm at New
Directions, and C East Chula Vista Community - Oct 24th, 6:30 pm
at McMillan Elementary
3 Don Lynn, Director of Thursdays Meal Thursdays Meal provides hot
meals to low income and homeless individuals and families John had
an updated handout South Bay Directory and Food Assistance blue
pocket size to hand out The parent organization is the South Bay
Ecumenical Council They are having their 15th Annual Souper Supper
on Friday October 26th from 5:00 pm to 7:00 pm at St Johns
Church on 760 First Ave The cost is 700 for homemade soups,
salads, breads and hot fudge ice cream brownies For more
information call 422-4141 or e-mail omanopa2004@msncom The funds
will be used to help various organizations with their wish lists
4 Heather Nemour, CVCC - SNAP is a volunteer program for seniors 50 yr
and older to help students make healthy choices at the salad bar
There will be a training at Otay Elementary on Wednesday, October

17th from 12 - 1 If you know of any seniors who might be
interested, please have them call 498-8042 for more information

Signing in note - our master sign in sheet was lost, so please excuse us
if you name/agency are not listed:
Nayelly Vicencio, CVCC HEAC Marietta Minjares, CV
Middle School
Chris Albers, Fleet Family Support Center Toni Terrazas, SUHSD
Catagorical
Mike Kaine, HTH Xinia G Sanchez, SDPRC
Foundación
Ebbes Nava, Mar Vista High Ginger Hartnett, CVESD
School Readiness
Sylvia Andrade, SD State Research Foundation Debbie Kiakane,
Volunteer San Diego
John Camara, Castle Park Middle Diana Rivera, MAAC
Project
Jose Armando Rubio, Volunteer San Diego Eleanor Slaughter,
Mental Health Services
Yovana Leal, Central School Ute Powell, HHSA Public
Health
Shelby Dopp, American Diabetes Association Patricia Pliego,
Caminando Con Fe
Yolanda Valdez, HHSA South Region Erin Pitts, So Bay YMCA
Don Lynn, Thursdays Meal/South Bay Ecumenical Council Ana Briones-
Espinoza, Mental Health Systems
Sharney
McLaughlin, HHSA South Region Ana Gonzalez, American
Diabetes Association
Crecencia Baribo, HHSA

KENTUCKY DEPARTMENT OF EDUCATION. MEDICAL EXAMINATION OF Medical (All serious medical & psychiatric diseases: Diabetes, Epilepsy, Heart Disease, etc. …

admin — Mon, 17 Nov 2008 05:26:08 +0000

KENTUCKY DEPARTMENT OF EDUCATION
MEDICAL EXAMINATION OF SCHOOL EMPLOYEES

Name___________________________________________________________Birth
Date__________________________Sex: M_____F_____

Address_____________________________________________________________________
_Telephone_______________________________

Applicant With Or Employed
By_______________________________________________________________________Boa
rd of Education

HISTORY

Medical All serious medical psychiatric diseases: Diabetes, Epilepsy,
Heart Disease, etc

Surgical All major
operations_________________________________________________________________
_________________________

Family History TB, Epilepsy,
Diabetes,___________________________________________________________________
_______________
_______________________________________________________
_____________________________________________________________

PHYSICAL

1 General Appearance ______________________
2 Eyes____________________________________
3 Ear, Nose Throat_______________________
4 Teeth
Gums___________________________
5 Thyroid_________________________________
6 Heart___________________________________
7 Blood Pressure ___________Pulse___________
8 Lungs___________________________________
9 Abdomen________________________________
10 Nervous System__________________________
11 Extremities______________________________
12 Other___________________________________

TB Skin Test
Date Given: _____________________
Type of Test: ____________________
Millimeters of Induration: _________

Date Read: ______________________
By Whom: ______________________

Date X-ray Taken: _______________
OR
______No further follow-up necessary unless signs/symptoms of tuberculosis
develop
TEAR OFF THIS PORTION AND RETURN TO SCHOOL SUPERINTENDENTS OFFICE

CERTIFICATION OF MEDICAL EXAMINATION

This is to certify that I have examined
___________________________________________, and find him/her free of
communicable disease and any physical or mental disabilities that might
interfere with performing his/her duties, except as
follows:

____________________________________
____________________________________
Date of Examination Signature
Physician/PA/ARNP

A separate form is provided for bus drivers
December 1999

Source:lawrence.edu

To strengthen education and training in diabetes research, prevention and control. The prevalence of diabetes has blown out of proportion in India. …

admin — Mon, 17 Nov 2008 05:26:07 +0000

Diabetes Research Centre
A WHO Collaborating Centre for
Research, Education and Training
in Diabetes in India

MVHospital for Diabetes

ANNUAL REPORT
Jan2007 - Dec-2007

DrVijay Viswanathan
MD,PhD, MNAMS
Head of the WHO Collaborating Centre
No 4, Main Road, Chennai-13
Tamilnadu, India

E-Mail: dr_vijay@vsnlcom, drvijay@mvdiabetescom
Website: wwwmvdiabetescom,wwwwhoccdindiacom
Phone: 91-044-25954913, 25965018
Fax: 91-044-25954919

World Health Organization Collaborating Centre

ANNUAL REPORT
Year- 2007

Terms of Reference

1 To conduct epidemiological research in diabetes prevention at community
level, its complications
and cardiovascular risk factors

2 To strengthen education and training in diabetes research, prevention
and control

3 To design and test on models of diabetes health care delivery system for
developing countries in the region and contribute to activities of
national diabetes programme

Implementation of the work plan for each main activity:

Work performed in relation to the Terms of Reference

1 To conduct epidemiological research in Diabetes and cardiovascular risk
factors in India

1 COPS study: Escalation of economy and increasing prevalence of non-
communicable diseases are like two sides of a same coin The prevalence
of diabetes has blown out of proportion in India There is not enough
data available on the prevalence of diabetes among focused groups like
the police personnel in India Hence an epidemiological study was
designed and carried out to determine the prevalence of Diabetes and
cardiovascular risk factors among the 318 male police personnel of
Chennai city The prevalence rates are as follows:
With 443 years as mean age of the study group:
- Crude prevalence of
Diabetes: 321
- Crude prevalence of hypertension - 29
Other risk Factors Prevalence:
- Triglyceridemia TG150mg/dl- 497
- Low HDLHDL-C40 mg/dl - 522
- Waist circumference 90 cms - 651
- IFG110-125mg/dl Fasting - 412
A report will subsequently be prepared and submitted to the
Government to enable intervention and planning strategies to reduce
the disease burden to an extent

Other Ongoing studies:
1 Child Obesity study
With an objective to determine the prevalence of Obesity and other
cardiovascular risk factors in school children and to derive at a cut off
values for overweight and obesity in Indian children, DRC has started the
project in September 2007
Interim analysis show that prevalence of overweight among affluent
schoolchildren is 114 and prevalence of obesity is 75 The study is
ongoing and is likely to be completed by January 2008
2 DRC Complication Study:
Primary objective of the study is to compare the effect of a
targeted intensified multi factorial intervention with that of
conventional treatment on modifiable risk factors for
micro and macro
vascular diseases in patients with type 2 diabetes Secondary objective
is to determine which of the micro vascular complications occur first
among type 2 diabetes and to determine if any of the established
complications is reversible
Started in June 2005
Follow up till mid 2008

3 Role of Genetic polymorphism in development of Diabetic Nephropathy:
The aim of the study is to determine if ACE Angiotensin
converting enzyme gene polymorphism plays an important role in
development of Diabetic nephropathy ACE gene polymorphism will be
determined in Type 2 diabetic subjects having diabetic nephropathy GFR
level will be estimated at the baseline and patients will be followed up
for 2 years as intensive group At the end of 2 years GFR will again be
estimated Hence state of GFR can be correlated with different ACE gene
polymorphisms
Started in Nov2006
4 Rosiglitazone Study:
Its a randomized study to evaluate the role of spironolactone
and amiloride in the prevention of rosiglitazone induced fluid retention
in type 2 diabetes It is a
collaborative study between Diabetes
Research Centre, Dr V Mohans Speciality Centre, Chennai, India and the
Unit for Metabolic Medicine, Cardiovascular Division, Guys Hospital,
Kings College London, UK It involves total of 180 patients from India
including both the centers Ninety patients have been randomized from
both the centres and the study is likely to be completed by July 2009
Started in Dec2006
5 Insulin Resistance in Diabetic Nephropathy:
It is a cross sectional study with primary objective to determine the
level of insulin resistance in various stages of Diabetic Nephropathy
The secondary objective of the study is to assess the association of
Insulin resistance with inflammatory molecules like C-reactive protein
CRP, IL - 6, VCAM - 1 in various stages of Diabetic Nephropathy in
South Indian subjects

Started in August 2007
Duration: 6 months

6 Diabetes Amputation Prevention Initiative in the Community DAPIC -
an on-going project to determine the prevalence of diabetic complications
in rural population of South India and to develop low cost methods to
diagnose and
treat foot complications in rural community This study is in
collaboration with CLRI Central leather Research Institute of India to
develop low cost footwear and footwear kit

7 Multicentric studies to determine the prevalence of amputation cause due
to diabetes
Indian Diabetic Amputation Survey - a National survey on prevalence of
diabetic amputations - involving 100 centres in India
Amputation Prevention Initiative API - Preventing foot amputation in
high risk foot by intensive treatment strategies

8 Multicentric study to determine the prevalence of Diabetic Nephropathy
in type 2 DM subjects in Indian Subcontinents:

Seven centres from all over India are participating in the study to
determine the micro and macro vascular complications in type 2 diabetes
registered at their centres

Started Dec - 2006
To be completed by Jan 2008

9 To determine and compare the prevalence of complications related to
diabetes in 3 countries-India, Tanzania, and Bangladesh
10 IGT - MAU study:

It is a cross sectional study to determine the prevalence of
microalbuminuria in patients with IGT Impaired Glucose Intolerance The
study
involves 2 groups, one group is the IGT subjects and another is NGT
Normal Glucose Tolerance The study will be used to determine the number
of cases of IGT with microalbuminuria, so that kidney complications that
develop due to diabetes mellitus can be prevented at early stage itself in
the due course of Diabetes Mellitus

11 Predictors of Glycemic control
A bi centric study between India and Tanzania, determining and
comparing the various factors responsible for the level of the glycemic
control among two groups of population

Started - October 2007
To be completed by January 2008

12 Cost analysis and economics of Diabetes Care
This is a project on economics of diabetes care and its comparison between
two countries- India and Tanzania

Started - October 2007
To be completed by January 2008

2 To strengthen education and training in diabetes research, prevention
and control

1 Training programmes for doctors and paramedics - Overseas and

National Candidates

1 One doctor from Dar-es-salam, Tanzania had attended the one month
training programme in Diabetes management in August
2007
2 The Government of Tanzania had sponsored and sent a nurse to get
trained in Intensive Diabetes foot care Programme for 2 weeks duration
in September 2007
3 A doctor and a paramedic from Vietnam attended the 2 week training
programme on Diabetic foot care management in September 2007
4 A senior nurse from Malaysia had undergone the Training on Management
of Diabetes for One month in November 2007
5 Eleven doctors and one nurse from Government of India sponsored by
the WHO have undergone the WHO- In -country Fellowship Training
programme from October 15th to December 15th 2007
22 Patient education programs

Detailed lectures are given on daily basis to all the patients
visiting MVHospital The medium of instruction is in 3 languages -
English, Hindi and Tamil All the patients are encouraged to attend this
education program with their family Topics covered include Lifestyle
Modification, Role of Exercise and Diet, and benefits continuous blood
glucose monitoring

23 Education programs for health workers on Primary Prevention of Diabetes

Workshops focusing on primary
prevention of diabetes are being conducted
on a regular basis to health workers from the Government and the Non
Governmental Organizations NGOs Topics covered during the one-day
workshop are, epidemiology of diabetes, diagnosis of diabetes, role of
diet in prevention, exercise and lifestyle modification, prevention of
complications So far, 120 health workers and field workers from various
organizations have been trained by the workshops

24 Medical education programs for medical and paramedical staff of the
hospital

25 Education programs on Obesity and Weight Management
Recently a weight management clinic for patients and general public
was inaugurated to deliver expertise only on reduction of weight and hence
prevent diabetes and its complications The clinic is equipped with
well
trained professionals Endocrinologist, Nutritionist, Physiotherapist,
mini Gym for workout, and education gallery Weight Management Kit was
designed and supplied to the participants in weight management program

Weight Management Kit:
Diet and Exercise Diary
Pedometer
Inch tape
BMI Scale
Standard measuring cups and spoons
Information Brochure

3 To design and test on models of diabetes health care delivery system for
developing countries in the region and contribute to activities of national
diabetes programme

31 Introducing Fellowship Certification in Diabetology FCD for General
Practitioners
Indian sub-continent is experiencing an alarming rise in the prevalence of
Diabetes This heavy a burden has to be borne by the health practitioners
in order to provide professional care to the patients, to treat the
complications and also to help prevent the development of this non-
communicable disease in high risk groups by way of education
India is also witnessing the problem of population explosion, hence
there is a huge difference in the doctor: patient ratio
To address this issue Indian Medical Association in collaboration
with
MV Hospital for Diabetes, Royapuram, Chennai has launched a one-year
distance education programme in Diabetology in the state of Tamilnadu for
the general practitioners There will be 6 contact classes and 5 days of
Hands on Experience The curriculum will cover the pathophysiology,
management and prevention of Diabetes, its complications and an exclusive
training on in-house exposure so as to enable the general practitioners to
manage the patients with Diabetes in a systematic and efficient manner
Initially, the aim is to cover atleast 350 doctors per
annumPreference is given to the applicants from the rural areas of India
This course will be started in January 2008

32 Pioneer in capacity building programmes for diabetes service
delivery, the DRC in collboration with WHO has trained doctors and
paramedics for various WHO Fellowships Programmes from within country
and from the developing countries of SEARO region Utilising the trained
manpower from different disciplines like doctors, nurses, educators and
dietitians , the Government can formulate strategies and develop various

programmes for diabetes prevention and must ensure that the Indian
population from the rural, semi-urban and peri -urban areas gain access
to effective and economically affordable diabetes care, utilizing the
existing health care infrastructure of the public, NGO and private health
care system

33 Numerous screening camps were conducted among the occupational groups
such as police, banks, software professionals, general public, Offices and
schools of Chennai city One to one counselling and mass lectures were also
given on diet and healthy living to prevent the disease All the results,
especially the police data will be submitted to the Government to initiate
further necessary action

Diabetes awareness and detection camps conducted by Diabetes research
Centre June to October, 2007

|SLNO |NAME OF THE ORGANISATION |DATE |No |
| | | |SCREENED |
|1 |Police Station - Royapuram |29-06-07 |87 |
|2 |Chennai north police zone |15-07-07 |115 |
|3 |Chennai central police zone |15-08-07 |121 |
|4 |Employees of MRF1st
phase |06-09-07 |150 |
|5 |Employees for MRF 2nd phase |14-09-07 |150 |
|6 |Employees of Bank of Baroda |22-09-07 |45 |
| |State bank of Bikaner and Jaipur | | |
|7 |Residents for Grahalakshmi |23-09-07 |250 |
| |apartments, Tondiarpet | | |
|8 |Employees of HSBC, Mount road branch |26-09-07 |37 |
|9 |Employees for HSBC, beach station |28-09-07 |51 |
| |branch | | |
|10 |Residents of Manali new town under |2-10-07 |176 |
| |human rights organization | | |
|11 |Flower bazar - police camp |5-10-07 |116 |
|12 |Residents of Thiruvathiyur |7-10-07 |95 |

Activities related to World Diabetes Day Celebrations
November 10- November 14 2007
i Launch of Manual on Prevention of Childhood Obesity and Diabetes
According to this years theme for World Diabetes Day in
November,Protecting Children with diabetes worldwide a nationwide
campaign on prevention of obesity among children
was launched The obesity
among children is increasing at an alarming rate This is leading to very
early development of diabetes and heart disease among children The WHO
Collaborating Centre in India for Research, Education and Training in
Diabetes organized a function on Sunday, Nov 11 2007 and launched a
Nationwide Childhood Obesity and Diabetes campaign The manual was launched
by the Education Minister of Tamilnadu GovernmentTen thousand copies of
the manual are printed for circulation among the schools throughout India

ii Exhibition on Awareness on healthy lifestyle habits

An exhibition depicting Obesity related problems, its
prevention/control, role of diet, lifestyle modifications, guidelines to
children and parents was organized by MVHospital Various stalls were set
up and advice was given with live demonstrations, video play, power point
presentations, etc on the background

iii Poster competition for children on topic - Fighting Childhood obesity
and diabetes

To stress on the knowledge and awareness and to develop the hidden
talents among the children a poster competition was also held for
children
aged 10-15 years on the topic Childhood obesity, its problems and
prevention The children had displayed their skills in the form of models,
charts, posters, etc Prizes were awarded for the winners

iv Puppet Show
A puppet show was organized by the hospital with dual aim of
entertainment to children and to spread the awareness on ill effects of
obesity and risks involving unhealthy eating habits

v Global Diabetes Walk

Global diabetes walk was organized by DRC in a famous park in Chennai
city Around 500 participants consisting of school children, general
public, patients, and MVHospital staff members participated in the
walk to spread the message Various banners showing slogans like -
Eat less walk more, Walk, Walk, Walk, Bunk the junk food Obesity
kills the city , etc were prepared by the school children The sole
objective was to create awareness on diabetes and its prevention
A poster competition was held for school children and every
participant was given prizes

———————–

Title of the Collaborating Centre: WHO Collaborating Centre
for
Research,Education and
Training in Diabetes in India

Institution Name: Diabetes Research
CentreMVHospital for Diabetes

City and Country of Location: 4, Main Road, Royapuram, Chennai-
600013INDIA

Source:greenup.k12.ky.us

serious medical and psychiatric diseases: Diabetes, Epilepsy, Heart Disease, etc. History (T.B., epilepsy, Diabetes, etc.) PHYSICAL. 1. General …

admin — Mon, 17 Nov 2008 05:26:07 +0000

KENTUCKY DEPARTMENT OF EDUCATION
MEDICAL EXAMINATION OF SCHOOL EMPLOYEES

HISTORY

PHYSICAL

|1 |General | |7 |Blood | |Pulse| |
| |Appearance | | |Pressure | | | |
|2 |Eyes | |8 |Lungs | |
|3 |Ears, Nose | |9 |Abdomen| |
| |Throat | | | | |
|4 |Teeth | |10|Nervous | |
| |Gums | | |System | |
|5 |Thyroi| |11|Extremiti| |
| |d | | |es | |
|6 |Heart| | |Other| |
| | | |
| |

Tuberculosis Risk Factor Assessment

_______________________________
__________________________________________
Date of Examination
Signature Physician/PA/ARNP

A separate form is provided for bus drivers

Source:dmh.mo.gov

Diabetes Atherosclerosis Intervention Study. Nutrition Subcomittee of the British Diabetes Association’s Professional Advisory Committee. …

admin — Mon, 17 Nov 2008 05:26:07 +0000

Plate Method/Model References

1 Armstrong J The plate model for dietary education [abstract] Proc
Nutr Soc 1993;52:19A

2 Hendricks S Nutrition Education–beyond the facts Can J Public
Health 1993;84:367-368

3 J Am Diet Assoc 1998 Oct;9810:1155-8 The Plate Model: a visual
method of teaching meal planning DAIS Project Group Diabetes
Atherosclerosis Intervention Study Camelon KM, Hadell K, Jamsen PT,
Ketonen KJ, Kohtamaki HM, Makimatilla S, Tormala ML, Valve RH
Department of Nutrition, Toronto Hospital, Ontario, CanadaRizor H

4 Karlstrom B, Vessby B, Eliasson M Diet– A balanced approach In:
Larkins R, Zimmett P, Chisholm D, eds Diabetes 1988 Amsterdam,
Netherlands Elsevier; 1989:923-925

5 Kicklighter JR Characteristics of older adult learners: A guide for
diabetes practitioners J Am Diet Assoc1991;91:1418-1422

6 Nutrition Subcomittee of the British Diabetes Associations
Professional Advisory Committee Dietary recomendations for people
with diabetes: An update for the 1990s Diabetic Medicine 1992;9:189-
202

7 Nutrition Subcomittee of the British Diabetes
Associations
Professional Advisory Committee Dietary recomendations for people
with diabetes: An update for the 1990s J Hum Nutr Diet 1992;9:189-
202

8 Nydahl M, Gustafsson IB, Eliasson M, Karlstom B A study of attitudes
and use of the plate model among various health professionals giving
dietary advice to diabetic patients J Hum Nutr Diet 1993;6:163-
170

9 Procedings of the Congress of the International Diabetes Federation,
1989 New York: Exerpta Medica; 1989:923-925

10 Raidl M, et all The Healthy Diabetes Plate January 2007 CDC online
journal Preventing Chronic Disease
http://wwwcdcgov/pcd/issues/2007/jan/06_0050htm

11 Richards S All our patients need to know about intensified diabetes
management they learned in fourth grade The Diabetes Educator 2000;
263:392-404

12 Rizor H, Smith M, Thomas K, Harker J, Rich M Have you tried? The
Idaho Plate Method American Dietetic Association Diabetes Care and
Education Practice Group DCE Newsflash 1996;17:18-20
13Rizor H, Smith M, Thomas K, Harker J, Rich M Practical Nutrition:
The Idaho Plate
Method Practical
Diabetology 1998; 17:42-45

14Steiner G The Diabetes Atherosclerosis Intervention Study DAIS: a
study conducted in cooperation with the
World Health Organization Diabetologia1996;39:1665-1661

15Yen PK Helping elders eat less fat Geriatric Nurs 1994; 15:1418-
1422

Source:whoccdindia.com

diabetes, coronary artery disease, and the need for dental care. include diabetes, degenerative joint disease, gout, alcoholism, gallbladder disease, …

admin — Mon, 17 Nov 2008 05:26:07 +0000

1 Early adulthood is generally a healthy period, which challenges the
health care worker
to be even more sensitive, insightful, and creative in implementing care
Health and
physical processes in the young adult are frequently taken for granted
Concern for health and well being is lower among those in the twenties and
starts to increase in the mid thirties

2 Young adulthood is marked by several events, such as taking on
financial responsibilities, making career choices, beginning social
relationships, entering
marriage, and becoming a parent It is the time to establish goals in
preventive care Most young adults need to increase their awareness of risk
factors related to smoking, drug abuse, problem drinking, sexually
transmitted disease, as well as problems with
obesity or poor eating habits and lack of exercise New roles in taking on
family responsibilities make it important to know about unwanted pregnancy,
cancer,
diabetes, coronary artery disease, and the need for dental care Public
education is the
best way to promote health and alterations in young adult life styles

3 In the mid-thirties, there is increased awareness of the need for
physical fitness, while
acknowledging
decreasing physical abilities There is also emphasis on
options related to work choices, financial security, and sexuality
Relationships with members of the same age group and family are valued
Also, there is an increased level of feeling
for independence in Activities for Daily Living ADL

4 The physical body peaks in the late teens and early 20s and most of the
bodys organs begin to decline in function about the age of 30:
Hearing20
Speech20-25
Taste30
Bones 30
Vision 40
Smell50

5 Common health problems in middle adulthood some of which are gender
related,
include diabetes, degenerative joint disease, gout, alcoholism, gallbladder
disease,
coronary artery disease, varicose veins varicosities, hypertension,
strokes, GI disorders,peptic ulcer disease, obesity, dental problems,
visual changes,
reproductive/menopausal problems, anxiety/stress, and accidents/injuries
Many of these
diseases are preventable wholly or in part through behavior changes Middle
aged adults
can influence their own health as well as their childrens through
healthier life styles

6 Cardiovascular problems of the middle and older age include:
- Decreased efficiency of the heart pumping blood to the body
-
Decreased circulation to tissue and organs
- Increased pressure on vessel walls cause increased Blood Pressure BP,
- hypertension
- Irregular prominences of the blood vessels varicosities
7 Normal aging may be viewed as those inevitable and irreversible changes
that occur
with time Today, it is expected that most people will live to be at least
65 How an
individual responds to the age-related changes visible in the mirror is
related to the
persons self-esteem Physical responses to getting older can be related to
lifelong health habits, heredity, diet, exercise patterns, and love and
belonging Successful aging depends on the individuals capacity to cope
and ability to change This affects the individual, the family, and society
at large

8 Although our veteran patient population is comprised of all adult age
groups, the
fastest growing segment is those 65 years and older In the year 2000, 37
of the veteran population was 65 years and older, in the year 2015, 46
will be over 65 years

9 Each of the five senses, vision, hearing, taste, smell and touch, become
less efficient
with advanced age, interfering in varying degrees with safety, normal
activities of daily
living and general
well-being Changes in vision include inability to focus
properly,
decreased peripheral side vision, altered color perception perception of
color tones, ie, blues, greens, and violet, decreased lubrication to the
eye, difficulty in seeing in dim
areas, and cataracts

10 Hearing loss is progressive; high frequency sounds are lost first, then
middle and low Sounds of s, sh, f, ph, and ch are filtered from normal
speech, making words sound
distorted When speaking to someone with hearing loss, communication is
improved if
you face the person when speaking to them Equilibrium sense of balance
of the elderly may be affected also When using stairs, it is best to hold
on to a hand rail if you suffer from equilibrium/balance problems

11 Sense of taste is diminished due to decrease in the number of taste
buds on the
tongue Flavors of sweet, sour, salt and bitter are diminished Also less
saliva production, poor oral hygiene and ill fitting dentures may cause
problems These all contribute to the loss of appetite and lack of proper
nutritional intake Problems like this might be decreased by eating no less
than three meals a day that are of nutritonal value and taking care of any
oral problems
with loose fitting dentures or tooth decay

12 By the age of 80, detection of all scent is almost half of what it was
at peak There are now less sensory cells in the nasal lining and fewer
sensory cells in the olfactory bulb of the brain

13 Tactile sensation in the elderly person reduces his/her ability to
sense pressure and/or pain and to differentiate temperatures These sensory
changes can cause misperception of the environment and as a result,
profound safety risks

14 Aging can be a difficult process Retirement, decreased income, a
shrinking world of
friends, and declining health may all contribute to a life of isolation and
loneliness
Medications, environmental factors, a loss of independence, and
insufficient activity can
also cause problematic behaviors Thoughts of depression and suicide, signs
of dementia, fatigue and insomnia may occur, but are not part of the normal
reactions to aging and indicate a need for help

15 The frail elderly, 70 years and older, are more likely to be
restrained Most frequently
the reason for using physical restraints is to prevent injury However,
studies show that
patients who are not restrained are less likely to suffer injuries

16 Older
persons are at high risk for developing respiratory disorders
Contributing
factors are smoking, immobility, poor nutrition, self-remedies and failure
to seek medical
help for symptoms Some of the major diseases, which are usually in
advanced stages
before they are diagnosed, are pneumonia, influenza, tuberculosis TB, and
lung
cancer Delays in diagnosis and treatment can be attributed to symptoms
masked
by medications, subnormal body temperatures, and decreased pain sensation

17 It is estimated that 4 million older adults suffer some form of
dementia
irreversible decline in mental abilities, mainly Alzheimers disease The
symptoms of
this progressive degenerative disease develop gradually and progress at
different rates
among affected individuals As patients regress, their dignity, personal
worth, freedom
and individuality are jeopardized Sometimes loved ones view the demented
family
member as a stranger, and sometimes health care workers view them as
another dependent or total-care patient A patient, regardless of their
condition, should
always be treated with dignity and respect

18 The reality of facing death is an issue which older adults must face
The elderly
should be included
in plans related to care and in decisions to undergo or
refuse extensivetherapeutic or resuscitative measures This would be an
appropriate time to discuss a Living Will Advanced Directives

Source:platemethod.com

non communicable diseases: diabetes, hypertension, cardiovascular disease, For Diabetes, HIV-AIDS/TB, and Mosquito-Borne Diseases …

admin — Mon, 17 Nov 2008 05:26:07 +0000

College of Micronesia-FSM
Course Outline

Course Title: Non Communicable/Communicable Diseases Department No CHS
232a

Course Description: This is a survey course of the most important diseases
that afflict people in Micronesia Its focus is on the interplay of host,
agent and environmental factors in the production of disease and on the
things that can be done to prevent each disease and to prevent disability
and death once disease occurs

Course Prepared By: Dr Mark Durand Campus: Yap

Hours Per Week No of Week Total Hours Semester
Credits
Lecture _____5_______ x ______16_______ ______80____
______5_______ Laboratory___________ x________________
____________ ______________
Workshop ____________x________________ ____________ ______________

Total Semester Credits ____5______

Purpose of Course: Degree Requirement ________________
Degree Elective ________________
Certificate ______X_________
Other ________________

Prerequisite: CHS 220a

Signature Chairperson, Curriculum Committee
Date

________________________________________
______

Signature, President, COM-FSM Date

General Course Objectives: Students will develop knowledge and skills
needed to accurately and effectively advise and provide specific preventive
services to prevent disease and disability in the community Basic first-
line diagnosis and curative care for these diseases is also covered

Specific Learning Objectives:

Explain the 10 principles for health workers in the Code of Conduct of
the International Red Cross as they apply both to disaster relief and
community health see Community Health Wood, CH AMREF, 2nd ed Nairobi
Kenya, 1997
Define confidentiality and explain why it is important for all health
workers to preserve confidentiality
Demonstrate 3 techniques for establishing rapport with a patient
Identify the location and function of organs affected by each of the core
diseases
Describe how each disease causes dysfunction of affected organ systems
Describe how dysfunction results in symptoms, illness and death from each
core disease
Identify which important diseases are suggested by the presence of common
symptoms
Identify safe
traditional remedies for common disease symptoms
Identify situations when it is dangerous to delay or interrupt modern
medical treatments for these diseases
Describe the roles of host factors, disease agent and environment
including disease vectors in the production of illness for each
condition
Describe the typical time course of each condition, including the pre-
clinical/incubation period
Recognize the typical presentation of each of the core diseases, select
the proper method for diagnostic confirmation and select the first line
treatment for the condition
Explain indications for referral of patients with each condition to a
higher level of care
Select the proper treatment, including the dose and dose interval and
cautions and contraindications of medications on the state essential
medication list that are used to treat these conditions
Prescribe the proper follow-up for patients being treated for each core
condition, including what parameters are to be checked on follow-up
Identify behavioral risk factors for each of the core diseases
Use a systematic approach to setting incremental and measurable behavior
change goals with
patients for modification of behavioral risk factors
Demonstrate mastery in the use of flip charts to systematically deliver
key messages about disease
Use educational materials in order to promote understanding and
motivation for people to use the MODFAT diet
Take accurate readings of pulse rate, respiratory rate, blood pressure,
and blood glucose
Identify whether readings taken are normal or abnormal, and relate the
significance of abnormal readings
Take accurate readings of weight and height, and plot these on a BMI
body mass index chart
Use the chart to classify patients as normal, underweight, overweight or
obese and relate the significance of these findings
Identify lesions that are suspicious for Hansens disease by inspecting
skin
Perform a systematic exam of feet of patients with diabetes and Hansens
disease to detect risk factors for foot ulcers
Based on these foot exam findings offer appropriate counseling for the
prevention of foot ulcers and amputations

Course Contents:

Basic pathophysiology of the most important communicable and non-
communicable diseases in Micronesia

Identification, risk factors, diagnosis, treatment,
follow-up and
counseling related to each condition

The following core conditions are considered:

non communicable diseases: diabetes, hypertension, cardiovascular disease,
stroke, kidney failure, emphysema, asthma, injuries, arthritis, liver
disease, gout and cancer-

communicable diseases: tuberculosis, Hansens disease, HIV/AIDS/STDs,
pneumonia, rheumatic fever, dengue fever, leptospirosis, cholera,
gastroenteritis, intestinal worms, and filariasis

Textbooks:
Diabetes is Everybodys Business- Introductory Diabetes Training Programme
for Community Health Workers Participants Manual Secretariat of the
Pacific Community, March, 2004

Cancer 301 Guide Book Aitaotao, N 2003 Available via Nia Aitaotao:
NAitaoto@papaolalokahiorg or Nia@hawaiiedu

Guidelines for the Prevention and Management of Diabetes in the FSM- A
national consensus Position FSM Dept of Health, Education and Social
Affairs, June, 2000

Hypertension Evaluation and Treatment Protocol FSM Dept of Health,
Education, and Social Affairs, Non-Communicable Diseases Program, 2004

Clinical Management for Health Centers and Dispensaries- A Manual for
Community Oriented Health Workers Petet, P Rural Health Series 10
African
Medical Research and Education Foundation, Nairobi, Kenya 1995 [ISBN 9966-
874-15-1]

Required Course Materials: Computer with LED projector, Chalkboard

WHO/Pacific Open Learning Health Net Modules on CD ROM:
For Diabetes, HIV-AIDS/TB, and Mosquito-Borne Diseases
Available via: http://wwwpolhncom

US Center for Disease Core Curriculum for Tuberculosis Powerpoint slide
show available at:
http://wwwcdcgov/nchstp/tb/pubs/slidesets/core/defaulthtm
Methods of Instruction: Lecture, discussion, role play

Methods of Evaluation:
Examinations
Successful performance of skills components based on skills checklists
see Tabella, Part 1
Assessment of student counseling skills by testing comprehension of lay
people who have been counseled about a topic by student

Attendance Policy: Per standard COM-FSM policy as stated in the current
catalog This will be explained to students on the first day of class

Academic Honesty Policy: Per standard COM-FSM policy as stated in the
current catalog

Source:elcamino.edu

Please fax an enlarged COPY of the front and back of your Type 1 or Type 2 Diabetes, Insulin Controlled ” Type 2 Diabetes, Non-Insulin Controlled ” …

admin — Mon, 17 Nov 2008 05:26:07 +0000

Please fax an enlarged COPY of the front and back of your INSURANCE CARD to
323-442-3351

Step 1: Health Questionnaire

1 Do you have any of the following conditions check all that apply? :
High Blood Pressure Hypertension
Type 1 or Type 2 Diabetes, Insulin Controlled
Type 2 Diabetes, Non-Insulin Controlled
Heart Disease
High Blood Cholesterol

Please list any other conditions:
______________________________________________
________________________________________________________________________

Yes No

2 Has a doctor ever said you have heart trouble or a heart condition?

3 Do you frequently suffer from pains in your chest?

4 Do you often feel faint or have spells of severe dizziness?

5 Has a doctor ever told you that you have a bone or joint problem,
such as arthritis, that has been aggravated or made worse by
exercise?

6 Is there a physical reason, not mentioned here, why it might be
hazardous for you to follow an
activity/nutritional program?

7 Do you have any of the following check all that apply? :
o Asthma
o Shortness of Breath
o Arthritis Bursitis
o Rheumatism
o Hernia
o Recent Surgery
o Gall Stones
o Angina
Yes
No
8 Have you consulted your physician regarding your participation in a
weight loss program?

9 What are your personal goals in regards to this program?
____________________________________________________________________________
____________________________________________________________________________
________________________________________________________________
__

Step 2: Availability - you may skip this section if youve already
selected a group

Please identify which campus, and which days and times, you would be
available for the weekly group meetings Meetings are one hour long, and no
meetings occur on the weekends Most commonly, groups are run between 11:00
AM and 2:00 PM, as well as 5:30 to 9:30 in the evenings Other times
of
day would be considered However, we seek to find approximately 12 people
who are available at the same day, time, and place before initiating a
group

Please circle the campus most convenient for you:

University Park Campus Health Sciences Campus
Near Jefferson Hoover Near Alcazar
Soto

Other please list locations:
____________________________________________________________________________
____

____________________________________________________________________________
____

Please list the times and days most convenient for you:

Monday: ____________________ Tuesday: ______________________

Wednesday: __________________ Thursday: _____________________

Friday: ______________________ Weekends: ____________________

RememberWe can come to you Just get a group of 10 friends, family
members or co-workers together and we can start a group at your location

Step 3: Paying for the Weight Loss Program
We request that all clients make any required co-payments or other
fees, in advance, every eight weeks Therefore, please bring payment for
the eight weeks to your
initial session At your initial session you will
be offered a reference book used during the program This is sold at cost
10, but purchasing the book from this program is completely optional
Please make all checks payable to the USC OT Faculty Practice
Payments made for sessions will apply only to the group in which the
client is enrolled Payments can not roll-over into the following cycle
of groups Credit for sessions will expire once the group has ended
Payments for the USC Lifestyle Redesign Weight Loss Program in the form of
co-pays, co-insurance or private pay are non-refundable Please consider
this financial commitment seriously before signing below No exceptions
will be made
The USC Occupational Therapy Faculty Practice will only allow clients
to make-up two sessions that they have missed This decision was based on
the difficulty finding another group at a day, time, and location that can
be attended, which is covering the material missed, as well as
consideration for the current members of such a group This decision was
also based on a study of our clients that revealed poorer outcomes for
those who
missed more than two sessions versus those who did not

I, , have read and understood the statements
above
Print Name

Signature: Date:

Step 4: Please Review Sign Below

Protecting your privacy is extremely important to us In exchange for
your trust, we promise to observe the following principles: We will ask
only for the information we need in order to provide the highest level of
service to you We will not release personal identifying information about
you without your consent We also ask that all information shared within
the groups, as well as the identities of those within the group sessions
remain confidential
Exercise and health are matters that vary from person to person
Participants in the USC Lifestyle Redesign Weight Loss Program should
speak with their own doctors about their individual needs before starting
any exercise or weight loss program This program is not intended as a
substitute for the medical advice and supervision of your personal
physician Any application of the recommendations set forth within
the
program is at the participants discretion and sole risk
A certified nutrition specialist developed the nutrition program
followed, and some of the information given within the sessions This
information is intended to be used only as a guideline for healthy eating,
and is not meant to be a substitute for a medically prescribed diet If
you are currently on a medically prescribed diet or have any specific
medical conditions that require you to

be on one, please consult your physician In addition, please use your
discretion regarding food allergies and intolerances Although there are a
variety of foods included within the program, it is not recommended that
you consume any foods you are allergic or intolerant to

Please print your name and sign below

I, , have read, understood, and agree to abide by
all of the statements above

Signature: Date:

Please fax an enlarged COPY of the front and back of your INSURANCE CARD to
323-442-3351

OCCUPATIONAL THERAPY REFERRAL FORM

Patient name:
Phone:

Address:
Diagnosis: ICD-9:

Secondary Diagnosis: ICD-9:

History/Precautions:

Physicians Name/ Title:
__________________________Phone:_________________________________
Address:
____________________________________________________________________________
_
Email:
____________________________________________________________________________
___
NPI :__________________________

Please send referral and current history to: USC Occupational Therapy
Faculty Practice

EVALUATION and REPORT
OCCUPATIONAL THERAPY EVALUATION AND TREATMENT

Frequency/Duration: 1x times weekly for 18 weeks

Lifestyle Redesign Weight Loss Program CPT code 97150
Facilitate clients development and enactment of a customized routine of
health promoting and meaningful activities designed to result in improved
life satisfaction and weight-loss

I certify re-certify that I have examined the patient and that
services will be furnished while the patient is under my care, and that the
plan is established and will be reviewed every 30 days, or more often if
the
patients condition requires I estimate that these services will be
needed for about months

_______
PHYSICIANS SIGNATURE DATE

Source:usc.edu

disease, such as those with a family history of eye disease, diabetes or high “Much like mammograms and diabetes screenings, regular eye exams will help …

admin — Mon, 17 Nov 2008 05:24:30 +0000

NEICAC FAMILY PLANNING

MEDICAL HISTORY

Review of Systems

Name:________________________________________________________
Birthdate:_________________ Age:________
Last First
Initial

Reason for your visit
today:______________________________________________________________________
_____
Family Planning serves a wide range of women We have tried to make this
form as complete as possible, realizing that some questions will not apply
to every womans particular circumstances All information is strictly
confidential

CONTRACEPTIVE HISTORY

Check all birth control methods you have used: Pill DepoProvera
Lunelle IUD Condom Sterilization Diaphragm
Foam/Suppository Natural Family Planning Rhythm Withdrawal
Other_________________________________________

|YES |NO | |
| | |Do you or your partner use birth control now? |
| | |If yes, what methods do you use?_________________________ How long have |
| | |you used this
method?_____________________ |
| | |Have you had problems with this or any birth control method? If yes, |
| | |explain:____________________________________________ |
| | |Do you plan to get pregnant in the next year? |
| | |Do you want a birth control method today? If yes, what |
| | |method?_____________________________________________________ |

SEXUAL HISTORY

Your answers to the following questions will help us assess your risk for
cervical cancer and sexually transmitted infections STIs
Age at first intercourse:________________
|YES |NO | |
| | |Are you sexually active now? Check all that apply: Vaginal Anal Oral |
| | |Other When did you last have sex?__________ |
| | |Do you take precautions against sexually transmitted infections? |
| |
|Explain:________________________________________________ |
| | |Have you had more than one or a new sexual partner in the past year? Are |
| | |your partners: Male Female Both |
| | |Do you feel that any of your partners have put you at risk for sexually |
| | |transmitted infections or HIV? |
| | |Do you want to be tested for sexually transmitted infections? |
| | |Do you have any other questions or concerns about sex that you would like to|
| | |discuss during this visit? |
| | |Explain:____________________________________________________________________|
| | |________________________________ |
| | |No of partners this year: ________ No of lifetime partners: |
| | |__________ |

SOCIAL/HEALTH RISK HISTORY

10/2004
Please list any ALLERGIES, including drug, metal, skin allergies or
irritants, or rubber/latex sensitivity___________________________________
____________________________________________________________________________
___________________________________________
FAMILY HISTORY
If you are adopted, check and skip to the next section
Has anyone in your immediate family ever had the following? If yes,
indicate father F, mother M, brother B, or sister S
______ No longer living Age/Cause of death:_______________________
_______Breast, Ovarian or Uterine Cancer age at onset:_________
______ Heart Attack/Heart Disease/Surgery Age at onset:_____________
_______Other Cancer
______ High Blood Cholesterol/High Blood Pressure
_______Diabetes Yes No
Women born 1940-1970: Did your mother take DES hormones during her
pregnancy with you? Yes No
MEDICAL HISTORY List current medications including herbs and
over the counter
meds:_________________________________

____________________________________________________________________________
________________
|YES |NO | |
| | |Have you ever had surgery or been a patient in a hospital? |
| | |If yes, |
| | |describe:___________________________________________________________________|
| | |___________________________ |
| | |Are you now, or have you been, under a doctors care for a serious illness |
| | |or condition? |
| | |If yes, |
| | |describe:___________________________________________________________________|
| | |___________________________ |
| | | |
| | |Do you have another source of health care? |
| |
|Where?________________________________________________________________ |

FILL THIS OUT IF YOU ARE UNDER 18 YEARS OLD
YES NO
Are your parents aware of your visit to Family Planning?
If not, did you discuss your plans to come to the clinic with
another adult? Who?__________________________________
Would you like information on talking to your parents about
sexuality?
Are you in a relationship where you are being forced to have
sexual relations?

TO THE BEST OF MY KNOWLEDGE, THIS INFORMATION IS COMPLETE AND CORRECT

Patient Signature___________________________________________ Date of
Birth__________________ Date_______________

Comments: Staff
Signature_____________________

———————–
Clinician:____________________
Clinic Location:_______________
Date:________________________
Chart
______________________

Source:neicac.org

to help raise $1million for diabetes research This is the sixth Australian Ride to Cure Diabetes. or reversing the effects of type 1 diabetes. …

admin — Mon, 17 Nov 2008 05:24:29 +0000

FOR IMMEDIATE RELEASE CONTACT: American Academy
August 17, 2007 Ophthalmology media
relations
415 561-8534 or
Eye Surgeons Associates
Julie Berntgen, Director
of Marketing
563-459-6609

Eye Disease on the Rise
Among Older Americans,
Few Realize Risk

American Academy of Ophthalmology issues new recommendation for eye
health
and launches new initiative, EyeSmart Campaign, to educate public
about risks

Quad Cities - - A new national health survey[i] of 1,200 Americans
conducted for the American Academy of Ophthalmology finds that most
Americans are unaware of the risks associated with age-related eye
diseases, despite a projected 65 percent spike in those conditions by the
year 2020 The survey indicates that few
Americans see themselves truly at
risk for eye disease and that populations most at risk for developing eye
disease are unaware of the factors that make them susceptible Overall,
most Americans rank blindness and vision loss relatively low on their list
of health concerns

Age-related eye diseases including cataracts, diabetic retinopathy,
glaucoma and age-related macular degeneration are expected to dramatically
increase-from 28 million today to 43 million by the year 2020[ii] Left
untreated, these diseases can cause serious vision loss and blindness At
the heart of this upsurge lie Americas 78 million baby boomers, who will
increasingly face the effects of eye diseases as they get older Despite
these statistics, Americans remain relatively unconcerned about vision
loss The Academys survey reveals that less than a quarter of Americans
23 percent are very concerned about losing their vision, while a majority
feel weight gain or joint and back pain are of greater concern than vision
loss

The unfortunate reality is that millions of people will suffer significant
vision loss and blindness because they dont know that they are at risk,
said Dr Benevento, Medical Director at Eye
Surgeons Associates Letting
people know what they can do to prevent vision loss and blindness will be
key We are trying to get the word out through our web site, seminars, and
health fairs

The Academy, the worlds largest association of eye physicians and
surgeons, is also helping by issuing a new eye disease screening
recommendation for aging adults and is launching a new public initiative
called EyeSmart to educate Americans about the risks they face

The Academy now recommends that adults with no signs or risk factors for
eye disease get a baseline eye disease screening at age 40-the time when
early signs of disease and changes in vision may start to occur Based on
the results of the initial screening, an ophthalmologist will prescribe the
necessary intervals for follow-up exams For individuals at any age with
symptoms of or at risk for eye disease, such as those with a family history
of eye disease, diabetes or high blood pressure, the Academy recommends
that individuals see their ophthalmologist to determine how frequently
their eyes should be examined The new recommendation does not replace
regular visits to the ophthalmologist to treat ongoing disease or injuries,
or vision
examinations for eye glasses or contact lenses

Much like mammograms and diabetes screenings, regular eye exams will help
identify signs of disease at an early stage, when many treatments can have
the greatest impact, said Dr Benevento

EyeSmart, a public service program offered in partnership by EyeCare
American and the Academy, draws upon the combined resources of the Academy,
state and local ophthalmology societies and other partners to deliver
critical information on age-related eye diseases through multiple health
information channels, including doctors offices and grassroots networks
The EyeSmart Web site, wwwgeteyesmartorg, delivers eye disease and risk
information and a searchable database of local ophthalmologists

In order to impact the chief health care decision makers of American
families, EyeSmart will focus on reaching women over 40 These women are
more likely to serve as caregivers for their own families and increasingly
their aging parents, and they frequently act upon and share with friends
and loved ones positive health care information

EyeSmart also aims to reach people who dont traditionally consider
themselves at risk, such as individuals who do not wear
glasses or
contacts The survey revealed that 96 percent of individuals without
glasses or contacts do not think they are at high risk for eye disease
Wearing glasses or contacts has no impact on contracting age-related eye
diseases

Everyone is at risk, some more than others But with early detection and
early treatment we can minimize the damage from potentially blinding
diseases like glaucoma and diabetes comments Dr Benevento

For an executive summary of the survey and more information on specific age-
related eye diseases, visit wwwgeteyesmartorg

About Eye Surgeons Associates
Eye Surgeons Associates located in Bettendorf, Muscatine, Rock Island,
Silvis and Geneseo, provides comprehensive eye care for the entire family,
for a lifetime Our medical doctors are fully fellowship trained in their
specialties and board certified For more information visit us online at
wwwesaeyecarecom Dr Benevento joined Eye Surgeons Associates in 1994
He attended Stanford University, CA, graduating with departmental honors
He first came to the Midwest to attend Washington University in St Louis,
where he completed both his medical training and his residency in
ophthalmology As a board certified
ophthalmologist, Dr Benevento has
special interest in diabetes and the surgical treatment of cataracts with
the latest techniques
About the American Academy of Ophthalmology
The Academy is the worlds largest association of eye physicians and
surgeons - Eye MDs - with more than 27,000 members worldwide Eye
healthcare is provided by three sources - opticians, optometrists and
ophthalmologists It is the ophthalmologist, or Eye MD, who can treat it
all: eye diseases and injuries, and perform eye surgery To find an Eye
MD in your area, visit the Academys Web site at wwwaaoorg
About EyeCare America
Established in 1985, EyeCare America, a public service program of the
Foundation of the American Academy of Ophthalmology, is committed to the
preservation of sight, accomplishing its mission through public service and
education EyeCare America provides eye care services to the medically
underserved and for those at increased risk for eye disease through its
corps of 7,200 volunteer ophthalmologists dedicated to serving their
communities More than 90 percent of the care made available is provided
at no out-of-pocket cost to the patients EyeCare America includes
programs for seniors,
glaucoma, diabetes, AMD and children, and is the
largest program of its kind in American medicine Since its inception,
EyeCare America has helped more than 860,000 people EyeCare America is a
non-profit program whose success is made possible through charitable
contributions from individuals, foundations and corporations More
information can be found at: wwweyecareamericaorg

———————–
[i]45Khjrxy{|EÏÕÖïðñ | G U j s w ?
TXnüøôðìèøôüáüøüøüðôÉ?????uhÈs
CJ]?aJh4;ihaRCJ]?aJhaR5?6?CJaJhÕlhaR5?6?CJaJh9thaR Americans, Eye
Health, and Eye Disease National Survey, Greenberg, Quinlan Rosner
Research Inc, June, 2007 Telephone survey of 1,200 adults Margin of
error /- 28 percentage points
[ii] The Eye Disease Prevalence Research Group, Cause and Prevalence of
Visual Impairment Among Adults in the United States, Archives in
Ophthalmology 2004;122;477-485

Source:eyesurgeonspc.com

Have you, or someone you know, recently been diagnosed with Type 2 Diabetes? Funded by diet, in addition to usual care, in patients with Type 2 diabetes. …

admin — Mon, 17 Nov 2008 05:24:29 +0000

Riding towards a cure: {suburb/town name} local takes up challenge
to help raise 1million for diabetes research

Up to 300 amateur cyclists from across Australia will participate in a
spectacular bike ride through the Barossa Valley on Saturday 17th January
2009 in aid of the Juvenile Diabetes Research Foundation JDRF

Among the riders will be { your name} of { name of suburb/town} who has
taken up the challenge to raise money for much needed research into a cure
for type 1 juvenile diabetes

This is an important cause and a great way to raise awareness and much
needed research funds said { your name}

Im proud to be associated with JDRF and the Ride to Cure Diabetes We are
hoping to make a significant contribution to the final fundraising tally

This is the sixth Australian Ride to Cure Diabetes Riders have spent
recent months raising a minimum of 3500 each to participate in either the
35km, 80km or 160km ride course Riders range in age from 10 to 70 years
and most have a connection with type 1 diabetes - they either live with the
disease themselves or are riding for someone who does

{include a quote about your relationship to type 1 diabetes if
applicable}

Unlike other forms of diabetes, type 1 or juvenile diabetes is a disease
of the immune system that most commonly strikes in childhood It is caused
by the unpredictable and uncontrollable destruction of the cells in the
body that produce insulin Without insulin, the body cannot convert food to
energy The 140,000 Australians who currently suffer type 1 diabetes have
to inject multiple shots of insulin daily, however this is not a cure and
doesnt prevent the development of complications such as blindness, heart
disease or kidney failure Medical research is the only hope for preventing
or reversing the effects of type 1 diabetes

Researchers have made greater advances towards a cure in the last five
years than in the previous twenty The outlook is now so promising it isnt
a matter of if there will be a cure, but when, said Mike Wilson, CEO of
JDRF

With the support of the Australian community we know that we can achieve
our mission and find a cure for this devastating disease

For further information, please contact:

{Your name and contact details}

Source:jdrf.org.au

The NSF for Diabetes: Standards outlines best practice and will support prison 1 Diabetes is becoming a more common condition world-wide. …

admin — Mon, 17 Nov 2008 05:24:29 +0000

x
———————–
Have you, or someone you know, recently been diagnosed with Type 2
Diabetes?

If you have recently been diagnosed with diabetes, YOU may be eligible to
join the Early ACTID study

We are currently recruiting for an important new study investigating the
effects of increased exercise and improved diet, in addition to usual
care, in patients with Type 2 diabetes

If you have been diagnosed with Type 2 diabetes in the last 6 months, are
between 30 and 80 years old, and want more information about the study,
please ask your doctor or practice nurse or take a contact number from the
bottom of this poster and contact us directly

Early ACTID Study
0117 9282440

Early ACTID Study

0117 9282440

Early ACTID Study
0117 9282440

Funded by

Early ACTID Study
0117 9282440

Version 1 23/11/04

Source:bris.ac.uk

The prevalence of diabetes is substantially higher than among the majority Diabetes is twice as prevalent among Hispanics as among the majority of the population. …

admin — Mon, 17 Nov 2008 05:24:29 +0000

| |Prison Service Instruction |Number|
| | | |
| | | |
| | |07/200|
| | |2 |
| | | |

|Issued
|18/02/200|
| |2 |

NATIONAL SERVICE FRAMEWORK FOR DIABETES: STANDARDS

1 The Department of Health with the help of leading clinicians,
managers and staff sets national standards and defines service models
for key conditions and care groups through a series of National
Service Frameworks NSFs NSFs are based on what works and on
experience from around the country The Department of Health has
recently published the first part of the National Service Framework
for Diabetes: Standards copies of which are being sent to each prison
with this PSI for information and as a means of facilitating learning
and the spread of good practice A copy of the full text of the NSF
for Diabetes: Standards document is also available on the Department
of Healths website at wwwdohgovuk/nsf/diabetes together with more
detailed supporting information on interventions and service models

2 In line with requirements of the Health Services for Prisoners
Standard, this NSF will support prison health care staff in delivering
a service to people with
diabetes in prison broadly equivalent to that
delivered by the NHS A summary of key principles of particular
interest to people working in prisons is attached at Annex A

3 One of the central themes highlighted in this NSF is the need to
target those population groups at greatest risk These include people
from minority ethnic groups and socially excluded groups, both over
represented in prison populations The NSF also focuses on the
importance of integrated cross agency working to ensure that people
with diabetes experience well co-ordinated care appropriate to their
health needs whatever the setting

4 Governing Governors must arrange for copies of this PSI to be drawn
to the attention of:

Heads of Health Care along with a copy of the National Service
Framework for Diabetes: Standards document which should be retained in
the Health Care Centre

Impact and Resource Assessment

5 There are no additional staff or non-staff resources required to
implement this PSI The NSF for Diabetes: Standards outlines best

practice and will support prison staff in their ongoing work to
deliver high quality diabetes care in prison settings equivalent to
that provided in the community

Dr Felicity Harvey
Director of Prison Health and Head of Prison Health Policy Unit
Annex A

NATIONAL SERVICE FRAMEWORK FOR DIABETES : STANDARDS

1 Diabetes is becoming a more common condition world-wide It can
affect people of all ages in every population The National Service
Framework for Diabetes: Standards highlights the impact diabetes can
have on the physical, psychological and material well-being of
individuals It can lead to complications such as heart disease,
stroke, renal failure, amputation and blindness There is also
evidence to show that:

the onset of Type 2 non insulin dependent diabetes can be delayed,
or even prevented;

effective management of the condition increases life expectancy and
reduces the risk of complications;

self management is the cornerstone of effective diabetes care

2 The
National Service Framework for Diabetes: Standards document sets
out twelve new standards summarised in the table on page 5 and key
interventions necessary to raise the standards of diabetes care
Further detailed supporting information can be found on the Department
of Health website at http://wwwdohgovuk/nsf/diabeteshtm A second
stage of the NSF the National Service Framework for Diabetes: Delivery
Strategy will be published in summer 2002 following further
consultation on service models and will set out early milestones for
delivery in the NHS over the ten year implementation programme

Key messages for prison healthcare staff

3 Central themes highlighted in the NSF of particular interest to
people working in prisons focus around the need to tackle variations
in care to ensure consistent high quality diabetes care wherever
people are living and the importance of reaching communities at
greatest risk

Equivalent standards of health care for people with diabetes in prison
settings

4 In line with the overarching
Health Services for Prisoners Standard
to provide prisoners with access to the same range and quality of
services that the general public receives from the National Health
Service, this first part of the National Service Framework for
Diabetes makes clear that people with diabetes living in custodial
settings should be managed in line with the standards set out in this
NSF see paragraph 9 of the supporting material on Health Inequalities
published on the Diabetes NSF website

5 Close partnership working between the prison health care team and
local NHS specialist diabetes service is essential to underpin this
and drive up standards Regular liaison particularly with the diabetes
specialist nurse will ensure for example:

an inclusive approach to care planning at local level The community
specialist diabetes nurse can provide advice and support on individual
case management where necessary and increase confidence in day to day
diabetes management both for prisoners with diabetes in line with
Standard 3 of the NSF on empowering people with diabetes and
prison
health care staff;

that there is regular surveillance of prisoners with long term
diabetic complications in line with Standard 10 of the NSF

Regional Prison Health Leads will be able to advise prison health care
staff if they have any difficulty in identifying or engaging with this
service

High risk groups over represented in the prison population

6 Diabetes does not affect everyone equally Significant inequalities
exist in the risk of developing diabetes, in accessing health services
and in health outcomes The burden of disease falls disproportionately
on people from minority ethnic and socially excluded groups For
example, Type 2 diabetes is up to six times more common in people of
South Asian descent and up to three times more common amongst those of
African and African Caribbean origin compared with the white
population Both mortality and morbidity resulting from diabetic
complications are increased by socio-economic deprivation

7 On any day the prison population in England and Wales averages around
65,000 Most prisoners are
in custody for less than 6 months In
general, prisoners have poorer health than the population at large,
many have unhealthy lifestyles and have had little or no regular
contact with health services before entering prison Prison
populations reveal strong evidence of health inequalities and social
exclusion Whilst the prevalence of diabetes amongst prisoners is
unknown, the NSF makes clear that high risk hard to reach groups are
over-represented in this population see page 10 of the NSF standards
document and also pages 1 and 2 of the Health Inequalities section
and that a period of imprisonment can be an opportunity to screen for
diabetic complications and improve care Establishing a register of
diabetes patients in the prison can be a single first step towards
planning and managing care for this group of prisoners

Source:medicareadvocacy.org

Diabetes. Diabetes is a condition in which blood glucose is unable to enter the cells More than 80% of people with diabetes die from cardiovascular disease. …

admin — Mon, 17 Nov 2008 05:24:29 +0000

Health care Disparities: Facts and IssueS

Source:
The Commonwealth Fund 2001 Health Care
Quality Survey

Source: Physicians Characteristics and Distribution in the US, 2004
Edition American Medical Association
———————–
Introduction
Not all Americans have access to the high quality of care that is available
in this country And not all patients are treated in the same manner For
example:
Providers may order fewer diagnostic tests for patients of different
cultural backgrounds because they may not understand or believe the
patients description of symptoms
Patients are less likely to adhere to a prescribed treatment or medical
advice if they do not understand or trust the medical provider
To receive the best quality of care, it is important that providers become
more aware of the specific needs of minority populations, and increasingly
comfortable in
dealing with patients from differing backgrounds Healthcare
consumers and advocates should also educate themselves in order to insure
the best care for everyone
Sources: National Healthcare Disparities Report 2003, The Providers Guide
to Quality Culture wwwercmshorg

African Americans
The cardiovascular disease death rate for both men and women far exceeds
the rate for the majority population and for other ethnic groups
The prevalence of diabetes is substantially higher than among the
majority population, and the incidence of complications, including lower-
limb amputations and end-stage renal disease is double
African-American women are far more likely than women of the general
population to be infected with HIV, and about 64 of all women with new
HIV infections in a given year are African American
African-Americans have a higher incidence of hypertension, sickle cell
anemia and are more likely to be lactose intolerant than the general
population Certain diseases, including prostate and breast cancer, may
progress more rapidly than in the general population
Source: The Providers Guide to
Quality Culture wwwercmshorg

Women
Females have traditionally been diagnosed and treated as if their bodies
were the same as males Women are often excluded from clinical trials
Less than 1/3 of uninsured pregnant women get proper prenatal care, while
well-insured pregnant women suffer from many unnecessary interventions,
such as cesarean sections, episiotomies, labor inductions and continuous
electronic fetal monitoring
Some insurance companies have sought to deny coverage to battered women
on the grounds that they constitute a high risk population
Women are at a disadvantage paying for care, because they are paid less
than men
Source: Reed, Alyson Womens Healthcare Disparities and Discrimination
Civil Rights Journal, Fall 1999

Hispanics/Latinos
Overweight and obesity are common in some Hispanic groups: for example,
combined overweight and obesity are found among 639 of Mexican-American
men and 659 of Mexican-American women
The incidence of cervical cancer in Hispanic women is double that of non-
Hispanic European-American women
Hypertension is common in
Hispanic populations
Although Hispanics have a lower incidence of breast, oral cavity,
colorectal, and urinary bladder cancers, their mortality from these
cancers is similar to that of the majority population
Diabetes is twice as prevalent among Hispanics as among the majority of
the population

Source: The Providers Guide to Quality Culture wwwercmshorg

Factors Resulting in Poor Care
Entry Barriers: A lack of health insurance, lack of a usual source of
care, unmet needs
Structural Barriers: Difficulties in getting care, lengthy waiting times
Patients Perceptions: Provider-Patient Communication, provider lack of
cultural competency skills, linguistic barriers, lack of culturally or
linguistically specific healthcare information
Financial incentives to limit services, high cost of care,
Fragmentation of healthcare financing and delivery
Source: National Healthcare Disparities Report 2003, IOM Unequal
Treatment: Confronting Racial and Ethnic Disparities 2002

General Recommendations
Increase awareness of racial and ethnic disparities in health care among
the general public
and key stakeholders, and increase health care
providers awareness of disparities
Promote the consistency and equity of care through the use of evidence-
based guidelines
Provide the use of interpretation services where community need exists
The use of community health workers and multidisciplinary treatment and
preventive care teams should be encouraged
Implement patient education programs to help increase patient knowledge
of how to best access and maximize care
Integrate cross-cultural education into the training of all current and
future health professionals
Conduct further research to identify sources of racial and ethnic
disparities and assess promising intervention strategies
Source: National Healthcare Disparities Report 2003, IOM Unequal
Treatment: Confronting Racial and Ethnic Disparities 2002

Asian-Americans
Lactose intolerance is common
Common sites of cancer among Chinese women are the lungs, breast, colon,
stomach and pancreas Invasive cancer rates are much higher among
Southeast Asian women in general than in the majority US population
The rates of cervical
cancer incidence and mortality for Vietnamese
American women exceed those of any other minority or majority population
in the US
Some Asians may develop a severe form of Glucose-6-phosphate
dehydroginase G-6PD deficiency
Source: The Providers Guide to Quality Culture wwwercmshorg

Immigrants
Newcomers may have tuberculosis, Hepatitis B, internal parasites or
malaria
Sickle-cell anemia occurs in populations originating in Africa, India,
Saudi Arabia and Sicily
Recent immigrants may suffer from dental concerns as a result of poor
dental care in their own country or increased consumption of processed
foods since their arrival in the United States
Recent immigrants may experience cultural or linguistic difficulties
Source: The Providers Guide to Quality Culture wwwercmshorg

American Indians/Alaska Natives
Almost 3 times as likely to have diabetes as non-Hispanic European
Americans of similar age
Native Alaskan men and women suffer disproportionately higher rates of
cancers of the colon and rectum compared to European Americans
Source: The Providers Guide to
Quality Culture wwwercmshorg

Source:fredonia.edu

admin — Mon, 17 Nov 2008 05:24:29 +0000

Coronary Heart Disease CHD
Coronary heart disease CHD is a condition in which the arteries that
supply the heart muscle with oxygen and nutrients are narrowed by fatty
deposits such as cholesterol and triglycerides Narrowing of the coronary
arteries diminishes blood supply to the heart muscle, which can lead to a
heart attack In the United States, CHD accounts for approximately 21 of
all deaths and about 50 of all cardiovascular deaths Over half of the
people who die experience no previous symptoms The following are leading
contributors to the development of CHD:
1 Physical inactivity
- Aerobic exercise has potentially the greatest impact in reducing overall
risk for cardiovascular disease
2 High blood pressure
- Blood pressure should be checked regularly regardless of whether its
elevated or not
- Ideal blood pressure is 120/80 or below
- Chronically elevated blood pressure is anything above 140/90
- Those who have elevated blood pressures are advised to engage in regular
aerobic exercise, weight control, a low-salt/low-fat and high potassium
/high-calcium diet, decreased intake of caffeine and alcohol, steps
towards smoking cessation,
and stress management
3 Excessive body fat
- In the United States, 63 of men and 55 of women are overweight and 21
of men and 27 of women are obese, which yields 97 million people who
are overweight and over 30 million who suffer from obesity
4 Low HDL-cholesterol
- High-density lipoprotein HDL, also known as good cholesterol, offers
some protection against heart disease
- HDL-cholesterol is determined genetically Women have higher levels
than men do with the female sex hormone estrogen tending to raise HDL
- Habitual aerobic exercise, weight loss, niacin, and smoking cessation
all help raise HDL-cholesterol
5 Elevated LDL-cholesterol
- Low-density lipoprotein LDL, also known as bad cholesterol, tends to
release cholesterol whereas HDL tends to take in cholesterol when coming
in contact with cholesterol-filled cells
- A desirable LDL-cholesterol level is below 130 Between 130 and 159
mg/dl is considered borderline-high and 160 and above presents a high
risk for cardiovascular disease
- LDL-cholesterol can be lowered by losing body fat, taking medication,
participating in regular aerobic exercise program, and having a diet
low
in fat, saturated fat, and cholesterol, and fiber intake between 25 to
30 grams a day
6 Elevated triglycerides
- Triglycerides, which are fats formed by glycerol and fatty acids, speed
up the formation of plaque These fatty acids are found in poultry
skin, lunch meats, and shellfish, but are manufactured primarily in the
liver, from refined sugars, starches, and alcohol
- A high intake of alcohol and sugars raises triglyceride levels
significantly
- The level of triglycerides can be lowered by cutting down on some of the
foods mentioned along with engaging in aerobic activity
7 Diabetes
- Diabetes is a condition in which blood glucose is unable to enter the
cells either because the pancreas totally stops producing insulin or
does not produce enough to meet the bodys needs
- More than 80 of people with diabetes die from cardiovascular disease
8 Abnormal electrocardiograms ECG
- Electrocardiograms ECG are a recording of the electrical activity of
the heart A stress ECG is used frequently to diagnose CHD, which
reveals the hearts tolerance to high-intensity exercise
9 Tobacco use
- Cigarette smoking is the single
largest preventable cause of illness and
premature death in the United States, responsible for 400,000 deaths a
year, with about 53,000 being non-smokers who were exposed to secondhand
smoke Secondhand smoke is ranked as the third-leading preventable
cause of the death in the United States
- Pipe and cigar smoking and chewing tobacco also increase the risk for
heart disease
10 Stress
- Those who are not able to relax place a constant low-level strain on the
cardiovascular system that could manifest itself in heart disease
- When a person is placed in a stressful situation, the coronary arteries
that feed the heart muscle constrict, reducing the oxygen supply to the
heart
11 Personal and family history of cardiovascular disease
12 Age and gender
- Age become a risk factor for men over the age of 45 and women over the
age of 55
- The greater incidence of heart disease may stem in part from lifestyle
changes as one ages

Source:gov.mb.ca

According to Kathleen, the Diabetes Collaborative is even on Washington Governor The Diabetes Objective Research Project (DORP) is currently aggregating 60,000 …

admin — Mon, 17 Nov 2008 05:24:29 +0000

CDEMS User Support Newsletter

November 16, 2005 Kent, WA

Meeting Highlights

Twenty CDEMS users attended the CDEMS User Support Meeting in Kent, WA on
November 16, 2005 Participants were: Bev Roder Tammie Bigelow
Physicians of SW Washington, Cathy Irby, Jim Strawn, Shari Peterson, Jean
Gambrielle, Kelly LaRue Northwest Physicians Network, Judy Tomassene
Seattle Indian Health Board, Francisco Arias Erica Long SeaMar
Community Health Center - Seattle, Shonnie Evans Yeshi Zelleke Country
Doctor Community Health Centers, Cassandra Beard Shari Giomo St
Peters Family Medicine, Colette Rush The Polyclinic, Crystal OBrien,
Anita Christiansen, Linda Pelland Snoqualmie Tribe North Bend Family
Clinic, Sue Barwick Mason General Hospital, Barb Flock Rockwood
Clinic, along with Kathleen Clark Jeanne Harmon WA DOH, and Dusty
Knobel Jackie Gianunzio CDEMS Support

User Presentation: Spread of the Planned Care Initiative at NPN

Cathy Irby, QI Initiatives Manager at Northwest Physicians Network NPN
lead a panel discussion about the NPN experience in spreading the CDEMS
registry to over 100 independent providers in South King and Pierce
Counties Panel members also included:
Jean Gambrielle Credentialing,
Kelly LaRue, RN, Shari Peterson, RN, and Jim Strawn, IT The NPN
PowerPoint slide presentation is available to all on the Newsletter page
at wwwcdemscom

CDEMS is a tool that NPN has provided it members to offer support beyond
the normal activities of a clinic office Cathy reviewed some of the
benefits of using the registry more control for providers and staff in
knowing how patients are doing, increased job satisfaction, empowerment,
reduced faxes for prescription renewal, better patient care and
emphasized that building registry confidence has taken some time Its
not something that starts quickly It takes awhile to get to the point to
where you really believe in it It can take up to six months before a
clinic begins to see the benefits of registry work so its critical to be
able to sustain the registry during that initial six month period
Eventually the number of patients that can be seen increases as time is
saved through use of the progress note checklist Cathy summarized some
key first steps in initiating spread:

Establish flow of information and responsibilities within the office;
identify and re-examine roles of how the
flowsheet is used and who
records updates Cathy shared Roles buttons that were used in
training to lay out roles for everyone involved in areas of the
registry form The exercise demonstrated the flow through an office
and helped people know who was playing a role that might be swapped or
shared with someone else

Get providers to understand the power of the information in the
registry early This important concept has prompted NPN to bump
training about queries and summary reports to the forefront of the
registry implementation process

Organize care around appointments and planned visits; reduce triage
phone calls for med refills by implementing a meds by appointment
policy

Lessons Learned:

Make it simple and practical

Get everyone involved As Bev Roder Physicians of Southwest
Washington says, Many hands make light work

Get people using lists and reports early
Include a patient education component - teach patients what to expect
during a visit This is an active and ongoing idea

Staff meetings are important to keep communication flowing and
maintain contact
and interest about the project

Make users more independent - mentoring vs support

How to make time for Data entry? Cathy Irby says, Take time to make
time It will save provider time later

Participants discussed the big issue of standardization versus
customization of registry forms Francisco Arias shared that
standardization of the progress note among five Sea Mar Community Health
Center sites has been driven largely by the Collaborative and has worked
well

Users also discussed other ideas for sustaining changing and for applying
different models that work for different populations While planned visits
are more difficult in the community health care setting, patients without
insurance can be included in quarterly diabetes training sessions as
suggested by Linda Pelland of the Snoqualmie Tribe North Bend Family
Clinic At SeaMar Community Health Centers, free diabetes education and
preventive services are offered through internal programs such as REACH,
and the CDEMS registry is used to identify patients eligible for
alternative assistance on Asthma Day and Diabetes Day Judy Tomassene
of the Seattle Indian Health Board reiterated that having the CDEMS
sheet
in the chart encourages providers to start working on Diabetes issues
whenever the patient is seen even if the visit is unplanned or not a
Diabetes visit

Quotes of the Day

Everything is a process and never
done

Talking is not teaching; listening
is not learning

- Dusty Knobel, CDEMS Programmer Developer

DPCP Chat: Sustaining Change Initiative

Kathleen Clark, Washington Diabetes Prevention and Control Program, updated
the group on Collaborative and registry-related activities at the State
level

The Washington State Collaborative WSC is a system change and
quality improvement program Over 100 organizations have gone
through four Washington State Collaboratives According to Kathleen,
the Diabetes Collaborative is even on Washington Governor Christine
Gregoires radar Weve hit the big time Medicaid folks are
taking more of an interest in the Collaborative work and are looking
at the possibility of pay-for-performance incentives
for
Collaborative organizations that can demonstrate outcomes and
improvements in health care

The fifth WSC begins Learning Session 1 on Feb 13-14, 2006 with
tracks for Diabetes and Cardiovascular Prevention Enrollment for
WSC-5 is required by December 15, 2005 and scholarships are
available Visit the Washington State Collaborative web site
wwwqualishealthorg/wsc for more information

The Diabetes Objective Research Project DORP is currently
aggregating 60,000 CDEMS diabetes records to see how were really
doing with patient care in WA
The Sustaining Change Initiative is an 18-month structured program
providing ongoing support of the planned care model after the conclusion of
the Collaborative The Initiative assists organizations who have been
through the WA State Collaborative to sustain and spread planned care by
providing tools and interactive experiences that build skills, confidence,
competencies and infrastructure to improve the care of all patients

Kathleen explained the difference between sustaining change and
spreading Sustaining change is keeping the registry up, adding new
patients, keeping teams
active and motivated at each site; Spreading is
moving to new conditions, sites, and prevention Spread actually helps
sustain change

Suggestions for a framework to continue and perpetuate change:

1 Sustain change in your corner of the world by updating job
descriptions to include the planned care model and registry work,
introducing planned care model during new employee orientation,
documenting changes made and procedures
2 Work in all components quadrants of the planned care model
3 Whatever makes it easier will sustain it, eg lab interfaces,
service interface from health care plans, quarterly cleanup of
registry
4 Build in time to work on your B list - things beyond crisis mode
5 Communicate with others about what youre doing; use your social
network to sustain changes
6 Engage senior leaders in your project Help senior leaders with
concrete activities they are responsible for eg have senior leader
drop in on a discussion of the planned care model to show support,
personalize understanding of the model with a connection to senior
leaders life, schedule time with senior leaders
7 Have providers
spread to other providers by mentoring peers

Barriers:

Lack of senior lead engagement If you are an earlier adopter, you
can go pretty far If senior leaders are not brought along — like a
rubber band — you can only stretch so far
Clinical information systems
Lack of response to train others in use of the Planned Care Model

Jeanne Harmon, also with the Diabetes Prevention and Control Program,
shared a story about a small clinic in eastern Washington where a CDEMS
registry tracking 50 Diabetes patients spread the registry to monitor 200
patients with bronchiolitis and asthma Providers and nurses there were
unaware of the rich data available in the registry, and Jeanne met with
them to enhance their understanding of the full capability of the registry
- the power of information

Dusty Celebration

Dustys closing thoughts were a last pitch for the SQL Server version of
CDEMS He reiterated the benefits of CDEMSSQL that include tighter
security protections to satisfy HIPAA requirements and increased protection
against massive data loss through a transaction rollback feature Dusty
shared his excitement over a Michigan installation of CDEMSSQL that
was
accomplished in just 30 minutes

Dusty Knobel, CDEMS programmer and developer, officially retires from
public service on December 1 so the User Meeting concluded with a special
farewell luncheon Everyone enjoyed a slideshow of Dustys on the job
memories and shared stories and sentiments in appreciation of his registry
work and respectful, supportive style of assisting non-technical users
Thanks to all who attended to share in the celebration of Dustys work

Tammie Bigelow, won the Japanese Family tile door prize for this meeting
Congratulations, Tammie, with thanks for supporting and spreading the
registry to providers in southwest Washington

Source:cdems.com

Detection of People at High Risk of Diabetes. Other diagnostic categories Diagnosed Patient with Type 2 Diabetes. Activity and Lifestyle Advice. Dietary …

admin — Mon, 17 Nov 2008 05:24:29 +0000

Background

These guidelines have been developed to support appropriate care and timely
referral for people with diabetes in the Nottingham area They are a
consensus view and incorporate, where available, national and international
recommendations on standards of care In the event of significant new
research findings or national recommendation, specific areas may be updated
ad hoc Full revision will be undertaken every two to three years

By 2010, it is estimated that there will be 30,000 people with diabetes in
Nottingham

Guideline Development

The following people have contributed:

Return to Index page

If you have comments on the content of the guidelines, please contact:

Dr Tasso Gazis Tel:
0115 924 9924 ext 41100
Diabetes and Endocrinology Department Fax: 0115 970 1080
C Floor, South Block E-mail: tassogazis@qmcnhsuk
University Hospital
Nottingham
NG7 2UH

Referral Guidance

Diagnosing Diabetes / Glucose Intolerance

Also see other diagnostic categories below

Oral Glucose Tolerance Test OGTT

Detection of People at High Risk of Diabetes3

Routine / population screening of non-pregnant, asymptomatic adults is not
recommended

The following groups are at higher risk of diabetes
- In these groups, opportunistic testing for
diabetes may be appropriate
over age 45 years
- Only laboratory samples can be used to diagnose diabetes, not
fingerprick samples
- If glucose tolerance is abnormal, but not in the range for diabetes,
follow up testing may be appropriate

Known impaired fasting glycaemia / impaired glucose tolerance
History of vascular disease
Race / ethnicity - South Asian, African / Caribbean
Parent or sibling with diabetes
Polycystic ovarian syndrome
Prior gestational diabetes
Obesity BMI 30kg/m2

Does the Newly Presenting Patient Need Insulin?

Guidance below not appropriate for paediatric patients

Monitoring and Complications

The Annual Review

Structured care with annual review is essential
Prevention and identification of complications is otherwise frequently
inadequate
Underlined text is hyperlinked to explanatory flowsheet / text - point and
click

General

- Weight / body mass index
- Lifestyle advice
- Dietary Advice or Referral to Dietitian
- Smoking cessation advice
- Sick day rules
- Medication problems -
polypharmacy / dosette box refer to pharmacist
- Clinical waste / sharps

Macrovascular Disease
- Coronary Heart Disease Risk
- Blood Pressure
- Aspirin and Lipid Lowering Treatments
- The Diabetic Foot

Glucose Control
- Review Glucose Monitoring records
- HbA1c
- Oral Hypoglycaemic Agents Tablets
- Symptoms of hyperglycaemia / episodes of hypoglycaemia
- Injection sites for lipohypertrophy

Microvascular Disease
- Microalbuminuria and Proteinuria
- Retinopathy
- The Diabetic Foot
- Erectile dysfunction

Blood Glucose Monitoring
See notes below
Blood glucose testing is useful if it makes a difference to treatment
Education in use of information from blood glucose testing is key to
appropriate use
Every patients needs should be individually assessed by an appropriately
experienced healthcare provider Changes in testing regimen should be
agreed with the patient
The guidance below is neither rigid nor exhaustive

Notes for Blood Glucose Monitoring

Blood glucose tests are usually done before meals and bed

Lower frequency testing may be:
the occasional test before meals or bed
testing before each meal and bed
2-3 times per week

this will be patient dependent

Glycosylated Haemoglobin - HbA1c

HbA1c is generally measured every 2 - 6 months
Measures average blood glucose over previous 4 - 6 weeks
Measures how much glucose is stuck to red blood cells life span about 6
weeks
The HbA1c target should be individualised - if 1 above target, consider
adjusting treatment
Conditions which affect red cells affect HbA1c - including haemolysis,
bleeding, haemoglobinopathies and others

Retinopathy Screening

Diabetes remains the leading cause of preventable blindness in the working
age population

The retinopathy screening service now complies with Quality Assurance
Standards developed by the National Screening Committee and the National
Service Framework for Diabetes

This service replaces optometry-based retinopathy screening - but not
refraction / glaucoma assessment

The Nottingham Diabetic Retinopathy Service DRS uses digital photography
It provides centralised annual call-recall and notifies patients and
Practices of screening results Patients with sight threatening retinopathy
are referred directly for treatment, reducing the risk of visual
loss

Contact details are:

Web: wwwnottinghamretinopathycouk

Phone: 0115 919 4411

Post: The Nottingham Diabetic Retinopathy Service DRS
Department of Diabetes and Ophthalmolgy
Nottingham University Hospitals
QMC Campus
C Floor, South Block
Derby Road
Nottingham NG7 2UH

Currently, there are 4 screening sites The number will increase over 2007
Hospital transport is available by the usual route:

Carlton Park House Health Social Care Centre
Stapleford Care Centre
Queens Medical Centre Campus - Clinic 2
City Hospital Campus - Dundee House

Microalbuminuria, Proteinuria and Renal Disease

Measure serum creatinine / GFR and see notes and renal referral guidance
below
See Aspirin and Lipid section calculate CHD / CVD risk
See Blood Pressure section

Notes for GFR, Microalbuminuria and Proteinuria

Glomerular filtration rate GFR
Preferred measure of renal function as it accounts for age, sex,
ethnicity and weight
Already or shortly to become routinely reported in local hospitals
If abnormal, annual repeat testing
unlikely to be sufficient See renal
referral guidance

Microalbuminuria

Excess albumin in the urine but not detectable using protein dipstick
Earliest indicator of chronic kidney disease nephropathy
Predictive of cardiovascular morbidity and mortality

Proteinuria

Excess albumin in the urine but detectable using protein dipstick
An important finding in patients with type 1 and type 2 diabetes
Represents progression of urine albumin excretion from microalbuminuria
Associated with progressive chronic kidney disease due to diabetic
nephropathy
Predictive of cardiovascular morbidity and mortality

Urine sample for laboratory screening
10 ml early morning first pass urine sample in a Universal specimen
container
Early morning sample excludes postural proteinuria
Clinical chemistry form for albumin/creatinine ratio ACR or
protein/creatinine ratio PCR

PCR is the best test to confirm clinical proteinuria - at higher levels
above 30 mg/mmol ACR may be inaccurate There is no need for 24 hour
urine collections

Renal Unit Referral Guidance

Also see Microalbuminuria and Proteinuria section above
General renal referral advice / guidance is available from CHN Renal Unit
969 1169

If non-diabetic renal disease suspected
If patient under care of Diabetes Service, referral may already be in hand

Malignant hypertension visual disturbance, retinal haemorrhages
exudates
Immediate referral by phone or fax on 0115 962 7678

Proteinuria with oedema and low serum albumin nephrotic syndrome
Dipstick proteinuria with urine protein : creatinine ratio 100 mg/mmol
and patient not known to UHN / CHN diabetes service
Dipstick proteinuria and microscopic haematuria present
Macroscopic haematuria but urological tests negative

For management of advancing chronic kidney disease
If patient under care of Diabetes Service, referral may already be in hand

GFR 15 ml/min
Roughly equivalent to serum creatinine 400 umol/L in men

300 umol/L in women

Immediate referral to renal service by phone 969 1169or fax 962
7678
Ensure general renal referral guidance followed
GFR 15-29 ml/min
Roughly equivalent to serum creatinine 200-400 ?mol/L in men

150-
300 ?mol/L in women
Repeat within 5 days
If repeat GFR 15 ml/min: urgent renal referral as above
Otherwise routine renal referral - ensure general renal referral
guidance followed
GFR 30-59 ml/min
progressive fall in GFR / increase in serum creatinine OR
microscopic
haematuria present OR
dipstick proteinuria present OR
unexplained anaemia, abnormal potassium, calcium or phosphate OR
symptoms suggest systemic illness eg SLE OR
uncontrolled BP 150/90 on 4 agents
Routine referral - ensure general renal referral guidance followed
GFR 60-89 ml/min
not chronic kidney disease unless other problems persistent
proteinuria or haematuria
GFR 90 ml/min
normal

Blood Pressure

See Notes on next page
See Aspirin and Lipid section calculate CHD / CVD risk
See Microalbuminuria and Proteinuria section
The aim is to lower systolic and diastolic pressure below target
Check blood pressure and adjust treatment every 4 weeks until target
attained

Notes for Blood Pressure

Initial assessment

Measuring blood pressure - British Hypertension Society recommendations:

Patient seated and relaxed for 5 minutes with arm supported

No tight clothing to constrict the arm
Bladder should encircle between three-quarters and whole upper arm
Cuff level with heart
Alternative adult cuff 125 - 130 x 35 recommended
for use in all
adults
For arm circumference over 42 cm large bladders may be required

Cuff Sizes Width cm Length cm
Normal 120 - 130 23 - 33
Alternative adult 125 - 130 35 - 42

Electronic monitors
- in general wrist monitors are inaccurate, upper arm machines are
suitable
More information available at http://wwwbhsocorg
Ambulatory / Home Blood Pressure readings
- Subtract 10/5 mmHg to correlate with clinic pressure
- 130/75 ambulatory / home 140/80 in clinic

Non-pharmacological measures prior to pharmacological treatment

Stop smoking
Weight Loss
Increase physical activity
No added salt diet
Reduce alcohol to 2 units /day

ACE Inhibitors / AII Receptor Blockers
Make sure patient not taking potassium-retaining diuretic or Lo-Salt

Check potassium and creatinine before and within 2 weeks of
- starting ACE inhibitor or AII-receptor blocker OR
- increasing dose

Stop ACEI / ARB and refer for investigation for renal artery stenosis
if:
- K 60mmol/L OR
-
Creatinine rise 20 OR
- GFR fall of 15

If ACE inhibitor not tolerated or cough, switch to Angiotensin II
receptor blocker

Ethnicity

People of African-Caribbean ethnicity may respond poorly to ACEI, AII
receptor blockers and -blockers
Addition of a diuretic partially overcomes this
Consider calcium channel blocker as alternative

Aspirin and Lipid Lowering Treatments4

See Notes on next page
See Microalbuminuria and Proteinuria section
See Blood Pressure section

Notes for Aspirin and Lipids

Initial assessment

Pre-existing cardiovascular disease means prior myocardial infarction,
angina, CABG, angioplasty or heart transplant, peripheral vascular
disease, transient ischaemic attack TIA or ischaemic stroke
10-year coronary heart disease CHD risk should be assessed annually if
there is no pre-existing cardiovascular disease primary prevention:
- UKPDS risk engine type 2 diabetes
http://wwwdtuoxacuk/indexhtml?maindoc/ukpds/publicationshtml
- Framingham equation - underestimates risk where there is a family history
of premature CHD, microvascular end-organ damage
and in some ethnic
groups eg south Asians
10-year CHD risk of 15 is equivalent to a cardiovascular disease CVD
risk of 20
Identify people with adverse lipid profile secondary to conditions other
than diabetes mellitus - excess alcohol consumption, hypothyroidism

Aspirin
Usual dose is 75 mg daily
In primary prevention, reduce systolic blood pressure 145mmHg
Consider proton pump inhibitor if GI side effects
Use clopidogrel 75mg daily only in those truly allergic not just
intolerant of aspirin

Statin
Ideally,
- LDL target 20 mmol/l
- Total cholesterol target 40 mmol/l
Otherwise, reduce total cholesterol by 25 or LDL cholesterol by 30

Fibrate
Use of a statin and fibrate together increases the likelihood of adverse
effects see British National Formulary

Fasting lipid profiles
Both insulin and sulphonylureas may cause fasting hypoglycaemia
If you wish to check a fasting lipid profile, ensure that you have given
clear instructions to the patient about avoiding hypoglycaemia
Treatment decisions can often be taken using results from random samples

The Diabetic Foot

Community Podiatry

Referral to Community Podiatry
Service
POD 1 referral form available from health centres to nearest health
centre irrespective of GP practice

A podiatrist will carry out an assessment using the evidence based Trent
Diabetic Assessment Tool This includes vascular and neurological
examination together with podiatric and biomechanical examinations and will
result in a risk classification

Podiatrists employed by Gedling Primary Care Trust PCT spend between
three and six months working in UHN or CHN foot clinics to support the
practitioner and standardise practice

Musculoskeletal Podiatry / Biomechanics

Examination of lower limb function bone structure, muscles and joint
function This enables diagnosis of functional problems
Problems treated with orthoses and strengthening / stretching exercises to
improve foot function Referral should be made via general referral to the
Podiatry service

Minor Surgery
Podiatrists carry out nail surgery at a number of community clinics
Performed using local anaesthetic and may involve phenolisation of the nail
bed
Effective for chronic and acute nail problems where conservative measures
have been ineffective

Podiatry Service Lead for Diabetes

UHN
Alison Shone 0115 9249924 Ext 44122
CHN Alison Shone 0115 9691169 Ext 37946

Good Foot Care
TAKE CARE OF YOUR FEET AND PROBLEMS CAN BE PREVENTED
Diabetes can cause nerve damage and poor circulation in your feet
Nerve damage means you are less likely to feel an injury to your feet
Poor circulation means the injury or ulcer may be slow to heal

Check your feet carefully every day

Between the toes
The soles and tops of your feet
Your heels
If you cannot do this ask someone else to help if possible

Look for

red areas
cracks on the heels or between the toes
any hard skin
any new sores or ulcers

If you spot any of these contact your local GP surgery, Health Centre or
Podiatrist for advice

Community Podiatry / Chiropody Clinics

Arnold Health Centre

High Street,
Arnold
NG5 7BQ
Tel 0115 967 0888
Fax 0115 967 1909

Beeston Health Centre

38, Wollaton Road,
Beeston,
NG9 2NR
Tel 0115 925 4281
Fax 0115 925 3361

Bestwood Park Health Centre

Pedmore Valley
Bestwood Park
NG5 5NN
Tel 0115 920 8799
Fax 967 1910

Bulwell Health Centre

Main street
Bulwell
NG6 8QJ
Tel 0115 977 0022
Fax 0115 977 1236

Calverton Health Centre

4 St Wilfreds Square
Calverton
NG14 6FP
Tel 0115 965 2610
Fax 0115 965 5456

Carlton Health Centre

61 Burton Road
Carlton
NG4 3DQ
Tel 0115 961 7616
Fax 0115 961 3268

John Ryle Health Centre

Southchurch Drive
Clifton
NG11 8EW
Tel 0115 940 5298
Fax 0115 945 6455

Cotgrave Health Centre

Candleby Lane
Cotgrave
NG12 3JG
Tel 0115 989 2627
Fax 0115 989 9359

Daybrook Health Centre

Salop Street
Daybrook
NG5 6HP
Tel 0115 919 3230
Fax 0115 967 4803

Eastwood Health Centre

Nottingham Road
Eastwood
NG16 3GL
Tel 01773 712218
Fax 01773 530655

Hucknall Health Centre

Curtis Street
Hucknall
NG15 7JE
Tel 0115 968 0011
Fax 0115 968 0497

Kimberley Health
Centre

Newdigate Street
Kimberley
NG12 2NJ
Tel 0115 916 3301

Mary Potter Health Centre

Gregory Boulevard
Hyson Green
NG7 5HY
Tel 0115 942 0330
Fax 0115 979 2765

Meadows Health Centre

1 Bridgeway Centre
The Meadows
NG2 2JG
Tel 0115 986 1831
Fax 0115 986 1397

Old Basford Health Centre

1 Bailey Street
Old Basford
NG6 0HB
Tel 0115 942 0323
Fax 0115 942 3053

Radford Health Centre

Ilkeston Road
Nottingham
NG7 3GW
Tel 0115 942 0360
Fax 0115 942 2672

Radcliffe on Trent Health Centre

Main Road
Radcliffe on Trent
NG12 2GD
Tel 0115 933 2948
Fax 0115 933892

St Anns Health Centre

St Anns Well Road
Nottingham
NG3 3PX
Tel 0115 948 0560
Fax 0115 958 8493

Sherwood Health Centre

Elmswood Gardens
Sherwood
NG5 4ND
Tel 0115 969 1777
Fax 0115 969 3167

Sneinton Health Centre

Beaumont Street
Sneinton
NG2 4PJ
Tel 0115 948 0488
Fax 0115 958 8382

Stapleford Health Centre

97 Derby Road
Stapleford
NH9 7AT
Tel 0115 939 6111
Fax 0115 970 9241

Strelley Health Centre

116 Strelley Road
Strelley
NG8 6LN
Tel 0115 929 6911
Fax 0115 929 0295

West Bridgford Health Centre

97 Musters Road
West Bridgeford
NG2 7PX
Tel 0115 945 5066
Fax 0115 945 5731

Wollaton Vale Health Centre

Wollaton
Vale
Nottingham
NG8 2GR
Tel 0115 928 7793
Fax 0115 928 0590

East Leake Health Centre

Gotham Lane
East Leake
Loughborough
Leicestershire
LE12 6JG
Tel 01509 852181
Fax 01509 852099

Type 2 Diabetes

Patient Education

People learn partly by what they are told or read, but mainly from their
own experiences of living with diabetes For example, hypoglycaemia can be
explained but is often meaningless until the individual has experienced the
symptoms

Education needs to be specific to individual needs This is best achieved
by structured, one to one or group education It is important that the
information given is accurate, clear, concise and not conflicting or
ambiguous It is essential that educators are appropriately trained

When providing education to the patient with diabetes:
Allow sufficient time and avoid information overload:
- proceed at an appropriate pace for each patient
- be aware of the patients saturation point
Ensure that everyone is saying the same things
Written material should enhance teaching, not replace it
- make sure you know what is in the booklets / leaflets you use
- messages often need to be re-iterated several
times Much of what is
said is forgotten, not heard or not understood
Include a relative or friend where appropriate
Be aware of language and cultural implications
Education may have legal implications, for example driving and
hypoglycaemia, DVLA, insurance and employment - so use a checklist to
record what has been said and done

New Patient Education

At first appointment, a comprehensive history and examination must be
performed

Print the checklist and use the annual review guidance to ensure all
aspects of care are covered
Lipid profile
Blood pressure
HbA1c
Retinopathy screening
Dip urine and perform urinary albumin : creatinine ratio if appropriate
UE, creatinine
Foot examination
Body mass index
Full blood count
Thyroid function tests
Liver function tests

Book Second appointment

if SYMPTOMATIC in 2 weeks

if ASYMPTOMATIC in 4 weeks
Use the checklist below and the annual review guidance to ensure all
aspects of care covered

Book Third appointment

if SYMPTOMATIC in 2 weeks

if ASYMPTOMATIC in 4 weeks
Use the checklist below and the annual review guidance to ensure
all
aspects of care covered

Book Next appointments

Use the checklist below and the annual review guidance to ensure all
aspects of care covered
Follow Practice protocols

Education checklist for diet/tablet treated diabetes

See second part on next page also

Education checklist for diet/tablet treated diabetes

Activity and Lifestyle Advice

General advice
Increase activity levels within patient capability
Initially may be by reducing sedentary behaviour at home and increasing
walking

Benefits
Weight loss and improved insulin sensitivity
Lower
blood glucose
Increase HDL and lower LDL cholesterol
Lower blood pressure

Aims
Current activity recommendations are:
30 minutes of moderate activity on at least 5 days of the week OR
10,000 steps a day

Schemes
There are a number of activity schemes throughout Nottinghamshire:
Ashfield Go for Fit
Get Moving Nottingham - LEAP
Exercise Referral Schemes including:
Positive Moves, Exercise for Health in Rushcliffe, Broxtowe Borough
Exercise for
Health
Walking the Way to Health Schemes including:
Arnold Golden Amblers, Walk off Weight, Broxtowe Borough Walk and Talk,
Hucknall Taking Steps, Best Foot Forward, Trent Tickers

Further information on these schemes and other ways of increasing activity:
wwwnottinghamhearthealthnhsuk

Basic Dietary Guidance / Advice

Literature and training is available for non-dietetic staff

Aims:
Minimise symptoms of hyperglycaemia and fluctuations in blood glucose
Minimise the risk of hypoglycaemia
Minimise the long term macro- and microvascular complication of diabetes
Promote weight loss in people who are overweight
Reduce the risk of coronary artery disease

Advise on diet following assessment of:

Readiness to make changes to diet and lifestyle
Lifestyle
Social circumstances
Current intake

The recommended diet follows the UK healthy eating guidelines
Dietary changes should be negotiated with each patient using the following
general principles:
Modify existing eating habits rather than attempt major changes to the
patients pattern of eating
When weight loss is advised reduce total calorie intake by 500 kcal to
- promote a weight loss of 1 to 2 kg/month
- aim for an agreed target weight
At least half of the energy intake should comprise carbohydrate with the
majority in the form of complex carbohydrate, with a high fibre content,
especially soluble fibre
Increase:
- fruit and vegetables to at least 5 portions/day to achieve recommended
antioxidant intakes
Encourage:
- low glycaemic index foods at each meal as part of a balanced diet
- 1-2 portions of oily fish a week
Reduce:
- intake of refined carbohydrate, especially sugary foods and drinks
- total fat and replace saturated fat with monounsaturated and
polyunsaturated fats
- dietary salt to less than 6g/day Avoid salt substitutes
- alcohol Maximum
of 14 units for women and 21 units for men per week,
including 1 to 2 alcohol free days each week
Special diabetic products are high in calories, cause gastrointestinal
upset and are not recommended

Community Dietetic Services for Patients with Diabetes

Diabetes Education Groups
- Held at various health centres around Nottingham Health District
- Patients will be offered a place if one is held in their area
- Contact the Community Nutrition and Dietetic Service for further
information
Clinics in health centres and clinics throughout Nottingham Health
District
Dietary management of some patients can be dealt with in general
practice
Referral may be appropriate when more specific advice is needed - if
unsure seek advice from a dietitian prior to written referral
One 30-minute appointment is offered:
- detailed patient assessment
- care plan or dietary targets agreed
- referrer and GP informed
- follow up in primary care recommended
Support available includes:
- telephone advice
- dietetic information for non-dietetic staff
- training for non-dietetic staff

Whom to refer to
Community Dietitian

Dietetic Information for Non-dietetic Staff

Patient Literature - available from Community Dietetic Service
The following information should be given to all patients with diabetes:
Healthy Eating for Diabetes - Advice for Lowering Blood Sugar Levels
This is an A4 sheet giving basic guidance on dietary management of
diabetes
AND/OR
Eating, Drinking and Diabetes - a Guide for You This is a booklet
giving comprehensive dietary advice on the dietary management of
diabetes 2nd edition 2003

Further dietary information is available from the:
wwwbdaukcom
wwwbdaweightwisecom
wwwdiabetesorguk

Staff Training Courses

Suitable for anyone whose role includes discussion on food and nutritional
related issues:
Practice Nurses, School Nurses, District Nurses, Health Visitors
Community Health Doctors, General Practitioners

The Balance of Good Health - Half day, bi-monthly
Learning Outcomes
- Current evidence based healthy eating messages
- The use of the National Food Guide The Balance of Good Health as a
teaching tool for different
client groups

Dietary Management of Diabetes and Hyperlipidaemia - Half day, twice yearly
Learning Outcomes
- Current evidence based dietary advice for diabetes and hyperlipidaemia
- Reinforce the use of the Balance of Good Health model as a tool for
education
- Eliminate misconceptions concerning dietary advice for these conditions

An Holistic Approach to Obesity Management - Half day, twice yearly
Learning Outcomes
- Current evidence based dietary advice for the management of obesity
- Reinforce the use of the Balance of Good Health model as a tool for
education
- Eliminate misconceptions concerning dietary advice for these conditions

Contact: Community Dietetic Service

Cost: 30 for each course, to those not exempt from charges

Courses advertised in:
Learning Development Opportunities Brochure
Nottingham PCTs Learning Development Shared Services
Standard Court
1 Park Row
Nottingham
NG1 6GN
Tel 9123344

Smoking Cessation

New Leaf is a free NHS service for any one that wants to stop smoking
It offers support from trained advisors at over 40 clinics across the
Greater Nottingham District

Further
information on Nottingham Heart Health website:
wwwnottinghamhearthealthnhsuk
or by contacting the service:

Asian Diabetes Liaison Worker

Preventative programmes of care:
Developing / facilitating exercise in the community
- safe levels of exercise
- cultural / religious appropriateness
Health Promotion
- raise awareness of diabetes - incidence, recognition of symptoms and
referral routes
Development of community initiatives to:
- Promote healthy eating messages and increase intake of fresh fruit and
vegetables
- Improve links between voluntary and statutory organisations

Diabetes Education Role

Group sessions amongst the Asian population
- at GP practices and other venues
- allow patients to share experiences and practical ways of managing
diabetes
Participation in local events to raise awareness of diabetes

Oral Hypoglycaemic Agents Tablets

See Notes on next page

Notes for Oral Hypoglycaemic Agents Tablets

Only prescribe one agent from each class - there is no point prescribing
two sulphonylureas together
Substituting agents is unlikely to
significantly improve glucose control -
swapping metformin plus sulphonylurea for metformin plus glitazone is
unlikely to significantly improve glucose control
The addition of a third agent to a combination of two oral hypoglycaemic
drugs taken at maximally tolerated doses is unlikely to significantly
improve glucose control If a glitazone is used as a third agent, do not
stop either of the first two agent as this may precipitate significant
deterioration in control

Glycaemic Target
A target should be discussed with each patient
Tight control HbA1c 65 - 75 / fasting glucose 6 mmol/l is an
appropriate aim for most patients providing they are not having frequent
hypoglycaemia
In the very elderly or frail, symptom control alone may be the priority

Metformin - see BNF for prescribing guidance
Take tablets with or immediately after a meal to increase insulin
sensitivity
Consider in all patients with diabetes with residual functioning islet
cells
Increase dose every 2-4 weeks to achieve glycaemic target up to 1 gram
three times daily
Diarrhoea occurs in up to 20, is dose dependent and may resolve with
dose
reduction
Alternatively, try modified release preparation
AVOID in patients with
- creatinine 150 mol/l / eGFR60ml/min, severe heart failure / severe
liver disease lactic acidosis risk
Stop metformin 48 hours before
- radiological procedure needing intravenous contrast
- surgery requiring general anaesthesia
- re-start if renal function stable after the intervention completed
May reduce cardiovascular events in obese patients

Sulphonylureas - gliclazide, glimepiride, glibenclamide - see BNF for
prescribing guidance
Take tablets before meals to stimulate insulin release from the pancreas
Increase dose every 4-6 weeks to achieve glycaemic target or maximal dose
is reached
Average weight gain is 2-4 kg and in some patients this may exceed 10kg
However, there is little evidence to support routine use of a glitazone
as a second agent in overweight patients
Educate patients in recognising and treating hypoglycaemia
AVOID long acting sulphonylureas - Glibenclamide and Chlorpropamide
- in patients over 70 years old
- in those with poor renal function
Glimepiride has a lower risk of hypoglycaemia / weight gain than

glibenclamide

Thiazolidinediones Glitazones - see BNF for NICE and prescribing guidance
Reduce insulin resistance and increase glucose uptake into muscle
Licensed as monotherapy and as add on therapy
- patient already taking one oral hypoglycaemic and
- glycaemic targets not achieved and
- metformin / sulphonylurea not tolerated as 2nd agent
Little evidence to support routine use as second agent in overweight
patients or in triple therapy - though probably effective in some
patients
- if glitazone used as third agent, do not stop either of the first two
agents immediately as this may precipitate abrupt deterioration in
control
- if unsure, discuss with Diabetes Consultant / Registrar at UHN / CHN
Associated with modest weight gain few kg
Maximal therapeutic effect in 3-6 months
Not licensed for combination with insulin
- if unsure, discuss with Diabetes Consultant / Registrar at UHN / CHN
AVOID in patients with heart failure fluid retention recognised side
effect, acute liver disease or ALT 25 x upper limit of normal

Insulin Therapy in Type 2 Diabetes

There is no best insulin
regimen for patients with type 2 diabetes
Consider a trial of insulin in all patients who remain symptomatic or do
not achieve their glycaemic target despite maximal doses of two oral
agents

Local audit data suggest that patients with HBA1c 87 despite optimal
diet and tablet therapy are most likely to benefit from a trial of insulin
therapy

Tablets and insulin

Combining insulin with metformin may help to limit weight gain -
particularly useful in overweight patients
Commonly used regimens include:
twice daily pre-mixed insulin with twice or three times daily metformin
bedtime intermediate / long-acting acting insulin and twice or three
times daily metformin and other oral hypoglycaemics
Combination with thiazolidinediones glitazones is not currently licensed
but probably safe

Insulin alone

Where continuing metformin therapy is unacceptable
Twice daily pre-mixed insulin is generally used first but four times
daily insulin may be necessary

How to start insulin treatment

UHN and CHN offer audited insulin start services - refer by letter / fax
/ electronic
- generally using twice daily mixed insulin with metformin if appropriate
- patient reviewed by
Consultant
- insulin initiation led by Specialist Nurse and Specialist Dietitian
- appropriate use of home blood glucose monitoring
- autonomy in insulin adjustment
- what to do during illness
- UHN offers small group and one-to-one teaching to start insulin
- CHN offers one-to-one teaching to start insulin

Insulin starts in Primary Care depend on local expertise

Clinical Waste / Sharps

Sharps boxes for syringes, needles and fingerprick testing equipment should
be provided on FP10
Collection of full sharps boxes from people with diabetes is from the
Health Centres below
Health centres do not issue new sharps boxes They need to be provided on
FP10

All GP surgeries in EREWASH will accept full sharps boxes from patients who
are registered at that surgery

Type 1 Diabetes

Structured Diabetes Education for Type 1 Diabetes

- Intensive education programmes to promote empowerment for people with
Type 1 diabetes
- Supported by NICE guidance
- Suitable for people with type 1 diabetes who are prepared to manage
diabetes intensively
- blood testing four or more times daily
- insulin four or more times daily
- carbohydrate counting
- Referral is via the respective diabetes service

University Hospital

DAFNE - Dose Adjustment For Normal Eating
Part of the national DAFNE collaborative
Associated with long term reduction in HbA1c, weight stability and improved
quality of life
- One week, non-residential course for up to 8 participants at Queens
Medical Centre
- People attend introduction evening prior to enrolment on DAFNE course
- Diabetes
specialist nurse and diabetes specialist dietitian jointly
facilitate each course with input from a diabetologist
- Long term follow up in a DAFNE clinic is offered

Nottingham City Hospital

EDWARD - Education for Diabetes Without A Restricted Diet
Based on the existing BERTIE Model of Patient Education
- A series of workshops held one day a week for four consecutive weeks
at Dundee House
- People attending EDWARD have a pre-assessment appointment with a
Diabetes Specialist Nurse and then join an EDWARD programme with up to
8 participants
- Diabetes specialist nurse and diabetes specialist dietitian jointly
facilitate each workshop with input from a diabetologist
- A further 3 month post Edward follow up is offered
- Long term follow up is offered

Insulin Pump Service for Adults

- Supported by NICE guidance
- Suitable for people with type 1 diabetes
- Referral to pump team via secondary care diabetes services at UHN and CHN

Suitable for people with type 1 diabetes who:
- Have attended an intensive Type 1 diabetes education programme with
carbohydrate counting
- Use a basal bolus multiple injection
insulin regimen
- Find it impossible to maintain HbA1C 75 without disabling
hypoglycaemia despite a high level of self care of diabetes and
adequate trials of analogue short and/or long acting insulins
- Have no medical, communication, psychological or personal problem
which would prevent insulin pump use

Requires: assessment for individual NHS funding arrangements - NICE
approval
use of pager-sized insulin infusion pump 24 hours a day
replacement of infusion set and subcutaneous cannula every 3
days
ongoing support from trained insulin pump team

Paediatric Services

General Information
UHN and NCH services are closely integrated, sharing Diabetes Specialist
Nurses DSN and a common approach to management Children and
adolescents are managed on insulin regimens comprising 2,3 or 4
injections daily and using pen injection devices
There are a small number of patients on insulin pumps
The DSNs facilitate close liaison with families, General Practitioners,
nurseries and schools and work to promote education and self-care
Transition arrangements are made to the geographically
appropriate adult
team
Emergencies
Families are encouraged to seek prompt medical or specialist nurse advice
in order to anticipate and prevent problems of hypoglycaemia, illness
induced ketoacidosis and persistent poor control
Contact numbers

Outpatient Clinics
Dr T Randell and Dr L Denvir
UHN Friday am 1st and 3rd occasional 5th age banded 6-
18 yr
UHN Thursday am 1st pre-school
Newark Monday pm 2nd Newark Grantham area
UHN Friday pm Nurse led/pump patients
Dr J Drew
NCH Wednesday pm 1st, 3rd occasional 5th age banded 8-
16 yr
NCHDundee Hs Wednesday pm 2nd Transition clinic
16-18yr
NCH Monday am 2nd of month age banded 0-7 yrs
NCH Thursday 4th Nurse led/Drop in
Patients have 3 or 4 clinic reviews per year An annual review incorporates
retinal examination, blood pressure measurement and screening for
microalbuminuria, coexistent autoimmune thyroid disease or coeliac disease
The erratic nature of diabetes in the young is such that there
is
considerable additional home visiting and telephone contact

Pregnancy, Fertility and Contraception

Gestational Diabetes
See Notes and post-natal advice on next page

Notes for Gestational Diabetes

Glucose Tolerance Testing in Pregnancy
Risk of GDM increases with duration of pregnancy: normal OGTT in early
pregnancy does not exclude possibility of GDM later on in pregnancy
There is no universal agreement about the interpretation of the OGTT in
pregnancy Patients with fasting glucose ?6 or 2 hrs ?78 mmol/l will
generally require specialist supervision but this will depend on the
individual patient

Diabetes Ante-Natal Clinics
Pregnancy Assessment Centre PAC at UHN ext 44873 or via Diabetes
Service
Ante-natal clinic at CHN ext 45244 or via Diabetes Service

Post- Natal Glucose Testing
75g OGTT at 6-8 weeks usually arranged by hospital
Women with GDM have a 50 risk of developing Type 2 diabetes over the
following 15 years
Recommend:
- lifestyle advice
- annual fasting blood glucose
- counselling and assessment prior to future planned
pregnancy

Diabetes and Contraception

As with all patients seeking contraception, discussion should be in the
context of what will best suit the need of the patient Condom use is
encouraged to help prevent sexually transmitted infection

Combined oral contraceptives

Generally safe in younger patients with type 1 diabetes
Patients with two or more risk factors ie diabetes plus any one of the
following: age 35yrs, hypertension, vascular disease, obesity BMI 30
kg/m2, smoking should not use the combined contraceptive pill
Low dose combined pills with gestodene or desogestrel 3rd generation
have a minimal effect on carbohydrate and lipid metabolism but a higher
thromboembolic risk
Low dose combined pills containing levonorgestrel 2nd generation have a
greater effect on carbohydrate and lipid metabolism but a lower
thromboembolic risk
Low dose combined pills are especially suited to the young patient

Progestogen only pill

Metabolically neutral but less reliable than low dose combined
contraceptive pill
Safe in patients with diabetes

Depo Provera
Injectable contraception may alter the dosage requirements for
diabetic
control, but these are suitable for use in patients with diabetes

Implanon
Suitable for patients with diabetes

IUCD/US
Safe in women with diabetes Avoid in women with multiple sexual partners

Barrier methods

Safe but less reliable than hormonal contraceptives Encourage use to
help prevent sexually transmitted infection

Hormone Replacement Therapy

Evidence from randomised trials suggests that HRT increases the risk of
cardiovascular disease during the first few years of use
Not recommended for routine use
Use should be restricted to women:
- with severe, intractable symptoms of oestrogen insufficiency
- in the lowest dose and for the shortest duration possible
- following clear counselling about cardiovascular risk

Summary

Diabetes and Erectile Dysfunction

Inability to obtain and sustain an erection suitable for intercourse

References and Other Guidance Used

1 Tuomilehto J, Lindstrom J, Eriksson JG, et al Prevention of Type 2
Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired
Glucose Tolerance N Engl J Med 2001;
344:1343-1350
2 The Diabetes Prevention Program Research Group Costs Associated With
the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes
Prevention Program Diabetes Care 2003; 26:36-47
3 Screening for Type 2 Diabetes Diabetes Care 2004; 27:11S-14
4 Brandle M, Davidson MB, Schriger DL, Lorber B, Herman WH Cost
Effectiveness of Statin Therapy for the Primary Prevention of Major
Coronary Events in Individuals With Type 2 Diabetes Diabetes Care
2003; 26:1796-1801
5 Jeffcoate WJ, Harding KG Diabetic foot ulcers Lancet 2003; 361:
1545-1551
American Diabetes Association Preventive Foot care in Diabetes Diabetes
Care 2004; 27 suppl 1: S63-S64

National Institute for Health and Clinical Excellence guidance:
wwwniceorguk
Technology appraisals:
smoking cessation 39
long acting insulin analogues 53
insulin pump therapy 57
patient education models 60
glitazones 63
Guidelines
Type 1 diabetes CG15
Type 2 diabetes - blood glucose
Sep 2002

Type 2 diabetes - footcare
CG10
Type 2 diabetes - management of blood pressure and blood lipids
Oct 2002
Type 2 diabetes - renal disease
Feb 2002
Type 2 diabetes - retinopathy
Feb 2002

The Renal Association: wwwrenalorg
The National Kidney Foundation wwwkidneyorg
The British Hypertension Society: wwwbhsocorg
Diabetes UK: wwwdiabetesorguk
The American Diabetes Association: wwwdiabetesorg

Diabetes and Kidney Disease International Diabetes Federation, 2003
Diabetes and Foot Care: Time to Act International Diabetes Federation,
2003
Diabetes Education International Diabetes Federation, 2004
The Diabetic Foot: Amputations are preventable International Diabetes
Federation 2005

Nottingham Preferred Prescribing List: http://onlinenottingham-
pctnhsuk/docs/guidelines/{96D1DEFD-6379-4794-B7EF-
7AC430793C3A}_Preferred20Prescribing20Listpdf

———————–
Refer next diabetes antenatal clinic

Present

Blood glucose testing generally routine

4 or more times daily in some circumstances
Strips usually on repeat prescription

Absent

9mmol/l

HbA1c
Creatinine
LH / FSH / testosterone
TSH

Prolactin

Less than 6 mmol/l fasted OR
Less
than 7 mmol/l with 2 hr of meal

Psychosexual therapy?

Endocrine opinion if testosterone / prolactin abnormal

Possible type 1 diabetes
Refer same day to Diabetes Service
1
Nottingham Diabetes Management Guidelines 2006

Education, lifestyle, diet

Yes

Nutrition and Dietetic Service
Linden House
261 Beechdale Road
Aspley
Nottingham NG8 3EY
Tel: 0115 942 8744

Yes

See Aspirin and Lipid section See Blood Pressure section

Repeat in 12 months

Start ACE inhibitor - see UE monitoring guidance

Yes

2 / 3 Positive

Repeat x 2 in 3 months

Normal

Abnormal

Send for albumin : creatinine ratio

IF or greater
Send for protein : creatinine ratio
See Renal Unit referral guidance

Negative

Positive

Obtain morning urine sample - but any sample is better than none
Dip with standard dipstick

Over 6 mmol/l fasted OR
7 - 9 mmol within 2 hr of meal

Fibrate
Consider referral to lipid or diabetes clinic

Fasting triglycerides 10 mmol/L

Fibrate
Monitor annually

Fasting triglycerides 23 but 10 mmol/l

Reduce alcohol consumption, obesity and improve diabetes control if
possible

Yes

Lifestyle measures
Repeat assessment annually

Random triglycerides 23 mmol/l

Aspirin and Statin

Diabetes unlikely Present

Yes

Estimate 10 year CHD risk

Yes

Pre-existing cardiovascular disease OR
Hypertension OR
Microalbuminuria OR
Proteinuria OR
Abnormal renal function

Under 35 years choose from
Combined oral contraceptives
IUCD/IUS POP
Depo Provera Implanon
Barrier

Consider switch from combined pill to progestogen only pill if other
cardiovascular risk factors present

If above target 130/75mmHg start

If above target 140/80mmHg start

Yes

ACE inhibitor - click for UE monitoring guidance

If above target 130/75mmHg add

Bendroflumethiazide
If normal renal function
Furosemide
If impaired renal function

If above target 130/75mmHg add

Yes

Long acting calcium channel blocker
eg Diltiazem

If above target 130/75mmHg add

Alpha blocker

If above target 130/75mmHg

Bendroflumethiazide

Paediatric DSN
Vreni Verhoeven 0115 9346411 Full time MAILBOX
Karen Cuttell 0115 9346412 Full time MAILBOX
Glyn Feerick 0115 9345951 Full time MAILBOX

Emergency Pager FOR URGENT
MEDICAL ADVICE ONLY
800am - 600pm Tel 0765 913 2445 -Leave a short message including name
and number If no answer after 15 mins please try again Monday - Friday
only
600pm - 800am Contact on-call Paediatric Medical Registrar at relevant
hospital
and at WEEKENDS AND BANK HOLIDAYS

City Hospital
Dr J Drew secretary
Tel 0115 9691169 Ext 49792
Fax 0115 9620564

If above target 140/80mmHg add

Glucose tolerance test at 14 weeks gestation
Ethnicity

If above target 140/80mmHg add

Newly diagnosed or suspected patients
Urgent same day telephone referral to Paediatric Medical on-call team at
UHN or CHN

If above target 140/80mmHg

Consider 5th agent / referral

Microvascular complications OR
Pre-existing cardiovascular disease OR
Microalbuminuria OR
Proteinuria OR
Abnormal renal function

Present

University Hospital
Dr T Randell and Dr L Denvir secretary
Tel 0115 9249924 Ext 43343
Fax 0115 9709763

Typical symptoms AND
Diagnostic blood glucose

Patient ill: vomiting or semiconscious

TWO or more of the following
Severe symptoms
nocturia x 3-4
Short
history days / weeks
Marked weight loss disregard absolute weight
A first degree relative with type 1 diabetes
A personal history of autoimmune disease

Moderate / heavy ketones in urine

Normal weight
BMI 20- 25 kgm-2

Gliclazide 40-80mg od

CONTACT NUMBERS FOR REFERRAL

UHN 0115 924 9924 Dr Simon Page Secretary 64464
Fax 970 1080 Dr Peter Mansell Secretary 63834
Dr Tasso Gazis Secretary 61100
Dr Garry Tan Secretary 63862
Diabetes Unit Secretary 61215
Diabetes Unit Direct line 9709215
Diabetes Registrar via switchboard

NCH 0115 969 1169 Dr Alan Archer Secretary 39357
Fax 962 7959 Dr Renee Page Secretary 37929
Dr Nigel Sturrock Secretary 46200
Dr William Jeffcoate Secretary 46201
Dr Fran Game Secretary 34161
Dundee House Manager 46812
Diabetes Registrar via switchboard

Or discuss
with Diabetes Registrar in hours / On-call Medical Registrar out
of hours

Yes

Patient label

Yes

Guidelines provide guidance
These recommendations should not be rigorously applied in all clinical
circumstances Good clinical practice always involves weighing the
advantages and disadvantages of a clinical intervention depending on
individual circumstances

Yes

Admit to hospital

No immediate need for insulin
Dietary advice

Patient under 30 years of age

No immediate need for insulin
If first degree relative on diet or tablets consider Maturity Onset
Diabetes of the Young MODY

Consider non-urgent referral

Strong indication for insulin
Same Day referral

Other Diagnostic Categories

Impaired glucose tolerance IGT Impaired fasting glycaemia
IFG
Fasting glucose 7 mmol/l Fasting glucose ? 61 but 70
mmol/l
2 hour glucose ?78 but 111 mmol/l

IFG and IGT are risk factors for future diabetes
Exercise and weight loss reduces the risk of developing diabetes1 There is
no consensus on the cost effectiveness of the use of metformin to prevent
diabetes in these patients2
Annual OGTT is recommended
for those with IGT; 3 yearly for IFG

Symptoms of Diabetes
Polyuria passing a lot of urine
Polydipsia drinking excessively
Weight loss
Lassitude
Blurred vision
Urinary or genital infection
Skin infection including pruritis

There may be few if any symptoms

12 hour fast prior to test water only for comfort
Refrain from smoking / eating / drinking / exercise during the test

Take baseline venous sample for glucose
Give 75g oral anhydrous glucose - equivalent to Lucozade Original Energy
- 394ml
Take further venous glucose sample 2 hours later
The patient should remain rested, fasted and in the surgery
Send samples to laboratory
Fingerprick glucose values should not be used to diagnose diabetes

Most cases are diagnosed in this way
75g OGTT is not usually necessary

DIABETES

Fasting plasma glucose 70 mmol/l
OR
Random venous plasma glucose 111 mmol/l
OR
2 hour venous plasma glucose 111 mmol/l on OGTT

PLUS, on a separate day

PLUS

Symptoms of diabetes

Fasting plasma glucose 70 mmol/l
OR
Random venous plasma glucose 111 mmol/l
OR
2 hour venous plasma glucose 111 mmol/l on OGTT

Check urine ketones Present

Symptoms of diabetes?

Yes

Check random glucose and note last time of
meal

TWO DIAGNOSTIC ELEMENTS NEEDED

Test for glycosuria at each antenatal visit

Shayasta Taj
Asian Diabetes Liaison Worker
Radford Health Centre
Ilkeston Road, Radford
Nottingham
Tel: 0115 942 0360
Fax: 0115 942 2672

Adjust dose every 1-3 months to optimise glycaemic control or until maximal
tolerated dose reached

Absent

Glycaemic target achieved?

Overweight OR Obese
BMI 25-30 kgm-2 BMI 30 kgm-2

Metformin 500mg od

Yes

Trial of insulin ?

Adjust dose every 1-3 months to optimise glycaemic control or until maximal
tolerated dose reached

Add gliclazide 40-80mg od

Add metformin 500 mg od

Yes

Review every 2 - 6 months

Glycaemic target achieved?

Obesity - BMI 35 kg/m2
Large for dates baby - FAC 97 th centile
Polyhydramnios
1st degree relative with Type 2 or gestational diabetes
Polycystic ovarian syndrome

Polycystic ovarian syndrome

Review every 2 - 6 months

glitazones - see notes

Glucose tolerance test at 28 weeks gestation

Check for alternative causes:
Infection - Send to microbiology for microscopy, culture and sensitivity
Thrush
Menstruation

Interpretation of HbA1c

HbA1c Interpretation

Less than 6
Hypoglycaemia?
Less than 7 Excellent
7 - 8 Acceptable
8 - 9 Poor
Over 9 Very poor

Glycaemic target achieved?

The Nottingham Diabetes Service Advisory Group NDSAG does NOT recommend
referral for uncomplicated, newly diagnosed Type 2 diabetes
Initial management diagnosis, education, treatment and monitoring is the
responsibility of Primary Care Teams, supported by the PCTs and Nottingham
Diabetes Management Guidelines

ACE inhibitor - see UE monitoring guidance

Organic cause suggested by:
Normal libido
Gradual onset of erectile dysfunction
Partial erection achieved
Normal ejaculation

Risk factors:
Smoking
Alcohol
Current medication
Operation / radiotherapy or trauma to pelvis / scrotum

Over 35 years consider
switch from combined pill to progestogen only pill if other cardiovascular
risk factors present

IUCD/IUS or sterilisation if family complete

Review every 2 - 6 months

Yes

Type 1 diabetes
Insulin or insulin and tablet treated type 2 diabetes

Planning pregnancy
Pregnant
Preparation for insulin therapy in type 2 diabetes

Diet treated Type 2 diabetes
Metformin monotherapy
Glitazone monotherapy

Blood glucose testing not
needed routinely
Testing may be needed in some circumstances
Urine testing useful if:
Acceptable to patient
Renal threshold for glucose normal
Appropriate action taken following test

Sulphonylurea mono / combination therapy
Illness / unstable control / change in treatment
Suspected hypoglycaemia
Driving
Renal failure
Unpredictable lifestyle
Significant exercise

Blood glucose testing may be needed
Lower frequency testing: see notes below
Education in appropriate use
Strips usually provided via specific request

Check HbA1c 2 - 6 monthly

Yes

High Risk Pregnancy

Usual antenatal care

Book with Consultant Obstetrician

Yes

New Leaf
The Voluntary Action Centre
7 Mansfield Road
Nottingham
NG1 3FB
0115 934 9526

Annual assessment from GP Practice team

OGTT via antenatal clinic

HbA1c Equivalent mean plasma glucose mmol/l
6 75
7 95
8 115
9 135
10 155
11 175
12 195

Abnormal sensation
OR
Impalpable / reduced foot pulses

Infection, ulceration, necrosis, suspected Charcot foot

Community podiatry

Hospital diabetic foot clinic

Yes

Obesity - BMI 40 kg/m2
Prior macrosomia
97th centile
for gestational age or 45 kg at term
Prior unexplained intra-uterine death
Prior gestational diabetes

Increased Risk of Gestational Diabetes

Yes

History and examination

Poor response / not tolerated ?

If physical treatment appropriate / desired

Psychogenic cause suggested by:
Sudden onset of erectile dysfunction
Early collapse of erection
Good quality spontaneous /self stimulation / waking erections
Premature ejaculation or inability to ejaculate
Relationship / psychological problems or major life events

PDE5 inhibitor
Sublingual apomorphine
Vacuum device
Urethral alprostadil
Intracavernosal alprostadil

In surgery or via referral to diabetes erectile dysfunction service at UHN
/ CHN

Print and hand out
Good Foot Care
page of Guidelines

For Practices in City PCT, support is available from:
Gill Peck
Lead Specialist Nurse Diabetes
Base: Sneinton Health Centre
Beaumont Street
Sneinton Nottingham
Tel: 0115 948 0488

Consider referral for review / advice

Yes

First-line advice when newly diagnosed with
Type 2 Diabetes OR
Impaired fasting glycaemia OR
Impaired glucose tolerance
Follow up support for those initially advised by a
dietitian

Referral letter to include:
Body mass index BMI
Relevant blood results
Current medication
Whether interpreter required and language spoken

In the first instance, advice from
General Practitioner OR
Practice Nurse OR
Community Nurse
Following appropriate training
and using appropriate literature

Specialist advice from a Registered Dietitian:
CHD risk factors and diabetes OR
Poor control - HbA1c consistently 8 OR
Poor understanding of dietary management following first line advice

Source:nottinghamdiabetes.nhs.uk

Department of Health and Diabetes UK. Structured patient education in diabetes: report from the patient education working group. …

admin — Mon, 17 Nov 2008 05:23:28 +0000

AMENDED AGENDA
Amended items are indicated by an asterisk

10 Call to Order

20 Review and Approval of Minutes

1 Meeting Minutes - July 10, 2007

30 Unfinished Business

31 Previously Tabled Application for NHA Licensure
311 Sister Carol Marie Ferrucci

2 Previously Tabled Applications for Continuing Education
Activities - Provider is NAB Approved
1 Institute for Natural Resources - Home Study Courses
1
Pharmacological Interventions for Children with ADHD
- Home Study - Ongoing - 30 hrs
2 ADHD: Latest Diagnostic Guidelines - Home Study - 30
hrs
3 Alternative and Behavioral Treatments of ADHD - Home
Study - 30 hrs
4 Learning Disabilities other than Dyslexia - Home
Study - 30 hrs
5 ADHD in Adults - Home Study - 30 hrs
6 Dyslexia in Adults - Home Study - 30 hrs
7 Splitting the Brain - Home Study - 30 hrs
8 Smart Drugs? - Home Study - 30 hrs
9 Womens Health: Chronic Pain - 3 hrs
10 Womens Health: Depression - 3 hrs
11 Womens Health: Insomnia - 3 hrs
12 Womens Health: Menopause - 3 hrs
13 Autism: Pervasive Developmental Disorder - 3 hrs
14 Anti-Anxiety Drugs - 3 hrs
15 Arthritis and Rheumatic Diseases - 3 hrs
16 Brain and Stress: Disorders and Coping Strategies - 3
hrs

17 Can You Type? Type 1 vs Type 2 Diabetes - 3 hrs
18 33217 Chocolate: Food, Drug, or Preventative
Medicines- 3 hrs
19 Chronic Fatigue Syndrome: The Prognosis Improves - 3
hrs
20 Cognitive Behavior Therapy - 3 hrs
21 Eating Disorders: Anorexia, Bulimia, Binge Eating,
Orthorexia - 3 hrs
22 Fibromyalgia - 3 hrs
23 Food Cravings and Appetite Control - 3 hrs
24 Head Ache - 3 hrs
25 Heart Health - 3 hrs
26 Hepatitis A - 3 hrs
27 Hepatitis C - 3 hrs
28 Herbs for Menopausal Women - 3 hrs
29 High-Fat/High-Protein Diets - 3 hrs
30 Loss of Control: Fighting Back with Full Strength - 3
hrs
31 Memory and Amnesia - 3 hrs
32 Mild Brain Injury - 3 hrs
33 Neurotransmitters: The Bridges of the Brain - 3 hrs
34 Omega-3 Fatty Acids: A Clinical Update - 3 hrs
35 The
Pain Mutiny - 3 hrs
36 The Pain Truth - 3 hrs
37 Paradise Regained: Achieving Remission in Depression
- 3 hrs
38 Poles Apart: Unipolar vs Bipolar Depression - 3 hrs
39 Prevent Breast Cancer - 3 hrs
40 Rx for Women - 3 hrs
41 Snacking: An Opportunity for Better Health? - 3 hrs
42 Some Nerve - 3 hrs
43 Stop Losing Sleep - 3 hrs
44 Sugar, Sugar: Management of Diabetes - 3 hrs
45 Topic of Cancer - 3 hrs
46 Virus Alert: Smallpox West Nile Viruses - 3 hrs
47 Vitamin C, E, and Folic Acid: Three Efficacious
Vitamins - 3 hrs
48 Wide Bodies: Children, Obesity, and Diabetes - 3 hrs
49 Alzheimers: Prevention of the Disease and Other
Dementias - 3hrs
50 Medical Ethics: A Clinical Update - 3 hrs
51 Non-HIV/AIDS Sexually Transmitted Diseases - 3 hrs
52 Non-Traditional
Approaches: Anxiety, Insomnia,
Depression - 3 hrs
53 Obesity and Hormones - 3 hrs
54 Over the Counter Pain Medication: A Clinical Update -
3 hrs
55 Stimulants: Caffeine, Amphetamines, and Appetite
Suppressants - 3 hrs
56 Stop Gaining Weight - 6 hrs
57 Stress and Eating - 3 hrs
58 Successful Aging - 4 hrs
59 Thyroid Disorders - 3 hrs
60 The Common Cold and Flu - 3 hrs
61 Food Allergies - 3 hrs
62 Germs: Bacteria, Viruses, Fungi, Protozoa
Helminthes - 3 hrs
63 HIV/AIDS - 3 hrs
64 Irritable Bowel Syndrome Inflammatory
Gastrointestinal Disorders - 3 hrs
65 Skin Allergies, Skin Care, and Wrinkles - 3 hrs
66 Malpractice: An Update for Health Professionals - 3
hrs
67 Low-Carb Diets - 3 hrs
68 Obesity and Low Fat Diets - 3 hrs

69 Arthritis, Diet, and Exercise - 3 hrs
70 Asthma and Allergies - 3 hrs
71 Autoimmune Disease and Multiple Sclerosis - 3 hrs
72 Parkinsons Disease and ALS - 3 hrs

3 Strategic Planning
331 Discussion on Exam Results and License Issuance
332 Discussion on Expired AITs

34 Status of Complaint
341 Case 29-02-07 - Schedule Hearing
342 Case 29-01-07 - Ms Gray

4 New Business

41 Review of AIT Application:
1 Lindsey C Johnson - Review of SNF Preceptor and AIT
Outline
2 Charlotte J Brown - Review of Final Progress Report for
SNF Portion of AIT Program
3 Jeffrey L Blaier - Request for extension of the SNF
Portion of the AIT program, SNF preceptor Kim Blunt
4 Laura Dittmar - Review of Final Progress Reports for AL and
SNF Portions of AIT Programs, NHA application and Request
to Sit for NAB Exam
5 Mary F Drandorff - Review of Completed Progress Report for
AL Portion of AIT Program,
Request to Sit for NAB Exam
6 Lawrence Joseph Squire - Review of AIT Outline and AL and
SNF Preceptor letters

1 Review of Nursing Home Administrator Applications:
1 John A Clancy - Reciprocity - PA
2 Tawnya L Dennis

43 Review of Continuing Education Activities
3 Delaware Health Care Facilities Association
1 Signs, Symptoms and Self Care: Learning How
to Manage Stress - 10/24/2007 - 60 hrs
4 Division of Long Term Care Residents Protection
1 Reducing Pressure Ulcers - What Really Works
- 8/9/2007 - 50 hrs

5 Health Care Association of New Jersey HCANJ
1 HCANJ 59th Annual State Health Care
Convention and EXPO - 10/23, 24, 25/2007 -
80 hrs
6 Center For Competitive Management
1 Legal Background Checks: How to Limit
Liability Hire Smart - 8/20/2007 - 15 hrs
7 Activities for Geriatric Enrichment AGE
1 The Challenges and Rewards of
Volunteer
Program Design Implementation - 50 hrs
8 Wilmington College: Tawnya Dennis
1 Law, Regulation and the Workplace - 9/10/07 -
10/22/07 Mondays - 350 hrs

2 Strategic Planning
1 Online License Renewal
2 Assimilation of New Board Members
3 Ensure Proper Procedures for Reciprocity
4 Revise Substantially Related Crimes List
5 Update, Clarify and Improved Remaining Regulations

5 Other Business before the Board for discussion only

6 Public Comment

7 Next Meeting - November 13, 2007

8 Adjournment

Please Take Note: Applications for this agenda must be complete and
received by 4:30 pm on the third business day previous to the meeting
date; thus a final amended agenda will be published to reflect any items
received after posting of the original agenda Unforeseen circumstances
may result in a meeting being cancelled should there be a lack of quorum

Pursuant to 29 Delaware Code, Section 10004e2, the Board shall pre-
announce or pre-publish all Executive Sessions; however, such
agenda shall
be subject to change to include additional items including Executive
Sessions which arise at the time of the bodys meeting

MEMBERS: PLEASE CALL THE OFFICE OF THE DELAWARE BOARD of EXAMINERS OF
NURSING HOME ADMINISTRATORS AT 302-744-4505 OR EMAIL
nicolemoniquewilliams@statedeus IMMEDIATELY IF YOU CANNOT ATTEND THE
MEETING THANK YOU

———————–
PUBLIC MEETING NOTICE: BOARD OF EXAMINERS OF NURSING HOME
ADMINISTRATORS

DATE AND TIME: Tuesday, September 11, 2007 at 2:00 pm

PLACE: 861 Silver Lake Boulevard, Dover, Delaware
Conference Room B, second floor of the Cannon Building

Diabetes check-up have been diabetic for six years and your diabetes treatment has been going well. for a diabetes checkup, including cholesterol …

admin — Mon, 17 Nov 2008 05:23:28 +0000

PLEASE RETURN TO: Check
here if previous MCG student [ ]
Student Health Service
Last date enrolled:________ Program_________________
Medical College of Georgia Name
Used___________________________________________
Augusta, Georgia 30912-9070
706721-3448
MEDICAL RECORD INFORMATION CONFIDENTIAL
Name:__________________________________________________________________
_______________________
Last First
Middle Pulse ID
Address:_______________________________________________________________
_______________________
Number Street City
State Zip Telephone
Birthdate:_____________ Birthplace____________ Sex: M[ ] F[ ] Marital
Status: S[ ] M[ ] Other[ ]

Emergency Notification: Please list two
1 Name:______________________________________________
Relationship:_________________
Address:____________________________________________________________________
______ Business Phone:_______________ Home
Phone:_____________
2 Name:______________________________________________
Relationship:_________________
Address:____________________________________________________________________
______ Business Phone:_______________ Home Phone:_____________

I have been accepted into the school of Check One: MEDICINE, DENTAL,
NURSING ,
ALLIED HEALTH:
Department Check One: Rad Tech, Dental Hygiene, Med Tech, Occ Therapy,
Phy Assist ,
Nuc Med, HIA, Resp Therapy, PharmD, Child Life, Ultrasound Radiography

GRADUATE: Please Print - Department:___________________________________
Nursing, Phy Therapy, Cell molecular, etc
HEALTH HISTORY: Detail of YES answers - use additional paper if needed -
identify and include pertinent information
Have you ever had or been treated for:
YES NO
YES NO
|1 Serious disease of eyes, | [ ]| 20 Infectious | [ ]|
|ears, nose, or throat? |[ ] |mononucleosis? |[ ] |
|2 Frequent or severe | [ ]| | |
|headaches, convulsions, severe|[ ] |21 Recurrent fever |[ ] |
|head injury? | |blisters? |[ ] |
|3 Lung disease, tuberculosis,|[ ] |
| |
|persistent cough? |[ ] |22 Mumps? |[ ] |
| | | |[ ] |
|4 High blood pressure, |[ ] | | |
|rheumatic fever, heart murmur |[ ] |23 Chicken pox |[ ] |
|or blood vessel disease? | | |[ ] |
| |[ ] | | |
|5 Jaundice, hepatitis, |[ ] |24 Malaria |[ ] |
|intestinal bleeding, ulcer | | |[ ] |
|colitis, gall bladder disease?| | | |
| | | | |
|6 Sugar, albumin, or blood in|[ ] | 25 Tuberculosis? |[ ] |
|urine; cystitis, nephritis, |[ ] | |[ ] |
|kidney stones? | | | |
|7 Diabetes, thyroid disease |[ ] | 26 Human Immuno |[ ] |
|or other endocrine disorder? |[ ] |deficiency virus? |[ ] |
| | | 27 Did your Mother | |
|8 Anemia, or other disorders |[ ] |receive DES
|[ ] |
|of the blood? |[ ] |Diethystilbesterol while |[ ] |
| | |pregnant | |
| | |with you? | |
|9 Deformity, lameness, |[ ] | 28 Sexually transmitted |[ ] |
|paralysis, arthritis, gout, |[ ] |diseases? |[ ] |
|disc problems, other disorders| | | |
|of muscles, bones, or joints? | | | |
|10 Hay fever, asthma, hives, |[ ] | 29 Have you been treated |[] [|
|other allergies? |[ ] |for a nervous or mental |] |
| | |disorder? | |
|11 Severe acne, eczema, other| [ ]|30 Do you consider |[ |
|skin disorders? |[ ] |yourself more nervous than |[ ] |
| | |the average person? |[ ] |
|12 Cancer, other tumors? |[ ] |31 Are you self-conscious |[ ] |
| |[ ] |in the company of others to|[ ] |
| | |an annoying | |
| | |extent?
| |
|13 Significant emotional or |[ ] |32 Does uncertainty or |[ ] |
|psychological difficulties? |[ ] |doubt about yourself and |[ ] |
| | |your activities bother you?| |
|14 Any operations or serious |[ ] |33 Have you ever undergone|[ ] |
|injuries? List dates ____ |[ ] |psychotherapy? |[ ] |
|15 Other hospitalizations, |[ ] |34 Men only: Have you |[ ] |
|for medical or psychiatric |[ ] |ever had testicular lumps? |[ ] |
|care? | | | |
|16 Allergic reactions to |[ ] |35 Women only: Any |[ ] |
|penicillin or other medicines?|[ ] |disorders of menstrual |[ ] |
| | |periods or of the female | |
| | |organs or breasts? | |
|17 Allergic reactions to |[ ] |36 Do you take |[ ] |
|insect bites or to food? |[ ] |birth-control pills? |[ ] |
|18 X-ray therapy to the head |[ ] |37 Have you had a pelvic |[ ] |
|or neck? |[ ] |exam and Pap smear? If so |[ ] |
| | |SEND copy of |
|
| | |test results for most | |
| | |recent | |
|19 Are you adopted? | |
|[ ] [ ] | |

PLEASE RESPOND TO THE FOLLOWING:
ALLERGIES:__________________________________________________________________
________________________________________________________
DRUG
ALLERGIES:__________________________________________________________________
___________________________________________________
CURRENT
MEDICATIONS:________________________________________________________________
_______________________________________________
MEDICAL
PROBLEMS:___________________________________________________________________
________________________________________________
PERSONAL HABITS
PLEASE CHECK THE APPROPRIATE RESPONSE:
A Do you smoke? yes no
B If yes, how many packs per day? less than one between one and two two
packs or more
C Do you drink alcohol? yes no
D If yes, how often? daily only on weekends two or three drinks a week
donly on special occasions
E Do you use recreational drugs? no I have in
the past yes, occasionally
yes, often
F I use over-the-counter drugs ie, Tylenol, Sominex, Ex-Lax, Allerest,
etc: never sometimes boccasionally coften
G Are you presently, or have you been on a weight loss diet yes no
H Are you presently, or have you recently been on a diet intended to help
you gain weight? yes no
I How often do you exercise or participate in sports? never once a week 2
or 3 times a week more than 3 times
J Do you use a seat belt? always never
FAMILY HISTORY
|NAME |AGE |OCCUPATION |STATE OF HEALTH|AGE AND CAUSE OF |
| | | | |DEATH |
|FATHER |
|MOTHER |
|BROTHERS |
|SISTERS |

Have any close relatives had at any timecircle any that apply and give
details High Blood pressure, heart disease, stroke, bleeding disorder,
diabetes, peptic ulcers, kidney disease, epilepsy, migraine, arthritis,
cancer, tuberculosis, asthma or other allergies, mental
illness:
____________________________________________________________________________
________________
____________________________________________________________________________
________________
STATEMENT AND SIGNATURE BY PATIENT:
All statements in this health form are true to the best of my
knowledge and I have no
abnormality, limitation or restriction not mentioned in this record I
understand that
this form is a part of my medical record and agree to notify the
Student Health Service
of any change that occurs in my physical or mental health in a timely
fashion while I
am a student at MCG In an emergency situation, I give permission for
such diagnostic,
therapeutic, and operative procedures as may be deemed necessary to
preserve life or
good health
_______________________________________________________________________
______
PATIENT SIGNATURE
DATE