Diabetic patients are often inflicted with a variety of complications, due to their disease. One of the more common is that of ulcers of the legs and feet. For many, conventional therapy does not do an adequate job in debriding the necrotic tissue. The article reviewed investigates the use of maggot therapy instead of, and in addition to, conventional therapy, as a means of treating foot and leg ulcers in patients, where conventional therapy is not effective.
Maggot Therapy

"Impaired wound healing is a common and costly problem for those with diabetes. Non-healing diabetic foot ulcers account for 25 -- 50% of all diabetic hospital admissions, and most of the 60,000 -- 70,000 yearly amputation in the U.S." (Sherman, 2003). For this reason, the researcher investigated the use of maggot therapy on diabetic patients with foot and leg ulcers.

This problem is significant to nursing, due to its prevalence and the tens of…...

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References

Sherman, R.A. (Feb. 2003). Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care, 26(2). Retrieved March 9, 2005, from Proquest database.

Cae fo Diabetic Foot Ulces in Long-Tem Cae Residents
Diabetic foot ulces ae chonic wounds that negatively affect the mobidity, motality and quality of life of diabetes patients. Diabetic patients who develop foot ulces ae at geate isk of heat attack, fatal stoke, and pematue death. Unlike othe types of chonic wounds, diabetic foot ulces ae moe complicated and pesent unique teatment challenges especially when coupled with diminished tissue pefusion, neuopathy, and defective synthesis of poteins Lipsky, Holoyd, & Zasloff, 2008()

Diabetes foot ulces ae common aound the wold. It is estimated that close to 400 million people have diabetes in the wold and 25% of these suffe fom diabetes foot ulces at one point in thei lives. In the UK, it is estimated that between 5 and 8% of diabetic people have foot ulces.

Apat fom the health poblem associated with foot ulces, they also pesent economic poblems. A study that…...

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references and Care Goals among Older Patients with Diabetes and Their Physicians. Medical Care, 46(3), 275-286. doi: 10.2307/40221655

Crawford, F. (2008). Uncertainties Page: How Can We Best Prevent New Foot Ulcers in People with Diabetes? BMJ: British Medical Journal, 337(7669), 575-576. doi: 10.2307/20510758

Gonzalez, E.L.M., Johansson, S., Wallander, M.A., & Rodriguez, L.A.G. (2009). Evidence-based public health policy and practice: Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. Journal of Epidemiology and Community Health (1979-), 63(4), 332-336. doi: 10.2307/20720950

Lipsky, B.A., Berendt, A.R., Cornia, P.B., Pile, J.C., Peters, E.J.G., Armstrong, D.G., . . . Senneville, E. (2012). 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clinical Infectious Diseases, 54(12), 1679-1684. doi: 10.2307/23213413

Lipsky, B.A., & Hoey, C. (2009). Topical Antimicrobial Therapy for Treating Chronic Wounds. Clinical Infectious Diseases, 49(10), 1541-1549. doi: 10.2307/27799388

Standard of Care in Place for Treatment of Diabetic Foot Ulcers in Long-Term Care Patients
Known as "the silent killer" because its symptoms can go undiagnosed until the condition becomes deadly, diabetes mellitus remains a major public health care threat in the United States today. One of the more common afflictions that is suffered by people with diabetes mellitus is foot ulcers, a problem that can result in the need for amputation or even more severe clinical outcomes including death. To determine why there should be a standard of care in place for the treatment of diabetic foot ulcers in long-term care patients, this paper provides a review of the relevant peer-reviewed and scholarly literature, followed by a summary of the research and important findings concerning diabetic foot ulcers in the conclusion.

eview and Analysis

The Significance of the Problem and How Addressing the Issue will Contribute to Society

There has been growing…...

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References

Ebersole, P. & Hess, P. (1999). Toward healthy aging: Human needs and nursing response. St.

Louis, MO: Mosby.

Fidler, B.D. (2009, August 19). Diabetic foot care. Drug Topics, 146(16), 34-39.

Prentice, D. & Ritchie, L. (2011, December 1). A case management experience: Implementing best practice guidelines in the community. Care Management Journals, 12(4), 150-155.

Diabetic Vascular Disease state caused by the deficiency of a chemical in the body called insulin which is a hormone is called Diabetes. There are two forms of diabetes. In the type-one diabetes no insulin is formed and people require insulin injections for existence. This was once thought it would affect only children, but now it can occur at any age. The type2 diabetes is due to the resistance of the body towards the effects of insulin. This also includes insulin which is insufficient. ut in this type there is some amount of insulin produced. In both the types the blood glucose levels is increased. When compared to people without diabetes, people with diabetes are prone to certain problems. These problems occur in the nerves (neuropathy), kidney (nephropathy) and eye (retinopathy). These people are prone to early heart attacks and stroked due to the hardening of the arteries (arteriosclerosis). With…...

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Bibliography

Diabetes Basics-About Diabetics," Retrieved from www.orthop.washington.edu/faculty/Hirsch/diabetesAccessed on March 3, 2004

Diabetes & Vascular Disease Research" retrieved from www.medstv.unimelb.edu.au/Research/DCVDR/. Accessed on March 3, 2004

Haptoglobin: A major susceptibility gene for diabetic vascular complications," retrieved from www.pulsus.com/europe/07_02/szaf_ed.htm. Accessed on March 3, 2004

Pathophysiology of Diabetes" retrieved at Accessed on March 3, 2004http://www.dhss.state.mo.us/diabetes/manual/DMOverview.pdf.

Diabetes Foot Care
Qualitative esearch Critique: Diabetes Foot Care

Sue Flood (2009) saw a need to examine the nurse-patient interaction in relation to diabetes foot care outcomes, in part because at least one health care organization (Agency for Healthcare esearch and Quality) has concluded that diabetes care received by patients often do not meet best practice standards. The impact of substandard care includes a 45 to 85% difference in the incidence of foot ulcers and amputations, as reported by the U.S. Centers of Disease Control and Prevention. The author further justified this study based on the ongoing global obesity and diabetes epidemics.

Flood (2009) decided to examine the nurse-patient interactions because this relationship has been shown to have a significant impact on patient outcomes. This represents the primary assumption the author tests in her study. The four components of nurse-patient interactions are: (1) affective support, (2) health information, (3) decisional control, and (4)…...

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References

Flood, L.S. (2009). Nurse-patient interactions related to diabetes foot care. MEDSURG Nursing, 18(6), 361-370.

Osteomyelitis in the Diabetic Patient
Management OF OSTEOMYELITIS IN THE DIABETIC PATIENT

Osteomyelitis is an infection of the bone or bone marrow which is typically categorized as acute, subacute or chronic.1 It is characteristically defined according to the basis of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and physical location of the infection site.2 Infection modes usually take one of three forms: direct bone contamination from an open fracture, puncture wound, bone surgery, total joint replacement, or traumatic injury; extension of a soft tissue infection such as a vascular ulcer; or hematogenous (blood borne) spread from other infected areas of the body such as the tonsils, teeth or the upper respiratory system.2(p807) Bacteria such as Staphylococcus aureus, Pseudomonas, Klebsiella, Salmonella, and Escherichia coli are the most common causative agents of the disease, although viruses, parasites and fungi may also lead to the development of osteomyelitis.3

Patients most at risk…...

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References

1. Stedman's Medical Dictionary. 27th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.

2. Butalia S, Palda V, Sargeant R, Detsky A, Mourad O. Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?. JAMA: Journal of The American Medical Association [serial online]. February 20, 2008; 299(7):806-813. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.

3. Lavery L, Peters E, Armstrong D, Wendel C, Murdoch D, Lipsky B. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Research & Clinical Practice [serial online]. March 2009; 83(3):347-352. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.

4. Turns M. The diabetic foot: an overview of assessment and complications. British Journal of Nursing [serial online]. August 12, 2011;:S19-S25. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.

Lee is only the first step in the process of building a team that is able to cover all aspects of Mrs. Lee's care. The team approach involving a social worker, nurse, physician, pharmacist, and physical therapist affords Mrs. Lee a full range of professionals attending to her various needs.
Although Mrs. Lee has a number of problems that need to be addressed the one problem that must be addressed immediately is her elevated blood pressure. Hypertension is an important risk factor for the development and worsening of many complications of diabetes and an elevated blood pressure is like walking around with a detonated bomb. Within moments, and with little warning, a diabetic patient can suffer a stroke or heart attack as a result of an elevated blood pressure. Well over fifty percent of diabetics suffer from hypertension and proper treatment of hypertension can minimize most of the tangential problems…...

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References

Calle-Pascual, A.L. (2002). A preventive foot care programme for people with diabetes with different stages of neuropathy. Diabetes Research and Clinical Practice, 111-117.

Caminal, J. And Barbara Starfield, et. al.(2004). The role of primary care in preventing ambulatory care sensitive conditions. European Journal of Public Health, 246-251.

Deichmann, R.E. (1999). Improvements in Diabetic Care as Measured by HbA1c After a Physician Education Project. Diabetes Care, 1612-1616.

Epstein, M. (1997). Diabetes and hypertension: the bad companions. Journal of Hypertension, 55-62.

ursing Annotated Bibliography
ursing

Annotated Bibliography

Annotated Bibliography

This article categorizes diabetes as an epidemic that can responds well with the adjunctive treatment of HBOT. The authors use two clinical case studies in their literature review of how oxygen plays a part in the healing of lower extremity diabetic ulcers. They argue for the necessity of further study and research into HBOT because of its efficacy and the potential to drastically lower medical costs for diabetic patients, whose numbers continue to increase steadily. There is a very clear focus on the costs of diabetic treatments on a global scale in relation to the number of diabetic patients worldwide, as part of the authors' strategy to advocate the widespread use of HBOT. Charts and color photographs contextualized the text and make the research more concrete in the mind of the reader, especially the photographs of diabetic amputees who have not had HBOT.

Daly, M.C., & Faul,…...

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Neal, M.S. (2001). Benefits of hyperbaric oxygen therapy for diabetic foot lesions. Journal of Wound Care, 10(1), 507 -- 509.

This article provides a quantitative explanation for the presence of lower extremity ulcers and wounds in diabetic patients. The article additional explains how HBOT elevate the presence of circulating stem cells in diabetic patients. Their research aims to prove how HBOT stimulates the vasculogenic stem cell mobilization in the bone marrow of diabetics, which then are used to heal skin wounds. The authors explain their experience with these types of patients and HBOT treatments because at the hospital where they all work, HBOT is standard operating procedure for the qualifying patients in they study. This is another example of a highly statistical article with the presence of charts and graphs, even digital images of blood samples from the participants both in color and in black and white. Images have the potential to bring the reader closer to the content of the text. Their research shows that HBOT increases important agents in diabetics' bone marrow that lead to increased circulation and healing properties.

Thom, MD, PhD, S.R., Milovanova, MD, PhD, T.N., Yang, MD, M., Bhopale, PhD, V.M., Sorokina, E.M., Uzun, MD, G., Malay, D.S., Troiano, M.A., Hardy, MD, K.R., Lambert, MD, D.S., Logue, MD, C.J., & Margolis, MD, PhD, D.J. (2011). Vasculonic stem cell mobilization and wound recruitment in diabetic patients: Increased cell number and intracellular regulatory protein content associated with hyperbaric oxygen therapy. Wound Rep Reg, 19(2011), 149 -- 161.

Given the frequency of pressure ulcers, the strategies used in mitigating those wounds must be effective. Sherman reports that 61 ulcers in 50 patients got maggot therapy and 84 ulcers in 70 patients did not receive maggot therapy (instead, those wounds received traditional care). The results showed that "eighty percent of maggot-treated wounds were completely debrided" but only 48% of conventionally-treated wounds were "completely debrided" (Sherman, 208).
(Qualitative) Laura Jean van Veen presents a case in the Journal of ound, Ostomy and Continence Nursing; a 59-year-old woman (a Jehovah's itness) was seriously injured in an auto accident in Vancouver. In order to save her legs (her religion did not permit blood transfusions) the family asked for maggot therapy. After applying maggots weekly for 6 weeks, "…the patient [was] now free of infection" and had skin graft surgery (van Veen, 2008, 432).

(Qualitative) Another case study in the Journal of ound, Ostomy…...

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Works Cited

Courtenay, M., Churdh, J.D.T., and Ryan, T.J. (2000). Larva therapy in wound management.

Journal of the Royal Society of Medicine, Vol. 93, 72-74.

Fenn-Smith, P. (2008). Case Study: Maggot Debridement Therapy. Wound Practice and Research, 16(4), 169-170.

Paul, Aaron G., Ahmad, Nazi W., Lee, H.L., Ariff, Ashraff M., Saranum, Masri, Naicker,

Patient Management -- Heloma Durum
Presentation and Management

The patient suffering from heloma durum typically presents with complaints of discomfort from the formation of hardened tissue in localized areas of the foot such as the on the dorsolateral aspect of the fifth toe or the dorsum of the interphalangeal joints of the lesser toes (Dunn, Link, Felson, et al., 2004; Taylor, Lillis, & LeMone, 2008). While the condition is normally benign (Dunn, Link, Felson, et al., 2004; Freeman, 2002), it can also be the source of physical discomfort that causes patients to alter their choice of footwear and activities, and in extreme cases, it can cause changes in their gait which can also precipitate other physiological problems such as of the knees, hips, and spine (Dunn, Link, Felson, et al., 2004; Taylor, Lillis, & LeMone, 2008). The condition is normally managed through the most conservative means possible (Hamric, pross, & Hanson, 2009).

Heloma…...

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Sage, R.A., Webster, J.K., and Fisher, S.G. "Outpatient care and morbidity reduction in diabetic foot ulcers associated with chronic pressure callus." Journal of American

Podiatric Medical Association. Vol. 91, No. 6; (2001): 275-9.

Taylor, C., Lillis, C., and LeMone, P. (2008). Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia, PA: Lippincott, Williams, and Wilkins.

At the same time, one does not know whether they offer the workers any benefit or perk as is provided by Korean employers.
This matter has to be sorted out by the Korean partner as the workers are more likely to trust him than Australians. He may also find it possible to offer the workers the same perks that are offered to his employees in other concerns. The hours of working and such details may also be fixed up early so that future conflicts of this are avoided in the future. The difficulties in culture will be very high for any Australian to come and work here, so the responsibility of recruiting the workers may be left to the South Korean partner. The only aspect that one can check is that he does not end up employing only his relatives and friends. This had cost many banks a lot of…...

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References

Deep Inside China, Expats Struggle to Cope. Far Eastern Economic Review. Retrieved August 17, 2005, from the World Wide Web:  http://www.careerjournaleurope.com/myc/workabroad/20050803-areddy.html 

Gilley, Bruce. Asia's Top Employers Value Happy Workers. Far Eastern Economic Review. Retrieved August 17, 2005, from the World Wide Web:  http://www.careerjournaleurope.com/specialreports/bestasia/20010910-gilley.html 

Kerman, Faiz. 2004. South Korea set to surprise? Chiltern International. 1 October. Retrieved August 17, 2005, from the World Wide Web:  http://www.inpharm.com/External/InpH/1,2580,1-3-0-0-inp_intelligence_art-0-248799,00.html 

Knowledgeable employees -- the key to a new labor relations structure. Retrieved August 17, 2005, from the World Wide Web: http://152.99.129.68:8787/board/issue_view.jsp?idx=104&code=C&bcategory=&pageNum=0&searchWord=&searchType=null

Electromagnetic Therapy
A review of the existing scientific literature

The use of magnets in medicine is long-standing. "Physicians from ancient Greece, China, Japan, and Europe successfully applied natural magnetic materials in their daily practice" (Marko 2007). This is "based on the belief that an imbalance of the electromagnetic frequencies or fields of energy can cause illness. By applying electrical energy to the body, the imbalance can be corrected. Many electrical devices are available on the market to treat a variety of symptoms" (Electromagnetic Therapy, 2012, New York Presbyterian Hospital). "With the advent of the commercial availability of electricity during the last 20 years of the Nineteenth Century with a push by inventors and visionaries like Thomas Edison, an increase in experimentation and applied research by means of electromagnetic fields became more intense during the middle of the twentieth century" (Pretorious et al. 2011). However, the therapy's full incorporation into contemporary medicine has…...

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References

Battisti, E., Albanese, A., Bianciardi, L., Piazza, E., Rigato, M., Vittoria, A., & Giordano, N.

(2007). Efficacy and safety of new TAMMEF (therapeutic application of musically modulated electromagnetic fields) system in the treatment of chronic low back pain.

Environmentalist, 27(4), 441-445.

Cadossi, R., Setti, S., & Fini, M. (2011). Cartilage chondroprotection and repair with pulsed electromagnetic fields: I-ONE therapy. Environmentalist, 31(2), 149-154

Arterial Ulcerations:Management of Arterial ulcerations in the diabetic patient
Arterial Ulcerations: Management of Arterial ulcerations in the diabetic Patient

There Approximately 10 per cent of all leg ulcers are arterial ulcers. The legs and feet are often start to feel very cold and then they may have a color that looks either white or blue, shiny appearance. Arterial leg ulcers normally can be certainly painful. Pain normally starts to escalate when the person's legs are elevated and resting. ith this condition, most have learned tha they can reduce that pain just by lying down on the bed. The gravity will then cause more blood to start flowing directly into the legs. Ulcers normally happen when the breaks in the legs do not heal properly. They may be escorted by irritation. A lot of the times they do not heal correctly thus causing them to become chronic. People that have arterial leg ulcers…...

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Works Cited

(n.d.).

Anand SC, D.C. (2003). Health-related quality of life tools for venous-ulcerated patients. Br J. Nurs, 17(2), 34-56.

C:, W. (1995). Living with a venous leg ulcer: a descriptive study of patients' experiences. Journal of Advanced Nursing, 23(7), 23-30.

Franks PJM, M.C. (1998). Who suffers most from leg ulceration? Journal of Wound Care, 18(3), 383-385.

cultural diversity issues and its impact on nursing professionals' practice. It assesses a client hailing from a different culture, and employs information derived from the assessment determining and reflecting on health practices and beliefs of the client's culture. Lastly, nurses' role in the care of patients hailing from diverse backgrounds care is analyzed, and a conclusion is drawn.
Client Interview Data

Client's health beliefs in relation to cultural diversity

The client comes from a family-focused background, in which she plays the role of chief household organizer and attends to her family and their needs. She believes one ought to lead a life of a good and virtuous individual, and support one's family, particularly in times of need. In her opinion, sickness must be tended to, for preserving life. She believes in healthcare professionals and services they offer, for leading a healthy life. She is comfortable having healthcare professionals take care of her…...

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References

American Nurses Association. (1998). Discrimination and Racism in Health Care. Silver Spring, MD: American Nurses Association.

Anderson, L. (2012, October 10). Cultural Competence in the Nursing Practice. Retrieved from Nurse Together:  http://www.nursetogether.com/cultural-competence-nursing-practice 

Coe, S. (2013, January 15). Cultural Competency in the Nursing Profession. Retrieved from Nurse Together:  http://www.nursetogether.com/cultural-competency-nursing-profession 

Graue, M., Dunning, T., Hausken, M. F., & Rokne, B. (2013). Challenges in managing elderly people with diabetes in primary care settings in Norway. Scand J Prim Health Care, 31(4), 241-247.

Critical Pathway: Chronic enal Failure
Advanced Pathophysiology

egents Online Degree Program

Critical Pathway: Chronic renal failure

Chronic renal failure is often occasioned by chronic kidney disease, immune disorder, trauma among other conditions. It does not have any specific symptoms and might include feeling unwell generally and experiencing a reduced appetite. It is diagnosed following screening of individuals who are identified to be at risk of kidney problems, like individuals with diabetes or high blood pressure and others who have blood relative with chronic kidney disease. It always seems complex when trying to come up with the right diagnosis for a patient.

M.A. is a 60-year-old man who has a stage V chronic kidney disease mainly as a result of diabetic nephropathy and a 12-year of type 2 diabetes. He has symptomatic peripheral vascular insufficiency, and 3 years ago he had undergone coronary artery bypass 3. Within the ten months that passed, Mr. M.A. had been…...

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References

Ahern J, Kruger DF, Gatcomb P, Petit W, Tamborlane W.,(1989). The Diabetes Control and Complications Trial (DCCT): the trial coordinators perspective. Diabetes Educ 15:236 -- 281

Bassilios N, Launay-Vacher V, Khoury N, et al. (2001) Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrol Dial Transplant.

Blum RA, Comstock TJ, Sica DA, et al.(1994). Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clin Pharmacol Ther;56(2):154-159

Brawek B, Loffler M, Dooley DJ, Weyerbrock A, Feuerstein TJ.(2008) Differential modulation of K (+)-evoked (3)H-neurotransmitter release from human neocortex by gabapentin and pregabalin. Naunyn Schmiedebergs Arch Pharmacol.:376(5):301-307