by Timothy Gieseke MD, CMD

This year, our state QIO, HSAG, has been sponsoring webinars that help our facilities reduce the risk for incurring a readmission payment penalty, when the financial penalties go live January 1, 2019.  I will be presenting the webinar on June 27th for reducing the risk of serious hypoglycemia. You can register at:  https://www.hsag.com/en/events/20182/june-20182/change-in-condition-diabetes-and-hypoglycemia/

While there are many traditional things we can do to identify and manage this risk, our tool bag for safely lowering the risk has increased in recent years with the addition of SLG2’s and Incretin Receptor Agonists.  Both classes of medicines have a much lower risk of inducing serious hypoglycemia then oral sulfonylureas or insulin and both may help reduce weight and may reduce the risk of macro-vascular disease. Empagliflozin (Jardiance) and lirglutide (Victoza) now have an FDA indication for macrovascular risk reduction.  Empagliflozin is ineffective if EGFR is < 30, but liraglutide has no dose adjustment for renal or hepatic disease. The expense of both of these medicines is similar to the now high cost of our insulins.

Methods: We analyzed NH Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned.

by Janice Hoffman Simen, PharmD, EdD, APP, BCGP, FASCP

Recently, an article published in the British Medical Journal, April 2018, looked at patients in the UK with a new dementia diagnosis and the use of prescription medications with anticholinergic adverse effects up to 20 years previously (Richardson, et al., 2018). In this study, the researchers found a link between a new dementia diagnosis and an increasing average Anticholinergic Burden score (ACB). According to the results of this study, the risk of dementia increases with an ACB greater than three, including exposure 15-20 years prior to diagnosis, with the following drug classes: antidepressants, urologic, and antiparkinson agents. The findings are interesting as a risk factor for the onset of dementia and encourages the assessment of anticholinergic burden in younger patients.

by Timothy Gieseke MD, CMD

As the recipient of the 2018 CALTCM Leadership Award at this month’s annual meeting, I have had time to reflect on my career in medicine and the events that shaped that career.  I recalled my wife’s decision to become a pediatric physical therapist, in large part related to volunteer work she had done in High School at “We Care for Children.” (http://www.wecarechildren.org/) and how that led this “Lone Ranger” trained physician to highly value the work of the various disciplines in our specialty.