Evidence-Based Management Of The Diabetes Epidemic: Fill & Download for Free

TOP 9 STRATEGIES TO GET RID OF DIABETES IN 2 WEEKS.Here is Leslie Mcdonald. Hi friends, let me show amazing 9 strategies from Linda Williams, Registered Nurse from The Johns Hopkins Hospital to get rid of diabetes as follows.Tags: Diabetes. Health, Quora1- Have A Sound Sleep: Linda Williams said: It is very important to have at least 8 hours of sleep. It promotes good mental as well as physical health. If your sleeping habits are not proper, then it may affect your blood sugar levels and insulin sensitivity, which is a root cause of weight gain.2- Stress Management: Linda Williams said: Poorly managed stress can make blood sugar levels harder to control, says McLaughlin. Try using relaxation techniques to chase away stress. Top-notch stress busters for diabetes include yoga, tai chi, meditation, massage, and soothing music.3- Exercise: Linda Williams said: A study that had people aim for 10,000 steps a day and at least 2 1/2 hours of moderate exercise a week along with cutting 500–750 calories a day and following a specific insulin and medication routine saw more than half of them reach near-normal blood sugar without medication. Some were able to keep those levels long-term, too.4- Diet: Linda Williams said: A study showed that eating very few calories (500–600) 2 days a week and a normal diet the other days helped people with type 2 diabetes lose weight and lower their blood sugar levels just as much as limiting calories to 1,200–1,500 every day.5- Apple Cider Vinegar: Linda Williams said: The primary compound in ACV is acetic acid and is believed to be responsible for many of its health benefits. There are many evidence-based approaches to using ACV. Taking 2 tablespoons before bedtime can reduce your morning fasting sugar levels. Even better, 1–2 tablespoons of ACV taken with meals can decrease the glycemic load of a carbohydrate rich meal.6- Lose weight: Linda Williams said: Health Harvard notes that losing just 5 to 7 percent of your body weight can help lower your risk of developing type 2 diabetes. So, if you are 200 pounds, aiming to lose about 10 to 14 pounds might help you prevent prediabetes from progressing to full-blown type 2 diabetes or help halt the advancement of type 2 diabetes if you have already been diagnosed.7- Monitoring your blood sugar: Linda Williams said: Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you’re on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.8- Diabetes medications and insulin therapy: Linda Williams said: Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might combine drugs from different classes to help you control your blood sugar in several different ways.9- Drink Sufficient Water: Linda Williams said: Have you been wondering how to control diabetes naturally? This is one of the most common home remedies for diabetes. A lot of studies say that drinking water helps control the blood sugar levels.Resources: frree ebook: Top 23 ways to cure diabetes in 7 days

The VA is challenging. For credibility on the street, you want someone who was a veteran (ideally enlisted or NCO) and someone who is a medical professional. Without those two credentials, a lot of the key constituent groups will start out assuming you can’t be trusted or don’t know what you’re doing.Those are also the two least important factors for success in administering the VA (but they’re essential for credibility and politics).The most important areas of expertise for managing and leading the VA are:Experience as a senior executive with HUGE organizations. The VA has over 1,000 out-patient and medical center locations, 126 cemeteries, a budget of over 135 billion, over 350,000 employees and this is spread around the globe. Quite simply, managing an organization in one location (a hospital) does not prepare you to manage a global organization that is so dispersed.Experience as an executive in government. Citizens who haven’t worked in the Federal government (or haven’t been in an executive role) like to disparage Federal service as being inefficient and full of incompetents. Actually, the biggest demographic in the Federal workforce are former vets. And that’s also true of the VA—it’s made up of a huge number of former military. Being an executive in the Federal Govt. is challenging on at least 3 levels: First, you don’t have a lot of absolute authority. You’re not a figure head. But you can’t just say “hey, I’m giving Jack a bonus” or “Ralph, you’re promoted” or “let’s create this program based on a new idea I have.” Second, you serve many masters. You don’t just report to the President. Or a Board of Directors (like the private sector). And the VA has several thousand “masters.” Private industry (let’s say company XYZ) gives money to a Senator and that Senator then grills you on why you aren’t outsourcing more work to the private sector, like those excellent folks at Company XYZ? You can’t just decide to support or not support a program that provides dogs for wounded vets. You have to confront all sorts of private sector competitors, other federal agencies that claim to have a say in this, veteran’s groups who have a position on this. Third, you really can’t do long-range planning and strategic thinking on a realistic level. Think of how many times in the past 10 years we’ve had a govt. shutdown or a threat of a shutdown. Just in the past 6 months we’ve had 6 either shutdowns or near shutdowns. That impacts your ability to be strategic, to allocate money for long-range projects, to plan ahead. Instead you staff and spend assuming you’ve got a budget for 3 months or maybe 6 months and then it’s not definite. Now I know some people will shout “but the VA isn’t affected by a shutdown” not true! Oh, the medical facilities aren’t affected. But claims processing is. Cemeteries are. Counseling is. So you have an organization that is not only HUGE but some of it plays by one set of budget rules and some of it plays by another set of budget rules. These reasons I’ve just listed are why most business executives don’t do so well in government.Anti-business. Wait you say, don’t we want government to be more efficient? Sure, and there is a lot that government can borrow from business. But right now, there are significant forces trying to privatize the VA. The argument being used is “provide more choice and more efficiency.” Sounds fine in theory. Except…veterans don’t want to be privatized, they don’t want all their care to come from the private sector. For very vet who says “I want to see a counselor in the private sector” there are 30 who say “I want to go to a VA facility and deal with people who have worn the uniform and being a waiting room with people who have experienced what I experienced.” And besides, the lobbyists and forces who are pushing this are not doing do to provide better care, it’s about making money. If the VA eliminated all of their counseling services and instead hired a contractor, that would be BIG BUCKS to whomever got that contract. So whomever heads the VA needs to be someone who understands what is really driving the privatization argument, can stand up to that, fight those battles and only go with outsourcing and private provides when it truly provides a choice or efficiency. Right now, that is NOT the case. And if you think I’m off-base here, that is why Shulkin is now an ex-VA Secretary: a number of the political appointees under him were pushing outsourcing of business to business cronies. When Shulkin wouldn’t sign off on that they looked to sabotage him by leaking bad stories and embarrassing information. It’s a snake pit right now in senior management at the VA and the primary reason is the fight over this issue (to outsource as much of the VA as possible with the ultimate goal of eliminating all VA centers and facilities, but starting first with services in a number of areas).Process focused. Geary Rummler (who is credited with providing the intellectual capital at Motorola that led to what we now call Six Sigma) used to say: “pit a good person against a bad process and the bad process will win almost every time.” Real simply, we tend to think that if you put a bunch of good people, smart people together than you’ll have a successful organization. Tell that to Salomon Brothers. Or a host of other organizations that had smart people that went bankrupt. Ultimately, the way you improve organizations is through a process and systems focused. You don’t just hire “good people” (b/c with 300,000+ personnel, that’s a lot of folks to hire or replace). And if you put a good person in a sucky situation with incentives for bad behavior, you bring out the worst in them. So the big improvements in the VA are not going to come from a lot of hiring and firing. They’re going to come from process and system changes.Embracing technology. The medical field needs to do a much better job at EBM (Evidence-based Medicine) and utilizing technology to share information, access data, have more comprehensive records.Able to embrace new insights and changes around PTS, TBI, traumatic and multi-amputee, opioid, and diabetic cases. The VA has always had these issues. But the US is undergoing an opioid and diabetic epidemic beyond anything we’ve seen in our history. The VA is particularly guilty of over-subscribing opioids. And the diabetic epidemic (driven mostly by sugar) is producing a lot more amputees among retired vets plus there is a shortage of talent in producing prosthetics. The wars we’re in right now (and likely for the future) combined with higher survivability rates (due to FSTs and field medicine technology) mean there are more wounded who have lost 3 or 4 limbs and suffer traumatic burns that were not survivable in previous wars. And IEDs produce a lot of TBI. The VA needs to do a much better job at confronting all of these challenges. This is going to require a VA Secretary who can drive change in those areas, implement new programs, drive new research, and hire the right kind of program leaders to drive progress on these issues.Networking and sharing information. Partially this is a technology issue but it’s so much more than that. VA facilities have tended to operate in silos. A mistake at one facility doesn’t get shared well with all others so they end up making the same mistake too. In such a dispersed system, it’s critical to have a leader who knows how to lead in a soloed organization, where it’s hard for everyone to feel like they’re part of a larger whole. It’s not about just doing site visits to the facility in Grand Rapids and the one in South Forks and so on. It’s about finding ways to connect across the VA, share insights, leverage expertise (so each facility doesn’t have to have a specialist in a particular type of care. Instead, one facility has deep expertise but can share that expertise in real time with other centers and out-patient facilities). This is not mostly about technology, it’s really more about silo-busting and organizational culture.

A couple of illustrative examples on how personality and cultural, social or economic pressures influence the acceptance of once-scorned medical treatments.Personality and cultural mores: Ignaz Philipp Semmelweis became a 19th century pioneer of the scientific method in medicine in the process of discovering the out-sized value of the aseptic method (hygiene) when examining a patient. Obviously the norm today, the medical community of his time was averse to his recommendations, eventual acceptance needing the subsequent discovery of microbes, the agents responsible for infectious (contagious) diseases.Social and economic pressures: Maggot therapy - Wikipedia is slowly regaining acceptance in clinical wound management as limitations imposed by rampant antibiotic resistance inadvertently create an environment receptive to what would otherwise be considered a retrograde practice by a modern medicine increasingly reliant on high tech solutions.The Case of Semmelweis: When being avant-garde became a career-ending millstoneHospital births are the norm today across much of the developed world and yet merely a blink of the eye in the past, in the mid-19th century, childbed (puerperal) fever or Postpartum infections - Wikipedia prevailed at such epidemic proportions across much of Europe that maternal mortality rates were far lower in home births and sky high in hospital deliveries.While the scientific record suggests Oliver Wendell Holmes (1), the Finnish doctor Carl Robert Ehrström - Wikipedia (2) as well as the Scottish obstetrician Alexander Gordon (physician) - Wikipedia # independently realized the importance of aseptic procedures in reducing childbed fever risk, Semmelweis' contribution was monumental, being a trailblazer in using the scientific method to help clearly link sterility to reduced risk of contagious disease (3, 4, 5, 6, 7, 8, 9, 10, 11, 12).As a 28 year old assistant professor at the Vienna Lying-in Hospital in 1847, Semmelweis noticed a conspicuous difference in childbed fever deaths in its two obstetric wards.Ward 1, where medical students trained in obstetrics, had maternal mortality rates of 9.9% (sometimes even as high as ~30%) while Ward 2, where midwives trained in obstetrics, had rates as low as ~4%.Medical students would examine expectant mothers directly after performing an autopsy or after examining a patient's infected wound, wearing the same soiled and blood-spattered coats. On the other hand, the mid-wives placed a premium on personal cleanliness.After cutting himself during a dissection, Jakob Kolletschka - Wikipedia, one of Semmelweis' colleagues, died from symptoms and pathology eerily similar to those of Ward 1 mothers. This observation apparently spurred Semmelweis to suspect the cause of death in such cases to be the transfer of something from some cadavers – something he called 'putrid particles'.Thus, in May 1847, Semmelweis directed his medical students to wash their hands, specifically to scrub with soap and warm water then wash in lime chloride solution until their hands were slippery before entering Ward 1. He also instructed them to likewise disinfect all the equipment and materials likely to come in contact with the mothers' birth canals.One year later, Ward 1 maternal mortality rate declined to ~3% and even lower to ~1% the following year.Semmelweis even showed that rabbits brushed with autopsy material discharge died from infection with pathology similar to those seen in Ward 1 mortalities.Copious and impressive empirical data notwithstanding, Semmelweis got nowhere with his Vienna superiors.Pasteur and the discovery of microbes in general and the discovery of Streptococcus specifically (major cause of childbed fever) were decades away. Miasma or 'bad air' was the reigning theory for spread of contagious diseases, despite being unable to explain mortality rate differences between the two wards, which shared the same air.No scientific understanding of disease causation, no rigorous analytical methods, no reliance on pathology to characterize the specific appearance of a given disease, such were the prevailing norms.Considered alienating, difficult and non-diplomatic by his colleagues didn't help Semmelweis' cause either and neither did his waiting 13 years to publish his treatise with its voluminous supporting data.Repeatedly denied promotions in Vienna, Semmelweis returned to Budapest a disappointed even broken man to lecture on obstetrics, dying shortly thereafter following what appears to be a total nervous breakdown.Yet Semmelweis' insight was remarkably astute, which is why it has stood the test of time (below from 4, emphasis mine),“Without any knowledge of microbiology, which was then not taught in medical schools anywhere in the world, Semmelweis correctly reasoned that an open wound of the skin permitted transmission of the fatal poison. By the time of his important publication of 1861 Semmelweis, without histological aids, had rightly concluded that invisible animal matter was the source of the difficulty.”Modern graphical representations of Semmelweis' impressive datasets only add luster to his outstanding scientific ability (below from 13, 14).Maggot Therapy: Using Insect Larvae For Wound HealingImagine maggots feasting on your rotting flesh. A skin crawling vision* (below from 15, 16) and yet many studies suggest larvae of the greenbottle blowfly (Lucilia sericata) efficiently clean out chronic deep wounds.*figures below not recommended for the squeamish.Maggot therapy for wound debridement is reported to have been prevalent in ancient cultures from Australian Aboriginals (the Ngemba tribe) to Central American Mayans and is even mentioned in the Old Testament (17).It had a brief heyday in war medicine in Europe after observant French surgeons such as Ambroise Paré - Wikipedia in the 16th century and Dominique Jean Larrey - Wikipedia in the 18th century clinically observed its effectiveness in cleaning out dead tissue while not harming healthy tissue, even helping it along in fact.In the modern era, it had a brief early 20th century flare (triggered by Johns Hopkins orthopedic surgeon William Baer in 1929, 18) and then a prolonged post-antibiotic slump.However, antibiotic resistance increased hand-in-hand with antibiotic use, setting the stage for maggot therapy's comeback by the 1980s, with its official comeback in clinical medicine dating to 2004 when the FDA approved it as a medical device for a wide range of wound debridement applications (below from 19, 20).Individuals such as Ronald Sherman and Edward Pechter in the US, and John Church and Stephen Thomas in the UK helped revive maggot therapy (17). As rates of chronic diseases such as diabetes skyrocket, chronic deep tissue wounds such as diabetic foot ulcers are an increasing health burden, with ~70000 annual amputations from diabetes-related complications in the US alone. Wound bed preparation is an important part of chronic wound management where wound debridement (21)Removes dead and damaged tissue from a trauma or infection-associated site to expose the underlying healthy tissue.Reduces local inflammation and influx of leukocytes, conditions favorable for harmful bacterial growth.Restores normal tissue physiology including wound healing, tissue remodeling, and cell turnover.Restores normal skin-associated microbiota.Maggots devouring open, chronic wounds (below from 22)Clear out dead/damaged tissue by secreting powerful digestive enzymes. Healthy tissue is in no danger since it automatically neutralizes these enzymes on contact.Rid of damaged tissue-associated pathogenic bacteria/biofilms by secreting powerful anti-bacterial peptides locally as well as by increasing local pH by secreting sodium bicarbonate, which inhibits bacterial growth.Secrete growth factors locally that help initiate and sustain wound healing, and support local tissue regeneration.Even as companies such as BioMonde in Europe supply larvae for clinical use and as a meta-analysis of multiple studies suggests maggot therapy may be far more economical compared to conventional clinical wound management (23), mainstream clinical use remains stymied by lack of good data – clinical trials too few, small in size, sub-optimally designed.Nevertheless, in recent years, thousands of medical institutions in at least 30 countries have started offering maggot therapy and at least 12 labs in 20 countries supply the maggots. Pervasive antibiotic resistance and unmet need in chronic diseases, and in disaster and emergency medicine have revived a place for maggot therapy in the modern medicine tool-kit.# noteworthy for an extraordinary and bizarre personal statement (cry for help?) by a Wikipedia editor on this page.Bibliography1. Lane, Hilary J., Nava Blum, and Elizabeth Fee. "Oliver Wendell Holmes (1809–1894) and Ignaz Philipp Semmelweis (1818–1865): preventing the transmission of puerperal fever." American journal of public health 100.6 (2010): 1008. Oliver Wendell Holmes (1809–1894) and Ignaz Philipp Semmelweis (1818–1865): Preventing the Transmission of Puerperal Fever2. Turunen, Aarno. "CR Ehrström, the Finnish predecessor of Ignaz Semmelweis, the defeater of puerperal fever." Centaurus 12.3 (1968): 197-201.3. Semmelweis, I. P. "A corner of history. Ignaz Philipp Semmelweis." Preventive medicine 3.4 (1974): 574.4. Wangensteen, Owen Harding, and Sarah D. Wangensteen. "The rise of surgery: from empiric craft to scientific discipline." (1978).5. Carter, K. Codell. "Semmelweis and his predecessors." Medical history 25.1 (1981): 57-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1138986/pdf/medhist00092-0065.pdf6. Wykticky, Helmut, and Manfred Skopec. "Ignaz Philipp Semmelweis, the prophet of bacteriology." Infection Control & Hospital Epidemiology 4.5 (1983): 367-370.7. Newsom, Samuel WB. "Ignaz Philipp Semmelweis." Journal of Hospital Infection 23.3 (1993): 175-187.8. Sepkowitz, Kent A. "Cassandra and Ignaz Semmelweis." International Journal of Infectious Diseases 1.1 (1996): 57-58. https://core.ac.uk/download/pdf/82357880.pdf9. Buyse, Marc. "A biostatistical tribute to Ignaz Philip Semmelweis." Statistics in medicine 16.24 (1997): 2767-2772.10. Ligon, B. Lee. "Biography: Historical moments in the recognition of hand hygiene for control of infections: A short biography of Ignaz Philipp Semmelweis (1818-1865)." Seminars in Pediatric Infectious Diseases. Vol. 2. No. 12. 2001.11. Bencko, Vladimír, and Miriam Schejbalová. "From Ignaz Semmelweis to the present: Crucial problems of hospital hygiene." (2006): 3-7. https://www.researchgate.net/profile/Vladimir_Bencko/publication/247731782_From_Ignaz_Semmelweis_to_the_Present_Crucial_Problems_of_Hospital_Hygiene/links/5887237792851c21ff4e50f0/From-Ignaz-Semmelweis-to-the-Present-Crucial-Problems-of-Hospital-Hygiene.pdf12. Loudon, Irvine. "Ignaz Phillip Semmelweis' studies of death in childbirth." Journal of the Royal Society of Medicine 106.11 (2013): 461-463. Your gateway to world-class journal research13. La Rochelle, Pierre, and Anne-Sophie Julien. "How dramatic were the effects of handwashing on maternal mortality observed by Ignaz Semmelweis?." Journal of the Royal Society of Medicine 106.11 (2013): 459-460. Your gateway to world-class journal research14. Carson, Edward A., and Nadeem Toodayan. "Ignaz Philipp Semmelweis (1818–1865): herald of hygienic medicine." The Medical journal of Australia 209.11 (2018): 480-482.15. Sherman, Ronald A. "Mechanisms of maggot-induced wound healing: what do we know, and where do we go from here?." Evidence-Based Complementary and Alternative Medicine 2014 (2014). http://downloads.hindawi.com/journals/ecam/2014/592419.pdf16. Gottrup, Finn, and Bo Jørgensen. "Maggot debridement: an alternative method for debridement." Eplasty 11 (2011). Maggot Debridement: An Alternative Method for Debridement17. Whitaker, Iain S., et al. "Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential." Postgraduate medical journal 83.980 (2007): 409-413. https://pdfs.semanticscholar.org/01cd/230dafad0c0c8b20a70cc2904f90217838fb.pdf18. Baer, William S. "The treatment of chronic osteomyelitis with the maggot (larva of the blow fly)." JBJS 13.3 (1931): 438-475.19. 510(k) Premarket Notification20. Shi, Eric, and David Shofler. "Maggot debridement therapy: a systematic review." British journal of community nursing 19.Sup12 (2014): S6-S13.21. Pritchard, D. I., and Y. Nigam. "Maximising the secondary beneficial effects of larval debridement therapy." journal of wound care 22.11 (2013): 610-616.22. Cazander, Gwendolyn, et al. "Multiple actions of Lucilia sericata larvae in hard‐to‐heal wounds: larval secretions contain molecules that accelerate wound healing, reduce chronic inflammation and inhibit bacterial infection." Bioessays 35.12 (2013): 1083-1092.23. Arabloo, Jalal, et al. "Safety, effectiveness and economic aspects of maggot debridement therapy for wound healing." Medical journal of the Islamic Republic of Iran 30 (2016): 319. Safety, effectiveness and economic aspects of maggot debridement therapy for wound healingThanks for the R2A, Stefan Pociask.