Perspectives in Circulation Today
National Diabetes Surveillance System and Newsletters Updated
Hospitalizations for Nontraumatic Lower Extremity Amputation - Newsletters #1 & #2 Updated
Age-Adjusted Hospital Discharge Rates for Nontraumatic Lower Extremity Amputation per 10,000 Population, United States, 1980–2005
The age-adjusted rate of hospital discharge for nontraumatic lower extremity (LEA) per 10,000 population increased after the 1983 implementation of the prospective reimbursement system by the Center for Medicare and Medicaid Services, leveled off during the mid-to-late 1980s, and then began increasing in the early 1990s. After peaking in 1996, LEA rates decreased slightly. In 2005, the age-adjusted LEA rate (2.4 per 10,000 population) was 1.5 times that of the rate in 1980 (1.6 per 10,000 population). The above data and commentary is taken verbatim from the National Diabetes Surveillance System. It is seen that there is a recent downward trend but the number of amputations exceeds those in the 1980's. |
|
Incidence of Obesity - Volume 2 Number 4 Updated
| During the past 20 years there has been a dramatic increase in obesity in the United States. In 2008, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty-two states had a prevalence equal to or greater than 25%; six of these states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia ) had a prevalence of obesity equal to or greater than 30%. The complications of diabetes will remain big business for years to come as the incidence of obesity, its chief predisposing factor, continues to be a major problem. |
The Epidemic of Diabetes Parallels that of Obesity
| Average, annual age-adjusted incidence rates of diagnosed diabetes among adults aged >= 18 years are given on the left. The pattern resembles that for obesity seen above. |
Complications of Systemic Antibiotics - Update of Vol4 Number3
| In previous Newsletters, the successes and advantages of local antibiotics over systemic antibiotics have been pointed out. To remind the reader of these issues here we call attention to C-Difficile and methicillin-resistant Staphylococci. |
C-Difficile:
| Jagai and Maumova in their report on Clostridium difficile–associated disease in the elderly in the United States (Feb 2009) found an increase in overall hospitalizations that included a diagnosis of C-Difficile (panel A left) and an increase in the rates of infection from 13.71/10,000 elderly in 1993 to 38.78/10,000 in 2004. Patients over age 85 had the highest rate of infection (48.2/10,000) versus those aged 65-74 (11.9)and those aged 75-84 (26.0). They pointed out that their rates were increased because they included cases recorded in all 10 diagnostic codes. Panel A above-left shows the change in the proportion of C-Diff cases in each in each diagnostic code over their study period. In panel B, C-Diff cases (black) are compared to other GI infectious cases without C-Diff (red). The C-Diff cases showed a significant increase during the study period and a marked seasonal variability peaking in March perhaps suggesting an environmental factor (? usage of antibiotics during the flu season). |
| MRSA, or methicillin-resistant Staphylococcus aureus, caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005, most of them connected with healthcare settings (JAMA 298:1763-71, 2007). Fifty-nine % were "community-onset" (cases with at least 1 of the following risk factors: invasive device at time of admission; h/o MRSA infection or colonization; h/o surgery, hospitalization, dialysis, or residence in a LTC facility in 12 mos preceding culture). Twenty-eight % were "hospital-associated" (cases with positive culture obtained >48 hrs after hospital admission - may also have risk factors). Fourteen % were "community-associated" (cases with community-onset and none of above risk factors documented). |
Central Line-Associated Blood Stream Infections
(CLABSIs) in Intensive Care Units - USA, 1997-2007
| The chart on the left shows trends in MRSA incidence rate, MSSA (methicillin-sensitive SA) incidence rate, and %MRSA for central line-associated bloodstream infections (or CLABSIs) in intensive care units (ICUs) that were reported to CDC from 1997 to 2007. No data are available for 2005. The y-axis ranges from 0 to 0.8 in 0.1-unit increments and represents, alternatively, the pooled mean CLABSI incidence rate per 1,000 central line days, or the %MRSA (expressed as a fraction). It is seen that %MRSA increased from 48% in 1997 to 65% in 2007. In recent years both MRSA incidence (2nd line) and MSSA incidence (third line) decreased. |
of statins over the last few decades. Obesity and diabetes continue in epidemic proportions and will feed the wound healing clinics
for years to come. Standard therapies addressing these problems all have significant risks. Attempts to curb costs by treating patients at home with intravenous antibiotics are indeed also expensive as the visiting nurses are well paid and, as with the ICU,
complications of the therapy are common. The Circulator Boot has proved to improve the circulation in those at risk of amputation.
Usage of the local injection of antibiotics and/or the addition of antibiotics to solutions within the boot have proved effective,
free of complications and more economical.