Clinics in podiatric medicine and surgery
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Clin Podiatr Med Surg · Jul 2007
ReviewCurrent perioperative treatment of patients with type 1 and type 2 diabetes.
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. ⋯ Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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The increasing pervasiveness of diabetes mellitus on a global stage has been well documented. Many groundbreaking studies have detailed the consequences of inadequate glycemic control, but only recently have data supported evidence that demonstrates benefits in the acute setting. ⋯ This article discusses glycemic control, with special emphasis on the perioperative patient. Emerging therapeutic treatments and less frequently encountered protocols such as insulin pump management and insulin infusion are considered.
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Advanced thought and planning are required when preparing for podiatric surgery. In addition to appropriate procedure selection and follow-up, perioperative management has a key role in patient and physician satisfaction. Neglect of this aspect of podiatric care can also be a source of malpractice. This article analyzes many of the common medical treatments currently employed and makes recommendations for treatment before, during, and after surgery.
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Teaching rounds are a vital part of every residency program. Patient rounds provide an avenue to incorporate evidence-based medicine, current literature, and personal experiences into daily teaching while allowing residents to experience the doctor-patient relationship. ⋯ The daily protocol followed by the Podiatry Service at University Hospital, University of Medicine and Dentistry of New Jersey is also described. Conducting beneficial teaching rounds is an important aspect of a residency program when developing highly competent physicians.
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Journal club is a structured meeting that is required at a residency program, which is designated to train residents in the necessary skills to evaluate and apply scientific literature critically to clinical decision making. A successful journal club is one in which residents develop competency in evaluating the scientific literature for evidence-based answers that can be applied to clinical questions. The objective in establishing a successful journal club is to build a forum for residents to formulate answers to their clinical questions through the development of essential critical appraisal skills. This article discusses the setting, format, content, and purpose of a successful journal club.