Fluoroquinolones and Peripheral Neuropathy

Peripheral neuropathy, this is an often devastatingconditionwhich people develop pain and numbnesstheir hands and feet. Basicallythey're told on the evening news that they should be taking this or that mediion sothat they can get through life. That's treating the smoke and ignoring thefire. Those medicines that you're seeing advertised don't treat the neuropathy, they only treatthe symptoms. But what's causing peripheral neuropathy? Well we know thatAmerica,one of the biggest causes of peripheral neuropathy is being diabetic, which is clearly relatedto the foods that you eat by and large. Becoming a type 2 diabetic amatically increases yourrisk for having peripheral neuropathy and

fact being devastated by it. This is adisease that effects 115 Americans. Let's take a look. So again this is 115 Americans—thisis 20 million Americans afflicted by this disease, that aside from diabetes, we're toldthe cause is unknown. Well maybe that's not exactly true. Last month,the journal Neurology,an incredible study was published describing a relationship between what are called fluoroquinolones,and the risk of developing a peripheral neuropathy. You may not know what fluoroquinolones are,but chances are you may have actually been exposed to fluoroquinolone. These are antibioticsused for treating things like upper respiratory

infections and even urinary tract infections.Things like Levaquin and Cipro are commonly usedwalks. If you have a urinarytract infection, you may have received these mediations. Well, here's what the study showedus: So this is a study publishedSeptember2014 that looked at men between age 45 to 80 years of age followed for a 10 year periodandthis group there were over 6,000 cases of peripheral neuropathy. And they comparedthese individuals to about 25,000 aged match controls, and what they found was that riskfor developing this devastating condition called peripheral neuropathy was doubled inthose individuals exposed to this class of

antibiotics called fluoroquinolones. And whatthe researchers also told us is that, and I quote, quot;Fluoroquinolones have been shownto neurotoxic. Oral fluoroquinolones have also been associated with reported cases ofpsychosis and seizures, which similar to peripheral neuropathy have been shown to be acute eventsoccurring within days of fluoroquinolone use. In light of strong evidence of unnecessaryprescribing of oral fluoroquinolonesthe United States, ians must weigh the riskof PN against the benefits of prescribing FQ when prescribing these ugs to their patients.quot; We've got to practice medicine under the dictumof quot;above all do no harm.quot; One of our most

well respected peer journals is nowtelling us that the use of these mediions—these fluoroquinolone antibiotics is associatedwith doubling of the risk of peripheral neuropathy. A disease which often is not treatable. Sokeep thatmind the next time you think you need an antibiotic for this or that problem,discuss this study with your treating physician. I'm David Perlmutter.

ICD10 Coding and Diabetes

Welcome to CMS eHealth. By October 1, 2015, the new ICDcoding system will beplace for both diagnosesand inpatient procedures. Using ICD10, s willcapture much more information, meaning they can betterunderstand important details about a patient's healththan with ICD9. The new codes reflecthow health care has changed over the past 30 years with manyadvancesal practice.

You'll notice updates,including definition changes, terminology changes,and a lot more specifics. The most obvious change is thatthe code structure has expanded. While the old codes havethree to five characters, the new codes have up to seven, allowing for more detaileddescriptions. The first three charactersrepresent the egory of disease or health condition,followed by a decimal point.

The fourth, fifth,and sixth characters represent al details,such as the cause of the disease, its severity,and its anatomical loion. Let's look at how this all worksusing the example of diabetes. ICD9 has two major egoriesof diabetes codes, diabetes and secondary diabetes, but ICD10 separates Type 1diabetes from Type 2 diabetes. ICD10 also eliminates the broadegory of secondary diabetes,

instead offeringsecondary options, such as underlyingconditions or causes. To capture more details,subegories can be added to represent both compliionsand affected body systems. For example, the diabetessubegories include ketoacidosis,kidney compliions, ophthalmic compliions,neurological compliions, and circulatory compliions.

Let's say a patient has diabetesdue to an underlying condition. That's code E08,followed by a decimal point. Next come the detailsin the form of subegories, starting with the fourth digit. Ketoacidosis, for example,has a fourth digit of 1. To add even more detail,a fifth digit of zero is ketoacidosis without coma, and a fifth digit of oneis ketoacidosis with coma.

These subegoriesstay the same, no matter what type of diabetesis being described. For example, diagnosis code .621 describes the compliionof foot ulcer. So E10.621 is type 1 diabeteswith foot ulcer, and E11.621 is type 2 diabeteswith foot ulcer. In this example,the provider has documented the egory of diabetesand the compliions.

Surgical Site Infections SSI Surveillance with Case Studies Part I

gt;gt; First of all, I just wantto introduce myself. I'm Janet Brooks and my subject matterexpertise right now is SSI and I probably feel like I know everyone of youthe roomfrom different questions that I've answered.NSH400:00:12,726 gt; 00:00:15,806My mailbox, now people just say,quot;Send it to Janet,quot; you know. So I feel like I know all ofyou quite well at this point. I know where you are and how you feel. I had over 20 years experiencethe trenchesas an infection preventionist at large and small s so I know thetrials and tribulations with especially as we change our definitions.

I want to welcome everybody herein the room and those of you that are listening via webstreaming today, all of those, probably thousands that are on there right now. I haven't heard a number yet fromCourtney of how many are loggingbut I'm sure there's a lot of people listening. Let's go ahead and get started. So our objectives today is to look atour methodology for collecting our data and identify we're going tofocus on our SSI changes for 2014.

I do go over fillingdenominator data,that's your procedures; and your numerator data which is your surgical site infections. So especially for the newer IPsthis can be helpful for everybody. And then how to apply thesedefinitions to some case studies. And I've sort of thrown case studies throughoutthe whole presentation this year rather than having a giant chunk at the end. I'm trying to present a piece of informationand then see how you can apply that. So I know that Kathy Bridson asked early on,but I'm just curious again, how many of you

is it really maybe less than a year thatyou've been as a younger IP or a new, as an infection preventionist, areless than a year working with SSIs? Okay, good. I just want to kind of get afeel for that because I do go over the basics and then some advanced issues. Well, this is my, you know, the goto spot. This is the we're on the NHSN website andthis is your surgical site infection section. And over here on the right you can quicklinkrather than agging down to the bottom

of the page get to your trainings, yourprotocols, your data collection forms, a whole section on CMS reporting materials. The bottom are supporting materials and I'mgoing to be going over thata minute. You can quicklink to your analysis resources. And I have to thank Maggie for her presentation. I mean, perfect timingterms of reallyhitting a lot of the SSI questions that I get as well that she gets around what'sgoing on with risk adjustment and what we're collecting rightnow, some of this new data.

And then we have our Frequently Asked Questions. And I think it was mentionedearlyon, I'm not sure by whom, but we've just finished updating all our FAQs to reflect the new definitionsand the new protocols. And there were quite a bitof changes for SSI'14. And I think probably within the nextweek the FAQs that I get, you know, for SSI Protocol will be up there. And we've actually moved this timeup into this protocol section here