In This Issue

Donna Heun examines for the reader some of the barriers and reasons for readmissions that are not the direct results of purposeful neglect of diabetes management. She next discusses the major barriers in detail:

* Depression, burnout, and diabetes

* Alcoholism, drug addiction, and diabetes

* Homelessness and lack of resources

* Mental illness and diabetes

* Gastroparesis

Heun indicates that there are very few people with diabetes who may choose not to control their diabetes and may truly be considered noncompliant. Having an improved understanding of barriers discussed may aid case managers, nurses, and social workers to work toward breaking down these barriers to help make it possible for people to be able to do a better job of controlling diabetes.

Darrell Schapmire opens his discussion on diagnostic testing for the reader by stating, "One of the issues that is a source of frustration for case managers is the fact that diagnosis of the patient is not necessarily related to the eventual outcome." In functional capacity evaluations, "why are outcomes uneven, unpredictable?" He answers this question in detail and comments on each of the following:

* Range of motion testing

* Manual strength testing

* Machine testing

* Isometric testing

* Hand strength testing

Schapmire challenges the reader to combine what is objectively known about the claimant's medical condition with what can objectively be demonstrated with regard to behavior. From these data, a mapping process will develop evidence-based case management decisions.

Discharging the ventilator-dependent patient to home is discussed by a group from the Medical University of South Carolina. In the opening of Part 1 of their article, they explain that ventilator-dependent patients can present a discharge dilemma because they have a chronic medical condition that requires expensive and specialized long-term care. They address the discharge plan and outline the initial assessment. The major points to be considered are support systems, home environment, and finance in order to determine whether the discharge is feasible.

They discuss the development of the interdisciplinary team, its makeup, and strengths and weaknesses. In Part 2, in the next issue, they will discuss educational needs and the actual execution of the discharge process.

-Frances Snowden, BS, RN, CRRN, CCM

Contributing Editor