Population meta-analysis of low plasma glucose thresholds in full-term normal newborns.

There is extreme variation in the definition of low plasma glucose levels in newborn infants in the first postnatal days, ranging from < 30 to < or = 60 mg/dL. The goal of the present study was to define low thresholds (< or = 5th percentile) of plasma glucose concentrations in full-term normal newborns during the first 72 hours of life. Population meta-analysis was performed on published studies of neonatal hypoglycemia ascertained by MedLine search.

Impact of California's licensed nurse-patient ratios on unit-level nurse staffing and patient outcomes.

This article presents the first analysis of the impact of mandated minimum-staffing ratios on nursing hours of care and skill mix in adult medical and surgical and definitive-observation units in a convenience sample of 68 acute hospitals participating in the California Nursing Outcomes Coalition project. Findings, stratified by unit type and hospital size, reveal expected changes as hospitals made observable efforts toward regulatory compliance. These data cannot affirm compliance with ratios per shift, per unit, at all times; however, they give evidence of overall compliance.

Leveling the learning curve for laparoscopic bariatric surgery.

Background: The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality.

Methods: The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated surgical team. Surgeon A operated as primary surgeon, with surgeon B assisting (Stage 1).

Creating and analyzing a statewide nursing quality measurement database.

Purpose: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals.

Design: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual.

Methods: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care.

Body mass index determines evoked growth hormone (GH) responsiveness in normal healthy male subjects: diagnostic caveat for adult GH deficiency.

GH secretion is decreased in obese subjects, whereas age-adjusted IGF-I concentrations are normal. This study was undertaken to rigorously delineate the extent of obesity [elevated body mass index (BMI)] associated with decreased somatotrope secretory function resulting in apparent adult GH deficiency. The peak GH response evoked by combined arginine (0.

The impact of dedicated medication nurses on the medication administration error rate: a randomized controlled trial.

Background: Concerns about hospital medication safety mount as the pace of new drug releases accelerates.

Methods: We performed a randomized study at 2 hospitals (A and B) to examine whether the medication administration error rate could be decreased by having "dedicated" nurses focus exclusively on administering drugs. "Medication nurses," after receiving a brief review course on safe medication use, were responsible solely for drug delivery for up to 18 patients each.

Duodenal fat intensifies the perception of heartburn.

Background: Patients with gastro-oesophageal reflux disease (GORD) frequently report that meals high in fat worsen heartburn. Nevertheless, studies to determine whether high fat meals promote gastro-oesophageal reflux have produced conflicting and equivocal conclusions.

Patients And Methods: To determine, alternatively, whether fat in the small intestinal lumen intensifies the perception of heartburn, we studied 11 patients with typical heartburn from GORD.

Postcibal gastric emptying of pancreatin pellets: effects of dose and meal oil.

To treat pancreatic exocrine insufficiency, physicians often prescribe enterically coated pellets of pancreatin to be taken with meals. The pellets are only partially effective in correcting the digestion and absorption of fat. We sought to determine in normal subjects whether emptying of pellets from the postcibal stomach was dose-related and whether the gastric emptying of lipophilic Creon-20 or Pancrease was altered by the presence or the absence of oil in a meal.

Dilutions of low- vs. high-fat diets on intakes and gastric volumes in rats.

Rats adapt to changes in dietary energy to maintain nearly constant energy intakes. This regulation indicates that animals sense and respond to nutrient content. We sought to determine whether this response was affected by the fat content of the diet.

Gastric emptying of indigestible versus digestible oils and solid fats in normal humans.

Recent scintigraphic studies indicate that lipolytic products in the small intestine do not inhibit gastric emptying of fat as potently as previously suggested by studies that compared a liquid indigestible oil with a solid digestible fat. The older studies left open the confounding possibility that solid fats emptied differently than liquid oil. We studied eight normal subjects who ingested four meals in which fat was (1) liquid, digestible Crisco oil, (2) liquid, indigestible sucrose polyester oil, (3) digestible, solid Crisco, and (4) indigestible, solid olestra.

Accuracy of ultrasonic pachymetry and videokeratography in detecting keratoconus.

Purpose: To compare the accuracy of ultrasonic pachymetry measurements and videokeratography-derived indices in distinguishing keratoconus patients from those with normal eyes.

Setting: A subspecialty cornea practice (Los Angeles, California, USA) and the Keratoconus Genetics Research Project.

Methods: Corneal thickness was measured by ultrasonic pachymetry at the center and inferior margins of the pupil of 142 normal and 99 keratoconus patients The corneal surface topography of patients was studied with the Topographic Modeling System (TMS-1).

Gastric emptying of oil from solid and liquid meals. Effect of human pancreatic insufficiency.

Digestion of fat in pancreatic insufficiency (PI) is strongly affected by how rapidly fat enters the duodenum. We postulated that: (1) oil empties faster in PI than in normals and (2) in both, it empties in a load-dependent fashion. We used a gamma camera to test these ideas by comparing gastric emptying of iodine-123 iodinated oil in normal and pancreatic-insufficient subjects after 15 g of free oil were ingested in a small spaghetti meal and 60 g of oil were ingested in a large spaghetti meal and in a milk emulsion.

Videokeratography database of normal human corneas.

Aim: To form a database of videokeratography patterns and quantitative indices describing normal human corneas using the absolute scale.

Methods: Both eyes of 195 normal subjects were examined with a TMS-1 videokeratoscope. Videokeratographs were divided into 10 categories based on a classification scheme devised from the absolute scale and analysed with 10 quantitative indices devised to describe phenotypic features of keratoconus videokeratographs.

Bile salt inhibits acid-promoting feeding tube occlusion.

Occlusion of feeding tubes is a common and costly complication of enteral feeding. Although the composition of feeding formulas, the size, design, and material of the feeding tube, and the rate of delivery have been considered as factors that determine the rate of tube occlusion, little information is available on the effect of the luminal content of the gut on tube occlusion. Enteral feeding tubes are placed either in the stomach or postpylorically, in the small intestine.

Frequency of gastric pacesetter potential depends on volume and site of distension.

Little is known about the response of the frequency of gastric pacesetter potential (PP) to luminal distension. When volume distension occurs as a result of a meal, gastric emptying may play an important role, since the site of distension shifts as the meal is displaced from the stomach to the small bowel. In this study, using does equipped with duodenal fistulas and serosal electrodes on the antrum, we compared the frequency of gastric PP during the course of gastric emptying while isolating the volume distension to either the stomach or the small bowel.

Upper gastrointestinal hemorrhage clinical--guideline determining the optimal hospital length of stay.

Purpose: Physicians lack objective outcome data to define the medically appropriate length of stay (LOS) for patients hospitalized with acute upper gastrointestinal hemorrhage (UGIH), resulting in wide variations in resource utilization and quality of care. A clinical practice guideline with the ability to assign relative risk for adverse events is proposed.

Methods: A comprehensive scoring system was derived from the literature by using four variables; hemodynamics, time from bleeding, comorbidity, and esophagoduodenoscopy findings.

Bile salt-dependent inhibition of gallbladder emptying.

Little is known about the inhibitory controls of gallbladder emptying. Since cholestyramine, a binding agent that reduces luminal concentration of bile salt, has been reported to accelerate gallbladder emptying, suggesting that bile salt is inhibitory, we hypothesized that fat-stimulated gallbladder emptying is inhibited by a bile salt-dependent mechanism. To test this idea, we compared gallbladder emptying in 10 dogs equipped with duodenal and jejunal fistulas that allowed for complete diversion of the native bile while varying concentrations of bile salt were perfused into the small intestine.

Isogravitational heterogeneity of perfusion after unilateral lung transplantation.

1. Single-photon emission computerized tomography in both an intact canine model and man has demonstrated an aspect of pulmonary perfusion to be independent of gravitational forces. 2.

Bronchiolitis obliterans in single-lung transplant recipients.

The presentation and clinical course of bronchiolitis obliterans (BO) in single-lung transplant (SLT) recipients has thus far not been well described. We retrospectively analyzed the serial spirometry of 15 SLT patients with BO. All the patients fulfilled the criteria for BO syndrome, and 11 of the 15 had histologically documented BO.

The relationship between oxygen consumption and work rate in patients with airflow obstruction.

The oxygen cost of augmented ventilation is increased in patients with chronic obstructive pulmonary disease, either at rest or during exercise. Thus, if excessive demands are placed on the respiratory muscles during exercise in these patients, we postulate that the total oxygen consumption (VO2) may increase relative to the work rate compared to control subjects. The aim of this study was to examine the relationship between VO2 and work rate during exercise in patients with airflow obstruction.

Control of canine gastric emptying of fat by lipolytic products.

Dietary fat is ingested in three forms: 1) in solid food, 2) as aqueous emulsions, and 3) as unemulsified, liquid oil. On the basis of a scant previous literature, we postulated that liquid fat (emulsions or oils) would empty from the stomach at speeds that varied with the amounts ingested but that this dynamic would be modulated by feedback inhibition from lipolytic products. To test these ideas, we used a gamma camera to track gastric emptying of 123I-labeled fat in dogs with chronic pancreatic fistulas by which lipase was excluded from or replenished in the duodenum in varied amounts after dogs were fed 15-, 30-, and 60-g loads of liquid fat given with solid foods or as emulsions.

Stimulation of duodenal motility by hyperosmolar mannitol depends on local osmoreceptor control.

Duodenal motility is stimulated by hyperosmolar solution. Since intestinal distension also stimulates intestinal motility, this increase in the motility response may be due to either stimulation of duodenal local osmoreceptor control or intestinal distension resulting from osmotic equilibration. To test which mechanism is primarily responsible for this osmotically sensitive effect, we compared the number of duodenal spike bursts in five dogs equipped with duodenal fistulas that allowed for the preservation or removal of intestinal distension.

Disproportionate ileal digestion on canine food consumption. A possible model for satiety in pancreatic insufficiency.

In animals, ileal sensors of nutrients signal satiety more potently than similar sensors in jejunum. We postulated that inadequate food intake and weight loss in human pancreatic insufficiency might arise by the displacement of digestion to ileum, where excessive release of digestive products would enhance satiety. To test this idea, we studied dogs prepared with pancreatic fistulas, which allowed reversible switching of pancreatic juice from entry at duodenum to entry at mid-small intestine.

Prediction of maximal exercise capacity in obstructive and restrictive pulmonary disease.

We evaluated the predictive value of resting pulmonary function tests (PFTs) in the determination of maximal exercise capacity in patients with obstructive and restrictive ventilatory disease. We performed resting PFTs and an incremental exercise study on a bicycle ergometer in 146 patients with chronic obstructive pulmonary disease (COPD) and 68 patients with restrictive disease. The patients with obstructive disease were further subdivided into mild, moderate, and severe based on the severity of their airway obstruction (mean +/- SD:FEV1, 2.

Nutrient feedback inhibition of gastric emptying plays a larger role than osmotically dependent duodenal resistance.

The slowing of gastric emptying by hyperosmolar solutions has been postulated to result from the triggering of duodenal osmoreceptor feedback on the stomach. We tested the idea that the inhibition of gastric emptying by a hyperosmolar solution depended on the duodenal resistance and the triggering of nutrient-specific feedback by tracking gastric emptying of 300 and 1,200 mosmol/kgH2O test solutions in 12 dogs in which duodenal resistance was either removed (by temporarily diverting chyme from uncorked duodenal fistula) or preserved (by keeping duodenal fistula corked). Mannitol was used to test osmolality alone, and glucose was used to examine the combined effects of osmolality and nutrient-specific inhibitory feedback.