In Silico Examination of Initiation of Long-Acting Insulin Analogs Toujeo Compared to Lantus Under 3 Dosing Titration Rules in Virtual Type 2 Diabetes Subjects.

Background: Despite the benefits and clinical necessity of insulin treatment in type 2 diabetes (T2D), healthcare providers are reluctant to initiate insulin, and patients are reluctant to start it for several reasons, one of these being the complexity of insulin treatment. Patients and their healthcare providers can benefit from titration algorithms (TAs) or rules that assist with the initiation and titration of insulin, performing the calculations that are needed to safely initiate and conservatively adjust.

Methods: The primary objective for this in silico study was to examine the effectiveness of 3 dose TAs (1-3) for optimization of basal insulin glargine (Gla-100 and Gla-300).

RETROSPECTIVE STUDY OF GLYCEMIC CONTROL FOLLOWING TRANSITION FROM THE INTENSIVE CARE UNIT IN A NATIONAL SAMPLE OF U.S. HOSPITALS.

Objective: Retrospective study to evaluate glycemic control outcomes after transition from the intensive care unit (ICU) to a non-ICU area in a national sample of U.S. hospitals.

Accuracy of a novel noninvasive transdermal continuous glucose monitor in critically ill patients.

Stress hyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the critically ill. Intermittent, random blood glucose (BG) measurements can miss episodes of hyper- and hypoglycemia. The purpose of this study was to determine the accuracy of the Symphony® continuous glucose monitor (CGM) in critically ill cardiac surgery patients.

Benchmarking glycemic control in u.s. Hospitals.

Objective: Report data on glucose control from 635 U.S. hospitals.

Software-guided insulin dosing: tight glycemic control and decreased glycemic derangements in critically ill patients.

Objective: To determine whether glycemic derangements are more effectively controlled using software-guided insulin dosing compared with paper-based protocols.

Patients And Methods: We prospectively evaluated consecutive critically ill patients treated in a tertiary hospital surgical intensive care unit (ICU) between January 1 and June 30, 2008, and between January 1 and September 30, 2009. Paper-based protocol insulin dosing was evaluated as a baseline during the first period, followed by software-guided insulin dosing in the second period.

Trends in glycemic control over a 2-year period in 126 US hospitals.

Background: Cross-sectional data on inpatient glucose control in a large sample of US hospitals are now available, but little is known about changes in glycemic control over time in these institutions.

Objective: To evaluate trends in glycemic control in US hospitals over 2 years.

Design: Retrospective analysis.

Characterizing glucose changes antecedent to hypoglycemic events in the intensive care unit.

Objective: To determine whether patterns of glucose changes before hypoglycemia vary according to the severity of the event.

Methods: In this retrospective analysis, point-of-care blood glucose (POC-BG) data were obtained from the intensive care units (ICUs) of a convenience sample of hospitals that responded to a survey on inpatient diabetes management quality improvement initiatives. To evaluate POC-BG levels before hypoglycemic events, data from patients who experienced hypoglycemia during their time in the ICU were examined, and their glucose changes were assessed against a comparison group of patients who achieved a glycemic range of 80 to 110 mg/dL without ever experiencing hypoglycemia.

Assessing inpatient glycemic control: what are the next steps?

Despite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported.

Update on inpatient glycemic control in hospitals in the United States.

Objective: To provide data on glucose control in hospitals in the United States, analyzing measurements from the largest number of facilities to date.

Methods: Point-of-care bedside glucose (POC-BG) test results were extracted from 575 hospitals from January 2009 to December 2009 by using a laboratory information management system. Glycemic control for patients in the intensive care unit (ICU) and non-ICU areas was assessed by calculating patient-day-weighted mean POC-BG values and rates of hypoglycemia and hyperglycemia.

Case discussion in blood glucose variability.

Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate three cases in which intensive insulin therapy was administered using a standardized insulin dosing protocol to normalize the BG and reduce glycemic variability.

Benchmarking glucose results through automation: the 2009 Remote Automated Laboratory System Report.

Background: Hyperglycemia in the adult inpatient population remains a topic of intense study in U.S. hospitals.

Diabetes and hyperglycemia quality improvement efforts in hospitals in the United States: current status, practice variation, and barriers to implementation.

Objective: To determine the status of diabetes and hyperglycemia quality improvement efforts in hospitals in the United States.

Methods: We designed and administered a survey to a convenience sample of hospitals, and the responses were analyzed statistically.

Results: We received 269 responses from 1,151 requested surveys.

Inpatient glucose control: a glycemic survey of 126 U.S. hospitals.

Background: Despite increased awareness of the value of treating inpatient hyperglycemia, little is known about glucose control in U.S. hospitals.

Inpatient point-of-care bedside glucose testing: preliminary data on use of connectivity informatics to measure hospital glycemic control.

Background: Point-of-care (POC) bedside glucose (BG) testing and timely evaluation of its effectiveness are important components of hospital inpatient glycemic control programs. We describe a new technology to evaluate inpatient POC-BG testing and report preliminary results of inpatient glycemic control from 10 U.S.

Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair.

Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair.

Independent risk factors for anemia in cancer patients receiving chemotherapy: results from the European Cancer Anaemia Survey.

Objectives: To develop a hitherto unavailable risk factor model for accurately predicting anemia development in cancer patients before chemotherapy (CT) administration.

Methods: 2,070 nonanemic patients from the European Cancer Anaemia Survey (ECAS) with hemoglobin (Hb) > or =12 g/dl at enrollment who received their first CT during ECAS and underwent at least two CT cycles were divided randomly into split half (SH) 1 and SH2 (n = 1,035 each). The model was developed on SH1 using logistic regression to simultaneously evaluate predictive factors, and was validated using SH2 and an additional similar subpopulation of 5,901 ECAS patients.

Carotid endarterectomy: update on the gold standard treatment for carotid stenosis.

Many prospective, randomized clinical trials evaluating the safety and efficacy of carotid endarterectomy (CEA) versus medical management in the prevention of ischemic stroke were performed in the 1990s. Clinical trials are underway that will compare CEA outcomes to carotid stenting; however, relatively few studies have examined the outcomes of modern CEA. The purpose of this report is to examine current outcomes of CEA and evaluate hospital costs and length of stay.

Examination of sex as an independent risk factor for adverse events after carotid endarterectomy.

Background: The incidence of adverse events after carotid endarterectomy (CEA) for women compared with men is controversial. This report compares the incidence of perioperative stroke and death in men and women by examining the effect of comorbidities and hospital setting on CEA outcomes.

Methods: All CEAs performed in non-Federal acute-care Virginia hospitals between 1997 and 2001 were reviewed.

The aspect ratio (dome/neck) of ruptured and unruptured aneurysms.

Object: In this retrospective study the authors examined the aspect ratio (AR; the maximum dimension of the dome/width of the neck of an aneurysm) and compared the distribution of this ratio in a group of ruptured and unruptured aneurysms. A similar comparison was performed in relation to the maximum dimension of the aneurysm alone. The authors sought to evaluate the utility of these measures for differentiating ruptured and unruptured aneurysms.

Stroke risk factor profiles in African American women: an interim report from the African-American Antiplatelet Stroke Prevention Study.

Background And Purpose: If sex differences in stroke risk factor profiles exist among African Americans in the United States, prevention strategies will need to reflect those differences. African Americans and women have been underrepresented in stroke prevention studies. The purpose of this study was to determine whether medical and lifestyle factors differ among women and men who have enrolled in the African-American Antiplatelet Stroke Prevention Study (AAASPS).

Mild hypothermia: an alternative to deep hypothermia for achieving neuroprotection.

The role of excitotoxins in the ischemic cascade that results in ischemic neuronal death has been clearly defined and has brought about attempts to halt the progression of neurologic damage. Improved understanding of this process has allowed for the development of interventions to optimize neurologic outcome following periods of ischemia. Deep hypothermia (15-22 degrees C) has long been recognized as one method of achieving neuroprotection, but is not without serious implications and risks to the patient.

Cigarette smoking as a cause of aneurysmal subarachnoid hemorrhage and risk for vasospasm: a report of the Cooperative Aneurysm Study.

Object: Cigarette smoking is associated with aneurysmal subarachnoid hemorrhage (SAH) and subsequent vasospasm. The purpose of this study was to quantify this association.

Methods: Nearly 3500 patients with SAH from North America and Europe have been enrolled in five different multicenter, controlled studies coordinated at the Neuroclinical Trials Center of the Virginia Neurological Institute at the University of Virginia.

Education to improve stroke awareness and emergent response. The NINDS rt-PA Stroke Study Group.

Patients delay in responding to stroke as an emergency in part because they have deficient information about the disease and treatment. Healthcare providers may also have a lack of information about stroke assessment and management, which could attribute to delays in patient care. In order to provide early, rapid stroke treatment in eligible persons, the public and the healthcare community must be informed.