Basal-bolus insulin therapy in postoperative inpatients with diabetes mellitus: directions for future quality-improvement initiatives.

Aim: To determine variables associated with hyperglycemia and insulin therapy in postoperative inpatients with diabetes mellitus following a quality-improvement initiative.

Materials & Methods: Patients with diabetes mellitus following an elective surgical procedure (n = 782; 877 surgical procedures) were selected.

Results: Age, hemoglobin A corticosteroids, insulin therapy and year of surgery were associated (p < 0.

Relationship between the timing of preoperative medical visits and day-of-surgery glucose in poorly controlled diabetes.

Background: This study evaluated referral patterns for preoperative evaluations of patients with poorly controlled diabetes mellitus (DM) and determined whether intervals between evaluations and surgery day were associated with preoperative glucose levels.

Results/methodology: In this retrospective analysis of DM patients with a hemoglobin A level greater than 8.0%, of the 163 patients who underwent preoperative medical evaluation, only 45% were evaluated by endocrinology.

Perioperative Management of Patients with Diabetes and Hyperglycemia Undergoing Elective Surgery.

Diabetes mellitus (DM) and hyperglycemia are associated with increased surgical morbidity and mortality. Hyperglycemia is a determinant of risk of surgical complications and should be addressed across the continuum of surgical care. While data support the need to address hyperglycemia in patients with DM in the ambulatory setting prior to surgery and in the inpatient setting, data are less certain about hyperglycemia occurring during the perioperative period-that part of the process occurring on the day of surgery itself.

GUIDELINES TO IMPROVE PERIOPERATIVE MANAGEMENT OF DIABETES MELLITUS: ASSESSMENT OF THE IMPACT OF CHANGE ACROSS TIME.

Objective: Assess the impact of guidelines on the care of patients with diabetes undergoing elective surgery.

Methods: A multidisciplinary team developed perioperative guidelines. Overall changes in key measures were evaluated after guidelines were introduced and compared with a historical cohort.

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy.

Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures.

Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation.

Clinical and molecular features of Hürthle cell carcinoma of the thyroid.

Context: Hürthle cell cancer (HCC) of the thyroid remains the subject of controversy with respect to natural course, treatment, and follow-up.

Objective: The objective of the study was to evaluate the clinical and molecular features associated with outcome in HCC.

Design: The study was a review of 173 HCC cases treated at Mayo Clinic over 11 years with a median 5.

Overcoming clinical inertia in the management of postoperative patients with diabetes.

Objective: To assess the impact of an intervention designed to increase basal-bolus insulin therapy administration in postoperative patients with diabetes mellitus.

Methods: Educational sessions and direct support for surgical services were provided by a nurse practitioner (NP). Outcome data from the intervention were compared to data from a historical (control) period.

Perioperative management of patients with diabetes undergoing ambulatory elective surgery.

Objective: The objective was to assess processes of care for patients with diabetes undergoing elective surgery.

Methods: A retrospective review of medical records was conducted to determine frequency of perioperative glucose monitoring, changes in glucose control, and treatment of intraoperative hyperglycemia.

Results: A total of 268 patients underwent 287 elective procedures.

Clinical inertia during postoperative management of diabetes mellitus: relationship between hyperglycemia and insulin therapy intensification.

Objective: Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes.

Methods: A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult.

Ewing sarcoma of the adrenal gland: a rare entity.

A 63-year-old man was referred to our office with an enlarging left adrenal mass found on work-up for prostate cancer. Imaging performed over the course of 6 months demonstrated an increasing left adrenal mass from 2.8 to 3.

Metastatic carcinoid tumors--are we making the cut?

Background: Although controversial, surgical resection for metastatic carcinoid tumors (MCTs) can potentially prolong survival.

Methods: Patients with MCTs were identified from the Surveillance, Epidemiology and End Results database. Patients undergoing surgery were compared to unresected patients.

Insulin pump therapy in the perioperative period: a review of care after implementation of institutional guidelines.

Background: An institutional policy was previously established for patients with diabetes on insulin pump therapy undergoing elective surgical procedures.

Method: Electronic medical records were reviewed to assess documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of care.

Results: Twenty patients with insulin pumps underwent 23 procedures from March 1 to December 31, 2011.

Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period.

Case reports indicate that diabetes patients receiving outpatient insulin pump therapy have been allowed to continue treatment during surgical procedures. Although allowed during surgery, there is actually little information in the medical literature on how to manage patients receiving insulin pump therapy during a planned surgical procedure. A multidisciplinary work group reviewed current information regarding the use of insulin pumps in the perioperative period.

Insulin pump therapy in patients with diabetes undergoing surgery.

Objective: To assess perioperative management of patients with diabetes mellitus who were being treated with insulin pump therapy.

Methods: We reviewed records for documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of surgery.

Results: Thirty-five patients (21 men) with insulin pumps underwent surgical procedures between January 1, 2006, and December 31, 2010.

Outcomes of minimally invasive myotomy for the treatment of achalasia in the elderly.

Background: An increasing number of elderly patients diagnosed with achalasia are being referred for minimally invasive myotomy. Little data are available about the operative outcomes in this population. The objective of this study was to review our experience with this procedure in an elderly population.

Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience.

Hypothesis: Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is safe and effective.

Design: Retrospective medical record review.

Setting: Tertiary referral center.

Anterior mediastinotomy for parathyroidectomy.

Background: Approximately 2% of ectopic parathyroid glands reside within the mediastinum in a location that requires a thoracic approach.

Methods: All patients with mediastinal parathyroid tumors who underwent anterior mediastinotomy were included in this review.

Results: Over the course of 16 years, 10 patients with primary hyperparathyroidism underwent anterior mediastinotomy.

Laparoscopic repair of colonoscopic perforations: indications and guidelines.

Iatrogenic colonic perforation is one of the most serious potential complications of colonoscopy. Standard management is surgical repair. No prospective data exist to clearly define the indications for laparoscopic repair.

The development of a laparoscopic donor nephrectomy program in a de novo renal transplant program: Evolution of technique and results in over 200 cases.

Background And Objectives: In 1999, our institution began a kidney transplant program with collaboration between the departments of General Surgery/Transplantation and Urology. From the onset, donor nephrectomies were performed laparoscopically and are currently the domain of Urology, which had no prior laparoscopic experience before this undertaking. We reviewed our experience.

Cell-free expression and selective isotope labelling in protein NMR.

Isotope labelling is a very powerful tool in NMR studies of proteins and has been employed in various ways for over 40 years. 15N and 13C incorporation, using recombinant expression systems, is now commonplace because heteronuclear experiments assist with the fundamental problems of peak resolution and assignment. The use of selective labelling for peak assignment has been restricted by the scrambling of isotope label through metabolic pathways within the expression host organism.

Telepathy: maximizing resident exposure to surgical pathology decision making.

Background: General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings.

Methods: A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter, an operating room was equipped to view frozen section images in real time and verbally communicate with the pathologist (TelePATHy).

Hand movements in laparoscopic suturing: a simple vector analysis.

Background: Laparoscopic suturing is a complex task that is vital to the performance of many advanced laparoscopic procedures. Mastery can be difficult and problematic for surgical trainees.

Methods: We present a description of hand movements in laparoscopic suturing.

Interdomain tilt angle determines integrin-dependent function of the ninth and tenth FIII domains of human fibronectin.

Integrins are an important family of signaling receptors that mediate diverse cellular processes. The binding of the abundant extracellular matrix ligand fibronectin to integrins alpha(5)beta(1) and alpha(v)beta(3) is known to depend upon the Arg-Gly-Asp (RGD) motif on the tenth fibronectin FIII domain. The adjacent ninth FIII domain provides a synergistic effect on RGD-mediated integrin alpha(5)beta(1) binding and downstream function.