Dextrostix-Eyetone in the insulin hypoglycaemia test.

The Ames Dextrostix-Eyetone system was evaluated for monitoring the blood glucose concentration during insulin-induced hypoglycaemia. The results agreed well with laboratory values for plasma glucose, obtained by an orthotoluidine method, and the method was practicable as a bedside technique. In two cases quick results obtained with the Eyetone enabled the insulin tolerance test to be interrupted to prevent severe hypoglycaemia before the clinical indications were obvious. The extra time and effort required were minimal, and its value seems to far outweigh the disadvantage of the extra work entailed. Nevertheless, care in using the system was important, and the operator must familiarise himself with the system before the most reliable results can be obtained.     

Evaluating the Impact of Inadequate Meal Consumption on Insulin-Related Hypoglycemia in Hospitalized Patients

ObjectiveMeal intake is sometimes reduced in hospitalized patients. Meal-time insulin administration can cause hypoglycemia when a meal is not consumed. Inpatient providers may avoid ordering meal-time insulin due to hypoglycemia concerns, which can result in hyperglycemia. The frequency of reduced meal intake in hospitalized patients remains inadequately determined. This quality improvement project evaluates the percentage of meals consumed by hospitalized patients with insulin orders and the resulting risk of postmeal hypoglycemia (blood glucose [BG] <70 mg/dL, <3.9 mmol/L).MethodsThis was a retrospective quality improvement project evaluating patients with any subcutaneous insulin orders hospitalized at a regional academic medical center between 2015 and 2017. BG, laboratory values, point of care, insulin administration, diet orders, and percentage of meal consumed documented by registered nurses were abstracted from electronic health records.ResultsMeal consumption ≥50% was observed for 85% of meals with insulin orders, and bedside registered nurses were accurate at estimating this percentage. Age ≥65 years was a risk factor for reduced meal consumption (21% of meals 0%-49% consumed, P < .05 vs age < 65 years [12%]). Receiving meal-time insulin and then consuming only 0% to 49% of a meal (defined here as a mismatch) was not rare (6% of meals) and increased postmeal hypoglycemia risk. However, the attributable risk of postmeal hypoglycemia due to this mismatch was low (4 events per 1000) in patients with premeal BG between 70 and 180 mg/dL.ConclusionThis project demonstrates that hospitalized patients treated with subcutaneous insulin have a low attributable risk of postmeal hypoglycemia related to inadequate meal intake.     

Precision and costs of techniques for self-monitoring of serum glucose levels.

The poor correlation between serum and urine glucose measurements has led to the development of new techniques for monitoring the blood glucose level in diabetic patients. Either a nurse or the patient can perform these tests, which involve spreading a single drop of blood onto a reagent strip. A colour change that is proportional to the serum glucose level can be read visually or with a reflectance meter. Evaluated against simultaneous serum glucose levels determined by the hospital biochemistry laboratory, those of the new techniques employing reflectance meters all showed excellent correlation (r2 = 0.85 to 0.96). Reagent strips used without meters showed poorer correlation (r2 = 0.69 to 0.90). The instruction given to the patients and one nurse enabled them to obtain more accurate results with one of the meters than nurses not specially trained (r2 = 0.94 and 0.92 v. 0.85 respectively). The mean cost per glucose determination with the new techniques was 75, compared with +1.45 for the laboratory determinations done with automated equipment. It was concluded that the new techniques compared well with the reference method, particularly when reflectance meters were used, and that they were easily applied by the patient, as well as the medical staff, at a reasonable cost.     

Development and implementation of evidence-based guidelines for IV insulin: A statewide collaborative approach

Purpose: Recent studies have shown that the outcomes of hospitalized patients are greatly enhanced when steps are taken to improve control of their blood glucose levels. The Georgia Hospital Association Research and Education Foundation's Partnership for Health Accountability established a Diabetes Special Interest Group (D-SIG) in February 2003. Goals of the D-SIG were to enlighten health care professionals in Georgia hospitals about the benefits of controlling hyperglycemia in hospitalized patients and to develop processes to assist hospitals in the adoption of an IV insulin dosing algorithm, development of an IV insulin standing order set, and implementation of a hyperglycemia management plan.Methods: The D-SIG created an assessment tool titled “Key Elements of IV Insulin Guidelines” and evaluated numerous published IV insulin administration algorithms and protocols. After an extensive literature review, including international protocols and guidelines, user-friendly guidelines for subcutaneous and IV insulin were developed by a multidisciplinary work group, with members representing hospitals and other stakeholders from throughout the state. The group chose a well-researched method that was available in both computerized and hand-calculated formats and developed a Columnar Insulin Dosing Chart to assist with IV insulin infusions. This insulin-infusion table stems from mathematical formulas published by multiple investigators since the 1980s. The D-SIG guidelines and dosing chart were evaluated for ease of use, effectiveness, and safety in 3 settings: a small, rural critical-access hospital (CAH); an intensive care unit (ICU) in the trauma center of a large Georgia teaching hospital; and a surgical ICU in a midsize metropolitan hospital.Results: After implementation of the guidelines, the incidence of hypoglycemia (blood glucose level <60 mg/dL) was 0.9% in the trauma center ICU and 0.6% in the surgical ICU. All hypoglycemic patients in these 2 settings were asymptomatic, remained hypoglycemic only for a short time, and experienced no complications attributable to hypoglycemia. Using a moderate insulin sensitivity level for dosing initiations resulted in a time to target blood glucose level (80–110 mg/dL) of 6.4 hours, whereas using the most conservative approach required 12.8 hours to attain target range. At the CAH, time to reach the target blood glucose level (90–140 mg/dL) was 5.8 hours, and no episodes of hypoglycemia were reported. Although not part of the pilot initiative, the surgical ICU also reported a 5-fold reduction in surgical infection rates. The success of the dosing chart and standing order set paralleled that of the computerized formula when similar initiation doses were used.Conclusions: The Columnar Insulin Dosing Chart and sample clinical guidelines were piloted at 3 different settings and found to be safe and effective. Furthermore, by including the treatment for hypoglycemia in the guidelines, nurses in all patient care areas were able to manage blood glucose levels below the target range in a safe and timely manner. Use of the dosing chart and guidelines reduced blood glucose levels to the target range with no clinically significant hypoglycemia.     

Validation of a glucose meter at an intensive care unit

IntroductionHyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose.Material and methodsEighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline.ResultsMean whole blood glucose level measured by the glucose meter was 126.53 + 49.28 mg/dL (range, 33.5-431 mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13 + 78.6 mg/dL (range, 43-451 mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99.ConclusionsThe tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring.     

The absorption of insulin from various regions of the rat intestine

The absorption of intact, biologically active insulin from the ileum, or the ascending colon was measured by the resulting changes in blood glucose concentration. One hour after injection of the ascending colon with a 1 ml volume containing 12 u insulin and 2 mg DOC the blood glucose level was reduced to 50% of the initial value, i.e. 31±2.0 mg%.When insulin was injected directly into the lumen of the ileum, the addition of 3 mg soybean trypsin inhibitor boosted the insulin effect. Direct injection of the ileum with 12 u insulin and 3 mg soybean trypsin inhibitor resulted in a significant drop in blood glucose: 69±5.0 and 85±8.1% of the initial concentration, following 1 and 2 hours, respectively.In the presence of soybean trypsin inhibitor, it was found that the endogenous bile salts in the ileum aid in the absorption of biologically active insulin.     

Once-Daily Insulin Glargine Versus 6-Hour Sliding Scale Regular Insulin for Control of Hyperglycemia after a Bariatric Surgical Procedure: A Randomized Clinical Trial

ObjectiveTo determine whether once-daily insulin glargine could provide better glycemic control after an abdominal surgical procedure than the traditional use of sliding scale regular insulin (SSRI).MethodsBecause 20% to 30% of patients undergoing gastric bypass have a history of overt diabetes and another 5% to 10% are estimated to have impaired glucose tolerance, we chose to study these patients. We treated 81 patients with postoperative blood glucose levels of more than 144 mg/dL after a Roux-en-Y gastric bypass surgical procedure. They were randomized to receive either SSRI or insulin glargine either directly or after initial intravenous insulin infusion in the intensive care unit (ICU).ResultsOverall, the mean blood glucose level after SSRI therapy was 154 ± 33 mg/dL, and the mean blood glucose value after insulin glargine treatment was 134 ± 30 mg/dL (P < 0.01). The mean blood glucose level for patients first treated with intravenous insulin infusion in the ICU was 125 mg/dL, in comparison with 145 mg/dL in the non-ICU patients whose treatment began directly with 0.3 U/kg of insulin glargine. Of 926 blood glucose measurements, only 3 were less than 60 mg/dL.ConclusionIn this study, control of postoperative hyperglycemia was significantly better with use of insulin glargine in comparison with SSRI therapy, and hypo-glycemia was very infrequent. (Endocr Pract. 2007;13: 225-231)     

神经外科ICU与普通ICU病区患者分离肺炎克雷伯菌耐药性比较

目的分析温州市永嘉县人民医院神经外科ICU和普通ICU病区患者分离肺炎克雷伯菌的标本来源及耐药性的差异,为指导患者合理使用抗生素提供依据。方法采用回顾性分析方法对该院神经外科ICU和普通ICU病区五年来分离的肺炎克雷伯菌的标本来源及药敏结果进行分析,并运用统计学软件Whonet 5.4进行耐药分析。结果五年来该院神经外科ICU分离的肺炎克雷伯菌123株来自痰液,占51.68%;52株来自尿液,占15.97%;38株来自血液,占21.85%;12株来自脓液,占5.04%;8株来自引流液,占3.36%。而普通ICU病区分离肺炎克雷伯菌164株来自痰液,占41.72%;68株来自血液,占22.52%;53株来自尿液,占17.55%;35株来自引流液,占11.59%;12株来自脓液,占3.97%。对药敏结果分析发现,神经外科ICU分离株对头孢噻肟、头孢他啶、头孢吡肟、头孢曲松、阿米卡星、亚胺培南及美罗培南的耐药率大部分高于普通ICU分离株,而对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、环丙沙星及左氧氟沙星的耐药率低于普通ICU分离株。结论该院神经外科ICU分离肺炎克雷伯菌的标本来源及耐药性与普通ICU分离肺炎克雷伯菌存在显著差异,针对不同ICU病区分离菌株的抗生素选择也有所不同。     

Adapting to the new consensus guidelines for managing hyperglycemia during critical illness: the updated Yale insulin infusion protocol

ObjectiveTo report our preliminary experience with the revised, more conservative Yale insulin infusion protocol (IIP) that targets blood glucose concentrations of 120 to 160 mg/dL.MethodsWe prospectively tracked clinical responses to the new IIP in our medical intensive care unit (ICU) by recording data on the first 115 consecutive insulin infusions that were initiated. All blood glucose values; insulin doses; nutritional support including intravenous dextrose infusions; caloric values for enteral and parenteral nutrition; and use of vasopressors, corticosteroids, and hemodialysis or continuous venovenous hemodialysis were collected from the hospital record.ResultsThe IIP was used 115 times in 90 patients (mean age, 62 [± 14 years]; 51% male; 35% ethnic minorities; 66.1% with history of diabetes). The mean admission Acute Physiology and Chronic Health Evaluation II score was 24.4 (± 7.5). The median duration of insulin infusion was 59 hours. The mean baseline blood glucose concentration was 306.1 (± 89.8) mg/dL, with the blood glucose target achieved after a median of 7 hours. Once the target was reached, the mean IIP blood glucose concentration was 155.9 (± 22.9) mg/dL (median, 150 mg/dL). The median insulin infusion rate required to reach and maintain the target range was 3.5 units/h. Hypoglycemia was rare, with 0.3% of blood glucose values recorded being less than 70 mg/dL and only 0.02% being less than 40 mg/dL. In all cases, hypoglycemia was rapidly corrected using intravenous dextrose with no evident untoward outcomes.ConclusionsThe updated Yale IIP provides effective and safe targeted blood glucose control in critically ill patients, in compliance with recent national guidelines. It can be easily implemented by hospitals now using the original Yale IIP. (Endocr Pract. 2012;18:363-370)     

Customized Reference Ranges for Laboratory Values Decrease False Positive Alerts in Intensive Care Unit Patients

Background

Traditional electronic medical record (EMR) interfaces mark laboratory tests as abnormal based on standard reference ranges derived from healthy, middle-aged adults. This yields many false positive alerts with subsequent alert-fatigue when applied to complex populations like hospitalized, critically ill patients. Novel EMR interfaces using adjusted reference ranges customized for specific patient populations may ameliorate this problem.

Objective

To compare accuracy of abnormal laboratory value indicators in a novel vs traditional EMR interface.

Methods

Laboratory data from intensive care unit (ICU) patients consecutively admitted during a two-day period were recorded. For each patient, available laboratory results and the problem list were sent to two mutually blinded critical care experts, who marked the values about which they would like to be alerted. All disagreements were resolved by an independent super-reviewer. Based on this gold standard, we calculated and compared the sensitivity, specificity, positive and negative predictive values (PPV, NPV) of customized vs traditional abnormal value indicators.

Results

Thirty seven patients with a total of 1341 laboratory results were included. Experts’ agreement was fair (kappa = 0.39). Compared to the traditional EMR, custom abnormal laboratory value indicators had similar sensitivity (77% vs 85%, P = 0.22) and NPV (97.1% vs 98.6%, P = 0.06) but higher specificity (79% vs 61%, P<0.001) and PPV (28% vs 11%, P<0.001).

Conclusions

Reference ranges for laboratory values customized for an ICU population decrease false positive alerts. Disagreement among clinicians about which laboratory values should be indicated as abnormal limits the development of customized reference ranges.     

Consumption of Clarified Grapefruit Juice Ameliorates High-Fat Diet Induced Insulin Resistance and Weight Gain in Mice

To determine the metabolic effects of grapefruit juice consumption we established a model in which C57Bl/6 mice drank 25–50% sweetened GFJ, clarified of larger insoluble particles by centrifugation (cGFJ), ad libitum as their sole source of liquid or isocaloric and sweetened water. cGFJ and control groups consumed similar amounts of liquids and calories. Mice fed a high-fat diet and cGFJ experienced a 18.4% decrease in weight, a 13–17% decrease in fasting blood glucose, a three-fold decrease in fasting serum insulin, and a 38% decrease in liver triacylglycerol values, compared to controls. Mice fed a low-fat diet that drank cGFJ experienced a two-fold decrease in fasting insulin, but not the other outcomes observed with the high-fat diet. cGFJ consumption decreased blood glucose to a similar extent as the commonly used anti-diabetic drug metformin. Introduction of cGFJ after onset of diet-induced obesity also reduced weight and blood glucose. A bioactive compound in cGFJ, naringin, reduced blood glucose and improved insulin tolerance, but did not ameliorate weight gain. These data from a well-controlled animal study indicate that GFJ contains more than one health-promoting neutraceutical, and warrant further studies of GFJ effects in the context of obesity and/or the western diet.     

Accuracy of handheld blood glucose meters at high altitude

Background

Due to increasing numbers of people with diabetes taking part in extreme sports (e.g., high-altitude trekking), reliable handheld blood glucose meters (BGMs) are necessary. Accurate blood glucose measurement under extreme conditions is paramount for safe recreation at altitude. Prior studies reported bias in blood glucose measurements using different BGMs at high altitude. We hypothesized that glucose-oxidase based BGMs are more influenced by the lower atmospheric oxygen pressure at altitude than glucose dehydrogenase based BGMs.

Methodology/Principal Findings

Glucose measurements at simulated altitude of nine BGMs (six glucose dehydrogenase and three glucose oxidase BGMs) were compared to glucose measurement on a similar BGM at sea level and to a laboratory glucose reference method. Venous blood samples of four different glucose levels were used. Moreover, two glucose oxidase and two glucose dehydrogenase based BGMs were evaluated at different altitudes on Mount Kilimanjaro. Accuracy criteria were set at a bias <15% from reference glucose (when >6.5 mmol/L) and <1 mmol/L from reference glucose (when <6.5 mmol/L). No significant difference was observed between measurements at simulated altitude and sea level for either glucose oxidase based BGMs or glucose dehydrogenase based BGMs as a group phenomenon. Two GDH based BGMs did not meet set performance criteria. Most BGMs are generally overestimating true glucose concentration at high altitude.

Conclusion

At simulated high altitude all tested BGMs, including glucose oxidase based BGMs, did not show influence of low atmospheric oxygen pressure. All BGMs, except for two GDH based BGMs, performed within predefined criteria. At true high altitude one GDH based BGM had best precision and accuracy.     

An internal positive control for the enumeration of CD45(+) and CD34(+) cells by flow cytometry allows monitoring of reagent and operator performance

BACKGROUND: Three-color flow cytometry assays are used to determine CD34(+) cell doses prior to stem cell transplantation. These assays require high-quality reagents that are dispensed accurately to ensure reproducible results. We have developed a flow cytometry assay for CD34(+) cells with an integral positive control (KG1a cells) for monitoring reagent and operator performance. METHODS: The method was validated using samples from 127 allogeneic donations (42 BM, 85 PBSC) from healthy donors and 195 autologous donations (46 BM, 149 PBSC) from patients in remission from hematologic malignancies. The mean, SD and range of CD45(+) and CD34(+)cell counts were determined for each donation type. An internal control was used to assess performance of reagents and operators by comparison with a predetermined target value and an experienced operator. RESULTS: Replicate studies showed the method to be accurate and precise, with KG1a cells at 97.7+/-3.9% of the target value and a CV of 4.0%. In routine use over 322 samples, the accuracy was 91.7+/-17.7% of the target value, with a CV of 19.3%. Investigations into the cause of the reduced precision showed that reagents performed consistently well but operator performance was variable, with two of six operators significantly under-dispensing KG1a cells. DISCUSSION: This study validates our three-color flow cytometry assay and demonstrates that KG1a cells may be used to monitor test performance in the routine working environment. In addition to monitoring performance within a single laboratory, its wider use in multicenter studies may be helpful regarding standardization of methods.     

Insulin secretion in the hibernating edible dormouse (Glis glis): in vivo and in vitro studies

Plasma glucose and insulin have been studied during lethargy and spontaneous arousal of hibernating edible dormouse. During lethargy blood glucose was low while plasma insulin remained at the same level as in other seasons. Plasma glucose and insulin did not fluctuate along the phase of lethargy. During spontaneous arousal plasma insulin rose strongly from the 17 degrees C stage, reaching the higher values at 26 degrees C while blood glucose was only 85 mg/100 ml, then decreased at 37 degrees C. The effect of glucose and temperature on insulin secretion was studied using perfused pancreas preparation from hibernating edible dormice. During the rewarming of the edible dormouse pancreas the insulin release did not occur in response to the absolute extracellular glucose level but occurred in response to a B cell membrane phenomenon which was dependent on the changing rate of glucose level. The effect of glucose and temperature on insulin secretion from perfused pancreas was compared between edible dormouse and homeotherm permanent, the rat. The B cell response to glucose of the dormouse pancreas increased up to 15 degrees C whereas that of the rat only from 25 degrees C. The dormouse insulin secretion reached a peak value at the 30 degrees C of temperature, whereas that of the rat progressively increased until 37 degrees C. These results showed that some biochemical adjustment or process of acclimatization took place in the B cells of the hibernators.     

An international proficiency study with the tumor marker CA 125

A strict and adequate quality assurance program is the only real guarantee of the reliability of laboratory test results. Such proficiency testing was carried out for the CA 125 test system in five university laboratories over a period of three years (1984-1987) using five different reference materials (BIOREF, FRG). A concentration-dependent performance profile could thus be established evaluating a total of 301 assays. Intra-assay precision of the test ranged between 4.8 and 11.5%, and interassay precision between 13.6 and 19.1%. Laboratory specific average values of the individual reference materials ranged between 26 and 32 U/ml for reference 1, 51 and 59 U/ml for reference 2, 109 and 121 U/ml and 193 to 240 U/ml for references 3 and 4, respectively. Mean values for reference 5 ranged between 401 and 458 U/ml. There was no significant difference between mean values for the laboratories. Considerable batch-dependent variations of values became evident during the study but these were not indicated by the kit control supplied by the manufacturer. During the whole investigation period no systematic drift in values could be observed using trend analysis, indicating excellent stability of the reference material if stored frozen (-20 degrees C).     

儿童ICU与普通病房铜绿假单胞菌分布及耐药性分析

目的了解铜绿假单胞菌在儿童重症监护病房（ICU）与普通病房的分布及耐药性差异,为临床合理、有效的治疗提供依据。方法分析重庆医科大学附属儿童医院2013年1月至2013年12月ICU及普通病房铜绿假单胞菌培养阳性患儿的年龄分布、菌株来源、抗菌药物的耐药性。结果 ICU和普通病房分别分离出82株和429株铜绿假单胞菌,年龄均小于2岁（70.73%和69.23%）,以痰标本来源（80.49%和64.80%）为主。ICU分离的铜绿假单胞菌对氟喹诺酮类药物的耐药率低于普通病房,对其余测试药物的耐药率均高于普通病房。ICU分离的铜绿假单胞菌中多重耐药菌55株（67.07%）,泛耐药菌44株（53.66%）,均明显高于普通病房（26.81%,3.26%）（P〈0.05）。结论铜绿假单胞菌是ICU常见的病原菌,具有多重耐药特性,加强耐药性监测,控制医院内感染,对临床医生选用有效的抗生素具有十分重要的意义。     

Novel device for quick measurement of glucose in POCT areas without pre‐analytical steps based on a multi‐way glucose biosensor

Professional Point of Care testing demands rapid analysis and professional quality. To assure rapid analysis of high quality the analytical tool ideally should be able to work without sample pre‐treatment and should offer the opportunity to calibrate and/or control the analytical performance of the tool. In contrast to an enormous number of different disposable‐strips used for patient self monitoring today and based on an extended knowledge with respect to multi‐way biosensors used in laboratory analyzers we decided to develop a professional Point of Care Testing system for glucose analysis based on a multi‐way biosensor. The multi‐way glucose biosensor placed in the instrument for 30 days did reduce the lag time between blood withdrawal and availability of a result of lab quality in a bedside area to about 10 seconds. No pre‐analytical steps are necessary for measuring capillary whole blood, no crossing over was observed, and the data could be transferred into a laboratory information system or a hospital information system. Thus, we were able to realize tools for professional health control able to measure glucose values in laboratory quality at places outside laboratories: e.g., in doctor's offices, hospital wards, critical care units, and training units of athletes. By combining the advantages of laboratory analyzers (high quality and low sample price) and the advantages of disposable strips (simple procedure and immediate results after sample withdrawal) with the Glukometer 3000 and LactatProfi 3000 we did start to fill the gap between the two basic technologies available on the market for diagnosis today. Glukometer 3000 and LactatProfi 3000 are worldwide the first and only mobile glucose and lactate measuring instruments for decentralized locations based on multi‐way biosensors.     

多药耐药菌肺感染患者应用改良后呼吸机对病室环境卫生学影响

目的:探讨应用改良后的呼吸机对病室环境卫生学的影响。方法:对10例产碳青霉烯酶肺炎克雷伯菌肺感染应用呼吸机的患者和40例肺部感染耐甲氧西林金黄色葡萄球菌(MRSA)使用呼吸机的患者进行分组试验,对病室环境卫生学监测结果进行统计分析。机器改良方法是呼吸机的呼气阀处连接一条螺纹管,将带菌空气引出,消毒后排放。结果:肺部感染产碳青霉烯酶肺炎克雷伯菌应用改良后呼吸机的一组在空气、床头桌、水池、操作中人员手的阳性率分别为20%、10%、20%、10%,较未改良的对照组为80%、70%、70%、50%有明显的下降。肺部感染MRSA使用有创改良呼吸机组空气、床头桌、水池、操作中人员手的阳性率分别为10%、10%、5%、10%均低于无创改良组的20%、20%、10%、20%。结论:此种方法有效地降低了环境的污染程度,降低了医源性医院感染的风险。加强洗手和隔离等卫生预防学措施可以有效的降低MRSA的医院感染率。     

The Effects of Pregnancy and Feeding on the Insulin and Glucose Concentrations in Blood of Ewes in Late Pregnancy

In 8 experimental ewes on normal diet the influence of pregnancy and feeding on insulin and glucose in the blood was studied. A reduction in insulin concentration was found as pregnancy advanced. Blood glucose fluctuated, but during late pregnancy the blood glucose level was significantly lower in twin–pregnant ewes than in ewes pregnant with 1 fetus. No increase in insulin concentration was demonstrated in twin–pregnant ewes after feeding, on the contrary an increase was found in ewes pregnant with 1 fetus. A limited effect of feeding on the glucose concentration was observed, especially compared to the reference range. A positive correlation was obtained between the concentration of glucose and insulin in the blood.     

Update on Inpatient Glycemic Control in Hospitals in the United States

ObjectiveTo provide data on glucose control in hospitals in the United States, analyzing measurements from the largest number of facilities to date.MethodsPoint-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. The relationship between POC-BG levels and hospital characteristics was determined.ResultsA total of 49,191,313 POC-BG measurements (12,176,299 ICU and 37,015,014 non-ICU values) were obtained from 3,484,795 inpatients (653,359 in the ICU and 2,831,436 in non-ICU areas). The mean POC-BG was 167 mg/dL for ICU patients and 166 mg/dL for nonICU patients. The prevalence of hyperglycemia (> 180 mg/ dL) was 32.2% of patient-days for ICU patients and 32.0% of patient-days for non-ICU patients. The prevalence of hypoglycemia (< 70 mg/dL) was 6.3% of patient-days for ICU patients and 5.7% of patient-days for non-ICU patients. Patient-day-weighted mean POC-BG levels varied on the basis of hospital size (P < .01), type (P < .01), and geographic location (P < .01) for ICU and non-ICU patients, with larger hospitals (≥ 400 beds), academic hospitals, and US hospitals in the West having the lowest mean POC-BG values. The percentage of patient-days in the ICU characterized by hypoglycemia was highest among larger and academic hospitals (P < .05) and least among hospitals in the Northeast (P < .001).ConclusionHyperglycemia is common in hospitals in the United States, and glycemic control may vary on the basis of hospital characteristics. Increased hospital participation in data collection may support a national benchmarking process for the development of optimal practices to manage inpatient hyperglycemia. (Endocr Pract. 2011;17:853-861)