bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital
Authors: Cheekati Vasundhara , Osburne Robert C. , Jameson Kimberly A. , Cook Curtiss B. 
Published: January 2009

AbstractBACKGROUND:Information regarding practitioner beliefs about inpatient diabetes care is limited.OBJECTIVE:To assess resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal glycemic control in an urban hospital setting.DESIGN:A previously developed questionnaire was modified and administered. Residents were asked about the importance of inpatient glucose control, desirable glucose ranges, and problems encountered when managing hyperglycemia.SETTING:Urban teaching hospital.RESULTS:Of 85 resident physicians, 66 completed the survey (mean age, 31 years; 47% men; 33% in first residency year). Most respondents categorized glucose control as “very important” in critically‐ill and perioperative patients but only “somewhat important” in non‐critically‐ill patients. Most residents said they would target a therapeutic glucose range within the recommended levels. Most residents (88%) also said they felt “very comfortable” or “somewhat comfortable” using subcutaneous insulin therapy, whereas some were “not at all comfortable” with either subcutaneous (11%) or intravenous (18%) administration. In general, respondents were not very familiar with existing institutional policies and preprinted order sets. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and their use. Anxiety about hypoglycemia was only the third most frequent concern.CONCLUSION:Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control. Journal of Hospital Medicine 2009;4:E1–E8. © 2009 Society of Hospital Medicine.
Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial
Authors: Schnipper Jeffrey L. , Ndumele Chima D. , Liang Catherine L. , Pendergrass Merri L. 
Published: January 2009

AbstractBACKGROUND:Inpatient hyperglycemia is associated with poor patient outcomes. It is unknown how best to implement glycemic management strategies in the non–intensive care unit (ICU) setting.OBJECTIVE:To determine the effects of a multifaceted quality improvement intervention on the management of medical inpatients with diabetes mellitus or hyperglycemia.DESIGN:Before‐after trial.SETTING:Geographically localized general medical service staffed by physician's assistants (PAs) and hospitalists.PATIENTS:Consecutively enrolled patients with type 2 diabetes or inpatient hyperglycemia.INTERVENTION:A detailed subcutaneous insulin protocol, an admission order set built into the hospital's computerized order entry system, and case‐based educational workshops and lectures to nurses, physicians, and PAs.MEASUREMENTS:Mean percent of glucose readings per patient between 60 and 180 mg/dL; percent patient‐days with hypoglycemia; insulin use patterns; and hospital length of stay.RESULTS:The mean percent of readings per patient between 60 and 180 mg/dL was 59% prior to the intervention and 65% afterward (adjusted effect size 9.7%; 95% confidence interval [CI], 0.6%‐18.8%). The percent of patient days with any hypoglycemia was 5.5% preintervention and 6.1% afterward (adjusted odds ratio 1.1; 95% CI, 0.6–2.1). Use of scheduled nutritional insulin increased from 40% to 75% (odds ratio 4.5; 95% CI, 2.0–9.9) and adjusted length of stay decreased by 25% (95% CI, 9%‐44%). Daily insulin adjustment did not improve, nor did glucose control beyond hospital day 3.CONCLUSIONS:This multifaceted intervention, which was easy to implement and required minimal resources, was associated with improvements in both insulin ordering practices and glycemic control among non‐ICU medical patients. Journal of Hospital Medicine 2009;4:16–27. © 2009 Society of Hospital Medicine.
Evaluation of hospital glycemic control at US Academic Medical Centers
Authors: Boord Jeffrey B. , Greevy Robert A. , Braithwaite Susan S. , Arnold Pamela C. , Selig Patricia M. , Brake Helga , Cuny Joanne , Baldwin David 
Published: January 2009

AbstractOBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN:This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics.RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%–63%) and timely admission laboratory glucose measurement (range, 39%–97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose ≤110 mg/dL. Hyperglycemia was common, 50% of all patients had ≥1 glucose measurement ≥180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days.CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal. Academic medical centers have opportunities to improve care to meet current American Diabetes Association hospital diabetes care standards. Journal of Hospital Medicine 2009;4:35–44. © 2009 Society of Hospital Medicine.
Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: Effect of structured subcutaneous insulin orders and an insulin management algorithm
Authors: Maynard Greg , Lee Joshua , Phillips Gerard , Fink Ed , Renvall Marian 
Published: January 2009

AbstractBACKGROUND:Structured subcutaneous insulin order sets and insulin protocols are widely advocated. The intervention effects are not well reported.OBJECTIVE:Assess the impact of these interventions on insulin use patterns, hypoglycemia, and glycemic control.DESIGN:Prospective observational.SETTING:400‐bed academic center.PATIENTS:Adult non‐critical care inpatients with diabetes or hyperglycemia and point‐of‐care (POC) glucose testing.INTERVENTIONS:Structured insulin orders, insulin management algorithm.MEASUREMENTS:Percent of insulin orders with basal insulin. Percent uncontrolled patient‐stays (day‐weighted mean glucose ≥180 mg/dL) and uncontrolled patient‐days (patient‐day mean glucose ≥180 mg/dL). Percent of monitored patient‐days and patient‐stays with hypoglycemia (glucose ≤60 mg/dL) and severe hypoglycemia (glucose ≤40 mg/dL).RESULTS:The percent sliding scale only insulin regimens decreased (72% versus 26% with structured insulin orders, P < 0.0001 chi square). The percent of uncontrolled patient‐days was 37.8% versus 33.9% versus 30.1% (P < 0.005) (TP1–Baseline; TP2–Structured insulin orders; TP3–Orders plus Algorithm). Expressed as relative risk with 95% confidence interval (RR with CI), the RR of an uncontrolled patient‐stay was reduced from baseline to 0.91 (CI 0.85–0.96) in TP2, and to 0.84 (CI 0.77–0.89) in TP3, with more marked effects in the secondary analysis limited to patients with at least 8 POC values. The percent of patient‐days with hypoglycemia was 3.8%, 2.9%, and 2.6% in 3 time periods, representing a RR for hypoglycemic day in TP3:TP1 of 0.68 (CI 0.59‐0.78). Similar reductions were seen in risk for hypoglycemic patient‐stays.CONCLUSIONS:Hypoglycemia and glycemic control can be improved simultaneously with structured insulin orders and management algorithms. Journal of Hospital Medicine 2009;4:3–15. © 2009 Society of Hospital Medicine.
Evaluation of glycemic control following discontinuation of an intensive insulin protocol
Authors: Czosnowski Quinn A. , Swanson Joseph M. , Lobo Bob L. , Broyles Joyce E. , Deaton Paul R. , Finch Christopher K. 
Published: January 2009

AbstractBACKGROUND:Intensive insulin protocols (IIPs) have been demonstrated to reduce morbidity and mortality in critically ill patients. Currently, there are no published studies evaluating glycemic control after discontinuation of an IIP.OBJECTIVE:The purpose of this study was to compare blood glucose (BG) control during an IIP and for 5 days following its discontinuation (follow‐up period).METHODS:The study was a retrospective review of intensive care unit patients who received an IIP for ≥24 hours. Data were collected during the last 12 hours of the IIP and subsequent follow‐up period.RESULTS:For all 65 included patients, the mean ± standard deviation for BG on the IIP was 123 ± 26 mg/dL versus 168 ± 50 mg/dL following discontinuation of the IIP (P < 0.001). The median (interquartile range) insulin that was administered decreased from 40 (22–65) units on the IIP to 8 (0–18) units after the IIP was stopped (P < 0.001). The mean daily BG during the follow‐up period was significantly higher than that during the IIP (P < 0.001). Additionally, an insulin requirement of >20 units during the last 12 hours of the IIP was identified as a risk factor for poor glycemic control during the follow‐up period (odds ratio: 4.62; 95% confidence interval: 1.17–18.17).CONCLUSIONS:This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP. A standardized insulin transition protocol may help better control BG after discontinuation of an IIP. Journal of Hospital Medicine 2009;4:28–34. © 2009 Society of Hospital Medicine.
Sleep in hospitalized medical patients, Part 2: Behavioral and pharmacological management of sleep disturbances
Authors: Young Julie S. , Bourgeois James A. , Hilty Donald M. , Hardin Kimberly A. 
Published: January 2009

AbstractBACKGROUND:As described in Part 1 of this article, multiple factors lead to disrupted sleep in hospitalized medical patients. Recognizing and addressing these factors can help clinicians more effectively manage patients' sleep complaints.METHODS:A PubMed search was conducted by cross‐referencing the terms “sleep deprivation,” “insomnia,” and “sleep”; “hospitalized,” “acutely ill,” and “critically ill”; and “medication,” “drugs,” “hypnotics,” “benzodiazepines,” and “sedatives.” The search was limited to English‐language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search.RESULTS:Few articles addressed the topic of the assessment and management of sleep problems in hospitalized medical patients. In Part 2, we propose an evaluation and treatment algorithm that includes recommendations regarding the use of nonpharmacologic and pharmacologic therapies as clinicians consider relevant clinical data. The algorithm is accompanied by 5 tables that include pertinent and practical information to assist clinicians as they manage their inpatients' sleep complaints.CONCLUSIONS:Assessment of a sleep complaint should include a review of factors that could exacerbate patients' sleep. The treatment could then focus on ameliorating these factors, and the judicious use of nonpharmacologic strategies and psychopharmacologic agents. Journal of Hospital Medicine 2009;4:50–59. © 2009 Society of Hospital Medicine.
Limited communication and management of emergency department hyperglycemia in hospitalized patients
Authors: Ginde Adit A. , Savaser Davut J. , Camargo Carlos A. 
Published: January 2009

AbstractBACKGROUND:Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.OBJECTIVE:To evaluate communication and early management of emergency department (ED) hyperglycemia.METHODS:This was a retrospective cohort study of patients with an initial serum glucose ≥140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1‐year period. We recorded clinical data and compared the content of inpatient and ED‐written discharge instructions.RESULTS:Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140‐199 mg/dL, and 2304 (8%) values were ≥200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140‐199 mg/dL and 31 (16%) patients with glucose ≥200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases.CONCLUSIONS:Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients. Journal of Hospital Medicine 2009;4:45–49. © 2009 Society of Hospital Medicine.
Modeling the interaction between the N‐terminal domain of the tumor suppressor p53 and azurin
Authors: Taranta Monia , Bizzarri Anna Rita , Cannistraro Salvatore 
Published: January 2009

AbstractIt is known that the half life of the tumor suppressor p53 can be increased by the interaction with the bacterial protein azurin, resulting in an enhanced anti‐tumoral activity. The understanding of the molecular mechanisms on the basis of this phenomenon can open the way to new anti‐cancer strategies. Some experimental works have given evidence of an interaction between p53 and azurin (AZ); however the binding regions of the proteins are still unknown. Recently, fluorescence studies have shown that p53 partakes in the binding with the bacterial protein by its N‐terminal (NT) domain. Here we have used a computational method to get insight into this interacting mode. The model that we propose for the best complex between AZ and p53 has been obtained from a rigid‐body docking, coupled with a molecular dynamics (MD) simulation, a free energy calculation, and validated by mutagenesis analysis. We have found a high degree of geometric fit between the two proteins that are kept together by several hydrophobic interactions and numerous hydrogen bonds. Interestingly, it has emerged that AZ binds essentially to the helices HI and HIII of the p53 NT domain, which are also interacting regions for the foremost inhibitor of p53, MDM2. Copyright © 2009 John Wiley & Sons, Ltd.
Olfactory ensheathing glia and Schwann cells exhibit a distinct interaction behavior with meningeal cells
Authors: Franssen Elske H. P. , Roet Kasper C. D. , de Bree Freddy M. , Verhaagen Joost 
Published: January 2009

AbstractSchwann cells (SCs) and olfactory ensheathing glia (OEG) have both been used as cellular transplants to promote spinal cord repair. Both cell types support axonal regeneration and have beneficial effects on functional recovery. A significant difference between SCs and OEG is the effect of these cell types on astrocytes (ACs) present in the neural scar. In contrast to OEG, which associate and intermingle with ACs, SCs and ACs form separate cellular territories. Here, we show that OEG and SCs also interact differently with meningeal cells (MCs), another major cellular component of the neural scar. Whereas OEG intermingle with MCs in cocultures, SCs aggregate into well‐defined cell clusters. Our data suggest that (a) soluble factor(s) as well as direct cellular contact are involved in the MC‐induced SC clustering. Furthermore, the cluster formation of SCs in coculture with MCs is different from the previously reported segregation of SCs and ACs in coculture. The present results help to understand the differential behavior of both cell types after transplantation in the injured spinal cord and will be important to either determine which cell has optimal capacities to render the scar more permissive for regeneration, or to exploit the transplantation of both cell types in combination. © 2009 Wiley‐Liss, Inc.
Analysis of the 2006 floods over northern Tanzania
Authors: Kijazi Agnes L. , Reason C. J. C. 
Published: January 2009

AbstractThis study analyses the circulation features over the Indian Ocean that may be responsible for anomalous wet seasons over Tanzania, giving specific focus to the heavy floods that occurred during the short rainfall season of October–December (OND) 2006. These floods caused devastating loss of life and property over the northern part of the country. A comparison of the 2006 event with a previous severe flooding episode (OND 1997) is conducted.Our results indicate that very heavy rainfall events experienced within a short duration exacerbated the 2006 flood. The circulation features show that the heavy rainfall recorded during OND 2006 can be associated with strong warming over the Indian Ocean, coupled with a convective zone over the western Indian Ocean and East African region, with enhanced moisture flux convergence and uplift over the western Indian Ocean and Tanzania. In turn, this warming was related to the ongoing El Niño and the positive phase of the Indian Ocean dipole mode that occurred during this season, as in OND 1997. In both cases, the severe flooding in Tanzania seemed to be preceded by warming near the Somali coast and an easterly moisture flux anomaly over the eastern equatorial Indian Ocean. Copyright © 2009 Royal Meteorological Society
Vacuum‐assisted closure therapy in the management of head and neck wounds
Authors: Dhir Karan , Reino Anthony J. , Jon Lipana  
Published: January 2009

AbstractObjectives:The wound vacuum‐assisted closure (VAC) has been used in many areas of surgery to promote healing and facilitate secondary reconstruction. Until recently, this treatment modality was overlooked in the otolaryngology literature, and the authors propose that its use should be routine in the treatment of complex head and neck wounds.Study Design:An unbiased cohort study without conflict of interest at two tertiary care centers.Materials and Methods:All patients treated by the authors presented with complex head and neck wounds from 2005 to 2007 and were subjected to wound VAC therapy. The wound VAC dressing was changed every 72 hours, and the wound etiology, wound site, history of chemotherapy and radiation, hospital duration, gender, outcome, and ancillary procedures were recorded.Results:Nineteen patients with 33 wounds were treated using VAC therapy. Eighty‐four percent of these patients healed completely without the need for further surgical intervention. The mean age of this cohort was 63.2 years, with a range of 48–75 years. Males far outnumbered females in this study (17:2). Outpatient therapy commenced at discharge after an average of 11.4 days following a hospital stay ranging between 5 and 28 days. Adjunctive procedures performed during and after VAC therapy included hyperbaric oxygen treatment, dermal grafts, salivary diversion, and regional flap reconstruction.Conclusions:This study shows the applicability and versatility of vacuum‐assisted wound closure in the head and neck. Based on our results the authors feel that this mode of therapy should be a routine part of the Otolaryngologist's armamentarium for the treatment of complex and refractory head and neck wounds. Laryngoscope, 119:54–61, 2009
The predictive and therapeutic value of thymidine phosphorylase and dihydropyrimidine dehydrogenase in capecitabine (Xeloda)‐based chemotherapy for head and neck cancer
Authors: Saito Koichiro , Khan Khurram , Yu Shu‐Zhen , Ronson Steve , Rhee Joung , Li Gouyan , Van Echo David , Suntharalingam Mohan , O'Malley Bert W. , Li Daqing 
Published: January 2009

AbstractObjectives:To evaluate whether two molecular biomarkers, thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD), could be clinically useful in predicting and improving the chemotherapeutic outcome of the oral fluoropyrimidine capecitabine (5′‐DFUR or Xeloda®), in the treatment of human head and neck squamous cell carcinoma (HNSCC).Experimental Design:Quantitative reverse‐transcriptase polymerase chain reaction was used to determine the TP and DPD expression levels in different HNSCC cell lines. The TP to DPD ratio was calculated and compared to the relative chemosensitivity between cell lines after treatment with 5′‐DFUR. The effect of TP transgene expression to alter the TP to DPD ratio and hence optimize the therapeutic outcome of capecitabine treatment was further evaluated in a murine model of human HNSCC using immunohistochemistry to detect TP and DPD expression in vivo.Results:No correlation was detected between sensitivity to 5′‐DFUR and the relative expression levels of TP or DPD in the multiple HNSCC cell lines tested. However, significant correlation was observed between the TP to DPD ratio versus drug resistance of the HNSCC cells (r = −0.914, p = 0.0281). In addition, we demonstrate that transgene expression of TP significantly enhanced the tumoricidal effect of capecitabine in HNSCC tumors with otherwise low endogenous TP to DPD ratios. This antitumor effect was observed up to 30 days after treatment.Conclusions:The results of this study suggest that HNSCC patients who would most benefit from capecitabine‐based chemotherapy could be identified by examining the TP to DPD ratio of their tumors. Furthermore, we demonstrate the potential role of TP gene therapy in TP to DPD ratio manipulation to optimize the tumoricidal effect of capecitabine. Laryngoscope, 119:82–88, 2009