Epsilon-Assisted Publications
Juneja R, Roudebush C, Kumar N, Macy A, Golas A, Wall D, Wolverton C, Nelson D, Carroll J, Flanders SJ. Utilization of a computerized intravenous insulin infusion program to control blood glucose in the intensive care unit. Diabetes Technol Ther. 2007 Jun;9(3):232-40.
Use of the GlucoStabilizer program in the ICU resulted in improved glycemic control compared to the previous manually calculated glycemic control protocols.
Moghissi E, Kongable G, Abad V, Leija D. Current State of Inpatient Diabetes Burden and Care, and Goal of Conference. Endocrine Practice. July/August 2006;12(Supplement 3):1-10.
This article reviews the current state of inpatient diabetes in hospitals in the United States and examines the results of a recent analysis of blood glucose data from 27 US hospitals. The data revealed that hyperglycemia in hospitalized patients is still inadequately addressed in US hospitals, although substantial improvements have been made. Implementation of targeted glucose control needs to become a greater priority.
Zito D, Kongable G, Anderson M. The Impact of Intensive Insulin Protocols on the Clinical Laboratory. J Ligand Assay.2005;28(4):202-206.
Review of the literature on the use of intensive insulin protocols/tight glycemic control initiatives. Additionally, this article outline ways in which the clinical laboratory can partner with the clinicians for successful implementation and data management for monitoring success.
Lameire N, Stevens, Raptis S, Thomas S, Schernthaner G. Individualized risk management in diabetics: how to implement best practice guidelines--design and concept of the IRIDIEM studies. Kidney Blood Press Res. 2004;27(3): 127-133.
Evidence-based medicine has shown that tight blood glucose control can delay the onset and retard the progression of diabetic complications, and while it is a challenge to closely manage the complexity of diabetes, it is more difficult to effectively treat the multiple associated comorbidities that develop. This article describes the concept of the IRIDIEM studies. The objective of these studies was to endorse and facilitate the use of current best practice guidelines for the management of frequent comorbid diseases and established risk factors in the treatment of type 2 diabetes associated with chronic kidney disease.
Cook C, Moghissi E, Joshi R, Kongable G, Abad V. Inpatient Point-of-Care Bedside Glucose Testing: Preliminary Data on Use of Connectivity Informatics to Measure Hospital Glycemic Control. Diabetes Technol Ther. 2007.9(6):493-500.
POC-BG data can be captured through automated data management software and can support hospital efforts to evaluate and monitor the status of inpatient glycemic control. Preliminary data suggest that there is a need to conduct broadbased efforts to improve inpatient glucose management. Increasing hospital participation in data collection has the potential to create a national benchmarking process for the development of best practices and improved inpatient hyperglycemia management.
Hyperglycemia in Pre-Surgical Patients
Roberts D, Meakem T, Dalton C, Haverstick D, Lynch C. Prevalence of Hyperglycemia in a Pre-Surgical Population. The Internet Journal of Anesthesiology. 2007; 12 (1).
Prevalence of diabetes mellitus (DM) and presumably undiagnosed DM in the US has risen at an accelerating rate. This article describes a prospective survey that studied 1,000 non-diabetic patients who were scheduled to undergo anesthesia and surgical procedures. The percent of pre-surgical patients with hyperglycemia was at or above the national population estimate, as was the fraction of patients with impaired FBG.
Kost GJ. Tran NK, Abad VJ, Louie RF. Evaluation of point-of-care glucose testing accuracy using locally-smoothed median absolute difference curves. Clin Chim Acta. 2007 Dec 3.
Erroneous results demonstrated by ISO 15197-difference plots must be carefully considered. LS MAD curves draw on the unique human ability to recognize patterns quickly and discriminate accuracy visually. Performance standards should incorporate LS MAD curves and the recommended error tolerance limit of 5 mg/dl for hospital bedside glucose testing.
Biesma B, van de Wef PR, Melissant CF, Brok RG. Anaemia management with epoetin alfa in lung cancer patients in The Netherlands. Lung Cancer. 2007;58(1):104-11.
Results are presented on the lung cancer population from a Dutch observational study. This study addressed the real-life situation of recombinant human erythropoietin (r-Hu-EPO or epoetin alfa) treatment in anaemic cancer patients receiving chemotherapy, with a focus on efficacy. Results from this observational study demonstrate that epoetin alfa treatment corrects chemotherapy-related anaemia in both NSCLC as well as SCLC patients. Early epoetin alfa intervention seems advantageous for lung cancer patients both in terms of maintaining adequate Hb levels during chemotherapy as well as reducing transfusions.
Ludwig H, et al. The European Cancer Anaemia Survey (ECAS): A large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. European Journal of Cancer. 2004;40(15): 2293-2306.
The European Cancer Anaemia Survey (ECAS) was conducted to prospectively evaluate the prevalence, incidence and treatment of anaemia (haemoglobin <12.0 g/dL) in European cancer patients, including the relationship of mild, moderate and severe anaemia to performance status. Patients were evaluated for up to 6 months.
Vincent JL, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002; Sep 25; 288(12):1499-1507.
Anemia is a common problem in critically ill patients admitted to intensive care units (ICUs), but the consequences of anemia on morbidity and mortality in the critically ill is poorly defined. This was a prospective observation study to define the incidence of anemia and use of red blood cell (RBC) transfusions in critically ill patients and to explore the potential benefits and risks associated with transfusion in the ICU. Study results revealed the common occurrence of anemia and the large use of blood transfusion in critically ill patients, and provided evidence of an association between transfusions and diminished organ function as well as between transfusions and mortality.
Abdominal Aortic Aneurysm Repair
Sandridge LC, Baglioni AJ Jr, Kongable GL, Harthun NL. Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair. Am Surg. 2006 Aug;72(8):700-4; discussion 704-6.
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. Results were collected for all hospitals, except for Veterans Administration hospitals, by a state-wide repository. Data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.
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