Background
The changes in metabolic pathways and metabolites due to critical illness result in a highly complex and dynamic metabolic state, making safe, effective management of hyperglycemia and ...hypoglycemia difficult. In addition, clinical practices can vary significantly, thus making GC protocols difficult to generalize across units.The aim of this study was to provide a retrospective analysis of the safety, performance and workload of the stochastic targeted (STAR) glycemic control (GC) protocol to demonstrate that patient-specific, safe, effective GC is possible with the STAR protocol and that it is also generalizable across/over different units and clinical practices.
Methods
Retrospective analysis of STAR GC in the Christchurch Hospital Intensive Care Unit (ICU), New Zealand (267 patients), and the Gyula Hospital, Hungary (47 patients), is analyzed (2011–2015). STAR Christchurch (BG target 4.4–8.0 mmol/L) is also compared to the Specialized Relative Insulin and Nutrition Tables (SPRINT) protocol (BG target 4.4–6.1 mmol/L) implemented in the Christchurch Hospital ICU, New Zealand (292 patients, 2005–2007). Cohort mortality, effectiveness and safety of glycemic control and nutrition delivered are compared using nonparametric statistics.
Results
Both STAR implementations and SPRINT resulted in over 86 % of time per episode in the blood glucose (BG) band of 4.4–8.0 mmol/L. Patients treated using STAR in Christchurch ICU spent 36.7 % less time on protocol and were fed significantly more than those treated with SPRINT (73 vs. 86 % of caloric target). The results from STAR in both Christchurch and Gyula were very similar, with the BG distributions being almost identical. STAR provided safe GC with very few patients experiencing severe hypoglycemia (BG < 2.2 mmol/L, <5 patients, 1.5 %).
Conclusions
STAR outperformed its predecessor, SPRINT, by providing higher nutrition and equally safe, effective control for all the days of patient stay, while lowering the number of measurements and interventions required. The STAR protocol has the ability to deliver high performance and high safety across patient types, time, clinical practice culture (Christchurch and Gyula) and clinical resources.
Background:
Continuous glucose monitoring (CGM) devices, with their 1-5 min measurement interval, allow blood glucose (BG) concentration dynamics to be captured more frequently and less invasively ...than traditional BG measures. One cohort CGM could provide insight is athletes. This study investigates what impact their heightened energy expenditure and dietary intake may have on their ability to achieve optimal BG.
Methods:
Ten subelite athletes (resting HR<60 bpm, training>6 hrs per week) were recruited. Two Ipro2 CGM devices (Medtronic Minimed, Northridge, CA) were inserted into the abdomen and remained in place for ~6 days. Time in band was calculated as the percentage of CGM BG measurements with in the 4.0-6.0 mmol/L. Fasting glucose was calculated using CGM calibration BG measurements and postprandial glucose response was also calculated using the CGM values.
Results:
4/10 athletes studied spent more than 70% of the total monitoring time above 6.0 mmol/L even with the 2-hour period after meals is excluded. Fasting BG was also in the ADA defined prediabetes range for 3/10 athletes. Only 1 participant spent substantial time below 4.0 mmol/L which was largely due to significantly lower energy intake compared to recommendations.
Conclusions:
Contrary to expectations high BG appears to be more of a concern for athletes then low BG even in those with the highest energy expenditure and consuming below the recommended carbohydrate intake. This study warrants further investigation on the recommended diets and the BG of athletes to better determine the causes and impact of this hyperglycemia on overall athlete health.
Although there are known disparities in neonatal and perinatal deaths across cultural groups, less is known about how cultural diversity impacts neonatal palliative care. This article critically ...reviews available literature and sets out key questions that need to be addressed to enhance neonatal palliative care provision for culturally diverse families. We begin by critically reviewing the challenges to recording, categorizing and understanding data which need to be addressed to enable a true reflection of the health disparities in neonatal mortality. We then consider whose voices frame the current neonatal palliative care agenda, and, importantly, whose perspectives are missing; what this means in terms of limiting current understanding and how the inclusion of diverse perspectives can potentially help address current inequities in service provision. Utilizing these insights, we make recommendations towards setting a research agenda, including key areas for future enquiry and methodological and practice-based considerations.
Background:
Access to affordable, appropriate housing is one of the key social determinants of health, affecting well-being across the lifecourse. However, beyond a recognition that housing quality ...is linked to place of death, little is known about the ways in which housing status impacts social, emotional, and practical aspects of dying and bereavement.
Method:
The Checking Out project is a qualitative study aiming to explore the ways in which socio-economic status impacts people’s experiences of, and attitudes towards, death, dying, and bereavement in the United Kingdom. Qualitative interviews were carried out with 14 bereaved individuals with experience of poverty at end of life or in bereavement, and 15 professionals supporting individuals in low-income communities. Interviews were conducted via phone/video call, and data include experiences of end of life and bereavement both before and during the pandemic. Transcripts were examined using thematic analysis.
Results:
Housing emerged as an important factor affecting people’s experiences, with 7 of the 14 bereaved individuals and all except 1 of the professionals discussing housing-related issues. Participants described ways in which unsuitable housing and housing insecurity impacted practical aspects of dying but also emotional and social well-being at end of life. Housing-related issues affected both patients and their families, though families found it difficult to air these concerns when their relative was dying.
Conclusion:
The paper demonstrates how trusted professionals are able to advocate or address the issues faced by bereaved individuals and suggests implications for policy and practice. A greater awareness of the potential impact of housing status across public services, including healthcare practitioners, welfare support, and housing providers, could better support patients and practitioners to address these issues proactively. Housing providers and policy-makers should be included as key partners in collaborative public health approaches to palliative care.
Urbanisation has been linked with sedentary lifestyles and poor mental health outcomes amongst women. The potential for natural environments to enhance physical activity and mental wellbeing in urban ...areas is now well recognised. However, little is known about the ways that women use natural spaces for health and wellbeing within the context of their everyday lives. This paper draws on ideas developed in the therapeutic landscapes literature to examine how experiences in different types of green and blue space provide important health and wellbeing benefits for women in Copenhagen, Denmark. As well as facilitating physical exercise, such spaces were found to enable a range of more subtle benefits that helped to restore mental wellbeing through stress and anxiety alleviation, the facilitation of emotional perspective, clarity and reassurance, and through the maintenance of positive family dynamics. However, amongst some women who were overweight, the socio-political associations they made with natural environments deterred use of such spaces. Such findings challenge dominant planning and policy assumptions that equate open public access to natural spaces with universal benefit.
•Broadens understandings of the role of green and blue space for the everyday health and wellbeing of urban women.•Expands understanding of the more subtle role of green and blue space experience for mental wellbeing.•Contextualises green and blue space experience within the wider context of surrounding geographies and social interactions.•Demonstrates the necessity of considering how socio-political associations can deter green and blue space uses and behaviours.
Background
Bariatric surgery is an increasingly common option for control of type 2 diabetes (T2D) and obesity. Mechanisms underlying rapid improvement of T2D after different types of bariatric ...surgery are not clear. Caloric deprivation and altered levels of non-esterified fatty acid (NEFA) have been proposed. This study examines how sleeve gastrectomy (SG), Roux-en-Y gastric bypass (GBP) or matched hypocaloric diet (DT) achieves improvements in T2D by characterising components of the glucose metabolism and NEFA levels before and 3 days after each intervention.
Methods
Plasma samples at five time points during oral glucose tolerance test (OGTT) from subjects with T2D undergoing GBP (
N
= 11) or SG (
N
= 12) were analysed for C-peptide, insulin and glucose before surgery and 3-day post-intervention or after DT (
N
= 5). Fasting palmitic, linoleic, oleic and stearic acid were measured. C-peptide measurements were used to model insulin secretion rate (ISR) using deconvolution.
Results
Subjects who underwent GBP surgery experienced the greatest improvement in glycaemia (median reduction in blood glucose (BG) from basal by 29 % IQR −57, −18) and the greatest reduction in all NEFA measured. SG achieved improvement in glycaemia with lower ISR and reduction in all but palmitoleic acid. DT subjects achieved improvement in glycaemia with an increase in ISR, 105 % IQR, 20, 220 and stearic acid.
Conclusions
GBP, SG and DT each improve glucose metabolism through different effects on pancreatic beta cell function, insulin sensitivity and free fatty acids.
...robust and efficient sterile manufacturing lines are essential across the manufacturing scales from the early phase to the commercial launch." "The focus is delivering critical therapies to ...vulnerable patient populations in methods that bypass many of the body's natural defence systems. ...to other drug product markets (i.e., OSD oral solid dosage), the greatest care must be taken to ensure product quality is maintained." ...aseptic fill lines and their associated barrier systems are custom and costly," he says. ...of these overheads, many manufacturers try to make their lines flexible so that the utility of their equipment can be maximized and new products, formulations, or formats can be added.
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