glucose and insulin management in critical care

... (O), and Italy and Spain none TRAINING IN INTENSIVE CARE MEDICINE IN THE UK An increasing number of appointments in ICM are now available to trainees in general internal medicine at senior house ... rehabilitation.9 TRAINING IN INTENSIVE CARE MEDICINE Improved training of medical and nursing staff and organisational changes have undoubtedly played their part in improving the outcome of critical illness ... producing many damaging mediators of inammation Inflammatory mediators The inammatory process is driven in part by cytokines including TNF- and IL-1, IL-6, and IL-8 All have been found in BAL uid and...

Ngày tải lên: 29/06/2014, 11:20

... M: Glucose absorption and gastric emptying in critical illness Crit Care 2009, 13:R140 Chapman MJ, Nguyen NQ, Fraser RJ: Gastrointestinal motility and prokinetics in the critically ill Curr Opin ... studies assessing intestinal absorption in ICU patients is a difficult task In particular, caution should be taken when interpreting the kinetics of 3-O MG (to represent glucose) absorption in the ICU ... ICU setting ICU patients indeed show pharmacokinetic differences compared with normal individuals, including increased volume of distribution and variable clearance of substances [9,10] In septic...

Ngày tải lên: 13/08/2014, 19:20

... is relevant in insulin- secreting b-cells In order to gain more insight into the physiological role of mir-9 in insulin secretion, we have specifically addressed the link between GSIS and the regulation ... altered in insulin- secreting cells during GSIS To conclude, we have discovered a functional interplay between glucose- dependent insulin secretion, mir-9 levels and Sirt1 protein in b-cells In addition, ... protein in insulin- secreting b-cells brought about by mir-9 Sirt1 is down-regulated in insulin- secreting cells in a mir-9-dependent manner Discussion Although we have described the targeting in...

Ngày tải lên: 06/03/2014, 00:21

... examination recognised by experts as linked to heavy drinking, such as injuries (including in the elderly), tremor of the hands and tongue, and excessive capillarisation of the facial skin and ... current drinking pattern TRAINING Training healthcare providers in the use of structured interventions enhances the efficacy of brief interventions.71 Training practice nurses at health centres in screening ... n n n n n n n n initial discussion and support advice regarding non-hazardous drinking levels and ways to reduce drinking counselling and therapy for the individual counselling and therapy for...

Ngày tải lên: 08/03/2014, 14:20

... participants in the tailoring process, the implemented changes in practice, and their ideas about influencing factors will be structured, interpreted, and described in a qualitative way Direct and indirect ... the tailoring process and the one-day training and feedback, (b) material costs for the one-day training, and (c) the costs per hour of the GP related to the implemented interventions In addition, ... depression and anxiety guidelines, collaboration with professionals and institutions specialised in mental healthcare and GPs’ levels of burnout This questionnaire is developed and used in the Netherlands...

Ngày tải lên: 10/08/2014, 11:20

... Formal screening method for depression Clinical reminders for depression care Performance Incentives Types of financial and non-financial incentives used in general and for depression care Quality ... of process and outcomes in primary care and other settings [64,67,68] Integrated care is also an important component of our framework [69,70] and contains several subdomains: coordination, communication, ... programs in VHA clinics [9,40] and by physician organizations has been linked to increased use of longitudinal care management processes [32] Formal screening and use of clinical reminders was also...

Ngày tải lên: 11/08/2014, 05:21

... Formal screening method for depression Clinical reminders for depression care Performance Incentives Types of financial and non-financial incentives used in general and for depression care Quality ... of process and outcomes in primary care and other settings [64,67,68] Integrated care is also an important component of our framework [69,70] and contains several subdomains: coordination, communication, ... programs in VHA clinics [9,40] and by physician organizations has been linked to increased use of longitudinal care management processes [32] Formal screening and use of clinical reminders was also...

Ngày tải lên: 11/08/2014, 16:20

... Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care N Engl ... restrictive multidisciplinary transfusion guidelines and implementing them in daily clinical practice [11], using recombinant human erythropoietin [12] and developing artificial oxygen carriers [13] On ... management in intensive care medicine is mandatory Such options include decreasing blood loss for diagnostic purposes using pediatric sampling tubes [2], establishing restrictive multidisciplinary transfusion...

Ngày tải lên: 12/08/2014, 20:20

... participants and in public trust in the research enterprise Challenges in oversight and monitoring The lack of effective oversight and monitoring in clinical research makes it similar in many respects ... their monitoring and oversight We not see it that way Although perplexing challenges related to monitoring and oversight in critical care research will invariably arise [13–15], such as informed ... research administration, we are forging what we believe is a fruitful new direction in research monitoring and oversight We are working to create a climate and culture within the institution...

Ngày tải lên: 12/08/2014, 20:20

... response to infection in patients with septic shock Insulin and glycemia in sepsis Rusavy and colleagues [16] compared energy expenditure and glucose uptake in response to insulin in non-diabetic ... numerous investigations in sepsis Goscinski and colleagues [21] investigated the ability of tobramycin and ceftazidime to alter the inflammatory response to endotoxin infusion Prior to endotoxin administration, ... controls In hemodynamically stable fasting patients (days 3–7 after sepsis onset), a two-step insulin clamp protocol was used to achieve two levels of hyperinsulinemia while maintaining normoglycemia...

Ngày tải lên: 12/08/2014, 22:22

... during and after liberation from mechanical ventilation using pressure support, CPAP, and T-piece (n = 20 each) During weaning, plasma insulin and glucose as well as urinary vanilmandelic acid increased ... protocol-based weaning procedure helped reduce duration of MV and ICU stay Koksal and coworkers [17] compared plasma insulin, cortisol, glucose and urinary vanilmandelic acid in patients ventilated ... acute hypoxia Although plasma renin activity and angiotensin II immunoreactivity increased during hypoxia, angiotensin-converting enzyme inhibition and type angiotensin II receptor blockade did not...

Ngày tải lên: 12/08/2014, 22:22

... onto ORSA plates (Oxacillin Resistance Screening Agar; Oxoid, Basingstoke, UK) and then suspended in ml colistin-salt broth (brain–heart infusion with 10 µg colistin/ml and 2.5% NaCl) as a backup ... saved using the qMRSA test • A substantial decrease in MRSA infections was seen in the medical ICU after increasing compliance with onadmission screening and implementing a strategy that linked ... in MRSA infections was seen in the medical ICU after increasing compliance with on-admission screening and linking the rapid test to preemptive isolation and cohorting of MRSA patients Despite...

Ngày tải lên: 12/08/2014, 23:21

... Critical Care Vol 10 No Pepe and Wigginton survivors, who typically remained in coma for significant periods [10,11], these rapidly wakening patients clearly did not ... survivors had never been trained how to use them [9] In essence, technology has now made the average person readily capable of delivering life-saving critical care Considering that sudden cardiac ... laypersons and health professionals with significant life-saving effects [12] However, its infrequent performance has been cited as perhaps the weakest link in the worldwide chain of survival and a...

Ngày tải lên: 12/08/2014, 23:21

... expanding the use of simulations Microsimulation in critical care is no experiment, no hobby; it is present and part of the very near future If intensivists remain at the barrier, they will definitely ... paper by Saka and colleagues, however, included additional data from the clinical course before they entered the intensive care unit (age, gender, and ethnicity), thus ‘recreating individual patients’ ... of the Working Group on Sepsis-related Problems of the European Society of Intensive Care Medicine Intensive Care Med 1996, 22:707-710 Clermont G, Kaplan V, Moreno R, Vincent JL, Linde-Zwirble...

Ngày tải lên: 13/08/2014, 03:21

... deprivation’, ‘actigraphy’, ‘actimetry’ and ‘polysomnography’, in combination with critical illness’, ‘intensive care , critical care , and ‘intensive care unit’ Reference lists of all identified ... those pertaining to sleep measurement in adult patients during their critical care admission and published in full in English Study comparing different sleep measurement techniques In the context ... Pharmacy and Medicines Management and Small Grants Scheme References 10 11 12 13 14 15 16 17 18 Parthasarathy S, Tobin MJ: Sleep in the intensive care unit Intensive Care Med 2004, 30:197-206 Weinhouse...

Ngày tải lên: 13/08/2014, 08:20

... goals, like having an adequate income, receiving training, doing research, taking career steps, teaching, and so on Conflicts arise in this area when the goals or interests of individuals cannot ... understand if we are listening If we not listen, we are obviously not interested in understanding We can learn much more by listening than by talking An ‘open ear and mind’ is needed to understand individual ... and job satisfaction in neonatal intensive care units Nurs Res 1984, 33:97-101 Vincent P, Billings C: Unit management as a factor in stress among intensive care nursing personnel Focus Crit Care...

Ngày tải lên: 13/08/2014, 08:20

... groups taking Drug (dark lines) and Drug (light lines) OA and OC represent the results of one trial, and AB and CD the other trial OA has the lesser slope, meaning Drug is superior in this trial ... uses individual patient data and is prospectively planned, suggesting future clinical investigators should carefully consider the advantages and disadvantages of this approach Competing interests ... BG, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients N Engl J Med 2001, 345:1359-1367...

Ngày tải lên: 13/08/2014, 11:22

... to insulin administration, use of vasoactive medications, and use of continuous renal replacement therapy [31] Observational data and findings from randomized trials have shown that TGC with insulin ... control in critically ill patients Curr Opin Clin Nutr Metab Care 2007, 10:206-209 13 Preiser JC, Devos P: Clinical experience with tight glucose control by intensive insulin therapy Crit Care Med ... Rosa G: Intensive insulin therapy after severe traumatic brain injury: a randomized clinical trial Neurocrit Care 2008, 9:159-166 39 Bilotta F, Spinelli A, Giovannini F, Doronzio A, Delfini R,...

Ngày tải lên: 13/08/2014, 16:21

... hormone-producing and cytokine-producing machinery, adipose tissue cannot stand passively by in the face of severe threat to life, and is involved in numerous inflammatory responses including production ... Pratley RE, Tataranni PA: Hypoadiponectinemia in obesity and type diabetes: close association with insulin resistance and hyperinsulinemia J Clin Endocrinol Metab 2001, 86:1930-1935 13 Kern PA, ... Nisbett J, Cohen J, Prins J: Changes in serum adiponectin concentrations in critical illness: a preliminary investigation Crit Care 2009, 13:R105 Friedman JM: Obesity in the new millennium Nature 2000,...

Ngày tải lên: 13/08/2014, 18:22

... 89 ± 34 minutes; P > 0.05) GE was inversely related to the baseline blood glucose level in the 16 critically ill patients who were not receiving insulin (retention at 60, 180 and 240 minutes - ... absorption and baseline blood glucose in either the healthy subjects or critically ill patients However, in the critically ill patients there was a relation between the increment in blood glucose and ... patients in this study, the postprandial increment in blood glucose was related to glucose absorption Glucose absorption across enterocytes takes place predominantly in the proximal small intestine,...

Ngày tải lên: 13/08/2014, 18:22