Institutional Blood Glucose Monitoring System for Hospitalized Patients: An Integral Component of the Inpatient Glucose Control Program

Background

The ability to measure patient blood glucose levels at bedside in hospitalized patients and to transmit those values to a central database enables and facilitates glucose control and follow-up and is an integral component in the care of the hospitalized diabetic patient.

Objective

The goal of this study was to evaluate the performance of an institutional glucometer employed in the framework of the Program for the Treatment of the Hospitalized Diabetic Patient (PTHDP) at E. Wolfson Medical Center, Holon, Israel.

Methods

As part of the program to facilitate glucose control in hospitalized diabetic patients, an institutional glucometer was employed that permits uploading of data from stands located in each inpatient department and downloading of that data to a central hospital-wide database. Blood glucose values from hospitalized diabetic patients were collected from August 2007 to October 2008. The inpatient glucose control program was introduced gradually beginning January 2008.

Results

During the follow-up period, more than 150,000 blood glucose measures were taken. Mean glucose was 195.7 ± 99.12 mg/dl during the follow-up period. Blood glucose values declined from 206 ± 105 prior to PTHDP (August 2007–December 2007) to 186 ± 92 after its inception (January 2008–October 2008). The decline was associated significantly with time (r = 0.11, p < 0.0001). The prevalence of blood glucose values lower than 60 mg/dl was 1.48% [95% confidence interval (CI) 0.36%] prior to vs 1.55% (95% CI 0.37%) following implementation of the PTHDP. Concomitantly, a significant increase in the proportion of blood glucose values between 80 and 200 mg/dl was observed, from 55.5% prior to program initiation vs 61.6% after program initiation (p < 0.0001).

Conclusions

The present study was designed to observe changes in institution-wide glucose values following implementation of the PTHDP. Information was extracted from the glucometer system itself. Because the aforementioned study was not a clinical trial, we cannot rule out that factors other than introduction of the program could explain some of the variability observed. With these limitations in mind, it nevertheless appears that the PTHDP, of which the institutional glucometer is an integral, essential component, was associated with improved blood glucose values in the hospitalized diabetic patient.     

Low HDL levels and the risk of death,sepsis and malignancy

Background High density lipoprotein (HDL) plays an important role as an anti-atherogenic molecule, but also possesses anti-inflammatory and anti-angiogenic properties. The effect of extremely low levels of HDL on the risk of sepsis and malignancy were therefore examined. Methods A retrospective analysis of patients hospitalized at the Edith Wolfson Medical center was conducted. Patients were divided into Group 1: 108 patients with serum HDL levels ≤20 mg/dl. Group 2: 96 patients with serum HDL levels ≥65 mg/dl. Medical history and laboratory data was recorded. Results The mean HDL levels in Group 1 were 16.1 ± 33 mg/dl compared to 74.9 ± 12.6 mg/dl in Group 2. Using a multivariate logistic regression analysis, low HDL was inversely associated with death (OR 0.96, 95% 0.93–0.99, P = 0.02), 3.98 fold increase in odds of fever (OR 3.98, 95% CI 1.3–11.8, P = 0.01), and 6.7-fold increase in the risk of cancer (OR 6.68, 95% CI 1.8–24.5, P = 0.004). HDL serum levels were inversely associated with sepsis. For each 1 mg/dl increase in HDL, a relative 11% decrease in odds of sepsis was observed (OR 0.886, 95% CI 0.8–0.976, P = 0.01). Conclusions Extremely low serum HDL levels (≤20 mg/dl) are associated with an increased risk of death, sepsis and malignancy.     

Neuregulin promotes autophagic cell death of prostate cancer cells

BACKGROUND: Prostate cancer is one of the most frequently diagnosed cancers in males. Autocrine/paracrine growth factors for the epidermal growth factor receptor (EGFR) have been identified in prostate tumors suggesting a role for EGFR in the progression of prostate cancer. The androgen-dependent prostate cancer cell line, LNCaP, expresses the EGFR as well as two additional members of the family; ErbB-2 and ErbB-3, which can be activated by neuregulin (NRG) isoforms. The effect of ErbB ligands on the viability of LNCaP cells was studied. METHODS: In the present study, we examined the effect of NRG on LNCaP cell growth and survival in the absence of androgen mimetic by the MTT assay, FACS analysis, nuclei staining, and Western blotting. RESULTS: Our results demonstrate that NRG activates ErbB-2/ErbB-3 heterodimers and induces cell death of LNCaP cells. By contrast, EGF activates ErbB-1/ErbB-1 or ErbB-1/ErbB-2 dimers and induces cell growth and survival. Interestingly, LNCaP cells treated with PI3K inhibitor underwent cell death but cells treated with both NRG and PI3K inhibitor survived as the control cells, indicating that the PI3K pathway may mediate NRG-induced cell death. NRG-induced cell death was not inhibited by the broad-spectrum caspases inhibitor, benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (Z-VAD-FMK). However, NRG-induced cell death was inhibited by type II cell death inhibitor, 3-methyladenine. CONCLUSIONS: These results suggest that NRG induces type II cell death of LNCaP cells through PI3K-dependent pathway.     

M1 muscarinic agonists can modulate some of the hallmarks in Alzheimer’s disease

M₁ muscarinic receptors (M₁ mAChRs) play a role in an apparent linkage of three major hallmarks of Alzheimer’s disease (AD): β-amyloid (Aβ) peptide; tau hyperphosphorylation and paired helical filaments (PHFs); and loss of cholinergic function conducive to cognitive impairments. We evaluated the M₁ muscarinic agonists AF102B (Cevimeline, EVOXAC?: prescribed for Sjøgren’s syndrome), AF150(S), and AF267B on some of these hallmarks of AD. Activation of M₁ mAChRs with these agonists leads, inter alia, to enhanced secretion of amyloid precursor protein (α-APP), (via α-secretase activation), to decreased Aβ (via γ-secretase inhibition), and to inhibition of Aβ- and/or oxidative stress-induced cell death. In several animal models mimicking different aspects of AD, these drugs restored cognitive impairments, and in select cases induced a decrease in brain Aβ elevation, with a high safety margin, following po administration. Notably, in mice with small hippocampi, unlike rivastigmine and nicotine, AF150(S) and AF267B restored cognitive impairments also on escape latency in a Morris water maze paradigm, in reversal learning. Studies from other labs showed that AF102B and talsaclidine (another M₁ agonist) decreased cerbrospinal fluid (CSF) Aβ in AD patients following chronic treatment, being the first reported drugs with such a profile. The clinical significance of these studies remains to be elucidated, yet based on in vivo (rabbits) and in vitro studies (cell cultures), our M₁ agonists can decrease brain Aβ, owing to a novel and dual complementary effect (e.g., inhibition of γ-secretase and activation of α-secretase). Remarkably, although M₁ agonists can decrease CSF Aβ in AD patients, an increased AD-type pathology in Parkinson’s disease was recently been associated with chronic antimuscarinic treatment. In another aspect, these agonists decreased tau hyperphosphorylation in vitro and in vivo. Notably, nicotinic agonists or cholinesterase inhibitors increased tau hyperphosphorylation. In summary, the M₁ agonists tested are effective on cognition and behavior and show unique disease-modifying properties owing to beneficial effects on major hallmarks of AD. This may place such drugs in the first line of modern AD therapies (e.g., β- or γ-secretase inhibitors, vaccines against Aβ, statins, and inhibitors of tau hyperphosphorylation).     

Inhibition of Immune-Mediated Concanavalin A-Induced Liver Damage by Free-Radical Scavengers

Background/Aims The aims of the present study were to elucidate whether oxidative stress has a role in Con A-induced hepatitis and to examine if antioxidants may protect against liver damage in this model. Methods Hepatitis was induced in Balb/c mice by administration of Con A (18 mg/kg) to the tail vein. Liver enzymes and histology were determined 24 h after Con A injection. Tumor necrosis factor alpha (TNFα) and interleukin-10 (IL-10) levels were assayed 2 h after Con A injection. Hepatic malondialdehyde levels were measured at 1, 3, 8, 12, 18, and 24 h after Con A injection in order to examine the timing of free-radicals formation. Nuclear factor kappa B (NF-κβ) activation was determined by electrophoresis mobility shift assay (EMSA) 1 and 2 h after Con A injection. In separate experiments, mice were pretreated with either dimethylsulfoxide or dimethylthiourea before Con A inoculation. The antioxidant and NF-κβ inhibitor pyrrolidine dithiocarbamate (PDTC) was used as positive control. Results Hepatic malondialdehyde levels increased 12, 18, and 24 h after Con A inoculation but not earlier. Serum levels of liver enzymes and TNFα, hepatic malondialdehyde, and protein carbonyls and the histologic necroinflammatory score were significantly reduced in the antioxidants-treated mice, while IL-10 levels were increased. Dimethylsulfoxide, dimethylthiourea, and PDTC inhibited oxidative stress, but only PDTC inhibited Con A-induced NF-κB activation. Conclusions Reactive oxygen species play a role in immune-mediated Con A-induced hepatitis probably secondary to immune-mediated liver damage. Scavenging of reactive oxygen species by antioxidants prevents hepatitis independently of NF-κB inhibition and may be a new therapeutic target in this experimental model.     

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998

BACKGROUND: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence. METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services. RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9). CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.     

The contribution of bibliotherapy to the counseling of aggressive boys

Abstract

This study investigated the contribution of bibliotherapy to the counseling of aggressive boys by novice counselors in Israel. Counseling for all children was provided within an integrative model (Hill, 2005); bibliotherapy was added as adjunct to the counseling process only in 1 group. Boys from 24 classrooms (3 per class) were randomly assigned to 1 of 3 conditions: integrative counseling (IC), integrative counseling plus bibliotherapy (ICB), or no counseling. Results of the comparison among the 3 conditions indicated reduced aggression and increased empathy in both IC and ICB conditions compared with the control condition. A difference between IC and ICB conditions was found for empathy and therapist satisfaction, with higher gains in ICB. In the ICB condition, boys also demonstrated higher stages of change (Prochaska, 1999) and had higher frequencies of insight and therapeutic change (Hill, 2005) compared with boys in the IC condition.

Zusammenfassung

Der Beitrag von Bibliotherapie zur Beratung von aggressiven Jungen

Diese Studie untersuchte den Beitrag von Bibliotherapie zur Beratung von aggressiven Jungen durch Beratungsanfänger in Israel. Die Beratung aller Kinder wurde innerhalb der Anwendung eines integrativen Models (Hill, 2005) gegeben. Die Bibliotherapie wurde zusätzlich zum Beratungsprozess nur bei der Gruppe 1 angewendet. Jungen von 24 Klassen (3 aus jeder Klasse) wurden dem Zufall nach einer von drei Bedingungen zugewiesen: Integrative Beratungen (integrative counseling [IC]), integrative Beratungen plus Bibliotherapie (ICB), oder keine Beratung. Die Ergebnisse zum Vergleich zwischen den drei Bedingungen wiesen einen Rückgang der Aggressionen und einen Anstieg von Empathie unter der IC und der ICB Bedingung im Vergleich zur Kontrollgruppe auf. Ein Unterschied zwischen der IC und der ICB Bedingung wurde für Empathie und Therapeutenzufriedenheit gefunden, mit größeren Anstiegswerten für ICB. Unter der ICB Bedingung zeigten die Jungen auch höhere Veränderungsniveaus (Prochaska, 1999). Im Vergleich zu den Jungen unter der IC Bedingung zeigten sie häufiger Einsicht und therapeutische Veränderung (Hill, 2005).

Résumé

La contribution de la bibliothérapie dans le counseling de garçons agressifs

Cette étude a investigué la contribution de la bibliothérapie dans le counseling de garçons agressifs par des conseillers novices en Israël. Le counseling pour tous les enfants était procuré dans le cadre d'un modèle intégratif (Hill, 2005)?; la bibliothérapie était rajoutée comme un supplément au processus de counseling dans un seul groupe. Des garçons de 24 classes (3 par classe) étaient attribués au hasard à 1 de 3 conditions?: counseling intégratif (CI), counseling intégratif plus bibliothérapie (CIB), pas de counseling. Les résultats comparatifs entre les 3 conditions montrent une agression diminuée et une empathie augmentée dans les conditions CI et CIB par rapport à la condition contrôle. Une différence entre CI et CIB se trouvait pour l'empathie et la satisfaction des thérapeutes, avec des gains supérieurs en CIB. Dans la condition CIB,les garçons montraient aussi des niveaux supérieurs de changement (Prochaska, 1999) et ils avaient plus d'insight et de changement thérapeutique (Hill, 2005) en comparaison avec les garçons de la condition CI..

Resumen

Contribución de la biblioterapia al counseling de jóvenes agresivos

Este estudio investigó la contribución de la biblioterapia al counseling de chicos agresivos realizado por consultores novicios en Israel. Se suministró counseling a todos los chicos dentro de un modelo integrativo (Hill, 2005), y se agregó biblioterapia al proceso en un grupo. En 24 aulas, tres chicos por aula se asignaron al azar a 1 de 3 condiciones: counseling integrativo (IC), counseling integrativo más biblioterapia (ICB) o ningún counseling. Los resultados de la comparación entre las tres condiciones fueron: agresión reducida y aumento de empatía tanto en la IC como en la ICB comparadas con la condición control. Se encontró una diferencia entre la IC y la ICB para la empatía y la satisfacción del terapeuta, con mayores mejorías en la ICB. En esta, los chicos demostraron también niveles mayores de cambio (Prochaska, 1999), mayores frecuencias de insight y de cambio terapéutico (Hill, 2005) en comparación con chicos de la condición IC.

Resumo

As contribuições da biblioterapia para o aconselhamento de rapazes agressivos

Este estudo investigou a contribuição da biblioterapia para o aconselhamento de rapazes agressivos por conselheiros principiantes em Israel. O aconselhamento para todas as crianças foi baseado no modelo integrativo (Hill, 2005); tendo-se adicionado a biblioterapia ao processo de aconselhamento apenas num grupo. Os rapazes de 24 salas (3 de cada sala) foram aleatoriamente distribuídos para uma das três condições: aconselhamento integrativo (IC), aconselhamento integrativo mais biblioterapia (ICB), ou nenhum aconselhamento. Os resultados da comparação entre as 3 condições indicaram redução da agressão e aumento da empatia nas condições de IC e ICB quando comparadas com a condição de controlo. Foi encontrada uma diferença entre as condições de IC e ICB em termos da empatia e satisfação do terapeuta, com maiores ganhos na ICB. Na condição ICB, os rapazes demonstraram maiores estádios de mudança (Prochaska, 1999) e tinham maiores frequências de insight e mudança terapêutica (Hill, 2005) comparados com os rapazes da condição de IC.

Sommario

Il contributo della biblioterapia al counseling di ragazzi aggressivi

Questo studio ha indagato il contributo della biblioterapia al counseling dei ragazzi aggressivi effettuato da counselors principianti in Israele.

Il counseling per tutti i bambini è stato fornito all'interno di un modello integrato (Hill, 2005); la biblioterapia è stata fatta come aggiunta al processo di counseling solo in un gruppo.

I ragazzi di 24 classi (3 per classi) sono stati assegnati casualmente ad 1 di 3 condizioni: counseling integrato (IC), counseling integrato più biblioterapia (ICB) o assenza di counseling.

I risultati del confronto tra le 3 condizioni hanno indicato riduzione di aggressività e incremento di empatia sia nella condizione IC che nella ICB, rispetto alla condizione di controllo. Una differenza tra le condizioni IC e ICB è stata trovata nell'empatia e nella soddisfazione dei terapeuti, con migliori risultati nell'ICB. Nella condizione ICB, inoltre, i ragazzi hanno mostrato più alti stati di cambiamento (Prochaska, 1999) ed avevano più alte frequenze di insight e cambiamento terapeutico (Hill, 2005) rispetto ai ragazzi nella condizione IC.

Abstract

     

Tyrphostins suppress the growth of psoriatic keratinocytes

Abstract Tyrosine kinase inhibitors of the tyrphostin family which block EGF receptor kinase are reported to arrest the growth of psoriatic keratinocytes in vitro. Three tyrphostins with the potency ratio AG555 >> AG18 >> AG814 were found to arrest growth with no adverse cytotoxic effects. The potency ratio to inhibit keratinocyte proliferation follows their potency to inhibit EGF receptor kinase activity in vitro. These compounds represent novel leads for the therapy of psoriasis.