Blood glucose regulation using an open-loop insulin delivery system in pancreatectomized dogs given glucose infusions

Summary This study characterizes the glycaemic and insulin responses of a group of 5 anaesthetized dogs to a portal glucose infusion of 10 mg/kg/min before and after pancreatectomy. Insulin was administered intraportally to the pancreatectomized dogs according to a simple preprogrammed waveform composed of a constant basal rate of 0.35±0.02 mU/kg/min which was increased to 2.00mU/kg/min at the time of the 60 minute glucose challenge. When this square waveform was applied the glycaemic response was similar to that seen in the normal controls in the baseline and challenge periods. Blood glucose concentration differed significantly (p<0.05) only from 20 to 100 minutes after the end of the challenge when it was higher by 20±1 mg/dl. Insulin levels were not significantly different from controls. It may be concluded that normoglycaemia and normoinsulinaemia can be maintained by a simple constant rate of portal insulin delivery while the blood glucose response to a glucose infusion can be ostensibly normalized without hyperinsulinaemia simply by enhancing insulin delivery during the challenge. The feasibility of this approach implies that with further development of the preprogrammed waveforms and with a greater understanding of their characteristics portable insulin delivery systems may be realized which accomodate more physiological challenges. The portal route for insulin delivery may however be necessary if peripheral hyperinsulinism is inappropriate.     

Intraosseous infusion: an alternative route of pediatric intravascular access

Substantial difficulties can be encountered when establishing rapid intravascular access in critically ill children. The historic technique of tibial intraosseous infusion is presented as an alternate intravenous route in children less than 3 years old. Review of the literature reveals this technique to be a rapid, reliable method with an acceptably low complication rate. Substances absorbed through the marrow, flow rates, technical difficulties, and complications are discussed.     

静脉用药调配中心优化院内感染控制管理对患者静脉输液质量及降低医院感染率的影响

目的:探究静脉用药调配中心(PIVAS)优化院内感染控制管理对患者静脉输液质量及降低医院感染率的影响。方法:抽取2015年1月—2016年12月间PIVAS 1586例患者资料(优化管理前);另抽取2017年1月—2019年1月实施优化管理后的1865例患者资料(优化管理后);优化管理前后PIVAS工作人员均为25名;比较优化管理前后静脉输液质量及医院感染率的差异。结果:与优化管理前相比,优化管理后化疗药物的包装、输液配制质量及操作台环境的满意度均较高(P<0.05),院内感染发生率低于优化管理前(P<0.05)。结论:PIVAS实施优化院内感染控制管理,有效提高了静脉输液质量,遏制了院内感染的发生,保证了患者用药的安全性。     

Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas

ObjectivesTo compare the characteristics of patients undergoing treatment with continuous intestinal infusion of levodopa-carbidopa (CIILC) for advanced Parkinson's disease and the data on the effectiveness and safety of CIILC in the different autonomous communities (AC) of Spain.MethodsA retrospective, longitudinal, observational study was carried out into 177 patients from 11 CAs who underwent CIILC between January 2006 and December 2011. We analysed data on patients’ clinical and demographic characteristics, variables related to effectiveness (changes in off time/on time with or without disabling dyskinesia; changes in Hoehn and Yahr scale and Unified Parkinson's Disease Rating Scale scores; non-motor symptoms; and Clinical Global Impression scale scores) and safety (adverse events), and the rate of CIILC discontinuation.ResultsSignificant differences were observed between CAs for several baseline variables: duration of disease progression prior to CIILC onset, off time (34.9-59.7%) and on time (2.6-48.0%; with or without disabling dyskinesia), Hoehn and Yahr score during on time, Unified Parkinson's Disease Rating Scale-III score during both on and off time, presence of ≥ 4 motor symptoms, and CIILC dose. Significant differences were observed during follow-up (> 24 months in 9 of the 11 CAs studied) for the percentage of off time and on time without disabling dyskinesia, adverse events frequency, and Clinical Global Impression scores. The rate of CIILC discontinuation was between 20-40% in 9 CAs (78 and 80% in remaining 2 CAs).ConclusionsThis study reveals a marked variability between CAs in terms of patient selection and CIILC safety and effectiveness. These results may have been influenced by patients’ baseline characteristics, the availability of multidisciplinary teams, and clinical experience.     

Two cases of asystolic cardiac arrests managed with therapeutic hypothermia

Poor neurological outcome is a common sequel of prolonged cardiac arrest. Although Therapeutic Hypothermia (TH) for neuroprotection has been a subject for research for over Half a century, its use has been limited because of many controversies and lack of clear guidelines. However for over two decades there has been a revival of interest in mild therapeutic hypothermia (32-34°C) for neuroprotection. However its use after primary asystolic cardiac arrest has been questioned.Herein presenting two cases of prolonged asystolic arrest (39 minutes and 25 minutes); where therapeutic hypothermia was successfully used in following prolonged cardio pulmonary resuscitation. On patients who were in deep coma after resuscitation, TH was applied for 24 hours as per institutional protocol with full neurological recovery in both the cases. Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.     

某院静脉滴注药品说明书滴速限制项标注情况分析

目的为药品生产厂家制订静脉滴注药品说明书及临床输液有效管理提供依据,保证患者用药安全。方法筛选某院可用于静脉滴注的注射剂药品说明书609份,对药品成分分类、药物作用系统、滴速限制项的描述方式及滴速要求等项目进行分别统计。结果 609份药品说明书中有264份(43. 35%)标注了滴速要求,其中中药类标注率为56. 10%,西药类标注率为42. 43%;消化系统用药、呼吸系统用药、抗感染药、心血管系统用药、神经系统用药的标注率相对较高;标注内容有5种描述方式;分别总结了不同滴速要求的药品种类。结论静脉输液时合理调整滴速对用药的安全性和有效性非常重要,通过医、药、护、患共同参与,加强药品说明书的管理和学习,加上药品生产厂家对静脉滴注药品说明书的不断完善,有利于提高用药安全。