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1.
Jennifer VanderWeele Teresa Pollack Diana Johnson Oakes Colleen Smyrniotis Vidhya Illuri Priyathama Vellanki Kevin OLeary Jane Holl Grazia Aleppo Mark E. Molitch Amisha Wallia 《Journal of diabetes and its complications》2018,32(7):650-654
Aims
This study validated enterprise data warehouse (EDW) data for a cohort of hospitalized patients with a primary diagnosis of diabetic ketoacidosis (DKA).Methods
247 patients with 319 admissions for DKA (ICD-9 code 250.12, 250.13, or 250.xx with biochemical criteria for DKA) were admitted to Northwestern Memorial Hospital from 1/1/2010 to 9/1/2013. Validation was performed by electronic medical record (EMR) review of 10% of admissions (N?=?32). Classification of diabetes type (Type 1 vs. Type 2) and DKA clinical status were compared between the EMR review and EDW data.Results
Key findings included incorrect classification of diabetes type in 5 of 32 (16%) admissions and indeterminable classification in 5 admissions. DKA was not present, based on the review, in 11 of 32 (34%) admissions. DKA was not present, based on biochemical criteria, in 15 of 32 (47%) admissions.Conclusions
This study found that EDW data have substantial errors. Some discrepancies can be addressed by refining the EDW query code, while others, related to diabetes classification and DKA diagnosis, cannot be corrected without improving clinical coding accuracy, consistency of medical record documentation, or EMR design. These results support the need for comprehensive validation of data for complex clinical populations obtained through data repositories such as the EDW. 相似文献2.
Guillermo Umpierrez Saumeth Cardona Francisco Pasquel Sol Jacobs Limin Peng Michael Unigwe Christopher A. Newton Dawn Smiley-Byrd Priyathama Vellanki Michael Halkos John D. Puskas Robert A. Guyton Vinod H. Thourani 《Diabetes care》2015,38(9):1665-1672
OBJECTIVE
The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial.RESEARCH DESIGN AND METHODS
We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100–140 mg/dL (n = 151) or to a conservative target of 141–180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events.RESULTS
Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124–139) in the intensive and 154 ± 17 mg/dL (IQR 142–164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008).CONCLUSIONS
Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings. 相似文献3.
4.
Priyathama Vellanki Rachel Bean Festus A. Oyedokun Francisco J. Pasquel Dawn Smiley Farnoosh Farrokhi Christopher Newton Limin Peng Guillermo E. Umpierrez 《Diabetes care》2015,38(4):568-574
OBJECTIVE
Clinical guidelines recommend point-of-care glucose testing and the use of supplemental doses of rapid-acting insulin before meals and at bedtime for correction of hyperglycemia. The efficacy and safety of this recommendation, however, have not been tested in the hospital setting.RESEARCH DESIGN AND METHODS
In this open-label, randomized controlled trial, 206 general medicine and surgery patients with type 2 diabetes treated with a basal-bolus regimen were randomized to receive either supplemental insulin (n = 106) at bedtime for blood glucose (BG) >7.8 mmol/L or no supplemental insulin (n = 100) except for BG >19.4 mmol/L. Point-of-care testing was performed before meals, at bedtime, and at 3:00 a.m. The primary outcome was the difference in fasting BG. In addition to the intention-to-treat analysis, an as-treated analysis was performed where the primary outcome was analyzed for only the bedtime BG levels between 7.8 and 19.4 mmol/L.RESULTS
There were no differences in mean fasting BG for the intention-to-treat (8.8 ± 2.4 vs. 8.6 ± 2.2 mmol/L, P = 0.76) and as-treated (8.9 ± 2.4 vs. 8.8 ± 2.4 mmol/L, P = 0.92) analyses. Only 66% of patients in the supplement and 8% in the no supplement groups received bedtime supplemental insulin. Hypoglycemia (BG <3.9 mmol/L) did not differ between groups for either the intention-to-treat (30% vs. 26%, P = 0.50) or the as-treated (4% vs. 8%, P = 0.37) analysis.CONCLUSIONS
The use of insulin supplements for correction of bedtime hyperglycemia was not associated with an improvement in glycemic control. We conclude that routine use of bedtime insulin supplementation is not indicated for management of inpatients with type 2 diabetes. 相似文献5.
6.
Georgia Davis Maya Fayfman David Reyes-Umpierrez Shahzeena Hafeez Francisco J. Pasquel Priyathama Vellanki J. Sonya Haw Limin Peng Sol Jacobs Guillermo E. Umpierrez 《Journal of diabetes and its complications》2018,32(3):305-309
Aims
To determine the frequency of increasing levels of stress hyperglycemia and its associated complications in surgery patients without a history of diabetes.Methods
We reviewed hospital outcomes in 1971 general surgery patients with documented preoperative normoglycemia [blood glucose (BG) < 140 mg/dL] who developed stress hyperglycemia (BG > 140 mg/dL or > 180 mg/dL) within 48 h after surgery between 1/1/2010 and 10/31/2015.Results
A total of 415 patients (21%) had ≥ 1 episode of BG between 140 and 180 mg/dL and 206 patients (10.5%) had BG > 180 mg/dL. The median length of hospital stay (LOS) was 9 days [interquartile range (IQR) 5,15] for BG between 140 and 180 mg/dL and 12 days (IQR 6,18) for BG > 180 mg/dL compared to normoglycemia at 6 days (IQR 4,11), both p < 0.001. Patients with BG 140–180 mg/dL had higher rates of complications with an odds ratio (OR) of 1.68 [95% confidence interval (95% CI) 1.15–2.44], and those with BG > 180 mg/dL had more complications [OR 3.46 (95% CI 2.24–5.36)] and higher mortality [OR 6.56 (95% CI 2.12–20.27)] compared to normoglycemia.Conclusion
Increasing levels of stress hyperglycemia are associated with higher rates of perioperative complications and hospital mortality in surgical patients without diabetes. 相似文献7.
Holly Kramer Gina Kuffel Krystal Thomas-White Alan J. Wolfe Kavitha Vellanki David J. Leehey Vinod K. Bansal Linda Brubaker Robert Flanigan Julia Koval Anuradha Wadhwa Michael J. Zilliox 《International urology and nephrology》2018,50(6):1123-1130
Purpose
To examine the characteristics of the midstream urine microbiome in adults with stage 3–5 non-dialysis-dependent chronic kidney disease (CKD).Methods
Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate [eGFR]?<?60 ml/min/1.73 m2) and diuretic use were recruited from outpatient nephrology clinics. Midstream voided urine specimens were collected using the clean-catch method. The bacterial composition was determined by sequencing the hypervariable (V4) region of the bacterial 16S ribosomal RNA gene. Extraction negative controls (no urine) were included to assess the contribution of extraneous DNA from possible sources of contamination. Midstream urine microbiome diversity was assessed with the inverse Simpson, Chao and Shannon indices. The diversity measures were further examined by demographic characteristics and by comorbidities.Results
The cohort of 41 women and 36 men with detectable bacterial DNA in their urine samples had a mean age of 71.5 years (standard deviation [SD] 7.9) years (range 60–91 years). The majority were white (68.0%) and a substantial minority were African-American (29.3%) The mean eGFR was 27.2 (SD 13.6) ml/min/1.73 m2. Most men (72.2%) were circumcised and 16.6% reported a remote history of prostate cancer. Many midstream voided urine specimens were dominated (>?50% reads) by the genera Corynebacterium (n?=?11), Staphylococcus (n?=?9), Streptococcus (n?=?7), Lactobacillus (n?=?7), Gardnerella (n?=?7), Prevotella (n?=?4), Escherichia_Shigella (n?=?3), and Enterobacteriaceae (n?=?2); the rest lacked a dominant genus. The samples had high levels of diversity, as measured by the inverse Simpson [7.24 (95% CI 6.76, 7.81)], Chao [558.24 (95% CI 381.70, 879.35)], and Shannon indices [2.60 (95% CI 2.51, 2.69)]. Diversity measures were generally higher in participants with urgency urinary incontinence and higher estimated glomerular filtration rate (eGFR). After controlling for demographics and diabetes status, microbiome diversity was significantly associated with estimated eGFR (P?<?0.05).Conclusions
The midstream voided urine microbiome of older adults with stage 3–5 non-dialysis-dependent CKD is diverse. Greater microbiome diversity is associated with higher eGFR.8.
9.
Kavitha?Vellanki Vinod?K.?BansalEmail author 《Current neurology and neuroscience reports》2015,15(8):50
Chronic kidney disease (CKD) is an increasing problem worldwide and is now being recognized as a global health burden particularly for cardiovascular and cerebrovascular events. The incidence of stroke increases in the presence of CKD with a 3-fold increased rate reported in ESRD. Atrial fibrillation (AF) increases the risk of stroke in CKD. There is conflicting observational evidence regarding benefit of anticoagulation in CKD for prevention of stroke in AF as risk of bleeding is high. Overall, anticoagulant in CKD may be beneficial in appropriate patients with meticulous monitoring of international normalized ratio (INR). Neurological manifestations related to electrolyte disorders, drug toxicity, and uremia are common in CKD. Appropriate drug dosing, awareness of potential side effects of medications, prompt diagnosis, and treatment are essential in preventing long-term morbidity and mortality. 相似文献
10.
A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder 下载免费PDF全文
Andrew J.O. Whitehouse Joanna Granich Gail Alvares Margherita Busacca Matthew N. Cooper Alena Dass Thi Duong Rajes Harper Wendy Marshall Amanda Richdale Tania Rodwell David Trembath Pratibha Vellanki Dennis W. Moore Angelika Anderson 《Journal of child psychology and psychiatry, and allied disciplines》2017,58(9):1042-1052