ABSTRACT
Evaluation of a nurse-titrated insulin infusion method for hyperglycemia treatment was conducted on data from a 19-bed mixed medical-surgical intensive care unit (ICU) with results demonstrating that glucose management did not consistently meet target glucose goals. A multidisciplinary team was created to evaluate and implement a method of insulin infusion administration that would decrease titration subjectivity and improve glycemic management. Utilizing a Plan-Do-Study-Act (PDSA) cycle for trial implementation of a calculation-based method, data demonstrated a significant improvement in glycemic management when compared to the previous method of insulin administration.
Subject(s)
Critical Illness , Hyperglycemia/drug therapy , Insulin Infusion Systems , Insulin/administration & dosage , Humans , Insulin/therapeutic use , Patient Care Team , Retrospective Studies , TitrimetryABSTRACT
APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.
Subject(s)
APACHE , Critical Illness/therapy , Intensive Care Units/organization & administration , Program Evaluation , Rural Population , Telemedicine/methods , Critical Illness/mortality , Hospital Mortality/trends , Humans , Length of Stay , Retrospective Studies , Treatment OutcomeABSTRACT
Over the last 15 years whole organ pancreas transplantation has emerged as the treatment of choice for selected patients with uremia and Type I Diabetes Mellitus. Improvements in surgical technique, better understanding of transplant related complications and advances in immunosuppressive therapy have encouraged the application of this procedure to an increasing number of patients. Pancreas transplantation occurs under three primary scenarios: simultaneous kidney pancreas transplantation, pancreas transplantation after kidney transplantation, and pancreas transplant alone. Overall results are excellent with 90%-95% one-year patient survival, and 85%-90% of patients achieving normal glycemic control. There also exists a significant long-term survival advantage among the simultaneous kidney pancreas transplant group.
