Inpatient diabetes management: examining morning practice in an acute care setting.

PURPOSE: Morning diabetes management in an inpatient acute care facility was examined. METHODS: A descriptive, nonexperimental research design was used to study the effect of the following variables on patients' prelunch blood glucose: duration of time between (1) blood glucose monitoring and insulin administration, (2) insulin administration and breakfast, and (3) blood glucose monitoring and breakfast. A nonprobability convenience sample was used to examine 40 adults with diabetes who were hospitalized in an urban, academic medical center. RESULTS: The chi2 test and measurements of central tendency were used for statistical analysis. The mean interval of time between (1) blood glucose monitoring and insulin administration was 93 minutes+/-52.82, (2) blood glucose monitoring and breakfast was 121+/-47 minutes, and (3) insulin administration and breakfast was 73+/-37.06 minutes. Insulin was administered in 28% of patients<45 minutes before breakfast, whereas in 39% and 33%, it was administered between 46 and 90 minutes and >90 minutes prior to breakfast, respectively. There was a statistically significant difference (P=.033) between mean prelunch glucose levels for subjects who received insulin>45 minutes before breakfast and mean glucose levels for those who received insulin<45 minutes before breakfast. Eighty percent of patients whose breakfast was >45 minutes following insulin had prelunch glucose values of >180 mg/dL (10 mmol/L) versus 20%<180 mg/dL (10 mmol/L). Of those whose breakfast was <45 minutes before insulin, 43% had blood glucose levels>180 mg/dL, and 57% had blood glucose<180 mg/dL (P=.026). A logistical regression model revealed that patients had a 5.3 times higher risk of having a prelunch blood glucose level>180 mg/dL when their breakfast time was >45 minutes after receiving insulin as compared to those whose insulin was given<45 minutes before breakfast (relative risk, 5.3; 95% confidence interval, 1.2-25; P=.031). CONCLUSION: Current practice suggests patients are at a higher risk of prelunch hyperglycemia, and multiple opportunities exist to improve care for the inpatient with diabetes.

A cohort mortality study of employees in the U.S. carbon black industry.

OBJECTIVES: The objectives of this study are to evaluate historical mortality patterns, especially due to cancers, among employees of the U.S. carbon black industry and to address the methodological shortcomings of previous U.S. mortality studies. METHODS: We followed mortality of 5011 workers employed 1 year or more since the 1930s at 18 carbon black facilities through December 31, 2003. Age-, race-, sex-, and calendar year-adjusted standardized mortality ratios (SMRs) were calculated using state-specific mortality rates. RESULTS: Follow up was 96% complete. All-cause (SMR = 0.74, 95% confidence interval [CI] = 0.70-0.78) and all-cancer mortality (SMR = 0.83, 95% CI = 0.74-0.92) showed significant deficits. No excess was observed from lung (SMR = 0.97, 95% CI = 0.82-1.15) or bladder (SMR = 0.93, 95% CI = 0.47-1.87) cancers or from nonmalignant respiratory diseases (SMR = 0.99, 95% CI = 0.83-1.18). No trends were seen with duration of employment or time since hire for any cause of death. CONCLUSION: Employment in carbon black production in the United States seems not to be associated with increased mortality overall, cancer overall and, in particular, lung cancer. Further research, however, incorporating a detailed exposure assessment is needed to determine whether exposure to carbon black at high levels may be associated with an increased risk of cancer.

Fresh produce: a growing cause of outbreaks of foodborne illness in the United States, 1973 through 1997.

Fresh produce is an important part of a healthy diet. During the last three decades, the number of outbreaks caused by foodborne pathogens associated with fresh produce consumption reported to the Centers for Disease Control and Prevention has increased. To identify trends, we analyzed data for 1973 through 1997 from the Foodborne Outbreak Surveillance System. We defined a produce-associated outbreak as the occurrence of two or more cases of the same illness in which epidemiologic investigation implicated the same uncooked fruit, vegetable, salad, or juice. A total of 190 produce-associated outbreaks were reported, associated with 16,058 illnesses, 598 hospitalizations, and eight deaths. Produce-associated outbreaks accounted for an increasing proportion of all reported foodborne outbreaks with a known food item, rising from 0.7% in the 1970s to 6% in the 1990s. Among produce-associated outbreaks, the food items most frequently implicated included salad, lettuce, juice, melon, sprouts, and berries. Among 103 (54%) produce-associated outbreaks with a known pathogen, 62 (60%) were caused by bacterial pathogens, of which 30 (48%) were caused by Salmonella. During the study period, Cyclospora and Escherichia coli O157:H7 were newly recognized as causes of foodborne illness. Foodborne outbreaks associated with fresh produce in the United States have increased in absolute numbers and as a proportion of all reported foodborne outbreaks. Fruit and vegetables are major components of a healthy diet, but eating fresh uncooked produce is not risk free. Further efforts are needed to better understand the complex interactions between microbes and produce and the mechanisms by which contamination occurs from farm to table.