RESUMO
Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. Insulin resistance has been reported and linked to low serum phosphate levels in animal models and studies in diabetic outpatients, but not in postoperative patients. The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing hypophosphatemia.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Hiperglicemia/tratamento farmacológico , Hipofosfatemia/tratamento farmacológico , Resistência à Insulina , Complicações Pós-Operatórias/tratamento farmacológico , Glicemia/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Hipofosfatemia/sangue , Hipofosfatemia/complicações , Insulina/sangue , Insulina/uso terapêutico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos RetrospectivosRESUMO
BACKGROUND: Morning report is an interactive case-based teaching session common to internal medicine training programs across North America. DESCRIPTION: We report here on a morning report web log ("blog"), created and updated after morning report sessions by the Chief Medical Resident with pertinent clinical topics, links to journal articles, and medical images. Trainees on their internal medicine rotation were e-mailed a web link with each posting. The aim was to enhance learning on clinical topics discussed at morning report by reinforcing topics and promoting further reading. EVALUATION: The educational impact of the blog was evaluated using detailed web metrics and surveys of attendees. The intended audience spent on average more than 5 min reading the blog and viewed more than 3 pages per visit. Almost half of attendees accessed the blog after completing their internal medicine rotation. The blog was also accessed by a global audience. Trainees rated the blogs a useful learning tool and cited it to be among the top 3 educational resources accessed during their rotation. CONCLUSIONS: In summary, a morning report blog was perceived by learners to be an effective complement to case-based teaching sessions. The combination of novel web metrics and survey data allowed for a multifaceted evaluation of the educational impact of the blog.
