The American journal of the medical sciences
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Multicenter Study Comparative Study
Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.
Previous research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (<70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia. ⋯ After adjusting for severity of illness and other potential confounders, hypoglycemia is significantly associated with 30-day mortality for patients hospitalized with pneumonia. Patients with hypoglycemia should be placed in closely monitored settings even when by pneumonia specific risk systems they would normally be discharged.
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Multicenter Study
Mechanical ventilation management by pulmonologists and surgeons in patients with adult respiratory distress syndrome.
Treatment of patients with acute respiratory distress syndrome (ARDS) is complex, and management by a specialist with expertise in pulmonary mechanics may improve outcomes. We compared mechanical ventilation management of patients with ARDS by pulmonologists and surgeons. ⋯ We found that patients who survived with ARDS spent fewer days on mechanical ventilation, and there was a trend for spending fewer days in the ICU when mechanical ventilation is managed by a pulmonologist compared with a surgeon. There was a lower mortality rate in the pulmonologist group, although this did not reach statistical significance. A small sample size and the retrospective design limit our findings. Further study using a multicenter design to determine if a disease specific specialist improves efficiency of care is needed because if our findings are confirmed, it would translate into significant cost savings.
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Multicenter Study
Contributions of weekly mean blood glucose values to hemoglobin A1c in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).
Daily self-monitored blood glucose testing is recommended for patients with insulin-treated type 2 diabetes. However, most patients do not test frequently enough for optimal glycemic control. Less frequent testing may be sufficient for assessing glycemic control among stable patients as well as improving patient compliance. The study objective was to evaluate the weekly contribution of glucose readings to hemoglobin (Hb)A1c during an 8-week period of intensified self-monitored blood glucose testing. ⋯ Glycemic control can be efficiently assessed by reviewing at least 5 weeks' worth of monitoring results, focusing on alternate weeks and giving less weight to more remote readings.