The impact of graves' disease and its treatment on handwriting characteristics

Thyroid hormones are crucial for metabolism in all tissues in humans, including the nervous system and muscles, and could thus affect handwriting, which is the synthesis of complex and fine movements. Hyperthyroidism, characterized by symptoms such as tremor and weakness, could affect handwriting, although this has not been studied yet. The aim of this study was to evaluate handwriting characteristics before and after therapy for hyperthyroid Graves' disease (GD)

Valutazione dell’introduzione di un protocollo a gestione infermieristica per il trattamento ed il monitoraggio del paziente con iperglicemia in ospedale

Scopo. Valutare l’efficacia di un protocollo a gestione infermieristica di trattamento del paziente ospedalizzato con iperglicemia, in un reparto di medicina. Metodi. Dal marzo al novembre 2007 sono stati introdotti schemi di terapia routinaria e terapia insulinica intensiva endovena per ipo-/iperglicemie gravi in pazienti ospedalizzati. Risultati. 189 pazienti (19% dei ricoveri) erano iperglicemici all’ingresso dal PS. Età mediana (±IQR) 77 (70-84) anni, 41% uomini, diabete noto 74%, il 18% presentava decubiti o ulcere arti inferiori. La glicemia mediana all’ingresso era 144.5 (98-220) mg/dl. Il 36% era euglicemico (60-126 mg/dl), il 3% ipoglicemico (<60 mg/dl), il 9% aveva una glicemia tra 127 e 140 mg/dl, il 40% tra 141 e 280 mg/dl, 12% superiore a 280 mg/dl. Nei 14 casi che hanno richiesto lo schema insulinico intensivo endovena la glicemia è rientrata in un range di sicurezza (tra 80 e 250 mg/dl) entro 15 ore dall’inizio dell’infusione, non è si è verificato nessun caso di ipoglicemia pericolosa per la vita o di coma ipoglicemico. Alla 3a giornata in terapia standard, le glicemie mediane erano accettabili: 142 (98-185) mg/dl pre-colazione, 144 (107-200) mg/dl pre-pranzo, 131 (102-190) mg/dl pre-cena, 183 (123-230) mg/dl post-prandiale. Conclusione. I risultati dimostrano che è possibile e sicura una gestione infermieristica della glicemia nei pazienti diabetici ospedalizzati, tramite protocolli

Efficacy of a training programme for the management of diabetes mellitus in the hospital: A randomized study (stage 2 of GOVEPAZ healthcare)

Aims: To assess the efficacy of a structured educational intervention for health professionals on the appropriateness of inpatient diabetes care and on some clinical outcomes in hospitalised subjects. Methods: A multicentre (6 regional hospitals) cluster-randomized (2:1) two parallel-group pragmatic intervention trials, as a part of the GOVEPAZ study, was conducted in three clinical settings, that is, Internal Medicine, Surgery and Intensive Care. Intervention consisted of a 2-month structured education of clinical staff to inpatient diabetes care. Twelve wards - 2 for each hospital - and 6 wards - 1 for each hospital - were randomized to usual care and to the intervention arm, respectively. Consecutively hospitalised diabetic subjects (n&nbsp;=&nbsp;524, age 74&nbsp;±&nbsp;14&nbsp;years, 57% males, median HbA1C 57&nbsp;mmol/mol) were included. The clinical appropriateness of inpatient diabetes management was assessed by a previously validated multi-domain performance score (PS). Clinical outcomes included hypoglycemia, glucose control biomarkers, clinical conditions at discharge and inpatient mortality rate. Results: A numerically, but not statistically significant, higher PS (+0.94; 95% C.I.: -0.53 - +2.4) was achieved in the intervention than in the usual care wards. Hypoglycemias (p&nbsp;=&nbsp;0.32), glucose control (p&nbsp;=&nbsp;0.89) and survival rates (p&nbsp;=&nbsp;0.71) were similar in the two experimental arms. Plasma glucose on admission (OR&nbsp;=&nbsp;1.52 per 1 SD; C.I. 1.07-2.17; p&nbsp;=&nbsp;0.021) and the number of hypoglycemic events per patient (OR&nbsp;=&nbsp;1.55 per 1 SD; C.I.:1.11-2.16; p&nbsp;=&nbsp;0.011) were independently associated with the inpatient mortality rate. Conclusions: Structured education of the clinical staff failed to improve the inpatient appropriateness of diabetes care or clinical outcomes. In-hospital hypoglycemia was confirmed to be an independent indicator of death risk

L'uso delle carte di rischio coronarico. Documento d'indirizzo

Printed from http://www.pnlg.it target=NewWindow>www.pnlg.it (November 2004). - On the title page: Data di pubblicazione febbraio 2002, Data di aggiornamento febbraio 2004. - Title on the cover: L'uso delle carte di rischio coronarico: filosofia, vantaggi, limiti ed applicabilita'Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk