Glucose variability measures and their effect on mortality: a systematic review

Objective: To systematically review the medical literature on the association between glucose variability measures and mortality in critically ill patients. Methods: Studies assessing the association between a measure of glucose variability and mortality that reported original data from a clinical trial or observational study on critically ill adult patients were searched in Ovid MEDLINE (R) and Ovid EMBASE (R). Data on patient populations, study designs, glucose regulations, statistical approaches, outcome measures, and glucose variability indicators (their definition and applicability) were extracted. Result: Twelve studies met the inclusion criteria; 13 different indicators were used to measure glucose variability. Standard deviation and the presence of both hypo-and hyperglycemia were the most common indicators. All studies reported a statistically significant association between mortality and at least one glucose variability indicator. In four studies both blood glucose levels and severity of illness were considered as confounders, but only one of them checked model assumptions to assert inference validity. Conclusions: Glucose variability has been quantified in many different ways, and in each study at least one of them appeared to be associated with mortality. Because of methodological limitations and the possibility of reporting bias, it is still unsettled whether and in which quantification this association is independent of other confounders. Future research will benefit from using an indicator reference subset for glucose variability, metrics that are linked more directly to negative physiological effects, more methodological rigor, and/or better reportin

Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches

Frauen auf dem Weg nach oben Karrieresprossen und Stolperfallen

UuStB Koeln(38)-930106028 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Entlastete Wellendichtringe

SIGLEAvailable from TIB Hannover: RN2441(44) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

MMTEG Heatsink Design

In this document, Cal Poly Senior Design Team F16 presents a summary of its work developing a suitable heatsink for Gas Technology Institute’s Methane Mitigation Thermoelectric Generator. After several months of iterating between experimental testing and simulated heat transfer, a suitable prototype was selected for use in further refining simulation parameters. This was called the structural prototype and it allowed Team F16 to confirm several remaining unknowns relating to component thermal conductivity. All documentation of this process can be found in Preliminary, Critical, and Interim Design Review documents (PDR, CDR, IDR), included in this report. Having a realistic model of the system enabled further rounds of simulation to select a heat fin array. This array was then added to the already existing structural prototype along with testing hardware to produce a final verification prototype. It performed satisfactorily during the team’s experimental testing, per GTI’s identified criteria and benchmarks. Team F16 also received sponsor confirmation that these results meet all project requirements. A final design and key recommendations for moving forward into high volume manufacturing are compiled along with this report

Surveillance postoperativer Wundinfektionen: methodischer Vergleich von IQTIG- und KISS-Strategie

Aim: In 2017, the Institute for Quality Assurance and Transparency in Healthcare (IQTIG) introduced a quality assurance system for the surveillance of surgical site infections (SSI) on behalf the Federal Joint Committee. The establishment of the new system was made in parallel to existing methods, such as the "Krankenhaus-Infektions-Surveillance-System" (KISS). The aim of this work was to perform a comparative analysis.Methods: All 2,233 cases at the University Medical Center Goettingen requiring an assessment of the presence of SSI as part of the IQTIG procedure in 2018 and 2019 were evaluated retrospectively according to the KISS protocol.Results: In total, 2,050 patients were included in the comparative evaluation. Overall, 1,779 (79.7%) had a surgical anamnesis (surgery during the stay or in the past), and 1,716 (83.7%) showed identical results for both surveillance strategies. Different results were found for 334 patients (16.3%), with 160 of these (7.8%) positive for SSI according to IQTIG and 174 (8.5%) positive for KISS. Risk factors were identified for a discordant assessment between the methods. Conclusion: The congruence of the two strategies was consistently high over the study period. There is evidence that the efficiency of the documentation algorithm can be increased without the loss of documentation of SSI, while preserving the precision of the documentation through training.Zielsetzung: Zur Surveillance postoperativer Wundinfektionen wurde 2017 im Auftrag des Gemeinsamen Bundesausschusses ein sektorenübergreifendes Qualitätssicherungsverfahren durch das Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) eingeführt (Vermeidung nosokomialer Infektionen - postoperati ve Wu ndinfektionen, QS WI ). Die Etablierung erfolgte parallel zu bestehenden Methoden wie z.B. des Krankenhaus-Infektions-Surveillance-Systems (KISS). Das Ziel dieser Arbeit war die vergleichende Analyse dieser beiden Methoden.Methodik: Alle 2.233 Patientenfälle, die im Rahmen des IQTIG QS-Verfahrens 2018 und 2019 an der Universitätsmedizin Göttingen (UMG) eine Bewertung bzgl. Vorhandenseins postoperativer Wundinfektionen erforderten, wurden retrospektiv gemäß den Vorgaben des KISS-Protokolls nachbeurteilt und abschließend mit den Ergebnissen der IQTIG-Methodik verglichen.Ergebnisse: 2.050 Fälle konnten in die vergleichende Auswertung einbezogen werden. 1.779 (79,7%) wiesen einen primären chirurgischen Bezug auf (OP während des Aufenthalts/zuvor/ggf. extern). 1.716 (83,7%) zeigten identische Resultate bei den Bewertungen durch die beiden Surveillance-Systeme. Bei 334 (16,3%) kam es zu abweichenden Ergebnissen, wobei sich 160 (7,8%) mit einer positiven Wundinfektionsbeurteilung nach IQTIG und 174 (8,5%) mit einer positiven Bewertung nach KISS ergaben. Es fanden sich verschiedene Risikofaktoren für eine unterschiedliche Beurteilung zwischen den Verfahren.Fazit: Die Kongruenz beider Strategien zeigt sich über den Beobachtungszeitraum konstant. Es konnten Hinweise zur Optimierung der Effizienz des potenziell zu breit angelegten Auslösealgorithmus im QS WI-Verfahren ohne Verlust der Dokumentation postoperativer Wundinfektionen identifiziert werden Zudem zeigt sich Potenzial zur Steigerung der Dokumentationspräzision durch Schulungsmaßnahmen