Abstract #1226: E-Glycemic Management System Safely Maintains Glycemic Targets with a Low Incidence of Hypoglycemia for Nondiabetic Cv Surgical Patients in the Inpatient Setting

Background: American Diabetes Association (ADA) guidelines recommend a basal bolus correction insulin regimen as the preferred method of treatment for non–critically ill hospitalized patients. However, achieving ADA glucose targets safely, without hypoglycemia, is challenging. In this study we evaluated the safety and efficacy of basal bolus subcutaneous (SubQ) insulin therapy managed by providers compared to a nurse-directed Electronic Glycemic Management System (eGMS). Method: This retrospective crossover study evaluated 993 non-ICU patients treated with subcutaneous basal bolus insulin therapy managed by a provider compared to an eGMS. Analysis compared therapy outcomes before Glucommander (BGM), during Glucommander (DGM), and after Glucommander (AGM) for all patients. The blood glucose (BG) target was set at 140-180 mg/dL for all groups. The safety of each was evaluated by the following: (1) BG averages, (2) hypoglycemic events <40 and <70 mg/dL, and (3) percentage of BG in target. Result: Percentage of BG in target was BGM 47%, DGM 62%, and AGM 36%. Patients’ BGM BG average was 195 mg/dL, DGM BG average was 169 mg/dL, and AGM BG average was 174 mg/dL. Percentage of hypoglycemic events <70 mg/dL was 2.6% BGM, 1.9% DGM, and 2.8% AGM treatment. Conclusion: Patients using eGMS in the DGM group achieved improved glycemic control with lower incidence of hypoglycemia (<40 mg/dL and <70 mg/dl) compared to both BGM and AGM management with standard treatment. These results suggest that an eGMS can safely maintain glucose control with less hypoglycemia than basal bolus treatment managed by a provider.

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A novel approach to neoadjuvant chemoradiation for soft tissue sarcoma using cisplatin and adriamycin.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e22515 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e22515-e22515

Author(s):

Ashley Brown ◽

Christina Henson ◽

Terence S. Herman ◽

William C. Dooley ◽

Alexis Schutz ◽

...

Keyword(s):

Soft Tissue ◽

Surgical Outcomes ◽

Soft Tissue Sarcomas ◽

Neoadjuvant Chemoradiation ◽

Surgical Patients ◽

Tumor Control ◽

Grading System ◽

Inpatient Setting ◽

Hematologic Toxicity ◽

Radiation Toxicity

e22515 Background: Soft tissue sarcomas (STS) are heterogeneous solid tumors of mesenchymal cell origin, often difficult to manage. Local recurrence of extremity STS with surgery alone ranges from 5-20% with amputation ; 40% with wide excision. Neoadjuvant therapies are used to improve surgical outcomes. There is currently no recognized optimal neoadjuvant chemoradiation regimen prior to resection of STS. At our institution, we have piloted a neoadjuvant regimen of daily Cisplatin with infusional Adriamycin concurrent with radiation to assess its impact on surgical outcomes and tumor control. Methods: Patients diagnosed with STS of any site were treated neoadjuvantly with Cisplatin 6mg/m2 IV over 3-5 mins given 20 to 30 minutes before radiation (5 days) for 6 weeks. Adriamycin was given in the inpatient setting at 12.5 mg/m2 IV over 24 hours on days 1-4, weeks 1 and 4. The radiation dose was 54 Gy in 30 fractions. More than 50% of patients were treated with IMRT planning. Results: Since 2011, 12 STS patients were treated preoperatively with this regimen. Of these patients, 9 underwent surgery. Six of the 9 surgical patients received this neoadjuvant protocol followed by resection in the upfront setting. All of the 6 upfront patients had negative surgical margins; all of these patients had grade 3 tumors. Necrosis was reported based on the FNCLCC grading system. The average percent of necrosis was 96.3% (95% confidence interval 50.4%, 99.8%). Toxicity: Reported according to the RTOG/EORTC Radiation toxicity grading system. Of all patients, grade 1-2 skin toxicity predominated (75%). No grade 4 toxicity reported. Hematologic toxicity: Of all patients, grade 2-3 hematologic toxicity during neoadjuvant chemotherapy was reported in 83% of patients; grade 4 in 1 patient. No febrile neutropenia occurred. Post-operative complications: Seroma/hematoma formation was the most common post-operative complication in the surgical patients. No severely delayed healing was noted. Survival:Nine of 12 patients were dead (6 of 9 surgical patients) at the time of this analysis, all of metastatic disease. Mean time to DM 7.4 months. Mean OS 10 months. Conclusions: Our novel regimen achieved high necrosis rates, and all surgical patients achieved negative margin status. These factors are prognostic and correlate with local control. The predominant pattern of failure was distant. With its acceptable toxicity, this regimen of neoadjuvant Cisplatin, Adriamycin and radiation should be examined in a randomized fashion versus neoadjuvant radiation alone to determine the long term outcomes.

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Safety of Compounded Calcium Chloride Admixtures for Peripheral Intravenous Administration in the Setting of a Calcium Gluconate Shortage

Journal of Pharmacy Practice ◽

10.1177/0897190013513617 ◽

2013 ◽

Vol 27 (5) ◽

pp. 474-477 ◽

Cited By ~ 3

Author(s):

Kevin E. Anger ◽

Caryn Belisle ◽

Megan B. Colwell ◽

Robert Dannemiller ◽

Burhan Alawadhi ◽

...

Keyword(s):

Adverse Drug Reaction ◽

Calcium Chloride ◽

Calcium Gluconate ◽

Grading System ◽

Inpatient Setting ◽

Site Reaction ◽

Infusion Site ◽

System A ◽

Time Period ◽

Low Incidence

Calcium gluconate is preferred over calcium chloride for intravenous (IV) repletion of calcium deficiencies in the inpatient setting. In the setting of a national shortage of IV calcium gluconate, our institution implemented a compounded calcium chloride admixture for IV administration. The objective of this analysis is to evaluate the peripheral infusion site safety of compounded IV calcium chloride admixtures in adult inpatients. A total of 222 patients, encompassing 224 inpatient admissions, from April to June 2011 were retrospectively reviewed. Sterile preparations of calcium chloride in 5% dextrose (600 mg/250 mL and 300 mg/100 mL) were used during the study time period. Adverse infusion site reactions were assessed using an institutional infiltration and phlebitis grading system. A total of 333 doses were administered peripherally. In all, 4 (1.8%) patients experienced a moderate to severe infusion site reaction, with 3 due to phlebitis and 1 due to infiltration. Naranjo Nomogram for Adverse Drug Reaction Assessment classified all 4 reactions to have a possible link to calcium chloride administration. Peripheral administration of compounded calcium chloride admixtures in 5% dextrose is associated with a low incidence of IV infusion site reactions and can be considered as an alternative in the event of a calcium gluconate shortage.

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Electronic Glycemic Management System and Endocrinology Service Improve Value in Cardiac Surgery

The American Surgeon ◽

10.1177/0003134820950685 ◽

2020 ◽

pp. 000313482095068

Author(s):

William Z. Chancellor ◽

James H. Mehaffey ◽

Robert B. Hawkins ◽

Eric J. Charles ◽

Curt Tribble ◽

...

Keyword(s):

Health Care ◽

Cardiac Surgery ◽

Glycemic Control ◽

Surgical Outcomes ◽

Management System ◽

Multivariate Regression ◽

Hospital Costs ◽

Value Added ◽

Consult Service ◽

Glycemic Management

Background Postoperative glycemic control improves cardiac surgery outcomes but insulin protocols are limited by complexity and inflexibility. We sought to evaluate the effect of implementing an electronic glycemic management system (eGMS) in conjunction with a cardiac surgery endocrinology consult service on glycemic control and outcomes after cardiac surgery. Methods All patients with a calculated preoperative risk of mortality who underwent cardiac surgery before and after implementation of an eGMS and an endocrinology consult service were identified. Glycemic control and surgical outcomes were compared using univariate analysis, and multivariate regression was used to model the risk-adjusted effects of the interventions on glycemic control, surgical outcomes, and resource utilization. The health care–related value added by the interventions was calculated by dividing risk-adjusted outcomes by total hospital costs. Results A total of 2612 patients were identified, with 1263 patients in the preimplementation cohort and 1349 in the postimplementation cohort. Multivariate regression demonstrated fewer postoperative hyperglycemic events (odds ratio [OR] 0.8, 95% CI, 0.65-0.99) after protocol implementation without an increase in hypoglycemic events (OR 0.96, 95% CI, 0.71-1.3). Average day-weighted mean glucose decreased from 144 to 138 mg/dL ( P < .001). The improved glycemic control correlated with a risk-adjusted decrease in composite morbidity or mortality (OR 0.61, 95% CI, 0.47-0.79). Although hospital costs increased after implementation, the protocol increased health care–related value by 38%. Conclusion Implementation of a protocol consisting of an eGMS paired with a cardiac surgery–specific endocrinology consult service was associated with improved glycemic control and reduced morbidity. Despite higher costs health care–related value increased as a result of eGMS implementation.

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The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

Thrombosis ◽

10.1155/2016/6043427 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Amy Leung ◽

Clare Heal ◽

Jennifer Banks ◽

Breanna Abraham ◽

Gian Capati ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Upper Limb ◽

Surgical Patients ◽

Vein Thrombosis ◽

Peripheral Catheter ◽

Low Incidence ◽

Deep Vein ◽

Limb Deep Vein Thrombosis ◽

Catheter Related Thrombosis

Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

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Glycemic Management in the Inpatient Setting

Hospital Practice ◽

10.3810/hp.2012.04.969 ◽

2012 ◽

Vol 40 (2) ◽

pp. 44-55 ◽

Cited By ~ 4

Author(s):

Lowell R. Schmeltz ◽

Carla Ferrise

Keyword(s):

Inpatient Setting ◽

Glycemic Management

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