SAGE open medicine
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Hyperglycemia is a significant risk for mortality in COVID-19 infections and is most dramatically noted in critically ill patients. Hyperglycemia and/or diabetes are noted in approximately 30%-40% of patients admitted with COVID-19 infections. Previous studies have shown a marked increase in mortality related to increased glucose concentrations and reduction with improved glucose control. ⋯ Optimal glucose control in intensive care is limited by manual sampling of glucose and intravenous insulin adjustment, as well as increased nursing workload and the need of protective equipment. Tools for safe and effective automation of glucose control in intensive care are discussed. A suitable closed loop device could save the lives of thousands of hospitalized hyperglycemic individuals infected with COVID-19 while protecting medical professionals from infection risk.
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To establish tailored preventive treatment, we studied the ability of coronary artery calcium scoring to reclassify patients with intermediate cardiovascular risk and its association with additional risk factors in our Mexican preventive care center. ⋯ Coronary artery calcium scoring is prevalent in this Mexican primary prevention cohort and has the ability to reclassify a significant percentage of intermediate cardiovascular risk patients.
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Chronic pain has a major impact on sufferers and their families. The associated health care costs are substantial. In the context of increasing prevalence, effective treatment options are ever more important. 10 kHz spinal cord stimulation has been shown to effectively provide pain relief, aid in opioid reduction, and improve quality of life in patients with chronic intractable pain. ⋯ Level 1 evidence has already been established for the use of 10 kHz SCS in treating chronic back and leg pain, corroborated by real-world, clinical experience. Exploratory studies also show the potential of the therapy in other refractory pain syndromes, although larger studies are desired to validate their findings. Overall, the literature suggests that 10 kHz SCS provides long-term pain relief in a high proportion of patients, along with improved quality of life and reduced opioid consumption.
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Early hospital readmissions have been rising and are increasingly used for public reporting and pay-for-performance. The readmission problem is fundamentally different in surgical patients compared with medical patients. There is an opportunity to intervene preoperatively to decrease the risk of readmission postoperatively. ⋯ The model stratifies readmission risk on the basis of vascular procedure type, which suggests that attempts to decrease vascular readmission should focus on emergency procedures. Given the current focus on readmissions and increasing pressure to prevent unplanned readmissions, this score stratifies patients by readmission risk, providing an additional resource to identify and prevent unnecessary readmissions.
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Fluid overload is associated with poor outcomes, but mitigating its occurrence poses significant challenges. ⋯ The volume of hidden fluid volume administered by intensive care unit day 3 independently predicted development of fluid overload.