No abstract

Aims/hypothesis We hypothesised that diabetic patients would differ from those without diabetes in regard to the handling of glucose-derived reactive metabolites, evidenced by triosephosphate intermediates (TP INT ) and methylglyoxal (MG), irrespective of the type of diabetes, plasma glucose level or HbA 1c value. Methods To test this hypothesis, erythrocytes were isolated from patients with type 1 (n012) and type 2 (n012) diabetes with varying blood glucose and HbA 1c levels. These were then compared with erythrocytes isolated from individuals without diabetes (n010), with respect to MG, as determined by HPLC, and TP INT , as determined by endpoint enzymatic assays. Results The concentrations of intracellular TP INT and MG were significantly elevated in erythrocytes from diabetic patients. Normalisation of either TP INT or MG to intracellular glucose concentration (nmol glucose/mgHb) confirmed that erythrocytes from diabetic patients accumulated more reactive metabolites than did those from healthy controls. Conclusions/interpretation Diabetic patients can be characterised by an increased formation of TP INT and MG. The 25-fold increase of MG in type 1 and the 15-fold increase in type 2 diabetes, together with a several-fold increase in TP INT and decreased glyceraldehyde-3-phosphate dehydrogenase activity even under normal glucose conditions, imply that normalising glucose level cannot completely prevent late diabetic complications until this acquired error of metabolism has been restored.

Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.

The study reveals significant opportunities for improvement in the effective delivery of palliative care. Care that met KPM was associated with improved quality, reduced costs and LOS. Institutions that benchmarked above 90% did so by integrating KPM into daily care processes and utilizing systematized triggers, forms and default pathways. The presence of a formalized palliative care program within a hospital system had a positive effect on the achievement of KPM, whether or not formal consultation occurred. Hospitals need to develop systematic methods to improve access to palliative care.

Vaccination programs that emphasized accountability to the highest levels of the organization, provided weekend access to vaccination, and used train-the-trainer programs had higher vaccination coverage. Of concern, the types of HCWs targeted by vaccination programs differed, and uniform definitions will be essential in the event of public reporting of vaccination rates.