Republication: Introducing the glucogram – Description of a novel technique to quantify clinical significance of acute hyperglycemic events

Stawicki, Stanislaw P.; Schuster, Dara; Liu, J Felix; Kamal, Jyoti; Erdal, Barbaros S.; Gerlach, Anthony T.; Whitmill, Melissa L.; Lindsey, David E.; Thomas, Yalaunda M.; Murphy, Claire V.; Steinberg, Steven M.; Cook, Charles H.

doi:10.4103/ijam.ijam_20_17

Cited by 3 publications

(7 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Instead, the authors approached serum glucose measurements are a “barometer” of physiologic stress and a global reflection of the body's ability to maintain homeostasis. [ 29 ] In this context, TF modality was only one of the possible factors influencing serum glucose concentrations. Despite that, the authors believed that if there were indeed “systemic physiologic differences” between patients receiving BTF and CTF, these effects would still be manifest in the global composite representation of GV differences between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Further research in this area is warranted, and should include multi-variable assessment of factors related to both GV and physiologic stress. [ 20 29 36 ]…”

Section: Discussionmentioning

confidence: 99%

“…The observed decrease in GV over time in both groups [ Figure 5 ] is likely attributed to the resolution of critical illness, a finding that is also supported by the down-trending APACHE II scores for both study groups [ Figure 4 ]. The initial increase and the subsequent peak in insulin utilization [ Figure 3 and 1 st –17 th epochs], followed by a decrease in insulin use [ Figure 3 and 18 th –34 th epochs] may be attributable to a number of factors such as corresponding changes in illness severity, fewer acute events (i.e., sepsis, hemorrhage),[ 20 29 ] and/or more closely adherent glucose protocol implementation by nursing. [ 36 39 ] Related to the latter two points, the current study provides no evidence that either BTF or CTF are associated with greater incidence of hypoglycemia (≤75 mg/dL, Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…[ 27 28 ] These measurements are then organized into 12-h epochs, and GV is subsequently calculated by determining serial differences between the maximum and the minimum value for each standardized time period. [ 20 29 ]…”

Section: Methodsmentioning

confidence: 99%

“…These measurements were then compressed in into equal, standardized 12-h epochs and formatted into the OHLC paradigm. [ 29 ] For each epoch, the opening value (the first value in the epoch), the minimum and maximum values, and the closing (last) value were recorded for analysis. GV was defined as the difference between maximum and minimum value.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization?

Evans

Forbes

Jones

et al. 2016

Int J Crit Illn Inj Sci

Self Cite

View full text Add to dashboard Cite

Introduction:Enteral nutrition (EN) is very important to optimizing outcomes in critical illness. Debate exists regarding the best strategy for enteral tube feeding (TF), with concerns that bolus TF (BTF) may increase glycemic variability (GV) but result in fewer nutritional interruptions than continuous TF (CTF). This study examines if there is a difference in GV, insulin usage, TF volume, and caloric delivery among intensive care patients receiving BTF versus CTF. We hypothesize that there are no significant differences between CTF and BTF when comparing the above parameters.Materials and Methods:Prospective, randomized pilot study of critically ill adult patients undergoing percutaneous endoscopic gastrostomy (PEG) placement for EN was performed between March 1, 2012 and May 15, 2014. Patients were randomized to BTF or CTF. Glucose values, insulin use, TF volume, and calories administered were recorded. Data were organized into 12-h epochs for statistical analyses and GV determination. In addition, time to ≥80% nutritional delivery goal, demographics, Acute Physiology and Chronic Health Evaluation II scores, and TF interruptions were examined. When performing BTF versus CTF assessments, continuous parameters were compared using Mann–Whitney U-test or repeated measures t-test, as appropriate. Categorical data were analyzed using Fisher's exact test.Results:No significant demographic or physiologic differences between the CTF (n = 24) and BTF (n = 26) groups were seen. The immediate post-PEG 12-h epoch showed significantly lower GV and median TF volume for patients in the CTF group. All subsequent epochs (up to 18 days post-PEG) showed no differences in GV, insulin use, TF volume, or caloric intake. Insulin use for both groups increased when comparing the first 24 h post-PEG values to measurements from day 8. There were no differences in TF interruptions, time to ≥80% nutritional delivery goal, or hypoglycemic episodes.Conclusions:This study demonstrated no clinically relevant differences in GV, insulin use, TF volume or caloric intake between BTF and CTF groups. Despite some shortcomings, our data suggest that providers should not feel limited to BTF or CTF because of concerns for GV, time to goal nutrition, insulin use, or caloric intake, and should consider other factors such as resource utilization, ease of administration, and/or institutional/patient characteristics.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Further research in this area is warranted, and should include multi-variable assessment of factors related to both GV and physiologic stress. [ 20 29 36 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization?

Evans

Forbes

Jones

et al. 2016

Int J Crit Illn Inj Sci

Self Cite

View full text Add to dashboard Cite

show abstract

An Exploratory Study of Geospace Perturbations Using Financial Analysis Tools in the Context of Complex Systems

et al. 2021

View full text Add to dashboard Cite

In the frame of complex systems research, methods used to quantitatively analyze specific dynamic phenomena are often used to analyze phenomena from other disciplines on the grounds that are governed by similar dynamics. Technical analysis is considered the oldest, currently omnipresent, method for financial markets analysis, which uses past prices aiming at the possible short-term forecast of future prices. This work is the first attempt to explore the applicability of technical analysis tools on disturbance storm time (Dst) index time series, aiming at the identification of similar features between the Dst time series during magnetic storms (MSs) and asset price time series. We employ the following financial analysis tools: simple moving average (SMA), Bollinger bands, and relative strength index (RSI), formulating an analysis approach based on various features, appearing in financial time series during high volatility periods, that could be found during the different phases of the evolution of an MS (onset, main development, and recovery phase), focusing on the temporal sequence they occur. The applicability of the proposed analysis approach is examined on several MS events and the results reveal similar behavior with the financial time series in high volatility periods. We postulate that these specialized data analysis methods could be combined in the future with other statistical and complex systems time series analysis methods in order to form a useful toolbox for the study of geospace perturbations related to natural hazards.

show abstract

Applications of Artificial Intelligence in Military Medicine and Surgery

Meyer,

Ullrich,

Goldsmith

et al. 2024

Artificial Intelligence in Medicine and Surgery - An Exploration of Current Trends, Potential Opportunities, and Evolving Threa

View full text Add to dashboard Cite

Artificial intelligence (AI) is rapidly being incorporated into many facets of medicine and surgery. This includes novel approaches utilizing machine learning (ML) in the management of injury, hemodynamic shock, and a range of military/battlefield/triage applications. In general, military-based medical systems are functionally similar to civilian equivalents domestically, especially when it comes to peacetime operations. Although there are also some similarities between military medicine and surgery during active engagements and high-volume penetrating trauma centers at surge capacity, the intensity and severity of injury are almost universally greater in the military-conflict setting. Given significant developments in the area of AI/ML in general, and in the prehospital setting in particular, benefits derived from existing AI/ML research and implementations should be translatable to the military setting (and vice versa). This chapter will address various niche medical and surgical needs applicable to both peacetime and active combat scenarios within the general sphere of military medicine and surgery. We will focus on various innovative and creative solutions and implementations utilizing a scoping literature review approach to evaluate the current state of AI/ML technology applications relevant to battlefield and battlefield-adjacent medical scenarios. We will also attempt to identify research gaps and possible avenues of moving forward.

show abstract

Republication: Introducing the glucogram – Description of a novel technique to quantify clinical significance of acute hyperglycemic events

Cited by 3 publications

References 2 publications

Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization?

Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization?

An Exploratory Study of Geospace Perturbations Using Financial Analysis Tools in the Context of Complex Systems

Applications of Artificial Intelligence in Military Medicine and Surgery

Contact Info

Product

Resources

About