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Biomedical subjects

F E Richards

Publications and source records attributed to F E Richards.

4 recordsLinked to original sources

Transfusion-to-cross-match community comparison data.

With blood supplies at low levels, and replacement and utilization becoming important issues throughout the nation, the Oregon Medical Professional Review Organization (OMPRO) looked at the blood replacement process in Oregon. The study addressed the utilization of type-and-screening and cross-matching in the acute care hospital setting-comparing the more common and expensive cross-match procedure to the less expensive and less utilized type-and-screen. The methodology involved two phases: (a) data collection, evaluation, and feedback to the hospitals and (b) post-monitoring. Although the study did not control for all possible variables, the post-monitoring results demonstrated an increase in the ratio from 0.569 (1992 data) to 0.577. For 1994, the total statewide transfusion cost was estimated at $5,909,700 as compared to $6,423,900 (1992 data)--a savings of more than $500,000 per year. By implementing minimal changes in the way blood is ordered and tested, hospitals can improve quality by maintaining a readily available blood supply, eliminating waste and saving money.

Algorithms↗

Multifactorial origin of hypoglycemic symptom unawareness in IDDM. Association with defective glucose counterregulation and better glycemic control.

To assess potential relationships between unawareness of hypoglycemic symptoms and both defective glucose counterregulation and therapy-associated altered glycemic thresholds, symptoms and hormonal responses to hypoglycemia were quantitated during standardized insulin infusion tests in 41 patients with insulin-dependent diabetes mellitus (IDDM). The glycemic thresholds for both neurogenic and neuroglycopenic symptoms (and those for both epinephrine and pancreatic polypeptide release) were at lower plasma glucose concentrations in both patients with defective (n = 9, 22%) and those with adequate glucose counterregulation and, among the latter, in patients with lower compared with higher glycosylated hemoglobin levels. The data are consistent with the concept that both defective glucose counterregulation and improved glycemic control contribute to excessive hypoglycemia in IDDM by reducing awareness of symptoms of developing hypoglycemia and by impairing physiological defenses against hypoglycemia. Thus, hypoglycemic symptom unawareness is multifactorial in origin and may be partly reversible.

Awareness↗

Intensive versus standard blood glucose awareness training (BGAT) with insulin-dependent diabetes: mechanisms and ancillary effects.

Insulin-dependent diabetes mellitus (IDDM) patients make critical daily self-care decisions on the basis of what they estimate their blood glucose (BG) levels to be. This study: a) replicated efficacy of Standard Blood Glucose Awareness Training (BGAT), b) evaluated the relative efficacy of an Intensive Blood Glucose Awareness Training (BGAT) to enhance patient accuracy of BG estimation, and c) evaluated the mechanisms and ancillary effects of BGAT. Thirty-nine subjects were randomly assigned to one of three groups. Compared with Control, both Standard and Intensive BGAT improved accuracy (p less than 0.001). Intensive BGAT post-treatment accuracy relative to Standard BGAT did not reach statistical significance (p = 0.177). Greater improvement in accuracy was associated with poorer pretreatment accuracy. Only Intensive BGAT improved metabolic control (glycosylated hemoglobin), and this improvement was associated with poorer pretreatment control. The effects of BGAT were highly specific, affecting only accuracy and metabolic control, and not affecting fear of hypoglycemia, diabetes knowledge, of frequency of blood glucose monitoring.

Adult↗