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Biomedical subjects

S Sakkal

Publications and source records attributed to S Sakkal.

9 recordsLinked to original sources
PubMed2006

Averting iatrogenic hypoglycemia through glucose prediction in clinical practice: progress towards a new procedure in diabetes.

BACKGROUND: Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. METHODS: Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. RESULTS: Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P<0.0001) and insulin therapy by just -9 U/day (P<0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers' interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. CONCLUSIONS: Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.

Adolescent↗
PubMed2005

Home blood glucose prediction: validation, safety, and efficacy testing in clinical diabetes.

BACKGROUND: Patients with diabetes do daily self-monitoring of blood glucose (SMBG). For such patients, we devised an engine that predicts not only the expected blood glucose level at the next meal but also the pending risks of hypoglycemia. The purpose of this study was to validate the predictions and provide evidence of the safety and efficacy of using predicted data in dosing decision support for routine patient care. RESEARCH DESIGN AND METHODS: The prediction engine is a computer program that accesses a central database into which daily records of self-monitored blood glucose data are captured by direct access either across the WWW or by an interactive voice response service on-line 24/7. Validation was done by comparison of predicted values to the subsequently observed data using a Clarke Error Grid. Safety focused on body weight and the frequency of hypoglycemia. Efficacy was judged according to glycated hemoglobin and daily insulin dosages. The experimental design contrasted patients in the tight control (TC) group who had been recently converted to intensified (basal-bolus) therapy with patients in the poor control (PC) group on conventional therapy and who were referred to begin intensified therapy. Both groups accessed the remote database to report their daily SMBG. Predicted glucose values were used in dosing decision support for the PC but not the TC group. RESULTS: Over the 6-month study period a total of 30,129 blood glucose levels were reported by the 54 study patients, and some 24,953 blood glucose predictions were made. Of these, 83% were in the clinically acceptable zones of the Clarke Error Grid. When these data were used for dosing decision support in the PC group, glycated hemoglobin levels fell significantly from 9.7 +/- 1.7% to 7.9 +/- 1.2%, and hypoglycemia dropped fourfold. Total daily insulin doses declined 22%, while body weight remained constant. In the parallel TC group (n = 24), glycated hemoglobin also fell, but only slightly from 7.6 +/- 0.9% to 7.2 +/- 1.1%, while daily insulin doses, rates of hypoglycemia and body weight remained constant. CONCLUSIONS: A novel engine is capable of generating meaningful predictions of blood glucose levels. Use of these validated predictions in decision support for managing medication doses proved safe and efficacious.

Algorithms↗
PubMed2001

Anatomical post design meets quartz fiber technology: rationale and case report.

Endodontically treated teeth frequently require a post and core to serve as a foundation for the coronal restoration. Remaining tooth structure, physical properties of the post material, post shape, and cement type all contribute to the success of the restoration. Post adaptation to the canal walls also represents an important element in the biomechanical performance of the prosthetic restoration. A double taper post system made of quartz fiber and epoxy was developed to conform more precisely to the shape of endodontically treated canals. Immediate benefits of this post system include minimal tooth structure removal during canal reshaping, greater post-to-canal adaptation in the apical and coronal half of the canal, and good post retention. The use of a quartz fiber/epoxy material with a lower modulus of elasticity also reduces the incidence of root fracture. Furthermore, the esthetic nature of the colors offered with this post system (translucent and off-white) provide a favorable foundation for eliminating discoloration caused by a metallic post placed under all-ceramic crown systems.

Adult↗
PubMed1997

[Dens in dente: apicoectomy and retrograde obturation].

Dens in dente is a developmental anomaly, which, in some advanced cases, requires a combination of conventional and surgical endodontic treatment. The purpose of this article is to suggest how to treat a Type 3 (Oehlers classification) dens in dente.

Apicoectomy↗
PubMed1994

A clinical appraisal of the Gonon post-pulling system.

Quite often during endodontic re-treatment, the practitioner is confronted with the problem of intra-radicular post removal. The aim of this paper is to present and evaluate the efficiency of the Gonon post-pulling system (Thomas extracteur de pivots, FFDM-Pneumat, Bourge, France).

Humans↗
PubMedDate not supplied

Diabetes intervention in the information age.

Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus. We have designed and evaluated an electronic information system which facilitates this task. The system is voice-interactive, physician directed and affords, to remote patients, 24 h access via touch-tone telephone. Accordingly, patients access the system each day to report self-measured blood glucose levels or hypoglycaemic symptoms together with dietary changes, planned exercise, stress, illness or other lifestyle events. In turn they receive immediate advice with respect to medication dosing changes, and other pertinent feedback. Preliminary system beta-testing for safety and efficacy was performed for one year in an open study of 204 patients derived from two independent, health-care environments. Among the two testing centres, over 60,000 telephone cells were received by the computer systems during the start-up year. Safety and efficacy expectations were met. In addition, prevalence of diabetes related crises (hyperglycaemia or hypoglycaemia) fell approximately 3-fold. Glycated haemoglobin fell significantly (1.0-1.3%) in patients actively using the system. In control groups of patients not actively using the system, there were no improvements in metabolic control while body weights were stable in all groups. The new system was safe and effective in our hands and empowered our health professionals to provide improved diabetes care.

Algorithms↗