The relationship of intravenous dextrose administration during emergence from anesthesia to postoperative nausea and vomiting: a randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) may occur despite antiemetic prophylaxis and is associated with unanticipated hospital admission, financial impact, and patient dissatisfaction. Previous studies have shown variable impact of IV dextrose on PONV. We sought to determine the relationship of IV dextrose administered during emergence from anesthesia to PONV. METHODS: This was a prospective, double-blind randomized placebo-controlled trial. Adult female ASA physical status I and II nondiabetic patients scheduled for outpatient gynecologic, urologic, or breast surgery were randomly assigned to infusion of 250 mL lactated Ringer's solution (group P; n = 75) or dextrose 5% in lactated Ringer's solution (group D; n = 87) over 2 hours beginning with surgical closing. Blood glucose was determined using a point-of-care device before transfer to the operating room, in the operating room immediately before study fluid infusion, and in the recovery room after study fluid infusion. No antiemetics were given before arrival in the recovery room. PONV scores were recorded at 0, 30, 60, and 120 minutes and 24 hours after arrival in the recovery room. Medication administration was recorded. RESULTS: Data from 162 patients with normal baseline blood glucose were analyzed. There were no significant intergroup differences in demographics, history of PONV, or tobacco use. There was no significant intergroup difference in PONV during the first 2 hours after anesthesia (group D 52.9% vs group P 46.7%; difference, 6.2%; 95% confidence interval [CI], -9.2% to 21.6%; P = 0.43). Patients in groups D or P who developed PONV within 2 hours of anesthesia had similar number of severity scores ≥1 during recovery stay (1.5 vs 1.0; difference, 0; 95% CI, 0%-0%; P = 0.93); and similar proportions of: PONV onset within 30 minutes of recovery room arrival (65.2% vs 57.1%; difference, 8.1%; 95% CI, -13.1% to 28.8%; P = 0.46); more than 1 dose of antiemetic medication (56.5% vs 62.9%; difference, 6.3%; 95% CI, -26.9% to 15.1%; P= 0.65); or more than 1 class of antiemetic medication (50.0% vs 54.3%; difference, 4.3%; 95% CI, -25.5% to 17.4%; P = 0.82). CONCLUSIONS: The administration of dextrose during emergence from anesthesia was not associated with a difference in the incidence of PONV exceeding 20% or in the severity of PONV in the first 2 hours after anesthesia. The relationship between PONV and the optimal dose and timing of IV dextrose administration remains unclear and may warrant further study.

Serious psychological distress and diabetes care among California adults.

OBJECTIVE: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin A 1 C checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). METHOD: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. RESULTS: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin A 1 C checks. CONCLUSIONS: The findings highlight a specific area--foot complication evaluation and prevention--for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

Discovery of 3-aryl-4-isoxazolecarboxamides as TGR5 receptor agonists.

A series of 3-aryl-4-isoxazolecarboxamides identified from a high-throughput screening campaign as novel, potent small molecule agonists of the human TGR5 G-protein coupled receptor is described. Subsequent optimization resulted in the rapid identification of potent exemplars 6 and 7 which demonstrated improved GLP-1 secretion in vivo via an intracolonic dose coadministered with glucose challenge in a canine model. These novel TGR5 receptor agonists are potentially useful therapeutics for metabolic disorders such as type II diabetes and its associated complications.

Mental health, binge drinking, and antihypertension medication adherence.

OBJECTIVES: To evaluate the relationship between self-reported mental health and binge drinking, as well as health status, sociodemographic, social support, economic resource, and health care access indicators to antihypertension medication adherence. METHOD: Analysis of 2003 California Health Interview Survey data. RESULTS: Having poor mental health days predicted medication nonadherence, whereas binge drinking did not. Nonadherence predictors included younger age, Latino, non-US citizen, uninsured, less education, and no regular medical care. Adherence predictors were older age, African American, having prescription insurance, a college degree, poor health, comorbid diabetes or heart disease, and overweight or obese. CONCLUSION: Better mental health may improve medication adherence among hypertensive individuals.

Binge drinking, poor mental health, and adherence to treatment among California adults with asthma.

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios < 1, p < .05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios > 1, p < .05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

Thyroid hormone levels and psychological symptoms in sexually abused adolescent girls.

OBJECTIVE: To explore the relationships between psychological symptoms and thyroid hormone levels in adolescent girls who had experienced the traumatic stress of sexual abuse. METHOD: The study design was cross-sectional/correlational. Subjects (N=22; age range=12-18 years) had their blood drawn, and they completed 2 psychological tests (depression and general distress/posttraumatic stress disorder [PTSD]). A pediatrician completed a sexual abuse questionnaire after reviewing law enforcement and Child Protective Services reports and conducting forensic interviews and medical examinations. RESULTS: Girls' average free T4, total T4, free T3, total T3, and TSH levels were within age-specific laboratory reference range limits, as were most individual concentrations. The strongest correlations (p<.05) were between free T3 and PTSD total score (-.50), PTSD-avoidance/numbing (-.49), and general distress (-.48); and between total T3 and depression (-.46), general distress (-.45), and PTSD-arousal (-.44). CONCLUSIONS: Our findings support one of the two contemporary models of the relationships between thyroid hormones (i.e., free and total T3) and psychological symptoms (i.e., depression, general distress, and PTSD)--one of "shutting down" (vs. "activation") in the face of trauma.