RESUMO
OBJECTIVE: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. MATERIALS AND METHODS: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. RESULTS: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. CONCLUSIONS: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients.
Assuntos
Glicemia/análise , Hiperglicemia/prevenção & controle , Pacientes Internados/estatística & dados numéricos , Testes Imediatos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Hiperglicemia/tratamento farmacológico , Hipoglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Cooperação e Adesão ao TratamentoRESUMO
ABSTRACT Objective: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. Materials and methods: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. Results: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. Conclusions: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Testes Imediatos/estatística & dados numéricos , Hiperglicemia/prevenção & controle , Pacientes Internados/estatística & dados numéricos , Padrões de Referência , Fatores de Tempo , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Cooperação e Adesão ao Tratamento , Hiperglicemia/etiologia , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêuticoRESUMO
In this work, chitosan beads were synthesized in acidic medium and cross-linked in 1% glutaraldehyde solution. The characterization of the materials using TG/DTG, XRD, and BET surface areas showed that the beads did not modify their characteristics after the cross-linking reaction. The cross-linked beads were utilized as adsorbents for the removal of the yellow-, blue-, and red-anionic reactive dyes from aqueous solutions at pH 2.0. Adsorption of the yellow-dye increased from 25 to 50 degrees C. However, adsorption of the blue-dye decreased from 25 to 50 degrees C. Interestingly, the adsorption of the red-dye decreased from 25 to 35 degrees C and increased from 45 to 50 degrees C. The kinetic data were evaluated using an Avrami kinetic model, where the parameter n was related to the determination of changes in the adsorption mechanisms. Adsorption data of the dyes in relation to the contact time, the chemical structures of the dyes, and temperature were presented and were discussed.
