Jerry Fahrni

Month: September 2012

  • Tight glycemic control has no proven benefits for children in the cardiac ICU [article]

    It looks like we’re still beating this dead horse. I thought we put the tight glycemic control issue to bed a while back. Then again I’ve been out of the game for quite some time, so it’s quite possible that I’ve missed something. Actually, it’s likely I’ve missed something.

    Tight glycemic control was all the rage in intensive care units (ICUs) all over the country in the late 90’s early 2000’s. Tight control was supposed to reduce infection, promote healing, improve outcomes, etc. Then we found out that tight control really didn’t do that, but it did cause a lot of adverse effects, namely severe hypoglycemia. Makes sense when you thing about it. Giving patient aggressive insulin infusions to keep blood glucose less than 110 mg per deciliter is bound to lead you down the path to hypoglycemia. Just sayin’.

    Every once in a while a new study shows up looking at tight glycemic control in the ICU. The most recent is a study in children. The nuts and bolts of the study? Basically there was no indication that tight blood glucose control showed any benefit in pediatric patients undergoing heart surgery. The results are from the Safe Pediatric Euglycemia in Cardiac Surgery (SPECS) trial, which was conducted at Boston Children’s and at the University of Michigan C.S. Mott Children’s Hospital. The full article appears in the September 7 online edition of the New England Journal of Medicine. It’s free to read, so I would encourage you to get it while you can. The article should be available in the September 27 print edition as well.

    SPECS examined tight glycemic control with insulin compared to standard glucose management in 980 children hospitalized in the cardiac intensive care unit (CICU). Results from the research showed that maintaining “normal” blood glucose levels [80 to 100 mg per deciliter] with insulin had no demonstrable impact on the incidence of care-related infections (such as surgical site infections and pneumonia), length of stay in the CICU, organ failure or mortality. And as expected, the glycemic-control group had a higher rate of severe hypoglycemia (<40 mg per deciliter) than did the standard-care group; 3% versus 1%, respectively. The rate of total hypoglycemia (<60 mg per deciliter) followed a similar pattern; 19% for the glycemic-control group versus 9% for the standard-care group.  Not surprising.

    Hey, it wasn’t all for nothing. The primary author of the article, Dr. Michael Agus had this to say, “There were two successes for this trial. One was that we were able to show that children and adults are different when it comes to the benefit of glucose control in an CICU. We were also able to demonstrate that we can safely control glucose in a young, vulnerable, sick population.” And there you have it, children are not adults and we can safely treat children under our care. Who knew.

     


  • Saturday morning coffee [September 8 2012]

    It’s obviously not Saturday morning. My daughter had a volleyball tournament today. We were out of the house at 6:00am so I obviously didn’t have much time to put this together. Nonetheless I have a cup of coffee in my hand, there are still many tabs open in my browser, and I have some things to say. Let’s begin …

    The coffee mug to the right is another from the great state of Texas. I picked it up in Austin while on vacation with my family. We had a great time in Austin. The capital building in Austin is huge and beautiful. We spent the better part of a couple of hours roaming through the building taking in the rich history of the state. After getting our fill of the State Capital we swung over to the University of Texas, home of Longhorns Football. My family and I also found some time to get in some great food from the likes of The Salt Lick in Driftwood, Tx just outside Austin and Gourdough’s Donuts. Both were awesome.

    The Possession was #1 at the box office last weekend. Haven’t seen it, and have no intentions to. Not my kind of flix. Lawless was #2 at the box office. Haven’t seen it either. I’m behind.
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  • NFC & RFID with Android [Slide deck from SlideShare]

    I came across this presentation while surfing the SlideShare superhighway of information. It gives a nice little overview of both RFID and NFC technologies, including hardware, software, and potential uses. It also provides information on how to use the Android SDK to build NFC enabled applications. Thinking about giving it a go.

  • More RFID refrigerator stuff – Cubixx and myCubixx

    The video below gives a brief overview of Cubixx and myCubixx from ASD Healthcare, an AmerisouceBergen Specialty Group. Cubixx is a large RFID refrigerator solution like you’d see in a pharmacy, and myCubixx is its little brother that is used by patients as a personal RFID controlled refrigerator at home. Pretty cool concept.

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  • Cool Pharmacy Tech – Fillmaster Plus

    I was talking with someone the other day about extemporaneous compounding and they mentioned FLAVORx. I like extemporaneous compounding and have been aware of FLAVORx for quite some time. In fact I featured it as a “Cool Technology for Pharmacy” back in February 2010.

    While I was at the FLAVORx website I came across a link to Fillmaster Plus made by Fillmaster Systems out of El Cajon, CA. The Fillmaster Plus is genius in its design because it’s simple, eloquent, makes use of current technology – barcode scanning, SD card, liquid pump, etc – and fits a niche.

    Fillmaster Systems is only a couple of hours from LA. Next time I’m down that way I should take an excursion to Fillmaster HQ and get a close-up look for myself. I wonder how they would handle a surprise visit.

  • Saturday morning coffee [September 1 2012]

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug to the right is from Stanford University. I took my daughters on a site visit to the Stanford campus in the Summer of 2011. The campus is beautiful. This is the last time I will use this particular mug. I haven’t decided whether to simply put it in storage or smash it to pieces and throw it in the trash. I’m a little upset with Stanford. My daughter applied to Stanford in late 2011 and was promptly turned down. My daughter has the highest GPA that can be earned in high school, graduated Summa Cum Laude, was Valedictorian, took the maximum number of AP courses allowed (received A’s in all of them), did community service, was on the Forensics team, part of the leadership club, did school cheer, was part of two National Championship Competitive Cheer teams (outside school activity), etc, etc. She really wanted to attend Stanford, and they broke her heart. Their loss. My daughter will be attending UCLA this fall. I’m very proud.

    - The Expendables 2 was #1 at the box office last weekend. My family and I saw it. Great movie. It was exactly what I wanted. It was action from beginning to end. Remember, I go to movies to be entertained, not to be enlightened. And I was entertained.

    Sylvester Stallone: I heard you were bit by a rattlesnake.

    Chuck Norris: I was and after 5 days of agonizing pain… it died.

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