Jeannette Y. Wick, RPh, MBA, FASCP

Severe hypoglycemia is a complication of insulin use that occurs in 20% of insulin-treated patients on a monthly basis. A small number of these patients become unconscious or seize as a result of severe hypoglycemia. Hospitals are prepared to intervene, but often in the community, a Good Samaritan needs to reconstitute and injection dry powder formulations of subcutaneous and intramuscular glucagon for unconscious or seizing patients.

Despite the many glucose monitoring and insulin delivery devices that are available, many diabetics who use them remain uncontrolled and experience hypoglycemia. Researchers dream of the day that drug-device combinations will track diabetics' glucose levels and deliver appropriate insulin dose.

Leptin (an adipocyte-secreted hormone) has been an object of observation since 1994. Its levels in the body are roughly proportional to an individual's amount of adipose tissue. It seems to regulate energy homeostasis, decrease energy intake, and increase energy expenditure. From its discovery, researchers hoped that its manipulation could be useful clinically.

Caloric restriction among mammals whose body mass index is normal, defined as eating about 25% fewer calories than one would during ad libitum intake, increases life span in many species.

The Institute of Medicine reported that almost half of surgical suite managers have seen healthcare providers distracted by electronic devices, and more than 5% are aware of an adverse event (including wrong-site surgery) linked to personal use of a mobile device.

According to researchers in Germany, complications and higher recurrence rates are more likely after laparoscopic ventral hernia repair.

Study results show that dutasteride is similar to the 5α-reductase inhibitor finasteride in its effect on post-operative blood loss in men treated for benign prostatic hyperplasia.

Renal transplant patients often develop anemia (up to 40% are anemic 1 year after transplant) and often, clinicians fail to treat anemia aggressively. Anemia has been correlated with increased hospitalizations and higher mortality

The US Centers for Disease Control indicates more than 30% of healthcare-acquired infections reported by acute care hospitals are urinary tract infections (UTIs), making them the most common healthcare-associated infections.

Many surgeons complain about operating room efficiency. Hospitals can benefit from improving OR efficiency, because most ORs top their list of the most costly divisions. Here are several successful low-cost, low-technology measures to improve efficiency that were implemented at a tertiary-care academic medical center/Level I trauma center.

Malignant hyperthermia is a potentially fatal disorder usually associated with administration of certain general anesthetics and/or succinylcholine. Until 30 years ago, its etiology was unknown. Then, researchers found that people who carry an autosomal dominant calcium channel mutation are at elevated susceptibility.

Although preoperative frailty in older adults is closely linked to postoperative adverse surgical outcomes, little research has been published to guide surgeons when faced with frail patients.

Certain healthcare provider behaviors can threaten team performance and patient safety. As task complexity increases, so do the team's interdisciplinary responsibilities. Medical organizations that take steps to identify troublesome behaviors can help employees correct the problem, thereby fostering teamwork and a culture of safety.

Some experts contend that hiatal hernia-related symptoms improve after weight-loss surgery, making repair of the hiatus unnecessary. Yet, simultaneous repair during bariatric surgery may be more efficient than undergoing separate procedures. A study published in the journal Surgery suggests repair of hiatal hernia during bariatric surgery appears safe and feasible.

Surgeons are more likely than ever to consider resective procedures in infants and young children who have refractory seizure disorders. Many reports describe good outcomes in infants and young children undergoing resective surgery, but longitudinal data have been published only rarely.

The evidence indicates resistant starches improve glucose metabolism beyond what would be expected from its reduced glycemic index.

Studies have shown that excessive caloric intake accelerates aging, whereas caloric restriction has been shown to lengthen lifespan and reduce the risk of several diseases.

When it comes to toxicology, the dose often makes the poison. Consider this report of a case of apparent mineralocorticoid excess apparently caused by licorice root extract.

Lipid resuscitation therapy was identified in 1998 as an effective treatment for local anesthetic systemic toxicity. Since then, researchers have developed a better understanding of the risk factors involved and the manner in which lipids work, using both dynamic scavenging and direct cardiotonic effects.

Joint arthroplasties, which are becoming quite common as the Baby Boomers age, improve function and relieves pain for most patients. Total knee arthroplasty is expected to grow by nearly 700% in the next few years and primary total hip arthroplasty will increase by nearly 200%.

Type 1 diabetes mellitus (T1DM) is treated by necessity with insulin analogues in an attempt to mimic normal physiological insulin profiles. Regardless, this approach is rarely completely successful and most T1DM patients experience fluctuating or suboptimal glucose control, significant hypoglycemia and microvascular tissue complications.

Most adults in developed nations struggle with their weight. Ample quantities of high-quality foods (and plenty of sugar- and fat-laden snacks) do more than just nourish us. They allow us to overindulge; in fact, they tend to make people eat mindlessly.

Cystic dilatation of the bile duct (usually called choledochal cyst)-is a rare condition that causes numerous complications, such as chronic pancreatitis, which is the most common cause of exocrine pancreatice insufficiency in adults.

A study that compared geriatric patients with isolated fractures below the hip to those with isolated hip fractures found that lower extremity fractures can be more disabling than hip fractures because they necessitate weight-bearing restrictions.

Researchers continue to look at the age-old question of when to stop treatment with antiplatelet drugs if surgery is necessary. Stopping them too soon increases risk of clotting. Stopping them too late increases risk of excessive blood loss.

A recent review article provided updated information on classification systems, preventive techniques, pathophysiological mechanisms, and treatment options for postoperative ileus.

A research team from Johns Hopkins Hospital in Baltimore, MD, set out to identify factors associated with variation in hospital hepatopancreatobiliary surgery charges.

Clinicians often discourage older patients with degenerative cervical myelopathy from pursuing surgery, worrying that lingering pathology, comorbidities, reduced physiological reserves, and age-related spinal cord changes will delay recovery.

Patients who experience traumatic injury in resource-poor and rural settings often fail to receive important accident scene care that would increase the likelihood of good surgical outcomes.

Deep brain stimulation is the most frequently used neurosurgical procedure for movement disorders. Patients generally experience few surgery-related problems, but a range of complications is possible.