Lisa Nainggolan (Medscape Medical News)

The substantially increased risk of premature death associated with type 2 diabetes is primarily confined to those individuals who also have kidney disease, new research shows. And the chief cause of this excess mortality was cardiovascular in nature, Maryam Afkarian, MD, from the University of Washington, Seattle, and colleagues report in a study published online in the Journal of the American Society of Nephrology. 

Dr. Afkarian said it was "surprising that kidney disease was such a prominent marker of dying early in type 2 diabetes. And we know from prior research that the more severe the kidney disease, the greater the risk, so we should focus on preventing kidney disease from developing in diabetics, and if they do develop it, we should try to slow it down," she told Medscape Medical News. "This population — with type 2 diabetes and kidney disease — is one we really need to focus on for modifying risk factors and controlling their diabetes. This could be where the big bucks are, the big pay in managing diabetes," she added. She noted also that "when you take kidney disease out, mortality is not much higher among type 2 diabetics than it is in the general population," something she says has not really been appreciated before.

Attempt to Better Define Why Diabetics Die Younger

Describing the observational study she and her colleagues conducted, Dr. Afkarian said: "Diabetes is known to be a risk factor for premature death; diabetics generally die younger, and we were attempting to better define that."

They examined 10-year mortality by diabetes and kidney-disease status for 15046 participants in the third US National Health and Nutrition Examination Survey (NHANES III) by linking baseline data with the National Death Index. Kidney disease — defined as a urinary albumin/creatinine ratio of 30 mg/g or less and/or an estimated glomerular filtration rate (GFR) 60 mL/min per 1.73 m2 or less — was present in 42.3% and 9.4% of individuals with and without type 2 diabetes, respectively.

Among those without kidney disease or diabetes (reference group), 10-year cumulative all-cause mortality was 7.7%, compared with 11.5% among individuals with type 2 diabetes but no kidney disease and 31.1% in those with diabetes and kidney disease. This represented an absolute risk difference with the reference group of 3.4% among those with diabetes (adjusted for demographics, smoking, blood pressure, and cholesterol) and 23.4% among those with type 2 diabetes and kidney disease (similarly adjusted). The fact that the risk differences were evaluated on an absolute scale is particularly relevant to clinical care and public health, Dr. Afkarian and colleagues say.

"The presence of kidney disease robustly identifies a diabetes subpopulation at high risk of death," they observe. "One of the major ways that kidney disease contributes to increased mortality is that it makes cardiovascular disease worse," Dr. Afkarian added.

And expanding upon the finding that mortality was not much higher in those with type 2 diabetes than in the general population, she remarked, "This has been seen before in type 1 diabetes, but type 2 is so different, and by the time you get it, you generally have high blood pressure, high cholesterol etc, so it was surprising."

The authors have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online January 24, 2013.

By Vincent L. Gott, MD, Nishant D. Patel, BA, Stephen C. Yang, MD, and William A. Baumgartner, MD

Acknowledgement: Reprinted from (Ann Thorac Surg 2006;82:1-3); © 2006 The Society of Thoracic Surgeons.

Over the last few years, there have been a number of articles about the problems facing our specialty, particularly with regard to attracting the best individuals into our cardiothoracic training programs. In an excellent article entitled Why Become a Cardiothoracic Surgeon [1], Nicholas Kouchoukos commences the paper with: “These are trying times for the specialty of cardiothoracic surgery.” He goes on to enumerate some of the factors contributing to these difficult times: six to nine years of surgical training after medical school; difficulty in finding suitable jobs at the completion of training and then the dual factors of increased malpractice payments in combination with diminishing annual incomes. Several thoracic society presidential addresses in the last two years have also presented the foregoing problems related to attracting “the best and brightest” medical students to our specialty. The supply/demand issue in our specialty was a major topic considered in the 2003 Society of Thoracic Surgeons' presidential address by one of us (WAB) [2]. We pointed out that the current semi-crisis in the cardiothoracic job market appears to be transient and we could be facing a shortage of cardiothoracic surgeons in 10 to 12 years. This prediction is based on a 2002 Cardiothoracic Manpower Study reported by Dr Richard Shemin that indicates that one-half of the current cardiothoracic surgeons will be retired in 13 years; this corresponds to a median calendar year of 2011 [3].

More recently, Irving Kron discussed the current supply/demand issue in cardiothoracic surgery in his presidential address at the Southern Thoracic Surgical Association meeting in November 2005 [4]. In his insightful presentation, Dr Kron indicated that because of our aging baby-boomer population, the US Medicare population will double between 2000 and 2030, and this dramatic increase in our aged population will no doubt provide many new patients who will require surgical procedures for ventricular dysfunction, valvular pathology, and coronary and pulmonary disease processes. Dr Kron also predicted a shortage of cardiothoracic surgeons within the next 5 to 10 years. Certainly a shortage of cardiothoracic surgeons, even in the next 10 years, makes it imperative that we try to attract at this time, a large number of highly qualified medical (and premedical) students to our specialty.

Those of us in the Divisions of Cardiac and Thoracic Surgery at the Johns Hopkins Hospital have made a concerted effort to attract Johns Hopkins medical and premedical students to the field of surgery in general, and more specifically to the specialty of cardiothoracic surgery. In this presentation, we would like to share our experience in two of these student areas; they are: 1) a clinical program specifically designed for Johns Hopkins premedical students and; 2) a program to introduce premedical and medical students to cardiothoracic surgical research.

Clinical Program Specifically Designed for Johns Hopkins Premedical Students

Each year, the Johns Hopkins undergraduate campus designates the student vacation month of January as theIntersession Month; during this period, a number of students take elective courses off of the undergraduate campus. In 2002, one of us (WAB) established with our Johns Hopkins University Premedical Advisory Office, a three-week rotation on our Cardiac and Thoracic Surgical Services for four or five students during the Intersession Month. Both premedical, and bioengineering students considering medical school, could apply for this rotation and the Premedical Office would make the final selection. It is estimated that approximately one-third of the 4400 Johns Hopkins undergraduate students are in one or the other of the above categories.

In the last four years, we have had a total of 18 undergraduate students on our two clinical services. Basically, they were integrated into our services much as our medical students. They even completed the necessary HIPAA compliance training required of our medical students. Each day began with a cardiothoracic faculty person reviewing the operative cases for the day. Catheterization cines were reviewed for all cardiac cases for the day and critical x-rays, cardiothoracic and magnetic resonance imaging scans were reviewed when appropriate. The students were able to observe any of the cardiac and thoracic operations each day. Their daily schedule also provided the opportunity to participate in morning and afternoon rounds in our cardiac and thoracic intensive care units. The students attended all clinical and teaching conferences on both of our services. The clinical conferences included our weekly Pulmonary, Esophageal and Thoracic Transplant Conferences. They also attended our weekly teaching conferences including General Surgery Grand Rounds and our Cardiac Resident Teaching Conference.

The students also met several times during their three-week rotation with members of our cardiac and thoracic faculty. These meetings included several “Recap Sessions” with each of the division chiefs and power-point presentations by faculty members on topics such as thoracic transplantation, ventricular assist devices, congenital cardiac surgery, and the history of cardiothoracic surgery. In addition to those experiences, students were able to observe large animal preps in our Cardiac Surgery Research Laboratory and attend our weekly laboratory meetings. Over the course of the last four years, we have been able to add new opportunities and experiences for our undergraduate students. This past January, for example, they were able to observe a mitral valve repair with the DaVinci robotic system and then, in the laboratory, use the system to perform simple operative maneuvers. Several of the students indicated that their involvement with the DaVinci robot was one of their most exciting experiences during their three-week rotation.

This program, over the past four years, has been remarkably successful with more and more students applying each year. In fact, because of “word of mouth” praise for the program on the undergraduate campus, approximately 100 premedical and/or bioengineering students applied for the four positions in January 2005.

The material in this summary has been obtained from a survey form containing 16 questions about the Intersession rotation. This questionnaire form was sent to 17 of the 18 students; one student from 2003 could not be located but the remaining 17 completed and returned their questionnaire.
Of our 17 undergraduate students, 8 considered themselves premedical and 9 indicated a joint interest in premedical science and bioengineering; six in this latter group were undecided about medical school before the Intersession rotation. One of our questions asked: “What were the main benefits of the cardiothoracic surgical rotation for you in making future decisions in your career?” Surprisingly, at the completion of the rotation, all 6 students who were undecided between bioengineering and medical school made a decision to go to medical school. Four of the 17 students indicated in their questionnaire that they definitely plan to complete training in a surgical specialty; two of these in cardiothoracic surgery. Eleven students were undecided about a future specialty but eight of the 11 have a strong interest in a surgical specialty, including cardiothoracic.

Overall, all 17 intersession students were extremely enthusiastic about their three-week rotation on our Cardiothoracic Surgical Services. Remarkably, 7 of the students indicated that their rotation on our services was the most rewarding experience that they have had in their three years of college. Their unsolicited comments included: “The single greatest opportunity given me at Hopkins”; “One of the most wonderful and rewarding medical experiences I've ever had”; “It was one of the greatest experiences that I've had in college”; “It was the most significant experience I've had while an undergrad”; and “The experience was incredible and I don't know how the cardiothoracic division could make it any better.”

All of the 13 students in the first three years of the program have applied to medical school. All indicated that they had cited their Intersession experience in their Applicant essay and during their medical school interviews. Several indicated that their Intersession experience was the basis for much of their discussion during medical school interviews. All of these 13 students during the first three Intersession years are currently in, or have been accepted for medical school. The four students who participated in our January 2005 Intersession are currently senior undergraduate students at Johns Hopkins and all are in the process of applying to medical school.

In summary, our three week Intersession Program set up for Johns Hopkins undergraduate students in 2002 has become exceedingly popular. It is encouraging that all 17 students are either in medical school or are currently applying to medical school (2005 students). It is also gratifying that a high percentage of these students have developed a strong interest in surgery and in several instances, in cardiothoracic surgery.

Program to Introduce Premedical and Medical Students to Cardiothoracic Surgical Research

Over the past 10 years, we have had the occasional Johns Hopkins medical student working in our Cardiac Surgery Research Laboratory during the summer months. In 2003, stimulated and organized by one of our residents, Dr Torin Fitton, we made a more concerted effort to accept students, both medical and undergraduate, for a summer experience in our laboratory. In the summer of 2003 for example, we had three Johns Hopkins undergraduate students and three medical students. All three medical students were subsequently coauthors on basic research or clinical research papers. Two of the three premedical students are coauthors on clinical research papers which are currently in press.
In the summer of 2004, we had three medical and two premedical students in our research laboratory. All three medical students are coauthors on clinical papers; two of these students presented posters at the Student Section of the American Medical Association meeting in 2004. The third student is a coauthor on a paper presented at the Southern Thoracic Surgical Association Meeting in November, 2005. The two premedical students who were in the laboratory in the summer of 2004 are also coauthors on a clinical paper.

In the summer of 2005, we had three Johns Hopkins medical students; all three actively participated in gathering data for clinical databases. One of these database papers has been submitted to a surgical journal; two other database summaries have not yet been completed.

We have had a total of 14 medical or premedical students in our laboratory during the past three summers. They have all commented on the unique opportunities they have had as premedical and medical students to assist in all aspects of canine cardiopulmonary bypass; to participate in clinical database studies and in the writing of various research publications. They also have greatly appreciated the opportunity to attend our national cardiothoracic meetings and for a few, the opportunity to present a paper at one of these meetings. A number of the students commented that their “hands-on” experience with the canine surgical preps provided them with an enhanced preparedness for their subsequent clinical surgical clerkships. All of these students are quite interested in cardiothoracic surgery, and we believe most of them will very likely specialize in surgery, possibly in our specialty.

In summary, it has been a pleasure for the four of us to share our thoughts on two of our programs designed to attract highly qualified premedical and medical students to our specialty. We have been particularly gratified with the success of our Intersession Program. Also, our summer cardiac surgery laboratory experience for premedical and medical students has been quite successful. Several students have had the opportunity to initially participate in our Intersession Program and then in our Cardiac Surgical Research Laboratory. Our coauthor (NDP), for example, was in the 2003 Intersession group and then worked in our Cardiac Surgical Research Laboratory during the summers of 2003, 2004, 2005; he currently is a Year II Johns Hopkins Medical student. He has been coauthor on 9 research publications from our Division (first author on five of these publications and presenter of papers at the American Association for Thoracic Surgery and the International Society of Heart and Lung Transplantation). At our upcoming 2006 Society of Thoracic Surgeons meeting, he is the first author on two publications; one will be a podium presentation and the second a poster presentation.

A third student opportunity not previously mentioned is being offered to Year III Hopkins medical students who elect a two-week rotation on our Cardiac Surgical Service. This is an opportunity for the students to accompany our transplant team on a heart and/or lung donor run when there is space available. Such an opportunity has not occurred all that frequently, but during the past years several of our Year III students have gone on donor runs (both ambulance runs within the state of Maryland and jet-flight runs to donor hospitals out of the state). These opportunities to participate in a donor run have usually been considered as one of the high points in the student's medical school career.

We feel that the various student opportunities that we have presented in this paper will direct a number of talented premedical and medical students into our specialty. As Dr Shemin and Dr Kron and others have indicated in recent publications and presidential addresses, we may well have a shortage of cardiothoracic surgeons in 5 to 10 years. A junior premedical student at Johns Hopkins University, who participated in our January 2005 Intersession Program would, after four years of medical school and six years of residency, not enter the cardiac surgical workforce until 2016. We think that it is advisable to try at this time to recruit the very best premedical students onto this 11-year academic track.

The authors wish to acknowledge the important role of the Johns Hopkins University Premedical Advisory Office in selecting each year the most qualified undergraduate students for our Cardiothoracic Intersession Program. Dr Ronald Fishbein (Assistant Dean of Pre-Professional Programs at Johns Hopkins University) was instrumental in 2001 in helping us establish this rotation and in the selection of students in 2002 and 2003. Dr Jean Kan, currently in the Premedical Advisory Office, was responsible for overseeing the selection of our 2004 and 2005 students. Dr Artin Shoukas, Professor of Biomedical Engineering at Johns Hopkins University, has also been involved from the beginning of this program in the selection of the most qualified undergraduate students. We also appreciate the recommendation of Dr Walter Merrill, Editor of the New Horizons in Cardiothoracic Surgery Section of CTSNet, that we summarize the results of these two programs for publication in this journal. These student programs have been supported by a variety of funding sources from within the Johns Hopkins University and the School of Medicine. Additional support was received from the Godfrey Rockefeller, Robert Cinqueqrana and Robert Waldrop Gift Funds. Nishant Patel was supported by an Alpha Omega Alpha Carolyn Kuckein Student Research Fellowship.

References

1. Kouchoukos NT. Why become a cardiothoracic surgeon? Residents Section of the New Horizons Section of CTSNet. August 2004.
2. Baumgartner WA. Cardiothoracic surgery: a specialty in transition – good to great? Ann Thorac Surg 2003;75:1685-92.
3. Shemin RJ. Thoracic Surgery Workforce: snapshot at the end of the twentieth century and implications for the new millennium. Ann Thorac Surg 2002;73:2014–32.
4. Kron IL. How many lives did you save today? Ann Thorac Surg 2006;81:1554–6.

Harold Clifton Urschel, Jr, passed away on November 12, 2012, aged 82. He was born in Toledo, Ohio on February 17, 1930 to Loma Elizabeth Powell Urschel and Harold Clifton Urschel Sr. His was an interesting and unusual childhood in large measure the harbinger of his remarkable life. His father was an engineer, an inventor and entrepreneur who founded the Urschel Engineering Company. During Hal’s early childhood the family moved to rural Arkansas where his Father developed a zinc and copper mining company. His Mother homeschooled Hal and instilled in him the desire for learning as well as for the morality and faith of her Father, Hal’s grandfather, a Methodist Bishop. Hal nurtured his love for the outdoors, which continued throughout his life exemplified by his passion for hunting and fishing . His Mother recognized the need to civilize the nativist young boy, and they returned to Bowling Green, Ohio where he spent his high school years. His Father died of heart disease at the age of 41, leaving Hal’s Mother with 3 children to manage. They moved back with her family, and Hal was greatly influenced by the academic environment provided by Bowling Green University. Bowling Green also happened to be where the Cleveland Browns professional football team began their football season. Under the indirect influence of Paul Brown, the legendary coach of the Cleveland team, Hal became an outstanding football player, becoming an all state selection in football in Ohio. He was recruited by several major college teams, but his Mother thought Princeton University was the best fit for her son, who was also an outstanding academic student. Hal went to Princeton, along with another Ohio football player, Dick Kazmaier, who won the Heisman Trophy. Hal’s Princeton football career was successful and his teams were undefeated his freshman and senior years. He went on to Harvard Medical School, and trained in surgery at the Massachusetts General Hospital.

The most significant event of an eventful life was the almost chance opportunity to spend time with someone else’s date when he injured himself with a ski pole during a ski trip in New England. Elizabeth Bradley (Betsey) was a Wellesley undergraduate, the daughter of two physicians. Her Mother was an internist, her Father a Navy career physician who rose to the rank of Admiral in the Navy Medical Corps. Betsey was Hal’s anchor, to use a Navy term. She moderated his enthusiasm with exquisite diplomacy and good taste, became an important member of the Harvard University community, and was every bit as much of an achiever as was her husband. In between all these activities she became Mother to 5 fantastic children, who, with their Mother, survive Hal: Harold C. Urschel, M.D. (wife Christi Carter Urschel), Bradley Van Fleet Urschel (wife Bonny Urschel), Sterling Locke Urschel, Amanda Elizabeth Goldstein (husband Robert Goldstein M.D.), and Susanna McKinley Urschel. Hal and Betsey have 7 grandchildren: Everest Goldstein, Haley Urschel, Chancellor Urschel, Rush Urschel, Bear Goldstein, Carr Urschel, and Liam Walters. His sister-in-law, Virginia Byers Urschel, cousins Mary Beth and Louis Horvath, and many nieces and nephews also survive him. He was preceded in death by his brother, William Powell Urschel and his sister, Elizabeth Ann Urschel.

It is no easy task to sum up the life of this remarkable man, it had so many different facets. Just about the time you focus on his brilliant surgical career one is reminded to recall the devotion to his family. When you remember the iconoclastic curmudgeon, you find yourself remembering as well the man of a thousand genuinely profound quotations. He was at one time or another, sometimes all at once, aggressive, kind, caring, brutally honest, and diplomatic, but above all devoted to his family, his friends, his faith and his profession. He had enough energy for 100 surgeons. He and Betsey were tireless in their professional activities, and at the time of his death he was at the American Heart Association meeting in Los Angeles, where he was presenting material on his latest research interest, the use of stem cells for the treatment of a heart failure. He was a Past President of the Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, the American College of Chest Physicians, and the Texas Surgical Association. He has been a Governor of the American College of Surgeons, Chairman of the American Board of Thoracic Surgery, Chairman of the Residency Review Committee for Thoracic Surgery, and a member of every important national and international medical and surgical society. His death leaves an empty place in the hearts of his family and friends, but we live on blessed by the warmth of our long association with him.

Hal’s favorite quotation is that of Hippocrates inscribed on the wall of Building 5 at the Harvard Medical School:

LIFE IS SHORT
THE ART IS LONG
THE OCCASION INSTANT
THE EXPERIMENT PERILOUS AND THE
DECISION DIFFICULT

Courtesy: CTSNet 

Boehringer Ingelheim (Germany) which began this study in August 2011 has halted the RE-ALIGN trial investigating the use of Dabigatran (Pradaxa) in patients with artificial heart valves. The phase 2 dose-ranging study was stopped because investigations into the dosing regimen "did not achieve the desired results," according to the company.

The study was testing three doses of dabigatran in patients with newly or previously implanted mechanical aortic valves, but concerns have been raised about the risk of valve thrombosis with the newer anticoagulant. In September 2012, as reported by heartwire, Canadian physicians reported the cases of two women who had undergone valve replacement years prior and had been faring well on warfarin but who subsequently suffered valve thrombosis when they were switched to Dabigatran. Dabigatran is not approved for patients with mechanical valves. It is approved by the Food and Drug Administration for preventing strokes and systemic embolism in patients with nonvalvular atrial fibrillation. Dabigatran is currently approved for use in Europe for venous thromboembolism prophylaxis after hip- and knee-replacement surgery but is not approved in the US for this indication.

"The presence of an artificial heart valve in patients is a clinical condition that is distinct from those for which dabigatran is an approved treatment," Boehringer Ingelheim stated in a press release. "In view of the interim trial results, the company is currently in discussions with the relevant regulatory authorities to reinforce the product label text accordingly and to discuss appropriate communication to physicians and relevant healthcare providers."

The RE-ALIGN study was started in December 2011, and approximately 370 patients were expected to be enrolled. The study's completion date was initially sometime in 2018.

Study of dabigatran in mechanical heart valve patients halted.

Hypertension along with diabetes has become one of the most dreaded chronic illnesses in India. To understand the disease we first need to understand  the basics of blood pressure. Our blood flows through our arteries with pressure. This pressure is determined by the pumping of the heart as well as resistance to the flow of blood by the arteries. Due to genetics, high cholesterol or other reasons, the wall of the blood vessels get thickened leading to increased resistance for the blood to flow. Due to this, even the heart has to pump harder. This causes the blood pressure to go up causing hypertension. All the complications mainly stem from thickening of the vessel walls, leading to reduced blood flow to different body parts. Some of the more serious complications of hypertension include:

1. Coronary artery disease (CAD): Elevated blood pressure makes the arteries (blood carrying vessels) thick and narrow and damage their lining (endothelium). This acts as a starting point for the formation of a clot which can grow and this block the blood supply to the heart. When there isn’t enough blood supply to the heart, its efficiency is reduced and the tissues are damaged leading to angina (chest pain). The tendency to develop coronary artery disease is more if you have other risk factors like diabetes, obesity and family history.

2. Heart failure: When the blood pressure is high it increases the workload of the heart and the heart has to pump the blood against this elevated pressure and in this process the heart has the work more. The heart pays the price of this hard work by thickening its muscle wall especially the left ventricle and many times this thick heart(hypertrophied)  may not be able to pump enough blood to the different organs thus compromising the body needs and eventually leading to heart failure.

3. Brain haemorrhage (stroke): Hypertension increases the risk of brain haemorrhage by almost 10 times. It weakens the small vessels in the brain causing them to rupture. In fact high BP is responsible for 80% of all heart attacks and stroke.

4. Aneurysm: Hypertension also weakens the vessel wall causing it to bulge. This forms an aneurysm (distension or a pouch-like structure in the vessel wall) which can rupture and is invariably fatal.

5. Kidney damage: Elevated blood pressure damages the small vessels in the kidney. This reduces the blood supply to it and the kidney starts losing its normal functions and eventually leads to kidney failure.

6. Vision loss: Blood vessels in the eye (retinal vessels) are narrowed and the vision can get impaired leading to retinopathy and eventually blindness.

7. Sexual dysfunction: The arteries supplying the penis can get narrowed leading to reduced blood supply and erectile dysfunction in males.

8. Memory: Hypertension has also been associated with memory loss.

9. In pregnancy it can cause convulsions in the mother eventually leading to coma and preterm labour. The babies that are born are usually low in weight.

Hence, the high blood pressure is not just a reading on your sphygmomanometer/BP monitor but a warning to work towards reducing your BP and prevent the disastrous complications. In short monitor your BP, take proper treatment and bring about lifestyle changes and move towards a healthy life!

By: Dr Varuna Mallya

The benefit of tight glycaemic control in the post-operative setting has come under increasing scrutiny of late. Initial small scale studies suggesting large clinical benefits have been followed by much larger multi-centre trials demonstrating neutral or even harmful effects of tight blood sugar control, with most investigators pointing towards the high occurrence of hypoglycaemia as being the main problem associated with therapy. These studies have been almost exclusively in adults but the role of tight glycaemic in critically ill children is less well understood. In this study, Agus et al examined whether tight glycaemic control reduces morbidity after paediatric cardiac surgery. In a two-centre, prospective, randomized trial, 980 children, 0 to 36 months of age, undergoing surgery with cardiopulmonary bypass were recruited. Participants were randomly assigned to either tight glycaemic control (with the use of an insulin-dosing algorithm targeting a blood glucose level of 4.4 to 6.1 mmol/l) or standard care in the cardiac intensive care unit. Continuous glucose monitoring was used to guide the frequency of blood glucose measurement and to detect impending hypoglycaemia. The primary outcome was the rate of health care-associated infections with secondary outcomes including mortality, length of stay, organ failure, and hypoglycaemia. A total of 444 of the 490 children assigned to tight glycaemic control (91%) received insulin versus 9 of 490 children assigned to standard care (2%). Although normoglycaemia was achieved earlier (6 hours vs. 16 hours, P<0.001) and was maintained for a greater proportion of the critical illness period (50% vs. 33%, P<0.001), tight control failed to show any benefit in the primary outcome (8.6 vs. 9.9 per 1000 patient-days, P=0.67), any of the secondary outcomes or in post-hoc analyses of high risk sub-groups. Due to the use of continuous glucose monitoring the rate of severe hypoglycaemia (<2.2 mmol/l) were very low occurring in only 3% of patients.

Source: Allistair Lindsay @ BMJ Group Blogs 

Conclusions:

Tight glycaemic control can be achieved with a low hypoglycaemia rate after cardiac surgery in children, but does not significantly change the infection rate, mortality, length of stay, or measures of organ failure, as compared with standard care.

• Agus MS, Steil GM, Wypij D, Costello JM, Laussen PC, Langer M, Alexander JL, Scoppettuolo LA, Pigula FA, Charpie JR, Ohye RG, Gaies MG; SPECS Study Investigators. Tight glycaemic control versus standard care after paediatric cardiac surgery. N Engl J Med. 2012 Sep 27;367(13):1208-19.

For a long time I have been making efforts to organise teaching and training in Medical Statistics on the CSiI, but failed miserably. I now feel that this wonderful site by UCLA can partly contribute towards that aim. 

This is an Internet-based probability and statistics E-Book. The materials, tools and demonstrations presented in this E-Book would be very useful for statistics educational curriculum. The E-Book is initially developed by the UCLA Statistics Online Computational Resource (SOCR). However, all statistics instructors, researchers and educators are encouraged to contribute to this project and improve the content of these learning materials. There are 4 novel features of this specific Statistics EBook. It is community-built, completely open-access (in terms of use and contributions), blends information technology, scientific techniques and modern pedagogical concepts, and is multilingual.

Copyrights: The Probability and Statistics EBook is a freely and openly accessible electronic book developed by SOCR and the general community.