IntroductionSevere hypoglycemia is a burden for both patients and the healthcare system payer alike. This study aimed to quantify the resource use associated with a severe hypoglycemic event (SHE) in patients with diabetes.MethodsThis retrospective cohort study compared resource use (e.g., physician visits, hospitalizations, and medications) 1 month pre- and post-SHE among patients with type 1 (T1D) or type 2 diabetes (T2D) from a large not-for-profit healthcare provider.ResultsFrom 2005 to 2014, 284 patients with T1D (52.5% male, mean age 29.8 years, mean HbA1c 7.9%) and 3691 patients with T2D (47.6% male, mean age 67.1 years, mean HbA1c 7.3%) were eligible for inclusion in the study. In total, 95.4% of patients with T1D and 32.8% of patients with T2D were insulin treated, while 3.5% of patients with T1D and 70.4% of patients with T2D were treated with oral drugs that could cause hypoglycemia (sulfonylureas or meglitinides). Hospital admissions increased by 95% in T1D and 127% in T2D (P < 0.001) 1 month post-SHE versus 1 month pre-SHE. Of those admitted to hospital (T1D n = 59; T2D n = 1214), the mean length of stay was significantly longer during the month post- versus pre-SHE [2.08 vs. 0.88 days, P = 0.036 (T1D) and 4.17 vs. 1.45 days, P < 0.001 (T2D)]. Outpatient visits also increased by 37% for T1D and 47% for T2D between these two time periods (P < 0.001). The total monthly expense per patient increased by 46% and 87% for T1D and T2D, respectively, from $485 pre-SHE to $708 post-SHE for T1D, and from $601 pre-SHE to $1121 post-SHE for T2D (P < 0.001). The greatest expense was hospital care, with increases of 179% and 166% for T1D and T2D, respectively, to $312 and $706 per patient/month.ConclusionThis real-world analysis from a large diabetes registry indicates an increased use of healthcare services, including more frequent and prolonged hospital admissions and outpatient visits after an SHE, which resulted in an increase in healthcare expense.FundingNovo Nordisk.

Objective: To assess a decade of growth hormone (GH) treatment patterns and outcomes in a real-world setting in Israel using a state-of-the-art computerized database.Methods: This large retrospective database study included 2,379 children initiating GH treatment in Maccabi Healthcare Services (between January 2004 and December 2014). Good adherence with therapy (proportion of days covered &gt;80%) was assessed during follow-up.Results: At GH treatment initiation: 62.1% were boys; height standard deviation score (SDS) was −2.36 ± 0.65 (mean ± SD); age was 9.8 ± 3.1 years; and time from short stature diagnosis to first GH purchase was 4.8 ± 3.3 years. Mean treatment period was 3.5 ± 0.95 years; 79.4% of children were treated for more than 3 years. The two main indications for GH therapy were idiopathic short stature (ISS) (n = 1,615, 67.9%) and GH deficiency (GHD) (n = 611, 25.7%). Children in the highest socio-economic-status (SES) tertile comprised 61.3% of ISS and 59.7% of GHD. After 3 years, mean height gain SDS was 1.09 ± 0.91 for GHD and 0.96 ± 0.57 for ISS (p = 0.0004). Adult height (age 15 for girls and 17 for boys) was recorded for 624 patients (26.2%) with better outcomes for GHD than ISS (−1.0±0.82 vs. −1.28±0.93, respectively; p = 0.0002). Good adherence was achieved in 78.2% of the cohort during the first year and declined thereafter to 68.1% during the third year of the treatment.Conclusions: Children who initiate GH therapy are predominantly male, belong mainly to the upper SES, commence treatment a long period after initial recognition of short stature, and have suboptimal adherence. Appropriate referral, diagnosis, and follow-up care may result in better treatment outcomes with GH therapy.

1. Our aim was to investigate the effect of experimental iron deficiency on cardiac functional properties. We recorded ventricular isometric twitch, action potentials and the L-type Ca2+ current in isolate ventricular myocytes from iron-deficient rats and control rats. 2. Twitch tension and maximal rates of tension activation and relaxation were reduced in iron-deficient compared with control rats, whereas twitch duration was prolonged. Isoproterenol (10-(6) mol/l) augmented tension in iron-deficient rats (P < 0.05), but only moderately affected control rats. In contrast, maximal rates of tension activation and relaxation were increased equally by isoproterenol in the two groups. 3. To determine the mechanism(s) responsible for the reduced mechanical function in iron-deficient rats, action potentials and the L-type Ca2+ current (with or without isoproterenol) were recorded in both groups. 4. The L-type Ca2+ current was smaller in ventricular myocytes from control rats than in those from iron-deficient rats; at a membrane potential of 0 mV, L-type Ca2+ current amplitudes were -1.44 +/- 0.18 and -0.97 +/- 0.07 nA in myocytes from control and iron-deficient rats respectively (P < 0.05). 5. Action potential duration was markedly shortened in myocytes from iron-deficient compared with control rats; action potential duration at 50% repolarization was 12.0 +/- 1.6 and 7.2 +/- 1.4 ms in myocytes from control and iron-deficient rats respectively (P < 0.01). These iron deficiency-induced electrophysiological alterations most probably contribute to the depressed mechanical function in iron-deficient rats. 6. The L-type Ca2+ current was augmented equally by isoproterenol in the two groups, suggesting that the enhanced inotropic responsiveness in iron-deficient rats was not due to an increased response of the L-type Ca2+ current. 7. These results may have an important implication for anaemic (iron-deficient) patients; the attenuation of their cardiac mechanical performance may be compensated by an increased reactivity to beta-adrenergic stimulation.

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Significant differences in pain magnitude and urinary residual sense of indwelling catheters were observed among the three groups, with inhalation of linalyl acetate being significantly more effective than inhalation of lavender or vehicle. Conclusions: Inhalation of linalyl acetate is an effective nursing intervention to relieve pain and urinary residual sense of indwelling urinary catheters following their removal from patients who underwent CRC surgery. Acknowledgments: This research was supported by a NRF (2016R1D1A1B03931081).