实施标准化工作流程,及早发现异体干细胞移植受者类固醇引起的高血糖:质量改进项目

Q4 Medicine Transplantation Reports Pub Date : 2024-10-09 DOI:10.1016/j.tpr.2024.100162
Jordan Leal, William Wesson, Liza Rodriguez, Jason Gray, Kelly Bosak, Joseph McGuirk, Kristin Grdinovac
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引用次数: 0

摘要

背景类固醇诱导的高血糖(SIH)会恶化异体移植患者的总体预后。目前,还没有监测 SIH 的标准化工作流程。为了满足这一需求,作为堪萨斯大学护理学院护理实践博士项目的一部分,该学院实施了一项质量改进(QI)计划,以规范糖皮质激素(CG)治疗急性或慢性移植物抗宿主病(GVHD)后的血糖监测。研究设计该研究在美国中西部的一家大型血液和骨髓移植项目中进行。被诊断为急性或慢性 GVHD 且处方≥ 0.5 mg kg-1/day 的泼尼松当量 (PE) 类固醇的患者被要求在 14 天内监测餐后血糖值。对照组(回顾性病历审查)用于比较。结果在 9 周内,有 19 名患者参加了 QI 计划。对照组有 21 名患者。两组患者的中位 PE 类固醇剂量均为 1 毫克 kg-1/天(P = 0.8100)。19 名患者中有 18 名(95%)至少有一次血糖 (BG) 达到 180 mg/dL,而 21 名患者中只有 6 名(29%)至少有一次血糖达到 180 mg/dL(p = 0.0001)。QI 组患者血糖达到 180 mg/dL 的中位时间为 1.5 天,对照组为 7 天(p = 0.0232)。结论该项目证明,与仅在常规门诊进行监测相比,每日餐后血糖监测更有利于早期识别和治疗 SIH。
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Implementing a standardized workflow for early detection of steroid-induced hyperglycemia in allogeneic stem cell transplant recipients: A quality improvement project

Background

Steroid-induced hyperglycemia (SIH) worsens overall outcomes in the allo-SCT population. Currently, there is no standardized workflow for monitoring SIH. To address this need, a quality improvement (QI) initiative was implemented, as part of a Doctor of Nursing Practice project for the University of Kansas School of Nursing, to standardize glucose monitoring after the initiation of glucocorticoids (CGs) for the treatment of acute or chronic graft-versus-host-disease (GVHD).

Objective

This QI initiative aimed to decrease the median time to identification of SIH and the initiation of treatment in allo-SCT recipients on GCs for GVHD.

Study Design

The study took place at a large Midwestern blood and marrow transplant program. Patients diagnosed with acute or chronic GVHD and prescribed ≥0.5 mg kg-1/day prednisone equivalent (PE) steroids were requested to monitor postprandial blood glucose values for 14 days. A control group (retrospective chart review) was used for comparison. Time to the identification of SIH was compared between the two groups, as well as the time to treatment of hyperglycemia.

Results

Over 9 weeks, 19 patients enrolled in the QI initiative. The control group consisted of 21 patients. The median PE steroid dose was 1 mg kg-1/day in both groups (p = 0.8100). Eighteen of the 19 patients (95 %) had at least 1 blood glucose (BG) > 180 mg/dL and only 6 of 21 patients (29 %) had at least 1 BG > 180 mg/dL (p < 0.0001). The median time to a BG > 180 mg/dL was 1.5 days in the QI group and 7 days in the control group (p = 0.0232). The median time to insulin was 2 days in the QI group and 10 days in the control group (p = 0.0355).

Conclusion

This project demonstrated that daily postprandial blood glucose monitoring is superior for the earlier identification and treatment of SIH when compared to monitoring at routine clinic visits alone.
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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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