Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.

Application of Infusion Control System Based on Internet of Things Technology in Joint Orthopedics Nursing Work

In recent years, the Internet of Things technology has flourished, and there have been corresponding practical results in various fields. In medical care, the introduction of Internet of Things technology must also be a new trend in the development of hospital informatization, and it is the development stage of the digital medical process. The traditional infusion system shows that the infusion bottle is not replaced in time, the infusion waiting time is too long, the infusion efficiency is too low, and the existing medical staff is far from meeting the needs of the huge infusion population. Therefore, this article proposes a technology based on the Internet of Things application of the infusion control system in joint orthopedics nursing work to improve the efficiency of infusion in nursing work. This article deeply learns and uses the Internet of Things technology to build a new infusion management and control system, which is applied to joint orthopedics nursing treatment. This paper designs the application research experiment of the infusion control system. Through the Internet of Things technology, the relevant data in the infusion process are uploaded and sent to the network center of the hospital. Nursing staff can directly see the infusion situation directly through the computer console. This article compares and analyzes two different infusion systems and draws conclusions. The infusion ringing rate of the control group was 81.3%, and the infusion ringing rate of the IoT group was 29.8%; the time for timely replacement of the infusion bottle after IoT data control was 13.89 min, compared to 19.76 min before. A variety of data results show that the infusion management and control system based on the Internet of Things technology has played a great role in joint orthopedics care, which can greatly improve the efficiency of infusion, replace the infusion or deal with failures in time for patients, and improve patient satisfaction.

Nurse and Pharmacist Knowledge of Intravenous Smart Pump System Setup Requirements

Objective: The primary purpose of this research was to describe nurse and pharmacist knowledge of setup requirements for intravenous (IV) smart pumps that require head height differentials for accurate fluid flow. Methods: A secondary analysis of anonymous electronic survey data using a database of prerecruited clinicians was conducted. A survey was sent by email to 173 pharmacists and 960 nurses. The response rate for pharmacists was 58% (100 of 173), and the response rate for nurses was 52% (500 of 960). After removing respondents who did not provide direct care and who did not use a head height differential IV infusion system, the final sample for analysis was 186 nurses and 25 pharmacists. Results: Overall, less than one-half of respondents (40%) were aware that manufacturer guidelines for positioning the primary infusion bag relative to the infusion pump were available. Slightly more (49.5%) were aware of the required head height differentials for secondary infusion. Only five respondents selected the correct primary head height, eight respondents selected the correct secondary head height, and one respondent selected both the correct primary and secondary head heights. Conclusion: The results of this study identify a substantial lack of knowledge among frontline clinicians regarding manufacturer recommendations for accurate IV administration of primary and secondary infusions for head height differential infusion systems. Both increased clinician education and innovative technology solutions are needed to improve IV smart pump safety and usability.

Stability and Compatibility of Drug Mixtures from Intrathecal Pump Using High Performance Liquid Chromatography

Although management of intractable pain using long-term intrathecal analgesic administration by implantable infusion systems has become acceptable clinical practice, this method presents unique challenges regarding the stability of the pharmaceutical agent(s) delivered. The stability and compatibility of a single drug such as hydromorphone or bupivacaine, as well as mixtures of morphine-clonidine, have previously been reported, but only using implantable infusion systems and syringes under simulated clinical use conditions, not from implanted intrathecal pumps. The objective of this study was to assess the compatibility and stability of drug mixtures from intrathecal pumps placed in patients. For this case-series, 5 patients with intrathecal pumps who presented to the pain clinic for refill were randomly selected. An aliquot of sample extracted from the pump and an aliquot of new medicine used for pump refill were collected. High performance liquid chromatography (HPLC) was used to compare the 2 samples. Drug samples used were as follows: (A) hydromorphone only, (B) morphine and bupivacaine, (C) hydromorphone and ziconotide, (D) ziconotide and baclofen; and (E) hydromorphone, ziconotide, and baclofen. Samples B and E appeared to be stable when placed in situ in the SynchroMed II intrathecal pump based on the HPLC analysis. However, samples A, C, and D appeared to have undergone some degradation and/or byproduct formation as noted in the graphical display on HPLC. While sample A was a single-drug combination, the sample was in the pump for over 3 months; likewise, sample E was a 3-drug combination, however it was in the pump for only 30 days. Based on these results, it appears as though (a) when the length of time the drug stays in the intrathecal pump increases, or (b) when a combination of drugs is used in the intrathecal pump (as opposed to a single drug), some drug degradation and/or byproduct formation happens as seen on HPLC. This is the first reported study assessing the compatibility and stability of drug mixtures from intrathecal pumps. While the above reported HPLC data reveals quantitative differences, further qualitative analysis is required for confirmation and possible identification of possible degradation and/or byproducts. Key words: Degradation, high performance liquid chromatography, intrathecal pump