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Etyang C, Nambozi G, Brennaman L. A Nurse-Led Low-Cost Intervention Effectively Traces Prevalence of Catheter Associated Urinary Tract Infections at a Low-Resourced Regional Referral Hospital in Western Uganda: A Case for Policy Change. Policy Polit Nurs Pract 2020; 21:4-11. [PMID: 31711356 DOI: 10.1177/1527154419886289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Catheter associated urinary tract infection (CAUTI) is the most common hospital-acquired infection worldwide. Low- and middle-income countries (LMICs) with limited resources for health care have not allocated resources to adequately monitor or prevent CAUTIs. The infection is associated with several adverse clinical outcomes, including antibiotic resistance, septicemia, and prolonged hospital stays, that burden the already resource-constrained health systems in LMICs with increased morbidity, health care costs, and deaths. Owing to the lack of resource allocation, little is known about the prevalence of CAUTI in the government-owned and operated hospitals in LIMCs. The purpose of this research was to test a method of CAUTI prevalence surveillance suitable to the resource-constrained health system in a LMIC and to determine the prevalence of CAUTI among hospitalized patients at the study site. In an intermittent 4-week data collection plan, the sample of 68 catheterized adult participants was evaluated for the presence of CAUTI using the three-pronged screening criteria of American Urological Society. CAUTI prevalence in the sample was 17.6%. The high prevalence of CAUTI in this sample represents a substantial risk of consequences to hospitalized patients and to the resource-constrained health system in this LMIC. This first report of CAUTI surveillance using readily available and affordable tools provides evidence to health ministry policymakers of the need for and value of monitoring and prevention programs for hospital-acquired infections in LMICs. We recommend LMIC health policymakers to establish infection prevention teams in hospitals and provide resources to continue surveillance and prevention of CAUTI and other hospital-acquired infections.
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Affiliation(s)
- Charles Etyang
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Grace Nambozi
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Laura Brennaman
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
- Ron and Kathy Assaf College of Nursing, Nova Southeastern University, Fort Myers, FL, USA
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Vergari E, Knudsen JG, Ramracheya R, Salehi A, Zhang Q, Adam J, Asterholm IW, Benrick A, Briant LJB, Chibalina MV, Gribble FM, Hamilton A, Hastoy B, Reimann F, Rorsman NJG, Spiliotis II, Tarasov A, Wu Y, Ashcroft FM, Rorsman P. Insulin inhibits glucagon release by SGLT2-induced stimulation of somatostatin secretion. Nat Commun 2019; 10:139. [PMID: 30635569 PMCID: PMC6329806 DOI: 10.1038/s41467-018-08193-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/18/2018] [Indexed: 02/08/2023] Open
Abstract
Hypoglycaemia (low plasma glucose) is a serious and potentially fatal complication of insulin-treated diabetes. In healthy individuals, hypoglycaemia triggers glucagon secretion, which restores normal plasma glucose levels by stimulation of hepatic glucose production. This counterregulatory mechanism is impaired in diabetes. Here we show in mice that therapeutic concentrations of insulin inhibit glucagon secretion by an indirect (paracrine) mechanism mediated by stimulation of intra-islet somatostatin release. Insulin’s capacity to inhibit glucagon secretion is lost following genetic ablation of insulin receptors in the somatostatin-secreting δ-cells, when insulin-induced somatostatin secretion is suppressed by dapagliflozin (an inhibitor of sodium-glucose co-tranporter-2; SGLT2) or when the action of secreted somatostatin is prevented by somatostatin receptor (SSTR) antagonists. Administration of these compounds in vivo antagonises insulin’s hypoglycaemic effect. We extend these data to isolated human islets. We propose that SSTR or SGLT2 antagonists should be considered as adjuncts to insulin in diabetes therapy. Impaired glucagon secretion in patients with diabetes causes hypoglycemia. Here the authors show that therapeutic concentrations of insulin inhibit alpha-cell glucagon secretion by stimulating delta-cell insulin receptor and the release of somatostatin. Blocking somatostatin secretion or action ameliorates this effect.
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Affiliation(s)
- Elisa Vergari
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Jakob G Knudsen
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Reshma Ramracheya
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Albert Salehi
- Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden
| | - Quan Zhang
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Julie Adam
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Ingrid Wernstedt Asterholm
- Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden
| | - Anna Benrick
- Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden
| | - Linford J B Briant
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Margarita V Chibalina
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Fiona M Gribble
- Cambridge Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alexander Hamilton
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Benoit Hastoy
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Frank Reimann
- Cambridge Institute of Metabolic Science and MRC Metabolic Diseases Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nils J G Rorsman
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Ioannis I Spiliotis
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK.,Oxford National Institute for Health Research, Biomedical Research Centre, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Andrei Tarasov
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK.,Oxford National Institute for Health Research, Biomedical Research Centre, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Yanling Wu
- Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden
| | - Frances M Ashcroft
- Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden.,Department of Physiology, Anatomy and Genetics, Henry Wellcome Centre for Gene Function, University of Oxford, Parks Road, Oxford, OX1 3PT, UK
| | - Patrik Rorsman
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LE, UK. .,Department of Physiology, Institute of Neuroscience and Physiology, University of Göteborg, Box 430, Göteborg, SE40530, Sweden. .,Oxford National Institute for Health Research, Biomedical Research Centre, Churchill Hospital, Oxford, OX3 7LE, UK.
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