Zachary Hartsell

Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners

PURPOSE The purpose of this study is to explore attitudes among inpatient midlevel practitioners about hospital hyperglycemia and to identify perceived barriers to care. METHODS A questionnaire previously applied to resident physicians was administered to midlevel providers (physician assistants and nurse practitioners) to determine their beliefs about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in the hospital. Barriers to care reported in this study were also combined with responses from the prior resident survey. RESULTS Most respondents indicated that glucose control was very important in critically ill, noncritically ill, and perioperative patients. However, most felt only somewhat comfortable treating hyperglycemia and hypoglycemia and with using subcutaneous insulin; respondents expressed the least amount of confidence with using insulin infusions and insulin pumps. Respondents were not familiar with existing institutional polices and preprinted order sets relating to glucose management. The most commonly reported barrier to hyperglycemia management in the hospital was lack of familiarity with how to useinsulin, a finding that persisted after analyzing composite resident and midlevel responses. CONCLUSIONS Most midlevel providers acknowledged the importance of good glucose control in the hospital. Lack of familiarity with how to use insulin in the hospital was the most commonly cited barrier to care. Educational programs should heavily emphasize inpatient treatment strategies.

Rediscovering the art of healing connection by creating the Tree of Life poster.

The goal of this project was to provide a way for hospital staff to form meaningful therapeutic relationships with patients in the fast-paced hospital environment. Watsons Theory of Human Caring was the framework guiding the project. The Lifestory intervention was a Tree of Life poster depicting sources of encouragement and enjoyment, special memories, life lessons, family, and roots. Preintervention and postintervention measures included quality of life (QOL) and spirituality scales with established psychometrics. A one-sample t test was used to analyze data. Mean age of participants (n = 15) was 73.8. Ten (67%) patients reported the intervention positively affected their QOL. Improvements were noted in overall QOL (p = 0.05), as well as emotional (p = 0.005), physical (p = 0.02,) and spiritual well-being, as measured by the Expanded Version of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (p = 0.02). This simple Lifestory intervention was feasible and associated with improvement in several QOL dimensions in hospitalized older adults.

Managing alcohol withdrawal in hospitalized patients.

&NA; Therapy includes benzodiazepines to reduce withdrawal symptoms and prevent delirium. Symptom‐driven protocols may be more beneficial than scheduled‐dosing plans.

Interprofessional orientation for health professionals utilising simulated learning: Findings from a pilot study

ABSTRACT We describe a novel, interprofessional educational intervention pilot used to orient new health profession employees through the simulation laboratory. Health profession employees were recruited to engage in a simulation training session that focused on communication, collaboration, and healthcare roles and responsibilities. Learners (N = 11) were divided into two groups with representation from various health disciplines. Each group participated in a simulated patient scenario while the other group actively observed in another classroom. At the end of both sessions, the group reconvened for a debriefing session. Participants were given a survey before and after the training session, to evaluate the content, experience, and value to their practice. The pre- and post-evaluation survey analysis showed improvement in all objectives with a mean (SD) pre-evaluation score of 4.10 (0.40–1.01) and mean (SD) post-evaluation score of 4.73 (0.30–0.81). Results were favourable, and plans to expand this project are under way.

Managing hospitalized patients with chronic obstructive pulmonary disease.

ABSTRACTChronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and is a common diagnosis in outpatient and inpatient settings. COPD exacerbations account for more than 800,000 hospital admissions annually and are most commonly caused by viral or bacterial infections. This article reviews management of patients with COPD exacerbations, including recommended diagnostic evaluations and treatments.

Should patients at lower cardiac risk receive beta-blockers before noncardiac surgery?

›SEARCH CRITERIA AND RESULTS This question falls under the general category of therapy . The highest levels of evidence to help answer questions about therapy are high-quality metaanalyses; systematic reviews; or very large, well-conducted, randomized controlled trials (RCTs). We conducted a search of the medical literature using the following terms in MEDLINE 1966-current: adrenergic beta-antagonists AND perioperative care. Adrenergic beta-antagonists yielded 32,576 results, and perioperative care (exploded) yielded 65,018 results. Combining the terms yielded 293 articles. Limiting these to humans and English language reduced it to 238; that result was then limited to metaanalysis or RCT, resulting in 32. The abstracts of the excluded non-English papers were reviewed to ensure we did not miss a relevant study. Further searches of PubMed, evidence-based medicine prefi ltered databases, the Cochrane databases, and online search engines failed to yield any additional articles that were more pertinent or of a higher level of evidence. Ultimately, the recently published Perioperative Ischemic Evaluation Study (POISE) trial 3 was deemed to be the most pertinent trial addressing this clinical question.

Can B vitamin therapy help to prevent future vascular events

A70-year-old man with a history of type 2 diabetes, dyslipidemia, and MI (in 2000) is admitted to the hospital after experiencing difficulty speaking and right hemiparesis upon awakening this morning. The symptoms have resolved by the time he arrives in the emergency department. The initial workup, which includes head CT, laboratory tests, and radiology and ECG evaluations, is unremarkable. The patient is admitted for observation and initiation of an expedited workup for transient ischemic attack. Your hospital has preprinted stroke admission order forms that include suggested testing for homocysteine levels. You ask yourself, “Is there any evidence that reducing homocysteine levels will help prevent further vascular events?”