Hyperglycemia Management in Non-critically Ill Hospitalized Patients

2009 ◽  
Vol 22 (5) ◽  
pp. 467-477
Author(s):  
Lindsay M. Arnold ◽  
Darcie L. Keller ◽  
Toyin S. Tofade
Keyword(s):  
Health Care ◽  
Glycemic Control ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Hospitalized Patients ◽  
Negative Consequences ◽  
Care Providers ◽  
Specific Patient ◽  
Oral Agents

There is increasing evidence demonstrating negative consequences and poor clinical outcomes associated with untreated hyperglycemia in hospitalized patients. Data in specific patient populations, primarily critically ill patients, demonstrate improved patient outcomes with tight glycemic control. To date, no clear evidence exists to determine optimal glycemic targets in non-critically ill patients; however, experts agree that better glycemic control in hospitalized patients is warranted. Glycemic control is complicated by numerous factors in hospitalized patients including increased circulating stress hormones, changing nutritional status, and administration of medication therapies that contribute to hyperglycemia. In addition, fear of hypoglycemia among health care providers, a commonly cited barrier, contributes to the failure to adopt more intensive insulin regimens. Current practice trends have proven ineffective and major changes are needed. Some of those trends include the use of sliding scale insulin, continuation of oral agents or combination insulins upon admission, and provider reluctance to initiate insulin in patients not receiving insulin prior to admission. With proper education, safe and effective use of insulin can be used during hospitalization to improve glycemic control. The following article reviews the benefits of glycemic control, identifies barriers to achieving glycemic control, and describes strategies for health care providers and institutions to realize glycemic control in medically ill hospitalized patients.

scholarly journals A Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients

2014 ◽  
Vol 21 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Rohit K Singal ◽  
Robert Sibbald ◽  
Brenda Morgan ◽  
Mel Quinlan ◽  
Neil Parry ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Public Awareness ◽  
Surgical Trauma ◽  
Care Providers ◽  
Inappropriate Care ◽  
End Of Life Issues

BACKGROUND: Health care providers’ perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive.OBJECTIVE: To prospectively determine the incidence and causes of health care providers’ perceptions regarding appropriateness of end-of-life treatments.METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician.RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients’ wishes 22% (1129 of 5224) of the time.CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States

2018 ◽  
Vol 35 (10) ◽  
pp. 1080-1094 ◽  
Author(s):  
Kartikeya Rajdev ◽  
Nina Loghmanieh ◽  
Maria A. Farberov ◽  
Seleshi Demissie ◽  
Theodore Maniatis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
The United States ◽  
Care Providers ◽  
Strongly Agree ◽  
Eol Care

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers’ self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient’s poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.

scholarly journals Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients

2017 ◽  
Vol 53 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Drayton A. Hammond ◽  
Tiffany Chiu ◽  
Jacob T. Painter ◽  
Nikhil Meena
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Medication Cost ◽  
Care Providers ◽  
Medication Costs ◽  
Medical Intensive Care ◽  
High Utilization ◽  
Attending Physicians

Purpose: Medication cost is frequently overlooked when treating critically ill patients. Stewardship of health care resources in high-utilization settings is imperative. This study was conducted to determine nonpharmacist health care providers’ knowledge and perceptions of medication costs in a medical intensive care unit (MICU). Methods: Nonpharmacist health care providers in a MICU completed a 27-item survey. The survey queried perceptions regarding medication cost, cost-limiting strategies, and most/least expensive medications in 8 classes, medication price ranges, and intravenous-to-oral comparisons for commonly prescribed medications. Responses were analyzed using descriptive statistics and compared between providers using Fisher exact tests. Results: Among 98 health care providers (76 medical trainees, 5 attending physicians, 17 nurses), when ordering a medication, 49% consider its cost. Few (15%) providers considered themselves knowledgeable regarding medication costs with no difference between providers ( P = .174). Attending physicians were more aware of the most/least expensive medications than residents (correct out of 16: 9.6 vs 8.5, P = .044). The correct price ranges for select medications (11%-36%, P = .373) and intravenous-to-oral relative costs (3%-49%, P = .596) were similarly low. Most (59%) believed pharmacists limit expensive medication use, particularly senior physicians (58% resident vs 100% attending, P = .007). Conclusion: In spite of a goal of cost consideration, most nonpharmacist health care providers are unaware of medication costs and fail to include them in decision making. These knowledge gaps and perceptions should inform future efforts to improve knowledge and attitudes regarding medication costs.

scholarly journals Predicting mortality in critically ill patients with diabetes using machine learning and clinical notes

2020 ◽  
Vol 20 (S11) ◽  
Author(s):  
Jiancheng Ye ◽  
Liang Yao ◽  
Jiahong Shen ◽  
Rethavathi Janarthanam ◽  
Yuan Luo
Keyword(s):  
Machine Learning ◽  
Health Care ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Care Providers ◽  
Learning Models ◽  
Clinical Notes ◽  
Risk Of Mortality ◽  
Machine Learning Models

Abstract Background Diabetes mellitus is a prevalent metabolic disease characterized by chronic hyperglycemia. The avalanche of healthcare data is accelerating precision and personalized medicine. Artificial intelligence and algorithm-based approaches are becoming more and more vital to support clinical decision-making. These methods are able to augment health care providers by taking away some of their routine work and enabling them to focus on critical issues. However, few studies have used predictive modeling to uncover associations between comorbidities in ICU patients and diabetes. This study aimed to use Unified Medical Language System (UMLS) resources, involving machine learning and natural language processing (NLP) approaches to predict the risk of mortality. Methods We conducted a secondary analysis of Medical Information Mart for Intensive Care III (MIMIC-III) data. Different machine learning modeling and NLP approaches were applied. Domain knowledge in health care is built on the dictionaries created by experts who defined the clinical terminologies such as medications or clinical symptoms. This knowledge is valuable to identify information from text notes that assert a certain disease. Knowledge-guided models can automatically extract knowledge from clinical notes or biomedical literature that contains conceptual entities and relationships among these various concepts. Mortality classification was based on the combination of knowledge-guided features and rules. UMLS entity embedding and convolutional neural network (CNN) with word embeddings were applied. Concept Unique Identifiers (CUIs) with entity embeddings were utilized to build clinical text representations. Results The best configuration of the employed machine learning models yielded a competitive AUC of 0.97. Machine learning models along with NLP of clinical notes are promising to assist health care providers to predict the risk of mortality of critically ill patients. Conclusion UMLS resources and clinical notes are powerful and important tools to predict mortality in diabetic patients in the critical care setting. The knowledge-guided CNN model is effective (AUC = 0.97) for learning hidden features.

Ethical Consideration of Physical Restraint Use in Critically Ill Patients

2019 ◽  
Author(s):  
Nahla Shaaban Khalil
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Social Isolation ◽  
Nonverbal Communication ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
Physical Restraint ◽  
Care Providers ◽  
Restricted Movement ◽  
Restraint Use

Critically ill patients are unable to provide self-care for themselves and take decisions concerning their own needs, desires, and values due to their illness. Most of critically ill patients show struggling to all health care providers while providing care with verbal and nonverbal communication, loss of memory, restricted movement, and social isolation.

scholarly journals Struggling and Overcoming Daily Life Barriers Among Children With Congenital Heart Disease and Their Parents in the West Bank, Palestine

2018 ◽  
Vol 24 (4) ◽  
pp. 585-611 ◽  
Author(s):  
Kawther Elissa ◽  
Carina Sparud-Lundin ◽  
Åsa B. Axelsson ◽  
Salam Khatib ◽  
Ewa-Lena Bratt
Keyword(s):  
Health Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Health Care Providers ◽  
Congenital Heart ◽  
Daily Life ◽  
West Bank ◽  
Well Being ◽  
Negative Consequences ◽  
Care Providers

Advances in early diagnosis, treatment, and postoperative care have resulted in increased survival rates among children with congenital heart disease (CHD). Research focus has shifted from survival to long-term follow-up, well-being, daily life experiences, and psychosocial consequences. This study explored the everyday experiences of children with CHD and of their parents living in the Palestinian West Bank. Interviews with nine children aged 8 to 18 years with CHD and nine parents were analyzed using content analysis. The overall theme that emerged was facing and managing challenges, consisting of four themes: sociocultural burden and finding comfort, physical and external limitations, self-perception and concerns about not standing out, and limitations in access to health care due to the political situation. To provide optimum care for children with CHD and their parents, health care providers and policy makers must understand the negative consequences associated with sociocultural conditions and beliefs about chronic illness.

Health Care Providers' Liability Exposure for Inappropriate Pain Management

1996 ◽  
Vol 24 (4) ◽  
pp. 360-364 ◽  
Author(s):  
Robyn S. Shapiro
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Nursing Home Residents ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Experienced Pain ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Recent studies have exposed the startling inadequacy of health care providers knowledge about and practice of effective pain management. For example, in one study, it was reported that 79 percent of a random sample of 454 medical-surgical inpatients experienced pain during hospitalization, and that 58 percent of patients with pain considered the pain horrible or excruciating. In another study, 67 percent of 2,415 randomly selected hospitalized patients had pain during the twenty-four hours prior to being interviewed, and 50 percent reported pain at the time of the interview. In a study of seriously ill hospitalized patients reported in 1996, half of the patients complained of pain, and one-sixth reported that they experienced extremely severe pain at least half the time. According to one literature review, 75 percent of cancer patients have reported suffering pain, and one study estimates that 25 percent of cancer patients die with severe unrelieved pain. Chronic nonmalignant pain has been described as an extremely prevalent problem, and over two-thirds of nursing home residents experience serious pain.

Disaster Documentation for the Clinician

2013 ◽  
Vol 7 (4) ◽  
pp. 354-360 ◽  
Author(s):  
Richard M. Zoraster ◽  
Christopher M. Burkle
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Professional Organizations ◽  
Medical Decision ◽  
Regulatory Agencies ◽  
Care Practice ◽  
Care Providers ◽  
Health Care Practice ◽  
Specific Patient ◽  
Resource Limitations

AbstractDocumentation of the patient encounter is a traditional component of health care practice, a requirement of various regulatory agencies and hospital oversight committees, and a necessity for reimbursement. A disaster may create unexpected challenges to documentation. If patient volume and acuity overwhelm health care providers, what is the acceptable appropriate documentation? If alterations in scope of practice and environmental or resource limitations occur, to what degree should this be documented? The conflicts arising from allocation of limited resources create unfamiliar situations in which patient competition becomes a component of the medical decision making; should that be documented, and, if so, how?In addition to these challenges, ever-present liability worries are compounded by controversies over the standards to which health care providers will be held. Little guidance is available on how or what to document. We conducted a search of the literature and found no appropriate references for disaster documentation, and no guidelines from professional organizations. We review here the challenges affecting documentation during disasters and provide a rationale for specific patient care documentation that avoids regulatory and legal pitfalls. (Disaster Med Public Health Preparedness. 2013;0:1–7)

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