Point-of-Care Blood Glucose Testing for Diabetes Care in Hospitalized Patients: An Evidence-Based Review

Glycemic control in hospitalized patients with diabetes requires accurate near-patient glucose monitoring systems. In the past decade, point-of-care blood glucose monitoring devices have become the mainstay of near-patient glucose monitoring in hospitals across the world. In this article, we focus on its history, accuracy, clinical use, and cost-effectiveness. Point-of-care devices have evolved from 1.2 kg instruments with no informatics to handheld lightweight portable devices with advanced connectivity features. Their accuracy however remains a subject of debate, and new standards for their approval have now been issued by both the International Organization for Standardization and the Clinical and Laboratory Standards Institute. While their cost-effectiveness remains to be proved, their clinical value for managing inpatients with diabetes remains unchallenged. This evidence-based review provides an overall view of its use in the hospital setting.     

西藏自治区某医院高原肺水肿住院患者治疗药物结构分析

目的：了解西藏高海拔地区高原肺水肿患者的人群特点和治疗药物结构特点,并分析其规律,为合理配置卫生资源制定科学的疾病治疗措施提供参考。方法：统计西藏自治区某医院2016年1月-2017年6月收治住院的HAPE患者相关信息进行回顾性分析。结果：基于研究医院数据显示,HAPE住院患者中男性明显多于女性,年龄分布集中在20~50岁。在用药种类数方面抗感染药物（17.14%）和中成药（15.71%）种类数较多,但在用药人次数上以消化系统药物（22.64%）、抗感染药物（19.91%）、心血管系统药物（18.56%）、呼吸系统药物（18.09%）为主。HAPE具体治疗药物主要为呋塞米、氨茶碱、地塞米松。结论：基于调查结果,西藏地区HAPE的患病人群和用药结构有一定特点,可为医疗行业在该疾病的治疗措施及药品储备上提供一定参考。     

Dietetic intervention for inpatients on fluid‐only diets helps to achieve nutritional requirements

Aim

The present study aimed to assess whether dietetic intervention helps patients on fluid‐only diets to meet their energy and protein requirements. This topic has not been previously investigated.

Methods

A quasi‐experimental study of 57 patients receiving fluid‐only diets was conducted at The Townsville Hospital. The fluid consumption of participants was observed over 24 hours and was used to calculate total energy and protein intakes. The percentage of protein and energy requirements met was compared between patients receiving dietetic intervention and patients who were not.

Results

Patients receiving dietetic interventions met a higher percentage of their energy requirements (75.88) than the control group (18.10) based on median intakes (P < 0.001). Patients receiving dietetic intervention also met a higher percentage of their protein requirements (75.99) than the control group (13.80) based on median intakes (P < 0.001). Stratification for age, body mass index (BMI) and fluid diet type showed no change in effect.

Conclusions

This study shows that dietetic intervention enabled patients on fluid‐only diets to meet up to 80% more of their energy requirements and up to 95% more of their protein requirements. These results were consistent across age, BMI and fluid diet type. The significance of these differences has resulted in a change of clinical practice at the study hospital. All patients on fluid‐only diets for three days or longer are now blanket referred for dietetic intervention.     

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

AIM: This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards. BACKGROUND: Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent. METHOD: A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004. FINDINGS: The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds. CONCLUSION: Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods.     

综合医院住院患者情绪问题的调查

目的:探讨综合医院住院患者情绪问题。方法:应用综合医院焦虑抑郁量表(HADs)对榆林市5家综合医院14个科室1 216例住院患者进行评估及分析。结果:本组70.9%(862例)患者有情绪问题,其中焦虑273例(22.5%),抑郁433例(35.6%),焦虑合并抑郁156例(12.8%)。不同性别、文化程度的患者焦虑、抑郁发生率差异无统计学意义;40岁患者焦虑发生率明显增高(P0.05)。外科、内科、妇产科患者情绪问题发生率明显高于五官科(P均0.05)。胸外科患者抑郁发生率最高(56.5%),内分泌科患者焦虑发生率最高(29.9%),血液科患者焦虑合并抑郁发生率最高(21.3%)。结论:综合医院住院患者情绪问题发生率高,40岁患者更容易出现焦虑,外科患者更容易出现抑郁。     

Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well‐being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses’ authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend‐like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.     

Comparison of five measures of motivation to quit smoking among a sample of hospitalized smokers

OBJECTIVE: To compare the predictive validity of several measures of motivation to quit smoking among inpatients enrolled in a smoking cessation program. METHODS: Data collected during face-to-face counseling sessions included a standard measure of motivation to quit (stage of readiness [Stage]: precontemplation, contemplation, or preparation) and four items with responses grouped in three categories: “How much do you want to quit smoking” (Want), “How likely is it that you will stay off cigarettes after you leave the hospital” (Likely), “Rate your confidence on a scale from 0 to 100 about successfully quitting in the next month” (Confidence), and a counselor assessment in response to the question, “How motivated is this patient to quit?” (Motivation). Patients were classified as nonsmokers if they reported not smoking at both the 6-month and 12-month interviews. All patients lost to follow-up were considered smokers. MAIN RESULTS: At 1 year, the smoking cessation rate was 22.5%. Each measure of motivation to quit was independently associated with cessation (p<.001) when added individually to an adjusted model. Likely was most closely associated with cessation and Stage was least. Likely had a sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of 70.2%, 68.1%, 39.3%, 88.6%, and 2.2, respectively. CONCLUSIONS: The motivation of inpatient smokers to quit may be as easily and as accurately predicted with a single question as with the series of questions that are typically used.     

113 229例住院患者HIV抗体初筛结果分析

目的：了解某大型医院住院患者人类免疫缺陷病毒（ HIV）抗体初筛阳性率及其在临床科室中分布情况。方法对113229例住院患者进行HIV抗体初筛检测,比较不同性别患者的阳性率,分析HIV抗体阳性患者在不同科室的分布情况。结果 HIV抗体初筛阳性152例,阳性率为0．134％;其中男91例（0．161％）,女61例（0．107％）,不同性别间阳性率比较差异有统计学意义（P＜0．05）。 HIV抗体初筛阳性患者分布于20个科室,其中高发科室有耳鼻喉科、骨科、妇科、泌尿外科、普外科、神经内科、皮肤科、肿瘤科、眼科。这些科室的HIV抗体初筛阳性者占总筛查阳性的67．1％。结论住院患者中存在较高的HIV抗体初筛阳性率,且科室分布广泛。     

基于智能药柜的住院患者用药分散调剂模式构建

目的：应用智能药柜（ADC）建立住院患者用药分散调剂模式,缩短用药医嘱执行时间,提高药师、护士工作效率,提升药品管理质量。方法：介绍某院ADC分散调剂模式的构建方法及取得的效果。结果：ADC分散调剂模式实现了缩短住院医嘱执行时间,提高药师、护士工作效率,提高病区药品管理质量的目标。结论：全院范围应用ADC分散调剂在我国尚属较新的管理模式,还需要积累总结经验,优化工作流程,完善质量控制体系,让这种模式的优势得到更充分的体现,让药师可以借助信息化管理手段将更多精力用于专业技术性工作,实现工作模式转型。