Hospital practice (1995)
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Hospital practice (1995) · Apr 2011
ReviewUnderstanding glycemic control in the critically ill: 2011 update.
Intensive monitoring of blood glucose concentrations in critically ill patients has become a standard of care in intensive care units over the past 10 years, following the publication of a single-center randomized trial targeting euglycemia in postoperative patients. This article summarizes the literature describing the relationship between hyperglycemia and mortality in the critically ill, the main findings of the major interventional trials of intensive insulin therapy, the association between hypoglycemia and increased glycemic variability with adverse outcomes, and the impact of a preexisting diagnosis of diabetes. A framework for understanding dysglycemia in the critically ill, an approach that recognizes disturbances in the "3 domains" of glycemic control--hyperglycemia, hypoglycemia, and increased glycemic variability--is presented. Finally, practical considerations relating to the implementation of glycemic management protocols are discussed.
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Hospital practice (1995) · Apr 2011
Hyperglycemia is associated with increased hospital complications and mortality during parenteral nutrition.
Hyperglycemia is a recognized complication of parenteral nutrition (PN). We aimed to determine the impact of hyperglycemia during PN unaccompanied by tight blood glucose (BG) control on hospital complications and mortality. ⋯ Hyperglycemia during PN without tight BG control is associated with increased risk of hospital complications and mortality. Randomized controlled trials are needed to determine benefits of intensified glycemic control on clinical outcomes in hospitalized subjects receiving PN.
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Hospital practice (1995) · Apr 2011
Retrospective administrative database study of the time period of venous thromboembolism risk during and following hospitalization for major orthopedic or abdominal surgery in real-world US patients.
To assess the incidence and time course of symptomatic venous thromboembolism (VTE) events in patients during and following hospitalization for major orthopedic or abdominal surgery. ⋯ The time course of VTE in major surgery patients suggests that VTE risk is highest during the first 19 days after admission and that considerable VTE risk extends into the period after discharge.
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Hospital practice (1995) · Apr 2011
Implementation of a medical intensive care unit acute-care nurse practitioner service.
Demands for critical care services are increasing, but the supply of qualified physicians is not. Moreover, there are mounting national expectations for continuous on-site, senior providers and for adherence to quality and safety practices. In teaching institutions, manpower shortages are exacerbated by shrinking trainee duty hours, and there is a growing desire to recoup the revenue lost when a non-credentialed provider delivers a service. ⋯ Acute-care nurse practitioners also provide 40% of the daily resident core lectures and a monthly staff nurse conference. Insufficient data exist at this time, however, to report accurate billing or collection results. Specific areas discussed within this article include service structure, hiring and training, implementation, scheduling, supervision, problems encountered, productivity, monitoring, and future plans.