RESUMEN
PURPOSE: Blood glucose management in the inpatient setting has been shown to be crucial to patient outcomes. As the evidence develops to determine best clinical practices for achieving inpatient glycemic goals, the Clinical Center at the National Institutes of Health has implemented a streamlined multidisciplinary approach to managing blood glucose levels for hospitalized patients. The purpose of this article is to describe the blood glucose management service at the Clinical Center. CONCLUSION: The blood glucose management service has established a consistent plan of care for diabetes management that has gained acceptance among staff and patients and improved safety and patient outcomes. This plan of care has been applied across various nursing units that serve patient populations on clinical research trials investigating common and rare diseases and treating patients from the United States and around the world.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus/terapia , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Planificación de Atención al Paciente/organización & administración , Calidad de la Atención de Salud/organización & administración , Diabetes Mellitus/epidemiología , Femenino , Guías como Asunto , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/tratamiento farmacológico , Masculino , Maryland/epidemiología , Satisfacción del Paciente , Derivación y ConsultaRESUMEN
The study findings showed that homeless childbearing women are at greatest risk for cancer, violence, poor nutrition, sexually transmitted infections, unplanned pregnancy, and adverse pregnancy outcomes. Collaborating with personnel at a women's shelter, the authors studied homeless childbearing women's knowledge, attitudes, and beliefs about general health promotion, healthy pregnancy promotion, and preterm labor prevention. Guided by the Integrative Model of Behavioral Prediction and Change, 45 homeless women participated in focus groups. They were 28.7 years old (range 18-44 years), and approximately 87% of these women had custody of their children. Three themes identified included things you do to stay healthy during pregnancy, where you learned about staying healthy, and women's knowledge about preterm labor and general health promotion. These findings informed an 8-week educational session (1 hr/week). During the past year, four 8-week sessions were conducted with attendance between 8 and 14 participants. Each week a different health topic was discussed incorporating the associated unique challenges of homelessness.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personas con Mala Vivienda/psicología , Servicios de Salud Materna , Evaluación de Necesidades , Adolescente , Adulto , Femenino , Grupos Focales , Humanos , Embarazo , Investigación Cualitativa , Adulto JovenRESUMEN
New evidence has prompted changes in our national cardiopulmonary resuscitation guidelines for both neonates and adult patients. The purpose of this article is to provide an overview of the changes recommended by the American Heart Association, Academy of American Pediatrics, and the American College of Obstetrics and Gynecology. In addition, a strategy for implementing these guidelines into practice is suggested.
Asunto(s)
Enfermería Neonatal/normas , Enfermería Obstétrica/normas , Guías de Práctica Clínica como Asunto , Resucitación/normas , Medicina Basada en la Evidencia , Femenino , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Humanos , Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/normas , Enfermería Neonatal/métodos , Investigación en Enfermería , Enfermería Obstétrica/métodos , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/terapia , Resucitación/métodos , Resucitación/enfermeríaRESUMEN
OBJECTIVE: Our aims were to define the sonographic features of abdominal and pelvic lymphangioleiomyomas in lymphangioleiomyomatosis (LAM) and to evaluate the utility of sonography in visualizing diurnal change in the size of the masses. MATERIALS AND METHODS: Forty-four patients with LAM and abdominal and pelvic lymphangioleiomyomas found on screening CT underwent sonography. Twenty-two patients had two studies on the same day, one in the morning and the other late in the afternoon. RESULTS: Forty-nine masses were scanned in the 44 patients. The anatomic distribution of the masses was the following: retroperitoneal (29/44 patients, 66%), pelvic (10/44, 23%), and both retroperitoneal and pelvic (5/44, 11%). Of the 49 masses, 12 (24%) were cystic, 16 (33%) were solid, and 21 (43%) were complex. Twenty-two patients underwent sonography in the morning and afternoon. The masses increased in size between the two studies in all 21 patients in whom the masses were visualized in both studies. In three of 21 patients, the echotexture of the masses changed between the morning and afternoon studies: In two the echotexture changed from solid to complex, and in the other, it changed from hyperechoic to isoechoic relative to the liver. CONCLUSION: The sonographic characteristics of lymphangioleiomyomas are similar to some neoplasms such as lymphoma and ovarian cancer (a similarity that sometimes prompts biopsy). After a mass is shown in a patient with LAM, repeat sonography in the morning and afternoon is useful to depict diurnal variation in size and echotexture and to confirm the diagnosis of lymphangioleiomyoma and avoid biopsy.