For diabetic inpatients on insulin, how does tight control of diet compare with more liberal patient control of the diet in affecting patient satisfaction?

A search of PubMed:  (diabetes OR diabetic) AND inpatients AND (diet OR food service) AND patient satisfaction

retrieved the following study comparing use of the two diet plans for diabetic inpatients
Curll M, et al. Menu selection, glycaemic control and satisfaction with standard and patient-controlled consistent carbohydrate meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010 Aug;19(4):355-9.
This is a comparative study; the abstract does not indicate whether or not patients are randomized.  Compares levels of patient satisfaction, rates of hypoglycemia, and level of clinician oversight.

Using the related articles feature in PubMed retrieved these additional papers:

Bhattacharyya A, et al. In-patient management of diabetes mellitus and patient satisfaction. Diabet Med. 2002 May;19(5):412-6. Erratum in: Diabet Med. 2002 Sep;19(9):797.

Gosmanov AR, Umpierrez GE.  Medical nutrition therapy in hospitalized patients with diabetes.  Curr Diab Rep. 2012 Feb;12(1):93-100. doi: 10.1007/s11892-011-0236-5.  Review

Swift CS, Boucher JL. Nutrition therapy for the hospitalized patient with diabetes.
Endocr Pract. 2006 Jul-Aug;12 Suppl 3:61-7.

Curll M, et al. Menu selection, glycaemic control and satisfaction with standard and patient-controlled consistent carbohydrate meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010 Aug;19(4):355-9. doi: 10.1136/qshc.2008.027441.

What is the latest published evidence in the literature about preventing pressure ulcers?

Overview of latest published evidence:  See Prevention and Screening section of Pressure Ulcer topic in: DynaMed Plus.

Also see: Pressure Area Care: Management in Joanna Briggs Institute EBP Database.

Includes appraisals of

  • Use of risk assessment scales – not proven to prevent pressure ulcers better than clinical judgement
  • Nutritional therapy – DynaMed Plus includes systematic review that concludes there is not enough evidence addressing use of nutritional therapy
  • Support surfaces – DynaMed Plus includes recent systematic review addressing different types of surfaces (e.g., constant low-pressure, alternative foam, sheepskin, alternating pressure, etc.), generally the evidence is either conflicting, has methodologic limitations, or shows no significant difference.
  • Repositioning – DynaMed Plus systematic review finds insufficient evidence for specific schedules for repositioning; Joanna Briggs cites a cohort study showing that respositioning reduced length of time tissue under pressure and chance of developing ulcers.

DynaMed Plus also reviews evidence specific to patient with spinal cord injury.

Also see What is the efficacy of these specific interventions for treating or preventing pressure ulcers in acute care patients?

Nurse to nurse accountability on shift change

I searched PubMed on these concepts of shift change and nurse accountability.

Griffin, Terry. “Bringing change-of-shift report to the bedside: a patient- and family-centered approach.” The Journal of perinatal & neonatal nursing 24.4 (2010):348-53.

Powell, Suzanne K. “Handoffs and transitions of care: where is the Lone Ranger’s silver bullet?.” Lipincott’s case management 11.5 (2006):235-237.

Researchers provide new template for more effective handoffs.” Healthcare benchmarks and quality improvement 17.5 (2010):49-52.

Patterson, Emily S, and Robert LWears. “Patient handoffs: standardized and reliable measurement tools remain elusive.” The joint commission journal on quality and patient safety 36.2 (2010):52-61.

 

 

In patients receiving electroconvulsive therapy, does remifentanil lower seizure threshold?

Bottom line:  There is some lower level evidence that remifentanil may be associated with a lower seizure threshold.

Search methods:  Searched EMBASE and Medline using these concepts:
remifentanil AND electroconvulsive therapy
Applied filters for RCT and systematic reviews

Search results:
REVIEWS OF EVIDENCE:
Remifentanil: A review of its use in electroconvulsive therapy
Chen S.T.
Journal of ECT 2011 27:4 (323-327)
Review includes study (Sullivan et al.) that documented effect of remifentanil on seizure threshold (lowered threshold and results in lower rise in threshold than comparison group.)  This was a very small (n=24) retrospective study.

Effects of general anesthetic agents in adults receiving electroconvulsive therapy: A systematic review
Hooten W.M. and Rasmussen K.G.
Journal of ECT 2008 24:3 (208-223)

RCTS:
Effects of remifentanil on convulsion duration and hemodynamic responses during electroconvulsive therapy: A double-blind, randomized clinical trial
Nasseri K., Arasteh M.T., Maroufi A. and Shami S.
Journal of ECT 2009 25:3 (170-173)

Propofol versus propofol-remifentanil combination anaesthesia in electroconvulsive therapy: Effects on seizure duration and hemodynamics
Algül A., Şen H., Ateş M.A., Yen T., Özkan S., Durmaz O., Erbinç S., Daǧli G. and Çetin M.
Klinik Psikofarmakoloji Bulteni 2009 19:SUPPL. 1 (S153-S154)

Remifentanil supplementation of propofol during electroconvulsive therapy: Effect on seizure duration and cardiovascular stability
Vishne T., Aronov S., Amiaz R., Etchin A. and Grunhaus L.
Journal of ECT 2005 21:4 (235-238)

Effects of remifentanil and alfentanil on seizure duration, stimulus amplitudes and recovery parameters during ECT
Akcaboy Z.N., Akcaboy E.Y., Yigitbasi B., Bayam G., Dikmen B., Gocus N. and Dilbaz N.
Acta Anaesthesiologica Scandinavica 2005 49:8 (1068-1071)

Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy
Smith D.L., Angst M.S., Brock-Utne J.G. and DeBattista C.
Acta Anaesthesiologica Scandinavica 2003 47:9 (1064-1066)

The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy
Recart A., Rawal S., White P.F., Byerly S. and Thornton L.
Anesthesia and Analgesia 2003 96:4 (1047-1050)

Is capnography or end tidal CO2 assessment effective for monitoring adult patients in emergency departments or intensive care units who are undergoing moderate sedation or mechanical ventilation?

Bottom line:  There is evidence that associates capnography with improved detection of respiratory depression during procedural sedation and in management of mechanical ventilation.

Monitoring during moderate sedation:

PubMed search: (capnography OR end tidal carbon dioxide) AND sedation AND (emergency department OR intensive care OR critical care) AND humans[mesh]
Includes prospective studies, a systematic review and some lower quality comparative studies.

Higher quality study (Randomized controlled trial and prospective studies)
Proehl J, et al. J Emerg Nurs. 2011 Nov;37(6):533-6. Emergency Nursing Resource: the use of capnography during procedural sedation/analgesia in the emergency department.
Systematic review describes evidence from research studies, meta-analyses, systematic
reviews, and existing guidelines. Rates evidence using Appraisal of Guidelines Research & Evaluation methodology.

Deitch K, et al. Ann Emerg Med. 2010 Mar;55(3):258-64. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial.
Patients (n=132) in the ED who received propofol sedation received standard monitoring plus capnography and were randomized so that physicians administering care either had access to capnography readings or were blinded to capnography readings.  RESULTS:  Hypoxia was observed in 17 of 68 (25%) subjects with capnography and 27 of 64 (42%) with blinded capnography (P=.035; difference 17%; 95% confidence interval 1.3% to 33%).  Capnography identified all cases of hypoxia before onset (sensitivity 100%; specificity 64%), with the median time from capnographic evidence of respiratory depression to hypoxia 60 seconds (range 5 to 240 seconds)

Burton JH, et al. Acad Emerg Med. 2006 May;13(5):500-4. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?
60 patients (enrollment stopped after review of 20 acute respiratory events) underwent capnographic monitoring while under procedural sedation. Abnormal end tidal CO2 findings were documented in 36 patients (60%). Abnormal ETCO2 findings were documented before changes in SpO2 or clinically observed hypoventilation in 14 patients (70%) with acute respiratory events.

Monitoring during mechanical ventilation

PubMed:  (capnography OR end tidal carbon dioxide) AND mechanical ventilation AND (emergency department OR intensive care OR critical care) AND humans[mesh]
Filters:  Systematic reviews

Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation: 2011.  Respir Care. 2011 Apr;56(4):503-9.
Applied GRADE criteria to 200+ identified studies and guidelines. Includes several recommendations for use of capnography in monitoring patients on mechanical ventilation.

What are the orientation costs for registered nurses in a hospital setting?

Morris LL ; Pfeifer P ; Catalano R ; Fortney R ; Nelson G ; Rabito R ; Harap R Outcome evaluation of a new model of critical care orientation. American Journal of Critical Care, 2009 May; 18(3): 252-9

Greene, Mary Ann. Paying for nursing orientation: a huge cost to hospitals. Journal for Nurses in Staff Development, 2010 Nov-Dec; 26(6): E3-7

Recruitment & Retention Report. On the road to a meaningful, cost-effective orientation program. Nursing Management 2011 vol:42 iss:5 pg:10

Reiter, Margaret Decrease new graduate nurse orientation costs by using HESI exit exam scores. The Journal of nursing administration 2007 vol:37 iss:10 pg:459 -463

Kennedy, Julie Nursing department orientation: are we missing the mark? Journal for nurses in staff development 2012 vol:28 iss:1 pg:24 -26

Reviewed JKN 4/14

What is some research related to ambulation of patients as it relates to preventing post op ileus?

Delaney, C P Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterology and motility 2004 vol:16 Suppl 2 pg:61 -66

Zutshi, Massarat Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. The American journal of surgery 2005 vol:189 iss:3 pg:268 -272

Delaney, Conor Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Diseases of the colon & rectum 2003 vol:46 iss:7 pg:851 -859

van Bree, Sjoerd H W New therapeutic strategies for postoperative ileus. Nature reviews. Gastroenterology & hepatology 2012 vol:9 iss:11 pg:675 -683

Thompson, Melissa Management of postoperative ileus. Orthopedics 2012 vol:35 iss:3 pg:213 -217

Lubawski, James Postoperative ileus: strategies for reduction. Therapeutics and Clinical Risk Management 2008 vol:4 iss:5 pg:913 -917

Reviewed JKN 4/14