Bold Voices - April 2014 - (Page 13)

AT THE BEDSIDE Tight Glycemic Control Could Shorten Children's Hospital Stay C hanging the way pediatric intensive care units (PICUs) control blood sugar levels in critically ill children could significantly reduce hospital length of stay, according to research conducted in the United Kingdom. The trial, which included 1,369 children at 13 PICUs across the U.K., compared the effects of allowing a natural rise in blood glucose (conventional management) to the effects of controlling the rise using insulin to maintain normal glucose levels (tight glycemic control). The findings in "A Randomized Trial of Hyperglycemic Control in Pediatric Intensive Care," published in The New England Journal of Medicine, show a remarkable difference between the two treatment groups during a one-year follow-up. Among children in the ICU who had not undergone heart surgery, tight glycemic control resulted in an average hospital length of stay that was 13.5 days shorter than the stay for children receiving conventional management, in whom glucose levels were allowed to rise naturally. No such benefits were seen for children who had heart surgery. "Although we do not fully understand why controlling blood glucose levels during a child's most critical days leads to a quicker recovery, evidence from this study suggests that doctors caring for very sick children, who have not undergone heart surgery, should consider controlling blood glucose levels more closely during intensive care," lead researcher Duncan Macrae, a consultant at Royal Brompton & Harefield NHS Foundation Trust, says in a related article. For children admitted to a PICU who have not had heart surgery, a policy of tight glycemic control also could reduce costs by about £10,000 (about $16,312) per child, the study concludes. PICU clinicians should consider closer control of blood glucose levels for children who have not had heart surgery. Web-Based Patient Portals Improve SelfManagement Online portals offer patients convenient access to health information and improve self-care. P atient portals help patients manage their care, resulting in improved medication compliance and outcomes, states an article in Healthcare IT News. "Patient Portals Prove Prowess at Kaiser" indicates these Web-based portals are much more than conve©www.azaleahealth.com nient tools to access health information; they also improve patient care. For patients with diabetes "who accessed their online portal to refill medications, these care improvements translated to a significant increase in medication adherence in addition to an overall improvement in cholesterol levels," the article adds. The five-year observational cohort study, published in Medical Care, followed 17,760 patients with diabetes, 8,705 of whom refilled their prescriptions through the patient portal, and 9,055 reference-group patients, who never used online refills. The rate of nonadherence among patients who used the portal exclusively decreased by 6 percent compared with the nonuser reference group. "Offering patients the option of ordering prescription refills online may create efficiencies for pharmacy operations, convenience for patients, and also improvements in adherence and health," senior author Andrew J. Karter, research scientist at Kaiser Permanente, Oakland, Calif., says in the article in Healthcare IT News. AACN BOLD VOICES APRIL 2014 13 http://www.nejm.org/doi/full/10.1056/NEJMoa1302564 http://www.nejm.org/doi/full/10.1056/NEJMoa1302564 http://www.rbht.nhs.uk/media/press-releases/study-led-by-royal-brompton-expert-promises-improvement-in-childrens-intensive-care/ http://www.healthcareitnews.com/news/patient-portals-prove-prowess-kaiser?topic=,08,19 http://www.healthcareitnews.com/news/patient-portals-prove-prowess-kaiser?topic=,08,19 http://www.azaleahealth.com http://journals.lww.com/lww-medicalcare/Abstract/publishahead/Use_of_the_Refill_Function_Through_an_Online.99184.aspx http://www.dor.kaiser.org/external/Andrew_Karter/

Table of Contents for the Digital Edition of Bold Voices - April 2014

Another Angle
President’s Note (Teaser)
NTI2014: You Have to Come! An Unmatched Experience in the Mile High City
AACN Clinical Priorities 2014: Clinical Topics for Bedside Clinicians
NTI Network: Connect Online to Plan Your Week
Step Forward! Vote in AACN’s Election 2014
You May Inherit Atherosclerosis From Your Mummy
Pain, Agitation, Delirium Guidelines Expand Nurses’ Toolkit
Pediatric Flu Deaths Still a Concern, Expanded Vaccinations Advised
Are Senior-Specific EDs Worth the Investment?
‘Stop Sepsis’ Program Reduces Mortality Rate 40 Percent
Better Relationships Between Nurses, Cleaning Staff Can Improve Patient Care
Patient Outcomes Improve With Surgeon-Led Mortality Reviews
Reducing Cross-Contamination from Healthcare Personnel Attire
New Biomarker Could Improve Outlook in Esophageal Cancer
Long-Term Survival of Kids After Out-of-Hospital Cardiac Arrest
Tight Glycemic Control Could Shorten Children’s Hospital Stay
Web-based Patient Portals Improve Self-Management
In Our Journals
Nurse-Patient Communication Enhanced in AACN CSI Academy Projects
Link Between Shingles and Stroke Risk?
In Utero Exposure to Dyslipidemia Heightens High LDL Risk in Offspring
Palliative Care: Conversations Matter
Improving Communication About Chronic Critical Illness
Certification Capsules
April 16: National Healthcare Decisions Day
New Editorial Consults, Other Publishing Events at NTI 2014
AACN Scholarships for August EBP, Research Methods Institutes
Early-Bird Registration Ends April 3
Attend the Chapter Leadership Development Workshop at NTI 2014
Vote Now!
Letters
Transitions
‘I Am a Critical Care Nurse’
President’s Note

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