The Ridda wars (Arabic: Many people take a low dose of aspirin every day to lower their risk of a further heart attack or stroke, or if they have a high risk of either. Jollof Rice (with basmati rice) If you are not new to this blog, I am sure you already know I am a huge fan of basmati rice. They cook faster, look better. Jasinta Reply: December 5th, 2016 at 3:14 am. What a great treasure the fires springs ministry is. Teaching us to pray aggressively until we received our blessings. The much awaited RRB NTPC Results 2016 have been declared in different zones after all the due processes. The candidates qualified in written exam will need to appear.Diabetes Care in the Hospital. Recommendations. Consider performing an A1. C on all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. CInsulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold . Once insulin therapy is started, a target glucose range of 1. L (7. 8–1. 0. 0 mmol/L) is recommended for the majority of critically ill patients A and noncritically ill patients. CMore stringent goals, such as 1. L (6. 1–7. 8 mmol/L) may be appropriate for selected critically ill patients, as long as this can be achieved without significant hypoglycemia. CIntravenous insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin infusion rate based on glycemic fluctuations and insulin dose. EA basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for patients with good nutritional intake. AThe sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged. AA hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycemia should be established for each patient. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked. EThe treatment regimen should be reviewed and changed if necessary to prevent further hypoglycemia when a blood glucose value is < 7. L (3. 9 mmol/L). CThere should be a structured discharge plan tailored to the individual patient. BBoth hyperglycemia and hypoglycemia are associated with adverse outcomes, including death (1,2). Therefore, hospital goals for the patient with diabetes include preventing both hyperglycemia and hypoglycemia, promoting the shortest safe hospital stay, and providing an effective transition out of the hospital that prevents complications and readmission. High- quality hospital care requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. Hospital Care Delivery Standards“Best practice” protocols, reviews, and guidelines (2) are inconsistently implemented within hospitals. To correct this, hospitals have established protocols for structured patient care and structured order sets, which include computerized physician order entry (CPOE). Computerized Physician Order Entry. In 2. 00. 9, the federal Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted. A core requirement for stage 1 of the HITECH Act’s “meaningful use” included CPOE. The Institute of Medicine also recommends CPOE to prevent medication- related errors and increase efficiency in medication administration (3). A Cochrane review of randomized controlled trials using computerized advice to improve glucose control in the hospital found significant improvement in percentage of time in target glucose range, lower mean blood glucose, and no increase in hypoglycemia (4). As hospitals move to comply with “meaningful use,” efforts should be made to ensure that all components of structured insulin order sets are incorporated in the orders (5). Thus, where feasible, there should be routine structured order sets that produce computerized advice for glucose control. Considerations on Admission. Initial orders should state that the patient has type 1 diabetes or type 2 diabetes or no previous history of diabetes. If the patient has diabetes, an order for an A1. C should be placed if none is available within the prior 3 months (2). In addition, diabetes self- management education should be ordered and should include appropriate skills needed after discharge, such as taking glycemic medication, glucose monitoring, and coping with hypoglycemia (2). Glycemic Targets in Hospitalized Patients. Standard Definition of Glucose Abnormalities. Hyperglycemia in hospitalized patients has been defined as blood glucose > 1. L (7. 8 mmol/L). Blood glucose levels that are significantly and persistently above this level require reassessing treatment. An admission A1. C value . Hypoglycemia in hospitalized patients has been defined as blood glucose < 7. L (3. 9 mmol/L) and severe hypoglycemia as < 4. L (2. 2 mmol/L) (6). Moderate Versus Tight Glycemic Control. Glycemic goals within the hospital setting have changed in the last 1. The initial target of 8. L (4. 4–6. 1 mmol/L) was based on a 4. However, a meta- analysis of over 2. Normoglycemia in Intensive Care Evaluation–Survival Using Glucose Algorithm Regulation (NICE- SUGAR), showed increased rates of severe hypoglycemia and mortality in tightly versus moderately controlled cohorts (8). This evidence established new standards: initiate insulin therapy for persistent hyperglycemia greater than 1. L (1. 0. 0 mmol/L). Once insulin therapy is initiated, a glucose target of 1. L (7. 8–1. 0. 0 mmol/L) is recommended for most critically ill patients (2). More stringent goals, such as 1. L (6. 1–7. 8 mmol/L) may be appropriate for select patients, such as cardiac surgery patients (7), and patients with acute ischemic cardiac (9) or neurological events provided the targets can be achieved without significant hypoglycemia. A glucose target between 1. L (between 7. 8 and 1. L) is recommended for most patients in noncritical care units (2). Patients with a prior history of successful tight glycemic control in the outpatient setting who are clinically stable may be maintained with a glucose target below 1. L (7. 8 mmol/L). Conversely, higher glucose ranges may be acceptable in terminally ill patients, in patients with severe comorbidities, and in in- patient care settings where frequent glucose monitoring or close nursing supervision is not feasible. Clinical judgment combined with ongoing assessment of the patient’s clinical status, including changes in the trajectory of glucose measures, illness severity, nutritional status, or concomitant medications that might affect glucose levels (e. Antihyperglycemic Agents in Hospitalized Patients. In most instances in the hospital setting, insulin is the preferred treatment for glycemic control (2). However, in certain circumstances, it may be appropriate to continue home regimens including oral antihyperglycemic medications (1. If oral medications are held in the hospital, there should be a protocol for resuming them 1–2 days before discharge. Insulin Therapy. The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged (2,1. Critical Care Setting. In the critical care setting, continuous intravenous insulin infusion has been shown to be the best method for achieving glycemic targets.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
September 2019
Categories |