Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians.

OBJECTIVE: To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. METHODS: As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients. RESULTS: Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern. CONCLUSION: Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.

Female genital mutilation: cultural awareness and clinical considerations.

Clinicians in the United States are increasingly encountering girls and women who have undergone female genital mutilation. To foster a more trusting relationship with such patients, health care providers must have an accurate understanding of the cultural background surrounding this practice, a working knowledge of the different types of female genital mutilation procedures that may be encountered, and an awareness of both the acute and long-term complications. Some of these complications are potentially fatal, and the correct clinical diagnosis can be lifesaving.

Colonization of personal digital assistants used in a health care setting.

BACKGROUND: The use of personal digital assistants (PDAs) by health care workers is increasing. Increasing rates of infection in our institution led to the question of whether PDAs were colonized with pathogenic organisms. METHODS: Specimens for culture were obtained from PDAs used at our institution, and surveys were distributed to the users to determine factors predisposing to colonization. RESULTS: Forty percent of PDAs had growth on culture. The most common organism detected on 27 of 82 PDAs was coagulase-negative Staphylococcus (82%). No isolates of methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci were detected. Colonization was more common on PDAs that had undergone previous cleaning. No other predisposing factors to colonization were found. CONCLUSIONS: PDAs are frequently colonized with typical skin organisms and less commonly with pathogenic organisms. Whether PDAs used in the health care setting serve as vectors for nosocomial infection is not determined.