Evaluation of the Impact of an Inpatient Hyperglycemia Protocol on Glycemic Control.

PURPOSE: Inpatient hyperglycemia is associated with poor outcomes. Existing research assessing inpatient hyperglycemia protocols has shown improvements in average blood glucose levels with inconsistent results regarding rates of hypoglycemia and hyperglycemia. The objective of this study was to evaluate the impact of an inpatient hyperglycemia protocol on glycemic control. METHODS: This retrospective cohort study at a large, community teaching hospital included adult patients in non-critical care units requiring insulin administration for glycemic control. The intervention examined was utilization of an inpatient hyperglycemia protocol, comprised of a computerized physician order entry order set and provider education at the time of implementation. Two cohorts, a pre-protocol implementation group and a post-protocol implementation group, were compared. The primary outcome was the incidence of blood glucose values within 70-180 mg/dL over a 72-hour period between groups. Key secondary outcomes included the incidence of hypoglycemia (less than 70 mg/dL), severe hyperglycemia (above 300 mg/dL), total insulin use, and hospital length of stay. RESULTS: The primary outcome was significantly improved following protocol implementation (54.2% vs. 58.4%, p = 0.001). Compared to the pre-protocol group, the post-protocol group had lower incidence of hypoglycemia (3.1% vs. 1.2%, p < 0.001), severe hyperglycemia (9.9% vs. 6.7%, p < 0.001), less total insulin use (1.1 units/kg vs. 0.6 units/kg, p < 0.001), and shorter length of stay (5.1 days vs. 3.7 days, p < 0.001). CONCLUSIONS: The implementation of an inpatient hyperglycemia protocol was associated with improved glycemic control, decreased incidence of both hypoglycemia and severe hyperglycemia, and less total insulin use.

Evaluation of the efficacy and safety of direct oral anticoagulants in the treatment of portal vein thrombosis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of direct oral anticoagulants vs. warfarin for portal vein thrombosis treatment. METHODS: This was a single-center, retrospective study. Adult patients initiated on a direct oral anticoagulant or warfarin for treatment of a new portal vein thrombosis were included. The primary failure outcome was the absolute difference in recurrent thromboembolic events 90 days following initiation of a direct oral anticoagulant vs. warfarin. The primary safety outcome was the absolute difference in bleeding events 90 days following initiation of a direct oral anticoagulant vs. warfarin. Descriptive statistics, Fisher's exact, and Student's t-tests were utilized as appropriate. RESULTS: Thirty-three patients were included. Thirteen (39.4%) patients received direct oral anticoagulants, and 20 (60.6%) received warfarin. None of the patients receiving direct oral anticoagulants experienced a primary failure event compared to four receiving warfarin (P < 0.001). None of the patients receiving direct oral anticoagulants experienced a primary safety event vs. one receiving warfarin (P < 0.001). CONCLUSION: Direct oral anticoagulants appear to be effective and safe in the treatment of portal vein thrombosis and in preventing recurrent thromboembolic events. Future studies with larger sample sizes are warranted to confirm direct oral anticoagulants' efficacy in portal vein thrombosis.

Use of mixed-methods approach to assess the impact of a pre-professional health humanities honors course on developing interpersonal skills.

INTRODUCTION: The purpose of this study was to use a mixed-methods approach to provide evidence for growth in empathy, respect for patient autonomy, ability to relate to others, and self-awareness as a result of participating in a health humanities course. METHODS: The mixed-methods approach gathered quantitative data using a quasi-experimental design of a pre/post course survey and qualitative data from reflective writings and student papers. The reflective writings and student papers were evaluated using an adapted rubric to assess the quality of the reflections on measures of empathy, respect for patient autonomy, ability to relate to others, and self-awareness. RESULTS: Twenty-five students were enrolled in the course. Matched pair data was available from 22 students (88% response rate) for the quantitative survey data. Qualitative data was available from all 25 participants. The pre- and post-course surveys revealed a statistically significant increase in empathy (p < 0.001) as a result of completing the health humanities course. The final written report contained the highest quality of reflections compared to all other reflective writing assignments. Evidence for understanding empathy was prominent in the final written report. CONCLUSIONS: The evaluation of development of interpersonal skills through use of health humanities resources may be reproduced by using a mixed-methods assessment approach. The quantitative and qualitative data presented provide some evidence for enhancing awareness and understanding of empathy, particularly by utilizing health humanities resources in an undergraduate interdisciplinary seminar course.