Improving Hospital Glucometrics, Workflow, and Outcomes with a Computerized Intravenous Insulin Dose Calculator Built into the Electronic Health Record.

OBJECTIVE: To adjust for dynamic insulin requirements in critically ill patients, intravenous (IV) insulin infusions allow for titration of the dose according to a prespecified algorithm. Despite the adaptability of IV insulin protocols, human involvement in dose calculation allows for error. We integrated a previously validated IV insulin calculator into our electronic health record (Epic) and instituted it in the cardiovascular intensive care unit (CVICU). We aim to describe the design of the calculator, the implementation process, and evaluate the calculator's impact. METHOD: Employing an aggressive training program and user acceptance testing prior to significant elbow support at the time of institution, we successfully integrated the insulin calculator in our CVICU. We evaluated the glucometrics before and after implementation as well as nursing satisfaction following calculator implementation. RESULTS: Overall, our implementation led to increased frequency of blood sugar at various glycemic targets, a trend toward less hypoglycemia or hyperglycemia. For severe hypoglycemia, our preintervention cohort had 0.02% of blood sugars less than 40 mg/dL but no blood sugars less than 40 mg/dL were identified in our patient's postintervention. For the CVICU target blood glucose of 70-180 mg/dL, 87.97% blood sugars at baseline met goal compared to 91.39% at one month, 91.24% at three months, and 90.87% at six months postintervention. CONCLUSION: By utilizing an aggressive education campaign championing superusers and making adjustments to the calculator based on early problems that were encountered, we were able to improve glycemic control and limit glucose variability at our institution.

An anthropomorphic beating heart phantom for cardiac x-ray CT imaging evaluation.

The current work describes an anthropomorphic beating heart phantom constructed as a tool for the assessment of technological advances in cardiac x-ray computed tomography (CT). The phantom is comprised of a thorax, a compressor system, an ECG system, a beating heart with tortuous coronary arteries, and the option to add or remove pathologies such as aberrant beats, stents, and plaques. Initial trials with the phantom have shown its utility to assess temporal resolution, spatial resolution, radiation dose, iodine contrast, stents, and plaques.

A comparison of picture description abilities in individuals with vascular subcortical lesions and Huntington's Disease.

UNLABELLED: The lexical-semantic and syntactic abilities of a group of individuals with chronic nonthalamic subcortical (NS) lesions following stroke (n=6) were investigated using the Western Aphasia Battery (WAB) picture description task [Kertesz, A. (1982). The Western aphasia battery. New York: Grune and Stratton] and compared with those of a group of subjects with Huntington's Disease (HD) (n=6) and a nonneurologically impaired control group (n=6) matched for age, sex, and educational level. The performance of the NS and HD subjects did not differ significantly from the well controls on measures of lexical-semantic abilities. NS and HD subjects provided as much information about the target picture as control subjects, but produced fewer action information units. Analysis of syntactic abilities revealed that the HD subjects produced significantly more grammatical errors than both the NS and control subjects and that the NS group performed in a similar manner to control subjects. These findings are considered in terms of current theories of subcortical language function. LEARNING OUTCOMES: As a result of this activity, the reader will obtain information about the debate surrounding the role of subcortical language mechanisms and be provided with new information on the comparative picture description abilities of individuals with known vascular and degenerative subcortical pathologies and healthy control participants.