Preoperative considerations for patients with diabetes.

INTRODUCTION: Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies. AREAS COVERED: A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications. EXPERT OPINION: The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery.

Using Patient-Reported Outcomes Measurement Information System® (PROMIS) to Identify Physical and Psychosocial Quality of Life Issues in Lung Cancer Survivors.

Background: Lung cancer survivors (LCS) are living longer due to improved screening and treatment but often experience long-term treatment effects. Due to a traditionally poor prognosis, research related to LCS symptomology and associated quality of life (QOL) is lacking. Objective: The objective of this study was to develop a process for identifying symptomology and unmet needs affecting QOL in LCS. Methods: A literature review identified recommended methods of implementing a QOL screening program in LCS. Training guidelines using the best evidence were presented to the survivorship clinic (SC) staff. The Patient-Reported Outcomes Measurement Information System® (PROMIS-29) profile was used to collect data from LCS. The experience of the SC staff (N = 2) and providers (N = 2) in implementing the QOL screening program in LCS was assessed. Results: A 100% compliance rate in completing the PROMIS-29 profile was achieved. Physical function and pain interference were the most impacted QOL domains identified by LCS, while depression was the least. No challenges were identified in assisting LCS with profile completion. Providers agreed that the PROMIS-29 was instrumental in identifying QOL issues. Conclusion: A QOL screening program tailored to LCS-improved compliance and reliability in identifying QOL issues. Implications for Nursing: A QOL screening program using the PROMIS-29 may improve patient-provider interactions and value-based oncology care.

Understanding Motivations and Barriers of CRNAs Involved in Global Health: A Qualitative Descriptive Study.

Surgical care provided through short-term medical missions (STMMs) is an important component of global healthcare. Certified Registered Nurse Anesthetists (CRNAs) are equipped with valuable knowledge and skills to help those lacking access to healthcare. Understanding the motivations and barriers to the participation of CRNAs in STMMs is vital to increasing their participation in these trips, which positively influence global healthcare. A descriptive qualitative design to understand motivations underlying volunteerism was used to gain this understanding. Clary's use of Functionalist Theory was the theoretical framework informing this study. Semistructured interviews were conducted with 6 CRNAs who had participated in at least one STMM. Colaizzi's qualitative method of inquiry was used for data analysis. The study's main objective was to identify motivations and barriers specific to CRNAs' participation in STMMs. Major categories for motivation included humanitarian values, personal and professional growth, readiness to serve, and strong teamwork. Barriers of participation in STMMs were divided into categories of internal (eg, personal discomfort, obligations) and external (weakness of the organization). The study results yield greater understanding of what can draw increased participation in STMMs from CRNAs. Improved understanding may lead to more effective recruitment and better satisfaction of CRNA participants in STMM work.

Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access.

OBJECTIVE: While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health. METHODS: Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors. PARTICIPANTS: 316 truckers participated. RESULTS: Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly. CONCLUSIONS: The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

Culturally competent practice in a pre-licensure baccalaureate nursing program in the United States: a mixed-methods study.

AIM: This study examined how one pre-licensure baccalaureate nursing program at a public university in the southeastern United States integrated concepts and issues of culture and culturally competent practice into its curriculum. BACKGROUND: Teaching and learning about culturally competent practice in pre-licensure nursing programs are essential to ensure a culturally competent health care workforce. METHOD: A mixed-methods case study approach was used. Data were collected from student surveys (n = 111), student focus groups (three groups, n = 9), faculty interviews (n = 14), and school of nursing documents, including the mission statement, faculty and student handbooks, and course syllabi. Data were analyzed using descriptive statistics and content analysis. RESULTS: Findings provide evidence of cultural competence, barriers to deeper engagement with cultural issues, and suggestions for improvement. CONCLUSION: These findings suggest teaching/learning strategies and curricular design issues that may lead to greater student and faculty member cultural understandings.