Reducing Blood Glucose Testing Is Safe in Patients Receiving Parenteral Nutrition.

BACKGROUND: Hyperglycemia is a common adverse event associated with parenteral nutrition (PN); however, there is no consensus on optimal glucose monitoring. Unnecessary point-of-care (POC) blood glucose (BG) testing can result in additional healthcare cost and discomfort to the patient. This study's aim was to determine whether decreasing the frequency of POC glucose testing in patients receiving PN can reduce costs without increasing the frequency of glycemic events. METHODS: This study examined adult, noncritically ill patients who require PN and are managed by a nutrition support team. Guidelines were developed for the initiation and discontinuation of POC BG monitoring. Pre-intervention and post-intervention data were collected for each patient, including daily POC glucose and glucose from the basic metabolic panel (BMP). Equivalency testing was completed for each group. RESULTS: Data were collected on 171 subjects (86 preguideline, 85 postguideline). The total number of POC tests per patient was significantly less in the postintervention period (median 23.0 vs 25.5; P = .011), as well as the average number of POC tests per patient per day (2.9 ± 1.4 vs 3.6 ± 1.4; P < .001). The average BMP glucose (126 mg/dL preintervention vs 129 mg/dL postintervention; P = .005) and the number of hypoglycemic and hyperglycemic events per 100 tests (both P < .001) were equivalent. CONCLUSIONS: Implementation of new guidelines resulted in decreased frequency of POC BG tests by 20%, which may impact cost savings and patient comfort in hospitalized patients receiving PN without increasing average BG level or glycemic events.

Update on the management of intestinal failure.

Intestinal failure is a serious complication of conditions such as inflammatory bowel disease, mesenteric ischemia, and radiation enteritis--and of extensive bowel resection performed because of these diseases. Imbalances of fluids and electrolytes and poor nutritional status manifest as chronic diarrhea or increased ostomy output. Prompt referral to a center specializing in intestinal rehabilitation is key to achieving nutritional homeostasis and, in some cases, can help the patient return to oral food intake. We review the intestinal sequelae of bowel resection and provide an update on intestinal rehabilitation with dietary modification, drug therapy, and parenteral nutrition. We also review current experience with intestinal transplant, a potentially lifesaving option in select patients when intestinal rehabilitation fails or parenteral nutrition causes severe complications.

Emotional competence and behavior problems: Differences across Preschool Assessment of Attachment classifications.

This study examined attachment in association with preschoolers' emotional functioning among 54 predominantly low-income families living in Appalachia. Attachment was assessed at age 4 years using the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) and classified with the PAA (Crittenden, 2004). Emotional competence was measured via an interview about children's memories for six emotions, rated in terms of both emotion understanding and regulation. Parent-, teacher-, and self-reports of children's internalizing and externalizing symptoms were also completed. Questionnaires and interviews assessed socioeconomic risk and parental symptoms and negative childhood experiences. Children's PAA strategies were significantly associated with risks, emotion regulation and understanding, and symptoms. Children using highly coercive strategies showed the greatest difficulties. Emotion regulation and understanding also were associated with parent- and teacher-report of symptoms. These findings suggest that intervention efforts with at-risk youngsters should target not only attachment security, but also emotional competence skills.