Individualization Through Standardization: Electronic Orders for Subcutaneous Insulin in the Hospital.

Individualization through standardization: electronic orders for subcutaneous insulin in the hospital.

Filed under: Eating Disorders

Endocr Pract. 2012 Nov 1; 18(6): 976-87
Kennihan M, Zohra T, Devi R, Srinivasan C, Diaz J, Howard BS, Braithwaite SS

Objective: The objective was to design electronic order sets that would promote safe, effective, and individualized order entry for subcutaneous insulin in the hospital, based on a review of best practices.Methods: Saint Francis Hospital in Evanston, Illinois, a community teaching hospital, was selected as the pilot site for 6 hospitals in the Health Care System to introduce an electronic medical record. Articles dealing with management of hospital hyperglycemia, medical order entry systems, and patient safety were reviewed selectively.Results: In the published literature on institutional glycemic management programs and insulin order sets, features were identified that improve safety and effectiveness of subcutaneous insulin therapy. Subcutaneous electronic insulin order sets were created, designated in short: “patients eating”, “patients not eating”, and “patients receiving overnight enteral feedings.” Together with an option for free text entry, menus of administration instructions were designed within each order set that were applicable to specific insulin orders and expressed in standardized language, such as “hold if tube feeds stop” or “do not withhold.”Conclusion: Two design features are advocated for electronic order sets for subcutaneous insulin that will both standardize care and protect individualization. First, within the order sets, the glycemic management plan should be matched to the carbohydrate exposure of the patients, with juxtaposition of appropriate orders for both glucose monitoring and insulin. Second, in order to convey precautions of insulin use to pharmacy and nursing staff, the prescriber must be able to attach administration instructions to specific insulin orders.
HubMed – eating

Parenting Efficacy Related to Childhood Obesity: Comparison of Parent and Child Perceptions.

Filed under: Eating Disorders

J Pediatr Nurs. 2012 Dec 13;
Marvicsin D, Danford CA

The aim of this study was to explore child and parent perceptions of parenting efficacy related to child BMI. This descriptive, cross-sectional study recruited 27 parent-child dyads participating in a healthy eating/activity intervention. Parent and child perceptions of parenting efficacy were measured using a version of the Tool to Measure Parenting Self-Efficacy (TOPSE). Paired sample t test and correlational statistics were used. Parents and children had similar perception of parenting efficacy. Child report of parenting efficacy and child BMI was significant. Exploring perceptions of parenting efficacy will help individualize family-focused intervention programs to prevent obesity in children.
HubMed – eating

Gender differences in symptomatic profiles of depression: Results from the São Paulo Megacity Mental Health Survey.

Filed under: Eating Disorders

J Affect Disord. 2012 Dec 13;
Alexandrino-Silva C, Wang YP, Carmen Viana M, Bulhões RS, Martins SS, Andrade LH

BACKGROUND: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. METHODS: Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. RESULTS: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. LIMITATIONS: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. CONCLUSIONS: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.
HubMed – eating

Prevalence and Measures of Nutritional Compromise Among Nursing Home Patients: Weight Loss, Low Body Mass Index, Malnutrition, and Feeding Dependency, A Systematic Review of the Literature.

Filed under: Eating Disorders

J Am Med Dir Assoc. 2012 Dec 12;
Bell CL, Tamura BK, Masaki KH, Amella EJ

Weight loss and poor nutrition have been important considerations in measuring quality of nursing home care since 1987. Our purpose was to examine, synthesize, and provide a systematic review of the current literature on the prevalence and definitions of nutritional problems in nursing home residents. In the fall of 2011, we performed MEDLINE searches of English-language articles published after January 1, 1990. Articles were systematically selected for inclusion if they presented prevalence data for general nursing home populations on at least one of the following: weight loss, low body mass index, Mini-Nutritional Assessment or other measure of malnutrition, poor oral intake, or dependency for feeding. Data on each study, including study author, year, setting, population, type of study (study design), measures, and results, were systematically extracted onto standard matrix tables by consensus by a team of two fellowship-trained medical school faculty geriatrician clinician-researchers with significant experience in long-term care. The MEDLINE search yielded 672 studies plus 229 studies identified through related citations and reference lists. Of the 77 studies included, 11 articles provided prevalence data from the baseline data of an intervention study, and 66 articles provided prevalence data in the context of an observational study of nutrition. There is a wide range of prevalence of low body mass index, poor appetite, malnutrition, and eating disability reported among nursing home residents. Studies demonstrate a lack of standardized definitions and great variability among countries. Of all the measures, the Minimum Data Set (MDS) weight loss definition of ?5% in 1 month or ?10% in 6 months had the narrowest range of prevalence rate: 6% to 15%. Weight loss, as measured by the MDS, may be the most easily replicated indicator of nutritional problems in nursing home residents for medical directors to follow for quality-improvement purposes. Additional studies are needed, reporting the prevalence of the MDS weight loss definition among international nursing home residents.
HubMed – eating

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