Citations

Background: Successful diabetes management requires behavioral changes. Little is known about self-management behaviors (SMB) in adults on insulin pump (IP) therapy. Objective: Analyze and characterize observed common diabetes SMB in adult participants with type 1 diabetes (T1D) using IPs and to correlate behaviors with glycemic outcomes based on participant’s individual glucose targets. Materials and Methods: One month of IP data from adults with T1D were downloaded. Computer programs were written to automatically quantify the observed frequency of expected behaviors such as: insulin bolusing, checking blood glucose (BG), and recording carbohydrate intake, and other interactions with the IP. Results: Nineteen participants were recruited and 4,249 IP interactions were analyzed to ascertain behaviors. Intersubject variability of adherence to minimally expected behaviors was observed: daily documentation of carbohydrates and BG checks in 76.6 (31.7)% and 60.0 (32.5)%, respectively, and bolusing without consulting the IPBC in 13.0 (16.9)% of delivered boluses, while daily insulin bolus delivery was consistent 96.8 (5.7)%. Higher frequency of adherence to daily behaviors correlated with a higher number of glucose readings at target. Conclusion: Results indicate variability in SMB and do not always match recommendations. Case-scenarios based on observed real-life SMB could be incorporated into interviews/surveys to elucidate ways to improve SMB.

Aims We compared the outcome of total hip arthroplasty (THA) in obese patients who previously underwent bariatric surgery and those who did not, in a matched cohort study. Patients and Methods There were 47 THAs in the bariatric group (42 patients), and 94 THAs in the comparison group (92 patients). The mean age of the patients was 57 years in both groups (24 to 79) and 57% of the patients in both groups were women. The mean time between bariatric surgery and THA was five years (four months to 12 years) in the bariatric group. The mean follow-up after THA was three years (2 to 9). Results The mean BMI improved from 49.7 kg/m2 (35 to 75) prior to bariatric surgery to 35.3 kg/m2 (21 to 49) at the time of THA (p < 0.001). Patients in the comparison group had an increased risk of re-operation (Hazard Ratio (HR) 3.2; 95% confidence intervals (CI) 1.3 to 9.5, p = 0.01) and revision (HR 5.4; 95% CI 1.5 to 34.5, p = 0.01) when compared with the bariatric group. Conclusion Patients had a dramatic improvement in BMI after bariatric surgery and those with prior bariatric surgery had a lower risk of re-operation and revision in the short- and mid-term after a subsequent THA. Larger prospective studies are required before it can be concluded that this extra surgery should be advised in these patients. Cite this article: Bone Joint J 2016;98-B:1180–4.

Background The high risk and low volume of medical emergencies, combined with long periods between training sessions, on 2 progressive care units at Mayo Clinic, Rochester, Minnesota, established the importance of transforming how nursing staff are trained to respond to medical emergencies. Objectives To increase confidence levels and improve nursing performance during medical emergencies via in situ simulation. Methods An in situ, mock code quality improvement program was developed and implemented to increase nurses’ confidence while improving nursing performance when responding to medical emergencies. For 2 years, each unit conducted mock codes and collected data related to confidence levels and response times based on the recommendations in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Results In those 2 years, nursing staff response times for calling for help improved 12%, time elapsed before initiating compressions improved 52%, and time to initial defibrillation improved 37%. Additionally, staff showed an increase in perceived confidence levels. Staff reported their appreciation of the opportunity for hands-on practice with the equipment, reinforcing their knowledge and refining their medical emergency skills. Conclusions In situ mock codes significantly improve response times and increase staff confidence levels. In situ mock codes are a quick and efficient way to provide hands-on practice and allow staff to work as a team.

Particle detection instrumentation to address the in vivo verifications of proton dose and range is under development as part of a proton therapy research program focused on patient quality assurance. For in vivo proton range verification, a collimated gamma detector array is under construction to indirectly measure the position of the Bragg peak for each proton beam spot to within 1–2 mm precision. For dose flux verification, a proton fluence detector based on the technology of the Micromegas is under construction. This detector has an active area of about 100 cm2, coordinate resolution of better than 1 mm, and handling of incident proton beam fluxes of 109–1013 particles/s.

Health care information technology (IT) outages pose a threat to patient safety and patient care continuity. Organizations’ downtime plans must be updated regularly and staff at the work area level should have experience with implementing IT outage operations through downtime drills. This article describes the study institution’s IT Outage Toolkit, based on the acronym CLEAR, which guides the development of a downtime plan as well as design, execution, and assessment of work area downtime drills. Self-report and external audits of downtime drills help identify performance gaps and gaps in downtime plans.

Objective: This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. Methods: Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up. Results: Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up. Discussion: This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.