Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Dei... more Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Deintensification is defined as 'stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient's ongoing management.' The risk to benefit ratio changes as patients age, particularly when glycaemic control is tight (HbA1c <53 mmol/mol (7%). The benefits of intensive treatment decline with an increase in risks. Risks may begin to approximate benefits e.g. in older patients the rates of acute hypoglycaemic events are similar to those of cerebrovascular and coronary artery disease. Hence, both the risk of antihyperglycaemic therapy-induced hypoglycaemia and the risk of diabetes complications need to be considered when setting therapeutic goals. Benefits of intensive antihyperglycaemic therapy in older patients become less clear for a number of reasons. Shorter life-expectancies (e.g. 10 years) do not allow the window of time required for cardiovascular, microvascular and mortality benefits of intensive treatment. Changes in appetite and weight associated with increased age (and comorbidities) require less intensive antihyperglycaemic regimens to control blood glucose. This is particularly the case in frail patients where type 2 diabetes may become regressive, increasing the risk of hypoglycaemia with intensive antihyperglycaemic therapy.
BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mor... more BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking.ObjectiveDevelop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions.Design, setting and participantsSingle-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018.InterventionA 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing.Main outcome measuresImplementation was measured by repeated clinician surveys and direct observation. Patient outcomes included length of stay (LOS; ICU and hospital) and mortality (ICU, hospital and 30 days). Clinician perceptions were modelled over time using per cent positive responses in logistic regression. Patient outcomes were compared with matched control ‘transition’ patients from 1 year prior to implementation of the intervention.ResultsAmong 270 transition patients, 46.3% were female with a mean age of 55.9 years. Mechanical ventilation (64.1%) and in-hospital death (27.6%) rates were prevalent. Despite high implementation rates—handoff participation (93.8%), checklist utilisation (75.0%), videoconferencing (62.5%), nursing involvement (75.0%)—the intervention did not significantly improve LOS or mortality. Multidisciplinary survey data revealed significant improvement in acceptability by nursing staff, while satisfaction significantly declined for resident physicians.ConclusionsIn this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials.
Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Dei... more Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Deintensification is defined as 'stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient's ongoing management.' The risk to benefit ratio changes as patients age, particularly when glycaemic control is tight (HbA1c <53 mmol/mol (7%). The benefits of intensive treatment decline with an increase in risks. Risks may begin to approximate benefits e.g. in older patients the rates of acute hypoglycaemic events are similar to those of cerebrovascular and coronary artery disease. Hence, both the risk of antihyperglycaemic therapy-induced hypoglycaemia and the risk of diabetes complications need to be considered when setting therapeutic goals. Benefits of intensive antihyperglycaemic therapy in older patients become less clear for a number of reasons. Shorter life-expectancies (e.g. 10 years) do not allow the window of time req...
INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective m... more INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective means of long-acting birth control. This project analyzes demographics, string visualization, and follow up of women who opted for post-partum IUD insertion and considers the need for follow up including ultrasound (TVS). METHODS: From March 2016 to March 2017, the Post-Placental IUD Insertion Protocol was used for immediate post-partum Mirena® and ParaGard® IUD insertion at University Hospital, San Antonio, Texas. Retrospective chart analysis was used to assess patient demographics, follow up rates, and expulsion rates. RESULTS: A total of 128 women received post-partum IUDs, 70 post-cesarean and 58 post-vaginal delivery. Patient age ranged from 16-43 (average = 26.76) and parity ranged from 1-10 (average = 3.1). Over 80% of the population was Hispanic. Per protocol, patients were scheduled for a string check follow up 7-14 days post insertion. Of the 89 patients who followed up, 27 were...
BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mor... more BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking.ObjectiveDevelop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions.Design, setting and participantsSingle-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018.InterventionA 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing.Main outcome measuresImplem...
Gender in Management: An International Journal, 2021
Purpose The purpose of this study is to capture the journey of the first female leader in sports ... more Purpose The purpose of this study is to capture the journey of the first female leader in sports management in her country in the south-east Asian region for their National Sport and the values and behaviors enabling her to achieve it. Design/methodology/approach The study uses a mixed-methods case study design, quantitative and qualitative outcome measures, to assess the career progression of the first female executive director of a national sporting organization in her country, namely, BWN and her involvement in a two-week intensive sports management, leadership and development program. Findings A professional and courageous approach to identify and implement honest and evidence-based solutions were key for BWN’s success. BWN complemented professionalism with soft skills, clear communication and an outcome-based approach to challenging situations, successfully influencing change within her national sporting organization. This female leader is an inspiring role model for other wome...
Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Dei... more Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Deintensification is defined as 'stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient's ongoing management.' The risk to benefit ratio changes as patients age, particularly when glycaemic control is tight (HbA1c <53 mmol/mol (7%). The benefits of intensive treatment decline with an increase in risks. Risks may begin to approximate benefits e.g. in older patients the rates of acute hypoglycaemic events are similar to those of cerebrovascular and coronary artery disease. Hence, both the risk of antihyperglycaemic therapy-induced hypoglycaemia and the risk of diabetes complications need to be considered when setting therapeutic goals. Benefits of intensive antihyperglycaemic therapy in older patients become less clear for a number of reasons. Shorter life-expectancies (e.g. 10 years) do not allow the window of time required for cardiovascular, microvascular and mortality benefits of intensive treatment. Changes in appetite and weight associated with increased age (and comorbidities) require less intensive antihyperglycaemic regimens to control blood glucose. This is particularly the case in frail patients where type 2 diabetes may become regressive, increasing the risk of hypoglycaemia with intensive antihyperglycaemic therapy.
BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mor... more BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking.ObjectiveDevelop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions.Design, setting and participantsSingle-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018.InterventionA 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing.Main outcome measuresImplementation was measured by repeated clinician surveys and direct observation. Patient outcomes included length of stay (LOS; ICU and hospital) and mortality (ICU, hospital and 30 days). Clinician perceptions were modelled over time using per cent positive responses in logistic regression. Patient outcomes were compared with matched control ‘transition’ patients from 1 year prior to implementation of the intervention.ResultsAmong 270 transition patients, 46.3% were female with a mean age of 55.9 years. Mechanical ventilation (64.1%) and in-hospital death (27.6%) rates were prevalent. Despite high implementation rates—handoff participation (93.8%), checklist utilisation (75.0%), videoconferencing (62.5%), nursing involvement (75.0%)—the intervention did not significantly improve LOS or mortality. Multidisciplinary survey data revealed significant improvement in acceptability by nursing staff, while satisfaction significantly declined for resident physicians.ConclusionsIn this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials.
Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Dei... more Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Deintensification is defined as 'stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient's ongoing management.' The risk to benefit ratio changes as patients age, particularly when glycaemic control is tight (HbA1c <53 mmol/mol (7%). The benefits of intensive treatment decline with an increase in risks. Risks may begin to approximate benefits e.g. in older patients the rates of acute hypoglycaemic events are similar to those of cerebrovascular and coronary artery disease. Hence, both the risk of antihyperglycaemic therapy-induced hypoglycaemia and the risk of diabetes complications need to be considered when setting therapeutic goals. Benefits of intensive antihyperglycaemic therapy in older patients become less clear for a number of reasons. Shorter life-expectancies (e.g. 10 years) do not allow the window of time req...
INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective m... more INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective means of long-acting birth control. This project analyzes demographics, string visualization, and follow up of women who opted for post-partum IUD insertion and considers the need for follow up including ultrasound (TVS). METHODS: From March 2016 to March 2017, the Post-Placental IUD Insertion Protocol was used for immediate post-partum Mirena® and ParaGard® IUD insertion at University Hospital, San Antonio, Texas. Retrospective chart analysis was used to assess patient demographics, follow up rates, and expulsion rates. RESULTS: A total of 128 women received post-partum IUDs, 70 post-cesarean and 58 post-vaginal delivery. Patient age ranged from 16-43 (average = 26.76) and parity ranged from 1-10 (average = 3.1). Over 80% of the population was Hispanic. Per protocol, patients were scheduled for a string check follow up 7-14 days post insertion. Of the 89 patients who followed up, 27 were...
BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mor... more BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking.ObjectiveDevelop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions.Design, setting and participantsSingle-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018.InterventionA 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing.Main outcome measuresImplem...
Gender in Management: An International Journal, 2021
Purpose The purpose of this study is to capture the journey of the first female leader in sports ... more Purpose The purpose of this study is to capture the journey of the first female leader in sports management in her country in the south-east Asian region for their National Sport and the values and behaviors enabling her to achieve it. Design/methodology/approach The study uses a mixed-methods case study design, quantitative and qualitative outcome measures, to assess the career progression of the first female executive director of a national sporting organization in her country, namely, BWN and her involvement in a two-week intensive sports management, leadership and development program. Findings A professional and courageous approach to identify and implement honest and evidence-based solutions were key for BWN’s success. BWN complemented professionalism with soft skills, clear communication and an outcome-based approach to challenging situations, successfully influencing change within her national sporting organization. This female leader is an inspiring role model for other wome...
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