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Introduction Glucose meter fingerstick readings are used to determine insulin dosing requirements prior to meals on many acute care units. Unfortunately, timing varies widely, potentially resulting in inaccurate sliding scale insulin (SSI) dosing. Study Question The authors sought to determine the effect of different timing intervals on glucose values and insulin dosing. Hypothesis Pre-prandial point-of-care fingerstick glucose results obtained more than 30 minutes before the meal will demonstrate a variation in glucose values that is not consistent with insulin dosing regimens. Materials and Methods A convenience sample of 60 adult patients with diabetes on two acute care units with orders for SSI was enrolled. Patients who were disoriented or those requiring tube feedings were excluded. Informed written consent was obtained by study investigators for all participants and the study was approved by the institutional review board. Glucose values were obtained by patient care assistants (PCAs), according to the current practice before morning and noon meals. In addition, the study nurses obtained two additional glucose meter readings immediately before insulin dosing and meal time. Results and Outcomes Data represented 60 patients receiving 108 meals. Descriptive statistics, correlation statistics, and repeated measures were used to analyze the data. Blood glucose measurements were statistically significantly lower with increased time between PCA and RN measurements (a.m. p=0.002; p.m. p=0.007). This resulted in lower insulin dose requirements. Time lapse between a.m. and p.m. blood glucose measures: a.m. deviations were 20.6 points lower than p.m. measurements (p=0.001). Each additional minute was associated with an increase in blood glucose deviation by 0.39 points (p<0.0001). No difference by insulin type was noted. Discussion This study demonstrated timing of blood glucose measurement does affect the required SSI dose. The closer the blood glucose was obtained to the patient's meal time, the lower the glucose value (lower insulin requirement). Results suggest BG value and insulin dose administration should be accomplished immediately prior to meal time. [ABSTRACT FROM AUTHOR]

The article discusses a study evaluating the incidence of work-related foot pain or discomfort among registered nurses (RNs) and factors associated with it. A survey on 502 nurse participants revealed that factors that cause increased stress on structures of the foot included weight, age, nursing activity, floor surface of care unit, and certain aspects of choice of shoes. Some recommendations on addressing foot pain among RNs are highlighted.

Abstract: Although many studies around the world hope to measure or improve developmental progress in children to promote community flourishing and productivity, growth is sometimes used as a surrogate because cognitive skills are more difficult to measure. Our objective was to assess how childhood measures of anthropometry correlate with measures of child development in low‐income settings with high prevalence of poor nutrition and enteric disease, to inform studies considering growth outcomes in the absence of direct child developmental skill assessment. Children from the MAL‐ED study were followed from birth to 24 months of age in field sites in 8 low‐ and middle‐income countries across 3 continents. Monthly weight, length, and head circumference measurements were performed. At 24 months, the Bayley Scales of Infant and Toddler Development was administered. We correlated cognitive measures at 24 months with anthropometric measurements from birth to 2 years comparing 3 constructs: absolute attained monthly measures, summative difference in measures from the mean growth curve, and rate of change in measures. Growth faltering at multiple time periods is related to Bayley cognitive outcomes at 24 months. Birthweight, overall growth by 18–24 months, and rate of growth in the 6‐ to 18‐month period were most associated with 24‐month developmental scores. In this study, head circumference measurements, compared with length, was more closely linked to cognitive scores at 24 months. Notably, all studies between growth and cognitive outcomes exhibited low r2 values (0.001–0.049). Anthropometric measures, particularly head circumference, were related to cognitive development, although explaining a low percent of variance. When feasible, direct measures of child development may be more useful. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery anomalies are the second most common congenital cause of sudden cardiac death in young athletes. Some centers have advocated for limited transthoracic echocardiogram (TTE) protocols in the screening of college athletes, which may miss important causes of sudden cardiac death. Purpose: The purpose of this study was to evaluate the ability of screening TTE to determine the origin and proximal course of the coronary arteries in intercollegiate athletes. Methods: An institutional review board--approved retrospective review of all incoming National Collegiate Athletic Association Division-I athletes at a single institution for the 2013-2014 academic year was performed. Two pediatric cardiologists independently reviewed all TTE studies for right coronary artery (RCA) and left coronary artery (LCA) ostia, proximal course, and measurable course. Proximal course was defined as a measurable course 91 cm for the RCA and a measurable course >1 cm or observation of the bifurcation for the LCA. Measurable course was defined as the maximum continuously observable distance of coronary artery from a clearly delineable ostium. Results were compared among athlete characteristics, and interobserver reliability was evaluated. Results: Chart review identified 146 athletes, representing 22 sports and 6 ethnicities. No coronary anomalies were found. The average measurable course was 2.1 cm for the RCA and 1.5 cm for the LCA. Both readers observed the RCA ostium in 143 athletes (98%), LCA ostium in 143 athletes (98%), RCA proximal course in 119 athletes (82%), and LCA proximal course in 118 athletes (81%). Statistical analysis showed good interobserver reliability for observation of the ostia and proximal course. Conclusions: The origin and proximal course of the coronary arteries were readily and reliably observed in the majority of athletes, suggesting coronary artery evaluation should be included in athlete screening TTE protocols. [ABSTRACT FROM AUTHOR]