Improving the Transition from Intravenous to Subcutaneous Insulin in Critically Ill Hospitalized Patients

Many critically ill patients experience hyperglycemia as a result of physiological stress or as a consequence of diabetes mellitus. Once the condition of the critically ill hospitalized patient has stabilized, it is imperative to transition this patient from intravenous to subcutaneous insulin. The American Association for Clinical Endocrinologists, the American College of Endocrinologists and the American Diabetes Association have all provided guidelines for this transition process.A quality improvement project was conducted by a team of Master of Science in Nursing (MSN) students from the University of San Francisco at a metropolitan medical center in California. The team created and implemented an evidence-based protocol for transitioning hospitalized patients from intravenous to subcutaneous insulin. Due to time limitations and the vast scope of the project, the team was unable to fully implement the protocol. The team did conduct a microsystem assessment, root cause analysis, and literature review, and authored a final draft of the evidence-based transition protocol. Future MSN cohorts will engage in full implementation and evaluation of the protocol, which will include staff education and training, integration into the electronic health record and data collection regarding the protocol’s effectiveness

The nuclear magnetic resonance analyses of some geometric isomers.

The research problem presented herein involved the structural determination of several a,~-unsaturated acids and esters. The solution to this problem was sought in the nuclear magnetic resonance (n.m.r.) spectra of these compounds. The n.m.r. approach to structural problems in organic chemistry has been investigated extensively in the past ten years and it has proven to be an extremely powerful tool for this type of analysis. The data used in the structural determinations are presented in tabulated fo~, and in. the appendix tracings of the original spectra may be found. Each compound is discussed separately with respect to its probable structure and its recorded spectrum. Two brief sections follow the discussion of the spectra. One of these concerns a stereospecific solvent effect and the other relates to the effect of an anisotropic neighboring double bond on proton r -values. The configurational aSSignments for the various compounds were made possible by observing the changes in chemical shift for particular protons in different isomers and by comparison of the observed spin coupling constants with those reported in the literature. Allmost all of the compounds discussed in this thesis were of such a nature that their spectra could be interpreted on a simple first order basis. In the limited number of cases which involved more complex spectra, some approximations were attempted which made possible the assignment of configuration at several bonds. In some cases the assignments were not conclusive, but they found strong support in the approximate treatments given the complex splitting patterns

The Present, Future and Emerging Educational Requirements of Personnel in the Plastics Industry in Kentucky, with Implications for Morehead State University and the Industry

A thesis presented to the faculty of the School of Education at Morehead State University in partial fulfillment of.the.requirements for the Degree of Master of Higher Education by Thomas Richard Crawford in May of 1969