The Nurse Education and Transition (NEAT) model: educating the hospitalized patient with diabetes.

BACKGROUND: The number of patients with a diabetes mellitus (DM)-related diagnosis is increasing, yet the number of hospital-based diabetes educators is being reduced. Interest in determining effective ways for staff nurses to deliver diabetes education (DE) is mounting. The purpose of this multi-phase feasibility study was to develop and evaluate the Nurse Education and Transition (NEAT) inpatient DM education model. METHODS: Exploratory focus groups were conducted with staff nurses from inpatient units at academic tertiary and community hospitals to gain insight into barriers, content, delivery and support mechanisms related to providing DE to hospitalized patients. Findings informed the development of the NEAT model, which included a delivery protocol and toolkit with brief educational videos on key diabetes topics uploaded onto iPads, patient assessments and "teach back" tools, a discharge survival skills summary sheet, and guidelines for electronic medical record documentation and scheduling outpatient DE visits. Trained staff nurses used NEAT to deliver DE to hospitalized patients with DM and then participated in follow-up focus groups to assess their experiences, with particular attention to the usefulness of NEAT in meeting the needs of nurses related to the delivery of diabetes survival skill education. Information generated was analyzed to identify emerging key themes. RESULTS: Exploratory focus groups revealed that staff nurses view teaching patients with DM as part of their job, but report barriers. Nurses agreed that inpatient DE should be designed to assure safety after discharge and advised that it be patient-centered, targeted, assessment-based and user friendly. Nurses who participated in the delivery of NEAT found that the process and tools met the majority of the basic DE needs of their patients while relieving their workload. In particular, they reported that video and iPad technology provided a convenient and standardized method for facilitating teaching at the bedside, but requested that an interactive feedback mechanism be added to encourage patient self-knowledge assessment. CONCLUSIONS: This study presents challenges staff nurses face in providing DE to hospitalized patients and identifies opportunities and strategies for improving content and delivery to ensure safe transition of patients with DM from hospital to outpatient setting

With Strings Attached: Federal Income Tax Consequences to Donors of Conditional Gifts

Because giving a gift involves tax consequences to the donors, they have made various successful attempts to shift the tax burden to the recipients. The author examines the question whether the amount of gift tax paid by a recipient in this case nonetheless should be considered part of the donor\u27s taxible [sic] income to the extent the tax exceeds the donor\u27s basis in the gift property. After reviewing the basic approaches in the federal courts for answering the question, he suggests an approach he believes best reflects the policies underlying the Internal Revenue Code and existing case law

Labor Law - Involuntary Retirement - Age Discrimination in Employment Act - Retroactive Application of Statutes

The United States Court of Appeals for the Third Circuit has held that the 1978 amendments to the Age Discrimination in Employment Act are to be applied prospectively because retrospective application would result in manifest injustice. Sikora v. American Can Co., 622 F.2d 1116 (3d Cir. 1980)

National Standards for Diabetes Self-Management Education

Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community. A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/behaviorists, registered nurses, and registered dietitians; and a pharmacist. The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. The committee convened on 31 March 2006 and 9 September 2006, and the Standards were approved 25 March 2007

Using pharmacoepidemiologic methods to study pharmacotherapy in pregnancy: Application to opioid maintenance therapy and 17-OHPC for prevention of preterm birth

We used pharmacoepidemiologic methods to overcome barriers innate to studying medication use in pregnancy. We applied these methods to two topics of high public health relevance: 1) optimal opioid maintenance therapy aimed at decreased neonatal abstinence syndrome (NAS), and 2) directing treatment with 17-OHPC for recurrent preterm delivery to women most likely to benefit. Using a clinical dataset of women exposed to methadone or buprenorphine at Magee-Womens Hospital, Pittsburgh, PA (2013-2015, n=716), we performed a probabilistic bias analysis informed from an internal validation cohort to account for unmeasured confounding by maternal addiction severity. The historical increased risk of NAS associated with methadone compared with buprenorphine was not entirely attributable to maternal addiction severity [conventional adjRR: 1.3 (1.1, 1.5); bias adjRR: 1.2 (1.0, 1.4)]. Next, using an inverse probability weighted marginal structural model, we found that the association between treatment and NAS was mediated to a considerable degree through preterm birth (~25%). Because infants born preterm have lower rates of NAS, and methadone is associated with increased rates of preterm delivery, the increased risk of NAS associated with methadone was stronger among term births. For every 100 infants born to treated mothers, methadone was associated with 14 excess cases of NAS overall, which increased to 17 excess cases among term births [adjRD: 16.7 (9.3, 24.0)]. To study 17-OHPC, we built models inclusive of significant interactions between obstetric history factors to predict the risk of recurrent spontaneous preterm delivery (sptd) in a cohort derived from the NICHD MFM Omega-3 trial. This randomized controlled trial found no significant effect of omega-3 supplementation on recurrent sptd in addition to administration of 17-OHPC. Using the treated women in this trial (n=754) and an externally validated predictive model, we found that risk of recurrence increased with earliest gestational ages of prior delivery only in women with ≥2 previous spontaneous preterm deliveries. These findings support the argument that more information, beyond having one previous spontaneous preterm delivery, is needed to target therapy to those most likely to benefit. This is of utmost public health importance as preterm birth remains the primary contributor to neonatal morbidity and mortality

Translating the Diabetes Prevention Program Into an Urban Medically Underserved Community

https://care.diabetesjournals.org/content/diacare/31/4/684.full.pd

Translating the Diabetes Prevention Program Into an Urban Medically Underserved Community

https://care.diabetesjournals.org/content/diacare/31/4/684.full.pd