Appropriate identification of NICTH and prompt and complete tumor resection represents ideal management. However, when prompt resection is not feasible, iv glucose or dextrose often does not suffice to prevent hypoglycemia. In such cases, we suggest consideration of local antitumor therapies for disease control and trial of glucocorticoids alone or in combination with GH. Continuous glucagon infusion can be successful if the patient has a positive response to a glucagon stimulation test, and parenteral nutrition may allow higher glucose delivery, but both are limited by the need for continuous iv infusion. Diazoxide and octreotide have no role in NICTH.

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BACKGROUNDAlthough hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied.OBJECTIVETo test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program.DESIGNBefore-and-after design with concurrent control group.SETTINGA Midwestern Veterans Affairs medical center.INTERVENTIONMultimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians).MEASUREMENTSNumber of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination (“shelf” exam) scores, and clinical staff surveys.RESULTSLength of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non–Gold team students (84 vs 82; P = 0.006).CONCLUSIONSAcademic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates. Journal of Hospital Medicine 2013;8:702–710. 2013 The Authors. Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine

BackgroundSafe and effective diabetes management in the hospital is challenging. Inadequate knowledge has been identified by trainees as a key barrier. In this study we assess both the short-term and long-term impact of an interactive seminar on medical student knowledge and comfort with hospital diabetes management.MethodsAn interactive seminar covering hospital diabetes management and utilizing an audience response system was added to the third-year medical student curriculum. Students were given a multiple choice assessment immediately before and after the seminar to assess their comprehension of the material. Students were also asked to rate their confidence on this topic. Approximately 6 months later, students were given the same assessment to determine if the improvements in hospital diabetes knowledge and confidence were durable over time. Students from the preceding medical school class, who did not have a hospital diabetes seminar as a part of their curriculum, were used as a control.ResultsFifty–three students participated in the short-term assessment immediately before and after the seminar. The mean score (maximum 15) was 7.7 +/- 2.7 (51%) on the pre-test and 11.4 +/- 1.8 (76%) on the post-test (p < 0.01). 75 students who attended the seminar completed the same set of questions 6 months later with mean score of 9.2 ± 2.3 (61%). The control group of 100 students who did not attend seminar had a mean score of 8.8 ± 2.5 (58%). The difference in scores between the students 6-months after the seminar and the control group was not significantly different (p = 0.30).ConclusionsDespite initial short-term gains, a single seminar on hospital diabetes management did not durably improve trainee knowledge or confidence. Addition of repeated and focused interactions during clinical rotations or other sustained methods of exposure need to be evaluated.Electronic supplementary materialThe online version of this article (doi:10.1186/s40842-016-0038-4) contains supplementary material, which is available to authorized users.

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ObjectivesTo assess whether the organization and structure of inpatient team rounds affects medical student perception of the overall quantity and quality of teaching on an inpatient general medicine service.MethodsA pilot project to improve inpatient care was launched at the Department of Veterans Affairs Ann Arbor Healthcare System (VAAAHS). General medicine attending physicians involved in the pilot followed a “non-traditional” rounding structure (accentuating senior resident-run “work rounds” while time for “attending rounds” focused on critical issues and teaching). The remainder kept the “traditional” rounding structure (entire team rounds on patients one-by-one). In a cross-sectional design, third- and fourth-year medical students at the University of Michigan were surveyed after their rotation about their experience. Students were asked to rate their educational experience in 21 domains. Responses were evaluated by rounding structure.ResultsA total of 90 students (59%) responded. Across every domain surveyed, students rated the quantity and quality of teaching higher after experiencing “non-traditional” rounds. Statistically significant increases were seen in ratings for “teaching during rounds from senior resident”, “teaching during rounds from attending”, “sit-down teaching from attending”, “overall amount/quality of teaching”, and “overall improvement in internal medicine knowledge”, among others.ConclusionsThe organization and structure of inpatient rounds can significantly impact medical student education. Teaching physicians and medical school clerkship directors should consider this when organizing inpatient team workflow.

In patients before cardiac surgery, A1C criteria identified the largest number of patients with diabetes and prediabetes. For diagnosing prediabetes, A1C and FPG were discordant and characterized different groups of patients, therefore altering the distribution of diabetes risk. Simultaneous measurement of FGP and A1C may be a more sensitive and specific tool for identifying high-risk individuals with diabetes and prediabetes.

Appropriate management of diabetes mellitus before a procedure or operation is important for the prevention of hypo- and hyperglycemia in the periprocedural/perioperative period. This can significantly influence glucose levels after a procedure, which in turn affects outcomes. There is a paucity of prospective trials addressing algorithms to guide adjustment of oral diabetes medications and insulin prior to a procedure. Our institution has developed guidelines that allowed us to standardize the periprocedural process for glucose management across departments. This article describes our experience with guidelines, discusses salient features of medication management, and summarizes prospective trials and expert opinion to provide recommendations for clinicians to effectively manage glucose preprocedurally for their patients with diabetes.