Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit

To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24 hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (p < 0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (p < 0.05). Thus the APACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients’ condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.     

北京市三阶段新生儿听力筛查成本效果分析

目的 比较新生儿听力筛查两阶段和三阶段的成本效果, 为普遍性筛查提供依据。方法 对2010年10月至2012年12月北京市7家医院出生的正常新生儿进行听力筛查, 分别采用两阶段和三阶段策略及听力诊断性检查, 比较两种筛查的成本/效果比。其中筛查和诊断成本数据源自医院, 采用自行设计问卷对家长调查额外交通费和误工费。根据依从率进行敏感性分析。结果 新生儿初筛62 695人, 未通过5 809人, 阳性率为9.30%;复筛4 933人, 未通过972人, 阳性率为19.70%;复筛未通过并就诊于指定医疗机构者412人。完成诊断性评估360人, 听力异常者217例, 听力异常率为60.28%。完成三阶段筛查共276人, 未通过163人。其中125人完成诊断性检查, 异常112例(中度以上45例), 听力异常率为89.60%。以实际筛查率和诊断率计算成本/效果比, 两阶段(19 985元/例)优于三阶段(37 242元/例), 但随着筛查依从率的提高, 三阶段筛查的成本效果也随之提高。结论 筛查依从率影响三阶段筛查的成本效果, 在筛查依从率较高(>90%)的地区可考虑使用三阶段筛查方法。     

The stimulative effect of supracutaneous electroacupuncture on human skin and its analgesic effect on rats

The stimulative effect of supracutaneous electroacupuncture using a blunt-tip electrode on 120 points of human skin was observed in 12 healthy volunteers. A comparison of stimulation by the more expensive supracutaneous instrument specifically designed for this treatment and that of the more conventional transcutaneous electroacupuncture instrument, modified by use of a blunt-tip, belt-type electrode instead of the traditional electro-needle, showed similar therapeutic effects. An animal experiment, using the rat tail flick analgesia method to compare supracutaneous electroacupuncture, showed that the pain threshold was raised by both types of electroacupuncture, with both having an optimal stimulation time of 10–20 minutes. The percentage of change in maximum pain threshold was 206.6% for supracutaneous electroacupuncture at 7V and 175.4% for transcutaneous electroacupuncture at 2V.     

北京市顺义区哮喘小学生家长健康教育效果评估

目的在哮喘学生及家长中推广"健康之路计划",并对计划实施效果进行评估。方法选择顺义区20所小学6～11岁学生(15 653名)统一进行哮喘健康初筛,筛查出近12个月喘息过及曾经被医生诊断过哮喘的434名小学生及其家长为研究对象,并对他们进行哮喘健康教育,在教育前后分别对学生及其家长进行哮喘相关知识问卷调查。采用χ2检验比较教育前、后学生及家长哮喘相关知识和行为改变情况。结果家长问卷1、2回收率分别为90.55%和84.33%。与健康教育前比较,健康教育后学生家长对哮喘诱因和症状的知晓率,及对待孩子哮喘发作时的行为正确率明显提高,差异有统计学意义。结论该区哮喘学生家长的哮喘防治知识缺乏,健康教育明显提高了学生家长对哮喘病的认识和技能。建议在学校推广"健康之路计划"。     

Characterization of biotin interference in 21 Vitros 5600 immunoassays and risk mitigation for patient safety at a large academic medical center

BackgroundBiotin and streptavidin are commonly used reagents in clinical immunoassays. Several cases of biotin interference with immunoassay testing for patients taking biotin supplements have been reported, yet, not all analytes and platforms susceptible to biotin interference have been characterized. The objectives of this study are to characterize biotin interference with 21 immunoassays using the Ortho Clinical Diagnostics Vitros 5600, evaluate a biotin-depletion method, and apply risk mitigation strategies for biotin interference during routine clinical testing at our institution.MethodsResidual serum without and with increasing concentrations of exogenous biotin were used to evaluate biotin interference with 21 immunoassays using the Vitros 5600. Biotin-depletion was evaluated by comparing measured analyte concentrations in serum with and without exogenous biotin and streptavidin-microparticle pretreatment. Focused education for healthcare professionals about biotin interference was performed in February 2018. Samples with suspected biotin interference were investigated using this biotin-depletion method, and analyte testing by alternate methodology for select samples.ResultsExogenous biotin in serum caused dose-dependent negative biases in 15 immunometric assays, and dose-dependent positive biases in 6 competitive immunoassays. Streptavidin-microparticle pretreatment of serum containing exogenous biotin demonstrated recoveries 100 ± 15% of expected values for all 21 analytes. Physicians identified 21 samples suspicious for biotin interference over 11 months, and streptavidin-microparticle pretreatment verified 11 cases of biotin interference.ConclusionsAnalytical bias caused by biotin interference is dependent on biotin concentration but independent of analyte concentration for immunometric methods using the Vitros 5600, and dependent on both biotin and analyte concentration for competitive immunoassays. Multi-disciplinary education and a lab streptavidin-microparticle pretreatment method help mitigate risk of erroneous results due to biotin interference for patient safety.     

Solving a myth: Does boric acid stabilize aldosterone in urine at typical clinical laboratory storage conditions?

Aldosterone is produced by the adrenal gland and plays an important role in blood pressure regulation and electrolyte hemostasis. Clinically, measurement of urine aldosterone provides evidence for the diagnosis of hyper- and hypo-aldosteronism. Urine specimen that is collected in consecutive 24 h is preferred, which mitigates the risk of misdiagnosis due to large diurnal variation in aldosterone secretion. Preservatives such as boric acid are routinely added to the collection containers prior to urine collection. However, little is known of the effectiveness of these preservatives on stabilizing aldosterone in urine. In the current study, we examined the stability of urine aldosterone under typical clinical laboratory storage conditions with and without the supplementation of boric acid. Our result demonstrated that the addition of boric acid is unnecessary.