Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines

Background

In the absence of clinical practice guidelines prior to 1999, the consumption of human albumin in the Liguria region of Italy was very high, despite possible adverse effects, limited supply, and significant cost.

Objective

The purpose of this study was to assess the impact of comprehensive guidelines on the amount of albumin used in 2 general hospitals and to compare it with that of a third general hospital that did not adopt the guidelines.

Methods

We analyzed the influence of the guidelines on albumin use in 2 general hospitals (hospitals 1 and 2) in the Liguria region by comparing albumin consumption during the year before the distribution of the guidelines (1999) with consumption in the 2 years after their distribution (2000 and 2001). We compared these data with those of a third general hospital that did not adopt the guidelines (hospital 3). The parameters considered were total consumption of albumin, consumption per bed, consumption per hospital stay, mean time to discharge, expenditure per bed, and mortality rate.

Results

In the years 2000 and 2001, the adoption of guidelines reduced albumin consumption in hospitals 1 and 2. In hospital 1, where the release of albumin was carefully controlled by the transfusion service, albumin use per hospital stay decreased 8.7% in 2000 and 7.6% in 2001 from 1999; in hospital 2, use decreased 73.8% and 77.4%, respectively, from 1999. In hospital 3, rejection of the guidelines was coupled with an increase of 2.9% and 8.4%, respectively, in the amount of albumin used per hospital stay. In the years 2000 and 2001, the savings in the expenditure for albumin was ∼17,000 euro in hospital 1 and ∼200,000 euro in hospital 2.

Conclusion

This study confirms that the adoption of guidelines may substantially reduce the inappropriate use of albumin and relative costs.     

23种常用生化试剂交叉污染情况调查

目的探讨23种常用生化试剂在使用时存在的交叉污染情况。方法把23种常用生化试剂分别当标本进行23个项目的检测,筛查出某些试剂对某个项目的污染,基于基质效应,进一步将1例混合血清分为2例,1例加等量生理盐水,另1例加等量试剂进行检测,从而确定交叉污染存在的情况。结果在常用的23种试剂中,其中丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、总蛋白（TP）、清蛋白（ALB）、总胆汁酸（TBA）、肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、磷（P）、镁（MG）、肌酐（CREA）、血糖（GLU）、总胆红素（TBIL）、尿酸（UA）分别受到不同试剂、不同程度的影响。结论在常用的生化试剂中,有相当部分的试剂间存在着一定的交叉污染情况,因此,在全自动生化分析仪上使用时,应注意项目间的合理设置,以减少交叉污染。     

The use of fall prevention guidelines in German hospitals – a multilevel analysis

Aims Falls and fall‐related injuries are major problems in hospitals. The aim of this study was to examine the impact of fall prevention guidelines on falls and fall‐related injuries in hospitals. Method A cross‐sectional study was conducted in German hospitals. Some 28 hospitals participated with a total of 5046 patients. Eleven of these hospitals had already implemented a fall prevention guideline, 10 were in the process of developing such a guideline and seven hospitals were not using any fall prevention guideline at all. A standardized questionnaire was used on the individual patient level to obtain details regarding the socio‐demographic background, falls, fall‐related injuries and other problems relevant to nursing. A further questionnaire referred to the use of fall prevention guidelines in the individual hospitals. Data specific to falls were analysed both on hospital level and on ward and patient level by means of a multilevel logistic model. Results The univariate analyses suggest that patients in hospitals that are using guidelines are more likely to fall [odds ratios (OR) = 1.19, confidential interval (CI) = 0.65–2.18] than in hospitals that do not use any guideline (reference category) or are still in the developing stage (OR = 0.82, KI = 0.77–0.87). If, in a multivariate analysis, the ward level and individual patient variables (age, disorientation, confusion, incontinence) are included, the following results are obtained: the probability of falls in hospitals not using guidelines (reference category) is higher than in hospitals developing a guideline (OR = 0.86, KI = 0.58–1.28) or using a guideline (OR = 0.71, KI = 0.44–1.14). The differences are even more distinct regarding the injuries resulting from a fall that require medical treatment. The probability of these injuries is significantly lower in hospitals using guidelines (OR = 0.27, KI = 0.09–0.85) than in hospitals developing a guideline (OR = 0.61, KI = 0.24–1.54) or not using any guidelines at all (reference category). Conclusion The present results of the multilevel analysis show that falls and fall‐related injuries can be reduced by the implementation of fall prevention guidelines.     

Relationship between the number of different antibiotics used and the total use of antibiotics in European hospitals

OBJECTIVES: The aim of this study was to establish whether there was a relationship between the number of antibacterial agents used and total antibiotic use in European hospitals. METHODS: A total of 139 hospitals from 30 countries supplied data on antibiotic use (ATC group J01) for 2001, expressed as the number of defined daily doses per 100 occupied bed-days (DDD/100 BD) and also numbers of different antibiotics used. RESULTS: Participating hospitals used a median of 46 antibiotics in 2001 (range 16-82). The most frequently used antibiotic per hospital accounted for a median of 16.5% (range 7.2-60.9%) of total use and the 10 most frequently used agents accounted for a median of 73.7% (range 53.0-98.5%) of total use. Numbers of antibiotics used varied significantly by European geographical region (Kruskal-Wallis test, P = 0.001). The median total antibiotic use was 49.6 DDD/100 BD. A statistically significant relationship was found between the number of antibiotics used and total antibiotic use (Spearman's rank, r = 0.40 and P < 0.01) for all hospitals. Individual correlations were significant in Western (r = 0.57, P < 0.01) and Southern Europe (r = 0.67, P < 0.01) only. CONCLUSIONS: The quantitative use of antibiotics in European hospitals was highly variable as was the number of different antibiotics used. In the two areas exhibiting highest total use, the greater the number of antibiotics used, the higher the total use of these drugs. Intervention studies are now needed to ascertain whether or not successful antibiotic restriction policies can reduce total antibiotic use and subsequently reduce antibiotic resistance.     

Care of substance-exposed infants: the current state of practice in Canadian hospitals

Many practices related to care of infants exposed to drugs and alcohol during th e prenatal period have been developed on an anecdotal basis. There are few available research studies to validate these interventions. This study describes current practices used in daily care, discharge planning, and community support for drug- and alcohol-exposed infants, their families, and alternate caregivers in one country. A survey of Canadian hospitals with annual birth rates of greater than 500 was conducted with a 51% return rate. Variations were noted in the perception of the importance of the issue of perinatal substance use, nursery care, discharge planning, and community support. Nurses are encouraged to consider these results within the context of their own communities to evaluate and develop standards of practice for substance-exposed infants and their families and caregivers.     

In vitro susceptibilities of 25 Giardia lamblia isolates of human origin to six commonly used antiprotozoal agents.

The role drug resistance plays in the occurrence of chronic and recurrent giardiasis has not been established. Extensive data on the susceptibility to antimicrobial agents of living Giardia spp. trophozoites from human origin are lacking. We have determined with a macrodilution method in semisolid medium the in vitro susceptibility of 25 Giardia lamblia isolates, all obtained by routine cultivation of the duodenal fluid of children to six commonly used antiprotozoal drugs. The results showed tinidazole to be the most active drug (all isolates have MICs of less than or equal to 0.5 micrograms/ml). Metronidazole was equally active on all but one isolate, for which an MIC between 0.5 and 1 micrograms/ml was found. Furazolidone was the most active nonimidazole compound tested. More than 50% of the isolates were very susceptible to paromomycin, pyrimethamine, and chloroquine. Two of the strains presented an MIC for paromomycin higher than 10 micrograms/ml, and six strains needed more than 50 micrograms of pyrimethamine per ml to be inhibited. Decreased susceptibility of several of the isolates to different agents appears to be linked.     

Stability of quinine dihydrochloride in commonly used intravenous solutions

The stability of quinine dihydrochloride (Q) at a concentration of 12 mg/ml, in three common intravenous (i.v.) solutions, was studied. Admixtures of Q were prepared in the following vehicles, in glass containers: 5% dextrose in water, 5% dextrose in normal saline solution and normal saline solution. The solutions were kept under fluorescent light at room temperature. Concentrations of Q were monitored for 24 h using a stability–indicating high–pressure liquid chromatographic (HPLC) method. More than 90% of the initial concentration of Q remained in all solutions under the study conditions, and all samples remained clear and colourless over the entire 24–h period. Admixtures containing Q at a concentration of 1.2 mg/ml in the three solutions were stable (<10% decomposition) for at least 24 h and did not require protection from light. However, the use of the admixtures as soon as possible after preparation is still recommended because some decrease in concentration was observed on storage.     

Pain: a review of three commonly used pain rating scales

Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain‐rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain‐rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain‐rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain‐rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain‐rating scale is not as straightforward as it might first appear.     

外出体检采集不合格血液标本的原因分析

目的分析外出体检采集血液标本不合格的原因,降低血液标本不合格率。方法对外出体检的181 247人次中所采集不合格血液标本的表现和原因进行回顾性分析。结果不合格血液标本105份,表现为血量不足、凝血、溶血和标识不清。原因以采集和运送欠规范为主。结论应加强护理人员检验知识的培训,规范采集和运送环节,提高血液标本的采集和送检质量。     

Pharmacology I: effects on sleep of commonly used ICU medications

Critically ill patients are almost universally administered medications to treat their acute illnesses and to maximize their comfort. The effects of many of these medications on their sleep, however, may be important. It is known that critically ill patients have severely disrupted sleep and that this disrupted sleep has a negative impact on ICU outcomes. This article reviews how some commonly used ICU medications may affect patients' sleep.     

影像学期刊论文中常用统计学资料的分析思路

随着21世纪分子影像研究日益广泛和深入,在国际高影响因子（impact factor, IF）期刊发表专业文章已经成为众多影像研究者的毕生追求。恰当的影像数据分析和精确的统计学结果都是高质量SCI期刊文章的必要条件。目前,我国不少影像学论文存在诸如统计方法使用不合理或对统计资料分析结果的理解有偏差等问题而未能成功发表。为此,作者综述国外高IF期刊和国内核心期刊中常用的影像资料分析方法并结合统计学处理经验,引用举例探讨常用影像学统计方法描述和推理方法,并其简要分析其应用。     

临床常用量水平氨氯地平稳定动脉粥样硬化斑块的实验

目的:观察动脉粥样硬化斑块稳定性与氨氯地平对巨噬细胞基质金属蛋白酶9及其组织抑制物1mRNA表达和分泌的影响。方法:实验于2003-11/2004-07在解放军总医院动物中心完成。选择BALB/C型雄性小鼠26只,收集小鼠腹腔冲洗液中的巨噬细胞与不同浓度的氨氯地平(5,15,30μg/L)共同培养,采用反转录聚合酶链反应检测不同浓度的氨氯地平对细胞基质金属蛋白酶9及基质金属蛋白酶组织抑制物1mRNA的表达。结果:①低浓度的氨氯地平(5μg/L)对基质金属蛋白酶9的表达和分泌几乎没有影响,中等浓度(15μg/L为临床常用量水平)和高浓度(30μg/L)时可以完全抑制基质金属蛋白酶9的表达。②氨氯地平药物浓度为15,30μg/L时,基质金属蛋白酶组织抑制物1的表达均有所增加,药物浓度为15μg/L时明显高于药物浓度为30μg/L时的表达(t=3.74,P<0.05)。结论:实验结果提示中等浓度的氨氯地平(15μg/L为临床常用量水平)可以明显抑制巨噬细胞基质金属蛋白酶9的表达,增加基质金属蛋白酶组织抑制物1mRNA的表达,发挥稳定动脉粥样硬化斑块、减少斑块破裂的作用。     

Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines

AIM: To assess the effectiveness of the ILCOR Advisory Statements on Advanced Life Support adopted by the Resuscitation Council (UK), as the standard for resuscitation following cardiac arrest. METHOD: Over the period May to November 1997, data on the process and outcome of cardiopulmonary resuscitation following in-hospital cardiac arrest were collected from 49 hospitals throughout the UK. RESULTS: Of 2074 audit forms submitted, 1368 were included in the final analysis. The initial rhythm monitored was ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 429 patients, of whom 181 (42.2%) were discharged alive, compared to 6. 2% when the initial rhythm was non-VF/VT. Overall, 240 (17.6%) patients were discharged alive. At 6 months after discharge 195 (82. 3%) of 237 patients were still alive. Successful initial resuscitation, defined as return of spontaneous circulation lasting longer than 20 min (ROSC>20 min), was significantly associated with VF/VT as the initial arrest rhythm, return of circulation in less than 3 min, age less than 70 years and the use of an advanced airway (P<0.01). There was a significant increased likelihood of survival to discharge when the circulation was restored in less than 3 min and age was less than 70 years (P<0.05). The administration of any adrenaline (epinephrine) was significantly associated with a reduced likelihood of ROSC>20 min or alive discharge (P<0.0001). CONCLUSION: Compared to the last major multiple hospital study published in 1992, the results of this study suggest that there appears to have been an improvement in survival of in-hospital patients in the UK who have a VF/VT cardiac arrest. How much of this is directly attributable to the adoption of the latest guidelines is uncertain.