Fibrin sealant: summary of a conference on characteristics and clinical uses

The 2-day conference clearly outlined the formulations of products that are being developed or are commercially available in Europe. The major difference between products in the United States and those in Europe is that US manufacturers are preparing fibrin sealant that does not contain aprotinin, epsilon amino caproic acid, or any other type of antifibrinolytic agent, whereas antifibrinolytic agents are included in all such preparations used in Europe. The conference provided no clear consensus that such agents are essential to the efficacy of the product. Although many investigators believe in the clinical benefit of fibrin sealant, most of the studies to demonstrate efficacy have not been performed in a well-controlled fashion. However, fibrin sealant, if found in a controlled trial to have clinical efficacy, could be approved by the FDA for a narrow indication. Opportunities remain for greater exploration of different forms of the product, not only as a hemostatic agent, but as an adjunct to wound healing and as a matrix for delivery of drugs and proteins with other biologic activities.     

Hospital readmission from a transitional care unit

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.     

Unplanned hospital readmissions: a home care perspective

BACKGROUND: The extensive literature concerning hospital readmissions is grounded in a medical or hospital perspective, and fails to address hospital readmissions during home care. OBJECTIVES: To describe clients who have unplanned returns to an inpatient setting during the first 100 days of home care service delivery. METHOD: Using the Hospital Readmission Inventory (HRI), an audit tool with previously established validity and reliability, 916 medical records for clients from 11 midwestern home care agencies were reviewed retrospectively. RESULTS: Typically, clients were referred for their first home care admission after a 9-day hospital length of stay for a cardiovascular, respiratory, or neoplastic disorder. After an average 18-day length home care stay, clients were readmitted to the hospital, usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms were generally present at hospital readmission. Typically, readmitted clients were 75 year old married females, who had been able to care for themselves at home. At hospital readmission, home care nurses judged these clients to be moderately ill, and likely in need of acute care. CONCLUSIONS: Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Intensive study of home care service arrangements utilized by readmitted patients, as well as agency variations, are needed. Study findings concerning patients readmitted from home care point to similarities with rehospitalized patients generally. Findings may assist home care clinicians in targeting high risk patients who could benefit from interventions aimed at minimizing unplanned returns to the hospital.     

Clinical characteristics useful in screening for renovascular disease

In an effort to detect renovascular hypertension, clinical characteristics are used to select patients likely to have renal artery stenosis. We prospectively evaluated the ability of commonly used clinical features to predict the presence of renal artery stenosis in 100 hypertensive adults. All subjects had conventional renal arteriography. Renal artery stenosis was diagnosed if there was 50% or more stenosis of a main renal artery. Eighteen of the 100 had renal artery stenosis. The presence of a bruit was strongly associated with renal artery stenosis (P less than .0005). In patients without a bruit, only refractory hypertension was associated with the presence of renal artery stenosis (P = .051). These data suggest that a bruit and refractory hypertension are associated with renal artery stenosis, but that other clinical features investigated may not be and that other means of screening for renovascular disease are needed.     

A comparative analysis of computer-based grading programs

There are several elements to nursing students' course grades: quizzes, examinations, and presentations. There are several weights for the elements, which adds to the complexity of calculating grades. The accuracy and efficiency of calculating grades can be increased with the help of an appropriate computer program. Nursing faculty may have access to a variety of these computer software programs to aid them in calculating and maintaining students' course grades. These programs include spreadsheets, specific grading programs, and grading features included in online course programs. This article reviews selected computer-based grading programs and reviewers' evaluation of each program, based on the major features.     

Towards robust glucose chemical exchange saturation transfer imaging in humans at 3 T: Arterial input function measurements and the effects of infusion time

Dynamic glucose-enhanced (DGE) magnetic resonance imaging (MRI) has shown potential for tumor imaging using D-glucose as a biodegradable contrast agent. The DGE signal change is small at 3 T (around 1%) and accurate detection is hampered by motion. The intravenous D-glucose injection is associated with transient side effects that can indirectly generate subject movements. In this study, the aim was to study DGE arterial input functions (AIFs) in healthy volunteers at 3 T for different scanning protocols, as a step towards making the glucose chemical exchange saturation transfer (glucoCEST) protocol more robust. Two different infusion durations (1.5 and 4.0 min) and saturation frequency offsets (1.2 and 2.0 ppm) were used. The effect of subject motion on the DGE signal was studied by using motion estimates retrieved from standard retrospective motion correction to create pseudo-DGE maps, where the apparent DGE signal changes were entirely caused by motion. Furthermore, the DGE AIFs were compared with venous blood glucose levels. A significant difference (p = 0.03) between arterial baseline and postinfusion DGE signal was found after D-glucose infusion. The results indicate that the measured DGE AIF signal change depends on both motion and blood glucose concentration change, emphasizing the need for sufficient motion correction in glucoCEST imaging. Finally, we conclude that a longer infusion duration (e.g. 3–4 min) should preferably be used in glucoCEST experiments, because it can minimize the glucose infusion side effects without negatively affecting the DGE signal change.     

Comparison of quality of chest compressions during training of laypersons using Push Heart and Little Anne manikins using blinded CPRcards

Background

Mass Cardio-Pulmonary Resuscitation (CPR) training using less expensive and easily portable manikins is one way to increase the number of trained laypeople in a short time. The easy-to-carry, low-cost CPR training model called Push Heart (PH) is widely used in Japan. The aim of this study was to examine if PH can achieve chest compression quality that is similar to that using more conventional Little Anne (LA) manikins for training laypersons.

Methods

This prospective randomized crossover study was done during routine community CPR training of laypersons in Singapore. The participants were randomly allocated into two groups, using the PH and LA models respectively. They crossed over during the training so that both groups had measurements using both models. Chest compression data were collected using blinded CPRcards, which are credit card-sized devices with accelerometers and data capture. Participants did not receive any CPR feedback during measurement.

Results

Forty-two people had data captured for the study with 15 males. The median compression depth was 41.5 mm on LA and 38.0 mm on PH (p?=?0.0664), and median compression rate was 105 cpm on LA and 103 cpm on PH (p?=?0.2429). Overall, only 1.5% of compressions performed on the PH achieved adequate depth of between 50–70 mm compared to 5.5% achieved on LA (p?=?0.049). In contrast, 84% of all compressions performed on the PH were within the adequate rate of 100–120 cpm compared to 79.5% on LA (p?=?0.457). Only the under 20-year-old group was able to achieve adequate median compression depth (50.5 mm) on LA, while the older age groups did not (p?=?0.0024). The other age groups performed similar quality of chest compression regardless of the model used. 73.8% of participants preferred the LA for training. After the training, participants felt similarly well-prepared with either model with a median score of 8/10 on LA compared to 7/10 on PH (p?=?0.0011).

Conclusions

The PH can be an alternative mass CPR training model. Both models achieved satisfactory chest compression rates, but the majority of participants, especially the elderly, had difficulty achieving adequate depth.

     

Evaluation of the polyethylene glycol-indirect antiglobulin test for routine compatibility testing

All specimens received in the blood bank over a 5-month period for crossmatch or group and screen requests were tested in parallel by a polyethylene glycol-indirect antiglobulin test (PEG-IAT) and a low-ionic-strength saline (LISS)-IAT. The sera of 41 of 1471 patients had reactions, with 50 antibodies being detected. Ten antibodies reacted only on the PEG-IAT and 14 only by the LISS-IAT; the remaining 26 antibodies were detected by both methods. Of the antibodies that reacted only by the LISS-IAT, one (anti-Jka) was considered clinically significant, whereas five of the antibodies that reacted only by the PEG-IAT (1 anti-c, 2-Fya, 1-Jkb, and 1-S) were considered significant. Two antibodies of questionable clinical significance were detected only by the PEG-IAT. In 97 percent of the sera tested, no reaction was detected by either method. The PEG-IAT is an acceptable technique for routine compatibility testing.     

骨髓干细胞移植后Western blot免疫印迹分析鼠抗肌萎缩蛋白表达的变化

目的:Western blot免疫印迹分析骨髓干细胞移植后mdx鼠抗肌萎缩蛋白表达的变化。方法:实验于2004-09/12在中山大学附属第一医院神经科实验室完成。①选取7～8周龄mdx鼠25只,随机数字表法分为骨髓移植4,8,12,16周组、空白对照组,5只/组。另选取4～6周龄C57鼠20只作为供体鼠,10周龄C57鼠5只作为阳性对照组。②各组在移植前均给予照射剂量为7Gy的放疗预处理。放疗完毕后,骨髓移植4,8,12,16周组均进行尾静脉细胞移植,移植细胞数为2×107/只,0.3～0.5mL;空白对照组、阳性对照组尾静脉输入0.3mL磷酸盐缓冲液。③骨髓移植4,8,12,16周组分别于对应时间点处死,取其腓肠肌,制备抗肌萎缩蛋白样品,进行抗肌萎缩蛋白Western blot免疫印迹分析,以GAPDH作为内参。结果:25只7～8周龄mdx鼠、5只10周龄C57鼠全部进入结果分析。骨髓干细胞移植后抗肌萎缩蛋白Western Blot免疫印迹分析结果:空白对照组无抗肌萎缩蛋白的表达;骨髓移植4周组仅可见抗肌萎缩蛋白的微弱表达,dystrophin/GAPDH灰度比值约为0.095±0.267;骨髓移植12周组约为0.218±0.338;随骨髓移植时间的延长抗肌萎缩蛋白表达量逐渐增加,移植后16周的表达量较移植后8周明显增加(0.393±0.385,0.173±0.284;t=6.062,P<0.05),但仍明显低于阳性对照组1.172±0.328(t=3.14,P<0.05)。结论:骨髓干细胞移植mdx鼠后应用WesternBlot免疫印迹分析可于不同时间检测到抗肌萎缩蛋白的表达,且随移植时间延长表达量增多,提示骨髓干细胞移植可长久持续参与受损骨骼肌的修复与再生。