The cost-effectiveness ratio of a managed protocol for severe sepsis

Purpose

Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis.

Materials and methods

This is a prospective cohort study involving a historical comparison (before and after the implementation of the protocol) of patients who had been hospitalized with severe sepsis and septic shock. The group of patients who were treated before the assistance routine was implemented was considered to be the control. The case-managed nurse involved with assistance protocol performed the data collection. This nurse received special training to ensure the quality of the data and to measure the intervention throughout the implementation process.

Results

A total of 414 patients were analyzed. The mortality rates were 57% in the control group and 38% in the protocol group (P = .002). After the implementation of the protocol, the absolute risk reduction was 18%; and the relative risk reduction was 31.8%. There was a tendency for a reduction in the cost of the full hospitalization, but this trend did not reach statistical significance. Nevertheless, the cost of hospitalization in the intensive care unit was reduced significantly from US $138,237 ± $202,418 in the control group to US $85,484 ± $127,471 in the protocol group (P = .003). The managed protocol for sepsis resulted in an average gain of 3.2 life-years after being discharged from the hospital (8.8 ± 13.3 years in the control group and 12.0 ± 14.0 years in the protocol group, P = .01).

Conclusions

Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.     

食道癌中miR-542-3p对Survivin基因的作用研究

目的研究食道癌中Survivin基因是否受某些miRNA的调控,探讨miR-542-3p的表达变化对Survivin基因的影响。方法细胞水平上通过转染miR-542-3p的模拟物,从而过表达miR-542-3p,通过荧光定量PCR检测Survivin基因的表达变化情况。结果 miR-542-3p过表达后,Survivin基因的表达水平显著降低。结论根据上述结果,笔者推测miR-542-3p对Survivin基因具有负调控作用,有利于改善食道癌的恶化,为食道癌的治疗提供一种潜在的手段。     

COX-2与Survivin在不同喉腔病变组织中的表达及其与喉癌发生发展过程的病理关系

目的比较环氧化酶-2和生存素在不同喉腔病变组织中的表达活性,分析其与喉癌发生发展过程的病理关系。方法27例喉鳞状细胞癌、22例喉角化症、12例声带息肉病变组织标本,应用免疫组织化学方法检测其中COX-2和Survivin蛋白表达活性,分析不同指标检测结果与喉癌发生发展过程的病理相关性。结果喉癌Ⅲ～Ⅳ期、喉癌Ⅰ～Ⅱ期、喉角化症、声带息肉组织的COX-2表达阳性率分别为63.6%、43.8%、22.7%、0%,P<0.01;Survivin的表达阳性率分别为72.7%、68.8%、68.1%、8.3%,P<0.01。喉癌原发灶组织标本Survivin的总阳性率为76.8%,与COX-2的表达具有相关性(P<0.05)。结论COX-2和Survivin在喉癌的发生发展过程中发挥重要的交互作用,COX-2的凋亡抑制效应可能通过调控Survivin表达途径而实现。     

APP霜治疗兔足重度冻伤实验研究

日本白色大耳家兔158只,分对照组、基质组及实验组。用液体冷冻法,造成兔足重度冻伤,采用“APP”霜局部外敷治疗。实验结果表明:冻区存活面积对照组为8.66±2.11％;基质组为8.23±3.11％;实验治疗组为89.27±2.18％。对照组、基质组与实验治疗组的差别非常显著,说明“APP”霜对兔足重度冻伤有显著疗效。重度冻伤病理形态学也证明“APP”霜有保护和恢复受冻组织存活的作用。     

Emergency care staff can improve survival rates from sepsis

Patients die from sepsis. Reports of mortality as high as 50% are associated with patients who have severe sepsis. Often the signs and symptoms are unmanaged within the emergency care environment. This paper discusses the Surviving Sepsis Campaign and outlines a number of management steps that practitioners caring for patients within emergency care can use to reduce mortality. The sepsis resuscitation bundle is discussed in depth as its goals can be achieved within the emergency department. A number of relevant web sites are provided that guide interested readers to other information on the Surviving Sepsis Campaign.     

An audit of ward nurses' knowledge of sepsis

Many of the patients with sepsis admitted to intensive care and high dependency units develop severe sepsis/septic shock in general hospital wards. If the Surviving Sepsis Campaign's aim of a 25% reduction in mortality from sepsis is to be achieved by 2009, then it is essential that registered nurses are aware of the standard definitions of sepsis, and the recommendations for its initial management. The aim of this study was to audit ward nurses' knowledge of sepsis against standard definitions and evidence-based management guidelines. An audit was carried out in one acute hospital to assess ward nurses' knowledge of sepsis. Seventy-three registered nurses from medical, surgical and orthopaedic wards completed a questionnaire about the signs and symptoms of sepsis and its initial management. The results showed that some ward nurses appeared to have a poor knowledge of the signs and symptoms of sepsis, severe sepsis/septic shock and some aspects of its initial management. Following the results of the audit, a variety of educational initiatives were introduced to raise awareness of the standard definitions and the surviving sepsis management guidelines. In conclusion, targeted education must be provided for nurses working in general wards if the Surviving Sepsis Campaign is to achieve its aim of a 25% reduction in mortality by 2009.     

surviving,caspase-3,AQP1与妊娠晚期羊水过少相关性研究

目的:探讨Survivin、caspase-3及水通道蛋白1(Aquaporin 1,AQP1)与妊娠晚期羊水过少中的作用及相关性,为妊娠晚期羊水过少的临床治疗提供新的思路。方法:收集32例选择性剖宫产羊水过少临床病例以及30羊水正常的胎膜组织样本,采用免疫组织化学SP法检测Survivin、caspase-3及AQP1,并对其强度行定量分析。结果:羊水过少患者胎膜组织Survivin、AQP1的表达均低于羊水正常组,而caspase-3表达高于正常组。Survivin与caspase-3表达呈负相关,与AQP1表达呈正相关,caspase-3与AQP1表达呈负相关。结论:妊娠晚期羊水过少可能与Survivin表达减少,caspase-3表达增加引起胎膜组织细胞过度凋亡,AQP1下调,羊水的跨膜运输异常有关。     

Surviving sepsis: a trust‐wide approach. A multi‐disciplinary team approach to implementing evidence‐based guidelines

Aim: To share an experience of examining the true extent of the number of patients with severe sepsis being admitted, and the overall compliance with existing treatment guidelines in a district general hospital (DGH). Background: Because of its aggressive, multi‐factorial nature, sepsis is a rapid killer. Mortality associated with severe sepsis remains unacceptably high: 30–50%. When shock is present, mortality is reported to be even higher: 50–60%. The rapid diagnosis and management of sepsis is vital to successful treatment. The International Surviving Sepsis Campaign (SSC) was developed to help meet the challenges of sepsis and to improve its management, diagnosis and treatment. The overall aim is to reduce mortality from sepsis by 25% by 2009. Data sources and methods: Data on the number of patients admitted with severe sepsis to the DGH were previously unknown. The aim of the baseline audits was to determine the true extent of the problem and baseline mortality rates, resulting in an action plan to provide evidence‐based care to patients with sepsis regardless of where in the hospital they were located. Results: It was found that 11% of the patients audited presented with signs of severe sepsis and demonstrated elements of poor compliance with some elements of existing treatment guidelines as set out by the resuscitation component of the Surviving Sepsis Care Bundle. Conclusion: As an international campaign introduced predominantly within critical care, within this DGH the SSC teams' innovative approach has resulted in:

• ? Better educated staff;
• ? Objectives agreed within multi‐disciplinary teams;
• ? The appropriate assessment of resources;
• ? Standardization of practice in terms of patients presenting with severe sepsis.

     

膀胱移行细胞癌中Survivin基因的检测及临床意义

目的：探讨Survivin基因在膀胱移行细胞癌中的表达及其临床意义。方法：通过逆转录一聚合酶链反应（RT-PCR）检测40例膀胱癌和12例非膀胱癌组织及尿液标本中Survivin基因mRNA的表达,采用免疫组织化学方法（SP法）复检Survivin基因的表达并确定其临床病理分期和分级。结果：40例膀胱癌组织中Survivin基因的阳性表达率为67．5％,mRNA表达结果与免疫组织化学结果一致;在尿液中的阳性表达率为55．5％。12例非膀胱癌组织中Survivin基因的阳性表达率仅为8．3％;尿液中未见Survivin基因表达。显示Survivin基因在膀胱癌中的表达显著高于在非膀胱癌中的表达（P〈0．05）;而组织标本与尿液标本对Survivin基因的检出率无明显差异（P〉0．05）;Survivin的阳性表达与膀胱癌的恶性程度、临床病理分级或是否复发关系密切（P〈0．05）,Survivin基因的阳性表达与患者年龄、性别、肿瘤的分期无明显相关性。结论：Survivin基因在膀胱癌的恶性程度、肿瘤转移及预后等方面可能有较大的临床意义,而检测尿液中Survivin基因的表达可作为膀胱癌的早期发现、早期诊断、术后复查的新方法。     

Blood cultures in acute surgical admissions

IntroductionObtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions.MethodsData on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management.ResultsOf 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%).ConclusionsBlood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.