Adherence to transition guidelines in European paediatric nephrology units

Background

There is increasing focus on the problems involved in the transition and transfer of young adult patients from paediatric to adult renal units. This situation was addressed by the 2011 International Pediatric Nephrology Association/International Society of Nephrology (IPNA/ISN) Consensus Statement on transition.

Methods

We performed a survey of transition practices of 15 paediatric nephrology units across Europe 2 years after publication of the consensus statement.

Results

Two thirds of units were aware of the guidelines, and one third had integrated them into their transition practice. Forty-seven per cent of units transfer five or fewer patients with chronic kidney disease (CKD) stage 5 per year to a median of five adult centres, with higher numbers of CKD stages 2–4 patients. Seventy-three per cent of units were required by the hospital or government to transfer patients by a certain age. Eighty per cent of units commenced transition planning after the patient turned 15 years of age and usually within 1–2 years of the compulsory transfer age. Forty-seven per cent of units used a transition or transfer clinic. Prominent barriers to effective transition were patient and parent attachment to the paediatric unit and difficulty in allowing the young person to perform self-care.

Conclusions

Whereas awareness of the consensus statement is suboptimal, it has had some impact on practice. Adult nephrologists receive transferred patients infrequently, and the process of transition is introduced too late by paediatricians. Government- and hospital-driven age-based transfer policies distract focus from the achievement of competencies in self care. Variable use of transition clinics, written patient information and support groups is probably due to economic and human-resource limitations. The consensus statement provides a standard for evolving and evaluating transition policies jointly agreed upon by paediatric and adult units.     

Appropriate antibiotic use according to diagnoses and bacteriological findings: report of 12 point-prevalence studies on antibiotic use in a university hospital

The objective of this study was to evaluate antibiotic use in relation to diagnoses and bacteriological findings in a 600-bed Norwegian university hospital. Twelve point-prevalence studies of antibiotic use were conducted between 1996 and 1999. In the point-prevalence studies, 1,096 of 6,588 adult patients (16.6%) used on average 1.25 antibiotics each. Of the patients who received antibiotics, 35% were treated for hospital-acquired infections. Lower respiratory tract and urinary tract infections accounted for more than half of all antibiotic use. Pencillins represented 54% of antibiotic use, cephalosporins 9%, quinolones 6% and antifungal agents 0.7%. The prescribed daily doses for the penicillins were 2-3 times higher than the defined daily doses. Bacteriological samples were obtained from 929 (85%) patients. Compliance with the guidelines was > 90% and was highest when the results of bacteriological samples were positive. Good compliance led to low prevalence of antibiotic use and the use of narrow-spectrum antibiotics.     

Examining the Relationship Between Intentionality for Child Well-Being (CWB) and Program Outcomes in a Meta-Evaluation

We analyzed data collated in a review of 92 programs (designs and evaluations) and examined the extent to which programs were intentional for CWB. We also examined program outcomes reported in evaluation reports and assessed the relationship between different levels of CWB intentionality and program outcomes. Most programs mention CWB in their goals and measurement indicators; but fall short of elaborating a theory of change for achieving sustained well-being of children. Greater CWB intentionality is associated with higher levels of program quality and outcomes both for children and communities at large.     

Repellent efficacy of DEET and KBR 3023 against Amblyomma hebraeum (Acari: Ixodidae)

The bont tick, Amblyomma hebraeum Koch, is the principal vector of Rickettsia africae, the agent of African tick bite fever, in southern Africa. In contrast to most other hard ticks, members of the genus Amblyomma exhibit a characteristic attack host-seeking behavior. The efficacy of topically applied 20% lotions of DEET (diethyl-3-methylbenzamide), the currently considered reference repellent substance, and KBR 3023, a recently developed piperidine compound, was evaluated against laboratory-reared A. hebraeum nymphs on treated fingers. Both substances repelled >85% of nymph attacks at 0 and 1 h postapplication. At 2, 3, and 4 h, the repellent efficacies of DEET were 84%, 68% and 71%, whereas those of KBR 3023 were 56, 55, and 54%. The observed differences between the two test substances were statistically significant only at 2 h postapplication. This first study of topical repellents against A. hebraeum suggests that 20% lotions of DEET and KBR 3023 are effective for 2 and 1 h, respectively, but that the repellent efficacies decrease thereafter.     

Comparison of immunofluorescence, Western blotting, and cross-adsorption assays for diagnosis of African tick bite fever

In testing paired serum samples from 40 consecutive cases of African tick bite fever, we detected diagnostic antibodies against spotted fever group rickettsiae in 45% of the patients by immunofluorescence assay (IFA) and in 100% of the patients by Western blotting (WB) (P < 0.01). A specific diagnosis of Rickettsia africae infection could be established in 15% of the patients by IFA and in 73% of the patients by a combination of WB and cross-adsorption assays (P < 0.01).     

Comparison of Immunofluorescence, Western Blotting, and Cross-Adsorption Assays for Diagnosis of African Tick Bite Fever

In testing paired serum samples from 40 consecutive cases of African tick bite fever, we detected diagnostic antibodies against spotted fever group rickettsiae in 45% of the patients by immunofluorescence assay (IFA) and in 100% of the patients by Western blotting (WB) (P < 0.01). A specific diagnosis of Rickettsia africae infection could be established in 15% of the patients by IFA and in 73% of the patients by a combination of WB and cross-adsorption assays (P < 0.01).