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Assessment of urea removal in haemodialysis and the impact of the European best practice guidelines.
Nephrol Dial Transplant. 2008 Nov 27;
Authors: Couchoud C, Jager KJ, Tomson C, Cabanne JF, Collart F, Finne P, de Francisco A, Frimat L, Garneata L, Leivestad T, Lemaitre V, Limido A, Ots M, Resic H, Stojceva-Taneva O, Kooman J,
BACKGROUND: Dialysis adequacy, assessed by urea kinetics, is an important determinant of patient outcome, and is therefore an important clinical performance indicator. In this perspective, renal registry data may be useful to compare practices across countries. To serve that purpose available data should be comparable and preferably collected using a standardized procedure. The aim of this study, initiated by the European Renal Association-European Dialysis and Transplantation Association (ERA-EDTA) QUality European STudies (QUEST) initiative, was to make an inventory of the different methods used to determine urea kinetic measurements in the light of the European Best Practice Guidelines. METHODS: Via their national and regional registries, European haemodialysis centres were invited to complete a questionnaire regarding their practice of measuring dialysis adequacy. RESULTS: Fourteen regional or national registries among 51 sent back 255 questionnaires. Great variability in the methodology to assess Kt/V was observed. The urea reduction ratio (URR) was used alone by 37% (in association 46%) of dialysis centres, spKt/V by 25% (35%) and on-line clearance by 4% (12%), whereas only 10% (13%) used eKt/V, as recommended by EBPG. Forty percent of centres measured urea removal less than once a month, 6% of which never measured urea removal and 9% only every 6 months or less frequently. CONCLUSION: Despite the fact that the use of URR is not recommended by EBPG, it was the most commonly used indicator to measure urea removal, whereas eKt/V was only used by a small minority of centres. This study allowed us to point out the need to standardize definitions and procedures and to develop an effective plan for implementation of the guidelines.
PMID: 19039029 [PubMed - as supplied by publisher]
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Freitag, 12. Dezember 2008
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Assessment of the impact of new UK guidelines on the management of aromatase inhibitor-associated bone loss.
Rheumatology (Oxford). 2008 Nov 29;
Authors: Sowden E, Evans B, Greenbank CM, Bukhari M, Halsey JP
PMID: 19043085 [PubMed - as supplied by publisher]
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Freitag, 12. Dezember 2008
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Translational Research - Implementation of NHLBI Obesity Guidelines in a Primary Care Community Setting: The Physician Obesity Awareness Project.
J Nutr Health Aging. 2008 Dec;12(10):764s-9s
Authors: Schuster RJ, Tasosa J, Terwood NA
Background: Greater than 65 percent of the United States (US) population is overweight, with 32 percent obese. It is a problem in both developed and developing nations. While guidelines exist, counseling by physicians about obesity and weight loss is inconsistent, and physician approaches to obesity management have limited success. This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity. Twenty-one physicians in a suburban, middle class population in the Midwestern United States participated. Methods: Physician obesity awareness, weight, height, BMI, blood pressure, lipids, and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up. All 21 physicians received academic detailing and were presented with their clinical outcomes. Ten physicians received an Enhanced Intervention. They were additionally asked to place a sticker in the chart of their overweight or obese patients. Results: Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline, decreasing to 0% at followup (p = 0.041). Reference to obesity management by Intervention physicians increased from 2.4% to 9.2% (p = 0.001) while for Enhanced Intervention physicians documentation increased from 3.9% to 15.6% (p = 0.002). Those patients in the Enhanced Intervention group lost an average of 6.19 lbs (3.3%) (p = 0.083) during the one year period versus 4.6 lbs (2.5%) (p = 0.20) in the Intervention group. The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group. The data from both groups was pooled at both baseline and follow-up. The average weight of patients decreased from 185.7 lbs to 180.3 lbs (excluding outliers weighing > 311 lbs). This 5.4 pound loss was significant (p = 0.027). The BMI decreased from 30.1 to 29.1 (p = 0.095). Cardiovascular co-morbidities improved. Conclusion: Obesity and overweight have a very high prevalence in a primary care community based settings. Clinicians are not comfortable diagnosing and managing obese and overweight patients. A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss.
PMID: 19043654 [PubMed - in process]
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Freitag, 12. Dezember 2008
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Centers for disease control and prevention guidelines for preventing central venous catheter-related infection: Results of a knowledge test among 3405 European intensive care nurses*
Crit Care Med. 2008 Nov 28;
Authors: Labeau SO, Vandijck DM, Rello J, Adam S, Rosa A, Wenisch C, Bäckman C, Agbaht K, Csomos A, Seha M, Dimopoulos G, Vandewoude KH, Blot SI,
OBJECTIVE:: To determine European intensive care unit (ICU) nurses’ knowledge of guidelines for preventing central venous catheter-related infection from the Centers for Disease Control and Prevention. DESIGN:: Multicountry survey (October 2006-March 2007). SETTING:: Twenty-two European countries. PARTICIPANTS:: ICU nurses. MEASUREMENTS AND MAIN RESULTS:: Using a validated multiple-choice test, knowledge of ten recommendations for central venous catheter-related infection prevention was evaluated (one point per question) and assessed in relation to participants’ gender, ICU experience, number of ICU beds, and acquisition of a specialized ICU qualification. We collected 3405 questionnaires (70.9% response rate); mean test score was 44.4%. Fifty-six percent knew that central venous catheters should be replaced on indication only, and 74% knew this also concerns replacement over a guidewire. Replacing pressure transducers and tubing every 4 days, and using coated devices in patients requiring a central venous catheter >5 days in settings with high infection rates only were recognized as recommended by 53% and 31%, respectively. Central venous catheters dressings in general are known to be changed on indication and at least once weekly by 43%, and 26% recognized that both poly-urethane and gauze dressings are recommended. Only 14% checked 2% aqueous chlorhexidine as recommended disinfection solution; 30% knew antibiotic ointments are not recommended because they trigger resistance. Replacing administration sets within 24 hrs after administering lipid emulsions was recognized as recommended by 90%, but only 26% knew sets should be replaced every 96 hrs when administering neither lipid emulsions nor blood products. Professional seniority and number of ICU beds showed to be independently associated with better test scores. CONCLUSIONS:: Opportunities exist to optimize knowledge of central venous catheter-related infection prevention among European ICU nurses. We recommend including central venous catheter-related infection prevention guidelines in educational curricula and continuing refresher education programs.
PMID: 19050628 [PubMed - as supplied by publisher]
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Freitag, 12. Dezember 2008
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Time- and Fluid-Sensitive Resuscitation for Hemodynamic Support of Children in Septic Shock: Barriers to the Implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a Pediatric Intensive Care Unit in a Developing World.
Pediatr Emerg Care. 2008 Nov 21;
Authors: Oliveira CF, Nogueira de Sá FR, Oliveira DS, Gottschald AF, Moura JD, Shibata AR, Troster EJ, Vaz FA, Carcillo JA
OBJECTIVES:: To analyze mortality rates of children with severe sepsis and septic shock in relation to time-sensitive fluid resuscitation and treatments received and to define barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing country. METHODS:: Retrospective chart review and prospective analysis of septic shock treatment in a pediatric intensive care unit of a tertiary care teaching hospital. Ninety patients with severe sepsis or septic shock admitted between July 2002 and June 2003 were included in this study. RESULTS:: Of the 90 patients, 83% had septic shock and 17% had severe sepsis; 80 patients had preexisting severe chronic diseases. Patients with septic shock who received less than a 20-mL/kg dose of resuscitation fluid in the first hour of treatment had a mortality rate of 73%, whereas patients who received more than a 40-mL/kg dose in the first hour of treatment had a mortality rate of 33% (P < 0.05). Patients treated less than 30 minutes after diagnosis of severe sepsis and septic shock had a significantly lower mortality rate (40%) than patients treated more than 60 minutes after diagnosis (P < 0.05). Controlling for the risk of mortality, early fluid resuscitation was associated with a 3-fold reduction in the odds of death (odds ratio, 0.33; 95% confidence interval, 0.13-0.85). The most important barriers to achieve adequate severe sepsis and septic shock treatment were lack of adequate vascular access, lack of recognition of early shock, shortage of health care providers, and nonuse of goals and treatment protocols. CONCLUSIONS:: The mortality rate was higher for children older than 2 years, for those who received less than 40 mL/kg in the first hour, and for those whose treatment was not initiated in the first 30 minutes after the diagnosis of septic shock. The acknowledgment of existing barriers to a timely fluid administration and the establishment of objectives to overcome these barriers may lead to a more successful implementation of the American College of Critical Care Medicine guidelines and reduced mortality rates for children with septic shock in the developing world.
PMID: 19050666 [PubMed - as supplied by publisher]
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Freitag, 12. Dezember 2008
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Practitioners’ Attitudes concerning Evidence-Based Guidelines in Belgian Substance Abuse Treatment.
Eur Addict Res. 2008 Dec 3;15(1):47-55
Authors: Autrique M, Vanderplasschen W, Broekaert E, Sabbe B
Background/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners’ attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample of 60 agencies dispensing specialized treatment to alcohol and drug abusers. Results: The study revealed that evidence-based guidelines are rarely used in substance abuse treatment in Belgium, but that many agencies use self-developed guidelines. The attitude concerning evidence-based guidelines is mainly positive. Practitioners’ concerns mostly relate to the risk of disregarding their clients’ needs and the constraining character of using evidence-based guidelines. The study also reveals some barriers concerning the implementation of evidence-based guidelines and suggests some strategies to overcome them. Conclusion: Practitioners appear to be prepared to work with evidence-based guidelines. When developing, adapting and implementing evidence-based guidelines for substance abuse treatment, it is important for policy makers to take into account the state of the art in clinical practice as well as practitioners’ needs and requirements.
PMID: 19052462 [PubMed - as supplied by publisher]
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Freitag, 12. Dezember 2008
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Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: we could go faster.
J Crit Care. 2008 Dec;23(4):455-60
Authors: Zambon M, Ceola M, Almeida-de-Castro R, Gullo A, Vincent JL
PURPOSE: The aim of this study is to evaluate the feasibility of applying sepsis bundles in the intensive care unit (ICU) and their effect on outcomes. METHODS: In this prospective, observational study in a 31-bed capacity department of intensive care, we measured the time taken to perform sepsis bundle interventions in 69 consecutive patients with severe sepsis or septic shock. RESULTS: Compliance with the 6-hour bundle was obtained in 44 (72%) of 61 patients; these patients had a lower mortality rate (16% vs 41%, P = .04) and shorter ICU stay (median [range], 5 [3-10] vs 9 [6-19] days, P = .01) than other patients. Compliance with the 24-hour bundle was obtained in 30 (67%) of 44 eligible patients. The mortality rate and duration of ICU stay were not significantly lower in the 24-hour compliant as compared with the noncompliant group (23% vs 33% and 6 [4-11] vs 9 [6-25] days, respectively; P value is not significant). Patients who complied with the 24-hour sepsis bundle after only 12 hours had a lower mortality rate (10% vs 39%, P = .036) and shorter stay (6 [4-10] vs 9 [6-25] days, P = .055) than those who were compliant after 24 hours. CONCLUSIONS: Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay. Earlier implementation of the 24-hour management bundle could result in better outcomes.
PMID: 19056006 [PubMed - in process]
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