Reduction of burden of hemolyzed specimens in a large urban emergency department: A real-world, five years’ experience

In vitro hemolysis may jeopardize patient care because tests results generated using unsuitable specimens may lead to inappropriate patient management. The prevalence of hemolyzed specimens is high in the emergency department (ED). We previously showed that collecting blood by means of a closed system entailing manual aspiration of blood instead of using conventional evacuated systems was effective to cut-down by nearly half the rate of hemolysis. Aim of this real world study was to verify whether longterm replacement of standard evacuated blood collection systems may be really effective to reduce the burden of spurious hemolysis. Starting from May 2014 in the ED of our Hospital vacuum tubes were replaced with S-Monovette serum tubes. We compared data about hemolyzed specimens entered in the two years before the implementation of the new device (i.e., 2012 and 2013) and the two years after introducing SMonovette in manual aspiration mode (i.e. 2015 and 2016). The year 2014 was not considered due to mixed data. The rate of hemolyzed specimens decreased from 4.36% to 3.07% with the use of S-Monovette in manual aspiration mode (Chi squared, 183.8; P<0.001). The likelihood of obtaining hemolyzed specimens was hence reduced by approximately 30% (relative risk, 0.707), with an expected economic saving of approximately 510€/year. The results of this real-world study demonstrate that the use of an alternative closed device encompassing manual aspiration for drawing blood from intravenous catheters may reduce hemolyzed samples by approximately 30%, so representing a valuable perspective for safeguarding patient safety and improving ED efficiency

The use of S-Monovette is effective to reduce the burden of hemolysis in a large urban emergency department

Background: Due to the high prevalence of hemolysis in specimens received from the emergency department (ED), several strategies have been proposed to improve sample quality, but none of these seem effective to overcome the problem. In a preliminary study we showed that the use of S-Monovette blood collection system was effective to lower the risk of hemolysis in venous blood samples collected from intravenous catheters. This study was hence aimed to verify whether the replacement of a conventional vacuum system with S-Monovette may be effective to reduce the burden of hemolysis in the daily practice of a large urban ED. Materials and methods: The study was divided in two observational periods of 4 months each. In the former period, blood was collected from intravenous catheters using BD Vacutainer SST II Plus plastic serum tubes, whereas in the latter period the blood was drawn from intravenous catheters using S-Monovette blood tubes in aspiration mode. Sample hemolysis was automatically assessed in all serum samples by photometrical measurement. Results: The total number of hemolysed serum specimens was 624/14155 (4.41%) in the first phase of the study, and 342/13319 (2.57%) in the second phase of the study (P < 0.001). Conclusion: Results of our study confirm that the introduction of the Sarstedt S-Monovette blood tubes has reduced the hemolysis rate in the emergency department compared to the previously used BD Vacutainer® SST II Plus plastic serum tube

Reduction of burden of hemolyzed specimens in a large urban emergency department: A real-world, five years' experience

In vitro hemolysis may jeopardize patient care because tests results generated using unsuitable specimens may lead to inappropriate patient management. The prevalence of hemolyzed specimens is high in the emergency department (ED). We previously showed that collecting blood by means of a closed system entailing manual aspiration of blood instead of using conventional evacuated systems was effective to cut-down by nearly half the rate of hemolysis. Aim of this real world study was to verify whether longterm replacement of standard evacuated blood collection systems may be really effective to reduce the burden of spurious hemolysis. Starting from May 2014 in the ED of our Hospital vacuum tubes were replaced with S-Monovette serum tubes. We compared data about hemolyzed specimens entered in the two years before the implementation of the new device (i.e., 2012 and 2013) and the two years after introducing SMonovette in manual aspiration mode (i.e. 2015 and 2016). The year 2014 was not considered due to mixed data. The rate of hemolyzed specimens decreased from 4.36% to 3.07% with the use of S-Monovette in manual aspiration mode (Chi squared, 183.8; P<0.001). The likelihood of obtaining hemolyzed specimens was hence reduced by approximately 30% (relative risk, 0.707), with an expected economic saving of approximately 510€/year. The results of this real-world study demonstrate that the use of an alternative closed device encompassing manual aspiration for drawing blood from intravenous catheters may reduce hemolyzed samples by approximately 30%, so representing a valuable perspective for safeguarding patient safety and improving ED efficiency

Multicenter observational study on the reliability of the HEART score

Objective To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians. Methods The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study\u2019s aim. Results After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [\u3ba], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; \u3ba, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; \u3ba, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (\u3ba, 0.37 and 0.42, respectively). Conclusion The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component. Keywords HEART score; HEART pathway; Chest pain; Acute coronary syndrome; Emergency service, hospita

Estudio multidisciplinario e interinstitucional de dos fuentes principales de agua potable para la Provincia de Córdoba

Las fuentes de aguas superficiales son eje de desarrollo de los seres humanos, ya que permiten el abastecimiento para diferentes actividades socioeconómicas. No obstante, de forma paradójica, muchas de estas actividades causan alteración y deterioro de las mismas. Con el fin de contribuir al fortalecimiento de la articulación entre el estado, la sociedad y la Universidad desde hace aproximadamente dos décadas un equipo conformado por docentes investigadores, ayudantes de investigación, profesionales y personal técnico realizan un estudio multidisciplinar e interinstitucional en cuerpos de agua superficiales de la provincia de Córdoba. Los mayores esfuerzos están enfocados hacia dos fuentes principales de agua potable de la provincia: El río Tercero (Ctalamochita) -como parte de la cuenca del río Carcarañá- y el embalse Los Molinos. Dado que el agua propicia el bienestar de la población y el crecimiento inclusivo, y tiene un impacto positivo en la vida de las personas, al incidir en aspectos que afectan la seguridad alimentaria y energética, la salud humana y el ambiente; en el presente trabajo se brindan las principales conclusiones y recomendaciones (para diferentes usos) en ambos cuerpos de agua abordando la problemática de calidad y cantidad de agua. Tales recomendaciones aspiran a contribuir al desarrollo de un sistema de gestión integrada de los recursos hídricos con un enfoque participativo para asegurar la sostenibilidad de los ecosistemas involucrados.Fil: Bazan, Raquel. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: García, Marcelo. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Díaz Lozada, José Manuel. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Estudios Avanzados en Ingeniería y Tecnología. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Estudios Avanzados en Ingeniería y Tecnología; ArgentinaFil: chalimond, María Laura

Prevalence of HDV infection in people living with HIV: Data from a multicenter Italian cohort

ObjectivesThe development of novel antiviral agents active against Hepatitis Delta Virus (HDV) might change the natural history of chronic infection, reducing the risk for end-stage liver disease. People living with HIV (PWH) are at risk for bloodborne pathogens infection, but limited data on epidemiology of HDV infection is available in this setting. The aim of this study was to investigate HDV prevalence and attitude toward HDV testing and treatment in infectious diseases centers.MethodsA cross sectional survey was performed among centers participating in the CISAI (Coordinamento Italiano per lo Studio dell’Allergia in Infezione da HIV) Group. The survey addressed anti-HDV prevalence and HDV-RNA detectability rates in PWH as well as perceived obstacles to treatment.ResultsOverall, responses from ten sites were collected. Among participating centers, 316 PWH with HBV chronic infection are currently followed. Of them, 15.2% had positive anti-HDV antibodies, while 13.9% were not tested yet. Overall, 17% of anti-HDV positive PWH tested at least once for HDV-RNA had active HDV infection, and 71% of them had advanced liver disease. Most infectious diseases centers intend to treat locally HDV infection with upcoming anti-HDV drugs, but some concerns exist regarding treatment schedule.DiscussionHDV testing needs to be implemented in PWH. At present, few patients followed in the CISAI centers seem to be candidate to receive new direct active anti-HDV agents, but repeated HDV-RNA measures could change this proportion

Effectiveness and safety of electrical cardioversion for acute-onset atrial fibrillation in the emergency department: a real-world 10-year single center experience

Objective Despite limited evidence, electrical cardioversion of acute-onset atrial fibrillation (AAF) is widely performed in the emergency department (ED). The aim of this study was to describe the effectiveness and safety of electrical cardioversion of AAF performed by emergency physicians in the ED. Methods All episodes of AAF electrically cardioverted in the ED were retrieved from the database for a 10-year period. Most patients not already receiving anticoagulants were given enoxaparin before the procedure (259/419). Procedural complications were recorded, and the patients were followed-up for 30 days for cardiovascular and hemorrhagic complications. Results Four hundred nineteen eligible cases were identified; men represented 69%, and mean age was 61±13 years. The procedure was effective in 403 cases (96.2%; 95.4% in women, 96.5% in men), with considerable differences with respect to the age of the patients, the procedure being effective in 100% of patients aged 18 to 39 and only 68.8% in those >80 years. New ED visits (33/419) were identified within 30 days (31 due to atrial fibrillation/atrial flutter recurrence, 1 due to iatrogenic hypokalemia, 1 due to hypertensive emergency). No strokes, major bleeding, life-threatening arrhythmias or peripheral thromboembolism were recorded. Nine small and mild skin burns were observed. Conclusion Electrical cardioversion is an effective and safe procedure in the vast majority of patients, albeit less effective in patients aged >80 years. It appears reasonable to avoid anticoagulation in low-risk patients with AAF and administer peri-procedural heparin to all remaining patients. Long-term anticoagulation should be planned on an individual basis, after assessment of thromboembolic and hemorrhagic risk

Proyecto de trayectoria pedagógicas individuales

Fil: Ponciano, Elio. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Osorio, Roxana. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Burgos, Rosa. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Bonfanti, Silvina. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Osorio, Lucía. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Martín, Carolina. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Roccasanlva, Andrea. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Papini, Julieta. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Salcedo, Susana. Universidad Nacional de Cuyo. Colegio Universitario CentralFil: Saborido, Laura. Universidad Nacional de Cuyo. Colegio Universitario Centra

Multicenter observational study on the reliability of the HEART score

Objective To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians. Methods The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim. Results After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively). Conclusion The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component

Linfoma T cutáneo en paciente con artritis reumatoidea

La artritis reumatoidea incrementa el riesgo de muerte en pacientes que la padecen, ya sea por las comorbilidades como enfermedades cardiovasculares y las infecciones, como así también por una mayor frecuencia de desórdenes linfoproliferativos asociados a la enfermedad de base. Se presenta el caso de un paciente de sexo masculino de 74 años de edad, con artritis reumatoidea poliarticular y nodular de larga data. Tratado con DMARs, etanercept y abatacept con poca eficacia, por lo que inició rituximab con excelente respuesta, recibiendo luego como mantenimiento tofacitinib 5 mg/ día. En abril de este año presenta lesiones nodulares y eritematosas en ambos miembros inferiores que luego se necrotizan y esfacelan. Se suspende tratamiento inmunosupresor. Se indica biopsia de piel que muestra linfoma T cutáneo con compromiso dérmico e hipodérmico. Se inició quimioterapia CHOP pero luego del segundo ciclo el paciente presenta aplasia medular y fallece