Survival of patients transferred to tertiary intensive care from rural community hospitals

BACKGROUND: Accessibility to tertiary intensive care resources differs among hospitals within a rural region. Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population. METHODS: In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital. RESULTS: The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant. CONCLUSIONS: Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services

Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review

Abstract Study aim The current study compares the diagnostic accuracy of BNP and NT-proBNP assays for the diagnosis of heart failure, according to evidence based laboratory medicine (EBLM) principles. Methods In May 2006, studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays were selected by means of a computerized literature search performed on National Library of Medicine. The comparison took into account the area under the curve (AUC) and diagnostic odds ratio (DOR) derived from ROC analysis of original studies. Results Both BNP and NT-proBNP assays were found to be clinically useful for the diagnosis of heart failure. A meta-analysis of these data was made difficult by the heterogeneity of data, regarding patient population, diagnostic criteria, end-points and immunoassay methods for both BNP and NT-proBNP. Separate meta-analyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic odds ratio (DOR) for BNP assay (DOR 8.44, 95% CI 4.66 – 15.30) was not significantly different from NT-proBNP one (23.36, 95% CI 9.38 – 58.19). In patients with acute heart failure, the mean DOR for BNP assay was 16.46 (95% CI 10.65 – 25.43) and for NT-proBNP assay 18.61 (95% CI 12.99 – 26.65), without a significant difference. Conclusion Our results indicate that both BNP and NT-proBNP assays have a high degree of diagnostic accuracy and clinical relevance in both acute and chronic heart failure

Educazione terapeutica ai malati oncologici: esperienza degli infermieri italiani

Introduction. Therapeutic patient’ education is a complex process requiring a proper level of communication between the patient and the healthcare professional. Nurses play a key role in providing the patients and their families with educational activities. Objective: This paper is the report of a study which investigates the experiences of some Italian nurses with regards to their role in therapeutic education to cancer patients. Methods: Qualitative research. Semi-structured interviews were carried out with 52 nurses working in different Local Health Service Units of two northern Italy regions: Piedmont and Valle d’Aosta. To identify categories and items arising from the data, the researchers used a qualitative content analysis. Results: The interview format was classified into six main categories: a) Patient education as daily care activity; b) Relevance of communication and dialogue for educational purposes; c) Relative usefulness of written information; d) Therapeutic education recording; e) Patients’ feedbacks as a tool for assessing therapeutic education; and f) Difficult communication. Conclusions: The experience of nurses in terms of their professional role in therapeutic education for cancer patients shows the steady presence of educational activities carried out in a non-planned way. This research confirms the need to launch educational interventions for nurses. Implications for Practice: It is essential to implement an action plan to promote opportunities of professional training in the field since among the most frequent reasons for project failure in therapeutic education is the lack of expert human resource

Die Wirksamkeit leistungsstarker Hydraulikbagger als ein Kriterium zur Bestimmung der Maschinengrösse

A method developed only recently for determining the main characteristics of hydraulic excavators which are suitable for fulfilling planned production requirements was confirmed by the “Dipartimento di Georisorse e territorio” of the “Politecnico di Torino” when it was applied in trials carried put at the Balangero opencast mine. The new R994 hydraulic excavator fulfilled the desired production requirements satisfactorily under all working conditions. Further confirmation of the general validity of the correlation (interrelationship) on which the method of selection is based was provided by trials with a smaller R 984 hydraulic excavator

Altered tissue degradation and distribution of Atrial Natriuretic Peptide in patients with idiopathic dilated cardiomyopathy and its relationship with clinical severity of the disease and sodium handling

Background Atrial natriuretic peptide (ANP) has been suggested to play an important role in heart failure, preserving cardiorenal homeostasis through maintenance of the sodium balance and inhibition of the detrimental effects of the neurohormonal vasoconstrictor system. The current study was designed to investigate whether there is a disturbed renewal and distribution of ANP in patients with idiopathic dilated cardiomyopathy (IDC) with differing clinical severity of disease. Methods and Results We used a tracer method to perform a cross-sectional study of 15 IDC patients with differing clinical severity (New York Heart Association functional class I to III), prospectively divided into two groups according to their functional class (group 1, classes I and II; group 2, classes II-III and III). Eleven normotensive, nonobese male volunteers also were studied as a control group. Main ANP kinetic parameters were derived from the disappearance curve of the labeled hormone after the bolus injection of [ 125 I]-labeled ANP. A high-performance liquid chromatography technique was used to separate the radiolabeled hormone in each plasma sample. Patients in group 1 showed higher ANP metabolic clearance rate (MCR) (2731.9±726.2 mL · min −1 · m −2 ) than patients of group 2 (1718.4±621.2 mL · min −1 · m −2 ) and control subjects (1873.1±551.2 mL · min −1 · m −2 ). ANP disposal (MCR) positively correlated with biological hormonal effect (urinary sodium excretion) both in control subjects and in patients. In IDC patients of both groups, however, MCR values were always higher (approximately doubled) than the values found in control subjects at the corresponding sodium excretion. This finding indicates that a reduced ANP biological activity is associated with hormone degradation in patients. Moreover, patients of group 2 showed significantly higher ANP production rates (395.6±183.8 ng · min −1 · m −2 ) than group 1 (166.0±139.0 ng · min −1 · m −2 ) and control subjects (130.7±105.4 ng · min −1 · m −2 ) despite a marked reduction in sodium excretion. Patients with IDC showed a progressive reduction in the total distribution volume (group 1, 19.8±5.8 L/m 2 ; group 2, 12.7±6.9 L/m 2 ; control subjects, 27.0±11.6 L/m 2 ) of the hormone; this probably was due to a reduction in exchanges of ANP with peripheral tissues. Conclusions Our study demonstrates a markedly altered degradation and distribution of ANP in patients with IDC, even in those at the early stage of clinical disease (classes I and II, group 1) who have ANP plasma levels in the normal range. </jats:p