The pharmacy screening project - An evaluation of pharmacy-based screening programmes

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Validation of a prediction rule for renal artery stenosis.

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The prevention of contrast-induced nephropathy in Dutch hospitals

Background: A major adverse effect of intravascularly administrated iodinated contrast medium is contrast-induced nephropathy (CIN). To reduce CIN incidence, two different prevention guidelines have been introduced in the Netherlands. Objective: Our goal was to assess the use of CIN prevention guidelines at the radiology departments in Dutch hospitals. Methods: We conducted a survey in all 90 Dutch hospitals with a radiology department. The questionnaire included questions about guideline execution (e.g. which guideline, (compliance) problems). Results: All responding (67/90) hospitals used a CIN prevention guideline. When asked who was responsible for conducting preventive measures in high-risk patients identified according to either guideline, the referring physician was responsible in 38 hospitals (56.7%); in 23 hospitals (34.3%) there was a specialised CIN outpatient clinic. Renal function was routinely checked after exposure to intravenous iodinated contrast medium in all CIN outpatient clinics (23) and radiology departments (2) when these were responsible for this measurement and in 52.6% (18/38) hospitals when the referring physicians were responsible. When asked if identifying patients at risk caused any problems, 47.8% reported problems. Conclusion: In all responding Dutch hospitals a CIN prevention guideline was used. There was considerable variation in the execution of the guidelines and there were substantial compliance problems. The follow-up procedure was more consistent in hospitals with an outpatient clini

Pathophysiologic and prognostic role of cytokines in dengue hemorrhagic fever.

Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam. Dengue shock syndrome is a severe complication of dengue hemorrhagic fever (DHF), characterized by a massive increase in vascular permeability. Plasma cytokine concentrations were prospectively studied in 443 Vietnamese children with DHF, of whom 6 died. Shock was present in 188 children on admission to hospital, and in 71 children it developed later. Contrary to expectations, certain inflammatory markers (interleukin-6 and soluble intercellular adhesion molecule-1) were lower in the group with shock, and this may reflect the general loss of protein from the circulation due to capillary leakage. Only soluble tumor necrosis factor receptor (TNFR) levels showed a consistent positive relationship with disease severity. In patients with suspected DHF without shock, admission levels of sTNFR-75 in excess of 55 pg/mL predicted the subsequent development of shock, with a relative risk of 5.5 (95% confidence interval, 2.3-13.2). Large-scale release of soluble TNFR may be an early and specific marker of the endothelial changes that cause dengue shock syndrome