RESUMO
Contaminated blood cultures result in a significant waste of healthcare resources and can lead to inappropriate antibiotic therapy. Practitioners have taken measures to reduce contamination rates. These include thorough skin disinfection, effective hand decontamination, introduction of a standardised approach to collection, and the introduction of blood culture collection packs (BCCP). This study aims to assess the impact of introducing BCCP and staff training on the rate of contamination. The study demonstrated that contamination rates are greatest in high patient throughput units where practitioners are under most pressure. The introduction of blood culture packs and staff training has reduced contamination rate significantly from 43% to 25% of the total number of positives, equating to an overall reduction of 42%. Thus, there is a demonstrable benefit in the purchase of commercially produced blood culture packs and the investment in staff training.
Assuntos
Coleta de Amostras Sanguíneas/métodos , Sangue/microbiologia , Competência Clínica/normas , Equipamentos Descartáveis , Pele/microbiologia , Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/normas , Contaminação de Equipamentos , Reações Falso-Positivas , Humanos , Capacitação em Serviço , Staphylococcus/isolamento & purificaçãoRESUMO
We have previously found that estradiol increases (within 4 h) but then decreases (within 48 h) cell proliferation in the dentate gyrus of adult female ovariectomized (OVX) rats and of intact meadow voles and that estradiol partially stimulates adrenal activity to suppress cell proliferation in rats. Estradiol enhances N-methyl-D-aspartate receptor (NMDAr) activity and NMDAr activation suppresses cell proliferation in the adult rodent dentate gyrus. Therefore, we tested whether estradiol alters cell proliferation in the dentate gyrus of adult OVX female meadow voles by stimulating NMDAr activity. In experiment 1, OVX females were injected with estradiol (10 micro g) or oil and then with NMDA (30 mg/kg) or vehicle 3 h later and bromodeoxyuridine 4 h later (BrdU; 50 mg/kg). Voles were perfused 1 h after BrdU injection. Relative to oil vehicle, estradiol increased (P=0.001) and NMDA decreased (P=0.006) labeled cell number. Coadministration of estradiol/NMDA increased labeled cell numbers relative to NMDA alone (P=0.03), suggesting that within 4 h estradiol does not influence the effect of NMDA receptors on cell proliferation. In experiment 2, OVX females were injected with either estradiol or oil and then with either MK-801 (1 mg/kg) or vehicle 47 h later and BrdU 48 h later. The animals were perfused 1 h after BrdU was injected. Relative to oil-treated voles, estradiol-treated voles had fewer (P<0.006) and MK-801-treated voles had more labeled cells (P=0.0001) in the dentate gyrus. However, estradiol did not appear to stimulate NMDA receptors to suppress cell proliferation because estradiol (48 h)/MK-801-treated voles had fewer BrdU-labeled cells than oil (48 h)/MK-801-treated voles (P=0.06). The results show that estradiol time-dependently influences cell proliferation but that estradiol does not stimulate NMDAr activity to influence cell proliferation in the dentate gyrus of adult voles.
Assuntos
Giro Denteado/citologia , Estradiol/farmacologia , Receptores de N-Metil-D-Aspartato/metabolismo , Animais , Arvicolinae , Bromodesoxiuridina/farmacologia , Contagem de Células , Divisão Celular/efeitos dos fármacos , Corantes , Giro Denteado/metabolismo , Maleato de Dizocilpina/farmacologia , Feminino , Imuno-Histoquímica/métodos , N-Metilaspartato/antagonistas & inibidores , N-Metilaspartato/farmacologia , Fármacos Neuroprotetores/farmacologia , Ovariectomia , Fatores de TempoRESUMO
BACKGROUND: Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy. AIM: To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic. METHODS: We prospectively recruited 157 patients (83 females/74 males) mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS). Oxygen saturation (SaO2 ), heart rate (HR) and systolic blood pressure (SBP) were recorded. Quality of biopsies was evaluated. RESULTS: Analysis included 161 procedures (TNE:79, SOGD:82) with duodenal intubation achieved in all patients. VAS scores for patient comfort were significantly better in the TNE group (7.3 vs. 5.3 respectively, P < 0.001). Twenty patients with previous experience of standard endoscopy were randomised to TNE and 19 of them (95.5%) preferred the TNE. Gagging was significantly less in the TNE group (0.12 vs. 3.41 respectively, P < 0.001). Cardiovascular stress was significantly less in the TNE group irrespective of the degree of gagging or comfort. TNE biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy. CONCLUSIONS: Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress. TNE can routinely be used as alternative to SOGD under local anaesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients.
Assuntos
Duodeno/patologia , Endoscopia Gastrointestinal/métodos , Satisfação do Paciente , Adulto , Idoso , Anestesia Local , Biópsia , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Boca , Nariz , Medição da Dor , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Dissociative reactions in post-traumatic stress disorder (PTSD) have been regarded as strategic responses that limit arousal. Neuroimaging studies suggest distinct prefrontal responses in individuals displaying dissociative and hyperarousal responses to threat in PTSD. Increased prefrontal activity may reflect enhanced regulation of limbic arousal networks in dissociation. If dissociation is a higher-order regulatory response to threat, there may be differential responses to conscious and automatic processing of threat stimuli. This study addresses this question by examining the impact of dissociation on fear processing at different levels of awareness. METHOD: Functional magnetic resonance imaging (fMRI) with a 1.5-T scanner was used to examine activation to fearful (versus neutral) facial expressions during consciously attended and non-conscious (using backward masking) conditions in 23 individuals with PTSD. Activation in 11 individuals displaying non-dissociative reactions was compared to activation in 12 displaying dissociative reactions to consciously and non-consciously perceived fear stimuli. RESULTS: Dissociative PTSD was associated with enhanced activation in the ventral prefrontal cortex for conscious fear, and in the bilateral amygdala, insula and left thalamus for non-conscious fear compared to non-dissociative PTSD. Comparatively reduced activation in the dissociative group was apparent in dorsomedial prefrontal regions for conscious fear faces. CONCLUSIONS: These findings confirm our hypotheses of enhanced prefrontal activity to conscious fear and enhanced activity in limbic networks to non-conscious fear in dissociative PTSD. This supports the theory that dissociation is a regulatory strategy invoked to cope with extreme arousal in PTSD, but this strategy appears to function only during conscious processing of threat.