Appointing 'trained donation practitioners' results in a higher family consent rate in the Netherlands: a multicenter study.

The consent process for organ and tissue donation is complex, both for families and professionals. To help professionals in broaching this subject we performed a multicenter study. We compared family consent to donation in three hospitals between December 2007 and December 2009. In the intervention hospital, trained donation practitioners (TDP) guided 66 families throughout the time in the ICU until a decision regarding donation had been reached. In the first control hospital, without any family guidance or training, 107 families were approached. In the second control hospital 'hostesses', who were not trained in donation questions, supported 99 families during admittance. A total of 272 families were requested to donate. We primarily compared consent rates, but also asked families about their experiences through a questionnaire. Family consent rate was significantly higher in the intervention hospital: 57.6% (38/66), than in the control hospitals: 34.6% (37/107) and 39.4% (39/99). The 69% response rate to the questionnaire -~5 months after death - showed no confounding variables that could have influenced the consent rate. Appointing TDPs in the intervention hospital to guide families during admittance and the donation decision-making process, results in higher family consent rates.

Anti-Xa activity after subcutaneous administration of dalteparin in ICU patients with and without subcutaneous oedema: a pilot study.

INTRODUCTION: Intensive care unit (ICU) patients often suffer from subcutaneous oedema, due to administration of large fluid volumes and the underlying pathophysiological condition. It is unknown whether the presence of subcutaneous oedema impairs the absorption of dalteparin, a low molecular weight heparin, when it is given by subcutaneous administration for venous thromboembolism prophylaxis. The objective of this study is to compare the anti-Xa activity of dalteparin after subcutaneous administration in ICU patients with and without subcutaneous oedema. METHODS: This non-randomized open parallel group follow-up pilot study was conducted in two mixed medical-surgical intensive care units at two teaching hospitals. Seven ICU patients with subcutaneous oedema (index group) and seven ICU patients without subcutaneous oedema (reference group) were studied. Anti-Xa activity was determined at 0, 3, 4, 6, 8, 12 and 24 hours after subcutaneous administration of 2,500 IU dalteparin. Plasma concentrations of factor anti-Xa activity were measured using a chromogenic factor Xa inhibition assay. RESULTS: The characteristics of the index group were: age, 58 years; male/female ratio, 5/2; body mass index at admission, 23.4 kg/m2 (at study day, 30.6 kg/m2). The characteristics of the reference group were: age, 49 years; male/female ratio, 6/1; body mass index at admission, 24.8 kg/m2 (at study day, 25.0 kg/m2). In the index group, creatinine clearance was lower compared to the reference group (71 versus 131 ml/minute, p = 0.003). Sequential organ failure assessment score did not differ between index and reference groups (4 versus 5). Mean arterial pressure was comparable between index and reference groups (91 versus 95 mmHg) and within the normal range. The mean Cmax value was not different between ICU patients with and without subcutaneous oedema (0.15 +/- 0.02 versus 0.14 +/- 0.02 IU/ml, p = 0.34). In the index group, the mean AUC(0-24 h) value was slightly higher compared with the reference group (1.50 +/- 0.31 versus 1.15 +/- 0.25 h.IU/ml, p = 0.31). This difference was not significant. CONCLUSION: In this pilot study, there was no clinically relevant difference in anti-Xa activity after subcutaneous administration of 2,500 IU dalteparin for venous thromboembolism prophylaxis between ICU patients with and without subcutaneous oedema. Critically ill patients seem to have lower anti-Xa activity levels than healthy volunteers.

['Tick-borne' encephalitis in an immunocompromised patient]. / 'Tick-borne'-encefalitis bij verminderde afweer: de ernstige gevolgen van een tekenbeet.

BACKGROUND: 'Tick-borne' encephalitis virus (TBEV) is a flavivirus that is transmitted by ticks. TBEV is endemic in East Asia, Russia and a number of other European countries. In the Netherlands it is seen only in travellers who have been to these regions. The clinical picture is variable: from a mild form of meningitis to lethal meningoencephalomyelitis. There are no therapeutic options available, only symptomatic treatments. CASE DESCRIPTION: A 48-year-old woman with a history of systemic lupus erythematosus (SLE) for which she used immunosuppressives, developed meningoradiculoencephalitis following a holiday in Germany. She was initially treated for cerebral SLE vasculitis, but it later became apparent that it was a tick-borne encephalitis. The patient died of abscessing pneumonia following protracted mechanical ventilation. CONCLUSION: Tick-borne encephalitis may have serious consequences. Important is to think of this infection in patients who travelled to endemic areas. Vaccination should be recommended to travellers visiting endemic regions, especially if they are immunocompromised.