Institutional Guidelines (institutional + guideline)

Distribution by Scientific Domains

Selected Abstracts

Angiotensin-converting enzyme genotype and encephalopathy in Chernobyl cleanup workers

A. D. Kehoe
Background and purpose:, To identify, using a genetic model, a key role for the renin,angiotensin system (RAS) in the development of dyscirculatory encephalopathy (DE) in Chernobyl cleanup workers (CCW). The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene denotes a substantial individual variation in RAS activity with the D-allele being associated with higher ACE activity. Methods:, Ninety-three male, Caucasian CCW were recruited from those under regular review at the All-Russia Centre of Emergency and Radiation Medicine, St. Petersburg. The presence or absence of DE was determined using existing institutional guidelines. ACE genotype was determined using internationally accepted methodologies. Results:, Angiotensin-converting enzyme genotype distribution in 59 subjects with DE was II: 10 (17%), ID: 31 (53%), DD: 18 (30%), D-allele frequency 56.8%. Whereas in those without the condition the distribution was II: 12 (35%), ID: 19 (56%), DD 3 (9%) and D-allele frequency 35.9% (P = 0.02). Conclusions:, These data are the first to identify an association between the ACE D-allele and DE in CCW. They provide evidence of a significant role for the RAS in the development of DE and suggest that clinical trials of ACE inhibition would be profitable in this group. [source]

Transboundary Aquifers: A Global Program to Assess, Evaluate, and Develop Policy

GROUND WATER, Issue 5 2005
S. Puri
Transboundary aquifers are as important a component of global water resource systems as are transboundary rivers; yet, their recognition in international water policy and legislation is very limited. Existing international conventions and agreements barely address aquifers and their resources. To rectify this deficiency, the International Association of Hydrogeologists and UNESCO's International Hydrological Programme have established the Internationally Shared (transboundary) Aquifer Resource Management (ISARM) Programme. This multiagency cooperative program has launched a number of global and regional initiatives. These are designed to delineate and analyze transboundary aquifer systems and to encourage riparian states to work cooperatively toward mutually beneficial and sustainable aquifer development. The agencies participating in ISARM include international and regional organizations (e.g., Organization of American States, United Nations Environment Programme, United Nations Economic Commission for Europe, Food and Agriculture Organization, and South African Development Community). Using outputs of case studies, the ISARM Programme is building scientific, legal, environmental, socioeconomic, and institutional guidelines and recommendations to aid sharing nations in the management of their transboundary aquifers. Since its start in 2000, the program has completed inventories of transboundary aquifers in the Americas and Africa, and several ISARM case studies have commenced. [source]

An Educational Intervention to Improve Antimicrobial Use in a Hospital-Based Long-Term Care Facility

(See Editorial Comments by Dr. Lona Mody on pp 130, 1302)
OBJECTIVES: To improve antimicrobial use in patients receiving long-term care (LTC). DESIGN: Prospective, quasi-experimental before,after assessment of the effects of physician education and guideline implementation. SETTING: Public LTC and acute care hospital. PARTICIPANTS: Twenty salaried internists who provided most of the medical care to LTC patients. INTERVENTION: National guidelines, hospital resistance data, and physician feedback were incorporated into a series of four teaching sessions presented over 18 months and into booklets detailing institutional guidelines on the optimal management of common LTC infection syndromes. MEASUREMENTS: One hundred randomly selected LTC patients treated with antimicrobials were reviewed before these interventions were implemented and 100 after, and measures of the quality of care were compared. The effect of the interventions on antimicrobial days and starts were also assessed using interrupted time series analysis. RESULTS: Charted clinical abnormalities met guideline diagnostic criteria (62% vs 38%, P=.006), and initial therapy agreed with guideline recommendations (39% vs 11%, P<.001), more often in the post- than in the preintervention cohort. Mean census-adjusted monthly LTC antimicrobial days fell 29.7%, and antimicrobial starts fell 25.9% during the intervention period; both decreases were sustained during the 2-year postintervention period. CONCLUSION: The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients. [source]

Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement

Mohamad G. Fakih MD
Abstract Objectives:, Avoiding placement of unnecessary urinary catheters (UCs) in the emergency department (ED) affects UC utilization during hospitalization. The authors sought to evaluate the effect of establishing institutional guidelines for appropriate UC placement coupled with emergency physician (EP) education on UC utilization. Methods:, Urinary catheter utilization was measured before and after the establishment of guidelines and EP education. Data collected included the presence of a UC on ED arrival, placement of a UC in the ED, documentation of a physician order for UC placement, reasons for placement, and compliance with the guidelines. Chi-square analyses were used to study the association between pre- and postintervention time periods and catheter use. Results:, A total of 377 (15%) patients had UCs; only 151 (47%) UCs initially placed in the ED had a physician order documented. UC placement was appropriately indicated in 75.5% of patients with a documented physician order, but in only 52% of cases without a documented physician order (p < 0.001). The physician intervention was associated with an overall reduction in UC utilization from 16.4% to 13% (p = 0.018). Physicians ordered 40% fewer UCs postintervention compared to preintervention. Preintervention, a physician order for UC placement was found indicated in 72.6% patients, compared to 82.2% patients with UC placed postintervention (p = 0.21). Conclusions:, Establishing guidelines for UC placement and physician education in the ED were associated with a marked reduction in utilization. However, addressing appropriate UC utilization may require evaluating other factors such as nursing influence on utilization. ACADEMIC EMERGENCY MEDICINE 2010; 17:337,340 2010 by the Society for Academic Emergency Medicine [source]