Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients.

OBJECTIVE: To determine the effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheters (UCs). DESIGN: Quasi-experimental study with a control group, in 3 phases: preintervention, intervention, and postintervention. SETTING: Twelve medical-surgical units within a 608-bed teaching hospital, from May 2006 through April 2007. INTERVENTION: A nurse trained in the indications for UC utilization participated in daily multidisciplinary rounds on 10 medical-surgical units. If no appropriate indication for a patient's UC was found, the patient's nurse was asked to contact the physician to request discontinuation. Data were collected before the intervention (for 5 days), during the intervention (for 10 days), and 4 weeks after the intervention (for 5 days). Two units served as controls. RESULTS: Of 4,963 patient-days observed, a UC was present in 885 (for a total of 885 "UC-days"). There was a significant reduction in the rate of UC utilization from 203 UC-days per 1,000 patient-days in the preintervention phase to 162 UC-days per 1,000 patient-days in the intervention phase (P = .002). The postintervention rate of 187 UC-days per 1,000 patient-days was higher than the rate during the intervention (P = .05) but not significantly different from the preintervention rate (P = .32). The rate of unnecessary use of UCs also decreased from 102 UC-days per 1,000 patient-days in the preintervention phase to 64 UC-days per 1,000 patient-days during the intervention phase (P < .001); and, significantly, the rate rose to 91 UC-days per 1,000 patient-days in the postintervention phase (P = .01). The rate of discontinuation of unnecessary UCs in the intervention phase was 73 (45%) of 162. CONCLUSIONS: A nurse-led multidisciplinary approach to evaluate the need for UCs was associated with a reduction of unnecessary UC use. Efforts to sustain the intervention-induced reduction may be successful when trained advocates continue this effort with each team.

Distribution of cadmium in leaves of Thlaspi caerulescens.

Knowledge of the intracellular distribution of Cd in leaves is necessary in order to understand the mechanisms of hyperaccumulation in Thlaspi caerulescens. Ganges and Prayon, two ecotypes accumulating Cd to different levels, were grown in nutrient medium containing varying concentrations (0, 5, 10, 50, and 100 microM) of Cd. Several different approaches were combined in this study to (i) validate the results obtained by a specific method and (ii) establish the link between observations and measurements performed at different scales. In both ecotypes, Cd, localized by autoradiography, was found mainly at the edges of the leaves, but also in points of higher concentration spread over the whole limb surface. This localization was clearly correlated with the necrotic spots observed on Prayon leaves. Scanning electron microscopy coupled with energy dispersive X-ray microanalysis (cryo-SEM-EDXMA) and tissue fractionation (apoplasm, cell walls, mesophyll protoplasts, and lower epidermis) showed that Cd had similar patterns of distribution in leaf cells of both ecotypes. Cadmium was found both inside the cells and in the cell walls, mainly in the large epidermal cells but also in small epidermal cells. All the methods used agreed well and the results indicated that metal storage in the plants studied involves more than one compartment and that Cd is stored principally in the less metabolically active parts of leaf cells.