Implementation of sepsis management guideline in a community-based teaching hospital - can education be potentially beneficial for septic patients?

OBJECTIVE: To assess clinical outcomes associated with the implementation of the sepsis management guideline in a community-based hospital. In addition, evaluate the utility and effectiveness of a Sepsis Education Program. RESEARCH DESIGN AND METHODS: This is an observational cohort study of patients presenting to the Emergency Department at a community-based teaching centre meeting severe sepsis or septic shock criteria. A quality improvement programme consisting of a comprehensive Sepsis Education Program based on recommendations from the Surviving Sepsis Campaign was implemented and evaluated. Patients were identify by the admission diagnosis and were evaluated over two time periods (7/2003-6/2004 and 7/2005-6/2006) and to show clinical outcomes before and after implementation of the sepsis guideline/quality improvement programme. RESULTS: A total of 96 patients with severe sepsis (34 control group and 62 SSC group) were included. Both groups had similar intensive care unit (ICU)-length of stay (3 vs. 3 days, p = 0.647). Patients who required mechanical ventilation (MV) had similar MV time (4 vs. 3.5 days p = 0.349). A greater percentage of survival was found in the SSC group [45% vs. 73% (p = 0.006)]. Patient received similar care with regards to appropriate early antibiotics (85% vs. 90%, p 0.459). The main difference between the two group was the early fluid resuscitation (2 l vs. 3 l, p = 0.006) over the first 3 h and a difference remained significant at 6 h (4.2 l vs. 6.3 l, p = 0.013). CONCLUSIONS: In a community based teaching hospital, implementing the surviving sepsis campaign guideline through an education programme was feasible and resulted in early therapy with aggressive fluid administration and appropriate antibiotics. The Sepsis Education Program resulted in early therapeutic interventions and contributed to the survival benefits.

Evaluation of genotoxic effects in human leukocytes after in vitro exposure to 1950 MHz UMTS radiofrequency field.

In the present study the third generation wireless technology of the Universal Mobile Telecommunication System (UMTS) signal was investigated for the induction of genotoxic effects in human leukocytes. Peripheral blood from six healthy donors was used and, for each donor, intermittent exposures (6 min RF on, 2 h RF off) at the frequency of 1950 MHz were conducted at a specific absorption rate of 2.2 W/kg. The exposures were performed in a transverse electro magnetic (TEM) cell hosted in an incubator under strictly controlled conditions of temperature and dosimetry. Following long duration intermittent RF exposures (from 24 to 68 h) in different stages of the cell cycle, micronucleus formation was evaluated by applying the cytokinesis block micronucleus assay, which also provides information on cell division kinetics. Primary DNA damage (strand breaks/alkali labile sites) was also investigated following 24 h of intermittent RF exposures, by applying the alkaline single cell gel electrophoresis (SCG)/comet assay. Positive controls were included by treating cell cultures with Mitomycin-C and methylmethanesulfonate for micronucleus and comet assays, respectively. The results obtained indicate that intermittent exposures of human lymphocytes in different stages of cell cycle do not induce either an increase in micronucleated cells, or change in cell cycle kinetics; moreover, 24 h intermittent exposures also fail to affect DNA structure of human leukocytes soon after the exposures, likely indicating that repairable DNA damage was not induced.

An accurate 3-D model for magnetic stimulation of the brain cortex.

We present a 3-D model for the simulation of a realistic clinical situation during magnetic stimulation. The electromagnetic problem is solved by reconstructing the inhomogeneous head tissues from magnetic resonance images and associating relative values of conductivity to each tissue. Application of Maxwell's equations in the integral form leads to an equivalent 3-D electrical network, whose solution gives the current density distribution in the brain. The high spatial resolution and rigorous electromagnetic approach make this model an accurate and useful tool for stimulator design and for estimating the efficiency and safety of this clinical methodology.