For Debate: Personalized Health Care: As Exemplified by Home Sodium Measurements in a Child with Central Diabetes Insipidus and Impaired Thirst Perception.

BACKGROUND: We describe a 6-year old boy with central diabetes insipidus (CDI) caused by destruction of the pituitary gland due to treatment of an optical pathway glioma. He has been treated with chemotherapy and has had several debulking operations over the past years and consequently developed central hypocortisolism, hypothyroidism and CDI. The treatment of CDI was gravely complicated by an impaired thirst perception and compulsive drinking behavior. He was frequently seen at the ER or admitted due to dysregulation of fluid balance. METHODS: In order to provide better self-reliance, home point of care testing (POCT) sodium measurement was introduced. RESULTS: Realizing POCT sodium measurement resulted in a significant decrease of ER visits and clinical admissions due to dysregulation of fluid balance. CONCLUSION: This case is an example of personalized health care and has led to better self-reliance and quality of life.

Strategies to reduce wastage of red blood cell units.

BACKGROUND AND OBJECTIVES: Wastage of red blood cell units (RBCs) due to their inappropriate storage at the clinical ward has become both a financial and ethical challenge in the daily hospital practice. This study was aimed at identifying the extent of RBC wastage and evaluating the effects of various interventions in reducing this wastage. MATERIALS AND METHODS: From January 2011 to March 2011, baseline wastage level was evaluated using temperature-sensitive labels. Following this initial analysis, various interventions were implemented, including modifying the transfusion practice, intensifying training of and communication with the medical staff and improving the transport conditions. The impact of these interventions on wastage was measured during two periods, and results were compared with baseline wastage level. RESULTS: Based on the extent of label colouring, 7·5% of the units dispensed by the transfusion laboratory were determined as non-reusable at baseline. After implementation of the various interventions, wastage decreased to 1% of the units dispensed, potentially leading to an annual saving for our hospital of approximately €208·000/$230·600 on the total number of RBCs dispensed. CONCLUSION: Relative straightforward interventions, such as raising awareness among medical staff and particularly improving transport conditions, had a clear impact on the level of RBC wastage, accommodating the financial issue not to waste public money as well as the ethical issue that RBC wastage should be as low as possible.