Eighteen years experience of granulocyte donations-acceptable donor safety?

BACKGROUND: Granulocyte transfusions are given to patients with life-threatening infections, refractory to treatment. The donors are stimulated with corticosteroids ± granulocyte colony stimulating factor (G-CSF). However, data regarding the donors' safety is sparse. The objective was therefore to evaluate short- and long-term adverse events (AE) in G-CSF stimulated donors. STUDY DESIGN AND METHODS: All consecutive granulocyte donors from 1994 to 2012 were identified through our registry. From the donation records, the number of aphereses, stimulation therapy, AE, blood values post donation, and recent status were evaluated. RESULTS: One hundred fifty-four volunteer donors were mobilized for 359 collections. Age at first granulocyte donation was 43 years (median; range 19-64 years). Follow-up was 60 months (median; range 0-229 months). The dose of G-CSF per collection was 3.8 ug/kg body weight (median; range 1.6-6.0 ug/kg). Sedimentation agent was HES. Short-term AE were mild. Blood values 4 weeks post donation with minor reductions/elevations mostly resolved in later donations. Fourteen donors were excluded from the registry due to hypertension (4), diabetes (2), atrial flutter (1), breast carcinoma (1), urethral carcinoma in situ (1), MGUS (1), thrombosis (1), anaphylaxis (1), primary biliary cirrhosis (1), and unknown (1). Three donors are deceased due to diabetes, acute myocardial infarction, and unknown cause. All excluded/deceased donors except one were excluded/died at least 6 months after first granulocyte donation. CONCLUSION: No serious short-term AE were observed. Due to the variability of diagnoses among excluded/deceased donors, we propose that it is less likely that granulocyte donations have a causative impact on these donors' exclusion or death.

A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure.

BACKGROUND: The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome. METHODS: The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 µmol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement. RESULTS: At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium × phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1. CONCLUSIONS: However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.

Strategies in caring for women with postpartum psychosis--an interview study with psychiatric nurses.

AIM AND OBJECTIVE: The aim of this study was to explore strategies in caring for women with postpartum psychosis used by nurses. BACKGROUND: The most serious type of psychiatric illness in connection with childbirth is postpartum psychosis. Nearly two in 1000 newly delivered women are stricken by postpartum psychosis. Most of these patients need psychiatric care to recover. While earlier studies point to the need for psychiatric care, knowledge of specific nursing strategies in caring for postpartum psychosis patients remains limited. METHODS: Interviews with 10 experienced psychiatric nurses were carried out, transcribed verbatim and an inductive content analysis was made. RESULT: The main strategies for care found in this study were: (i) To create a patient-nurse relationship and (ii) To apply nursing therapeutic interventions. Presence, continuity and nurse-patient partnership contributed to create a relationship and incorporate the rest of the care team. To satisfy the patients' basic needs and feeling of security was the foundation of the nursing therapeutic interventions. Confirmation and giving hope were also used as nursing therapeutics as well as information to the patient and her relatives about her illness. CONCLUSION: The conclusion of the study is that strategies used by nurses are a combination of general and psychiatric nursing approaches but the specificity in caring knowledge for caring patients with postpartum psychosis requires further development. RELEVANCE TO CLINICAL PRACTICE: The result of the study indicates that it is important to organize patient care for postpartum psychosis with continuity and consistency and to support the nurse to create a relationship and therapeutic intervention with the patient. The present study shows the importance of further developing specific nursing theories that can be applied when caring for patients with postpartum psychosis. It also shows the need for further pedagogical education for mental health nurses.

Marine protected areas in the eastern African Region: how successful are they?

This article reviews the governance and management of Marine Protected Areas (MPAs), and the coral reefs they contain, in the eastern African Region. This includes the Comoros, Kenya, Madagascar, Mauritius, Mozambique, Tanzania, and the Seychelles. Three generations or categories of MPAs are distinguished: i) small areas for protection of a single species or unique marine habitat; iii) large multiple use MPAs designed for coastal development as well as biodiversity protection; and iii) MPAs managed by a nongovernmental organization (NGO) or the private sector. Each of these MPA types is examined according to the policies, legislation, and management systems they entail as well as the economic and community situation they operate within. The paper also provides a review of some eastern African MPAs in terms of their size and location, the type of MPA, zonation schemes, and financial status. The successes of the different types of MPAs are discussed based on specific indicators, such as changes in biodiversity, infrastructure, compliance to regulations and the level of involvement of primary stakeholders in the management. From the review it is clear that a fourth generation of MPAs may be forthcoming; community-based MPAs. Although lack of data makes it difficult to assess the effectiveness of these different categories of MPAs, it is clear that no MPA can succeed without support of the local communities. Generally, the results of the analysis are promising for MPAs, however a lack of data is hampering a deeper analysis. The major issues facing MPAs in the region are highlighted, as well as some regional initiatives striving to address these issues. A number of recommendations are made, aiming to strengthen the establishment and management of MPAs in the eastern African region.