SUMMARY Factor VIII-containing materials were administered to four severely affected haemophiliacs twice weekly in doses calculated to raise the factor VIII level to either 15 % or 30 % of average normal. The pooled results from those patients with statistically similar baseline bleeding frequencies showed a significant reduction in bleeding frequency on both doses in the first 48 hours. The 30 % dose produced a more significant reduction than the 15 % dose in the first 24 hours, but there was no significant difference between the two doses in the second 24 hours. It appears that to reduce the bleeding frequency of severely affected haemophiliacs by 60 % would require a two-and-ahalf-fold increase in therapeutic materials. A 90 % reduction would need nine times the amount of material currently in use.There have been great advances in the management of haemophiliac bleeds over the past decade but little attention has been paid to their prevention. Conflicting results have been reported in the trials of prophylaxis (Robinson et al., 1967;Nilsson et al., 1970;Ramsay and Parker, 1973). This may have been due in part to the several sources of potential observer and patient bias inherent in any attempt to evaulate such a regime. A double-blind controlled trial of prophylactic treatment has been carried out at the Treloar Haemophilia Centre (Aronstam et al., 1976) where personnel facilities and geographic considerations permit the separation of clinical management and trial administration. The weekly administration of factor VIII-containing material calculated to raise the factor VIII level to 0-25 IU/ml (25% of average normal) reduced the overall bleeding frequency in nine severe haemophiliacs by 15%. Analysis of the results on each individual day after a prophylactic dose showed a two-thirds reduction of bleeding frequency over the first two and one-third days. It was calculated that a two-and-a-half-fold increase in therapeutic materials would be needed to achieve this substantial reduction in bleeding frequency.In view of the implications for the limited financial and human resources available to service such a commitment, it is important to confirm these findings and to establish the lowest dose which might be "Present address:
Introduction Antimicrobial resistance is increasing globally. Surgical inpatients are more likely to receive inappropriately broad-spectrum and prolonged antimicrobial treatment, against local policy. Electronic prescribing (e-prescribing) has the potential to promote antimicrobial stewardship. We conducted a closed-loop audit to assess the impact of e-prescribing on surgical inpatient prescriptions. Method Audit standards (from Public Health England) included: (1) documentation of allergy status, prescriber contact information, antimicrobial indication and review/stop dates; and (2) prescription of appropriate antimicrobials for appropriate durations (IV and total). Prospective data collection occurred over 1-week. The interventions included an educational session, a once weekly microbiology round of surgical inpatients and the introduction of e-prescribing (Cerner©). Results Compliance improved significantly between cycle 1 (n = 54 prescriptions) and 2 (n = 59 prescriptions), for: documentation of prescriber contact details (69 vs 100%) and appropriate antimicrobial review/stop dates (17 vs 100%), indications (78 vs 96%), selection (76 vs 90%) and IV and total antibiotic duration (63 vs 93% and 87 vs 100%, respectively); p < 0.05 throughout. Conclusions Audit compliance improved significantly, partly because Cerner© prompts clinicians to input contact details, review dates and indications before prescribing. E-prescribing in combination with appropriate education is likely to promote antimicrobial stewardship and should be considered by other Trusts using paper prescriptions.
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