BackgroundChronic kidney disease (CKD) is an emerging worldwide problem. The lack of attention paid to kidney disease is well known and has been described in previous publications. However, little is known about the magnitude of the problem in highly specialized hospitals where serum creatinine values are used to estimate GFR values.MethodsWe performed a cross-sectional evaluation of hospitalized adult patients who were admitted to the medical or surgical department of Santa Maria della Misericordia Hospital in 2007. Information regarding admissions was derived from a database. Our goal was to assess the prevalence of CKD (defined as an estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) and detection of CKD using diagnostic codes (Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]). To reduce the impact of acute renal failure on the study, the last eGFR obtained during hospitalization was the value used for analysis, and intensive care and nephrology unit admissions were excluded. We also excluded patients who had ICD-9-CM codes for renal replacement therapy, acute renal failure, and contrast administration listed as discharge diagnoses.ResultsOf the 18,412 patients included in the study, 4,748 (25.8%) had reduced eGFRs, falling into the category of Kidney Disease Outcomes Quality Initiative (KDOQI) stage 3 (or higher) CKD. However, the diagnosis of CKD was only reported in 19% of these patients (904/4,748). It is therefore evident that there was a "gray area" corresponding to stage 3 CKD (eGFR 30-59 ml/min), in which most CKD diagnoses are missed. The ICD-9 code sensitivity for detecting CKD was significantly higher in patients with diabetes, hypertension, and cardiovascular disease (26.8%, 22.2%, and 23.7%, respectively) than in subjects without diabetes, hypertension, or cardiovascular disease (p < 0.001), but these values are low when the widely described relationship between such comorbidities and CKD is considered.ConclusionAlthough CKD was common in this patient population at a large inpatient regional hospital, the low rates of CKD detection emphasize the primary role nephrologists must play in continued medical education, and the need for ongoing efforts to train physicians (particularly primary care providers) regarding eGFR interpretation and systematic screening for CKD in high-risk patients (i.e., the elderly, diabetics, hypertensives, and patients with CV disease).
Introduzione: La somministrazione di farmaci per via endovenosa è uno degli interventi infermieristici più frequenti nella cura quotidiana. Si stima, infatti, che circa il 80% dei pazienti richiede qualche forma di terapia endovenosa. Obiettivo: Lo scopo di questo studio è testare un dispositivo per l’infusione a gravità con nuove caratteristiche: una membrana filtrante idrofila che mantiene il deflussore completamente riempito di liquido, fermando l’aria in caso svuotamento della camera di gocciolamento e un cappuccio protettivo rivestito con un membrana idrofoba, posizionata sul raccordo Luer Lock, che impedisce la fuoriuscita di liquidi e protegge contro la contaminazione. Materiali e Metodi: Una valutazione comparativa tra i due dispositivi di infusione di gravità (Intrafix® Safeset vs dispositivo di infusione standard) è stato condotto con un questionario ad hoc composto da 16 items. 100 infermieri provenienti da 14 diverse aree (medico, chirurgica e specialistica) di un ospedale universitario italiano sono stati arruolati come tester. Risultati: Il nuovo dispositivo ha ricevuto una valutazione positiva statisticamente significativo per ciascuno degli endpoint primari di prova: facilità d’uso, sicurezza del paziente e dell’operatore e risparmio di tempo. Discussione: Un dispositivo di infusione gravità , che incorpora un sistema di bloccaggio di ingresso aria e di fuoriuscita di liquidi dalla tubo di infusione può garantire una maggiore sicurezza degli operatori e pazienti e risparmiare il tempo assistenziale.
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