AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration fo...AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.展开更多
Objective To explore the effective therapy for deficiency syndrome in the maintenance hemodialysis patients of end-stage renal disease. Methods Ninety-seven maintenance hemodialysis patients of end-stage renal disease...Objective To explore the effective therapy for deficiency syndrome in the maintenance hemodialysis patients of end-stage renal disease. Methods Ninety-seven maintenance hemodialysis patients of end-stage renal disease were divided into an observation group （51 cases） and a control group （46 cases） randomly, and routine western medicines were used in both groups. On this base, moxibustion was given at Zusanli （足三里 ST 36） and Sanyijiao （三阴交 SP 6） with a paper-tube-moxibustion equipment in the observation group. The therapeutic effects on syndromes were evaluated by comparing the symptom scores in two groups before and after treatment. Results After treatment, all the symptom scores in the observation group were improved significantly （all P〈0.05）, with fatigue and weakness, short breath and aversion to talking, poor appetite, lassitude in loin and knees, aversion to cold, cool extremities and so on most obviously improved, and the total effective rate on the syndrome in observation group （64.7%, 33/51） was significantly higher than that in control group （23.9%, 11/46）, with a significant difference between the two groups （P〈0.05）. Conclusion Moxibustion can improve the clinical symptoms of maintenance hemodialysis patients of end-stage renal disease, and it has some therapeutic effect on the deficiency syndrome.展开更多
文摘AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.
基金Supported by the second lot TCM superior diseases clinical research items of China Academy of Chinese Medical Sciences: CACMS07Y0019
文摘Objective To explore the effective therapy for deficiency syndrome in the maintenance hemodialysis patients of end-stage renal disease. Methods Ninety-seven maintenance hemodialysis patients of end-stage renal disease were divided into an observation group （51 cases） and a control group （46 cases） randomly, and routine western medicines were used in both groups. On this base, moxibustion was given at Zusanli （足三里 ST 36） and Sanyijiao （三阴交 SP 6） with a paper-tube-moxibustion equipment in the observation group. The therapeutic effects on syndromes were evaluated by comparing the symptom scores in two groups before and after treatment. Results After treatment, all the symptom scores in the observation group were improved significantly （all P〈0.05）, with fatigue and weakness, short breath and aversion to talking, poor appetite, lassitude in loin and knees, aversion to cold, cool extremities and so on most obviously improved, and the total effective rate on the syndrome in observation group （64.7%, 33/51） was significantly higher than that in control group （23.9%, 11/46）, with a significant difference between the two groups （P〈0.05）. Conclusion Moxibustion can improve the clinical symptoms of maintenance hemodialysis patients of end-stage renal disease, and it has some therapeutic effect on the deficiency syndrome.
