JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Clinical Trial
Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective.
We prospectively studied the safety of replacing intravenous delivery systems, including those used in total parenteral nutrition, at 72- compared with 48-hour intervals in 487 patients. Although the prevalence of contamination of intravenous fluid was higher in administration sets replaced at 72-hour intervals (10/664, 1.5%) than in sets replaced every 48 hours (6/710, 0.8%), the difference is not statistically significant. ⋯ Contaminants were recovered less frequently from peripheral venous infusions (0.6%) than from infusions used for central venous access or hemodynamic monitoring (1.5%) or total parenteral nutrition (3.6%); infusions in an intensive care unit were more frequently contaminated (2.5%) than infusions on medical and surgical wards (0.9%). These data indicate that extrinsic contamination of intravenous fluid is a rare cause of endemic nosocomial septicemia, and for most infusions it is unnecessary to routinely replace delivery systems more frequently than every 72 hours.
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Delirium (acute confusional states), a common and often overlooked psychiatric disorder, can occur at any age, but elderly persons are especially prone to develop it. In later life, it is often a conspicuous feature of systemic or cerebral disease and drug (notably anticholinergic) toxicity, and it may constitute a grave prognostic sign. ⋯ Acute onset of a fluctuating level of awareness, accompanied by sleep-wake cycle disruption, lethargy or agitation, and nocturnal worsening of symptoms, are diagnostic. Early recognition of delirium and treatment of its underlying cause are essential.
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The relationship of cardiovascular disease (CVD) to the control of blood pressure (BP) and serum cholesterol levels was studied in 686 treated, middle-aged hypertensive men whose condition was followed up for 12 years. Both mean in-study BP (P less than .001) and serum cholesterol levels (P less than .001) were better predictors for CVD than the respective entry levels (both not significant) in multivariate analysis. ⋯ Analyses of CVD morbidity in relationship to changes in BP and serum cholesterol levels clearly showed that a combined reduction of both risk factors was necessary to achieve a substantial reduction in morbidity. These study findings indicate that (1) it may be unfavorable to reduce BP below a certain level in middle-aged hypertensive men; and (2) other risk factor interventions must be improved to improve the patient's prognosis.