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duminică, 5 august 2012

NIH's PRB Progesterone Therapy To Combat Infant Mortality Adopted By State Of Michigan

The Michigan Department of Community Health (MDCH) has unveiled the state's Infant Mortality Reduction Plan, a strategy that includes significant recommendations developed from medical research conducted by the Perinatology Research Branch (PRB) of the Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health (NICHD/NIH), at the Wayne State University School of Medicine.

Announced Aug. 1, the plan promotes the adoption of universal cervical length screening by ultrasound and the use of progesterone in women identified as high risk for premature birth. The use of progesterone in women with a short cervix can reduce the rate of preterm birth - the leading factor in infant mortality - by as much as 45 percent, according to research findings published by the PRB. The study, released last year, was conducted at more than 40 centers worldwide. Roberto Romero, M.D., branch chief of the PRB, was the principal investigator on behalf of NICHD/NIH. Wayne State was the lead center in the trial, led by Sonia Hassan, M.D., associate dean for maternal, perinatal and child health at WSU.

The ultrasound examination is simple to perform, painless and can be performed between the 19th and 24th weeks of pregnancy. Pregnant women with a cervix less than 20 millimeters are at very high risk for preterm delivery. If a woman is found to have a short cervix, she can be treated with vaginal progesterone. Treatment with vaginal progesterone reduced the rate of preterm birth, neonatal morbidity and respiratory distress syndrome. Women can self-administer a once-daily dose.

The recommendation that the state adopt the progesterone protocol was first introduced by Valerie M. Parisi, M.D., M.P.H., M.B.A., dean of the WSU School of Medicine, during the state's Call to Action to Reduce and Prevent Infant Mortality Summit in October 2011. The summit, convened by Gov. Rick Snyder to address the state's high rate of infant mortality, brought together hundreds of health care providers and stakeholders to develop recommendations to combat the problem.

"The strategies introduced by the state today will go a long way in dramatically reducing the state's infant mortality rate, which remains too high," Parisi said. "The key recommendations were developed through medical research conducted at the Perinatology Research Branch at Wayne State University, which demonstrates the branch's significant importance to the people of Michigan and the Detroit region."

The MDCH, headed by Director Olga Dazzo, said the strategies were selected because they reflect evidence-based practices that will reduce and prevent infant deaths.

While the 2010 state infant mortality rate set a new record low at 7.1 deaths per 1,000 live births, Michigan's rate remains higher than the national average of 6.1 deaths per 1,000 live births, according to the MDCH.

Premature birth is the leading cause of infant mortality in Michigan. The rate of premature birth increased more than 10 percent between 1998 and 2008. One of every eight babies born in Michigan - 295 in an average week - is born prematurely. And Michigan's rate of preterm birth (12.7 percent) exceeds the national average of 12.3 percent.

The new practices call for the state to partner with Wayne State University and the Detroit Medical Center to share progesterone therapy practices and develop protocol and implementation statewide. The state also will coordinate with the Medical Services Administration to assure benefit coverage for universal ultrasound screening of pregnant women and progesterone administration for Medicaid covered pregnancies.

"The implementation of universal cervical ultrasound screening for all pregnant women to identify women at risk for premature birth, and the use of vaginal progesterone, will be critical in the plan to reduce the rate of preterm birth and infant mortality," said Hassan.

Statewide universal ultrasound screening, Parisi said, would be cost effective if the scan costs no more than $186. With Michigan's 110,000 births annually, the potential cost savings would be $19,603,380 (in 2010 dollars) for every 100,000 women screened.

Premature births are costly. Nationally, preterm birth is a $26 billion annual problem. The CDC reports that preterm births topped the list of the most expensive hospitalizations in Michigan in 2007. Each premature birth in the state costs an average of $102,103 at the time of discharge from the hospital. That is 14 times the cost of a normal birth.

The state's other strategies include promoting the adoption of policies to eliminate medically unnecessary deliveries before the 39th week, promoting safe infant sleep practices to prevent suffocation, expanding home-visiting programs to support vulnerable women and infants, programs to reduce unintended pregnancies, and weaving social determinants of health into all its strategies to reduce racial and ethnic disparities in infant mortality.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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n.p. "NIH's PRB Progesterone Therapy To Combat Infant Mortality Adopted By State Of Michigan." Medical News Today. MediLexicon, Intl., 3 Aug. 2012. Web.
5 Aug. 2012. APA

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duminică, 11 decembrie 2011

Few Hospitals Aggressively Combat Catheter-Associated Urinary Tract Infections

Main Category: Urology / Nephrology
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 11 Dec 2011 - 0:00 PST

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Hospitals are working harder than ever to prevent hospital-acquired infections, but a nationwide survey shows few are aggressively combating the most common one - catheter-associated urinary tract infections.

In the survey by the University of Michigan Health System and the Veterans Affairs Ann Arbor Healthcare Center, as many as 90 percent of U.S. hospitals surveyed increased use of methods to prevent central line-associated bloodstream infections and ventilator-associated pneumonia, between 2005 and 2009.

But prevention practices for urinary tract infections were regularly used by only a minority of hospitals, according to the survey published online today ahead of print in the Journal of General Internal Medicine.

"Despite being the most common healthcare-associated infection in the country, hospitals appear not to be using as many practices for prevention when compared with bloodstream infections and ventilator-associated pneumonia," says senior author Sanjay Saint, M.D., M.P.H., director of the VA/UM Patient Safety Enhancement Program, and U-M professor of internal medicine.

Using reminders to remove the catheter, cleaning the insertion site and avoiding indwelling devices by using appropriate alternatives are all ways hospitals can reduce infection risk.

Still, each year, 5 to 10 percent of hospitalized patients get a hospital-acquired infection, resulting in about $45 billion in health care costs. But in 2008, Medicare stopped paying non-federal hospitals for the additional costs of treating infections which are considered preventable with the right care.

"The actual impact of the no-payment rule appears limited given the fact that hospitals not affected by the rule change, such as VA hospitals, also increased their use of infection practices," says lead study author Sarah L. Krein, Ph.D., R.N., a VA research scientist and U-M associate general medicine professor.

There are likely other factors such as the introduction of practice guidelines and infection prevention collaboratives that contributed as much, if not more, to the increased use of certain infection prevention practices, she says.

Catheter-associated urinary tract infection is one of the no-payment conditions "but until recently there were no large-scale educational efforts or prevention guidelines created for this type of infection," Krein says.

The study was funded by Blue Cross Blue Shield of Michigan Foundation.

Guidance is available from the VA Ann Arbor Health Services Research and Development for patients and hospitals on what practices to use to prevent catheter-associated urinary tract infections.

If a patient has a urinary catheter, what can they do to prevent infection? Ask your doctor or your nurse every day if your urinary catheter is still necessary. The sooner it is removed, the lower your risk of infection and the sooner you can increase your mobility. Make certain you know how to care for your urinary catheter and keep it clean. If you do not know how to do this, please ask your nurse or doctor. Wash where the catheter enters your body every day with soap and water. Clean your hands with soap and water or alcohol-based hand rub before and after touching your urinary catheter. The urine drainage bag from your urinary catheter should stay lower than your bladder (your bladder is just below your belly button) at all times to prevent the urine from flowing back up into your bladder. This helps to prevent infection. If you notice that your drainage bag is too high, tell your nurse. More details are available online at http://www.catheterout.org. Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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