Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department

Introduction C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality. Objective To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED. Methods Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010. Results From 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests. Discussion Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.

Canto Gregoriano: redutor de ansiedade de mães com filhos hospitalizados

OBJETIVO: Verificar a presença de alteração do estado de ansiedade das mães de crianças hospitalizadas com a audição de canto Gregoriano. MÉTODOS: Pesquisa descritiva, exploratória, correlacional com análise quantitativa, quase experimental. A coleta dos dados foi realizada no período de julho de 2009 a fevereiro de 2010. A amostra inicial foi de 71 mães e destas 28 concluíram todas as etapas da pesquisa. RESULTADOS: O uso do canto Gregoriano diminuiu o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária acomodadas em quartos individuais. CONCLUSÃO: É necessário investigar os possíveis efeitos do canto Gregoriano em outros ambientes do hospital e em outras formas de acomodação do cliente.