Treatment of acute renal failure in the intensive care unit: lower costs by intermittent dialysis than continuous venovenous hemodiafiltration

Intermittent and continuous renal replacement therapies (RRTs) are available for the treatment of acute renal failure (ARF) in the intensive care unit (ICU). Although at present there are no adequately powered survival studies, available data suggest that both methods are equal with respect to patient outcome. Therefore, cost comparison between techniques is important for selecting the modality. Expenditures were prospectively assessed as a secondary end point during a controlled, randomized trial comparing intermittent hemodialysis (IHD) with continuous venovenous hemodiafiltration (CVVHDF). The outcome of the primary end points of this trial, that is, ICU and in-hospital mortality, has been previously published. One hundred twenty-five patients from a Swiss university hospital ICU were randomized either to CVVHDF or IHD. Out of these, 42 (CVVHDF) and 34 (IHD) were available for cost analysis. Patients' characteristics, delivered dialysis dose, duration of stay in the ICU or hospital, mortality rates, and recovery of renal function were not different between the two groups. Detailed 24-h time and material consumption protocols were available for 369 (CVVHDF) and 195 (IHD) treatment days. The mean daily duration of CVVHDF was 19.5 +/- 3.2 h/day, resulting in total expenditures of Euro 436 +/- 21 (21% for human resources and 79% for technical devices). For IHD (mean 3.0 +/- 0.4 h/treatment), the costs were lower (Euro 268 +/- 26), with a larger proportion for human resources (45%). Nursing time spent for CVVHDF was 113 +/- 50 min, and 198 +/- 63 min per IHD treatment. Total costs for RRT in ICU patients with ARF were lower when treated with IHD than with CVVHDF, and have to be taken into account for the selection of the method of RRT in ARF on the ICU.

Sind die empirischen Ergebnisse zum Umweltverhalten Artefakte? Ein Beitrag zum Problem der Messung von Umweltverhalten

In Untersuchungen zum Umweltbewusstsein und Umweltverhalten werden die zentralen Variablen in der Regel auf der Basis von Selbstauskünften und mittels Itembatterien erhoben. Fraglich ist dabei, ob die Items zur Messung ökologischen Handelns mehr als nur \"symbolisches Verhalten\" erfassen. Bodenstein, Spiller und Elbers (1997) haben kürzlich einen Index vorgeschlagen, der sich am tatsächlichen Energie- und Materialverbrauch eines Haushalts orientiert. Wir vergleichen dieses Konzept mit anderen Skalen und untersuchen empirisch anhand der Daten des Surveys \"Umweltbewusstsein in Deutschland 1998\", in welchem Ausmaß die Ergebnisse von Regressionsmodellen des Umwelthandelns von den jeweils zugrunde gelegten Skalen abhängen. Es zeigt sich, dass gerade bezüglich der zentralen Determinanten \"Umweltbewusstsein\" und \"Einkommen\" beträchtliche Unterschiede bestehen.

Progress in Monitoring alcohol consumption and alcohhol abuse by phosphatidylethanol

For early diagnosis and therapy of alcohol-related disorders, alcohol biomarkers are highly valuable. Concerning specificity, indirect markers can be influenced by nonethanol-related factors, whereas direct markers are only formed after ethanol consumption. Sensitivity of the direct markers depends on cutoffs of analytical methods, material for analysis and plays an important role for their utilization in different fields of application. Until recently, the biomarker phosphatidylethanol has been used to differentiate between social drinking and alcohol abuse. After method optimization, the detection limit could be lowered and phosphatidylethanol became sensitive enough to even detect the consumption of low amounts of alcohol. This perspective gives a summary of most common alcohol biomarkers and summarizes new developments for monitoring alcohol consumption habits.