Apparent limitations of OECD TG 431 for classification of acrylic- and methacrylic-based adhesives

For years, the strive for in vitro methods for toxicological assessment suitable to replace animal studies gained progressive importance. OECD Test Guideline (TG) 431 was implemented in 2004, allowing to circumvent animal testing according to OECD TG 404 while reliably predicting skin corrosion potential of many substances and products. However, non-animal assays often show protocol-dependent limitations, that complicate or even prevent the testing of several groups of substances. In this study, the suitability of the OECD TG 431 for assessment of the skin corrosion potential of known acidic, thus often skin corrosive or irritating acrylic and methacrylic acid-based adhesives and monomers, was investigated. The commercially available Phenion® Open Source Reconstructed Epidermis (OS-REp) model, developed at Henkel & Co. KGaA, was used. The EpiDerm™ prediction model was considered most applicable to the Phenion® OS-REp model. All Proficiency Substances listed in OECD TG 431, amongst them six acids, were correctly classified and subcategorized as Skin Corr. 1 A or 1B/C corrosives. The OS-REp model was shown to be suitable for the assessment of skin corrosion potential in accordance with OECD TG 431. However, our results also indicate that acrylic and methacrylic monomer-based adhesives might fall outside the applicability domain of this guideline.

Improving Discharge Efficiency and Charge Containment on a Pediatric Acute Care Cardiology Unit

BACKGROUND

Hospital discharge delays can negatively affect patient flow and hospital charges. Our primary aim was to increase the percentage of acute care cardiology patients discharged within 2 hours of meeting standardized medically ready (MedR) discharge criteria. Secondary aims were to reduce length of stay (LOS) and lower hospital charges.

METHODS

A multidisciplinary team used quality improvement methods to implement and study MedR discharge criteria in our hospital electronic health record. The criteria were ordered on admission and modified on daily rounds. Bedside nurses documented the time when all MedR discharge criteria were met. A statistical process control chart measured interventions over time. Discharge before noon and 30-day readmissions were also tracked. Average LOS was examined, comparing the first 6 months of the intervention period to the last 6 months. Inpatient charges were reviewed for patients with >2 hours MedR discharge delay.

RESULTS

The mean percentage of patients discharged within 2 hours of meeting MedR discharge criteria increased from 20% to 78% over 22 months, with more patients discharged before noon (19%-32%). Median LOS decreased from 11 days (interquartile range: 6-21) to 10 days (interquartile range: 5-19) (P = .047), whereas 30-day readmission remained stable at 16.3%. A total of 265 delayed MedR discharges beyond 2 hours occurred. The sum of inpatient charges from care provided after meeting MedR criteria was $332 038 (average $1253 per delayed discharge).

CONCLUSIONS

Discharge timeliness in pediatric acute care cardiology patients can be improved by standardizing medical discharge criteria, which may shorten LOS and decrease medical charges.