644 Improving VTE Prophylaxis in Spinal Patients – a Closed Loop Audit

Aim

Venous thromboembolism (VTE) prophylaxis is one of the key components of safe patient care and can be particularly challenging when it concerns spinal admissions to the orthopaedic trauma ward. The first cycle of our closed loop audit aimed to assess the safety of VTE prescribing in spinal admissions at a district general hospital. The current cycle aims to evaluate guideline compliance following our interventions.

Method

Quality of VTE prophylaxis prescribing was measured against NICE (NG89) recommendations as well as local guidelines. Patients were identified based on prospectively maintained admission lists. The initial audit cycle was presented locally, and the following measures were introduced in order to improve prescribing: staff teaching sessions, nomination of a VTE guardian, inclusion of VTE plans in op-notes, publication of a dedicated spinal guideline and addition of a spinal section into the trust principal VTE guideline. The current audit cycle identified 22 spinal admissions.

Results

Out of the 22 patients, only one (4%) received inadequate VTE prophylaxis which is a significant improvement compared to the initial data (8 cases - 18%). Minor prescribing concerns were noted in three cases (14%) versus 15 cases (34%) in the first cycle. Overall, the re-audit proved that following departmental interventions the majority of patients received appropriate VTE prophylaxis with no prescribing or documentation errors (82% in the current cycle vs 48% initially).

Conclusions

We have demonstrated that significant improvement in VTE prophylaxis prescribing can be achieved by the means of educating staff and introducing simple and cost-effective measures.

Seroprevalences of antibodies against ToRCH infectious pathogens in women of childbearing age residing in Brazil, Mexico, Germany, Poland, Turkey and China

Determination of antibodies against ToRCH antigens at the beginning of pregnancy allows assessment of both the maternal immune status and the risks to an adverse pregnancy outcome. Age-standardised seroprevalences were determined in sera from 1009 women of childbearing age residing in Mexico, Brazil, Germany, Poland, Turkey or China using a multiparametric immunoblot containing antigen substrates for antibodies against Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex viruses (HSV-1, HSV-2), Bordetella pertussis, Chlamydia trachomatis, parvovirus B19, Treponema pallidum and varicella zoster virus (VZV). Seroprevalences for antibodies against HSV-1 were >90% in samples from Brazil and Turkey, whereas the other four countries showed lower mean age-adjusted seroprevalences (range: 62.5-87.9%). Samples from Brazilian women showed elevated seroprevalences of antibodies against HSV-2 (40.1%), C. trachomatis (46.8%) and B. pertussis (56.6%) compared to the other five countries. Seroprevalences of anti-T. gondii antibodies (0.5%) and anti-parvovirus B19 antibodies (7.5%) were low in samples from Chinese women, compared to the other five countries. Samples from German women revealed a low age-standardised seroprevalence of anti-CMV antibodies (28.8%) compared to the other five countries. These global differences in immune status of women in childbearing age advocate country-specific prophylaxis strategies to avoid infection with ToRCH pathogens.

Polymorphisms of the humanPUMILIO2 gene and male sterility

The highly conserved Pumilio protein plays crucial roles in fertility of many organisms acting as a repressor of translation, and causing infertility when mutated. Although one of two human Pumilio homologs, PUMILIO2 is expressed mainly in the germ line, its role in mammalian germ cell development has not been reported yet. To shed light on the role of PUMILIO2 in development of the human male germ line, we screened this gene for mutations in 137 patients presenting a variety of phenotypes with spermatogenic failure. The first variant, we identified was a single base substitution within intron 15 (IVS15 + 6G > A). This variant was found in three azoospermic males, the second allele being the wild type. However, this variant was also present among fertile males, as frequently as in the patients. Although location of IVS15 + 6G > A substitution in close proximity to the canonical donor splice site GT, indicates that its influence on splicing cannot be excluded, our preliminary cDNA analysis has not revealed evidence of a splicing abnormality of PUMILIO2 pre-mRNA carrying this variant. Nevertheless, this study provides new interesting variant containing a donor splice site variant, which can be relevant for understanding of splicing mechanism of mammalian genes. The second variant, c.774 C > T transversion (Y258Y) in exon 6 was found only in one patient, but an influence on PUMILIO2 function is not obvious. Altogether, this study shows that variation in the PUMILIO2 gene is very low and it seems improbable that mutations of this gene significantly contribute to male infertility in humans.