scholarly journals Treating infections caused by carbapenemase-producing Enterobacterales (CPE): a pragmatic approach to antimicrobial stewardship on behalf of the UKCPA Pharmacy Infection Network (PIN)

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Stephen Hughes ◽  
Mark Gilchrist ◽  
Katie Heard ◽  
Ryan Hamilton ◽  
Jacqueline Sneddon
Keyword(s):  
Treatment Options ◽  
Antimicrobial Treatment ◽  
Individual Treatment ◽  
Evidence Based ◽  
Invasive Infection ◽  
Invasive Infections ◽  
Therapeutic Recommendations ◽  
National Expert ◽  
The Uk ◽  
Universal Treatment

Abstract The emergence of carbapenemase-producing Enterobacterales (CPE) as a major cause of invasive infection both within the UK and internationally poses a very real concern for all providers of healthcare. The burden of morbidity and mortality associated with CPE infections is well described. The need for early, targeted, effective and safe antimicrobial therapy remains key for the management of these infected patients yet reliable antimicrobial treatment options remain scarce. In the absence of a universal treatment for these CPE invasive infections, individual treatment options tailored to susceptibilities and severity of infection are required. This working group from within the UK Clinical Pharmacy Association (UKCPA) Pharmacy Infection Network has developed evidence-based treatment recommendations to support infection specialists in managing these complex infections. A systematic review of peer-reviewed research was performed and analysed. We report consensus recommendations for the management of CPE-associated infections. The national expert panel makes therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, dosing, dosage adjustment and monitoring of parameters for novel and established antimicrobial therapies with CPE activity. This manuscript provides the infection specialist with pragmatic and evidence-based options for the management of CPE infections.

scholarly journals Antimicrobial treatment of Acinetobacter neuii invasive infections: A systematic review

Praxis medica ◽  
2020 ◽  
Vol 49 (3-4) ◽  
pp. 25-32
Author(s):  
Milica Milentijević ◽  
Nataša Katanić ◽  
Jelena Aritonović-Pribaković ◽  
Aleksandar Kočović ◽  
Jovana Milosavljević ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Case Series ◽  
Pleural Empyema ◽  
Antimicrobial Treatment ◽  
Invasive Infection ◽  
Primary Case ◽  
Pathogenic Potential ◽  
Cochrane Database ◽  
Invasive Infections

Aims: The objectives of this study were to find out whether and to what extent Actinomyces neuii is pathogenic to humans in terms of causing invasive infections and to ascertain the most appropriate and effective antibiotic therapy against this bacterium. Material and method: This study was designed as a systematic review article. MEDLINE, Google Scholar, SCIndex, Cochrane database of published clinical trials - Central and Clinicaltrials.gov databases were systematically searched for primary case reports or case series describing invasive infection with Actinomyces neuii. Results: A literature search identified 23 studies that met the inclusion criteria, describing cases of patients with an invasive infection caused by Actinomyces neuii. It was found that A. neuii could cause endocarditis, endophthalmitis, osteomyelitis, pleural empyema, soft tissue abscesses, neonatal sepsis, ventriculoperitoneal shunt infections and periprosthetic tissue infections. The most prescribed antibiotics for the treatment of Actinomyces neuii infections were amoxicillin and vancomycin (n = 10; 12.3%), followed by penicillin (n =9; 11.1%), gentamicin (n = 6; 7.4%), ampicillin (n = 5; 6.2%) and ceftazidime (n = 4; 4.9%). Antibiotic treatment of infections caused by A. neuii was followed by clinical improvement or complete cure of all patients, with no recorded deaths. Conclusion: A. neuii has a relevant pathogenic potential to cause invasive infections of various organs and tissues, especially in immunocompromised individuals of any age. For the treatment of mild infections caused by this bacterium, the antibiotics of choice are penicillin or amoxicillin, while vancomycin should be used to treat severe infections caused by Actinomyces neuii.

scholarly journals Brief Behavioural Activation (Brief BA) for Adolescent Depression: A Pilot Study

2017 ◽  
Vol 46 (2) ◽  
pp. 182-194 ◽  
Author(s):  
Laura Pass ◽  
Carl W. Lejuez ◽  
Shirley Reynolds
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Young People ◽  
Adolescent Depression ◽  
Psychological Intervention ◽  
Clinical Effectiveness ◽  
Evidence Based ◽  
Behavioural Activation ◽  
Evidence Based Treatments ◽  
The Uk

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence-based psychological treatments is limited, and training and employing therapists to deliver these is expensive. Brief behavioural activation for the treatment of depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Method: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered eight sessions of Brief BA followed by a review around one month later. Self- and parent-reported routine outcome measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre–post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals.

Men's perception and understanding of male-factor infertility in the UK

2021 ◽  
Vol 30 (9) ◽  
pp. S8-S16
Author(s):  
Eleanor L Stevenson ◽  
Cheng Ching-Yu ◽  
Chang Chia-Hao ◽  
Kevin R McEleny
Keyword(s):  
Public Health ◽  
Emotional Support ◽  
Health Professionals ◽  
Male Fertility ◽  
Public Knowledge ◽  
Evidence Based ◽  
Male Factor Infertility ◽  
Male Factor ◽  
The Public ◽  
The Uk

Male-factor infertility is a common but stigmatised issue, and men often do not receive the emotional support and the information they need. This study sought to understand awareness of male fertility issues compared to female fertility among the UK general male public, and also what were perceived as being the optimum methods for providing support for affected men, emotionally and through information. Men feel that male infertility is not discussed by the public as much as female infertility. Lifestyle issues that affect male fertility are not well understood, and men affected by infertility desire more support, including online, from health professionals and through peer support. Health professionals, including those in public health, could offer evidence-based programmes to reduce stigma and increase public knowledge about infertility, as well as offer emotional support to men with infertility problems.

scholarly journals Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Hasselberg ◽  
K. H. Holgersen ◽  
G. M. Uverud ◽  
J. Siqveland ◽  
B. Lloyd-Evans ◽  
...  
Keyword(s):  
Mental Health ◽  
Multidisciplinary Teams ◽  
Evidence Based ◽  
Crisis Resolution ◽  
Health Crisis ◽  
The Core ◽  
Crisis Resolution Teams ◽  
Fidelity Scale ◽  
The Uk ◽  
Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

scholarly journals COVID-19: Before the Fall, An Evidence-Based Narrative Review of Treatment Options

2021 ◽  
Author(s):  
Nicholas Rebold ◽  
Dana Holger ◽  
Sara Alosaimy ◽  
Taylor Morrisette ◽  
Michael Rybak
Keyword(s):  
Treatment Options ◽  
Narrative Review ◽  
Evidence Based

scholarly journals 855. Significance of Invasive Infections due to Methicillin Sensitive Staphylococcus aureus in the neonatal population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S468-S468
Author(s):  
Mariawy Riollano ◽  
Deena Altman ◽  
shanna kowalsky ◽  
Stephanie Pan
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Characteristics ◽  
Invasive Disease ◽  
Control Measures ◽  
Invasive Infection ◽  
Single Center ◽  
Infection Control Measures ◽  
Invasive Infections ◽  
Mrsa Colonization ◽  
Neonatal Population

Abstract Background Staphylococcus aureus is a well-known cause of hospital acquired infections. Methicillin resistant staphylococcus aureus (MRSA) colonization is a recognized risk factor for invasive infections. The neonatal population in the intensive care unit (NICU) is particularly vulnerable to these types of infections, resulting in high mortality and morbidity. However, only scant data is available to establish the risk for invasive disease in patients with Methicillin sensitive staphylococcus aureus (MSSA). As a result, surveillance and prevention strategies are only address for MRSA colonization. Here, we describe the clinical characteristics of S. aureus colonized patients identified in late 2018 during transmission events in a single center NICU. As a result of the targeted surveillance investigation for MRSA infection control measures, S. aureus colonization was stratified, and we were able to compare the differences in invasive disease between MRSA and MSSA. Methods This is a retrospective chart review of the 47 colonized patients identified during October 2018- January 2019 SA transmission events in single center NICU. Risk factors, clinical characteristics, and the hospital course of these cases, including the proportion of invasive illness were reviewed. Results We found that most clinical characteristic, risk factors, and hospital course were the same between MRSA and MSSA colonized infants (p values > 0.05). Additionally, there was no difference in the proportion of invasive infection between MRSA and MSSA colonized patients (p value > 0.05). The type of invasive infections identified were SSTI, bacteremia, and osteomyelitis. Conclusion The proportion of invasive infection was the same in MSSA and MRSA colonized patients. This data provides us with supportive material for future recommendations of infection control measures for MSSA colonized patients. Disclosures All Authors: No reported disclosures

scholarly journals Comprehensive physiotherapy management in covid-19 – a narrative review

2020 ◽  
Vol 30 (1) ◽  
pp. 38030 ◽  
Author(s):  
Deivendran Kalirathinam ◽  
Raj Guruchandran ◽  
Prabhakar Subramani
Keyword(s):  
Narrative Review ◽  
World Health ◽  
Evidence Based ◽  
The United Kingdom ◽  
Global Pandemic ◽  
Related Quality ◽  
Health Related ◽  
Novel Coronavirus ◽  
Health Organization ◽  
The Uk

The 2019 novel coronavirus officially named as coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization, has spread to more than 180 countries. The ongoing global pandemic of severe acute respiratory syndrome coronavirus, which causes COVID-19, spread to the United Kingdom (UK) in January 2020. Transmission within the UK was confirmed in February, leading to an epidemic with a rapid increase in cases in March. As on April 25- 2020, there have been 148,377 confirmed cases of COVID-19 in the UK and 20,319 people with confirmed infection have died. Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy and community rehabilitation of COVID-19 patients has recently been identified as an essential therapeutic tool and has become a crucial evidence-based component in the management of these patients. This comprehensive narrative review aims to describe recent progress in the application of physiotherapy management in COVID 19 patients. Assessment and evidence- based treatment of these patients should include prevention, reduction of adverse consequences in immobilization, and long-term impairment sequelae. A variety of techniques and modalities of early physiotherapy in intensive care unit are suggested by clinical research. They should be applied according to the stage of the disease, comorbidities, and patient’s level of cooperation.

scholarly journals Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1864-1870 ◽  
Author(s):  
Dan M Dorobantu ◽  
Alireza S Mahani ◽  
Mansour T A Sharabiani ◽  
Ragini Pandey ◽  
Gianni D Angelini ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Primary Repair ◽  
Treatment Options ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Young Infants ◽  
Using Data ◽  
The Uk

ObjectivesTreatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study.MethodsThis a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated.ResultsPatients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05 vs PrR, HR=7.2, P=0.001 vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3 vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2 versus PrR, P=0.09).ConclusionsWe found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure.

scholarly journals Do Guidelines for the Diagnosis and Monitoring of Diabetes Mellitus Fulfill the Criteria of Evidence-Based Guideline Development?

2008 ◽  
Vol 54 (11) ◽  
pp. 1872-1882 ◽  
Author(s):  
Eva Nagy ◽  
Joseph Watine ◽  
Peter S Bunting ◽  
Rita Onody ◽  
Wytze P Oosterhuis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Methodological Quality ◽  
Guideline Development ◽  
Evidence Based ◽  
Test Results ◽  
Time Period ◽  
Therapeutic Guidelines ◽  
Therapeutic Recommendations ◽  
Evidence Based Guideline

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

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