509 Use of a burn sepsis screening protocol results in lower antibiotic usage rates

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
Charles W Jastram ◽  
Jeffrey E Carter ◽  
Sarah Bilbe ◽  
Catherine Vu ◽  
Herb A Phelan
Keyword(s):  
Insulin Requirement ◽  
Antibiotic Usage ◽  
Beta Lactam ◽  
Screening Protocol ◽  
Group A ◽  
Group B ◽  
Sepsis Screening ◽  
Post Hoc ◽  
Future Work ◽  
Usage Rates

Abstract Introduction Antibiotic stewardship is widely recognized as being a necessary component of modern hospital care but remains difficult to put into practice particularly on burn services where the risk of infection is known to be higher than the general hospital population. Our burn service instituted a protocol for sepsis screening triggers and antibiotic usage, becoming the only unit in our hospital to do so. In-house quality metrics have shown this protocol to be successful in reducing utilization. Methods With the opening of our burn unit in April 2018, a burn sepsis screening protocol was put in place (see accompanying image). Briefly, the first level of screening consists of threshold hemodynamic and physiologic parameters. If these are met the pathway leads to drawing of basic laboratory tests plus lactate and procalcitonin. Group A findings consist of either Serum Lactic Acid >2.2mmol/Lor Procalcitonin >0.69ng/ml, and Group B findings consist of: Platelets < 100,000/mmorGlucose >150 mg/dL or New Insulin Requirement. If one finding from each of groups A and B are present, antibiotics are started, and a source work up is initiated. De-identified aggregate data on antibiotic usage are routinely tracked as a quality metric by our hospital’s Infection Control Committee. The results from calendar year 2019 are presented here for all antibiotics, vancomycin usage, and beta-lactam usage. One-way Analysis of Variance with Tukey’s post-hoc testing was used to analyze the differences in intravenous antibiotic usage rates between the Burn Intensive Care Unit (BICU), the Trauma ICU (TICU), and the remainder of the hospital. Results The BICU used significantly fewer IV antibiotics than the TICU across all examined parameters and fewer than the remainder of the hospital for all antibiotics and vancomycin usage. Data is presented as antibiotic days/1000 patient days. Conclusions Initiation of a formal protocol for sepsis screening and IV antibiotic initiation significantly lowers antibiotic utilization. Future work will focus on this protocol’s impact on clinical outcomes.

scholarly journals Effect of Delayed Light-Curing Through a Zirconia Disc on Microhardness and Fracture Toughness of Two Types of Dual-Cure Cement

2019 ◽  
Author(s):  
Pouran Samimi ◽  
Sara Kaveh ◽  
Maryam Khoroushi
Keyword(s):  
Fracture Toughness ◽  
Delay Group ◽  
Fracture Toughness Test ◽  
Irradiation Group ◽  
Significant Difference ◽  
Group A ◽  
Light Curing ◽  
Group B ◽  
Post Hoc ◽  
Group D

Objectives: Photopolymerization immediately sets dual-cure cements and prevents the continuation of chemical polymerization. Delayed light-curing allows the chemical process to continue up to the point before starting irradiation; however, there is a controversy in this respect. The present study evaluates the effect of delayed light-curing through a zirconia disc on the microhardness and fracture toughness (KIC) of two types of dual-cure cement. Materials and Methods: Samples measuring 25×5×3 mm3 were prepared for fracture toughness test, and discs measuring 5 mm in diameter and 3 mm in thickness were prepared for microhardness test using Bifix and BisCem cements. Light-curing protocols were as follows: immediate light-curing (group A), a 2-minute delay (group B), a 5-minute delay (group C), direct irradiation (group D), and no irradiation (group E). In groups A to C, light-curing was carried out through a zirconia disc. Data were analyzed by two-way and one-way analysis of variance (ANOVA), post-hoc Tukey's test, and Kruskal-Wallis test at 95% confidence interval. Results: There was a significant difference in the microhardness of the cements (P=0.00). Delayed light-curing had no effect on microhardness (P=0.080). The microhardness of BisCem in group E was significantly lower than that in group D (P=0.015). The fracture toughness of Bifix in groups B and C was significantly different than that in group E and BisCem groups. Conclusions: Under the limitations of our study, delayed light-curing had different effects on microhardness and fracture toughness. Differences in light-curing protocols resulted in different effects based on the cement type. Light-curing is recommended to achieve optimal mechanical properties.

scholarly journals Antibiotic usage rates in bacterial versus nonbacterial diseases: a new way to monitor hospital-acquired infections in children: a retrospective case analysis

2020 ◽  
Vol 7 (11) ◽  
pp. 2176
Author(s):  
Jayendra R. Gohil ◽  
Chintu C. Chaudary ◽  
Sheena D. Sivanandan
Keyword(s):  
Antibiotic Usage ◽  
Retrospective Case ◽  
Hospital Acquired Infections ◽  
Group A ◽  
Added Benefit ◽  
Reduction Of Mortality ◽  
Group B ◽  
The Cost ◽  
Hospital Acquired ◽  
Selection Of

Background: While treating children, the selection of antibiotics, when indicated, should be from the point of its effectiveness, safety, suitability, and cost. However, this flow of action does not take place in all cases. Aim of the study was to assess the antibiotic usage in admitted children and mortality.Methods: The case records between January to July 2012 in children wards was evaluated for the use of antibiotics. Patients were grouped into; group A- ‘must use' antibiotic in all, and group B- where antibiotics are not indicated.Results: There were 1852 admissions, including 719 Thalassemia cases. Antibiotic usage was 63% in 1133 cases after excluding thalassemia. Out of 1133 cases, 423 were in group A and 710 cases were in group B. In group B the antibiotic usage was 41%. The mortality was 6.6% and 4.8% in group A and B. Inside group B, mortality was 5.9% versus 4.0% in those administered versus not administered, antibiotics.Conclusions: There was no increase in mortality in patients in whom antibiotics were not prescribed, and no added benefit of prescribing antibiotics was observed in nonbacterial group B disease patients. The mortality was similar in both the groups. In nonbacterial group B, the antibiotics did not offer any advantage in the reduction of mortality, but increased the cost of the treatment, and possibly the chance of development of drug resistance and adverse events. When analysing the hospital antibiotic usage, only the nonbacterial diseases should be considered to get a true picture of the inappropriate prescription of antibiotics.

Effect Of Citrullus Lanatus Juice On Hemoglobin, Red Blood Cells And Liver Enzyme; An Experimental Study

2019 ◽  
Vol 09 (04) ◽  
pp. 257-260
Author(s):  
Shahid Ali ◽  
Nuzhat Sultana ◽  
Muslim Abbas ◽  
Zareen Naz ◽  
Muhammad Akbar Hassan ◽  
...  
Keyword(s):  
Experimental Study ◽  
Red Blood Cells ◽  
Liver Enzyme ◽  
Blood Cells ◽  
Citrullus Lanatus ◽  
Treated Group ◽  
Control Group ◽  
Group A ◽  
Group B ◽  
Post Hoc

Objective: To determine effect of citrullus lanatus juice on hemoglobin and Serum Glutamic Pyruvic Transaminase (SGPT) level. Study design and setting: It was an experimental study conducted on healthy rabbits for sixty days in the research department of pharmacy University of Karachi. Methodology: Current study was planned to evaluate effect of Citrullus lanatus juice on red blood cells, hemoglobin and liver enzyme. 60 days study was performed at 2 different doses i.e 3and 6ml/kg on rabbits. These rabbits were from either gender and were divided into 3 groups their weight ranges from 1200 to 1800 grams. Group A is control group (Normal saline 6ml/kg), Group B is treated group (3 ml/kg), Group C is treated group (6ml/kg). After taking mean of all values they are compared with control group. Significance of mean can be estimated by Tukes Post Hoc Test. P<0.05 estimated as significant. Results: It was found that count of red blood cells rises significantly along with rise in hemoglobin level. As far as liver enzyme serum glutamate pyruvate transaminase (SGPT) was concerned its concentration decreases slightly. Conclusion: Citrullus lanatus juice contain ingredients which are important for RBC hemoglobin and synthesis .It also contains important antioxidants that have organoprotective role due to which SGPT level decreases even in healthy animals as compared to control groups

Young Children’s Divergent Movement Ability: Study II

1994 ◽  
Vol 13 (3) ◽  
pp. 228-241 ◽  
Author(s):  
Frances E. Cleland
Keyword(s):  
Critical Thinking ◽  
Treatment Group ◽  
Physical Education ◽  
Teaching Styles ◽  
Movement Experience ◽  
Scheffe Test ◽  
Movement Ability ◽  
Group A ◽  
Group B ◽  
Post Hoc

Young children’s (N = 50) divergent movement ability (DMA), which is one aspect of critical thinking in physical education, was examined in this study. Treatment Group A received 20 physical education lessons based on skill themes using indirect teaching styles (n = 16). Twenty lessons based on low-organized games content using direct teaching styles were provided to Treatment Group B (n = 17). No treatment was provided to the control subjects in Group C (n = 17). No significant DMA pretest differences were determined, and the independent variables (i.e., gender, intelligence, creativity, and background of movement experience) examined were not significantly related to subjects’ pretest DMA. A two-way ANOVA and post hoc Scheffe test revealed that Group A’s posttest DMA scores were significantly higher than those for either Group B or Group C, F(2, 47) = 11.7, p < .0001. Young children’s ability to generate different movement patterns (i.e., DMA), therefore, was significantly improved in response to employing critical thinking strategies in physical education.

scholarly journals The Effect of Bone Marrow Mesenchymal Stem Cells Application on Distracted Bone Quality during Rapid Rate of Distraction Osteogenesis

2018 ◽  
Vol 11 (3) ◽  
pp. 192-198
Author(s):  
Marwa El Kassaby ◽  
Khaled Abd El Kader ◽  
Nahed Khamis ◽  
Alaa Al Hammoud ◽  
Alaa Ben Talb ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Bone Quality ◽  
Distraction Osteogenesis ◽  
Rapid Rate ◽  
Marrow Mesenchymal Stem Cells ◽  
Group A ◽  
Group B ◽  
Post Hoc ◽  
Group D

Distraction osteogenesis (DO) bone regenerate usually suffers from an inferior quality especially with rapid rate. This study was conducted to investigate the effect of mesenchymal stem cells (MSCs) application on different rates of distraction bone quality. Twenty-four goats were divided into group A with standard DO and group B with rapid distraction osteogenesis (RDO) both aided by MSCs. Group C with standard DO and group (D) with RDO were controls. Kruskal–Wallis test and Conover's post hoc analysis was used to evaluate significance ( p = 0.05). Histomorphometry showed a strongly significant (SS) increase ( p = 0.00036) in trabecular bone (TB) in group A (TB = 174.7 μm, SD = 33.5) and group B (TB = 166.8 μm, SD = 14) compared with group C (TB = 115.4 μm, SD = 19.6) and group D (TB = 86.1 μm, SD = 9.3). There was SS decrease ( p = 0.00093) in osteoid percentage (OP) in group A (OP = 13.4%, SD = 2) and group B (OP = 11.5%, SD = 6.5) compared with group C (OP = 27.3, SD = 3.5) and group D (OP = 26.2%, SD = 2.6). Energy dispersive X-ray showed a nonsignificant increase ( p = 0.11) in calcification (Ca2+%) in group A (Ca2+% = 17.6%, SD = 4.9) and group B (Ca2+% = 17.6%, SD = 4.3) compared with group C (Ca2+ % = 14.2%, SD = 6.7) and group D (Ca2+% = 11.5%, SD = 2.4). MSCs application improved microscopic bone quality during standard DO and RDO. However, macroscopic bone quality improvement still needs further investigation.

scholarly journals Erosive potential of three different commonly used pediatric syrups on deciduous teeth enamel: an in vitro study

2020 ◽  
Vol 7 (10) ◽  
pp. 2041
Author(s):  
Neha Thilak ◽  
Sundeep K. Hedge ◽  
Sham S. Bhat
Keyword(s):  
In Vitro Study ◽  
Titratable Acidity ◽  
Deciduous Teeth ◽  
Hardness Tester ◽  
Titrable Acidity ◽  
Group A ◽  
Group B ◽  
Post Hoc ◽  
Group D

Background: The aim of the study is to compare the erosive potential of three different commonly used pediatric syrups on deciduous teeth enamel. The objectives of the study were to assess the endogeneous pH and titratable acidity of mefenamic acid syrup (meftal P), cetrizine syrup (alerid) and multivitamin syrup (zincovit) and to evaluate the microhardness of the enamel after successive immersion cycles in each of the syrups.Methods: 40 non carious deciduous teeth were included for the study The samples were then randomly allocated into 4 groups (10 in each group): Group A- mefenemic acid syrup (meftal P), Group B- cetrizine syrup (alerid), group C- multivitamin syrup (zincovit) and group D- control (distilled water). The samples were then subjected to the immersion cycles in the syrups. Assessment of enamel surface microhardness was done using Vickers hardness tester at 7th day and 14th day. The pH and titrable acidity of the syrups were also assessed. One way analysis of variance (ANOVA) and post hoc tests were used for the statistical analysis.Results: Out of the test groups, group C showed the lowest pH of around 4.2 and exhibited the largest titrable acidity (22.8 ml) compared with 21 ml in group A and 15.5 ml in group B. At the end of 14th day, group A had microhardness of about 293.43.84±6.34, group B had 299.930±6.85, group C had 313.380±6.23 and group D had 334.190±5.51.Conclusions: All the pediatric liquid medications assessed in the study, meftal P, alerid and zincovit showed acidic pH, high titrable acidities and all the syrups showed loss of microhardness after exposure to the syrups for 14 days. Loss of microhardness was highest for meftal P followed by alerid and least for zincovit.

scholarly journals Combining 10% propolis with carbonated hydroxyapatite to observe the RANKL expression in a rabbit’s alveolar bone

2020 ◽  
Vol 53 (4) ◽  
pp. 212
Author(s):  
Nungky Devitaningtyas ◽  
Ahmad Syaify ◽  
Dahlia Herawati
Keyword(s):  
Bone Regeneration ◽  
Alveolar Bone ◽  
Rankl Expression ◽  
Carbonated Hydroxyapatite ◽  
Treatment Groups ◽  
Group A ◽  
Group B ◽  
Post Hoc ◽  
Regenerative Periodontal Treatment ◽  
Open Flap Debridement

Background: Periodontitis causes an increased receptor activator level in the nuclear factor-κβ ligand (RANKL), which is one of the inflammatory mediators that plays a role in osteoclastogenesis. The open flap debridement (OFD) technique is the preferred treatment when accompanied by regenerative periodontal treatment using guided tissue regeneration (GTR) and guided bone regeneration (GBR). Carbonated hydroxyapatite is a GBR material that serves as a scaffold and has strong osteoconductive properties for bone regeneration. Propolis is natural product that can decrease osteoclastogenesis in periodontitis by decreasing the RANKL expression. Purpose: To investigate the RANKL expression after open flap debridement by applying carbonated hydroxyapatite to 10% propolis in the alveolar bone of rabbits. Methods: Nine induced-periodontitis rabbits (Oryctolagus cuniculus) were divided into three treatment groups of Group A OFD, Group B OFD followed by the application of carbonated hydroxyapatite, and Group C OFD followed by application of 10% propolis-carbonated hydroxyapatite. Each group was selected one to euthanised on the seventh, 14th and 28th day, respectively, and prepared using histology slides. The data was analysed using a two-way ANOVA followed by a post-hoc LSD test (p<0.05). Results: The RANKL expression in each group showed significant differences (p=0.00; p<0.05) on the seventh, 14th and 28th day. The post-hoc LSD test showed that the RANKL expression in the treatment group with carbonated hydroxyapatite-10% propolis had significant differences (p<0.05) in the intergroup analysis at different time points. Conclusion: Combining 10% propolis with carbonated hydroxyapatite in OFD treatment can decrease the RANKL expression in a rabbit’s alveolar bone.

scholarly journals SUPERSTITIOUS BEHAVIOR AMONG JUDO, TAEKWONDO AND BOXING PLAYERS

2016 ◽  
Vol 20 (2) ◽  
pp. 50-59
Author(s):  
Dureja Gaurav ◽  
Singh Gagandeep
Keyword(s):  
Sampling Technique ◽  
College Level ◽  
Mean Values ◽  
Superstitious Behavior ◽  
Group A ◽  
The Mean ◽  
Level Of Significance ◽  
Group B ◽  
Post Hoc ◽  
Affiliated Colleges

Purpose: The present study was designed to measure superstitious behavior among Judo, Taekwondo and Boxing players. Material: Thirty (N=30) male inter-college level players with the age group of 19-25 years were selected through purposive sampling technique to act as subjects from affiliated colleges of Panjab University, Chandigarh. They were further divided into three groups: Group-A [Judo (n=10)], Group-B [Taekwondo (n=10)] and Group-C [Boxing (n=10)]. One Way Analysis of Variance (ANOVA) was applied to find out the differences among judo, taekwondo and boxing players. Where F values found significant, Least Significant Differences (LSD) Post-hoc test was applied to find out the direction and degree of difference. Results: The level of significance was set at 0.05. The result revealed significant differences among judo, taekwondo and boxing players on the sub parameters: clothing and appearance, preparation, team ritual and coach. However, no significant differences have been observed on the sub-parameters fetish, game/competition, prayer and parameter superstitious (Total). Conclusions: The obtained results showed significant differences on the sub-parameter Coach among Judo, Taekwondo and Boxing players. While calculating the mean values of entire groups, it has been observed that Boxing players demonstrate significantly better on the sub-parameter Coach. Therefore, it can be ascertained that Boxing players are more confident that coach bring a lucky charm to our game.

Effects of perioperative enteral EPA-enriched immunonutrition on meaningful loss of lean body mass after total gastrectomy for gastric cancer: Post hoc analysis of a phase III study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 85-85
Author(s):  
Takaki Yoshikawa ◽  
Naoki Hiki ◽  
Kentaro Sakamaki ◽  
Seiji Ito ◽  
Kazumasa Fujitani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Enteral Nutrition ◽  
Total Gastrectomy ◽  
Phase Iii ◽  
Standard Diet ◽  
Group A ◽  
Phase Iii Study ◽  
Group B ◽  
Post Hoc

85 Background: Total gastrectomy for gastric cancer significantly reduces body weight, especially lean body mass (LBM), through surgical stress and decrease of the calorie intake. Eicosapentaenoic acid (EPA)-enriched enteral nutrition (EPA-EN) could modulate immune function and limits catabolism. In our phase III study to compare perioperative standard diet with or without EPA-EN, additional EPA-EN did not contribute to prevent weight loss or LBM. Recently, 5% or more LBM loss after surgery was reported to impair compliance of post-operative S-1 adjuvant chemotherapy. This post hoc study explored whether additional EPA-EN prevented meaningful loss of LBM for compliance of adjuvant chemotherapy after surgery. Methods: Key entry criteria of this phase III study was (1) histologically proven adenocarcinoma of the stomach, (2) clinical T1-T4a and M0, (3) R0 resection is possible by total gastrectomy, (4) sufficient oral intake, and (5) sufficient organ function. The patients were randomized to Group A: no supplementation with oral nutrients (standard diet) or Group B: standard diet with oral supplementation of ProSure including 600 kcal with 2.2 g EPA for 7 days before surgery and for 21 days after surgery. For both groups, patients underwent total gastrectomy with Roux-en Y reconstruction. Results: A total of 127 patients (Group A: 63, Group B: 64) were enrolled in the study. All background factors were well balanced between the both groups. Median relative performance of supplement in group B was 100% before surgery and 54% after surgery. 5% or more LBM loss at 1 month after surgery was observed in 44 patients (80.0%) in group A and in 37 patients (67.3%) in group B (p = 0.194), while that at 3 months after surgery was found in 51 patients (91.1%) in group A and in 43 patients (76.8%) in group B (p = 0.070). Conclusions: Perioperative standard diet with EPA-enriched enteral nutrition tended to prevent meaningful loss of LBM after total gastrectomy. Further analysis is required whether perioperative EPA enriched EN improve compliance of S-1 adjuvant chemotherapy after total gastrectomy. Clinical trial information: UMIN000006380.

The Role of Xylitol Gum Chewing in Restoring Postoperative Bowel Activity After Cesarean Section

2015 ◽  
Vol 18 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Jian Tao Lee ◽  
Mei-Hui Hsieh ◽  
Po-Jen Cheng ◽  
Jr-Rung Lin
Keyword(s):  
Cesarean Section ◽  
Chewing Gum ◽  
Control Group ◽  
Bowel Sounds ◽  
Gum Chewing ◽  
Group A ◽  
The Times ◽  
Group B ◽  
Post Hoc

Aims: The goal of this study was to evaluate the effects of xylitol gum chewing on gastrointestinal recovery after cesarean section. Methods: Women who underwent cesarean section ( N = 120) were randomly allocated into Group A (xylitol gum), Group B (nonxylitol gum), or the control group (no chewing gum). Every 2 hr post-cesarean section and until first flatus, Groups A and B received two pellets of chewing gum and were asked to chew for 15 min. The times to first bowel sounds, first flatus, and first defecation were then compared among the three groups. Results: Group A had the shortest mean time to first bowel sounds (6.9 ± 1.7 hr), followed by Group B (8 ± 1.6 hr) and the control group (12.8 ± 2.5 hr; one-way analysis of variance, p < .001; Scheffe’s post hoc comparisons, p < .05). The gum-chewing groups demonstrated a faster return of flatus than the control group did ( p < .001), but the time to flatus did not differ significantly between the gum-chewing groups. Additionally, the differences in the time to first defecation were not significant. Conclusion: After cesarean section, chewing gum increased participants’ return of bowel activity, as measured by the appearance of bowel sounds and the passage of flatus. In this context, xylitol-containing gum may be superior to xylitol-free gum.

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