scholarly journals Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Akane Takamatsu ◽  
Kenta Yao ◽  
Shutaro Murakami ◽  
Yasuaki Tagashira ◽  
Shinya Hasegawa ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Control Study ◽  
Tertiary Care ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

Abstract Background Postprescription review and feedback (PPRF) is one of the most common strategies in antimicrobial stewardship program (ASP) intervention. However, disagreements between the prescribers and ASP personnel can occur. The aim of the present study was to identify the factors associated with nonadherence to PPRF intervention. Methods The present retrospective nested case-control study was performed at a tertiary care center, which has been conducting a once-weekly PPRF for carbapenems and piperacillin/tazobactam since 2014. Nonadherence to ASP recommendations was defined as the failure of the primary care team to modify or stop antimicrobial therapy 72 hours after the issuance of PPRF recommendations. Factors associated with nonadherence to PPRF intervention were identified using multivariate logistic regression analysis. Results In total, 2466 instances of PPRF in 1714 cases between April 2014 and September 2019 were found. The nonadherence rate was 5.9%, and 44 cases were found in which carbapenems or piperacillin/tazobactam continued to be used against PPRF recommendations. Factors associated with nonadherence to PPRF recommendations were a previous history of hospitalization within 90 days (adjusted odds ratio [aOR], 2.62; 95% confidence interval [CI], 1.18–5.81) and a rapidly fatal McCabe score at the time of PPRF intervention (aOR, 2.87; 95% CI, 1.18–6.98). A review of the narrative comments in the electronic medical records indicated that common reasons for nonadherence were “the patient was sick” (n = 12; 27.3%) and “the antimicrobial seemed to be clinically effective” (n = 9; 20.5%). Conclusions Nonadherence to PPRF recommendations was relatively uncommon at the study institution. However, patients with a severe disease condition frequently continued to receive broad-spectrum antimicrobials against PPRF recommendations. Understanding physicians’ cognitive process in nonadherence to ASP recommendations and ASP interventions targeting medical subspecialties caring for severely ill patients is needed to improve ASP.

scholarly journals Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case–control study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001867
Author(s):  
Hao-Guang Li ◽  
Dan-Min Wang ◽  
Feng-Cai Shen ◽  
Shu-Xin Huang ◽  
Zhi-Duo Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Axial Spondyloarthritis ◽  
Disease Onset ◽  
Case Control ◽  
Buttock Pain ◽  
Juvenile Onset ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectiveTo evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS).MethodsA nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS.ResultsOverall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS.ConclusionPeripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.

scholarly journals Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Huseyin Bilgin ◽  
Murat Haliloglu ◽  
Ali Yaman ◽  
Pinar Ay ◽  
Beliz Bilgili ◽  
...  
Keyword(s):  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Pentraxin 3 ◽  
Surgical Intensive Care ◽  
Nested Case Control ◽  
Control Study

Purpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p<0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

scholarly journals Risk of neurodegenerative dementia in asthma patients: a nested case–control study using a national sample cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030227 ◽  
Author(s):  
So Young Kim ◽  
Chanyang Min ◽  
Dong Jun Oh ◽  
Hyo Geun Choi
Keyword(s):  
Case Control Study ◽  
Previous History ◽  
National Sample ◽  
Case Control ◽  
Region Of Residence ◽  
Neurodegenerative Dementia ◽  
Icd 10 ◽  
History Of ◽  
Nested Case Control ◽  
Control Study

ObjectivesThis study investigated the risk of neurodegenerative dementia following asthma.DesignA nested case–control studySettingThe ≥60-year-old population was selected from the Korean Health Insurance Review and Assessment Service – National Sample Cohort from 2002 to 2013.Participants and interventionsThe 11 442 dementia cases were matched with 45 768 control cases for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Asthma was classified using International Classification of Disease-10 (ICD-10) codes (J45 and J46) and medication history. Dementia was identified based on ICD-10 codes (G30 and F00).Primary and secondary outcome measuresThe ORs of a previous history of asthma in patients with dementia were analysed using conditional logistic regression analysis stratified for age, sex, income, region of residence, hypertension, diabetes and dyslipidaemia. Subgroup analysis was performed according to age and sex.ResultsOverall, 22.6% (2587/11 442) and 22.3% (10 229/45 768) of the cases in the dementia and control groups, respectively, had a previous history of asthma. The OR for asthma in the dementia group was not higher than that in the control group (adjusted OR=0.97, 95% CI 0.92 to 1.02, p=0.207). All age and sex subgroups demonstrated consistent results.ConclusionsAsthma was not related to an increased risk of dementia.

scholarly journals Type D Personality and Myocardial Infarction: A Case-Control Study

2020 ◽  
pp. 025371762094715
Author(s):  
MT Manoj ◽  
KA Joseph ◽  
Govindan Vijayaraghavan
Keyword(s):  
Myocardial Infarction ◽  
Case Control Study ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Developed Countries ◽  
Case Control ◽  
Type D Personality ◽  
Care Hospital ◽  
Type D ◽  
Control Study

Background: Coronary heart disease (CHD) is an impending global pandemic in developed countries as well as developing countries and economies in transition, such as India. A significant increase in the incidence of myocardial infarction (MI), one of the most common types of CHD, is being reported in India, and the incidence and severity of the disease are more among the youth in Kerala. Studies assessing the association between psychological factors and MI are few in India. Methods: We adopted a case-control study design. A total of 150 cases (with MI) and 150 controls (without MI and matched for age and gender) from a tertiary care hospital in Trivandrum, Kerala, India, were selected using convenient sampling method, between September 2016 and August 2017. Results: As compared to 33.3% of the controls, 50.7% of patients with MI had type D personality characteristics. Multivariate logistic regression analysis after adjusting for the confounders indicated a positive and statistically significant association between type D personality and MI: OR = 4.14, 95% CI = 2.19–8.85, P = 0.003. Conclusion: Type D personality is associated with MI.

scholarly journals Epilepsy and mortality: a retrospective cohort analysis with a nested case–control study identifying causes and risk factors from primary care and linkage-derived data

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052841
Author(s):  
Gabriella Wojewodka ◽  
Martin C Gulliford ◽  
Mark Ashworth ◽  
Mark P Richardson ◽  
Leone Ridsdale
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
General Population ◽  
Cause Of Death ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectivesPeople with epilepsy (PWE) have a higher mortality rate than the general population. Epilepsy-related deaths have increased despite all-cause mortality decreasing in the general population pre-COVID-19. We hypothesised that clinical and lifestyle factors may identify people more at risk.DesignWe used a retrospective cohort study to explore cause of death and a nested case–control study to identify risk factors.SettingWe explored factors associated with mortality using primary care population data from 1 April 2004 to 31 March 2014. Data were obtained from the Clinical Practice Research Datalink which compiles anonymised patient data from primary care in the UK. Cause of death data was supplemented from the Office of National Statistics when available.ParticipantsThe analysis included 70 431 PWE, with 11 241 registered deaths.ResultsThe number of deaths within the database increased by 69% between the first and last year of the study. Epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35. Factors associated with increased risk of death included attendance at emergency departments and/or emergency admissions (OR 3.48, 95% CI 3.19 to 3.80), antiepileptic drug (AED) polytherapy (2 AEDs: OR 1.60, 95% CI 1.51 to 1.71; 3 AEDs: OR 2.06, 95% CI 1.86 to 2.29; 4+AEDs: OR 2.62, 95% CI 2.23 to 3.08), status epilepticus (OR 2.78, 95% CI 1.64 to 4.71), depression (OR 1.67, 95% CI 1.57 to 1.76) and injuries (OR 1.54, 95% CI 1.43 to 1.67). No seizures in the prior year (OR 0.52, 95% CI 0.41 to 0.65).ConclusionOur results add to existing evidence that deaths in epilepsy are increasing. Future studies could focus on identifying PWE at high risk and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority as epilepsy may be a factor in close to half of deaths of PWE under 35 years of age.

scholarly journals Factors associated with neonatal near-miss in selected hospitals of Gamo and Gofa zones, southern Ethiopia: nested case-control study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abera Mersha ◽  
Agegnehu Bante ◽  
Shitaye Shibiru
Keyword(s):  
Antenatal Care ◽  
Case Control Study ◽  
Case Control ◽  
Near Miss ◽  
Southern Ethiopia ◽  
Factors Affecting ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study ◽  
Neonatal Near Miss

Abstract Background To scale up a comprehensive way of implementation to reduce neonatal mortality evaluation of factors for neonatal near-miss cases is very important. Certain studies were done in assessing near-miss cases, but they failed in identifying the proximate factors affecting profoundly. So, this study is to fill those gaps in the aforementioned studies, in assessing the factors affecting neonatal near-miss cases. Methods A nested case-control study was conducted in selected three Hospitals of Gamo and Gofa Zones, Southern Ethiopia from April 5, 2018, to March 5, 2019. The structured standard tool was used to identify neonatal near-miss cases. Data were entered into Epi data version 3.1 and exported to Stata version 15 for analysis. A conditional logistic regression model was used to identify factors associated with near-miss cases. The goodness of fit was tested by a log-likelihood ratio (LR). In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 121 neonatal near-miss cases, and 363 controls were involved. The identified factors that affect neonatal near-miss were multiparty (AOR = 3.81, 95%CI: 1.72, 8.42), antenatal care follow up (AOR = 0.02, 95%CI: 0.01, 0.05), premature rupture of membrane (AOR = 3.40, 95%CI: 1.53, 7.55), non-vertex presentation (AOR = 2.83, 95%CI: 1.44, 5.58), and cesarean delivery (AOR = 4.89, 95%CI: 2.34, 10.24). Conclusions Those identified factors are better should be intervened. Strengthening antenatal care services by providing appropriate information for the mother and counseling about the consequences of multiparty and providing information on family planning. There is a need to identify, screen and critical follow high-risk mothers and give immediate and appropriate intervention as early as possible.

scholarly journals Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study

2007 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan J Jimenez Rivera ◽  
Jose L Iribarren ◽  
Jose M Raya ◽  
Ibrahim Nassar ◽  
Leonardo Lorente ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Case Control Study ◽  
Case Control ◽  
Excessive Bleeding ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study
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