Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature

ABSTRACT Updated information on the epidemiology of candidemia, particularly during severe socioeconomic events, is important for proper management of these infections. A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of the recent financial crisis (2009 to 2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibilities, and drug consumption. The average annual incidence of 429 candidemic episodes was 2.03/10,000 bed days, with 9.88 in adult intensive care units (ICUs), 1.74 in surgical wards, and 1.81 in internal medicine wards, where a significant increase was observed (1.15, 1.85, and 2.23/10,000 bed days in 2009 to 2011, 2012 to 2014, and 2015 to 2018, respectively; P = 0.004). Candida albicans was the most common species (41%), followed by Candida parapsilosis species complex [SC] (37%), Candida glabrata SC (11%), Candida tropicalis (7%), Candida krusei (1%), and other rare Candida spp. (3%). Mixed infections were found in 20/429 (4.7%) cases, while 33 (7%) cases were due to non-Candida spp. Overall, 44/311 (14%) isolates were resistant/non-wild type (WT) to the nine antifungals tested, with 23/113 (20%) C. parapsilosis SC and 2/34 (6%) C. glabrata SC isolates being resistant to fluconazole (1 panechinocandin and 2 panazole resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished (P = 0.02), with a mean of 17.93 defined daily doses (DDD)/100 bed days, increased micafungin use was correlated with the rise in C. parapsilosis SC (P = 0.04). A significant increase of candidemia in internal medicine wards and of C. parapsilosis SC infections was found during the years of financial crisis. Although resistance rates remain low (<14%), fluconazole-resistant C. parapsilosis SC and multidrug-resistant C. glabrata SC isolates are of major concern.

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Assessing the sustainable nature of housing-related taxation receipts: the case of Ireland

Journal of European Real Estate Research ◽

10.1108/jerer-01-2016-0004 ◽

2016 ◽

Vol 9 (2) ◽

pp. 193-214 ◽

Cited By ~ 1

Author(s):

Diarmaid Addison Smyth ◽

Kieran McQuinn

Keyword(s):

Financial Crisis ◽

Housing Market ◽

Extended Period ◽

Market Regulation ◽

Content Type ◽

Public Finances ◽

Financial Market Regulation ◽

The Public ◽

Recent Financial Crisis ◽

Run Up

Purpose The Irish fiscal position was significantly affected by the recent financial crisis. Budgetary surpluses quickly gave way to significant deficits post 2007, culminating into a lengthy excessive deficit procedure and entry into a formal EU/IMF assistance programme in 2010. Much of the deterioration in the public finances was caused by a sharp decline in property-related taxes because the Irish housing market rapidly contracted. In this paper, the authors quantify the extent to which disequilibria in the housing market can affect the tax take, finding significant implications over an extended period. Design/methodology/approach The authors attempt to quantify the extent of housing-related tax windfall gains and losses in Ireland over a 30-year period as a result of disequilibrium in the housing market. This involves a three-step modelling approach where we relate property-dependent taxes to the housing market while estimating equilibrium in the latter before solving for the tax take consistent with that equilibrium. In so doing, the authors find that the fiscal position compatible with equilibrium in the housing market has at times diverged greatly from actual outturns. Findings This paper confirms the significant role played by the housing market in influencing both the tax-take and the overall fiscal position. The authors find that there have been a number of instances where excesses in the housing market have spilled over into fiscal aggregates, notably in the housing bubble period between 2003 and 2008. However, with the on-going adjustments in the housing market, it would appear that prices and volumes have overcorrected in recent years. Overall, much greater emphasis should be given to the role of the housing market in forecasting key taxation aggregates. Originality/value The recent crisis highlighted how domestic policy mistakes (both in terms of budgetary planning and financial market regulation) can greatly amplify economic shocks. Irish budgetary policy in the run up to the financial crisis of 2008/2009 was clearly based on unsustainable levels of housing-related tax receipts. This paper highlights the need for a much more granular approach in framing tax forecasts and in assessing the public finances by more explicitly factoring in housing market developments.

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The effect of financial crisis on auditor conservatism: US evidence

Accounting Research Journal ◽

10.1108/arj-06-2013-0033 ◽

2015 ◽

Vol 28 (2) ◽

pp. 160-171 ◽

Cited By ~ 3

Author(s):

Joseph Beams ◽

Yun-Chia Yan

Keyword(s):

Financial Crisis ◽

Design Methodology ◽

Environmental Changes ◽

Accounting Firms ◽

Content Type ◽

Going Concern ◽

Big 4 ◽

Distressed Firms ◽

Recent Financial Crisis ◽

Auditor Conservatism

Purpose – This paper aims to examine the effect that the recent financial crisis had on auditor conservatism in the form of increased going-concern opinions. Design/methodology/approach – This study uses a sample of US’ distressed firms from 2005 to 2011 to test the change in going-concern opinions issued. This paper uses a logistic regression model to control for other predictors of going-concern opinions to determine when the financial crisis led to an increase in auditor conservatism. Findings – The authors find that auditors became more conservative in the form of issuing higher levels of going-concern opinions even after controlling for other predictors of going-concern opinions. This increased conservatism was present in both Big 4 and non-Big 4 accounting firms. The increased conservatism quickly returned to normal levels when the financial crisis eased. Originality/value – These findings add to the literature on the effects of environmental changes on audit opinions. Additionally, this study finds a difference in the timing of the reaction by large and small accounting firms, but, overall, it finds consistency in that both increased conservatism during the crisis and quickly returned to normal afterward.

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Development of an Intravenous-to-Oral Route Conversion Program for Antimicrobial Therapy at a Canadian Tertiary Care Health Facility

Annals of Pharmacotherapy ◽

10.1177/106002809703100507 ◽

1997 ◽

Vol 31 (5) ◽

pp. 564-570 ◽

Cited By ~ 16

Author(s):

Monique T Zamin ◽

Monique M Pitre ◽

John M Conly

Keyword(s):

Internal Medicine ◽

Oral Therapy ◽

Respiratory Tract Infections ◽

Tertiary Care ◽

Soft Tissue Infections ◽

Intravenous Therapy ◽

General Internal ◽

Care Health ◽

Internal Medicine Wards ◽

Tract Infections

OBJECTIVE: To describe the effect of introducing a route conversion program on the prescribing of antimicrobials for the treatment of respiratory tract infections and skin/soft tissue infections in a sample population. DESIGN: Concurrent, pre- and postintervention study. SETTING: Four general internal medicine wards at The Toronto Hospital, a 1170-bed, tertiary care health center in Toronto, Ontario, Canada. PARTICIPANTS: Patients receiving antimicrobial therapy for respiratory tract infections and skin/soft tissue infections. INTERVENTION: Written guidelines and education sessions were presented to residents, interns, medical students, and pharmacists responsible for the care of patients admitted to four general internal medicine wards. MAIN OUTCOME MEASURES: Clinical and laboratory parameters related to the status of the infection were monitored prospectively and compared with the course of drug therapy, with consideration of the patient's ability to meet the criteria established in the guidelines. The number of days of intravenous therapy prescribed despite appropriateness of oral therapy was tallied. RESULTS: Twenty-seven patients (28 infections) were identified for inclusion in the 7-week preliminary audit, and 30 patients (32 infections) were included in the audit after the program, which continued for 5 weeks. Following implementation of the program, the number of days that intravenous therapy was continued despite the appropriateness of oral therapy was reduced from 41% to 26% of the total days of intravenous therapy prescribed. CONCLUSIONS: The program had a positive influence on antimicrobial prescribing behavior in the population studied. Strategies to ensure continued benefit from the program have been developed.

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Ethical aspects in the management of antibacterial agents utilization

Italian Journal of Medicine ◽

10.4081/itjm.2010.137 ◽

2013 ◽

pp. 137-144

Author(s):

Renato Malta ◽

Salvatore Di Rosa ◽

Natale D’Alessandro

Keyword(s):

Health Care ◽

Antibacterial Agents ◽

Wide Spectrum ◽

University Hospital ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

National Guidelines ◽

Beneficial Effects ◽

Defined Daily Doses ◽

Bed Days

Introduction: Antibacterial prescribing practices between 2004 and 2008 were investigated in the P. Giaccone University Hospital in Palermo, Italy to provide a foundation for critical analysis of the appropriateness of health-care resource usage. Materials and methods: Antibiotic prescribing practices between 2004 and 2008 were analyzed in the hospital as a whole and in different specialty areas. Results were expressed as defined daily doses (DDD) as a function of bed-days, number of admissions, and Diagnosis Related Group (DRG) points. Results: During the study period, increases were observed in the overall DDD per 100 bed-days (68.7 vs. 91.3) and the DDD per admission (4.53 vs. 5.54), but less variation was observed in the DDD/DRG score (3.55 vs. 3.63). Use of metronidazole, carbapenems, and glycopeptides increased, while use of third-generation cephalosporins, quinolones, and oral penicillins remained fairly stable. The drugs most commonly used in 2008 were (% of total DDD): levofloxacin (18.08%), amoxicillin + clavulanic acid (13.32%), ceftriaxone (9.01%), ciprofloxacin (8.21%), clarithromycin (5.74%), metronidazole (5.36%), ceftazidime (5.16%), amoxicillin (4.92%), gentamicin (1.88%), and meropenem (1.80%). An overall trend toward the prescription of newer wide-spectrum antibacterial agents was noted. National guidelines on chemoprophylaxis in surgery were observed in only 3/17 (17.7%) units. The prevalence of nosocomial infections was lower than those reported in the literature. Discussion: Although the cases treated in the hospital have become more complex over the years, the DDD documented in our study are far too high with respect to the actual clinical needs. These findings point to a trend toward the practice of excessively defensive medicine. Greater responsibility among physicians and the promotion of primary and secondary measures of preventive hygiene are fundamental to reduce the prescriptive pressure, a goal that should also have beneficial effects on health-care costs.

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In VitroAntimicrobial Susceptibility to Isepamicin of 6,296 Enterobacteriaceae Clinical Isolates Collected at a Tertiary Care University Hospital in Greece

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.06358-11 ◽

2012 ◽

Vol 56 (6) ◽

pp. 3067-3073 ◽

Cited By ~ 15

Author(s):

Sofia Maraki ◽

George Samonis ◽

Drosos E. Karageorgopoulos ◽

Michael N. Mavros ◽

Diamantis Kofteridis ◽

...

Keyword(s):

Antimicrobial Susceptibility ◽

Therapeutic Option ◽

Tertiary Care ◽

University Hospital ◽

Cross Resistance ◽

Intrinsic Resistance ◽

Content Type ◽

Microbiological Laboratory ◽

Almost All

ABSTRACTThe reevaluation of “forgotten” antibiotics can identify new therapeutic options against extensively drug-resistant Gram-negative pathogens. We sought to investigate isepamicin in this regard. We retrospectively evaluated the antimicrobial susceptibility to isepamicin ofEnterobacteriaceaesp. isolates from unique patients, collected at the microbiological laboratory of the University Hospital of Heraklion, Crete, Greece, from 2004 to 2009. Susceptibility testing was done with the automated Vitek 2 system. The breakpoints for susceptibility to isepamicin, tigecycline, and other antibiotics were those proposed by the Comité de l'Antibiogramme de la Société Française de Microbiologie (CA-SFM), the FDA, and the CLSI, respectively. A total of 6,296 isolates were studied, including primarily 3,401 (54.0%)Escherichia coli, 1,040 (16.5%)Klebsiella pneumoniae, 590 (9.4%)Proteus mirabilis, and 460 (7.3%)Enterobactersp. isolates. Excluding the species with intrinsic resistance to each antibiotic, antimicrobial susceptibility was highest for colistin (5,275/5,441 isolates [96.9%]) and isepamicin (6,103/6,296 [96.9%]), followed by meropenem (5,890/6,296 [93.6%]), imipenem (5,874/6,296 [93.3%]), and amikacin (5,492/6,296 [87.2%]). The antimicrobial susceptibility of the 1,040K. pneumoniaeisolates was highest for isepamicin (95.3%), followed by colistin (89.3%) and meropenem (63.0%). Regarding resistantK. pneumoniaeisolates, susceptibility to isepamicin was observed for 91.1% of the 392, 87.7% of the 375, and 85.6% of the 111 isolates that were nonsusceptible to the carbapenems, all other aminoglycosides, and colistin, respectively. Isepamicin exhibited highin vitroactivity against almost all of theEnterobacteriaceaespecies. It could particularly serve as a last-resort therapeutic option for carbapenem-resistantK. pneumoniaein our region, where it is endemic, as it does not show considerable cross-resistance with other aminoglycosides.

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Mortality Facts in Internal Medicine Wards: A Descriptive Study From A University Hospital

Acta Medica ◽

10.32552/2018.actamedica.314 ◽

2018 ◽

Vol 49 (4) ◽

pp. 6-13

Author(s):

Nursel Çalık Başaran ◽

Burak Yasin Aktaş ◽

Yusuf Ziya Şener ◽

Serdar Ceylan ◽

Emre Yekedüz ◽

...

Keyword(s):

Internal Medicine ◽

Causes Of Death ◽

Patient Characteristics ◽

Time Frame ◽

University Hospital ◽

Solid Cancer ◽

Duration Of Hospitalization ◽

Internal Medicine Wards ◽

The Mean ◽

Causes Of Deaths

Objective: We aimed to determine the mortality rates and the causes of death in hospitalized patients in Internal Medicine Wards in a University Hospital. Material and Methods: Medical records of patients who were hospitalized between 01 June 2014 and 31 May 2015 in Internal Medicine Wards of a University Hospital were reviewed and patients who died were examined retrospectively. Patient characteristics and causes of death were sorted out. Results: In the defined time frame, 5314 hospitalization episodes of 4500 patients were recorded and 416 (9.2%) patients died during hospital stay. The mean age of the patients who died was 62 (19-95) years and 54% of them were male. The median duration of hospitalization was 16 (0-142) days. The mean Charlson score was 6.3 ± 2.7. The rates of hospitalization and death did not differ between seasons. Malignancy was present in 71% of the cases and, 46% had metastatic solid cancer. The most common accompanying diseases were diabetes mellitus (25.7%), hypertension (35%) and congestive heart failure (18.8%). The most common reasons of admission were respiratory distress (23.8%), pneumonia (11.1%), and general deterioration (10.6%) among the patients who died. Sepsis (69%) and respiratory failure (15.9%) were the leading causes of deaths. Conclusion: Patients who died in internal medicine wards have high chronic illness burden. Sepsis was the most common cause of death. Keywords: Internal medicine, mortality, sepsis.

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Candidemia in Internal Medicine: Facing The New Challenge

10.21203/rs.3.rs-402788/v1 ◽

2021 ◽

Author(s):

Lucia Brescini ◽

Sara Mazzanti ◽

Gianluca Morroni ◽

Francesco Pallotta ◽

Annamaria Masucci ◽

...

Keyword(s):

Internal Medicine ◽

Logistic Regression ◽

Regression Analysis ◽

Candida Albicans ◽

Multivariate Logistic Regression Analysis ◽

University Hospital ◽

Multivariate Logistic Regression ◽

Related Factors ◽

Internal Medicine Wards ◽

Over Time

Abstract Candidemia is an alarming problem in critically ill patients including those admitted in Internal Medicine Wards (IMWs). Here, we analyzed all cases of candidemia in adult patients hospitalized over nine years (2010–2018) in IMWs of a 980-bedded University Hospital of Ancona, Italy. During the study period, 218/505 (43%) episodes of candidemia occurred in IMWs patients. The cumulative incidence was 2.5/1000 hospital admission and increased significantly over time (p = 0.013). Patients were predominantly male, with a median age of 68 years. Cardiovascular diseases and solid tumors were the most frequent comorbidities. Candida albicans accounted for 51% of the cases, followed by C. parapsilosis (25%), C. tropicalis (9%) and C. glabrata (7%). Thirty-day mortality was 28% and did not increased significantly over time. By multivariate logistic regression analysis, the presence of neutropenia (OR 7.247 [CI95% 1,368 − 38,400; p = 0.020]), pneumonia (OR 2.323 [CI95% 1,105-4,884; p = 0.026]), and being infected with C. albicans (OR 2.642 [95% CI 1,223-5,708; p = 0.013) emerged as independent predictors of mortality. The type of antifungal therapy did not influence the outcome. Overall, these data indicate that patients admitted to IMWs are increasingly at higher risk of developing candidemia. Mortality rate remains high and significantly associated with both microbiologic- and host-related factors.

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A comparison of bank and credit union growth around the financial crisis

American Journal of Business ◽

10.1108/ajb-03-2019-0017 ◽

2020 ◽

Vol 35 (1) ◽

pp. 25-44

Author(s):

Wenling Lu ◽

Judith Swisher

Keyword(s):

Financial Crisis ◽

Growth Rates ◽

Commercial Banks ◽

Credit Unions ◽

Credit Union ◽

Test Results ◽

Net Charge ◽

Content Type ◽

Union Growth ◽

Recent Financial Crisis

PurposeThe purpose of this research is to examine the growth rates of commercial banks and credit unions around the financial crisis and recovery. Credit unions are analyzed as a group and by field of membership. Specifically, this research analyzes the growth rates of assets, deposits, and loans.Design/methodology/approachThis research employs univariate tests of differences to examine the median growth rates for commercial banks and credit unions. Unbalanced pool regressions analyze growth rates during the pre-crisis, crisis, and recovery periods, controlling for size, net charge-offs, and unemployment.FindingsUnivariate test results that control for size show that banks grow at faster rates than credit unions for most of the pre-crisis years. However, medium sized credit unions grow at faster rates for most of the crisis and recovery years. Results of unbalanced pool regressions suggest that, overall, credit unions grow at slower rates than do banks. However, during the crisis and recovery, credit union growth is significantly greater than that of banks, after controlling for net charge-offs, size, and unemployment. Credit union growth varies by field of membership type.Originality/valueAlthough a large volume of research examines commercial bank performance around the financial crisis, only a few papers assess the performance of credit unions. And very few papers compare commercial banks and credit unions. This paper explores how the recent financial crisis influenced the growth of commercial banks and credit unions from 2005 to 2013.

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Visitors’ use of corridors in internal medicine wards

Facilities ◽

10.1108/f-01-2018-0024 ◽

2019 ◽

Vol 37 (5/6) ◽

pp. 313-329 ◽

Cited By ~ 1

Author(s):

Lusi Morhayim

Keyword(s):

Internal Medicine ◽

Architectural Design ◽

Design Methodology ◽

Future Research ◽

Floor Plan ◽

Content Type ◽

Burn Out ◽

Internal Medicine Wards ◽

Practical Implications ◽

And Task

Purpose This paper aims to analyze visitors’ waiting behavior in corridors of an internal medicine ward in relation to concepts of territoriality and privacy. Design/methodology/approach Waiting activities, visitors’ room numbers and duration of activities were recorded on a floor plan. Results were tallied according to behavioral and architectural zones in which the activity took place. Findings Locations that are near patient rooms that provide visual and auditory access are largely used as territorial areas for non-privacy-required activities. Ends of corridors, secondary corridors and staircases were mainly used for activities that required some level of privacy such as grieving. Research limitations/implications As is true with post-occupancy evaluations in other single buildings, this research may not be generalizable to all internal medicine wards. Future research could measure whether responding to visitors’ spatial needs could result in lower density and sense of crowding in the corridors, as well as reduce stress and task interruptions and increase efficiency of patient-check rounds. Practical implications The findings indicate that internal medicine wards should include waiting areas near the patient rooms for visitors to be able to keep visual and auditory connection with their patients, as well as areas that provide privacy. This may help lower density, sense of crowding, distraction of medical staff, stress and burn-out and errors, as well as increase the efficiency of patient checks. Originality/value The ways in which architectural design of internal medicine corridors can support visitors’ activities and environmental needs such as territoriality and privacy is an issue that is rarely examined. This paper also adds an example from a non-Western culture, to a literature that is dominated by examples from Western cultures.

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