Recent Practice Patterns and Variations in Children Hospitalized for Asthma Exacerbation in Japan

2020 ◽  
Vol 181 (12) ◽  
pp. 926-933
Author(s):  
Yusuke Okubo ◽  
Kenta Horimukai ◽  
Nobuaki Michihata ◽  
Kojiro Morita ◽  
Hiroki Matsui ◽  
...  
Keyword(s):  
Asthma Exacerbation ◽  
Linear Models ◽  
Hierarchical Cluster ◽  
Antibiotic Use ◽  
Developed Countries ◽  
Adjunctive Treatment ◽  
Antibiotic Prescribing ◽  
Mixed Effect ◽  
Cluster Analyses ◽  
Hierarchical Cluster Analyses

<b><i>Background:</i></b> High antibiotic prescribing rates for adults with an asthma exacerbation have been reported in developed countries, but few studies have assessed the variation of antibiotic and adjunctive treatment in the routine care of children. <b><i>Objective:</i></b> We evaluated the trends in health resource utilization for children hospitalized for asthma exacerbation, ascertained the variations of practices across hospitals and geographic location, and classified these different patterns at hospital levels. <b><i>Methods:</i></b> Using data on Japanese children hospitalized for asthma exacerbation with no indication of bacterial infection during 2010–2018, we conducted a retrospective observational study to assess the trends in initial treatment patterns and their variations. Mixed-effect generalized linear models were used to investigate the treatment trends. Hierarchical cluster analyses were performed to classify the treatment variations across hospitals. <b><i>Results:</i></b> Overall, 54,981 children were eligible for the study. Proportions of antibiotic use decreased from 47.2% in 2010 to 26.9% in 2018. Similarly, utilization of antitussives, antihistamines, and methylxanthine showed decreasing trends over the period, whereas the use of mucolytics and ambroxol increased. These treatment variations were more considerable in hospital levels than in 47 prefecture levels. Hierarchical cluster analyses classified these patterns into 6 groups, mostly based on mediator release inhibitor, ambroxol, and antitussives. <b><i>Conclusions:</i></b> Wide variations in antibiotics and adjunctive treatments were observed across hospital levels. Our findings support the improvement in reducing inappropriate antibiotic use and highlight the need for comparative effectiveness research of the adjunctive treatments among children hospitalized for asthma.

scholarly journals Responsible antibiotic therapy simplified

2020 ◽  
Vol 35 ◽  
pp. 29-38
Author(s):  
Abhay K. Shah ◽  
Aashay Abhay Shah
Keyword(s):  
Developing Countries ◽  
Antibiotic Therapy ◽  
Disease Burden ◽  
Critical Role ◽  
Antibiotic Use ◽  
Developed Countries ◽  
Bacterial Disease ◽  
Antibiotic Prescribing ◽  
Inappropriate Use ◽  
Current Article

Antimicrobial resistance is a global problem and is particularly pressing in developing countries where the infectious disease burden is very high. In developing countries, where relatively easy availability and higher consumption of medicines have led to disproportionately higher incidence of inappropriate use of antibiotics and greater levels of resistance compared to developed countries. The bacterial disease burden in India is among the highest in the world; consequently, antibiotics will play a critical role in limiting morbidity and mortality in the country. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Responsible antibiotic therapy is one of the most important components of antibiotic stewardship. The current article is an attempt to provide a set of key principles to guide efforts to improve responsible and rational antibiotic use.

scholarly journals Principal Components and Hierarchical Cluster Analyses of Trace Metals and Total Hydrocarbons in Gills, Intestines and Muscles of Clarias gariepinus (Burchell, 1822)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Patrick Omoregie Isibor ◽  
Tunde O. Thaddeus Imoobe ◽  
Alex Ajeh Enuneku ◽  
Paul Akinniyi Akinduti ◽  
Gabriel Adewunmi Dedeke ◽  
...  
Keyword(s):  
Trace Metals ◽  
Principal Components ◽  
Clarias Gariepinus ◽  
Hierarchical Cluster ◽  
Cluster Analyses ◽  
Total Hydrocarbons ◽  
Hierarchical Cluster Analyses

scholarly journals Genetic Diversity and Population Structure of Maize Inbred Lines with Varying Levels of Resistance to Striga Hermonthica Using Agronomic Trait-Based and SNP Markers

Plants ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 1223
Author(s):  
Adekemi Stanley ◽  
Abebe Menkir ◽  
Agre Paterne ◽  
Beatrice Ifie ◽  
Pangirayi Tongoona ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Population Structure ◽  
Molecular Diversity ◽  
Hierarchical Cluster ◽  
Molecular Data ◽  
Inbred Lines ◽  
Striga Hermonthica ◽  
Cluster Analyses ◽  
Maize Inbred Lines ◽  
Hierarchical Cluster Analyses

Striga hermonthica is a serious biotic stress limiting maize production in sub-Saharan Africa. The limited information on the patterns of genetic diversity among maize inbred lines derived from source germplasm with mixed genetic backgrounds limits the development of inbred lines, hybrids, and synthetics with durable resistance to S. hermonthica. This study was conducted to assess the level of genetic diversity in a panel of 150 diverse maize inbred lines using agronomic and molecular data and also to infer the population structure among the inbred lines. Ten Striga-resistance-related traits were used for the phenotypic characterization, and 16,735 high-quality single-nucleotide polymorphisms (SNPs), identified by genotyping-by-sequencing (GBS), were used for molecular diversity. The phenotypic and molecular hierarchical cluster analyses grouped the inbred lines into five clusters, respectively. However, the grouping patterns between the phenotypic and molecular hierarchical cluster analyses were inconsistent due to non-overlapping information between the phenotypic and molecular data. The correlation between the phenotypic and molecular diversity matrices was very low (0.001), which is in agreement with the inconsistencies observed between the clusters formed by the phenotypic and molecular diversity analyses. The joint phenotypic and genotypic diversity matrices grouped the inbred lines into three groups based on their reaction patterns to S. hermonthica, and this was able to exploit a broad estimate of the actual diversity among the inbred lines. The joint analysis shows an invaluable insight for measuring genetic diversity in the evaluated materials. The result indicates that wide genetic variability exists among the inbred lines and that the joint diversity analysis can be utilized to reliably assign the inbred lines into heterotic groups and also to enhance the level of resistance to Striga in new maize varieties.

Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia

2005 ◽  
Vol 26 (1) ◽  
pp. 100-104 ◽  
Author(s):  
Andrew J. Hughes ◽  
Norliza Ariffin ◽  
Tan Lien Huat ◽  
Habibah Abdul Molok ◽  
Salbiah Hashim ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Medical Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Developed Countries ◽  
High Rate ◽  
Antibiotic Prescribing ◽  
Tract Infections

AbstractBackground and Objective:Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.Methods:A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.Setting:Tertiary-care referral center in Malaysia.Patients:All inpatients during the time of the study.Results:Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).Conclusion:Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.

Principal component and hierarchical cluster analyses for classification and categorization of sesame germplasm

2015 ◽  
Vol 16 (2) ◽  
pp. 345
Author(s):  
Amit Singh ◽  
Ram Avtar ◽  
Nisha Kumari ◽  
O. Sangwan ◽  
R. K. Sheoran
Keyword(s):  
Principal Component ◽  
Hierarchical Cluster ◽  
Cluster Analyses ◽  
Hierarchical Cluster Analyses

Moral foundations and credence attributes in livestock production: Canada

2019 ◽  
Vol 36 (3) ◽  
pp. 418-428
Author(s):  
Ellen Goddard ◽  
Violet Muringai ◽  
Albert Boaitey
Keyword(s):  
Environmental Sustainability ◽  
Hierarchical Cluster ◽  
Antibiotic Use ◽  
Developed Countries ◽  
Livestock Production ◽  
Plant Production ◽  
Moral Foundations ◽  
Moral Foundation ◽  
Content Type ◽  
Strongly Agree

Purpose The purpose of this study is to assess the differences in individual purchasing and voting decisions for livestock products, produced with lower levels of antibiotic use or higher levels of environmental sustainability, by consumers with different degrees of agreement with moral foundation statements. Design/methodology/approach Data are collected from two national online surveys that were conducted in Canada in 2016 and 2017, including socio-demographic, attitude, belief and stated choice questions. Data are analysed using hierarchical cluster analysis and ordered probit regressions. Findings Respondents who strongly agree with the individualizing moral foundation statements are more likely to buy more environmentally sustainable milk/yogurt and pork from pigs that are raised with reduced antibiotic use, as compared to respondents who have weaker agreement with the statements. Respondents with stronger agreement with the moral foundation statements are also more likely to vote in favour of stricter livestock environmental standards and disease protocols. Research limitations/implications Monitoring people’s moral concerns might help in predicting consumers’ responses to new or different production practices. Originality/value Although moral foundations have been linked to other purchase decisions, in this study, the focus is on specific aspects of environmental sustainability and antibiotic use in livestock production. Both of these challenging issues are controversial and facing either regulatory changes (antibiotic use in livestock) or significant livestock production changes (responding to concerns that livestock production is less sustainable than plant production) in most developed countries. Understanding the linkages between fundamental beliefs and probable consumer behaviour will assist in predicting negative or positive outcomes to the regulatory or industry-based changes to livestock production. Differences between an individual’s desire to be able to identify products with certain attributes for purchase vs an individual’s desire to have government regulate industries to higher standards, in both contexts, will also be linked to the individual’s level of moral foundation beliefs.

scholarly journals Antimicrobial Stewardship Program Using Plan-Do-Study-Act Cycles to Reduce Unjustified Antibiotic Prescribing in Children Admitted With an Asthma Exacerbation

2017 ◽  
Vol 22 (6) ◽  
pp. 436-443
Author(s):  
Sasha E. Dorzin ◽  
Claudia Halaby ◽  
Maria Lyn Quintos ◽  
Asif Noor ◽  
Gladys El-Chaar
Keyword(s):  
Antimicrobial Stewardship ◽  
Asthma Exacerbation ◽  
Journal Club ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Stewardship Program ◽  
Children With Asthma ◽  
Improvement Interventions ◽  
Care Costs

OBJECTIVE Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma. The purpose of this study was to reduce unjustified antibiotic use at our institution by 25% in children through an ASP directed toward asthma. METHODS The study period lasted from November 2015 to March 2016. Children 6 months to 17 years of age, admitted for an asthma exacerbation, were included while those with comorbidities were excluded. A multidisciplinary team from pediatric pharmacotherapy, pulmonology, emergency department (ED), infectious diseases, and quality improvement was formed to focus on process improvement. Interventions were executed in a series of Plan-Do-Study-Act cycles. In cycle 1, our asthma guidelines on appropriate antibiotic use were disseminated to pediatric house staff and posted in pediatric units. Cycle 2 encompassed presenting the ASP and guidelines to the pediatric ED staff. Cycle 3 consisted of a journal club with the pulmonary division to discuss the role of azithromycin in an asthma exacerbation. RESULTS In cycle 1, twenty-four patients were reviewed in November 2015. Antibiotics were prescribed in 8/24 (33%) children, with an unjustified rate of 2/24 (8.3%). In cycle 2, twenty-three patients were reviewed in December and January with 8/23 (35%) prescribed antibiotics and an unjustified rate of 2/23 (8.7%). For cycle 3, in February and March 2016, twenty-one children were reviewed. Antibiotics were prescribed in 6/21 (27%) children and all were justified. In total, 68 patients were included in our study and had an unjustified antibiotic prescribing rate of 4/68 (5.9%), a reduction of 25%. CONCLUSION Our ASP surpassed the benchmark set by AAP guidelines, by reducing the percentage of unjustified antibiotics in children with asthma to 5.9%.

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