scholarly journals Regional variation in the potentially inappropriate first-line use of fluoroquinolones in Canada as a key to antibiotic stewardship? A drug utilization review study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Audray St-Jean ◽  
Dan Chateau ◽  
Matthew Dahl ◽  
Pierre Ernst ◽  
Nick Daneman ◽  
...  
Keyword(s):  
Nova Scotia ◽  
Antibiotic Stewardship ◽  
Outpatient Setting ◽  
Utilization Review ◽  
Chronic Obstructive ◽  
First Line ◽  
Obstructive Pulmonary Disease ◽  
Fluoroquinolone Antibiotics ◽  
Acute Bacterial Sinusitis ◽  
Drug Regulatory Agencies

Abstract Background Serious adverse effects of fluoroquinolone antibiotics have been described for more than decade. Recently, several drug regulatory agencies have advised restricting their use in milder infections for which other treatments are available, given the potential for disabling and possibly persistent side effects. We aimed to describe variations in fluoroquinolone use for initial treatment of urinary tract infection (UTI), acute bacterial sinusitis (ABS), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the outpatient setting across Canada. Methods Using administrative health data from six provinces, we identified ambulatory visits with a diagnosis of uncomplicated UTI, uncomplicated AECOPD or ABS. Antibiotic exposure was determined by the first antibiotic dispensed within 5 days of the visit. Results We identified 4,303,144 uncomplicated UTI events among 2,170,027 women; the proportion of events treated with fluoroquinolones, mostly ciprofloxacin, varied across provinces, ranging from 18.6% (Saskatchewan) to 51.6% (Alberta). Among 3,467,678 ABS events (2,087,934 patients), between 2.2% (Nova Scotia) and 11.2% (Ontario) were dispensed a fluoroquinolone. For 1,319,128 AECOPD events among 598,347 patients, fluoroquinolones, mostly levofloxacin and moxifloxacin, ranged from 5.8% (Nova Scotia) to 35.6% (Ontario). The proportion of uncomplicated UTI and ABS events treated with fluoroquinolones declined over time, whereas it remained relatively stable for AECOPD. Conclusions Fluoroquinolones were commonly used as first-line therapies for uncomplicated UTI and AECOPD. However, their use varied widely across provinces. Drug insurance formulary criteria and enforcement may be a key to facilitating better antibiotic stewardship and limiting potentially inappropriate first-line use of fluoroquinolones.

scholarly journals Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting.

Thorax ◽  
1997 ◽  
Vol 52 (10) ◽  
pp. 879-887 ◽  
Author(s):  
R Harper ◽  
J E Brazier ◽  
J C Waterhouse ◽  
S J Walters ◽  
N M Jones ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Outcome Measures ◽  
Outpatient Setting ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Elderly patients with metastatic castrate-resistant prostate cancer (mCRPC): Safety and efficacy of docetaxel retreatment.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 161-161
Author(s):  
A. Gernone ◽  
A. Pagliarulo ◽  
G. Calderoni ◽  
V. Pagliarulo
Keyword(s):  
Elderly Patients ◽  
Median Survival ◽  
Chronic Obstructive ◽  
First Line ◽  
Obstructive Pulmonary Disease ◽  
Psa Response ◽  
Third Line ◽  
Castrate Resistant ◽  
Ecog Ps ◽  
Docetaxel Chemotherapy

161 Background: Comorbidities are considered a therapeutically limiting problem in elderly patients (pts) with mCRPC. We analysed correlations between comorbidity, toxicity and efficacy of docetaxel re-treatment in pts ≥ 70 years with mCRPC. Methods: Pts were evaluated according to comprehensive geriatric assessment (CGA). From 2003 to 2010, 70 pts ≥ 70 years with mCRPC received 3-wk first line docetaxel therapy followed by retreatment on biochemical disease progression. Each patient was assessed according the Cumulative Illness Score Rating-Geriatrics (CISR-G) manual. The score was 0-4. The median age was 77 (70-84), ECOG PS 0-2, median baseline PSA 180 ng/ml (15-1200). The more frequent comorbidities were hypertension, diabetes, arrhythmias, chronic obstructive pulmonary disease. The endpoints were: PSA response proportion to first-second-third line chemotherapy, median survival in responding patients and toxicity. Results: All pts received a standard 3-wk regimen, dose was reduced by 25% for pts score 4. The incidence of adverse events was relatively low and no pts died on therapy. There were no episodes of neutropenic fever. Pts with score 1-2 were 70% (49 pts); pts with score 3 were 20% (14); pts with score 4 were 10% (7). 70 pts (score 0-4) received first line docetaxel chemotherapy with a median no of cycles 14 (6-18), a median survival of 18 months (mos), PSA response 70%. Of these pts 26 (score 0-3) were re-treated with the same regimen with no of cycles 12 (8-18), a median survival of 14 mos, PSA response 45%, duration of first chemotherapy holiday 5 mos (median). Of these pts, 4 (score 0-3) received third line treatment with no of cycles 10 (6-14), a median survival of 10 mos, PSA response 22%, duration of second chemotherapy holiday 4 mos (median). Of these pts only 1 (score 1) received third re-treatment with 8 cycles, PSA response 20%, third chemotherapy holiday 4 mos. 80% of symptomatic pts reported an improvement in symptoms control with docetaxel chemotherapy. Conclusions: Re-treatment with docetaxel is safe in mCRPC elderly pts despite the association of important comorbidities. Median survival in responding pts was approximately 40 mos from the first to the third line. No significant financial relationships to disclose.

scholarly journals Varenicline and evaluated outcomes in smoking cessation programmes

2015 ◽  
Vol 79 (1) ◽  
Author(s):  
P. Santus ◽  
L. Bassi ◽  
A. Airoldi ◽  
F. Giovannelli ◽  
D. Radovanovic
Keyword(s):  
Clinical Trials ◽  
Smoking Cessation ◽  
Lung Function ◽  
Premature Death ◽  
Chronic Obstructive ◽  
First Line ◽  
Obstructive Pulmonary Disease ◽  
Cochrane Database ◽  
Almost All ◽  
Unique Mechanism

The morbidity and mortality rates attributed to smoking are substantial and cigarette smoke remains the first preventable cause of premature death worldwide. Despite the knowledge of the adverse consequences of smoking, many smokers struggle to quit. Cigarette smoking is the primary cause of chronic obstructive pulmonary disease, and smoking cessation represents the most effective way of stopping its progression. Varenicline is one of the first-line smoking cessation aids recommended in many Clinical Practice Guidelines and its efficacy and safety have been demonstrated in several clinical trials. Varenicline has a unique mechanism of action and clinical trials support its use as an effective and generally well-tolerated therapy. This article reviews the clinical pharmacological trials on smoking cessation published in recent years on varenicline, with particular attention to the outcomes used in the studies. MedLine, the Cochrane database and Embase were evaluated. Almost all the trials have, as a primary endpoint, the abstinence from cigarettes at 9-12 weeks of treatment. Only one study considers lung function spirometric changes as a secondary endpoint. No study has evaluated lung function. This marker could be very important as a way of evaluating, objectively, an improvement in lung function, which correlates also with subjective parameters, as dyspnea and fatigue.

scholarly journals The Emerging Roles of Antioxidant Enzymes by Dietary Phytochemicals in Vascular Diseases

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 199
Author(s):  
Seung Eun Lee ◽  
Yong Seek Park
Keyword(s):  
Antioxidant Enzymes ◽  
Vascular System ◽  
Inflammatory Diseases ◽  
Vascular Diseases ◽  
Vascular Wall ◽  
Chronic Obstructive ◽  
First Line ◽  
Obstructive Pulmonary Disease ◽  
Beneficial Effects ◽  
Dietary Phytochemicals

Vascular diseases are major causes of death worldwide, causing pathologies including diabetes, atherosclerosis, and chronic obstructive pulmonary disease (COPD). Exposure of the vascular system to a variety of stressors and inducers has been implicated in the development of various human diseases, including chronic inflammatory diseases. In the vascular wall, antioxidant enzymes form the first line of defense against oxidative stress. Recently, extensive research into the beneficial effects of phytochemicals has been conducted; phytochemicals are found in commonly used spices, fruits, and herbs, and are used to prevent various pathologic conditions, including vascular diseases. The present review aims to highlight the effects of dietary phytochemicals role on antioxidant enzymes in vascular diseases.

scholarly journals Analysis of the Dimensions of Physiotherapy Index of Ventilatory Workload in People with Chronic Obstructive Pulmonary Disease During Stability and Exacerbation in An Outpatient Setting

2019 ◽  
Author(s):  
Rodrigo Muñoz Cofré ◽  
Mariano del Sol ◽  
Paul Medina González ◽  
Jorge Valenzuela Vásquez ◽  
Gerardo Molina Vergara ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Statistical Analysis ◽  
Pulmonary Disease ◽  
Outpatient Setting ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Inclusion Criteria ◽  
Chi Square ◽  
Obstructive Pulmonary Disease ◽  
Clinical Records

Background and objective: Addressing the global morbidity associated with pulmonary disease is an important need for the respiratory community. However, there is also a growing momentum to show the efficacy of new tools of diagnosis. Despite this, there are few physiotherapeutic tools that help identify and categorize these conditions. The aim was to analyze the variables of physiotherapy index of the ventilatory workload (PIVW) in people with chronic obstructive pulmonary disease (COPD) during stability and exacerbation in an outpatient setting. Material and Methods: Analyzed retrospectively of 198 clinical records were reviewed. The PIVW was extracted in stability and exacerbation of these patients with COPD. After applying the exclusion and inclusion criteria; 54 patients were classified. Through the statistical analysis of chi-square, a significant association was reported for each of the variables and the total PIVW score. Results: when analyzing the baseline with the peak of PIVW, there was a significant increase in patients COPD exacerbation. Similarly, the variables that constitute the loads, translations and supports underwent a significant increase from baseline to exacerbation (p<0.0001), except for the additional oxygen contribution, where the frequency of patients was the same in basal and exacerbation as well. Conclusions: the PIVW, serves to determine ventilatory problemas in outpatients, characterizing the specific changes of loads, translators or assistance.

Assessment of COPD Overdiagnosis as an Important Factor in COPD Readmission

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Pandey S ◽  
◽  
Ojha S ◽  
Keyword(s):  
Hospital Care ◽  
Hospital Readmissions ◽  
Correct Diagnosis ◽  
Chronic Obstructive Lung Disease ◽  
Outpatient Setting ◽  
Care Quality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inpatient Settings ◽  
Global Initiative

Introduction: The Hospital Readmission Reduction Program (HRRP) was established in 2012 to improve health care by linking payment to the quality of hospital care. Readmission is considered a hospital care quality measure. Under the program, hospitals are penalized for Chronic Obstructive Pulmonary Disease (COPD) readmission, which incentivizes improved care to avoid financial penalties. The effect of COPD overdiagnosis on COPD readmission has not been studied. Objective: The study aims to assess the effect of COPD overdiagnosis in outpatient and inpatient settings on hospital COPD readmissions. Methods: We conducted a retrospective study and examined outpatient and inpatient settings for COPD overdiagnosis. In the outpatient setting, we collected all COPD referrals to our clinic and reviewed charts to determine if those patients had COPD or an alternate diagnosis after our workup. We also studied 3-year inpatient data from January 2015 to March 2018 on hospital readmissions and extracted COPD readmissions. For patients seen by a pulmonary provider in our clinic, we studied patients’ pulmonary function test/ spirometry results and charts and determined if they had a true COPD diagnosis or an overdiagnosis. We also assessed the effect of COPD overdiagnosis on inflation of COPD readmission numbers. Results: Of patients referred to our clinic, 46% did not have COPD on our workup. Among inpatients, our results revealed that preventing COPD overdiagnosis could have reduced admissions attributable to COPD by 22.6%. Conclusion: Correct diagnosis using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria is an inexpensive way for hospitals to avoid readmission penalties.

scholarly journals Comparison of Nasal Cannulas and the OxyArm in Patients Requiring Chronic Domiciliary Oxygen Therapy

2006 ◽  
Vol 13 (8) ◽  
pp. 421-426 ◽  
Author(s):  
James Paul ◽  
Ted Otvos
Keyword(s):  
Oxygen Delivery ◽  
Oxygen Therapy ◽  
Outpatient Setting ◽  
Chronic Obstructive ◽  
Walk Test ◽  
Obstructive Pulmonary Disease ◽  
Current Design ◽  
Long Term Oxygen Therapy ◽  
Randomized Crossover Study

OBJECTIVES: The present study was designed to compare the performance of a new oxygen delivery device, the OxyArm (OA) (Southmedic Inc, Canada), with a standard nasal cannula (NC) (Salter-Style 1600, Salter Labs, USA) for both oxygen delivery and patient preference in patients on long-term oxygen therapy (LTOT).DESIGN AND SETTING: Randomized crossover study conducted in an outpatient setting.PATIENTS AND METHODS: Twenty-five clinically stable LTOT patients were randomly assigned to an oxygen device (NC or OA) sequence. The baseline saturation level was determined, and patients were then treated at oxygen flow rates of 2 L/min, 3 L/min, 4 L/min, 5 L/min, 6 L/min and 7 L/min for 10 min each while at rest. Patients were then crossed over to the second device and the procedure was repeated. Oximetry values were then obtained following a 5 min walk test using the same device sequence. Lastly, the patients were sent home for a four-week home OA trial, after which, they filled out a questionnaire.RESULTS: This sample of patients was primarily elderly ex-smokers with severe chronic obstructive pulmonary disease on oxygen therapy for the majority of the day. The primary findings were that the OA and NC were equally effective in delivering oxygen to patients and maintaining their oxygen saturation at both rest (P=0.82) and during a 5 min walk test (P=0.83). A patient’s personal experience and comfort were identified as the most important factors in deciding on an oxygen device. Most patients felt that the OA was most suited for oxygen therapy while at rest.CONCLUSIONS: The OA proved to be similar to the NC in delivering oxygen and maintaining saturation in patients on LTOT. The OA is one of the few alternatives to using NCs for these patients and, with its current design, appears to be most suited for resting conditions.

Evaluation of Antibiotic Prescribing in a Veterans Affairs Outpatient Setting: Identification of Stewardship Targets

2019 ◽  
Vol 34 (4) ◽  
pp. 268-278
Author(s):  
Collin M. Clark ◽  
Alexis T. White ◽  
John A. Sellick ◽  
Kari A. Mergenhagen
Keyword(s):  
Multivariable Analysis ◽  
Outpatient Setting ◽  
Veterans Affairs ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Va Health Care System

OBJECTIVE: To evaluate antibiotic prescribing practices for geriatric outpatients in a Veterans Affairs (VA) health care system.<br/> DESIGN: This is a single-center, observational, prospective cohort study.<br/> SETTING: Veterans Affairs Healthcare System.<br/> PATIENTS: Outpatients treated with oral antibiotics between June and September 2017.<br/> INTERVENTIONS: None.<br/> MAIN OUTCOME MEASURE(S): Appropriate therapy was assessed based on clinical practice guidelines. Multivariable logistic regression was used to identify predictors of appropriate treatment.<br/> RESULTS: This study yielded 1,063 prescriptions for analysis. No significant difference was observed for antibiotic indicated (60%), correct drug (50%), or correct duration (75%). Patients older than 65 years of age were more likely to receive an inappropriate dose (86% vs. 76%; P < 0.002). In the multivariable analysis, patients with chronic obstructive pulmonary disease (COPD) were more than 1.4 times likely to be treated appropriately (95% confidence interval 1.03-1.9) versus those without COPD. Older patients were not more likely to be re-treated or admitted within 30 days.<br/> CONCLUSION: Antibiotics are often inappropriately used in the outpatient setting; but not more frequently in elderly patients. Older adults were more likely to be prescribed an antibiotic at an inappropriate dose. Opportunities exist for stewardship teams to provide value in the outpatient setting to ensure appropriate antibiotic prescribing with a focus on dosing.

Postnephrectomy diaphragmatic hernia presenting as progressive dyspnoea

2020 ◽  
Vol 13 (10) ◽  
pp. e235881
Author(s):  
Aqeem Azam ◽  
Kirolos Michael
Keyword(s):  
Diaphragmatic Hernia ◽  
Imaging Modality ◽  
Multislice Ct ◽  
Outpatient Setting ◽  
Ct Imaging ◽  
Chronic Obstructive ◽  
Emergency Setting ◽  
Progressive Dyspnoea ◽  
Radiographic Images ◽  
Obstructive Pulmonary Disease

The diagnosis of diaphragmatic hernia (DH) in adults is rare and may be due to missed congenital DH or acquired DH from trauma or as a postoperative complication of certain thoracic and abdominal surgeries. We present a case of a patient with well-controlled chronic obstructive pulmonary disease who presented to the hospital with progressive dyspnoea, 6 months after laparoscopic nephrectomy. The patient was initially misdiagnosed and treated for empyema after plain radiographic images were reported as consolidation with gas locules. Multislice CT imaging undertaken before diagnostic thoracocentesis confirmed the presence of a right-sided DH, which was subsequently surgically repaired in the outpatient setting, given her haemodynamic stability. As patients with DH usually present in the emergency setting, requiring urgent inpatient surgical repair, there are currently no guidelines on the method and urgency of management of asymptomatic or mildly symptomatic, stable patients. Furthermore, while plain radiography is the usual first-line imaging modality used, misdiagnosis of DH as pleural effusion or empyema can lead to unnecessary and potentially harmful procedures such as diagnostic thoracocentesis. These risks can potentially be minimised with early utilisation of multislice CT imaging in patients with high clinical suspicion.

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