Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines

Background Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. Methods & findings Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month–12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1–3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. Conclusions Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research.

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Pharmacodynamic Target Attainment for Meropenem and Piperacillin/Tazobactam Using a PK/PD-based Dosing Calculator in Critically Ill Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.067 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S27-S27 ◽

Cited By ~ 1

Author(s):

Emily Heil ◽

David P Nicolau ◽

Gwen Robinson ◽

Andras Farkas ◽

Kerri Thom

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Plasma Concentrations ◽

Future Research ◽

Target Attainment ◽

Research Support ◽

Dosing Strategies ◽

Trough Concentrations ◽

Culture Positive ◽

Antibiotic Dosing

Abstract Background Unbound plasma concentrations of β-lactam antibiotics vary widely and attainment of PK/PD targets is highly variable in critically ill patients, which may affect microbiologic cure or contribute to toxicity. PK/PD-based antibiotic dosing programs may provide more accurate doses that achieve predicted targets for a cultured organism. Methods This was a single center, prospective study of critically ill patients with culture positive gram-negative infections treated with meropenem (MEM) or piperacillin/tazobactam (TZP). A PK/PD-based antibiotic dosing app was used to select doses that had a probability of target attainment (PTA) of 90% or greater for time above MIC (fT>MIC) of at least 40% for MEM and 50% for TZP. Total meropenem, piperacillin and tazobactam mid-point and trough concentrations were obtained at steady-state and adjusted for protein binding, to assess target attainment. Results Thirty-six patients were enrolled; 20 received MEM and 16 TZP. Antibiotic concentrations varied widely amongst patients, particularly with TZP. MEM and TZP concentrations are displayed in Table 1 and Figure 1. Doses evaluated for >90% probability of target attainment in the dosing calculator differed from standard package labeled doses for 25% (5/20) of MEM and 18.8% (3/16) of TZP patients. All (20/20) MEM and 94% (15/16) TZP patients maintained fT>MIC for the entire dosing interval. Conclusion A PK/PD based antibiotic dosing calculator that provides individualized β-lactam doses can lead to altered doses that may increase probability of target attainment in critically ill patients. Future research is needed to review the relevance of PK/PD-based dose adjustments on clinical outcomes. Disclosures D. P. Nicolau, Shionogi & Co.: Research Contractor, Research support; A. Farkas, Optimum Dosing Strategies: Employee, Salary.

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Workplace Ostracism and Its Negative Outcomes

Journal of Personnel Psychology ◽

10.1027/1866-5888/a000147 ◽

2016 ◽

Vol 15 (4) ◽

pp. 143-151 ◽

Cited By ~ 17

Author(s):

Xiaoming Zheng ◽

Jun Yang ◽

Hang-Yue Ngo ◽

Xiao-Yu Liu ◽

Wengjuan Jiao

Keyword(s):

Affective Commitment ◽

Psychological Capital ◽

Intention To Leave ◽

Future Research ◽

Conservation Of Resources ◽

Negative Consequences ◽

Negative Outcomes ◽

Workplace Ostracism ◽

Using Data ◽

The Relationship

Abstract. Workplace ostracism, conceived as to being ignored or excluded by others, has attracted the attention of researchers in recent years. One essential topic in this area is how to reduce or even eliminate the negative consequences of workplace ostracism. Based on conservation of resources (COR) theory, the current study assesses the relationship between workplace ostracism and its negative outcomes, as well as the moderating role played by psychological capital, using data collected from 256 employees in three companies in the northern part of China. The study yields two important findings: (1) workplace ostracism is positively related to intention to leave and (2) psychological capital moderates the effect of workplace ostracism on affective commitment and intention to leave. This paper concludes by discussing the implications of these findings for organizations and employees, along with recommendations for future research.

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Siblings and Illness

Vanderbilt Undergraduate Research Journal ◽

10.15695/vurj.v7i0.2924 ◽

2011 ◽

Vol 7 ◽

Author(s):

Leah Sawyer Vanderwerp

Keyword(s):

Depressive Symptoms ◽

Birth Order ◽

Family Size ◽

Multivariate Analyses ◽

Social Role ◽

Chronically Ill ◽

Demographic Variables ◽

Future Research ◽

Mother And Child ◽

Using Data

Using data from the National Longitudinal Survey of Youth-Mother and Child samples, I investigated the relationships among child and adolescent depressive symptoms, having a chronically ill sibling, and other child and familial demographic variables. From research on social support and social role transitions, with the Stress Process as a theoretical model, I hypothesized that children with chronically ill siblings experience more depressive symptoms. Specifically, I looked at age, gender, birth order and family size as potentially reducing the effect size of having a chronically ill sibling. Findings showed that having a chronically ill sibling is associated with demonstrating more depressive symptoms both in the bivariate and multivariate analyses. Although age, gender, birth order and family size do not interact significantly with having a chronically ill sibling in predicting depressive symptoms, they do present interesting findings about childhood depressive symptoms in general. Thus, the results of this study suggest specific and meaningful paths for future research.

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Secondary School Teachers’ Professional Development in Australia and Shanghai: Needs, Support, and Barriers

SAGE Open ◽

10.1177/21582440211026951 ◽

2021 ◽

Vol 11 (3) ◽

pp. 215824402110269

Author(s):

Guangbao Fang ◽

Philip Wing Keung Chan ◽

Penelope Kalogeropoulos

Keyword(s):

Professional Development ◽

Teaching And Learning ◽

Secondary School Teachers ◽

New Technology ◽

Development Program ◽

Future Research ◽

Information And Communication ◽

Using Data ◽

Teachers Professional Development ◽

Scheduled Time

Using data from the Teaching and Learning International Survey (TALIS; 2013), this article explores teachers’ needs, support, and barriers in their professional development. The research finds that Australian teachers expressed greater needs in information and communication technology (ICT) use and new technology training for teaching, while Shanghai teachers required more assistance to satisfy students’ individual learning and pedagogical competencies. More than 80% of Australian and Shanghai teachers received scheduled time to support their participation in professional development, whereas less than 20% of Australian and Shanghai teachers received monetary or nonmonetary support. In terms of barriers, Australian and Shanghai teachers reported two significant barriers that conflicted with their participation in professional development: “working schedule” and “a lack of incentives to take part.” This article reveals implications of the study in the design of an effective professional development program for Australian and Shanghai teachers and ends with discussing the limitations of the research and future research directions.

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How Collective-Action Failure Shapes Group Heterogeneity and Engagement in Conventional and Radical Action Over Time

Psychological Science ◽

10.1177/0956797620970562 ◽

2021 ◽

pp. 095679762097056

Author(s):

Morgana Lizzio-Wilson ◽

Emma F. Thomas ◽

Winnifred R. Louis ◽

Brittany Wilcockson ◽

Catherine E. Amiot ◽

...

Keyword(s):

Social Movements ◽

Collective Action ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Social Identification ◽

Future Research ◽

Group Efficacy ◽

Before And After ◽

Using Data ◽

Over Time

Extensive research has identified factors influencing collective-action participation. However, less is known about how collective-action outcomes (i.e., success and failure) shape engagement in social movements over time. Using data collected before and after the 2017 marriage-equality debate in Australia, we conducted a latent profile analysis that indicated that success unified supporters of change ( n = 420), whereas failure created subgroups among opponents ( n = 419), reflecting four divergent responses: disengagement (resigned acceptors), moderate disengagement and continued investment (moderates), and renewed commitment to the cause using similar strategies (stay-the-course opponents) or new strategies (innovators). Resigned acceptors were least inclined to act following failure, whereas innovators were generally more likely to engage in conventional action and justify using radical action relative to the other profiles. These divergent reactions were predicted by differing baseline levels of social identification, group efficacy, and anger. Collective-action outcomes dynamically shape participation in social movements; this is an important direction for future research.

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Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019

BMC Health Services Research ◽

10.1186/s12913-021-06653-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arthur Piraux ◽

Sébastien Faure ◽

Kurt G. Naber ◽

Jakhongir F. Alidjanov ◽

Aline Ramond-Roquin

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Secondary Care ◽

Administrative Database ◽

Community Pharmacies ◽

Antibiotic Prescribing ◽

Prescribing Behavior ◽

Using Data ◽

New Guidelines ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance. Objectives To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019. Methods Retrospective study using data extracted from the medico-administrative database ‘OpenMedic’ that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber’s specialty. Results Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (− 2% for the same period). Conclusion These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.

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Please, Do Not Interrupt Me: Work–Family Balance and Segmentation Behavior as Mediators of Boundary Violations and Teleworkers’ Burnout and Flourishing

Sustainability ◽

10.3390/su13137339 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7339

Author(s):

Vânia Sofia Carvalho ◽

Alda Santos ◽

Maria Teresa Ribeiro ◽

Maria José Chambel

Keyword(s):

Well Being ◽

Work And Family ◽

Future Research ◽

Boundary Violations ◽

Family Balance ◽

Work Family Balance ◽

Work Family ◽

Using Data ◽

The Relationship

The lockdown, in the COVID-19 pandemic, is considered an external crisis that evokes innumerous changes in individuals lives. One of the changes is the work and family dynamics. Based on boundary theory we examine the mediated role of work and family balance and boundary segmentation behavior in the relationship between boundary violations and teleworkers’ stress and well-being. However, because women and men live their work and family differently, gender may condition the way teleworkers lead with boundary violations and boundary segmentation. Hypotheses were tested through moderated mediation modeling using data collected of 456 teleworkers during lockdown. In line with our expectations, teleworkers who have suffered most boundary violations were those with least boundary segmentation behaviors and with least work-family balance which, in turn was related to higher burnout and lower flourishing. Furthermore, gender was found to moderate the relationship between boundary violations from work-to-family and segmentation behavior in the same direction and this relationship was stronger for females than for males. We discuss implications for future research and for managing teleworkers, creating sustainability, both during a crise and stable days.

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Chemical Constituents and Biological Activities of Cordia Myxa L.: A Review

The Natural Products Journal ◽

10.2174/2210315511666210210161803 ◽

2021 ◽

Vol 11 ◽

Author(s):

Varinder Singh ◽

Ankita Sood ◽

Simran Pruthi ◽

Manjinder Singh ◽

Balraj Saini ◽

...

Keyword(s):

Biological Activities ◽

Chemical Constituents ◽

Antimicrobial Activities ◽

Functional Health ◽

Future Research ◽

Health Food ◽

Toxicological Evaluation ◽

Cordia Myxa ◽

Chronic Fever ◽

Tract Infections

Background: Cordia myxa L. (CM) is a valuable ethnomedicinal plant from Boraginaceae family. Traditionally, CM parts especially fruits and leaves are used in chest and urinary tract infections, diarrhoea, dysentery, tuberculosis, liver and spleen disorders, chronic fever, malaria etc. Objective: Despite of known importance and uses, CM has gained relatively less attention of researchers and concise reviews revealing the medicinal potential of CM are scanty. The present review summarizes the chemical constituents and biological activities of CM and aims to stimulate future research to develop it as a functional health food. Results: Analysis of literature on CM showed that its fruits are a rich source of nutrients and are frequently employed in wide ailments such as urinary and respiratory tract infections, chronic fever, liver disorders, asthma, used as anthelmintic, diuretic, expectorant and purgative. Scientific studies have shown the antidiabetic, analgesic, anti-inflammatory, anti-cancer, antioxidant, antiplasmodial, hepatoprotective, hypotensive, antiulcer and antimicrobial activities of CM. More than 45 compounds belonging to carbohydrates, steroids, carotenoids, phenols, flavonoids and alkaloids have been reported from various parts of CM. Conclusion: Systematic preclinical studies support the traditional claims of CM. The analysis of available literature showed that CM could be developed as a drug. Further, studies such as detailed pharmacological and toxicological evaluation, isolation of bioactive compounds, quantitative phytochemistry and structure activity relationship are scanty and thus, crucial to be addressed for uplifting the scientific value of this revered medicinal plant.

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Coprescribing of Benzodiazepines and Opioids in Older Adults: Rates, Correlates, and National Trends

The Journals of Gerontology Series A ◽

10.1093/gerona/gly283 ◽

2018 ◽

Vol 74 (12) ◽

pp. 1910-1915 ◽

Cited By ~ 8

Author(s):

Taeho Greg Rhee

Keyword(s):

Older Adults ◽

Future Research ◽

Physician Visits ◽

Prescribing Trends ◽

Clinical Diagnoses ◽

Nationally Representative ◽

Using Data ◽

National Trends ◽

Ambulatory Medical Care ◽

Over Time

Abstract Background To estimate prescribing trends of and correlates independently associated with coprescribing of benzodiazepines and opioids among adults aged 65 years or older in office-based outpatient visits. Methods I examined a nationally representative sample of office-based physician visits by older adults between 2006 and 2015 (n = 109,149 unweighted) using data from the National Ambulatory Medical Care Surveys (NAMCS). National rates and prescribing trends were estimated. Then, I used multivariable logistic regression analyses to identify demographic and clinical factors associated with coprescriptions of benzodiazepines and opioids. Results From 2006 to 2015, 15,954 (14.6%) out of 109,149 visits, representative of 39.3 million visits nationally, listed benzodiazepine, opioid, or both medications prescribed. The rate of prescription benzodiazepines only increased monotonically from 4.8% in 2006–2007 to 6.2% in 2014–2015 (p < .001), and the rate of prescription opioids only increased monotonically from 5.9% in 2006–2007 to 10.0% in 2014–2015 (p < .001). The coprescribing rate of benzodiazepines and opioids increased over time from 1.1% in 2006–2007 to 2.7% in 2014–2015 (p < .001). Correlates independently associated with a higher likelihood of both benzodiazepine and opioid prescriptions included: female sex, a visit for chronic care, receipt of six or more concomitantly prescribed medications, and clinical diagnoses of anxiety and pain (p < .01 for all). Conclusion The coprescribing rate of benzodiazepines and opioids increased monotonically over time in outpatient care settings. Because couse of benzodiazepines and opioids is associated with medication burdens and potential harms, future research is needed to address medication safety in these vulnerable populations.

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Historical variation and trends in storminess along the Portuguese South Coast

Natural Hazards and Earth System Science ◽

10.5194/nhess-11-2407-2011 ◽

2011 ◽

Vol 11 (9) ◽

pp. 2407-2417 ◽

Cited By ~ 40

Author(s):

L. P. Almeida ◽

Ó. Ferreira ◽

M. I. Vousdoukas ◽

G. Dodet

Keyword(s):

Wave Height ◽

Linear Increase ◽

Annual Number ◽

The North ◽

Storm Wave ◽

Using Data ◽

The North Atlantic Oscillation ◽

Historical Variation ◽

Storm Characteristics ◽

South Portugal

Abstract. This work investigates historical variation and trends in storm climate for the South Portugal region, using data from wave buoy measurements and from modelling, for the period 1952 to 2009. Several storm parameters (annual number of storms; annual number of days with storms; annual maximum and mean individual storm duration and annual 99.8th percentile of significant wave height) were used to analyse: (1) historical storminess trends; (2) storm parameter variability and relationships; and (3) historical storminess and its relationship to the North Atlantic Oscillation (NAO). No statistically significant linear increase or decrease was found in any of the storm parameters over the period of interest. The main pattern of storm characteristics and extreme wave heights is an oscillatory variability with intensity peaks every 7–8 yr, and the magnitude of recent variations is comparable with that of variations observed in the earlier parts of the record. In addition, the results reveal that the NAO index is able to explain only a small percentage of the variation in storm wave height, suggesting that more local factors may be of importance in controlling storminess in this region.

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