scholarly journals The Impact of First Timing of Antibiotics for Community Acquired Pneumonia in Emergency Department

2020 ◽  
Author(s):  
Yiwu Zhou ◽  
Casey M. Clements ◽  
Man Li ◽  
Yanqi He ◽  
Rong Yao
Keyword(s):  
Quality Care ◽  
Severity Of Illness ◽  
Community Acquired Pneumonia ◽  
Antibiotic Overuse ◽  
Improved Outcomes ◽  
Clinical Scenarios ◽  
Key Factor ◽  
Short Term Mortality ◽  
Poor Outcomes ◽  
The Impact

Background: The reported associations between time to first antibiotic dose after hospital arrival and short-term mortality have varied in prior studies of CAP. It is unclear the benefit of early antibiotics in all patients given the risks of antibiotic overuse and misdiagnosis; Methods: A PubMed and Google Scholar search was performed to identify articles detailing the epidemiology, prognosis, diagnosis, and preliminary management of CAP; Results: In sepsis, antibiotics should not be delayed, and should be administered as soon as possible after recognition. For moderate or severe CAP patients without sepsis, antibiotics should be administered as soon as the diagnosis of CAP is highly likely. For stable, non–critically ill patients with CAP, the timing of antibiotics is not as clear and available evidence does not recommend strict requirements. Antibiotic timing – both rapid and delayed could be used as indicators of quality care in differing clinical scenarios; Results: The dogma of starting antibiotics quickly, within a rigid timeframe of expectations and guidelines has not improved outcomes in pneumonia patients, and has led to an increase in antibiotic treatment in uninfected patients. Severity of illness is the key factor associated with poor outcomes and should more significantly guide the timing of antibiotic initiation.

The impact of first Timing of antibiotics for community acquired pneumonia in emergency department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Severity Of Illness ◽  
Clinical Situation ◽  
Community Acquired Pneumonia ◽  
Antibiotic Administration ◽  
Eligibility Criteria ◽  
Antibiotic Overuse ◽  
The Impact

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

scholarly journals Do We Understand the Impact of Altered Physiology, Consequent Interventions and Resultant Clinical Scenarios in the Intensive Care Unit? the Antibiotic Story

2011 ◽  
Vol 39 (6) ◽  
pp. 999-1000 ◽  
Author(s):  
J. Lipman ◽  
A. A. Udy ◽  
J. A. Roberts
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Care Physician ◽  
Therapeutic Success ◽  
Adequate Dose ◽  
Improved Outcomes ◽  
Clinical Scenarios ◽  
Key Factor ◽  
Altered Physiology ◽  
The Impact

Early, appropriate antibacterial therapy is a key factor in effectively managing septic critically ill patients1. The prescriber must not only employ an agent of appropriate spectrum, but also in an adequate dose to achieve bacterial eradication at the site of infection. However, the relationship between drug administration and therapeutic success is complex in the critically ill, such that a patient's physiology heavily influences the way drugs distribute into tissue and are eliminated. This represents a significant challenge to the emergency or intensive care physician, and in this manner, personalising therapy, through a greater understanding of how a drug will behave in an individual patient, is likely to lead to improved outcomes.

scholarly journals Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 745
Author(s):  
Wenjuan Cong ◽  
Ak Narayan Poudel ◽  
Nour Alhusein ◽  
Hexing Wang ◽  
Guiqing Yao ◽  
...  
Keyword(s):  
Critical Illness ◽  
Scoping Review ◽  
Clinical Evidence ◽  
Length Of Hospital Stay ◽  
Severity Of Illness ◽  
Antibiotic Prescribing ◽  
Antimicrobial Use ◽  
Clinical Scenarios ◽  
Scoping Reviews ◽  
The Impact

This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.

Abstract WMP6: Delayed Device Access to the Occluded Target Vessel Predicts Worse Recanalization Rates and Poor Outcomes in Endovascular Therapy for Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marc Ribo ◽  
Brian Jankowitz ◽  
Syed Zaidi ◽  
Mouhammad Jumaa ◽  
Jennifer Oakley ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Infarct Volume ◽  
Univariate Analysis ◽  
Favorable Outcome ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Improved Outcomes ◽  
Poor Outcomes ◽  
Left Hemisphere Stroke ◽  
The Impact

During embolectomy for acute stroke, transfemoral access to occluded vessel may be technically difficult. We aim to study the impact of difficult catheter access to target artery. Methods: Single center review of anterior circulation stroke patients enrolled in prospective trials/registries (MR Rescue, MERCI, DEFUSE) requiring recording of time from groin puncture to first device deployment(Tdep). Patients were divided according to Tdep quartiles (Q): patients in Q4 were considered as difficult access. We recorded recanalization (TICI≥2a), complete recanalization (TICI≥2b), infarct volume(24h DWI), day 5 NIHSS, and favorable outcome (3 months mRS≤2). Results: We included 196 patients, mean age 66±14, median NIHSS 16(IQR:12-21). Overall outcomes were: median Tdep 52 min (36-77), recanalization 89.1%, complete recanalization 59.4%, favorable outcome 43.8%. We observed a positive correlation between Tdep and day 5 NIHSS (r=0.27; p=0.01) or 3 months mRS (r=0.26; p<0.01). Patients with difficult access (Q4: Tdep>77 min) had similar baseline NIHSS (16 Vs 17 p=0.58), time from symptom to procedure start (433 Vs 371min; p=0.28) and occlusion location (ICA/M1/M2: 46.7/42.2/11.1% Vs 39.1/54.3/6.5%; p=0.31). However, patients in Q4 had: longer IA procedures (153 vs 112 min;p<0.01), lower complete recanalization (41% Vs 66%;p<0.01), larger infarcts (87 Vs 53cc; p<0.01), higher day 5 NIHSS (15 Vs 9;p<0.01), and less favorable outcome (29.2% Vs 49%; p=0.02). After adjusting by age and time to reperfusion, a regression model identified admission NIHSS (OR% 1.12: 95%CI 1.02-1.21; p<0.01), age (OR% 1.03: 95%CI 1.01-1.06; p=0.01) and Tdep (OR% 1.02 95%CI 1.01-1.03; p=0.01) as independent predictors of poor outcome. In univariate analysis age>69, male gender and left hemisphere stroke were associated with difficult access. The combined presence of the 3 factors increased by 3.5 fold the likelihood of difficult access (OR:3.55 95%CI 1.5-8.6: p<0.01) Conclusion: Delayed device access to target occluded artery independently predicts poor outcome. Identification of difficult access using clinical scores or imaging may lead to alternative strategies; brachial, radial or cervical approaches that could result in shortened procedural times and improved outcomes

scholarly journals Influenza and Community-acquired Pneumonia Interactions: The Impact of Order and Time of Infection on Population Patterns

2012 ◽  
Vol 175 (5) ◽  
pp. 363-367 ◽  
Author(s):  
Brian M. Davis ◽  
Allison E. Aiello ◽  
Suzanne Dawid ◽  
Pejman Rohani ◽  
Sourya Shrestha ◽  
...  
Keyword(s):  
Influenza A ◽  
Animal Studies ◽  
Severe Disease ◽  
Severity Of Illness ◽  
Population Level ◽  
Community Acquired Pneumonia ◽  
Swine Flu ◽  
1918 Influenza ◽  
The Impact

AbstractDiscoveries made during the 1918 influenza A pandemic and reports of severe disease associated with coinfection during the 2009 hemagglutinin type 1 and neuraminidase type 1 (commonly known as H1N1 or swine flu) pandemic have renewed interest in the role of coinfection in disease pathogenesis. The authors assessed how various timings of coinfection with influenza virus and pneumonia-causing bacteria could affect the severity of illness at multiple levels of interaction, including the biologic and population levels. Animal studies most strongly support a single pathway of coinfection with influenza inoculation occurring approximately 7 days before inoculation with Streptococcus pneumoniae, but less-examined pathways of infection also may be important for human disease. The authors discussed the implications of each pathway for disease prevention and what they would expect to see at the population level if there were sufficient data available. Lastly, the authors identified crucial gaps in the study of timing of coinfection and proposed related research questions.

Competition Policy under Economic Crisis

2009 ◽  
pp. 54-69 ◽  
Author(s):  
A. Shastitko ◽  
S. Avdasheva ◽  
S. Golovanova
Keyword(s):  
Division Of Labor ◽  
Economic Crisis ◽  
Industrial Policy ◽  
Competition Policy ◽  
Transition Economy ◽  
Economic Recession ◽  
Price Rigidity ◽  
Key Factor ◽  
Policy Measures ◽  
The Impact

The analysis of competition policy under economic crisis is motivated by the fact that competition is a key factor for the level of productivity. The latter, in its turn, influences the scope and length of economic recession. In many Russian markets buyers' gains decline because of the weakness of competition, since suppliers are reluctant to cut prices in spite of the decreasing demand. Data on prices in Russia and abroad in the second half of 2008 show asymmetric price rigidity. At least two questions are important under economic crisis: the 'division of labor' between pro-active and protective tools of competition policy and the impact of anti-crisis policy on competition. Protective competition policy is insufficient in transition economy, especially in the days of crisis it should be supplemented with the well-designed industrial policy measures which do not contradict the goals of competition. The preferable tools of anti-crisis policy are also those that do not restrain competition.

Designing a CRM Framework for online & offline sports footwear retailers

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Rodrigo Cueva ◽  
Guillem Rufian ◽  
Maria Gabriela Valdes
Keyword(s):  
Environmental Changes ◽  
Customer Relationship ◽  
Business Strategies ◽  
Economic Sectors ◽  
Running Shoes ◽  
Brick And Mortar ◽  
Key Factor ◽  
On Line ◽  
The Impact

The use of Customer Relationship Managers to foster customers loyalty has become one of the most common business strategies in the past years.  However, CRM solutions do not fill the abundance of happily ever-after relationships that business needs, and each client’s perception is different in the buying process.  Therefore, the experience must be precise, in order to extend the loyalty period of a customer as much as possible. One of the economic sectors in which CRM’s have improved this experience is retailing, where the personalized attention to the customer is a key factor.  However, brick and mortar experiences are not enough to be aware in how environmental changes could affect the industry trends in the long term.  A base unified theoretical framework must be taken into consideration, in order to develop an adaptable model for constructing or implementing CRMs into companies. Thanks to this approximation, the information is complemented, and the outcome will increment the quality in any Marketing/Sales initiative. The goal of this article is to explore the different factors grouped by three main domains within the impact of service quality, from a consumer’s perspective, in both on-line and off-line retailing sector.  Secondly, we plan to go a step further and extract base guidelines about previous analysis for designing CRM’s solutions focused on the loyalty of the customers for a specific retailing sector and its product: Sports Running Shoes.

Glucose Levels and Outcome After Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Incidence Rate ◽  
Glucose Level ◽  
Intraventricular Hemorrhage ◽  
Laboratory Data ◽  
History Of ◽  
Poor Outcomes ◽  
The Impact

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

Sign in / Sign up

Export Citation Format

Share Document