scholarly journals Evaluasi Kesesuaian Penggunaan Antbiotik pada Pasien dengan Infeksi Methicillin Resistant Staphylococcus Aureus (MRSA) di RSUD. Dr. Moewardi Surakarta

2021 ◽  
Vol 17 (1) ◽  
pp. 15
Author(s):  
Tristina Devi Azzahra ◽  
Titik Nuryastuti ◽  
Ika Puspitasari
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Pharmacokinetic Profile ◽  
Antibiotic Use ◽  
Pharmacokinetic Parameters ◽  
Resistant Organism ◽  
Good Clinical Outcome ◽  
Dose Frequency ◽  
Mrsa Infection ◽  
The Relationship

MRSA is one of the Multi Drug Resistant Organism (MDRO) with a high number of cases and problem. Incidence of MRSA in Indonesia is quite significant every years. In 1986 there were 2.5%, 1993 increased to 9.4% and in 2006 23.5%. The problem is methicillin is no longer effective and other antibiotics vary in efficacy. The aims of this reasearch was to evaluate the used of antibiotics in patients with MRSA infection in Dr. Moewardi Hospital in Surakarta. The study was performed using retrospective Cohort study to examine the relationship between suitability antibiotic to clinical outcomes in patients with MRSA infection in Dr. Moewardi Hospital in Surakarta during period 1 January 2017 - 31 December 2018. The evaluation was conducted to the suitability of type, dose, frequency, duration of antibiotic use and pharmacokinetic profile. Chi-square test was used to analyse the relationship of antibiotic suitability to clinical outcomes including predicted pharmacokinetic parameters for clinical outcomes.There were 28 samples with MRSA infection tested in this study. Twenty one patients (75%) used appropriate antibiotics showed good clinical outcome 21 patients (85,7%) and 7 patients (25%) with unsuitable antibiotics showed good clinical outcome 71,4%.Keywords: antibiotic, clinical outcome, pharmacokinetic, MRSA.

Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial

2016 ◽  
Vol 9 (10) ◽  
pp. 929-932 ◽  
Author(s):  
Maxim Mokin ◽  
Elad I Levy ◽  
Adnan H Siddiqui ◽  
Mayank Goyal ◽  
Raul G Nogueira ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Stent Retriever ◽  
Study Cohort ◽  
Prime Trial ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
Clot Burden ◽  
Proximal Occlusion ◽  
The Relationship

BackgroundThe clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown.ObjectiveTo evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial.MethodsCBS was calculated for the endovascular arm (IV tissue plasminogen activator plus Solitaire stent retriever) of SWIFT PRIME using baseline CTA. The cohort of 69 patients was divided into three groups according to their CBS values: CBS 0–5 (n=14), CBS 6–7 (n=23), and CBS 8–9 (n=32).ResultsThe mean age of the 69 patients who formed the study cohort was 63.2±13.1 years, mean National Institutes of Health Stroke Scale score was 16.8±4.5, and 55% of the patients were male. There was no difference in clinical characteristics among the three groups, except for the baseline Alberta Stroke Program Early CT Score (p=0.049). The site of proximal occlusion varied significantly among the three groups (p<0.001). Rates of successful recanalization (TICI 2b/3), complete recanalization (TICI 3 only) and of good clinical outcome at 3 months were similar among the three groups (p=0.24, p=0.35, and p=0.52, respectively).ConclusionsThe combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.

scholarly journals Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haley J. Appaneal ◽  
Theresa I. Shireman ◽  
Vrishali V. Lopes ◽  
Vincent Mor ◽  
David M. Dosa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Antibiotic Use ◽  
Poor Clinical Outcome ◽  
Dose Frequency ◽  
Term Care ◽  
Increased Risk

Abstract Background Antibiotic use is associated with several antibiotic-related harms in vulnerable, older long-term care (LTC) residents. Suboptimal antibiotic use may also be associated with harms but has not yet been investigated. The aim of this work was to compare rates of poor clinical outcomes among LTC residents with UTI receiving suboptimal versus optimal antibiotic treatment. Methods We conducted a retrospective cohort study among residents with an incident urinary tract infection (UTI) treated in Veterans Affairs LTC units (2013–2018). Potentially suboptimal antibiotic treatment was defined as use of a suboptimal initial antibiotic drug choice, dose frequency, and/or excessive treatment duration. The primary outcome was time to a composite measure of poor clinical outcome, defined as UTI recurrence, acute care hospitalization/emergency department visit, adverse drug event, Clostridioides difficile infection (CDI), or death within 30 days of antibiotic discontinuation. Shared frailty Cox proportional hazard regression models were used to compare the time-to-event between suboptimal and optimal treatment. Results Among 19,701 LTC residents with an incident UTI, 64.6% received potentially suboptimal antibiotic treatment and 35.4% experienced a poor clinical outcome. In adjusted analyses, potentially suboptimal antibiotic treatment was associated with a small increased hazard of poor clinical outcome (aHR 1.06, 95% CI 1.01–1.11) as compared with optimal treatment, driven by an increased hazard of CDI (aHR 1.94, 95% CI 1.54–2.44). Conclusion In this national cohort study, suboptimal antibiotic treatment was associated with a 6% increased risk of the composite measure of poor clinical outcomes, in particular, a 94% increased risk of CDI. Beyond the decision to use antibiotics, clinicians should also consider the potential harms of suboptimal treatment choices with regards to drug type, dose frequency, and duration used.

scholarly journals Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (4) ◽  
pp. 504
Author(s):  
Dalibor Sila ◽  
Markus Lenski ◽  
Maria Vojtková ◽  
Mustafa Elgharbawy ◽  
František Charvát ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Good Clinical Outcome ◽  
Significant Difference ◽  
Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

Abstract W P48: Flair Vessel Hyper-intensities Could Predict Target Mismatch Signs in Acute Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Manabu Inoue ◽  
Michael Mlynash ◽  
Carlo W Cerada ◽  
Nishant K Mishra ◽  
Soren Christensen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Stroke Patients ◽  
Good Clinical Outcome ◽  
Kappa Score ◽  
Early Reperfusion ◽  
Diffusion Weighted Images ◽  
Fluid Attenuated Inversion Recovery

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.

Abstract T P13: Effect of Pre-treatment Cerebral Blood Volume and Time to Recanalization on Good Clinical Outcomes in Endovascular Thrombectomy

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tomohide Yoshie ◽  
Toshihiro Ueda ◽  
Tatsuro Takada ◽  
Shinji Nogoshi ◽  
Fumio Miyashita ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Cerebral Blood Volume ◽  
Modified Rankin Scale ◽  
Good Clinical Outcome ◽  
Endovascular Thrombectomy ◽  
Outcome Group ◽  
Pre Treatment ◽  
Mean Time

Introduction: Previous studies suggested that faster times to recanalization led to better clinical outcomes in patients after endovascular thrombectomy. Hypothesis: We assessed the hypothesis that an association between time to recanalization and clinical outcomes depends on cerebral blood volume (CBV) obtained from pre-treatment CT perfusion (CTP). Methods: In consecutive patients with acute ischemic stroke who were obtained successful recanalization (TICI 2A-3) by endovascular thrombectomy for internal carotid artery or middle cerebral artery M1 occlusion, we retrospectively analyzed the influence on clinical outcome of time to recanalization and relative CBV value (rCBV) evaluated by pre-treatment CTP. The patient population was divided into 3 groups according to rCBV: severe decreased rCBV group (rCBV <0.6), mild decreased rCBV group (rCBV 0.6 to 0.9) and normal rCBV group (rCBV >0.9). In each group, we compared time to recanalization from onset and CTP between good clinical outcome group (modified Rankin Scale score ≤2 at day 90) and poor clinical outcome group (modified Rankin Scale score ≥3). Results: Fifty-seven patients were eligible for this study. The mean age was 75.3 years and median baseline NIHSS was 17. Nineteen patients (33.3 %) achieved good clinical outcome. In the severe decreased rCBV group, mean time to recanalization from onset and CTP were 192 and 115 minutes, respectively, but no patient had a good clinical outcome. In the mild decreased rCBV group, mean time to recanalization from onset (180 versus 311 minutes, p=0.034) and CTP (102 versus 169 minutes, p=0.007) were significantly shorter in the good clinical outcome group. In the normal rCBV group, no association was found between clinical outcome and time to recanalization from onset (311 versus 313 minutes) and CTP (177 versus 184 minutes). Conclusions: Early successful recanalization resulted in better clinical outcome in patients with mild decreased rCBV. Severe decreased rCBV did not provide good outcome regardless of early successful recanalization.

The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes

2000 ◽  
Vol 30 (1) ◽  
pp. 195-204 ◽  
Author(s):  
TERESA TATTAN ◽  
NICHOLAS TARRIER
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Positive Relationship ◽  
Expressed Emotion ◽  
Case Manager ◽  
Case Managers ◽  
Informal Carers ◽  
The Relationship

Background. Expressed emotion (EE) measured from relatives and informal carers has been consistently demonstrated to be associated with clinical outcome in schizophrenic patients. There have also been published studies that have investigated EE in professional carers that have suggested that the quality of the relationship between staff and patient may also be associated with patient outcomes. A large controlled trial of the effectiveness of different intensities of case management provided the opportunity to assess the association between the EE of case managers, including the quality of the relationship they had with patients under their care, and later clinical outcomes.Method. This was a prospective naturalistic study of EE present in a case manager–patient dyad and subsequent patient outcomes. EE was assessed from the Five Minute Speech Sample (FMSS) at least 3 months after the case manager became responsible for the patient's care and a range of clinical outcomes were assessed 6 to 9 months later. Assessment of clinical outcomes was made independent and blind of the EE ratings.Results. High EE ratings were significantly associated with individual case managers and not to symptom or illness factors. High EE was not associated with later clinical outcome, however, the positive relationship between case manager and patient was. The absence of a positive relationship was significantly associated with poorer outcomes.Conclusions. In spite of very low face-to-face contact between case managers and patients, compared with the amount of contact patients have with their informal carers and family, aspects of staff attitudes and behaviour did influence clinical outcome. There are potential implications of these results for staff training and clinical practice.

Population health impact of extended window thrombectomy in acute ischemic stroke

2020 ◽  
pp. 159101992097220
Author(s):  
Minerva H Zhou ◽  
Akash P Kansagra
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Clinical Trial Data ◽  
Population Level ◽  
Health Impact ◽  
Stroke Severity ◽  
Good Clinical Outcome ◽  
Absolute Increase ◽  
Stroke Center ◽  
The Impact

Background Recent trials support endovascular thrombectomy (EVT) in select patients beyond the conventional 6-hour window. Objective In this work, we estimate the impact of extended window EVT on procedural volumes and population-level clinical outcomes using Monte Carlo simulation. Methods We simulated extending EVT eligibility in a system comprising an EVT-incapable primary stroke center (PSC) and EVT-capable comprehensive stroke center (CSC) using routing paradigms that initially direct patients to (1) the nearest center, (2) the CSC, or (3) either CSC or nearest center based on stroke severity. EVT eligibility and outcomes are based on HERMES, DEFUSE-3, and DAWN studies in the 0-6, 6-16, and 16-24 hour windows, respectively. Probability of good clinical outcome is determined by type and timing of treatment using clinical trial data. Results Relative increase in EVT volume in the three tested routing paradigms was 15.7-15.8%. The absolute increase in the rate of good clinical outcome 0.4% in all routing paradigms. NNT for extended window EVT was 239.9-246.4 among the entire stroke population. Conclusion Extended window EVT with DEFUSE-3 and DAWN criteria increases EVT volume and modestly improves population-level clinical outcomes.

Abstract 126: Inpatient Rehabilitation Facility Disposition Improves Odds For Good Clinical Outcome After Endovascular Stroke Reperfusion Therapy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Samir R Belagaje ◽  
Vishal Patel ◽  
Chung-Huan Sun ◽  
Cedric Pimentel ◽  
Brenda Glenn ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Binary Logistic Regression ◽  
Inpatient Rehabilitation ◽  
Apache Ii ◽  
Lower Probability ◽  
Good Clinical Outcome ◽  
Discharge Disposition ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

INTRO: A person with stroke has improved outcomes with post-acute care in an inpatient rehabilitation facility (IRF) compared to those who are discharged to a skilled nursing facility (SNF). However, this research was conducted in an era before acute stroke treatment was widely implemented. Endovascular reperfusion reduces ischemic stroke volume; however treatment effect may be diluted by discharge disposition. In this analysis, we hypothesize that patients will have better 90 day outcomes if they are discharged to a IRF or home compared to a SNF. METHODS: Subjects were identified from a prospective database tracking clinical outcomes of patients treated with endovascular reperfusion from a single primary care stroke center. Data included discharge disposition, NIHSS, THRIVE, HIAT-2, & APACHE II scores, and successful reperfusion. Univariate analysis was performed to assess predictors of good clinical outcome as defined by 90 day modified Rankin scores (mRS) ≤ 2. A binary logistic regression model was used to determine the impact placement to IRF versus a SNF on clinical outcomes. RESULTS: 177 subjects were included in the analyis; mean age was 66±14 and median NIHSS was 20. Modified APACHE II, NIHSS, THRIVE, & HIAT-2 scores were not different between the two groups Discharge dispositions included: 35(19.8%)home, 38(21.5%) IRF, 47(26.6%)SNF and 57(32.3%) died/went to hospice. Of the 85 patients discharged to SNF or IRF, only 26% of patients discharged to SNF compared to 50% to IRF achieved a good clinical outcome (p-value <0.03). In binary logistic regression modeling, after adjusting for age, infarct volume, pre-treatment ASPECT & NIHSS scores, and modified APACHE II score, disposition to SNF was significantly associated with a lower probability of achieving a mRS of 0-2 at 90 days, OR 3.31(95%CI 1.06-9.62, p<0.04). CONCLUSIONS: In our study, subjects discharged to SNF and IRF after thrombectomy have similar medical and neurological severity at admission and similar final infarct volumes at discharge. Despite these similarities, patients discharged to SNF had a significantly lower probability of achieving a good neurological outcome. Further study is required to determine if IRF could be considered in more patients to improve clinical outcomes.

Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques

2015 ◽  
Vol 8 (11) ◽  
pp. 1123-1128 ◽  
Author(s):  
Josser E Delgado Almandoz ◽  
Yasha Kayan ◽  
Mark L Young ◽  
Jennifer L Fease ◽  
Jill M Scholz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Independent Predictor ◽  
National Institutes Of Health ◽  
Good Clinical Outcome ◽  
Anterior Circulation ◽  
First Pass ◽  
Symptomatic Intracranial Hemorrhage

PurposeTo compare rates of symptomatic intracranial hemorrhage (SICH) and good clinical outcome at 90 days in patients with ischemic strokes from anterior circulation emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy using either Solumbra or A Direct Aspiration first-Pass Thrombectomy (ADAPT) techniques.MethodsWe compared clinical characteristics, procedural variables, and clinical outcomes in patients with anterior circulation ELVOs treated with mechanical thrombectomy using either a Solumbra or ADAPT technique at our institution over a 38-month period. SICH was defined using the SITS-MOST criteria. A good clinical outcome was defined as a modified Rankin Scale score of 0–2 at 90 days.ResultsOne hundred patients were included, 55 in the Solumbra group and 45 in the ADAPT group. Patients in the ADAPT group had higher National Institutes of Health Stroke Scale (NIHSS) (19.2 vs 16.8, p=0.02) and a higher proportion of internal carotid artery terminus thrombi (42.2% vs 20%, p=0.03) than patients in the Solumbra group. Patients in the ADAPT group had a trend toward a lower rate of SICH than patients in the Solumbra group (2.2% vs 12.7%, p=0.07). Patients in the ADAPT group had a significantly higher rate of good clinical outcome at 90 days than patients in the Solumbra group (55.6% vs 30.9%, p=0.015). Use of the ADAPT technique (OR 6 (95% CI 1.0 to 31.2), p=0.049) was an independent predictor of a good clinical outcome at 90 days in our cohort.ConclusionsIn our cohort, the ADAPT technique was associated with significantly higher good clinical outcomes at 90 days in patients with acute ischemic stroke due to anterior circulation ELVOs treated with mechanical thrombectomy.

Triple pelvic osteotomy in dogs less than 12 kg in weight

2010 ◽  
Vol 23 (06) ◽  
pp. 453-458 ◽  
Author(s):  
Y. M. Beosier ◽  
R. Daems ◽  
L. A. A. Janssens
Keyword(s):  
Body Weight ◽  
Femoral Head ◽  
Clinical Outcome ◽  
Head And Neck ◽  
Clinical Outcomes ◽  
Hip Dysplasia ◽  
Pelvic Osteotomy ◽  
Treatment Method ◽  
Good Clinical Outcome

SummaryTriple pelvic osteotomy (TPO) was used to treat a selected group of young dogs with clinical and radiographic signs of hip dysplasia. Good clinical outcomes have been reported in dogs between 17–85 kg body weight. Hip dysplasia however is also en-countered in smaller dogs. If surgery is performed in smaller dogs, femoral head and neck ostectomy is the main treatment method used. We wanted to determine if TPO could also be used in dogs under 12 kg bodyweight. Our study showed that it is technically possible to perform TPO surgery in dogs less than 12 kg of weight (down to 4.6 kg) with a good clinical outcome even in hips with high angles of reduction and subluxation.

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