scholarly journals Postoperative Antibacterial Prophylaxis in Vascular Surgery: Analysis of its Parameters Before and After Evaluation of Justification of Chosen Indications

2020 ◽  
Vol 18 (1) ◽  
pp. 48-51
Author(s):  
Edgars Supols
Keyword(s):  
Vascular Surgery ◽  
Retrospective Analysis ◽  
Structural Unit ◽  
Infectious Complications ◽  
University Hospital ◽  
Antibacterial Prophylaxis ◽  
Evidence Based ◽  
Surgical Practice ◽  
Before And After ◽  
One Year

SummaryIn surgical practice, antibacterial prophylaxis (AP) is widely used to reduce the risk of possible infectious complications; it is not always administrated according to evidence-based clinical indications. Administration of AP in cases when its inefficiency for exact situation has been scientifically proven, should be considered as unwarranted. A one-year-long retrospective analysis of AP cases in the Department of Vascular Surgery of Pauls Stradins Clinical University Hospital was performed and the results were broadly analyzed within the local structural unit. It was followed by the development of the local guidelines for administration of antibiotics, as a result, a significant decrease in cases of unwarranted AP has been achieved.

scholarly journals A Retrospective Analysis of Owner-reported Reasons for Canine Illness and Injury Visits in Veterinary General Practice: A List of the Top 50% of Complaints

2020 ◽  
Author(s):  
Gilbert Patterson ◽  
Michele O. Trofatter ◽  
Kathryn E. Daily-Trude ◽  
Rebecca L. Pierce ◽  
Stanley R. Robertson ◽  
...  
Keyword(s):  
General Practice ◽  
Retrospective Analysis ◽  
Care Delivery ◽  
Evidence Based ◽  
Delivery Methods ◽  
Veterinary Students ◽  
List Ranking ◽  
Veterinary Practice ◽  
One Year ◽  
Case Presentations

Abstract Background Veterinarians are required to use critical thinking and communication skills to proficiently guide a client through available options for disease treatment or management. While multiple viable approaches exist for treating common problems, data describing the actual types of owner-reported complaints most often encountered in general veterinary practices is lacking. An understanding of the nature and distribution of common conditions, as reported by the owner, is a key step in providing the evidence-based foundation directing further efforts toward solutions to overcome barriers in general practice, veterinary-care delivery. Methods A retrospective analysis of common canine owner-reported complaints presented in general veterinary practice over a one-year period was performed. Data was collected from participating practices, cleaned, and analyzed to reflect the top 50% new presenting complaints of owners at all participating practices for canine patients with an illness or injury during their visit. Results The outcome is a comprehensive list ranking the top canine owner-reported presenting illnesses/injuries complaints seen by general veterinary practices included in the study. Conclusions These results provide evidence-based knowledge of the distribution of owner complaints potentially encountered in general practice, providing justification for the need to emphasize certain clinical case presentations in veterinary educational curriculums. Being prepared with such knowledge, veterinary students can be empowered with the necessary skills and tools required to provide informed, ethical, and affordable choices for canine care in the general veterinary practice setting. This information also provides the scientific foundation for canine conditions which may benefit from additional evidence-based trials to better identify the outcomes of spectrum of care interventions for benefits to the owner, the canine, and the veterinarian.

scholarly journals Use of port-a-cath in cancer patients: a single-center experience

2014 ◽  
Vol 8 (11) ◽  
pp. 1476-1482 ◽  
Author(s):  
Philomena Charlotte D’Souza ◽  
Shiyam Kumar ◽  
Annupam Kakaria ◽  
Rashid Al-Sukaiti ◽  
Khawaja Farhan Zahid ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cox Regression ◽  
Infectious Complications ◽  
University Hospital ◽  
Factors Affecting ◽  
Cox Regression Analysis ◽  
Sultan Qaboos University ◽  
Single Center Experience ◽  
One Year ◽  
The Right

Introduction: Central venous catheters play an important role in the management of cancer patients. Different types of devices are associated with different patterns of complications. We report on the pattern of use and rate of complications of port-a-caths in patients diagnosed with malignant cancer at a single institution. Methodology: The data were collected retrospectively from patients who received the treatment for solid tumors or lymphoma through a port-a-cath at the Sultan Qaboos University Hospital (SQUH) between January 2007 and February 2013. Results: A total of 117 port-a-caths were inserted in 106 patients. The majority (86; 73.5%) were implanted by an interventional radiologist, and the right internal jugular vein was accessed in 79 (67.5%) patients. Mean catheter indwelling time was 354 (range 3–1,876) days for all patients, 252 (3–1,876) and 389 days (13–1,139) for patients with and without complications, respectively. Thirty (25.6%) port-a-caths were removed prematurely, mainly due to infectious complications, while 17 (14.5%) were removed after completion of treatment. Staphylococcus aureus was the most frequently isolated organism, found in 8 (6.8%) patients. Underlying diagnosis (p < 0.001), chemotherapy regimen (p < 0.001), sensitivity to antibiotics (p = 0.01), and any complication (p < 0.001) were significant factors affecting the duration of port-a-cath use. None of these factors were significant on multivariate cox regression analysis. Conclusions: The mean duration of port-a-cath use was almost one year. Infection was the most common complication leading to premature removal, followed by port thrombosis.

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Christoph Benedikt Duesberg ◽  
Christina Valtin ◽  
Jan Fuge ◽  
Frank Logemann ◽  
Thomas Fuehner ◽  
...  
Keyword(s):  
Working Hours ◽  
Standard Of Care ◽  
University Hospital ◽  
Relative Reduction ◽  
Evidence Based ◽  
Complication Rates ◽  
Single Centre ◽  
Period 2 ◽  
Before And After ◽  
Before And After Study

<b><i>Background:</i></b> Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. <b><i>Objectives:</i></b> Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. <b><i>Method:</i></b> A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. <b><i>Results:</i></b> Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (<i>p</i> &#x3c; 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. <b><i>Conclusion:</i></b> The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.

scholarly journals A Procalcitonin and C-Reactive Protein-Guided Clinical Pathway for Reducing Antibiotic Use in Children Hospitalized with Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 351
Author(s):  
Elisa Barbieri ◽  
Sara Rossin ◽  
Carlo Giaquinto ◽  
Liviana Da Dalt ◽  
Daniele Dona’
Keyword(s):  
Clinical Pathway ◽  
Lower Respiratory Tract ◽  
Antibiotic Use ◽  
University Hospital ◽  
Evidence Based ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Before And After ◽  
Quasi Experimental ◽  
Post Period

Despite the lack of evidence that bronchodilators, corticosteroids, and antibiotics are useful in treating bronchiolitis, their use is still widespread. This study aimed to determine the consumption of antibiotics for bronchiolitis before and after a procalcitonin-guided clinical pathway (CP) implementation. In December 2019, a CP for lower respiratory tract infection management was implemented at the Department of Women’s and Children’s Health at Padua University Hospital. This was a pre-post, quasi-experimental study that assessed the changes in the treatment of bronchiolitis during two bimesters preceding the CP implementation (pre-period: January 2018–February 2018 and January 2019–February 2019) and during the bimester after CP implementation (post-period January 2020–February 2020). After the CP implementation, there was a significant reduction in antibiotic prescriptions from 36.2% to 12.5% (p = 0.036) in patients hospitalized for bronchiolitis. Co-amoxiclav treatment, the antibiotic most commonly administered, decreased from 66.6% to 33.3%. Among outpatients’ bronchiolitis episodes, a statistically significant decrease in beta2-agonists’ use (from 18.0% to 4.4%, pre and post periods) and a quasi-significant decrease in corticosteroid use (from 8.0% to 0% pre and post periods) were observed. An evidence-based CP supported by educational lectures was associated with significant changes in the physicians’ prescribing habits.

scholarly journals Injection therapy for chronic prostatitis: A retrospective analysis of 77 cases

2018 ◽  
Vol 90 (1) ◽  
pp. 34 ◽  
Author(s):  
Attila Toth ◽  
Frederico Maria Guercini ◽  
Dawn Marta Feldthouse ◽  
Jun Chao Zhang
Keyword(s):  
Side Effects ◽  
Retrospective Analysis ◽  
Chronic Prostatitis ◽  
Symptom Index ◽  
Pain Scores ◽  
Symptom Scores ◽  
Before And After ◽  
One Year ◽  
Post Therapy

Objective: To compare pre- and post-therapy symptom scores reported on the National Institute of Health Chronic Prostatitis Symptom Index (NIHCPSI) after trans-rectal antibiotic injections therapy for men suffering from chronic prostatitis. Materials and methods: Retrospective analysis of NIHCPSI symptom scores obtained from chart reviews of 77 treated males suffering from chronic prostatitis before and after trans rectal injections for the treatment of chronic prostatitis. Results: Most patients reported a 40% to 60% improvement in symptom scores. In subgroups comparing scores in patients with less than 5 injections, the improvement was less than in patients who received 10 or more injections. Patients’ responses after a shorter (3 months) follow up showed better pain scores than patient’s scores after longer, over one-year or more, follow- up periods. Conclusion: Our findings show that direct antibiotic injection for chronic prostatitis is a viable addition to standard therapies. Improvements in symptom scores are long lasting. Discomfort is minimal and side effects are rare and avoidable

Hemodialysis Catheter-Related Sepsis

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Septic Shock ◽  
Cardiovascular Complications ◽  
Infectious Complications ◽  
University Hospital ◽  
Coagulase Negative Staphylococci ◽  
Hemodialysis Catheter ◽  
Candida Sp ◽  
One Year ◽  
Hospital Center

Introduction: Hemodialysis (HD) patients are exposed to various complications. Infectious complications are the second leading cause of morbidity and mortality after cardiovascular complications. The aim of our study is to describe the clinical, paraclinical and bacteriological aspects of the HD catheter-related infection. Patients and methods: We carried out a retrospective study over a period of one year, involving 25 HDs patients hospitalized in the Department of Infectious Diseases, Cardiology and Nephrology of Ibn Rochd University Hospital Center in Casablanca. Results: The majority of these patients were male (72%) with an average age of 59 years. Twenty patients had a jugular catheter. Fever was the main symptom found in all patients, associated with sepsis signs in 88% of cases, while 12% of patients were classified as a septic shock. All patients had a biological infectious syndrome with leukocytosis and positive CRP. Peripheral and catheter-based blood cultures, and culture of the distal tip of the catheter were performed in all patients., allowing the determination of the causative germ in 72% of the cases. The most frequently isolated germs were Staphylococcus aureus (66.7%), Gram-negative bacilli (16.7%), coagulase-negative staphylococci (11.1%), and Candida sp (5.5%). All patients received a probabilistic antibiotherapy based on vancomycin and amikacin combination adapted to the renal function andthe antibiogram results thereafter. Six patients had associated endocarditis. The evolution was favourable in 76% of the patients. Six patients died. The main cause of death is the septic shock (3 cases). Conclusion: Vascular access in HD deserves special attention. The prevention of infectious complications in this category is based on compliance with hygiene rules and the temporary use of catheters and then the creation of native arteriovenous fistula.

Information retrieval as a part of evidence-based practice: Retrieval skills, behavior and needs among nurses at a large university hospital

2019 ◽  
Vol 39 (4) ◽  
pp. 201-208 ◽  
Author(s):  
Anne Lee ◽  
Berit Elisabeth Alving ◽  
Mette Bøg Horup ◽  
Lars Thrysoee
Keyword(s):  
Information Retrieval ◽  
Educational Reform ◽  
Information Literacy ◽  
Evidence Based Practice ◽  
University Hospital ◽  
Bibliographic Databases ◽  
Evidence Based ◽  
Healthcare Information ◽  
Apply Research ◽  
Before And After

Nurses are required to apply research-based knowledge in order to perform evidence-based practice. A survey was conducted to identify nurses’ information-retrieval skills, behavior and needs and replies were received from 1301 nurses. The most used electronic resources for retrieval of healthcare information were the local intra-net and Google, while bibliographic databases were used to a lesser extent. Half of the respondents indicated that they were accustomed to search databases and an equal number indicated lack of time and that information retrieval was not requested by their colleagues. The majority assessed their own information-retrieval skills as good while one third lacked knowledge and described information retrieval as difficult. Significant differences in competences and use of bibliographic databases were found between nurses who had graduated before and after an educational reform in 2011. Further measures, including collaborations between librarians and nurse management, must be developed to support information literacy and evidence-based practice among nurses.

Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study

1993 ◽  
Vol 8 (3) ◽  
pp. 99-106 ◽  
Author(s):  
A. J. Leu ◽  
A. Yanar ◽  
M. Geiger ◽  
U. K. Franzeck ◽  
A. Bollinger
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Compression Therapy ◽  
Laser Doppler ◽  
University Hospital ◽  
Functional Changes ◽  
Severe Stage ◽  
Before And After ◽  
One Year ◽  
Doppler Flux

Objective: To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy. Design: Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®). Setting: Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland. Patients, participants: 15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years). Results: Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant. Conclusions: Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.

Changes in evidence-based practice beliefs and implementation after a postgraduate educational program: A before-and-after study over one year

2017 ◽  
Vol 37 (3) ◽  
pp. 164-171 ◽  
Author(s):  
Anne Kristin Snibsøer ◽  
Birgitte Espehaug ◽  
Donna Ciliska ◽  
Monica Wammen Nortvedt
Keyword(s):  
Educational Program ◽  
Healthcare Professionals ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Healthcare Outcomes ◽  
Postgraduate Educational ◽  
Before And After ◽  
One Year ◽  
Ebp Implementation ◽  
Before And After Study

Healthcare professionals are increasingly expected to use research evidence to improve healthcare outcomes. The aim of this study was to examine change in beliefs and implementation of evidence-based practice (EBP) one year after participation in a 15 ECTS postgraduate educational program in EBP. We conducted a before-and-after study among 158 healthcare professionals in a postgraduate program in EBP. Participants completed the Norwegian version of the EBP Beliefs Scale and the EBP Implementation Scale at baseline and one year after the program. Results indicated increased scores from pre-test to one year follow up on the EBP Beliefs Scale and the EBP Implementation Scale. Participants in evidence-based network groups reported higher scores on the EBP Implementation Scale than those who did not participate in these groups. Further research should examine other factors that may facilitate implementation of evidence-based practice.

scholarly journals Exploring the attitudes and experiences of adolescents with type 1 diabetes towards transition of care

2021 ◽  
Author(s):  
Saskia D’Sa ◽  
Deirdre J. Foley ◽  
Kerrie Hennigan ◽  
Maria Kelly-Conroy ◽  
Anne Quinn ◽  
...  
Keyword(s):  
Insulin Dose ◽  
University Hospital ◽  
Qualitative Assessment ◽  
Adult Care ◽  
Loss To Follow Up ◽  
Transition Clinic ◽  
Before And After ◽  
One Year ◽  
Lost To Follow Up

Abstract Introduction Transition from adolescence to adult care is very challenging for most patients. Without appropriate appointments and education, adolescents can get lost to follow up within one-year of transitioning to adult care (Mistry et al. Diabet Med 32(7):881–885, 2015). Loss to follow-up can increase risks of adverse short and long term diabetes-related complications, with healthcare contacts mainly limited to crisis-based management (Iversen et al. Scand J Caring Sci 33(3):723–730, 2019). Aims The purpose of this study was to evaluate the patient’s perspective of the process of transition from paediatric to adult-based diabetes services in the Mid-West Region of Ireland. Methods We implemented a new transition clinic at University Hospital Limerick with the collaboration of paediatric and adult endocrinology teams. Eighteen patients opted to attend the clinic, but only 17 patients consented to participate in a qualitative assessment study and completed questionnaires before and after the transition clinic. Results and conclusion In terms of medical management, patients had a good understanding of hypoglycaemia and insulin dose adjustment principles, but were least comfortable with carbohydrate counting. Patients self-ranked their knowledge on driving and sexual health with a diagnosis of diabetes as poor, in comparison to understanding effects of alcohol and smoking on diabetes. Overall, a majority of the respondents felt more confident in moving to adult-care after attending the transition clinic.

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