scholarly journals Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands

2004 ◽  
Vol 10 (3) ◽  
pp. 522-525 ◽  
Author(s):  
Peter G.M. Mol ◽  
Willem J.M.J. Rutten ◽  
Rijk O.B. Gans ◽  
John E. Degener ◽  
Flora M. Haaijer-Ruskamp
Keyword(s):  
The Netherlands ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Antimicrobial Treatment

scholarly journals Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aliaksandra Aniskevich ◽  
Iryna Shimanskaya ◽  
Iryna Boiko ◽  
Tatyana Golubovskaya ◽  
Daniel Golparian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Eastern Europe ◽  
Treatment Guidelines ◽  
Statistical Significance ◽  
Antimicrobial Treatment ◽  
National Guidelines ◽  
First Line ◽  
Exact Test ◽  
The Republic

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

scholarly journals Predicting emergency department visits in a large teaching hospital

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan Singh Erkamp ◽  
Dirk Hendrikus van Dalen ◽  
Esther de Vries
Keyword(s):  
Emergency Department ◽  
The Netherlands ◽  
Teaching Hospital ◽  
Time Trend ◽  
Prediction Models ◽  
Emergency Department Visits ◽  
Weather Data ◽  
Negative Consequences ◽  
Weather Variables ◽  
Ed Visits

Abstract Background Emergency department (ED) visits show a high volatility over time. Therefore, EDs are likely to be crowded at peak-volume moments. ED crowding is a widely reported problem with negative consequences for patients as well as staff. Previous studies on the predictive value of weather variables on ED visits show conflicting results. Also, no such studies were performed in the Netherlands. Therefore, we evaluated prediction models for the number of ED visits in our large the Netherlands teaching hospital based on calendar and weather variables as potential predictors. Methods Data on all ED visits from June 2016 until December 31, 2019, were extracted. The 2016–2018 data were used as training set, the 2019 data as test set. Weather data were extracted from three publicly available datasets from the Royal Netherlands Meteorological Institute. Weather observations in proximity of the hospital were used to predict the weather in the hospital’s catchment area by applying the inverse distance weighting interpolation method. The predictability of daily ED visits was examined by creating linear prediction models using stepwise selection; the mean absolute percentage error (MAPE) was used as measurement of fit. Results The number of daily ED visits shows a positive time trend and a large impact of calendar events (higher on Mondays and Fridays, lower on Saturdays and Sundays, higher at special times such as carnival, lower in holidays falling on Monday through Saturday, and summer vacation). The weather itself was a better predictor than weather volatility, but only showed a small effect; the calendar-only prediction model had very similar coefficients to the calendar+weather model for the days of the week, time trend, and special time periods (both MAPE’s were 8.7%). Conclusions Because of this similar performance, and the inaccuracy caused by weather forecasts, we decided the calendar-only model would be most useful in our hospital; it can probably be transferred for use in EDs of the same size and in a similar region. However, the variability in ED visits is considerable. Therefore, one should always anticipate potential unforeseen spikes and dips in ED visits that are not shown by the model.

scholarly journals Adherence to International Empiric Antibiotic Treatment Guidelines in a Tertiary Teaching Hospital in Mexico City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Marco Antonio Rodríguez-Cervera ◽  
Paulo Francisco Castañeda-Mendez ◽  
Luis Soto-Ramírez ◽  
Lorena Cabrera-Ruiz
Keyword(s):  
Mexico City ◽  
Antibiotic Treatment ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Tertiary Teaching ◽  
Empiric Antibiotic ◽  
Tertiary Teaching Hospital ◽  
Empiric Antibiotic Treatment

scholarly journals Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines

2018 ◽  
Vol 27 (9) ◽  
pp. 2754-2764 ◽  
Author(s):  
Olivier C. Dams ◽  
Inge van den Akker-Scheek ◽  
Ron L. Diercks ◽  
Klaus W. Wendt ◽  
Johannes Zwerver ◽  
...  
Keyword(s):  
The Netherlands ◽  
Achilles Tendon ◽  
Treatment Guidelines ◽  
Need For Treatment ◽  
Tendon Ruptures

High-dose steroid and heparin: a novel therapy for cerebral vasculitis associated with presumed group A Streptococcus meningitis

2021 ◽  
Vol 14 (2) ◽  
pp. e239618
Author(s):  
Brian Alexander Hummel ◽  
Julie Blackburn ◽  
Anne Pham-Huy ◽  
Katherine Muir
Keyword(s):  
Treatment Guidelines ◽  
Group A Streptococcus ◽  
Oral Prednisone ◽  
Acute Otitis Media ◽  
Antimicrobial Treatment ◽  
Cerebral Vasculitis ◽  
High Dose ◽  
Novel Therapy ◽  
Intravenous Heparin ◽  
Group A

Cerebral vasculitis is a serious complication of bacterial meningitis that can cause significant morbidity and mortality due to stroke. Currently, there are no treatment guidelines or safety and efficacy studies on the management of cerebral vasculitis in this context. Herein, we report a case of a previously well 11-year-old girl who presented with acute otitis media that progressed to mastoiditis and fulminant meningitis. Group A Streptococcus was found in blood and ear-fluid cultures (lumbar puncture was unsuccessful). Her decreased level of consciousness persisted despite appropriate antimicrobial treatment, and repeat MRI revealed extensive large vessel cerebral vasculitis. Based on expert opinion and a presumed inflammatory mechanism, her cerebral vasculitis was treated with 7 days of pulse intravenous methylprednisolone followed by oral prednisone taper. She was also treated with intravenous heparin. Following these therapies, she improved clinically and radiographically with no adverse events. She continues to undergo rehabilitation with improvement.

scholarly journals Non-adherence to antimicrobial treatment guidelines results in more broad-spectrum but not more appropriate therapy

2011 ◽  
Vol 31 (7) ◽  
pp. 1561-1568 ◽  
Author(s):  
L. B. J. van der Velden ◽  
M. Tromp ◽  
C. P. Bleeker-Rovers ◽  
M. Hulscher ◽  
B. J. Kullberg ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Treatment Guidelines ◽  
Antimicrobial Treatment ◽  
Appropriate Therapy

scholarly journals Experiences and challenges of adults living with type 2 diabetes mellitus presenting at the University Teaching Hospital in Lusaka, Zambia

2019 ◽  
Vol 7 (1) ◽  
pp. e000497
Author(s):  
Kunda Faith Mwila ◽  
Phoebe Albina Bwembya ◽  
Choolwe Jacobs
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Self Care ◽  
Mental Illnesses ◽  
University Teaching ◽  
The University

ObjectiveThe study explored the experiences and challenges of adults living with type 2 diabetes mellitus (T2DM) presenting at the University Teaching Hospital (UTH) in Lusaka.Research designA qualitative descriptive study was conducted. The research relied on purposive sampling to select 28 participants for in-depth interviews. Participants were interviewed during clinical visits at UTH.ResultsViews from participants showed that some adults living with T2DM experienced physical and mental illnesses. Participants’ views reflected that their livelihood with T2DM was influenced by family support, poor or non-adherence to treatment guidelines and access to information, education and communication materials. The most important challenges reported were psychosocial and financial.ConclusionThe study concluded that some adults living with T2DM experience a lot of physical sicknesses and their challenges, especially of the psychosocial nature may require professional attention. However, particular attention should be paid to the patient’s self-care and psychosocial therapy. Self-care protocols should be tailored to complement the different types of patients with diabetes and improve their quality of life.Cite Now

Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians

2017 ◽  
Vol 182 (11) ◽  
pp. 324-324 ◽  
Author(s):  
Alexia Van Cleven ◽  
Steven Sarrazin ◽  
Hilde de Rooster ◽  
Dominique Paepe ◽  
Sofie Van der Meeren ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Antimicrobial Treatment ◽  
Fourth Generation ◽  
National Guidelines ◽  
First Line ◽  
Clinical Scenarios ◽  
Prescribing Behaviour

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials.

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