scholarly journals Assessment of Appropriateness of Antimicrobial Therapy in Resource-Constrained Settings: Development and Piloting of a Novel Tool—AmRAT

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 200
Author(s):  
Ashish Kumar Kakkar ◽  
Nusrat Shafiq ◽  
Neeru Sahni ◽  
Ritin Mohindra ◽  
Navjot Kaur ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Educational Background ◽  
Audit And Feedback ◽  
Consensus Algorithm ◽  
World Health ◽  
Resource Constrained ◽  
Antimicrobial Prescribing ◽  
Percent Agreement ◽  
Group A ◽  
Group B

Inappropriate antimicrobial prescribing is considered to be the leading cause of high burden of antimicrobial resistance (AMR) in resource-constrained lower- and middle-income countries. Under its global action plan, the World Health Organization has envisaged tackling the AMR threat through promotion of rational antibiotic use among prescribers. Given the lack of consensus definitions and other associated challenges, we sought to devise and validate an Antimicrobial Rationality Assessment Tool—AmRAT—for standardizing the assessment of appropriateness of antimicrobial prescribing. A consensus algorithm was developed by a multidisciplinary team consisting of intensivists, internal medicine practitioners, clinical pharmacologists, and infectious disease experts. The tool was piloted by 10 raters belonging to three groups of antimicrobial stewardship (AMS) personnel: Master of Pharmacology (M.Sc.) (n = 3, group A), Doctor of Medicine (MD) residents (n = 3, group B), and DM residents in clinical pharmacology (n = 4, group C) using retrospective patient data from 30 audit and feedback forms collected as part of an existing AMS program. Percentage agreement and the kappa (κ) coefficients were used to measure inter-rater agreements amongst themselves and with expert opinion. Sensitivity and specificity estimates were analyzed comparing their assessments against the gold standard. For the overall assessment of rationality, the mean percent agreement with experts was 76.7% for group A, 68.9% for group B, and 77.5% for group C. The kappa values indicated moderate agreement for all raters in group A (κ 0.47–0.57), and fair to moderate in group B (κ 0.22–0.46) as well as group C (κ 0.37–0.60). Sensitivity and specificity for the same were 80% and 68.6%, respectively. Though evaluated by raters with diverse educational background and variable AMS experience in this pilot study, our tool demonstrated high percent agreement and good sensitivity and specificity, assuring confidence in its utility for assessing appropriateness of antimicrobial prescriptions in resource-constrained healthcare environments.

scholarly journals Outcome of implementing Surgical Safety Checklist in Pediatric Surgery in Tertiary Level hospital

2021 ◽  
Vol 23 (1) ◽  
pp. 60-65
Author(s):  
Jasmine Bajracharya ◽  
R Shrestha ◽  
HR Joshi ◽  
RP Adhikari
Keyword(s):  
Intervention Group ◽  
World Health ◽  
Care Group ◽  
Tertiary Level ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Operative Care ◽  
Group A ◽  
Group B ◽  
Level Hospital

The World Health Organization (WHO) implemented the Surgical Safety Checklist (SSCL) as a part of Safe Surgery Saves Lives campaign. Even after 12 years of implementation of WHO SSCL, available literature is still lacking from developing countries, where the potentially greatest impact could have been observed. A prospective randomized controlled trial done in Tertiary level hospital from September 2018 – February 2020 enrolled pediatric patients aged 0 day to 15 years. The patients were randomly allocated into groups by lottery as Group A - control and Group B – Intervention group. Group A was given the basic pre-operative care. Group B were enrolled in the safety checklist. The data were collected in the printed forms and analyzed. The patients were followed for surgical site infections (SSI). Compliance of the safety checklist was assessed with completion of the checklist fully or partially. Total cases enrolled were 310 with 155 in each group. Age of patients ranged from 1 day to 15 years. SSI was present in 35 patients in group A and 29 patients in group B. The Outcome of implementation of SSC on appearance of SSI was not significant. SSI was decreased on checklist implementation with OR of 0.78 (95% CI 0.45 – 1.37). Outcome of SSC compliance shown by OR was 0.39 (95% CI 0.15 – 0.99). Use of SSCL decreases the postoperative complications and improves the outcome. Compliance is the key to success of the implementation of the checklist.

scholarly journals Changing trends and determinants of caesarean section using robson criteria in a government tertiary level hospital

2021 ◽  
Vol 10 (3) ◽  
pp. 1066
Author(s):  
Anjali Singh ◽  
Renuka Malik
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Study Groups ◽  
World Health ◽  
Tertiary Level ◽  
Study Group ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
Level Hospital

Background: Robson Ten group classification system (TGCS) was proposed by World Health Organisation in 2014 for assessing, monitoring and comparing caesarean section rate between and within healthcare facilities. This tool was used in this study to analyse the determinants of caesarean section and compare with data of past.Methods: This observational comparative study was conducted at tertiary level hospital and included in study group A, 300 women delivered by caesarean section from November 2018 to November 2019 and in study group B, 300 women delivered by caesarean section from November 2015 to December 2016. The caesarean sections were classified as per TGCS to determine relative and absolute contribution made by each group to the overall caesarean section rate. The results were analysed to for determinants and change in trend.Results: In this study, the caesarean section rate in group A was 29.32% and group B was 28.03%. Group 2, 5, 1, 10 made the maximum contributions to overall caesarean section rate in both study groups. Group 2 was the largest contributor (25.00%) in study group A and 27.33% in study group B to overall caesarean sections.Conclusions: Implementing Robsons TGCS can help in comparing caesarean in an institution over a period of time and also among different institution at national and international level as a method of internal auditing, paving a way to rationalise and decrease Caesarean rate. 

scholarly journals ADHERENCE TO ESSENTIAL HYPERTENSION TREATMENT GUIDELINES IN A TERTIARY HOSPITAL IN NIGERIA

2020 ◽  
pp. 106-110
Author(s):  
ISAAC CHIJIOKE IBEZIM ◽  
IAN NAYLOR ◽  
ABDULMUMINU ISAH ◽  
NNEKA UCHENNA IGBOELI
Keyword(s):  
Blood Pressure ◽  
Treatment Guidelines ◽  
Beta Blockers ◽  
Study Groups ◽  
University Teaching ◽  
World Health ◽  
Channel Blockers ◽  
Cross Sectional ◽  
Group A ◽  
Group B

Objective: This study determined the level of prescribers’ adherence to the World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the management of hypertension at the Lagos University Teaching Hospital (LUTH), Nigeria. Methods: This study employed a retrospective cross-sectional design. Two groups were used: Group A (300 patients) were treated before the guidelines review in 2003, while Group B (200 patients) were treated after. The two study groups were compared, and systolic blood pressure of 130 mm Hg or above was taken as the index of hypertension. Results: There were 198 (66%) male patients in Group A, while Group B had 136 (68%) males. The highest age for Group A was 50–59 y for 89 (30%) patients, unlike group B that had 58 (29%) patients in aged 40–49 y as the highest. The highest blood pressure range for patients in Group A was 150–159 mm Hg for 64 (21%) patients, unlike Group B that had 43 (22%) patients as the highest in the same range. Furosemide was present in 282 (24%) prescriptions for group A patients. However, atenolol was present in 61 (20%) prescriptions for the same group. In group B, Furosemide was prescribed in 197 (97%) encounters, while Nifedipine was found in 81(40%) prescriptions. Conclusion: Prescribers at LUTH complied substantially with WHO/ISH guidelines in the management of hypertension. Diuretics and beta-blockers were used before the guideline review. After the review, diuretics and calcium channel blockers were the most frequently prescribed antihypertensives.

Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Study Group for Palliative Treatment of Metastatic Colorectal Cancer Study Protocol 1.

1996 ◽  
Vol 14 (8) ◽  
pp. 2274-2279 ◽  
Author(s):  
E Jäger ◽  
M Heike ◽  
H Bernhard ◽  
O Klein ◽  
G Bernhard ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Metastatic Colorectal Cancer ◽  
Low Dose ◽  
Multicenter Trial ◽  
World Health ◽  
High Dose ◽  
Who Grade ◽  
Group A ◽  
Group B

PURPOSE To determine the most effective dose of leucovorin (folinic acid [FA]) within a weekly bolus fluorouracil (FU) schedule, we conducted a randomized multicenter trial to compare therapeutic effects and toxicity of high-dose FA versus low-dose FA combined with FU at equal doses in both treatment groups. PATIENTS AND METHODS Patients with measurable inoperable or metastatic colorectal cancer were randomized to receive weekly FU 500 mg/m2 by intravenous (IV) bolus combined with high-dose FA 500 mg/m2 (group A) or low-dose FA 20 mg/m2 (group B) by 2-hour infusion. RESULTS Of 291 assessable patients (group A, n = 148; group B, n = 143), we observed, in group A, complete response (CR)/partial response (PR) in 32 (21.6%), no change (NC) in 64 (43.2%), and progressive disease (PD) in 52 (35.1%); and in group B, CR/PR in 25 (17.5%), NC in 63 (44.1%), and PD in 55 (38.5%). The median response duration was 24.8 weeks in group A and 23.1 weeks in group B. Median progression-free intervals were 29.3 weeks (group A) and 30 weeks (group B). The median survival time was 55.1 weeks in group A and 54.1 weeks in group B. Overall toxicity was moderate. Mild nausea and vomiting, and stomatitis were common side effects in both groups. The incidence of World Health Organization (WHO) grade III/IV diarrhea was significantly higher in group A (40 v 23 patients). Severe side effects were observed only in a minority of patients in both arms. WHO grade IV diarrhea was observed in seven patients: four in group A and three in group B. The rate of toxicity-related adjustments of dose and schedule was comparable in both groups. CONCLUSION High-dose FA/FU is not superior to low-dose FA/FU within a weekly treatment schedule. Response rates and survival were comparable in both treatment arms. Treatment-related toxicity was higher in group A (high-dose FA). Therefore, low-dose FA combined with weekly FU may be considered the preferred treatment for metastatic colorectal cancer.

Efficacy Comparison of Oral Rehydration Solutions Containing Either 90 or 75 Millimoles of Sodium per Liter

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 190-195
Author(s):  
Daniel Pizarro ◽  
Bernardita Castillo ◽  
Gloria Posada ◽  
Cecilia Lizano ◽  
Leonardo Mata
Keyword(s):  
Laboratory Data ◽  
Clinical Signs ◽  
World Health ◽  
Watery Diarrhea ◽  
Hydration Status ◽  
Oral Rehydration ◽  
Rehydration Solutions ◽  
Acute Watery Diarrhea ◽  
Group A ◽  
Group B

In a randomized trial, 62 infants 2 to 35 months of age with dehydration due to acute watery diarrhea were allocated to one of two groups: group A received solution A (World Health Organization-recommended oral rehydration solution), which contained (mmol/L): Na+ 90, K+ 20, Cl- 80, citrate3- 10, and glucose 110; group B received solution B (Pedialyte RS; Abbott Laboratories, North Chicago), which contained (in mmol/L): Na+ 75, K+ 20, Cl- 65, citrate3- 10, and glucose 139. Oral therapy was given until clinical signs of hydration status were normal. During the 48-hour trial, the following laboratory data were collected: blood gases, serum electrolytes, glucose, urea, and creatinine values and sodium and potassium concentrations in stool and urine; serial weights and clinical signs were also reported. Six of the 62 infants, three in each group, required intravenous fluids because of high stool output. Results of clinical outcome and normalization of altered serum electrolyte values were similar in both groups. During the 48-hour trial, eight patients in group A and four in group B had mild, asymptomatic hypernatremia. Pedialyte RS was found to be a safe glucose/electrolyte solution for oral rehydration therapy.

scholarly journals Randomized clinical trial comparing different iodine interventions in school children

1999 ◽  
Vol 2 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Jinkou Zhao ◽  
Fujie Xu ◽  
Qinlan Zhang ◽  
Li Shang ◽  
Aixiang Xu ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
School Children ◽  
Urinary Iodine ◽  
Iodine Content ◽  
Iodine Concentration ◽  
Iodized Salt ◽  
World Health ◽  
Iodized Oil ◽  
Group A ◽  
Group B

AbstractObjectiveThe purpose of this trial was to compare three different iodine interventions.DesignSchool children aged 8–10 years were randomized into one of three groups: group A was provided with iodized salt by researchers with an iodine concentration of 25 ppm; group B purchased iodized salt from the market; and group C was similar to group B with the exception that they were given iodized oil capsules containing 400 mg iodine at the beginning of the study. Salt iodine content was measured bimonthly for 18 months and indicators of iodine deficiency were measured at baseline and 6, 9, 12 and 18 months after randomization.ResultsThe prevalence of abnormal thyroid volumes, based on the World Health Organization (WHO) body surface area reference > 97th percentile, was 18% at baseline and declined to less than 5% by 12 months in groups A and C, and to 9% after 18 months in group B. Results for goitre by palpation were similar. The median urinary iodine was 94 μgl−1 at baseline and increased in all groups to > 200 μgl−1 at the 6-month follow-up.ConclusionsIn this population of school children with initially a low to moderate level of iodine deficiency, the group receiving salt with 25 ppm (group A) was not iodine deficient on all indicators after 18 months of study. When the iodine content of the salt varied, such as in group B, by 18 months thyroid sizes had not yet achieved normal status.

Conservative Chemotherapy in Gestational Trophoblastic Disease: Experience With Etoposide, Methotrexate, and Dactinomycin Chemotherapy

2016 ◽  
Vol 26 (4) ◽  
pp. 790-795 ◽  
Author(s):  
Seung Won Byun ◽  
Tae Chul Park ◽  
Seog Nyeon Bae
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
The Other ◽  
World Health ◽  
Who Grade ◽  
Trophoblastic Disease ◽  
Group A ◽  
Group B ◽  
Health Organization

ObjectiveThe goal of this study was to evaluate the efficacy, toxicity, and survival of patients in our institution treated by EMA (etoposide, methotrexate [MTX], and dactinomycin) chemotherapy for 3 groups of patients: ones that had low-risk gestational trophoblastic disease (GTD) that was resistant to MTX (group A), those with high-risk GTD (group B), and the group having low-risk GTD but the cancer being metastatic (group C).MethodsThe medical records of 58 patients who received EMA chemotherapy in groups A, B, and C in the 2000 to 2012 period at St Mary’s Hospital were examined. Clinical characteristics, chemotherapy responses, causes of treatment failure, and cases of drug toxicity were analyzed retrospectively.ResultsTreatment with the EMA regimen resulted in primary remission in 52 (96%) of 54 patients and resistance in 2 of the patients (3%). In the resistance group, one belonged to group B and was treated with etoposide, MTX, and actinomycin D with cyclophosphamide and vincristine (EMA-EP) and the other belonged to group A and died of refractory disease. World Health Organization (WHO) grade 4 leukocytopenia and thrombocytopenia with the EMA regimen occurred in 6% and 0.4% of the cycles, respectively; the other toxic effects were acceptable and manageable. Median cycles of EMA chemotherapy during the treatment were 7, 8, and 8 in groups A, B, and C, respectively. There was some reduction in total chemo cycle and toxicity, as compared with a previously reported study using the alternative cyclophosphamide and vincristine regimen. Among the EMA treated patients, 1 patient with a second malignancy of breast cancer was documented. In addition, 5 child births for the treated patients were recorded during the follow-up period of mostly 10 years.ConclusionsThe EMA chemotherapy seemed to reduce treatment duration and the relapse rate without increasing the adverse effects in patients with MTX resistance and low-risk GTD, but having confirmed metastatic lesions. Although this study had some limitations regarding the high-risk GTD, our findings will provide a basis for the use of EMA chemotherapy when cyclophosphamide and vincristine is contraindicated due to toxicity.

scholarly journals Antibodies against rabies virus in dogs with and without history of vaccination in Santa Maria - RS - Brazil

2017 ◽  
Vol 47 (11) ◽  
Author(s):  
Karina Gonzalez Fernandes ◽  
Mathias Martins ◽  
Bruna Portolan Amaral ◽  
Juliana Felipetto Cargnelutti ◽  
Rudi Weiblen ◽  
...  
Keyword(s):  
Rabies Virus ◽  
Neutralizing Antibodies ◽  
Neutralizing Antibody ◽  
World Health ◽  
Serum Samples ◽  
Antibody Titers ◽  
Group A ◽  
Group B ◽  
Santa Maria ◽  
Rabies Vaccination

ABSTRACT: The present study investigated the frequency and magnitude of neutralizing antibodies to rabies virus (RABV) in dogs with and without historic of vaccination in Santa Maria/RS. Group A included serum samples from 440 dogs with recent historic of vaccination against rabies, obtained during the 2015 rabies vaccination campaign. Group B included 300 serum samples from dogs submitted to the Veterinary Hospital of the Universidade Federal de Santa Maria in 2015, whose historic of rabies vaccination was unknown. Serum samples were submitted to the rapid fluorescent focus inhibition test (RFFIT) to detect neutralizing antibodies against RABV. In group A, 70.6% (310/440) of the samples had neutralizing antibody titers ≥0.5 international units per milliliter (IU mL-1), considered an indicative of protection against rabies by the World Health Organization. However, approximately 30% of the dogs did not contain antibodies in adequate levels. In group B, 42.3% (127/300) of the samples contained neutralizing antibody titers ≥0.5IU mL-1 and 57.7% (173/300) were negative or contained titers below of the value considered immunized. These results demonstrate that an important proportion of vaccinated dogs (~30%) did not develop adequate antibody levels, mainly those receiving a single vaccine dose. Serologic testing of animals with unknown historic of vaccination revealed relatively low vaccine coverage in the general dog population. Thus, reformulation of immunization strategies - especially the recommendation of a boost vaccination 30 days after the primary dose - and extension of vaccination campaigns are necessary to reach adequate levels and coverage of immunity against RABV in the canine population.

scholarly journals Association between blood group and susceptibility to malaria and its effects on platelets, TLC, and Hb

2016 ◽  
Vol 10 (10) ◽  
pp. 1124-1128
Author(s):  
Hira Burhan ◽  
Askari Syed Hasan ◽  
Syed Mansur-ul-Haque ◽  
Ghazanfar Zaidi ◽  
Taha Shaikh ◽  
...  
Keyword(s):  
Blood Group ◽  
Blood Groups ◽  
World Health ◽  
Total Leukocyte Count ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Health Organization ◽  
And Control ◽  
Control Study

Introduction: According to the World Health Organization, the estimated number of malaria cases in Pakistan is about 1.5 million. Hematological variables like platelets, total leukocyte count (TLC), and hemoglobin (Hb) need to be evaluated to diagnose malaria in suspects. This study aimed to investigate the association between blood group and susceptibility to malaria and effects on platelets, TLC, and Hb. Methodology: This was a case-control study with a sample size of 446, of which 224 were malarial cases and 222 were controls. A designated questionnaire was developed to know age, gender, malarial strain, Hb, TLC, platelets, and blood group. Results: Of 224 malarial cases, 213 were P. vivax, and 11 were P. falciparum. There were 58 patients with blood group A, 72 with group B, 69 were O and 23 were AB. There was no significant difference in the blood group of controls compared to malarial patients (p > 0.05). Mean Hb level was 11.5mg/dL in malaria patients and 12.5mg/dL in controls. There was significant difference (p<0.01) in the mean platelet count in malarial (11,7000/μL) and control (24,5000/μL) patients. All blood groups showed similar falls in Hb and platelet levels, showing no significant difference among blood groups (p = 0.79 and p = 0.52, respectively). TLC was not significant between malarial and control groups (p = 0.072). Males were two times susceptible to malaria. Conclusions: There was no significant association between the type of blood group and susceptibility to malaria or developing anemia or thrombocytopenia.

scholarly journals Monitoring of labor with WHO modified partogram – A study report

2014 ◽  
Vol 3 (2) ◽  
pp. 8-11 ◽  
Author(s):  
Md Alauddin ◽  
Runa Bal ◽  
Arunangsu De ◽  
Parthajit Mondal ◽  
Mayoukh Chakraborty
Keyword(s):  
Vaginal Delivery ◽  
World Health Organisation ◽  
World Health ◽  
Cesarean Sections ◽  
Significant Difference ◽  
Group A ◽  
Live Fetus ◽  
Group B ◽  
Comparison Of The Results ◽  
Vertex Presentation

Introduction: Partogram represents labor events. World Health Organisation (WHO) had produced a partogram in the last decade and subsequently modified it to make it easier to use. The present study was conducted to note the effectiveness of the WHO modified partogram. Methods: Altogether 430 primigravida women, at term, having single live fetus in vertex presentation, were included for the study. The women were randomly subdivided into three groups: Group A (180 women) - monitoring of labor done by WHO modified partogram; Group B (150 women)- monitoring of labor done by WHO original partogram and 100 women in Group C (control), the labor would be monitored clinically. The results were noted in each group regarding the length of labor, vaginal delivery, cesarean sections, augmentation of labor etc. The results of Group A were compared with Group B and Group C. Result: The comparison of the results of the Group A and Group B did not reveal any statistically significant difference. The comparison of the results of the Group A and Group C observed that significantly less number of women in Group A (4.44%) was in labor for more than 12 hours than in Group C (18%). The number of vaginal delivery was more and cesarean section was less in Group A than Group C (p < 0.05). More number of women required augmentation of labor in Group C (p<0.001). Conclusion: WHO modified partogram, which is easier to use, gives almost the same effects as the WHO original partogram but significantly better results than clinical monitoring. DOI: http://dx.doi.org/10.3126/njog.v3i2.10824 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 8-11

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