scholarly journals Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 516
Author(s):  
Neil Powell ◽  
Philip Howard ◽  
Martin J. Llewelyn ◽  
Tamas Szakmany ◽  
Mahableswhar Albur ◽  
...  
Keyword(s):  
Intensive Care ◽  
Repeated Measurements ◽  
Antibiotic Prescribing ◽  
Marked Variation ◽  
Single Test ◽  
Web Based ◽  
Nice Guidance ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Acute Admissions

A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of the COVID-19 pandemic. A web-based survey of antimicrobial leads gathered data about the use of procalcitonin testing. Responses were received from 148/151 (98%) eligible hospitals. During the first wave of the COVID-19 pandemic, there was widespread introduction and expansion of PCT use in NHS hospitals. The number of hospitals using PCT in emergency/acute admissions rose from 17 (11%) to 74/146 (50.7%) and use in Intensive Care Units (ICU) increased from 70 (47.6%) to 124/147 (84.4%). This increase happened predominantly in March and April 2020, preceding NICE guidance. Approximately half of hospitals used PCT as a single test to guide decisions to discontinue antibiotics and half used repeated measurements. There was marked variation in the thresholds used for empiric antibiotic cessation and guidance about interpretation of values. Procalcitonin testing has been widely adopted in the NHS during the COVID-19 pandemic in an unevidenced, heterogeneous way and in conflict with relevant NICE guidance. Further research is needed urgently that assesses the impact of this change on antibiotic prescribing and patient safety.

scholarly journals A Web-Based Recovery Program (ICUTogether) for Intensive Care Survivors: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Beverley Ewens ◽  
Helen Myers ◽  
Lisa Whitehead ◽  
Karla Seaman ◽  
Deborah Sundin ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Family Support ◽  
Well Being ◽  
Web Based ◽  
Time Points ◽  
Recovery Program ◽  
The Impact ◽  
Mental Well Being

BACKGROUND Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. OBJECTIVE The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. METHODS In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants’ evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. RESULTS Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. CONCLUSIONS This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population.

scholarly journals Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison K. Lew ◽  
Palak H. Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics > 48 h following admission or if another source of infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n = 76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n = 170), p < 0.001. The median DOT in the post-intervention group was 1.3 days shorter (p < 0.001) than the pre-intervention group, and antibiotics directed at atypical bacteria DOT was reduced by 2.8 days (p < 0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p = 0.001). There were no differences between groups in terms of clinical outcomes. Conclusion Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

2020 ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison Lew ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background: Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods: This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics >48hours following admission or if another infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results: A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n=76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n=170), p<0.001. The median DOT in the post-intervention group was 1.3 days shorter (p<0.001) than the pre-intervention group, and atypical antibiotic DOT was reduced by 2.8 days (p<0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p=0.001). There were no differences between groups in terms of clinical outcomes. Conclusion: Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

2020 ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison Lew ◽  
Palak B. Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background: Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19.Methods: This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics >48hours following admission or if another infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics.Results: A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n=76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n=170), p<0.001. The median DOT in the post-intervention group was 1.3 days shorter (p<0.001) than the pre-intervention group, and atypical antibiotic DOT was reduced by 2.8 days (p<0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p=0.001). There were no differences between groups in terms of clinical outcomes.Conclusion: Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

Using Prior Culture Results to Improve Initial Empiric Antibiotic Prescribing: An Evaluation of a Simple Clinical Heuristic

2020 ◽  
Author(s):  
Marion Elligsen ◽  
Ruxandra Pinto ◽  
Jerome A Leis ◽  
Sandra A N Walker ◽  
Derek R MacFadden ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Alternative Therapy ◽  
Intervention Group ◽  
Empiric Therapy ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Timely Initiation ◽  
Empiric Antibiotic ◽  
Clinically Significant ◽  
The Impact

Abstract Background A patient’s prior cultures can inform the subsequent risk of infection from resistant organisms, yet prescribers often fail to incorporate these results into their empiric antibiotic selection. Given that timely initiation of adequate antibiotics has been associated with improved outcomes, there is an urgent need to address this gap. Methods In order to better incorporate prior culture results in the selection of empiric antibiotics, we performed a pragmatic, prospective, hospital-wide intervention: (1) empiric antibiotic prescriptions were assessed for clinically significant discordance with the most recent methicillin-resistant Staphylococcus aureus (MRSA) surveillance swab, previous cultures for extended-spectrum beta-lactamases (ESBLs), and the most recent culture for a Gram-negative (GN) organism; and (2) if discordant, an antimicrobial stewardship pharmacist provided recommendations for alternative therapy. The impact was analyzed using a quasi-experimental design comparing two 9-month periods (pre- and postintervention) at a large academic, tertiary care institution. Results Clinically significant discordance was identified 99 times in the preintervention period and 86 times in the intervention period. The proportion of patients that received concordant therapy increased from 73% (72/99) in the control group to 88% (76/86) in the intervention group (P = .01). The median time to concordant therapy was shorter in the intervention group than the control group (25 vs 55 hrs, respectively; P &lt; .001; adjusted hazard ratio = 1.95 [95% confidence interval {CI}, 1.37–2.77; P &lt; .001]). The median duration of unnecessary vancomycin therapy was reduced by 1.1 days (95% CI, .5–1.6 days; P &lt; .001). Conclusions This intervention improved prescribing, with a shorter time to concordant therapy and an increased proportion of patients receiving empiric therapy concordant with prior culture results. The use of unnecessary vancomycin was also reduced.

scholarly journals Advances in the prevention, management, and treatment of community-acquired pneumonia

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 300 ◽  
Author(s):  
Mathias W. Pletz ◽  
Gernot G. Rohde ◽  
Tobias Welte ◽  
Martin Kolditz ◽  
Sebastian Ott
Keyword(s):  
Infectious Disease ◽  
Intensive Care ◽  
Community Acquired Pneumonia ◽  
Empiric Antibiotic Therapy ◽  
Evidence Based ◽  
Pneumococcal Vaccines ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Current Guidelines

Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Nevertheless, its importance is often underestimated. Large cohorts of patients with CAP have been established worldwide and improved our knowledge about CAP by far. Therefore, current guidelines are much more evidence-based than ever before. This article discusses recent major studies and concepts on CAP such as the role of biomarkers, appropriate risk stratification to identify patients in need of hospitalisation or intensive care, appropriate empiric antibiotic therapy (including the impact of macrolide combination therapy and antibiotic stewardship), and CAP prevention with novel influenza and pneumococcal vaccines.

Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020

2020 ◽  
Vol 59 (04) ◽  
pp. 294-299 ◽  
Author(s):  
Lutz S. Freudenberg ◽  
Ulf Dittmer ◽  
Ken Herrmann
Keyword(s):  
Nuclear Medicine ◽  
Health Systems ◽  
Personal Protective Equipment ◽  
Large Scale ◽  
Diagnostic Procedures ◽  
Protective Equipment ◽  
Current Crisis ◽  
Web Based ◽  
Public Versus Private ◽  
The Impact

Abstract Introduction Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. Materials and Methods A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. Results 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are –14.4 %, –47.2 %, –47.5 %, –40.7 %, –58.4 %, and –25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (–53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. Conclusions Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

The Role of Web Based Accounting Online System 2.0 as the Company's Income and Expense Management

2017 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Nur Azizah ◽  
Dedeh Supriyanti ◽  
Siti Fairuz Aminah Mustapha ◽  
Holly Yang
Keyword(s):  
Financial Management ◽  
Accounting System ◽  
Bank Account ◽  
Web Based ◽  
Online System ◽  
Version 2.0 ◽  
User Friendly ◽  
The Impact ◽  
A Company

In a company, the process of income and expense of money must have a profit-generating goal base. The success of financial management within the company, can be monitored from the ability of the financial management in managing the finances and utilize all the opportunities that exist with as much as possible with the aim to control the company's cash (cash flow) and the impact of generating profits in accordance with expectations. With a web-based online accounting system version 2.0, companies can be given the ease to manage money in and out of the company's cash. It has a user friendly system with navigation that makes it easy for the financial management to use it. Starting from the creation of a company's cash account used as a cash account and corporate bank account on the system, deletion or filing of cash accounts, up to the transfer invoice creation feature, receive and send money. Thus, this system is very effective and efficient in the management of income and corporate cash disbursements.   Keywords:​Accounting Online System, Financial Management, Cash and Bank

DAMPAK PROGRAM DIKLAT ONLINE TIK GURU PUSTEKKOM TERHADAP AKSESBILITAS KONTEN PEMBELAJARAN PADA FITUR RUMAH BELAJAR

2018 ◽  
Vol 19 (2) ◽  
pp. 84
Author(s):  
Eni Susilawati
Keyword(s):  
Teacher Training ◽  
Quantitative Research ◽  
Online Training ◽  
Research Approach ◽  
Intensity Level ◽  
Web Based ◽  
Learning Content ◽  
Open Questions ◽  
Ict Training ◽  
The Impact

The research objective is to analyze the impact of the participation of online  ICT teacher training to increase the number of accessibility the learning content of features in Rumah Belajar. This research used the quantitative research approach with descriptive quantitative analysis methods to be able to describe how the increase in accessibility features of Rumah Belajar and utilization in learning in school. Samples were selected in this study are all online training participants at 15 locations online training that has been conducted by Pustekkom in 2015 and 2016 in 2015. The data was collected using a questionnaire and a list of open questions in accordance with the purpose of research. The results showed that 1) online ICT teacher training participants, after completing the Pustekkom  training online  using become more motivated to access other feature in Rumah Belajar; 2) The order of the percentage of the intensity level of accessibility to the other features of Rumah Belajar are: Sumber Belajar 23%, BSE 23%, Bank Soal 21%, Kelas Maya 13%, Lab Maya 6%, Karya Guru 4%, Wahana Jelajah Angkasa 4%, Peta Budaya 4% and Karya Komunitas 2%, and ICT training online using the application PKB Rumah Belajar can be used as a reference for efforts to develop a web-based learning applications, in particular for the development of Rumah belajar portal belongs Pustekkom Kemendikbud. Tujuan penelitian yaitu untuk menganalisis dampak keikutsertaan diklat online  TIK guru Belajar terhadap peningkatan jumlah aksebilitas konten pembelajaran pada fitur-fitur rumah belajar. Penelitian ini menggunakan pendekatan penelitian kuantitatif dengan metode analisis kuantitatif secara deskriptif untuk bisa menggambarkan bagaimana peningkatan aksesbilitas fitur-fitur rumah belajar dan pemanfaatannya dalam pembelajaran di sekolah. Sampel yang dipilih dalam penelitian ini adalah semua peserta diklat online  pada 15 lokasi diklat online yang telah dilaksanakan oleh Pustekkom pada tahun 2015 dan 2016. Pengumpulan data menggunakan kuesioner dan daftar pertanyaan terbuka sesuai dengan tujuan penelitian. Hasil penelitian menunjukkan bahwa 1) peserta diklat online TIK Guru, setelah mengikuti diklat online Pustekkom, menjadi lebih termotivasi untuk mengakses fitur-fitur lainnya dalam Rumah Belajar; 2) Urutan prosentase tingkat intensitas aksesbilitas terhadap fitur-fitur Rumbel selain Pengembangan Keprofesian berkelanjutan (PKB) adalah: Sumber Belajar 23%, Buku Sekolah Elektronik (BSE) 23%, Bank Soal 21%, Kelas Maya 13%, Lab Maya 6%, Karya Guru 4%, Wahana Jelajah Angkasa 4%, Peta Budaya 4% dan Karya Komunitas 2%; dan 3) diklat online TIK menggunakan aplikasi PKB. Rumah belajar bisa dijadikan referensi bagi upaya pengembangan aplikasi pembelajaran berbasis web, khususnya bagi pengembangan portal Rumah Belajar milik Pustekkom Kemendikbud.

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