scholarly journals Clinical and microbiological parallels of delayed prescribing of antibiotics in patients with acute rhinosinusitis

2020 ◽  
pp. 49-57
Author(s):  
Mahmoud Joumaa Al Hariri ◽  
Ivanna V. Koshel ◽  
Vasil I. Popovich
Keyword(s):  
Standard Therapy ◽  
Negative Impact ◽  
Nasal Congestion ◽  
Intervention Group ◽  
Evaluation Criteria ◽  
Additional Treatment ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Acute Rhinosinusitis ◽  
Clinically Significant

Topicality: The rate of acute bacterial rhinosinusitisis 0,5-2% of all cases of acute rhinosinusitis, however, up to 60 % of patients receive the course of antibiotics since the first day of disease. It is well known that earlier use of antibiotics has almost no effect on the development of bacterial ARS and its complications. The purpose of study was to examine the bacterial spectrum of post-viral RS and evaluate clinical and bac-teriological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the microbiological composition of nasal microflora was examined and its comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of microbiological changes. Outcomes and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitis as a part of technique of delayed prescribing of antibioticsensures clinically significant decrease in the intensity of rhinorrhea symptoms, nasal congestion and post-nasal drip on the third day of supervision (p<0.05). It reduces the prescription of antibacterial medicines by 20%without negative impact on overall treatment results. Decrease in the number of prescription of antibacterial therapy correlates with the fair reduction in bacterial loadwith Staphylococcus aureus and typical representative of ABRS – S. pneumoniae, Haemophilus influenza and M. catarrhalis. Therefore, the intervention group in comparison with the control group has had “therapeutic advantage” during the first days of treatment which allowed to assess the course of disease as a “positive” and avoid in appropriate use of antibiotics. There have been documented no patients with adverse effects during the course of treatment. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to reduce the use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

scholarly journals Clinical and immunological efficiency of bacteriophage in technique of delayed prescribing of antibiotics in patients with acute post-viral rhinosinusitis

2021 ◽  
pp. 45-53
Author(s):  
Mahmoud Jоmaa Al Hariri ◽  
Ivanna V. Koshel ◽  
Vasyl I. Popovych
Keyword(s):  
Standard Therapy ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Evaluation Criteria ◽  
Additional Treatment ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Local Immunity ◽  
Acute Rhinosinusitis ◽  
Significant Difference

Topicality: Acute Rhinosinusitis can be characterised as acute bacterial rhinosinusitis just in about 0,5 - 2% of the number of viral one and only such patients need prescription of antibiotics. At the same time, antibacterial therapy is prescribed in from 54% to 77% cases of Acute Rhinosinusitis. To reduce the number of unreasonable prescriptions, the strategy of delayed prescribing of antibioticsis the forward-looking one. Aim: to evaluate the level of IgА and sIgA in patients with post-viral RS and estimate the clinical and immunological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the IgА and sIgA levels were evaluated and their comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of changes of serum and secretory IgА levels. Results and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitisas a part of technique of delayed prescribing of antibiotics ensures clinically significant, faster dynamics of regression of typical clinical symptoms of post-viral rhinosinusitis: rhinorrhea, nasal congestion and post-nasal drip in comparison with the control group (p<0.05). Positive dynamics of clinical symptomatology is followed by the fair increase of IgА and sIgA levels (p<0.005), in comparison with the level before treatment and the control group. The statistically significant difference between the control group and the intervention one in IgА and sIgA indicators is associated with fairly higher (by 20%) rate of prescribing of antibiotics in the control group. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to improve indicators of systemic and local immunity and reduce the rate of use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

CLINICAL AND LABORATORY JUSTIFICATION FOR USE OF POLYVALENT BACTERIOPHAGE IN TECHNIQUE OF DELAYED PRESCRIBING OF ANTIBIOTICS IN PATIENTS WITH ARS

2021 ◽  
Vol 74 (6) ◽  
pp. 1445-1450
Author(s):  
Vasyl I. Popovych ◽  
Ivanna V. Koshel ◽  
Mahmoud J. Al Hariri
Keyword(s):  
Staphylococcus Aureus ◽  
Sea Water ◽  
Nasal Congestion ◽  
Bacterial Load ◽  
Intervention Group ◽  
Control Group ◽  
Isotonic Solution ◽  
Haemophilus Influenza ◽  
Acute Rhinosinusitis ◽  
The Third

The aim: Of research was to evaluate the effectiveness of bacteriophage in patients with acute rhinosinusitis in respect of technique of delayed prescribing of antibiotics. Materials and methods: There were examined 155 patients who were given irrigation therapy with isotonic solution of sea water 4 times a day and mometasone furoate of 100 mg twice a day for 10 days. The patients of intervention group (n - 80) were additionally prescribed the polyvalent bacteriophage endonasally, in drops of 2-10 ml 3 times a day. Results: The patients in the control group were observed the decrease in intensity of rhinorrhea, nasal congestion and post-nasal drip on the third day of supervision (p < 0.05), the reduction in bacterial load with Staphylococcus aureus, S. pneumoniae, Haemophilus influenza and M. Catarrhalis (р <0,005), the increase of IgА and sIgA levels (p<0,005) and the reduction in prescription of antibacterial medications by 20%. Conclusions: Adding of polyvalent bacteriophage contributes to reducing the use of antibiotics and is recommended in the framework of the strategy of delayed prescribing of antibiotics.

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 A CLINICAL STUDY TO ASSESS THE EFFICACY OF SHWASAHARA DASHEMANI GHANAVATI IN CARDIAC ASTHMA W.S.R L.V.F

2021 ◽  
Vol p6 (1) ◽  
pp. 3179-3185
Author(s):  
Roopa M.R ◽  
Vasudev A Chate ◽  
Shreevathsa Shreevathsa ◽  
Mohan Kumar G
Keyword(s):  
Standard Treatment ◽  
Intervention Group ◽  
Simple Random Sampling ◽  
Control Group ◽  
P Value ◽  
Common Symptom ◽  
Open Label ◽  
Post Test ◽  
Clinically Significant ◽  
Cardiac Asthma

Introduction: Shwasa is said as Shigrapranahara Roga. It occurs as the main disease and also a symptom in various diseases. Shwasakruchrata is a common symptom that occurs in Hrudroga. Acharya Charaka mentioned the unique classification of drugs based on their action. Shwasahara Dashemani is one among them. It is containing 10 herbal drugs which are specially indicated in Shwasa Roga. Hence to evaluate the efficacy of Shwasahara Dashemani in Lakshana Roopi Shwasa in L.V.F (Cardiac Asthma) has taken for the study. Aim and Objective: The objective is to assess the efficacy of Shwasahara Dashemani in L.V.F with dyspnea (Cardiac Asthma). Method: The present study is a controlled comparative, open-label, clinical trial with pre and post-test design. A total of 40 subjects of a diagnosed case of L.V.F with dyspnea (Cardiac Asthma) were selected by using a simple random sampling method. Control group subjects were intervened with standard treatment of L.V.F and intervention group subjects were intervened with standard treatment of L.V.F along with Shwasahara Dashemani Ghana Vati, for the duration of 30 days. Its efficacy was assessed before treatment (0th day) and after treatment (31st day) by using BDI (Baseline Dyspnea Index Scale). Results: The P-value of dyspnea of the control group is 1.000 and the P-value of dyspnea of the intervention group is 0.105. This shows that the results of both groups are statistically not significant. But as compared to the control group, the intervention group is clinically significant because after the intervention 35% of subjects had shown improvement in the intervention group. Conclusion: As compared to the control group, in the intervention group Shwasahara Dashemani Ghanavati is clinically significant in relieving cardiac asthma when used with standard treatment of L.V.F. Keyword: Shwasahara Dashemani. Cardiac Asthma, L.V.F, Dyspnea

scholarly journals Effect of rehabilitation training on an elderly population with mild to moderate hearing loss: study protocol for a randomised clinical trial

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 582
Author(s):  
Parisa Rasouli Fard ◽  
Farnoush Jarollahi ◽  
Seyyed Jalal Sameni ◽  
Mohammad Kamali
Keyword(s):  
Clinical Trial ◽  
Hearing Loss ◽  
Negative Impact ◽  
Intervention Group ◽  
Randomised Clinical Trial ◽  
Control Group ◽  
Rehabilitation Training ◽  
Speech In Noise ◽  
Age Related ◽  
Moderate Hearing Loss

Background: Age-related hearing loss (presbycusis) is a form of hearing loss in over 60-year-olds and has a negative impact on quality of life. The pathophysiology of presbycusis is multifactorial and is predominately characterised with a loss of speech perception in noise. In the cochlea, auditory filters decompose broadband sound into a series of narrowband output signals, which contains two kinds of temporal information: slow changes in overall amplitude envelope (ENV) and faster variations in temporal fine structure (TFS). TFS is important for recognition of target speech in noise. The main aim of the study is to evaluate the effect of TFS rehabilitation training in participants over the age of 60 years with mild to moderate hearing loss. Methods: A randomised clinical trial  conduct on 30 participants with mild (loss of 20-39dB) to moderate (40-69dB) hearing loss, aged between 60 and 75 years old. Participants with conductive hearing loss, abnormal middle ear pathology and central nerve system disease were excluded. Participants were randomly selected to an intervention and control group with a 1:1 ratio. Rehabilitation for the intervention Group are 30-minute sessions three times a week for a total five weeks of vowel consonant vowel words that are used to eliminate ENV and keep only TFS. Word in noise test, binaural TFS test, and Speech, Spatial and Qualities of Hearing Scale scores are performed at the beginning and end of study to evaluate the effect of rehabilitation training. Conclusion:  Life expectancy in the elderly has improved, leading to an increased prevalence of age-related diseases including presbycusis. A literature review highlighted that TFS damage is permanent; however, in this study we will attempt to prove that TFS training may lead to speech in noise perception restored. Trial registration: Registry of Clinical Trials, IRCT2019625044006N1 (7th August 2019).

scholarly journals 1880. Reducing Antibiotic Prescribing for Acute Bronchitis in Outpatient Settings Using a Multifaceted Approach

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S49-S50
Author(s):  
Philip Chung ◽  
Regina Nailon ◽  
M Salman Ashraf ◽  
Scott Bergman ◽  
Teresa Micheels ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Patient Empowerment ◽  
Intervention Group ◽  
Acute Bronchitis ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Multifaceted Approach ◽  
Primary Care Clinics ◽  
Educational Videos ◽  
Outpatient Settings

Abstract Background Nebraska (NE) ranks among the highest states for per capita antibiotic (AB) use in outpatient (OP) settings. Nebraska Medicine (NM) partnered with NE Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a program funded by NE DHHS via a CDC grant, to reduce AB prescribing for acute bronchitis in OP settings. Methods The antimicrobial stewardship (AS) pilot program targeted NM OP clinics during winter 2018. All OP facility clinicians were notified of the availability of online AS educational videos. In addition, 5 primary care clinics (PCC) received clinician-directed interventions that included acute respiratory infection management pocket guides and posters for display in workrooms. Another 5 PCC received both clinician- and patient-directed interventions (examination room patient empowerment posters, Be Antibiotic Aware pledge cards and brochures). We compared AB prescribing rates for acute bronchitis between January and April 2017 and January and April 2018 among the 2 PCC groups and a control group of 5 immediate care clinics/emergency departments (ICC/ED). Clinicians in all 10 PCC were surveyed to assess usefulness of the AS campaign. Results A total of 593 acute bronchitis diagnosis encounters were included. AB prescribing rates for acute bronchitis for the 15 sites decreased from 53.7% to 43.6% (P = 0.02). Prescribing rates were unchanged in ICC/ED that received only notification of online educational videos (40.8% vs. 41.5%, P = 1.00) but were reduced in clinics that received clinician-directed (74.5% vs. 33.3%, P < 0.01) and patient-directed (61.1% vs. 48.8%, P = 0.07) interventions. Azithromycin was the most commonly prescribed AB (31.5% in 2017 and 29.8% in 2018). After the AS campaign, only the clinician-directed intervention group saw a reduction in azithromycin prescribing (33.3% vs. 13.9%, P < 0.05). Out of 51 clinicians who completed the survey, 45.1% felt campaign tools facilitated meaningful discussion with patients. Workroom posters and pocket guides were reported by 47.1% and 39.2% to be somewhat or extremely helpful, respectively. Conclusion This OP AS campaign led to a significant reduction in AB prescribing. Successful OP AS campaigns need multifaceted approaches but targeted clinician interventions appear most beneficial. Disclosures All Authors: No reported Disclosures.

scholarly journals Early intervention in panic: pragmatic randomised controlled trial

2010 ◽  
Vol 196 (4) ◽  
pp. 326-331 ◽  
Author(s):  
Peter Meulenbeek ◽  
Godelief Willemse ◽  
Filip Smit ◽  
Anton van Balkom ◽  
Philip Spinhoven ◽  
...  
Keyword(s):  
Early Intervention ◽  
Panic Disorder ◽  
Group Intervention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Report ◽  
Control Group ◽  
Cognitive Behavioural ◽  
Clinically Significant ◽  
Randomised Controlled

BackgroundMany people suffer from subthreshold and mild panic disorder and are at risk of developing more severe panic disorder.AimsThis study (trial registration: ISRCTN33407455) was conducted to evaluate the effectiveness of an early group intervention based on cognitive–behavioural principles to reduce panic disorder symptomatology.MethodParticipants with subthreshold or mild panic disorder were recruited from the general population and randomised to the intervention (n = 109) or a waiting-list control group (n = 108). The course was offered by 17 community mental health centres.ResultsIn the early intervention group, 43/109 (39%) participants presented with a clinically significant change on the Panic Disorder Severity Scale–Self Report (PDSS–SR) v. 17/108 (16%) in the control group (odds ratio (OR) for favourable treatment response 3.49, 95% CI 1.77–6.88, P = 0.001). The course also had a positive effect on DSM–IV panic disorder status (OR = 1.96, 95% CI=1.05–3.66, P = 0.037). The PDSS–SR symptom reduction was also substantial (between-group standardised mean difference of 0.68). The effects were maintained at 6-month follow-up.ConclusionsPeople presenting with subthreshold and mild panic disorder benefit from this brief intervention.

scholarly journals THE EFFECT OF THERAPEUTIC GROUP THERAPY ON THE DEVELOPMENT OF ADOLESCENT SELF IDENTITY IN ORPHANAGE

2020 ◽  
Vol 1 (1) ◽  
pp. 86
Author(s):  
Siti Kholifah ◽  
Hendy Muagiri Margono ◽  
Rizki Fitryasari ◽  
Ah Yusuf , ◽  
Hanik Endang ◽  
...  
Keyword(s):  
Group Therapy ◽  
Health Workers ◽  
Negative Impact ◽  
Intervention Group ◽  
Identity Status ◽  
Control Group ◽  
Therapeutic Group ◽  
Control Group Design ◽  
Significance Level ◽  
Self Identity

Introduction: Adolescents living in orphanages experience a lack of self-confidence, withdrawal, lack of interest in learning, lack of communication, and a closed attitude so that it will have a negative impact on cognitive, emotional, and social development. This study aims to determine the effect of Therapeutic Group Therapy (TKT) on the development of adolescent self-identity in orphanages. Methods : The study design was a Quasy experimental pre-post test control group design. The population was 104 children living in orphanages A and B. The research sample was 30 intervention groups and 32 control groups that met the inclusion criteria obtained through purposive sampling. The independent variable is Therapeutic Group Therapy while the dependent variable is self-identity. Data obtained using a questionnaire and analyzed using the Wilcoxon Sign Ranks Test and Mann-Whitney U Test with a significance level ∝ <0.05. Results : The results of the analysis of the intervention group showed the effect of TKT on self-identity (p = 0.0001). The results of the Mann-Whitney U Statistical Test of self-identity test showed a value of p = 0,0001 ( ∝ <0.05) meaning that there was an effect of TKT on self-identity between the two groups. Conclusion : TKT is done by health workers can help identify identity status teenagers and can improve self-identity teenager who lived in the orphanage through health education.

scholarly journals Effects of Levothyroxine Treatment on Lipid Profile in Subclinical Hypothyroidism: A Randomized Clinical Trial

2015 ◽  
Vol 4 (2) ◽  
pp. 72-77
Author(s):  
Karoon Shahebrahimi ◽  
Rozita Naseri ◽  
Tahereh Sadat Kalantarian ◽  
Mehrali Rahimi ◽  
Farid Najafi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Serum Lipids ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference ◽  
Before And After ◽  
Clinically Significant ◽  
Levothyroxine Treatment

Background: Studies demonstrated controversial results on subclinical hypothyroidism (SCH) regarding lipid profile alteration with or without Levothyroxine treatment. The purpose of this study is to investigate the effects of Levothyroxine on serum lipids in SCH. Materials and Methods: One hundred patients with SCH referred to Taleghani hospital in Kermanshah were recruited and randomly assigned into the intervention or the control group. Patients in intervention group received Levothyroxine 50-75 micrograms for three months. Patients in control group received the same placebo with the same dose and duration. Lipid profile was measured before and after the trial and the changes were compared between groups. (IRCT code: 138903244179N1). Results: Triglyceride, Total Cholesterol, LDL, HDL and Lipoprotein-A were measured before and after treatment. None of the factors showed significant difference either between or within groups, before and after the treatment (P<0.05). Conclusion: Treating with Levothyroxine does not have any clinically significant impact on lipid profile in SCH patients which indicates that we should not expect SCH patients to use Levothyroxine solely for lipid profile alternation, except those with other clinical indications for treatment.[GMJ.2015;4(2):72-77]

scholarly journals Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0259065
Author(s):  
Yue Chang ◽  
Yuanfan Yao ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Duan Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Intervention Group ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Feedback Intervention ◽  
Primary Care Settings ◽  
Cluster Randomised ◽  
Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

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