scholarly journals Guidelines and management of hospitalized patients with community-acquired pneumonia: the Italian experience of the FASTCAP study

2013 ◽  
pp. 5-18
Author(s):  
I. Iori ◽  
G. Gussoni ◽  
F. Blasi ◽  
A. Bulfoni ◽  
S. Costantino ◽  
...  
Keyword(s):  
Clinical Success ◽  
Guideline Implementation ◽  
Community Acquired Pneumonia ◽  
Therapeutic Success ◽  
Italian Experience ◽  
Prospective Phase ◽  
Therapeutic Recommendations ◽  
The Difference ◽  
Few Data ◽  
The Impact

BACKGROUND Nowadays few data are available addressing the validation of guidelines concerning diagnosis and treatment of Community-Acquired Pneumonia (CAP) in clinical practice. AIM OF THE STUDY To evaluate the impact of compliance to the recommendations issued by the Italian Federation of Internal Medicine (FADOI) in 2002 on the management of hospitalised CAP. METHODS National, multicentre, interventional, “before-after” survey, performed in 31 hospitals in Italy. All patients with CAP of Fine class IV or V (excluding those who were directly admitted to intensive care units) were included. The study was composed of three consecutive periods: 1) a retrospective phase (RP); 2) guideline implementation; 3) a prospective phase (PP). Results were expressed as Odds Ratios (OR) with 95% confidence intervals (95% CI) adjusted for risk factors and corrected for multiple comparisons in subgroups. RESULTS A significant increase in use of combinations was observed in the PP (p = 0.006). Moreover, a shift of prescription from β-lactams to fluoroquinolones as initial monotherapy was recorded. Therapies adherent to FADOI recommendations increased by 10.9% in the PP (p < 0.001). Therapeutic success improved after implementation of recommendations (73.9 vs 71.5%; OR = 0.83; 95% CI = 0.69-1.00; p = 0.049). The difference was particularly evident in Fine class V (58.0 vs 52.5%; OR = 0.71; 95% CI = 0.51-0.98; p = 0.036), where a trend towards a lower mortality occurred (23.1 vs 26.3%; OR = 0.71; 95% CI = 0.48-1.05; p = 0.090). Therapies compliant with FADOI recommendations showed a higher success rate in both study phases (76.6% vs 70.3%; OR = 0.74; 95% CI = 0.60-0.90; p = 0.004). Levofloxacin was the most clinically effective first-cycle therapy with 79.1% of success, the least effective being an antipneumococcal cephalosporin alone with 68.6% (OR = 0.72; 95% CI = 0.51-1.01; p = 0.053). Etiologic diagnosis was obtained in less than 12% of patients in both study phases. Mean lengths of hospital stay were 12.2 and 11.9 days in the RP and PP, respectively. CONCLUSIONS Implementation of FADOI therapeutic recommendations led to a significantly better outcome in terms of clinical success, especially in more severe cases of CAP. Possibly, more “aggressive” approaches towards implementation may result in further improvement in the overall management of CAP.

Cancer risk of aged people with HIV infection and of transplant people

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20063-20063
Author(s):  
D. Serraino ◽  
P. Piselli ◽  
G. Busnach ◽  
F. Citterio ◽  
L. Fratino ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Hiv Infection ◽  
Older Individuals ◽  
Aged People ◽  
Highly Active ◽  
Increased Risk ◽  
The Difference ◽  
Few Data ◽  
Risk Of Cancer ◽  
The Impact

20063 Background: Acquired immunesuppression due to HIV-infection or to anti-rejection therapies following organ transplantation is a well known risk factor for cancer. This increased risk has been well documented for young adults, whereas few data are available on older persons. In this study, we assessed the impact of cancer in HIV-positive persons (HIV+) and in transplant persons (TRP) who were 50 years of age or older. Methods: Data from a multi-cohort study conducted in Italy and France were analysed. Individuals ≥50 years of age were selected from the original study group constituted by 2002 HIV+ seroconverters from Italy, 6072 HIV+ from France and 2755 Italian TRP (1844 kidney, 702 heart, 159 liver and 50 lung TRP). Sex- and age-standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed to quantify the cancer risk as compared to the general population. Among HIV+, the risk of cancer was also assessed according to treatment with highly active antiretroviral therapies (HAART). Results: This analysis was based on 94 cancers diagnosed in 833 HIV+, and on 154 cancers diagnosed in 1558 TRP ≥50 years of age. The SIRs for all cancers decreased with ageing, ranging from 5.1 (95% CI: 4.0–6.5) in HIV+ aged 50–59 to 2.1 (95% CI: 1.4–3.1) in HIV+ aged 60 or older. In TRP, the SIRs for all cancer were 2.5 (95% CI:2.0–3.1) and 1.6 (95% CI: 1.2–2.0), respectively. In HIV+, the protective effect of HAART was more evident in those aged 50–59 (SIR = 6.8 in never treated and SIR = 2.4 in ever treated) than in HIV+ aged ≥60 (SIR = 2.8 and SIR = 1.6, respectively). This pattern of cancer occurrence was peculiar to virus-related cancers (e.g., Kaposi’s sarcoma, non-Hodgkin’s lymphoma, liver cancer). SIRs for lung cancer in both groups were significantly increased but did not significantly differ according to HAART and/or age. The survival of both HIV+ and TRP was significantly reduced by the diagnosis of cancer, but the difference in survival was not associated with ageing (p = 0.20). Conclusions: Aged individuals with acquired immunesuppression have a cancer pattern similar to younger persons with immunosuppression, but the burden of cancer will increase in absolute terms because of the increasing proportion of older individuals among both HIV+ and TRP. No significant financial relationships to disclose.

scholarly journals Pneumonia in nursing home patients: is it time for a specific therapeutic strategy?

2013 ◽  
pp. 212-219
Author(s):  
Gualberto Gussoni ◽  
Ido Iori ◽  
Francesco Blasi ◽  
Alessandro Bulfoni ◽  
Sebastiano Costantino ◽  
...  
Keyword(s):  
Nursing Home ◽  
Community Acquired Pneumonia ◽  
Nursing Home Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Prospective Phase ◽  
Post Hoc ◽  
Health Care Associated Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Background: Nursing home-acquired pneumonia (NHAP) was described in 1978, but only in 2005 it has been proposed as part of a new category (health care-associated pneumonia) distinct from community- or hospital-acquired infections. However, limited clinical data exist to validate this proposal. Aim of the study: To compare characteristics and outcome of patients hospitalised for pneumonia and coming from private residence or nursing home. Methods: Post-hoc analysis of the prospective phase of the FASTCAP study, performed to evaluate the impact of the Recommendations issued by the Italian Federation of Internal Medicine (FADOI) in 2002 on the management of hospitalised community-acquired pneumonia (CAP). Results: The study examined 1,219 patients coming from private residence, and 179 with NHAP. Failures of therapy were significantly more frequent in patients with NHAP (35.8% vs 24.9%; Odds Ratio 1.48; 95% confidence interval 1.05-2.09). Mortality was higher in patients coming from nursing home (24.0% vs 9.8%; OR 2.59; 95% CI 1.72-3.90). Antibiotic treatment was more frequently performed as monotherapy in case of NHAP. Conclusions: At the time of FASTCAP, NHAP was included in the category of CAP, and coherently, treatment of NHAP was not more aggressive if compared to community-acquired infections. However, our results confirm that NHAP is at increased risk for worst outcome, and probably worth considering for specific therapeutic strategies. Future studies are needed to better assess the microbiology of NHAP, and to evaluate if specific treatments, as those recommended by recent guidelines, may improve the outcome for these high-risk patients.

Evaluation of the impact of public investment programs on social and economic performance of territories

2019 ◽  
pp. 109-123
Author(s):  
I. E. Limonov ◽  
M. V. Nesena
Keyword(s):  
Bayesian Modeling ◽  
Positive Impact ◽  
Public Investment ◽  
Difference In Differences ◽  
The Public ◽  
Export Activity ◽  
Regional Investment ◽  
The Difference ◽  
The Impact ◽  
Development Institution

The purpose of this study is to evaluate the impact of public investment programs on the socio-economic development of territories. As a case, the federal target programs for the development of regions and investment programs of the financial development institution — Vnesheconombank, designed to solve the problems of regional development are considered. The impact of the public interventions were evaluated by the “difference in differences” method using Bayesian modeling. The results of the evaluation suggest the positive impact of federal target programs on the total factor productivity of regions and on innovation; and that regional investment programs of Vnesheconombank are improving the export activity. All of the investments considered are likely to have contributed to the reduction of unemployment, but their implementation has been accompanied by an increase in social inequality.

The Use of Multimedia and its Impact on Bangladeshi EFL Learners at Tertiary Level

2020 ◽  
Vol 4 (2) ◽  
pp. 150
Author(s):  
Farzana Sharmin Pamela Islam
Keyword(s):  
Language Learning ◽  
Academic Writing ◽  
Teaching And Learning ◽  
English Language ◽  
Capital City ◽  
Tertiary Level ◽  
Language Classroom ◽  
The Difference ◽  
The Government ◽  
The Impact

As 21st century is the era of modern technologies with different aspects, it offers us to make the best use of them. After tape recorder and overhead projector (OHP), multimedia has become an important part of language classroom facilities for its unique and effective application in delivering and learning lesson. Although in many parts of Bangladesh, a South Asian developing country, where English enjoys the status of a foreign language, the use of multimedia in teaching and learning is viewed as a matter of luxury. However, nowadays the usefulness and the necessity of it are well recognized by the academics as well as the government. The study aims to focus on the difference between a traditional classroom void of multimedia and multimedia equipped classrooms at university level by explaining how multimedia support the students with enhanced opportunity to interact with diverse texts that give them more in-depth comprehension of the subject. It also focuses on audio-visual advantage of multimedia on the students’ English language learning. The study has followed a qualitative method to get an in-depth understanding of the impact of using multimedia in an English language classroom at tertiary level. For this purpose, the data have been collected from two different sources. Firstly, from students’ written response to  an open ended question as to their comparative experience of learning  lessons with and without multimedia facilities; and secondly, through  observation of English language classes at a private university of Dhaka, the capital city of Bangladesh. The discussion of the study is limited to  the use of multimedia in English language classroom using cartoons, images and music with a view to enhance students’ skills in academic writing, critical analysis of image and critical appreciation of music. For this purpose, cartoons in English language, images from Google and music from You Tube have got focused discussion in this paper.

Case study: Prediction and field tests of railway noise and effects of a low-height noise barrier

2020 ◽  
Vol 68 (4) ◽  
pp. 303-314
Author(s):  
Yuna Park ◽  
Hyo-In Koh ◽  
University of Science and Technology, Transpo ◽  
University of Science and Technology, Transpo ◽  
University of Science and Technology, Transpo ◽  
...  
Keyword(s):  
High Speed ◽  
Field Tests ◽  
Residential Areas ◽  
Railway Systems ◽  
Railway Noise ◽  
Sound Levels ◽  
Noise Barrier ◽  
The Difference ◽  
Reduction Effect ◽  
The Impact

Railway noise is calculated to predict the impact of new or reconstructed railway tracks on nearby residential areas. The results are used to prepare adequate counter- measures, and the calculation results are directly related to the cost of the action plans. The calculated values were used to produce noise maps for each area of inter- est. The Schall 03 2012 is one of the most frequently used methods for the production of noise maps. The latest version was released in 2012 and uses various input para- meters associated with the latest rail vehicles and track systems in Germany. This version has not been sufficiently used in South Korea, and there is a lack of standard guidelines and a precise manual for Korean railway systems. Thus, it is not clear what input parameters will match specific local cases. This study investigates the modeling procedure for Korean railway systems and the differences between calcu- lated railway sound levels and measured values obtained using the Schall 03 2012 model. Depending on the location of sound receivers, the difference between the cal- culated and measured values was within approximately 4 dB for various train types. In the case of high-speed trains, the value was approximately 7 dB. A noise-reducing measure was also modeled. The noise reduction effect of a low-height noise barrier system was predicted and evaluated for operating railway sites within the frame- work of a national research project in Korea. The comparison of calculated and measured values showed differences within 2.5 dB.

scholarly journals Soil Moisture Dynamics in Response to Precipitation and Thinning in a Semi-Dry Forest in Northern Mexico

Water ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 105
Author(s):  
Argelia E. Rascón-Ramos ◽  
Martín Martínez-Salvador ◽  
Gabriel Sosa-Pérez ◽  
Federico Villarreal-Guerrero ◽  
Alfredo Pinedo-Alvarez ◽  
...  
Keyword(s):  
Soil Moisture ◽  
Forest Management ◽  
Water Availability ◽  
Dry Forest ◽  
Rainfall Events ◽  
Rainfall Characteristics ◽  
Northern Mexico ◽  
The Difference ◽  
The Impact ◽  
Moisture Dynamics

Understanding soil moisture behavior in semi-dry forests is essential for evaluating the impact of forest management on water availability. The objective of the study was to analyze soil moisture based in storm observations in three micro-catchments (0.19, 0.20, and 0.27 ha) with similar tree densities, and subject to different thinning intensities in a semi-dry forest in Chihuahua, Mexico. Vegetation, soil characteristics, precipitation, and volumetric water content were measured before thinning (2018), and after 0%, 40%, and 80% thinning for each micro-catchment (2019). Soil moisture was low and relatively similar among the three micro-catchments in 2018 (mean = 8.5%), and only large rainfall events (>30 mm) increased soil moisture significantly (29–52%). After thinning, soil moisture was higher and significantly different among the micro-catchments only during small rainfall events (<10 mm), while a difference was not noted during large events. The difference before–after during small rainfall events was not significant for the control (0% thinning); whereas 40% and 80% thinning increased soil moisture significantly by 40% and 53%, respectively. Knowledge of the response of soil moisture as a result of thinning and rainfall characteristics has important implications, especially for evaluating the impact of forest management on water availability.

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

2021 ◽  
pp. 153857442110232
Author(s):  
Spyridon N. Mylonas ◽  
Konstantinos G. Moulakakis ◽  
Nikolaos Kadoglou ◽  
Constantinos Antonopoulos ◽  
Thomas E. Kotsis ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Surgical Repair ◽  
Open Repair ◽  
Abdominal Aortic ◽  
Gender And Age ◽  
Baseline Values ◽  
The Difference ◽  
The Impact ◽  
Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

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