scholarly journals Biomarkers for sepsis: past, present and future

2016 ◽  
Vol 10 (4) ◽  
pp. 301 ◽  
Author(s):  
Giuseppe Chesi ◽  
Natale Vazzana ◽  
Claudio Giumelli
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Supportive Care ◽  
Early Identification ◽  
Antibiotic Stewardship ◽  
Treatment Strategies ◽  
Severe Infection ◽  
Antibiotic Use ◽  
Evidence Based ◽  
Drug Resistant

Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients.

Article Commentary: Strategies in the Prevention and Management of Ventilator-Associated Pneumonia

2007 ◽  
Vol 73 (5) ◽  
pp. 419-432 ◽  
Author(s):  
Fredric M. Pieracci ◽  
Philip S. Barie
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Lower Respiratory Tract ◽  
Antibiotic Use ◽  
Current Data ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Duration Of Therapy ◽  
Risk Of Aspiration

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in the intensive care unit. Prevention of VAP is possible through the use of several evidence-based strategies intended to minimize intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. Current data favor the quantitative analysis of lower respiratory tract cultures for the diagnosis of VAP, accompanied by the initiation of broad-spectrum empiric antimicrobial therapy based on patient risk factors for infection with multi-drug-resistant pathogens and data from unit-specific antibiograms. Eventual choice of antibiotic and duration of therapy are selected based on culture results and patient stability, with an emphasis on minimization of unnecessary antibiotic use.

Prophylaxis of Post-Inflammatory Hyperpigmentation From Energy-Based Device Treatments: A Review

2020 ◽  
pp. 120347542095763
Author(s):  
Ian T.Y. Wong ◽  
Vincent Richer
Keyword(s):  
Clinical Practice ◽  
Tranexamic Acid ◽  
Current Literature ◽  
Treatment Strategies ◽  
Post Treatment ◽  
Evidence Based ◽  
Hydroxy Acids ◽  
Psychosocial Burden ◽  
Alpha Hydroxy Acids ◽  
Dermatologic Disease

Post-inflammatory hyperpigmentation (PIH) is an acquired hypermelanosis that can result from inflammatory dermatologic disease, trauma, or iatrogenesis from procedures. This condition disproportionately affects individuals with skin of color, and it can place a significant psychosocial burden on affected patients. The management of PIH is, therefore, of great interest to clinicians, especially dermatologists. The treatment of established PIH has long been a principal focus within the literature, with publications on the topic outnumbering publications on prophylaxis of PIH. Prophylaxis strategies to prevent PIH vary greatly in clinical practice, likely due to the absence of an evidence-based consensus. Published approaches to PIH prophylaxis include pretreatment (topical alpha hydroxy acids, retinoids, hydroquinone, and brimonidine) and post-treatment strategies (photoprotection, corticosteroids, and tranexamic acid). This review will examine the current literature on prophylaxis of PIH from energy-based device treatments.

Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

2017 ◽  
Vol 57 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Marquita C. Genies ◽  
Julia M. Kim ◽  
Kristina Pyclik ◽  
Suzanne Rossi ◽  
Natalie Spicyn ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Educational Intervention ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
The United States ◽  
Evidence Based ◽  
Post Intervention ◽  
Variation In Care

Bronchiolitis is the leading cause of infant hospitalizations in the United States. Despite clinical practice guidelines discouraging the utilization of non–evidence-based therapies, there continues to be wide variation in care and resource utilization. A pre-post physician focused educational intervention was conducted with the aims to reduce the use of non–evidence-based medical therapies, including bronchodilators, among patients admitted for bronchiolitis. Among patients meeting inclusion criteria (pre: n = 45; post: n = 47), bronchodilator use decreased by 50% ( P < .001). Antibiotic use increased by 9% ( P < .02), although results remained within published acceptable utilization rates of less than 19%. There were no statistical differences in chest X-ray, respiratory viral panel, and steroid use. There were no differences in number of pediatric intensive care unit transfers, 30-day readmission rates, and mean length of stay. The findings demonstrate that a physician-focused educational intervention highlighting American Academy of Pediatrics clinical practice guidelines resulted in reduced utilization of bronchodilators.

scholarly journals Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling

2019 ◽  
Vol 150 (11) ◽  
pp. 906-921.e12 ◽  
Author(s):  
Peter B. Lockhart ◽  
Malavika P. Tampi ◽  
Elliot Abt ◽  
Anita Aminoshariae ◽  
Michael J. Durkin ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Antibiotic Use ◽  
Dental Pain ◽  
Evidence Based

scholarly journals Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines

2018 ◽  
pp. 1-13 ◽  
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Eng-Siew Koh ◽  
Weng Ng ◽  
Anthony Arnold ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Supportive Care ◽  
Practice Guidelines ◽  
Well Being ◽  
Evidence Based ◽  
Care Pathways ◽  
Clinical Recommendations ◽  
Patients With Cancer ◽  
Patient Reported ◽  
Automated Algorithms

Purpose High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. Methods We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. Results Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey–Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. Conclusion Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

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