scholarly journals Retrospective Analysis of the Initiation of Antibiotic Therapy In Severe Sepsis In Pediatric Patients

2009 ◽  
Vol 14 (4) ◽  
pp. 221-225
Author(s):  
Joseph M. LaRochelle ◽  
Jill A. Morgan ◽  
Kristine A. Parbuoni
Keyword(s):  
Severe Sepsis ◽  
Time Delay ◽  
Mortality Rate ◽  
Antibiotic Therapy ◽  
Sample Size ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Mortality Data ◽  
Average Weight ◽  
Pediatric Sepsis

BACKGROUND The 2008 Surviving Sepsis Campaign guidelines state that intravenous antibiotic therapy should be started within the first hour of recognition of septic shock. Currently, there are no published studies looking at antibiotic timing in pediatric sepsis patients. OBJECTIVES The purpose of this study is to determine if sepsis patients admitted to a Pediatric Intensive Care Unit (PICU) are administered antibiotics in the appropriate time frame according to the Surviving Sepsis Guidelines. METHODS A retrospective chart review was conducted during a six-month time frame. For the purpose of this pilot study the onset of severe sepsis was defined as the time of a physician order for a vasopressor. Antibiotic appropriateness was based on culture results, drug dosing, and route. Length of PICU stay, overall hospital days, and mortality data were collected. Descriptive statistics on patient demographics, and the prescribing and time of administration of both antibiotics and vasopressors are included. RESULTS Fifty-four patients were identified, 4 of which were admitted twice during the study period. Fifty admissions did not meet criteria for analysis, with a final sample size of 8 patients identified. All patients were male with an average age of 7.6 years, average weight of 33.4 kg, and zero mortality rate. Eighty-eight percent of the patients were administered appropriate antibiotics. The average time from vasopressor order to the administration of antibiotics was 7 hours and 40 minutes. CONCLUSIONS The time delay in administering antibiotics to our pediatric sepsis patients likely involved physicians, nurses, and pharmacists. System improvements are needed to decrease the time delay in providing antibiotics to this patient population. Although our sample size was small, the mortality rate found in this study is lower than what has been reported in adults with sepsis.

scholarly journals Sepsis Incidence: A Population-Based Study

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Lisa Mellhammar ◽  
Sven Wullt ◽  
Åsa Lindberg ◽  
Peter Lanbeck ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Antibiotic Therapy ◽  
Organ Dysfunction ◽  
Antibiotic Treatment ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Clinical Findings ◽  
Intravenous Antibiotic ◽  
Major Health Problem ◽  
Intravenous Antibiotic Therapy

Abstract Background Although sepsis is a major health problem, data on sepsis epidemiology are scarce. The aim of this study was to assess the incidence of sepsis, based on clinical findings in all adult patients treated with intravenous antibiotic in all parts of all hospitals in an entire population. Methods This is a retrospective chart review of patients ≥18 years, living in 2 regions in Sweden, who were started on an intravenous antibiotic therapy on 4 dates, evenly distributed over the year of 2015. The main outcome was the incidence of sepsis with organ dysfunction. The mean population ≥18 years at 2015 in the regions was 1275753. Five hundred sixty-three patients living in the regions were started on intravenous antibiotic treatment on the dates of the survey. Patients who had ongoing intravenous antibiotic therapy preceding the inclusion dates were excluded, if sepsis was already present. Results Four hundred eighty-two patients were included in the study; 339 had a diagnosed infection, of those, 96 had severe sepsis according to the 1991/2001 sepsis definitions, and 109 had sepsis according to the sepsis-3. This is equivalent to an annual incidence of traditional severe sepsis of 687/100000 persons (95% confidence interval [CI], 549–824) or according to the sepsis-3 definition of 780/100000 persons (95% CI, 633–926). Seventy-four patients had sepsis according to both definitions. Conclusions The incidence of sepsis with organ dysfunction is higher than most previous estimates independent of definition. The inclusion of all inpatients started on intravenous antibiotic treatment of sepsis in a population makes an accurate assessment of sepsis incidence possible.

scholarly journals Mortality among free-ranging California condors (Gymnogyps californianus) during 2010–2014 with determination of last meal and toxicant exposure

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Tabitha Viner ◽  
Rebecca Kagan ◽  
Bruce Rideout ◽  
Ilse Stalis ◽  
Rebecca Papendick ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cause Of Death ◽  
Time Frame ◽  
Mortality Data ◽  
Toxicant Exposure ◽  
Crude Mortality Rate ◽  
In The Wild ◽  
Proportional Mortality ◽  
Gymnogyps Californianus ◽  
The Impact

Over the past 30 years, the California condor (Gymnogyps californianus) population has rebounded from 22 individuals to over 200 birds living in the wild. Historical impacts to the population have been largely anthropogenic. In this study, we explore mortality and cause of death data from condors that died during the years 2010-2014 and compare these to mortality data described by Rideout et al. in 2012, covering the years 1992-2009. In addition, morphologic and genetic analysis of the contents of the upper gastrointestinal (GI) tract was performed on the 2010-2014 condor mortalities to determine animal origins of the last meal eaten. The maximum population at risk within this time frame was 329 birds. During this time, 88 condors died and underwent post-mortem examination, and 41 birds were lost to tracking efforts and presumed dead (crude mortality rate of 39%; 129/329). A cause of death was determined for 66 of the 88 necropsied birds. Lead toxicosis remained a significant negative factor in condor population recovery, being related to the deaths of 37 adult and juvenile condors (proportional mortality rate 56%). Compared to condors succumbing to other causes of death, cattle were less often part of the last meal of lead-intoxicated condors. Based on these data, continued efforts to mitigate the impact of lead on California condors should be pursued.

Perbandingan Linieritas Dalam Pendeteksian Faktor-Faktor Yang Mempengaruhi Angka Kematian Bayi Di Provinsi Aceh

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Desfira Ahya ◽  
Inas Salsabila ◽  
Miftahuddin
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Linear Model ◽  
Health Workers ◽  
Additive Model ◽  
Infant Mortality Rate ◽  
Mortality Data ◽  
Important Indicator ◽  
Penalized Spline ◽  
Aceh Province

Angka Kematian Bayi/ Infant Mortality Rate (IMR) merupakan indikator penting dalam mengukur keberhasilan pengembangan kesehatan. Nilai IMR juga dapat digunakan untuk mengetahui tingkat kesehatan ibu, kondisi kesehatan lingkungan dan secara umum, tingkat pengembangan sosio-ekonomi masyarakat. Penelitian ini bertujuan untuk memperoleh model IMR terbaik menggunakan tiga pendekatan: Model Linear, Model Linear Tergeneralisir dan Model Aditif Tergeneralisir dengan basis P-spline. Sebagai tambahan, berdasarkan model tersebut akan terlihat variabel yang mempengaruhi tingkat kematian bayi di provinsi Aceh. Penelitian ini menggunakan data jumlah kematian bayi di tahun 2013-2015. Data dalam penelitian ini diperoleh dari Profil Kesehatan Aceh. Hasil menunjukkan bahwa model terbaik dalam menjelaskan angka kematian bayi di provinsi Aceh tahun 2013-2015 ialah Model Linear Tergeneralisir dengan basis P-spline menggunakan parameter penghalusan 100 dan titik knots 8. Faktor yang sangat mempengaruhi angka kematian ialah jumlah pekerja yang sehat.   Infant mortality rate (IMR) is an important indicator in measuring the success of health development. IMR also can be used to knowing the level of maternal health, environmental health conditions and generally the level of socio-economic development in community. This research aims to get the best model of infant mortality data using three approaches: Linear Model, Generalized Linear Model and Generalized Additive Model with Penalized Spline (P-spline) base. In addition, based on the model can be seen the variables that affect to infant mortality in Aceh Province. This research uses data number of infant mortality in Aceh Province period 2013-2015. The data in this research were obtained from Aceh’s Health Profile. The results show that the best model can be explain infant mortality rate in Aceh Province period 2013-2015 is GAM model with P-spline base using smoothing parameter 100 and knots 8. Factor that high effect to infant mortality is number of health workers.

scholarly journals Characteristics of infective endocarditis in a cancer population

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001664
Author(s):  
Cullen Grable ◽  
Syed Yusuf ◽  
Juhee Song ◽  
George M Viola ◽  
Owais Ulhaq ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Mortality Data ◽  
Limited Information ◽  
Tertiary Care Centre ◽  
Indwelling Catheters ◽  
Patients With Cancer ◽  
Duke Criteria ◽  
Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

Abstract P261: Intensive Systolic Blood Pressure Lowering Will Prevent Over 100,000 Deaths Annually

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Holly Kramer ◽  
Adam Bress ◽  
Srinivasan Beddhu ◽  
Paul Muntner ◽  
Richard S Cooper
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Systolic Blood Pressure ◽  
Mortality Rates ◽  
Mortality Data ◽  
Blood Pressure Lowering ◽  
Cvd Risk ◽  
Pressure Lowering ◽  
Annual Mortality ◽  
The U.S

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) trial randomized 9,361 adults aged ≥50 years at high cardiovascular disease (CVD) risk without diabetes or stroke to intensive systolic blood pressure (SBP) lowering (≤120 mmHg) or standard SBP lowering (≤140 mmHg). After a median follow up of 3.26 years, all-cause mortality was 27% (95% CI 40%, 10%) lower with intensive SBP lowering. We estimated the potential number of prevented deaths with intensive SBP lowering in the U.S. population meeting SPRINT criteria. Methods: SPRINT eligibility criteria were applied to the National Health and Nutrition Examination Survey 1999-2006, a representative survey of the U.S. population, linked with the mortality data through December 2011. Eligibility included (1) age ≥50 years with (2) SBP 130-180 mmHg depending on number of antihypertensive classes being taken, and (3) presence of ≥1 CVD risk conditions (history of coronary heart disease, estimated glomerular filtration rate (eGFR) 20 to 59 ml/min/1.73 m 2 , 10-year Framingham risk score ≥15%, or age ≥75 years). Adults with diabetes, stroke history, >1 g/day proteinuria, heart failure, on dialysis, or eGFR<20 ml/min/1.73m 2 were excluded. Annual mortality rates for adults meeting SPRINT criteria were calculated using Kaplan-Meier methods and the expected reduction in mortality rates with intensive SBP lowering in SPRINT was used to determine the number of potential deaths prevented. Analyses accounted for the complex survey design. Results: An estimated 18.1 million U.S. adults met SPRINT criteria with 7.4 million taking blood pressure lowering medications. The mean age was 68.6 years and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.2% (95% CI 1.9%, 2.5%) and intensive SBP lowering was projected to prevent 107,453 deaths per year (95% CI 45,374 to 139,490). Among adults with SBP ≥145 mmHg, the annual mortality rate was 2.5% (95% CI 2.1%, 3.0%) and intensive SBP lowering was projected to prevent 60,908 deaths per year (95% CI 26, 455 to 76, 792). Conclusions: We project intensive SBP lowering could prevent over 100,000 deaths per year of intensive treatment.

A Case Series of the Use of Piezosurgery Instrument for Minimally Invasive Metopic Suturectomy

2021 ◽  
Author(s):  
Ben G McGahan ◽  
Joravar Dhaliwal ◽  
Gregory D Pearson ◽  
Ibrahim Khansa ◽  
Annie I Drapeau
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Minimal Invasive ◽  
Surgical Approaches ◽  
Average Weight ◽  
Entire Cohort ◽  
Metopic Suture ◽  
The Many ◽  
Single Suture ◽  
Metopic Craniosynostosis

Abstract BACKGROUND Minimal invasive suturectomy is one of the many surgical approaches to treat isolated single suture craniosynostosis. This approach can be technically challenging in metopic craniosynostosis given the narrow corridor and steep angle of the forehead. New instruments such as the Piezosurgery device (Mectron) have the potential to improve the ability to safely perform minimal invasive surgery in metopic craniosynostosis. OBJECTIVE To demonstrate the safety and efficacy of Piezosurgery technology in minimal invasive suturectomy for nonsyndromic metopic suture craniosynostosis and to describe our technique. METHODS A retrospective chart review was performed of all the single metopic suturectomies performed at our single institution from March 2018 to November 2019. Pre-, intra-, and postoperative data were collected to assess the safety of Piezosurgery. RESULTS The cohort consisted of 12 patients with an average of 95.25 d old and an average weight of 6.2 kg. A total of 91.7% were male, and 91.7% were Caucasian. There were no intraoperative or postoperative Piezosurgery device-related complications in the entire cohort. CONCLUSION The use of the Piezosurgery instrument was safe in this cohort of minimal invasive metopic suturectomy. This device has greatly increased the ease of this procedure in our hands.

Biases in the estimation of size-dependent mortality models: advantages of a semiparametric approach

2009 ◽  
Vol 39 (8) ◽  
pp. 1430-1443 ◽  
Author(s):  
Ghislain Vieilledent ◽  
Benoît Courbaud ◽  
Georges Kunstler ◽  
Jean-François Dhôte ◽  
James S. Clark
Keyword(s):  
Mortality Rate ◽  
Picea Abies ◽  
Abies Alba ◽  
Mortality Data ◽  
Strongly Nonlinear ◽  
Semiparametric Approach ◽  
Mortality Models ◽  
Large Trees ◽  
Parametric Functions ◽  
Related Mortality

Mortality rate is thought to show a U-shape relationship to tree size. This shape could result from a decrease of competition-related mortality as diameter increases, followed by an increase of senescence and disturbance-related mortality for large trees. Modeling mortality rate as a function of diameter is nevertheless difficult, first because this relationship is strongly nonlinear, and second because data can be unbalanced, with few observations for large trees. Parametric functions, which are inflexible and sensitive to the distribution of observations, tend to introduce biases in mortality rate estimates. In this study we use mortality data for Abies alba Mill. and Picea abies (L.) Karst. to demonstrate that mortality rate estimates for extreme diameters were biased when using classical parametric functions. We then propose a semiparametric approach allowing a more flexible relationship between mortality and diameter. We show that the relatively shade-tolerant A. alba has a lower annual mortality rate (2.75%) than P. abies (3.78%) for small trees (DBH <15 cm). Picea abies, supposedly more sensitive to bark beetle attacks and windthrows, had a higher mortality rate (up to 0.46%) than A. alba (up to 0.30%) for large trees (DBH ≥50 cm).

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