Evaluating Empiric Treatment Options for Secondary Peritonitis Using Pharmacodynamic Profiling

2007 ◽  
Vol 8 (2) ◽  
pp. 215-226 ◽  
Author(s):  
Kathryn J. Eagye ◽  
Joseph L. Kuti ◽  
David P. Nicolau
Keyword(s):  
Treatment Options ◽  
Secondary Peritonitis ◽  
Empiric Treatment

scholarly journals 1041. How Do Healthcare Providers Approach Empiric β-Lactam (BL) Treatment of Bloodstream Infections (BSI) Caused by Gram-Negative Rods (GNRs)? Analysis of Escherichia coli and Klebsiella pneumoniae BSI From the Veterans Health Administration (VHA)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S311
Author(s):  
Roberto Viau ◽  
Brigid Wilson ◽  
Scott R Evans ◽  
Federico Perez ◽  
Henry F Chambers ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Treatment Options ◽  
Bloodstream Infections ◽  
Empiric Antibiotic Therapy ◽  
Veterans Health ◽  
Health Administration ◽  
E Coli ◽  
Empiric Treatment ◽  
Specimen Collection

Abstract Background Physicians make decisions regarding antimicrobial chemotherapy based on clinical and demographic factors, choosing initial empiric therapy without knowing the pathogen or its susceptibilities. Given the various treatment options and resistance mechanisms, treatment of GNR BSI is challenging with 30 day mortality approaching 30%. Using a large cohort of Escherichia coli and Klebsiella pneumoniae BSI, we aimed to characterize empiric antibiotic therapy, comparing treatment before and after Gram stain (GS) results, and summarize clinical outcomes. Methods Using a cohort of patients hospitalized within VHA, we used the Corporate Data Warehouse to identify blood cultures positive for E. coli or K. pneumoniae from 2006 to 2015. We extracted inpatient antimicrobial regimens, demographics, and antibiotic susceptibility testing (AST) results. We excluded cases with missing GS result dates and those not treated with BLs. We defined “initial” empiric treatment as agents received between specimen collection and GS results; and “modified” empiric treatment as agents received after GS but before AST results. Patient characteristics, treatments, and outcomes were summarized overall and by organism. Results Of 36,531 BSI identified, we analyzed a subset of 21,597 that met our inclusion criteria (figure). Within this subset of patients, the mean age was 70.3 and all-cause 30-day mortality was 13.9% (2,054 out of 14,735) for E. coli and 17.8% (1,220 out of 6,862) for K. pneumoniae. Initial empiric treatment included an effective agent in 90.4% (91.2% in E. coli, 88.7% in K. pneumoniae) of cases. This rate increased to 95.3% (96.0% in E. coli, 93.8% in K. pneumoniae) for modified empiric treatment. The most commonly prescribed initial empiric BL was piperacillin/tazobactam, observed in 55% of treated patients, followed by ceftriaxone and cefepime in 14% and 11% of treated patients, respectively. Carbapenems were included in 8% of initial and 13% of modified empiric treatments. Conclusion In this cohort of older patients with E. coli and K. pneumoniae BSI, higher rates of effective BL empiric treatment were achieved after GS results. BL empiric regimens consisted mostly of broad-spectrum agents. These observations highlight the potential utility of a diagnostic tool available shortly after specimen collection to inform treatment and improve patient outcomes. Disclosures All authors: No reported disclosures.

The Collaborative Network Approach: a model for advancing patient-centric research for Castleman disease and other rare diseases

2019 ◽  
Vol 3 (1) ◽  
pp. 97-105
Author(s):  
Mary Zuccato ◽  
Dustin Shilling ◽  
David C. Fajgenbaum
Keyword(s):  
Rare Diseases ◽  
Treatment Options ◽  
Castleman Disease ◽  
High Impact ◽  
Collaborative Network ◽  
Network Approach ◽  
Grant Applications ◽  
Research Questions ◽  
Novel Strategy ◽  
Patient Centric

Abstract There are ∼7000 rare diseases affecting 30 000 000 individuals in the U.S.A. 95% of these rare diseases do not have a single Food and Drug Administration-approved therapy. Relatively, limited progress has been made to develop new or repurpose existing therapies for these disorders, in part because traditional funding models are not as effective when applied to rare diseases. Due to the suboptimal research infrastructure and treatment options for Castleman disease, the Castleman Disease Collaborative Network (CDCN), founded in 2012, spearheaded a novel strategy for advancing biomedical research, the ‘Collaborative Network Approach’. At its heart, the Collaborative Network Approach leverages and integrates the entire community of stakeholders — patients, physicians and researchers — to identify and prioritize high-impact research questions. It then recruits the most qualified researchers to conduct these studies. In parallel, patients are empowered to fight back by supporting research through fundraising and providing their biospecimens and clinical data. This approach democratizes research, allowing the entire community to identify the most clinically relevant and pressing questions; any idea can be translated into a study rather than limiting research to the ideas proposed by researchers in grant applications. Preliminary results from the CDCN and other organizations that have followed its Collaborative Network Approach suggest that this model is generalizable across rare diseases.

Establishing a Group Educational Session for Hyperacusis Patients

2019 ◽  
Vol 28 (2) ◽  
pp. 245-250
Author(s):  
Ann E. Perreau ◽  
Richard S. Tyler ◽  
Patricia C. Mancini ◽  
Shelley Witt ◽  
Mohamed Salah Elgandy
Keyword(s):  
Therapeutic Process ◽  
Treatment Options ◽  
Clinical Group ◽  
Education Session ◽  
Group Approach ◽  
Treatment Protocols ◽  
Educational Session ◽  
Evidence Based Treatment ◽  
Relationship Of ◽  
The Relationship

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Surgical treatment strategies for secondary peritonitis: Outcome in 278 patients

2001 ◽  
Vol 120 (5) ◽  
pp. A401-A401
Author(s):  
M BOERMEESTER ◽  
E BELT ◽  
B LAMME ◽  
M LUBBERS ◽  
J KESECIOGLU ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategies ◽  
Secondary Peritonitis

A Missing Diagnosis May Call for Empiric Treatment

2009 ◽  
Vol 40 (1) ◽  
pp. 22
Author(s):  
SHARON WORCESTER
Keyword(s):  
Empiric Treatment
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