scholarly journals 1143. Measuring Up! Benchmarking Antimicrobial Use in Canadian Children’s Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S407-S407
Author(s):  
Julie Blackburn ◽  
Jennifer Bowes ◽  
Mary-Ann Harrison ◽  
Nick Barrowman ◽  
Hélène Roy ◽  
...  
Keyword(s):  
First Generation ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Pediatric Hospitals ◽  
The Mean ◽  
Abdominal Infections ◽  
Third Generation Cephalosporins

Abstract Background Inappropriate antimicrobial use (AU) is recognized as a leading cause of antimicrobial resistance. However, quantifying AU in hospitals is challenging due to variability in information systems. Point prevalence surveys (PPS) provide a means to quantify AU in a cross-sectional manner within and between institutions. The aim of the study was to describe and compare the prescription patterns of AU across pediatric hospitals in Canada using PPS. Methods Two PPS (November 2018 and February 2019) were conducted at each of the 15 Canadian pediatric hospitals. For each PPS, AU data were collected for all inpatients ≤ 18 years (excluded mental health and birthing units) on the survey date. Data, including admitting diagnosis, age, comorbidities, Infectious Diseases consult, admitting service, documented pathogen(s), and antimicrobial(s) prescribed, was collected and entered into a RedCap database. Results In total, we surveyed 3826 patient-days. The mean proportion of children receiving at least one antimicrobial was 35.2% [range 25.1% to 42.9%]. Of the 1951 antimicrobials prescribed, the most common were third-generation cephalosporins [3GC] (16%; 321), aminopenicillins (15%; 297), TMP-SMX (11%; 207), piperacillin–tazobactam (10%; 193) and first-generation cephalosporins (9%; 181). Overall, the frequency of carbapenems, quinolones and vancomycin use was 4% (79), 3% (65) and 8% (151), respectively. Of the antimicrobials used for targeted or empiric therapy (n = 1541), 373 (24.2%) were for pneumonia, 278 (18%) for intra-abdominal infections and 251 (16.3%) for fever without a source. For the treatment of community-acquired pneumonia (CAP) (n = 178), aminopenicillins and 3GC use was 31% and 37%, respectively. Conclusion Our study used a standardized approach to assess AU to obtain benchmarking data for Canadian pediatric hospitals. About one-third of children hospitalized in Canadian pediatric hospitals are prescribed at least one antimicrobial. Of patients on treatment for CAP, only 31% were prescribed aminopenicillins. More detailed analysis of the rationale for AU, and assessment of appropriateness is required to fully understand antimicrobial prescribing practices in pediatric hospitals and develop stewardship initiatives. Disclosures All authors: No reported disclosures.

scholarly journals Attitude towards Antipsychotic Medications in Patients Diagnosed with Schizophrenia: A Cross-Sectional Study at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Tilahun Kassew ◽  
Demeke Demilew ◽  
Addis Birhanu ◽  
Mesele Wonde ◽  
Biks Liyew ◽  
...  
Keyword(s):  
Side Effects ◽  
Linear Regression ◽  
Associated Factors ◽  
First Generation ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Antipsychotic Medications ◽  
Specialized Hospital ◽  
The Mean

Background. Poor attitude towards antipsychotic drugs is high, and it is a factor for non-adherence to treatment. This increases the risk of relapse, associated healthcare utilization, and costs. This study aimed to assess attitude towards antipsychotic medication among patients with schizophrenia. Objectives. The aim of this institution based cross-sectional study was to assess attitude towards antipsychotic medications and associated factors among patients with schizophrenia who attend the outpatient clinics at Amanuel Mental Specialized Hospital, 2018. Methods. In a cross-sectional study, 393 schizophrenic patients from Amanuel Mental Specialized Hospital were recruited by a systematic random sampling technique. Drug Attitude Inventory (DAI-10) was used to assess attitude, experience, and belief about antipsychotics. Glasgow antipsychotic side effect scale modified version, positive and negative syndrome scale, and Birch wood’s insight scale for psychosis were the instruments used to assess the associated factors. Simple and multiple linear regression analysis models were fitted, and the adjusted unstandardized beta (β) coefficient at 95% confidence interval was used. Results. The mean score of attitude towards antipsychotic medications was 6.51 with standard deviation (SD) of 2.22. In multiple linear regression, positive symptoms (β= -0.07, 95% CI: (-0.09, -0.05)), negative symptoms (β= -0.04, 95% CI: (-0.06,-0.02)), shorter (≤5 years) duration of illness (β= -0.39, 95% CI: (-0.63, -0.15)), first generation antipsychotics (β = -0.35, 95% CI: (-0.55,-0.14)), having sedation (β= -0.28, 95% CI: (-0.52, -0.02)), and extra-pyramidal side effects (β= -0.34, 95% CI: (-0.59,-0.09)) were factors negatively associated with attitude towards antipsychotic medication treatment. Insight to illness (β= 0.24, 95% CI: (0.20, 0.27) was a factor positively associated with attitude towards antipsychotic medications. Conclusion. The result suggests that the mean score of participants’ attitude towards antipsychotic medications was good. Prevention of side effects particularly due to first generation antipsychotics is necessary.

scholarly journals Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110583
Author(s):  
Lawless Robert ◽  
Vickers Mark ◽  
Alawami Moayed ◽  
Appasamy Nivashen ◽  
Rajasingam Vinod ◽  
...  
Keyword(s):  
Risk Score ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Risk Scores ◽  
Sectional Study ◽  
Prescribing Practices ◽  
Prescribing Error ◽  
Cross Sectional ◽  
Antimicrobial Prescribing

Objective We aimed to assess prescribing practices, compliance with guidelines, and outcomes for patients who were admitted to the authors’ institution with community-acquired pneumonia (CAP). Methods We performed a single-center retrospective cross-sectional study of adults with CAP presenting during the 2019 influenza season. CAP severity was assessed using the CURB-65 risk score. The effect of CURB-65 risk score use on the rate of appropriate antimicrobial prescribing was assessed using the chi-square test and reported as odds ratio (OR). Fisher’s exact test was used to assess the relationship between prescribing appropriateness and patient outcomes. Results Patients with low-risk CAP were most likely to be inappropriately prescribed antimicrobials (OR: 4.77; 95% confidence interval: 2.44–10.47). In low-risk CAP, the most common prescribing error was overuse of ceftriaxone. In high-risk CAP, the most common errors were ceftriaxone underdosing and missed atypical coverage with azithromycin. Overall, 80% of patients were considered to have been inappropriately prescribed antimicrobials. No effect on mortality was observed. Conclusions In this study, we found low use of CAP risk scores and low adherence to antimicrobial prescribing guidelines for CAP at the authors’ institution.

scholarly journals Relative Clinical and Cost Burden of Community-Acquired Pneumonia Hospitalizations in Older Adults in the United States—A Cross-Sectional Analysis

Vaccines ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 59 ◽  
Author(s):  
Omotola Olasupo ◽  
Hong Xiao ◽  
Joshua Brown
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Disease Burden ◽  
Preventive Treatment ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Inpatient Mortality ◽  
Cross Sectional ◽  
The Mean ◽  
Sectional Analysis

The relative burden of community-acquired pneumonia (CAP) in older adults (≥65 years old) compared to other serious diseases is important to prioritize preventive treatment. A retrospective analysis was conducted using the 2014 National Readmission Database to evaluate the length of stay, inpatient mortality, 30-day readmissions, and costs of CAP compared to diabetes mellitus (DM), myocardial infarction (MI), and stroke. 275,790 hospitalizations were analyzed and represented a national estimate of 616,300 hospitalizations, including 269,961 for CAP, 71,284 for DM, 126,946 for MI, and 148,109 for stroke. The mean length of stay in CAP was 5.2 days, which was higher than DM (4.6) and MI (4.3) but similar to stroke (5.6). The inpatient mortality risk was lower for DM (RR: 0.37, 95% CI: 0.29–0.46) but higher for MI (RR: 1.67, 95% CI: 1.50–1.85) and stroke (RR: 1.67, 95% CI: 1.51–1.83). The median costs for CAP ($7282) were higher compared to DM ($6217) but lower compared to MI ($14,802) and stroke ($8772). The 30-day readmission rate was 17% in CAP, which was higher compared to MI (15%) and stroke (11.5%) and lower compared to DM (20.3%). In patients with CAP, disease burden is on par with other serious diseases. CAP should be prioritized for prevention in older adults with strategies such as vaccination and smoking cessation.

scholarly journals A mandatory indication-registration tool in hospital electronic medical records enabling systematic evaluation and benchmarking of the quality of antimicrobial use: a feasibility study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Annemieke K. van den Broek ◽  
Berend H. H. Beishuizen ◽  
Eric A. F. Haak ◽  
Michiel Duyvendak ◽  
Jaap ten Oever ◽  
...  
Keyword(s):  
Error Rate ◽  
Eligible Patient ◽  
Real Life ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Systematic Evaluation ◽  
Adherence Rate ◽  
Antimicrobial Use ◽  
National Guidelines ◽  
Tract Infections

Abstract Objectives Evaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes. Methods A mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines. Results The datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%). Conclusions After local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals.

scholarly journals Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016

2020 ◽  
Author(s):  
Nicole M A Le Saux ◽  
Jennifer Bowes ◽  
Isabelle Viel-Thériault ◽  
Nisha Thampi ◽  
Julie Blackburn ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Treatment ◽  
Audit And Feedback ◽  
Third Generation ◽  
Prospective Audit ◽  
Stewardship Program ◽  
Prospective Audit And Feedback ◽  
Third Generation Cephalosporins

Abstract Background Aminopenicillins are recommended empiric therapy for community-acquired pneumonia (CAP). The aim of the study was to assess treatment over a 5-year period after CAP guideline publication and introduction of an antimicrobial stewardship program (ASP). Methods Using ICD-10 discharge codes for pneumonia, children less than 18 years admitted to the Children’s Hospital of Eastern Ontario January 1, 2012 and December 31, 2016 were identified. Children ≥ 2 months with consolidation were included. One day of therapy (DOT) was one or more doses of an antimicrobial given for 1 day. Results Of 1,707 patients identified, 713 met inclusion criteria. Eighteen (2.5%) had bacteria identified by culture and 79 of 265 (29.8%) had Mycoplasma pneumoniae detected. Mean DOT/1,000 patient days of aminopenicillins/penicillin (AAP) increased by 18.1% per year (95% confidence interval [CI] −0.2, 39.9%) and decreased by 37.6% per year (95% CI −56.1, −11.3%) for second- and third-generation cephalosporins in the post-ASP period. The duration of discharge antimicrobials decreased. Of 74 (10.4%) patients who had pleural fluid drained, 35 (47.3%) received more than 5 days of AAP and ≤ 5 days of second-/third-generation cephalosporins with no difference in median length of stay nor mean duration of antimicrobials. Conclusions Implementation of CAP management guidelines followed by prospective audit and feedback stewardship was associated with a sustained decrease in the use of broad-spectrum antibiotics in childhood CAP. Use of AAP should also be strongly considered in patients with effusions (even if no pathogen is identified), as clinical outcome appears similar to patients treated with broad-spectrum antimicrobials.

scholarly journals COMMUNITY ACQUIRED PNEUMONIA

2016 ◽  
Vol 23 (09) ◽  
pp. 1052-1056
Author(s):  
Samar Raza ◽  
Tariq Zaffar Shaikh ◽  
Ghulam Hussain Baloch ◽  
Zaheer Ahmed ◽  
Syed Zulfiquar Ali Shah
Keyword(s):  
Study Design ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Male And Female ◽  
Reactive Protein ◽  
The Mean ◽  
Serum Crp

Objectives: To determine the frequency of raised serum CRP level in patientswith community acquired pneumonia. Study Design: Cross sectional descriptive study.Period: Six months. Setting: Liaquat University Hospital Hyderabad. Patients and Methods:All the patients with 20 -75 years of age, either gender diagnosed as community acquiredpneumonia were further evaluated for C-reactive protein while the data was analyzed in SPSSversion 16. Results: During six month study period, total 135 patients with community acquiredpneumonia were evaluated for C-reactive protein. The mean ±SD for age of patients with CAPwas 48.93±8.41 whereas it was 53.53±6.73 and 50.54±5.81 in male and female subjectsrespectively. The mean age ±SD of patient with raised CRP was 46.94±8.43. The mean ±SDof CRP in overall population was 08.8±1.52 while it was 07.94±1.32 and 10.83±1.64 in maleand female individuals respectively. Of 135 subjects 84(62.2%) were males and 51(37.8%) werefemales while the CRP was elevated in 91(67.4%) patients. The age in relation to gender andCRP was statistically significant (p= 0.02 and 0.05) while the gender in relation to CRP was alsostatistically significant (p=0.03). Conclusion: The present study found that the CRP was raisedin 91(67.4%) predominantly male individuals with community acquired pneumonia

Relationship of Sense of Coherence to Other Psychosocial Indices

2004 ◽  
Vol 20 (4) ◽  
pp. 227-236 ◽  
Author(s):  
Sara Holmberg ◽  
Anders Thelin ◽  
Eva-Lena Stiernström
Keyword(s):  
Social Support ◽  
Psychosocial Factors ◽  
Sense Of Coherence ◽  
Living Conditions ◽  
Strong Negative Correlation ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Work Related ◽  
Job Demand ◽  
The Mean

Summary: The concept of “sense of coherence” (SOC) has been widely recognized since it was first introduced by Antonovsky. The originality and usefulness of the SOC scale and its relation to other psychosocial measures has been the subject of lively debate. The aim of this paper was to test for associations between SOC and work-related psychosocial factors (mainly the Job Demand-Control model), general living conditions, education, and social network factors. Cross-sectional data from a population-based sample of 1782 rural males from nine counties in Sweden were analyzed with a multiple regression technique. The subjects were occupationally active at inclusion and the mean age was 50 years (range 40-60). SOC was assessed with the original 29-item questionnaire. Psychosocial variables and lifestyle factors were assessed using questionnaires and structured interviews. The mean SOC among the subjects was 152.3 (standard deviation, 19.4). A strong negative correlation was found between SOC and job demand, whereas a positive correlation with job control was demonstrated. A positive correlation with general living conditions and with social support was also found. However, there was no correlation to education and occupation. Thus, SOC was shown to be strongly correlated to work-related psychosocial factors and social support, but independent of sociodemographic factors.

Age related volume of cadaver-prostates in Bangladesh

1970 ◽  
Vol 4 (2) ◽  
pp. 74-77
Author(s):  
Rukshana Ahmed ◽  
Shamim Ara
Keyword(s):  
Prostate Gland ◽  
Age Groups ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Medical College ◽  
Age Related ◽  
Group A ◽  
Key Words Prostate ◽  
The Mean ◽  
Group B

Pathological changes in the prostate gland occur commonly with advancing age including inflammation, atrophy, hyperplasia and carcinoma and a change in volume is also evident. Estimation of volume of prostate may be useful in a variety of clinical settings. A cross-sectional descriptive study was designed to see the changes in volume of the prostate with advancing age and done in the Department of Anatomy, Dhaka Medical College, Dhaka from August 2006 to June 2007. The study was performed on 70 post-mortem human prostates collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age groups; group A (10-20 years), group B (21-40 years) and group C (41-70 years). Volume of the sample was measured by using the ellipsoid formula. The mean ± SD volume of prostate was 7.68 ± 3.64 cm3 in group A, 10.61 ± 3.99 cm3 in group B and 15.40 ± 6.31 cm3 in group C. Mean difference in volume between group A and group C, group B and group C were statistically significant (p<0.001). Statistically significant positive correlation was found between age and volume of prostate (r = + 0.579, p < 0.001). Key Words: Prostate; volume; Bangladeshi. DOI: 10.3329/imcj.v4i2.6501Ibrahim Med. Coll. J. 2010; 4(2): 74-77

Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

2020 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Mohammad Enayet Hussain ◽  
Bithi Debnath ◽  
AFM Al Masum Khan ◽  
Md Ferdous Mian ◽  
Md Nahidul Islam ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Diagnosis ◽  
Optic Neuropathy ◽  
Cross Sectional Study ◽  
P Value ◽  
Pattern Reversal ◽  
Cross Sectional ◽  
The Mean ◽  
Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

2019 ◽  
Vol 2 (1) ◽  
pp. 1-18
Author(s):  
Chijioke Okeudo ◽  
B.U. Ezem
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Fluid Volume ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
South Eastern ◽  
Amniotic Fluid Volume ◽  
The Mean ◽  
Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

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