scholarly journals A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription

2019 ◽  
Vol 13 (11) ◽  
pp. 961-967 ◽  
Author(s):  
Cem Karaali ◽  
Mustafa Emiroglu ◽  
Sabri Atalay ◽  
Ismail Sert ◽  
Ayberk Dursun ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Statistical Significance ◽  
Compliance Rate ◽  
Prophylactic Antibiotic ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Stewardship Program ◽  
Surgical Antibiotic Prophylaxis ◽  
Clean Contaminated

Introduction: This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP. Methodology: The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term. Results: The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year. Conclusions: Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.

scholarly journals Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey

2020 ◽  
Vol 14 (07) ◽  
pp. 758-764
Author(s):  
Cem Karaali ◽  
Mustafa Emiroglu ◽  
Huseyin Esin ◽  
Ismail Sert ◽  
Cengiz Aydın ◽  
...  
Keyword(s):  
Action Plan ◽  
Compliance Rate ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Inappropriate Use ◽  
Rational Drug ◽  
Surgical Antibiotic Prophylaxis ◽  
Contaminated Wound ◽  
General Surgeons ◽  
Clean Contaminated

Introduction: One of the most important aspects of inappropriate antibiotic use among general surgeons in Turkey is the use of surgical antibiotic prophylaxis (SP). In order to shed light on the current situation, we conducted a survey of general surgeons in our country. Our aim was to evaluate the approach taken by our general surgeons in prescribing SP, while providing data pertinent to the effectiveness of the ‘Rational Drug Use’ (AIK) national action plan. Methodology: A questionnaire on the subject of personal SP usage and compliance with guidelines was distributed amongst general surgeons between 2018-2019. The questions related to individual approaches taken by surgeons when treating patients with either clean or clean-contaminated wounds. Results of the questionnaires were collated and compliance with ASHP guidelines was evaluated. Results: A total of 317 completed questionnaires were evaluated. According to the questionnaire results, the rate of total compliance with ASHP guidelines was 26.8%. The compliance rate for preoperative SP was 69.7% in the clean wound group and 54.6% in the clean-contaminated wound group. Although 96.5% of the participants reported correct timing for the first dose of SP, this number dropped to 79.5% apropos the adminstration of further doses of prophylaxis. The percentage of surgeons prescribing continued antibiotics at discharge for clean and clean-contaminated cases was 22.7% and 38.5%, respectively. Conclusions: The results of this study indicate that inappropriate use of SP is widespread in our country, and that antibiotics continue to be prescribed at discharge.

Effects of greens+® A Randomized, Controlled Trial

2004 ◽  
Vol 65 (2) ◽  
pp. 66-71 ◽  
Author(s):  
Heather Boon ◽  
Joyce Clitheroe ◽  
Tonia Forte
Keyword(s):  
Outcome Measures ◽  
Repeated Measures ◽  
Outcome Measure ◽  
Statistical Significance ◽  
Treatment Protocol ◽  
Secondary Outcome ◽  
Controlled Clinical Trial ◽  
Secondary Outcome Measure ◽  
Female Population ◽  
Study Objective

Greens+® is a popular natural health product marketed as energy-enhancing; however, no objective data substantiate this claim. The study objective was to determine if ingestion of greens+® 1. increases vitality, energy, and perception of wellbeing; 2. increases overall mental health and general health, and 3. decreases the incidence of colds and flus in an otherwise healthy female population. A total of 105 women were enrolled in this 12-week, randomized, double-blind, placebo-controlled clinical trial; 63 (60%) completed the treatment protocol. Both treatment and placebo groups showed a significant time trend effect, scoring better on all outcome measures as the trial progressed. Compared with the placebo group, the greens+® group scored marginally higher on vitality, the primary outcome measure (p=0.055), and significantly higher on energy (a secondary outcome measure, p=0.018). Findings were based on repeated measures analysis of variance; baseline scores were used as covariates. Although a trend toward greater improvement in the greens+® group was noted in the other secondary outcome measures, this trend did not reach statistical significance. Overall, our findings were positive but not conclusive that greens+® increases vitality and energy. These results provide justification for further study of the effects of greens+®.

scholarly journals Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

2015 ◽  
Vol 73 (6) ◽  
pp. 476-479 ◽  
Author(s):  
Flávio Ramalho Romero ◽  
Roberto Bezerra Vital ◽  
Marco Antônio Zanini ◽  
Luis Gustavo Ducati ◽  
Roberto Colichio Gabarra
Keyword(s):  
Pain Relief ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Sacroiliac Joint Pain ◽  
Post Procedure ◽  
Radiofrequency Denervation

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain.Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

scholarly journals Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy

2015 ◽  
Vol 5 (3) ◽  
pp. 93-98
Author(s):  
Suad Trebinjac ◽  
Hamda Kitchbi
Keyword(s):  
Rotator Cuff ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Outpatient Setting ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Patient’S Satisfaction ◽  
Reduction Of Pain ◽  
Rotator Cuff Tendinopathy

Introduction: The objective of this study was to assess a long-term clinical effect of Prolotherapy on chronic symptomatic rotator cuff tendinopathy.Methods: We conducted a retrospective, uncontrolled study in the outpatient setting with 12 months follow-up. Adults diagnosed clinically and radiologically with rotator cuff tendinopathy that has been persisting for a minimum of six months were included. Patients received 15% extra-articular and 25% intra-articular hyperosmolar dextrose injections, repeated at weeks 5, 9, 13, 17 and 21. Primary outcome measure was validated Shoulder Pain and Disability Index (SPADI). Secondary outcome measure was validated visual pain analogue scale (VAS 0-10). The third outcome measures were patient’s satisfaction with Prolotherapy and adverse reactions after injections.Results: Twenty-one patients, 14 male and 7 female were treated with 6 sessions of hyperosmolar dextrose Prolotherapy repeated every 4 weeks. Average SPADI before starting the treatment was 73.995 ± 13.6, while 12 months after completed treatment was 20.84 ± 26.03 (P< 0.0001). Average VAS score before starting the treatment was 8.14 ± 1.2, while 12 months after completed treatment was 2.29 ± 2.8 (P<0.0001). Out of 21 patients, 18 (85.71%) would recommend Prolotherapy to other people with the similar condition, and no one participant reported any side effect that was not resolved within one week after the treatment.Conclusion: Hyperosmolar dextrose Prolotherapy may result in significant reduction of pain and disability index in adult patients with chronic rotator cuff tendinopathy, without eliciting long-lasting side effects. Results of this pilot study need to be validated in prospective controlled randomized trials.

Laser-assisted in situ keratomileusis long term outcomes in late adolescence

2020 ◽  
pp. 112067212096903
Author(s):  
Jorge L Alió del Barrio ◽  
Mario Canto-Cerdán ◽  
María Bo ◽  
Nuria Subirana ◽  
Jorge L Alió
Keyword(s):  
Refractive Error ◽  
Spherical Aberration ◽  
Late Adolescence ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Late Adolescent ◽  
Long Term Outcomes ◽  
Time Of Surgery

Purpose: Evaluate the long term outcomes of myopic-LASIK in a late adolescent population (age ⩾17 and <20 at the time of surgery). Methods: Monocentric retrospective case series study. Eyes with at least 3 years of follow-up time were included. Primary outcome measures were long term efficacy, safety and stability of the refractive error. Secondary outcome measure was the evaluation of the relation between the postoperative spherical aberration and the long term stability of the refractive error. Results: Forty-seven eyes of 25 patients were included. Mean follow-up was 9.23 ± 3.16 years. Mean age at the time of surgery was 18.74 ± 0.44 years. With time, postoperative UDVA showed a mild but significant deterioration of 1–2 Snellen lines ( p = 0.012), in connection with a mild but significant myopization of the SE (mean increase of −0.43 D; p < 0.001), sphere (mean increase of −0.29 D; p = 0.004) and cylinder (mean increase of −0.16 D; p = 0.013). CDVA remained stable over time ( p > 0.05). Efficacy index decreased from 1.01 to 0.87 in the long term (77% UDVA ⩾ 20/32). Safety remained at 1.06. 66% and 74% of eyes presented a SE within ±0.50 D and ±1.00 D respectively. SE changed over 0.50D in 33% of eyes. No correlation could be detected between the SE and the postoperative spherical aberration. No cases of corneal ectasia were detected. Conclusions: Myopic-LASIK in late adolescence is safe and effective, but a mild myopic progression occurs. Despite presence of refractive stability is preferable, if necessary, myopic LASIK provides relatively good outcomes in the long term in this young population.

Impact of maternal age on delivery outcomes following spontaneous labour at term

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Edwin Eseoghene Omih ◽  
Stephen Lindow
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Maternal Age ◽  
Outcome Measure ◽  
Statistical Significance ◽  
Perineal Trauma ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Assisted Vaginal Delivery ◽  
The Impact

AbstractAim:Pregnancy in women of advancing maternal age is linked to incrementally worsening perinatal outcome. The aim of this study is to assess the impact of maternal age on delivery outcome in women that spontaneously labour at term.Methods:This was a retrospective study of women that spontaneously labour at term. Women with singletons in spontaneous onset labour beyond 37 weeks of gestation were divided into five maternal age groups: <19 years, 20–24 years, 25–29 years, 30–34 years and >35 years by their age at delivery. The main outcome variables are augmentation of labour, caesarean section, assisted vaginal delivery, and perineal trauma, while admission of the newborn into the neonatal unit within 24 h following delivery was the secondary outcome measure.Results:A total of 30,022 met the inclusion criteria with primiparae and multiparae accounting for 46 and 54%, respectively. Increasing age in primiparae was associated with; augmentation of labour OR 2.05 (95% CI 1.73–2.43), second degree perineal tear 1.35 (1.12–1.61), assisted vaginal delivery 1.92 (1.53–2.41) and caesarean section 4.23 (3.19–5.12). While that for multiparae; augmentation of labour OR 1.93 (1.05–3.52), perineal trauma 2.50 (1.85–3.34), assisted vaginal delivery 4.95 (91.82–13.35) and caesarean section 1.64 (1.13–2.38). The secondary outcome measure did not reach statistical significance.Conclusion:Increasing maternal age is an independent risk factor for operative delivery, and perineal trauma. However, maternal age has no significant effect on admission of infants into the NICU during the first 24 h following delivery.

scholarly journals Treatment outcomes of a CBT-based group intervention for adolescents with Internet use disorders

2020 ◽  
Author(s):  
Carolin Szász-Janocha ◽  
Eva Vonderlin ◽  
Katajun Lindenberg
Keyword(s):  
Symptom Severity ◽  
Internet Use ◽  
Statistical Significance ◽  
Internet Gaming Disorder ◽  
Reliable Change Index ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Long Term Effects ◽  
Pathological Internet Use

AbstractBackground and aimsInstances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD.MethodsN = 54 patients (16.7% female), aged 9–19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission.ResultsPatients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology.Discussion and conclusionsThe present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT).

A National Survey of Surgical Antibiotic Prophylaxis in Turkey

2003 ◽  
Vol 24 (10) ◽  
pp. 758-761 ◽  
Author(s):  
Salih Hosoglu ◽  
Mustafa Sunbul ◽  
Serpil Erol ◽  
Mustafa Altindis ◽  
Rahmet Caylan ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
University Hospitals ◽  
Surgical Prophylaxis ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Surgical Antibiotic Prophylaxis ◽  
Clean Contaminated

AbstractObjective:To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures.Design:A cross-sectional, country-wide survey.Setting:Thirty-six hospitals in 12 cities in Turkey.Participants:Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest.Methods:A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures.Results:Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426–3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890–8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225–0.772; P < .001) were associated with inappropriate prophylaxis.Conclusion:Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

scholarly journals Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

Pathogens ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 490 ◽  
Author(s):  
Daniele Donà ◽  
Dora Luise ◽  
Elisa Barbieri ◽  
Nicola Masiero ◽  
Sonia Maita ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Pediatric Surgery ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Secondary Outcome ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program ◽  
Surgery Center

Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP.

scholarly journals Efficacy and Safety of Divaza for The Correction of Oxidative Disturbances in Patients with Cerebral Atherosclerosis: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Victoria V. Fateeva ◽  
Nataliia U. Lashch ◽  
Pavel R. Kamchatnov ◽  
Tatiana N. Fedorova ◽  
Olga A. Muzychuk ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cognitive Impairment ◽  
Placebo Group ◽  
Controlled Trial ◽  
Compliance Rate ◽  
Prospective Trial ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Cerebral Atherosclerosis ◽  
Endogenous Antioxidant

Abstract Objective: To determine if Divaza was safe and effective for the correction of oxidative disturbances and to stabilize cognitive impairment in patients with cerebral atherosclerosis. Study design: 12-week multicenter, randomized, double-blind, placebo-controlled, prospective trial in parallel groups.Setting: 10 clinical centers across the Russian Federation.Interventions: Patients were randomized into two groups and instructed to take either 2 tablets of the study drug or placebo 3 times per day in conjunction with basic therapy. Outcomes: The primary outcome was a change in the average endogenous antioxidant potential after the completion of the study. The laboratory indicators of oxidative stress were analyzed at baseline and then after 12 weeks of therapy using iron-induced chemiluminescence analysis. The Montreal cognitive assessment test was used as a secondary outcome measure to evaluate cognitive impairment at the end of the study.Results: 124 outpatients with a mean age of 60.7±7.6 years were enrolled and randomly assigned to receive Divaza (n=65) or placebo (n=59). The Administration of Divaza restored the activity of the endogenous antioxidant system. The change in the average level of lipoprotein resistance to oxidation after 12 weeks of therapy, compared to the baseline, was significantly higher in the Divaza group (14.8±14.7 [14.8±14.7] seconds latent period versus 6.4±16.9 [6.9±16.7] seconds in the placebo group (p=0.007 [p=0.0107]). In addition, a recovery of cognitive impairment was observed in all patients of the Divaza group at the end of treatment; this was significantly better when compared with the placebo group (100 [100] % versus 89.5 [89.1] %, respectively, p=0.0272 [p=0.0128]). The treatment was safe, well-tolerated, and had a high compliance rate. Conclusions: Divaza is a safe and effective therapeutic option for attenuating oxidative stress and recovery of cognitive impairment in patients with cerebral atherosclerosis.Trial registration: clinicaltrials.gov NCT03485495, of April 02, 2018.

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