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Antibiotic clinical decision support

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https://www.readbyqxmd.com/read/30301874/impact-of-decision-aids-used-during-clinical-encounters-on-clinician-outcomes-and-consultation-length-a-systematic-review
#1
Claudia Caroline Dobler, Manuel Sanchez, Michael R Gionfriddo, Neri A Alvarez-Villalobos, Naykky Singh Ospina, Gabriela Spencer-Bonilla, Bjorg Thorsteinsdottir, Raed Benkhadra, Patricia J Erwin, Colin P West, Juan P Brito, Mohammad Hassan Murad, Victor M Montori
BACKGROUND: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. METHODS: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion...
October 9, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/30293642/estimating-risk-of-pneumonia-in-a-prospective-emergency-department-cohort
#2
Alexander W Hirsch, Michael C Monuteaux, Mark I Neuman, Richard G Bachur
OBJECTIVE: To improve the prediction of pediatric pneumonia by developing a series of models based on clinically distinct subgroups. We hypothesized that these subgroup models would provide superior estimates of pneumonia risk compared with a single pediatric model. STUDY DESIGN: We conducted a secondary analysis of a prospective cohort being evaluated for radiographic pneumonia in an urban pediatric emergency department (ED). Using multivariate modeling, we created 4 models across subgroups stratified by age and presence of wheezing to predict the risk of pneumonia...
October 4, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/30278956/sooner-is-better-use-of-a-real-time-automated-bedside-dashboard-improves-sepsis-care
#3
Andrew D Jung, Jennifer Baker, Christopher A Droege, Vanessa Nomellini, Jay Johannigman, John B Holcomb, Michael D Goodman, Timothy A Pritts
BACKGROUND: Minimizing the interval between diagnosis of sepsis and administration of antibiotics improves patient outcomes. We hypothesized that a commercially available bedside clinical surveillance visualization system (BSV) would hasten antibiotic administration and decrease length of stay (LOS) in surgical intensive care unit (SICU) patients. METHODS: A BSV, integrated with the electronic medical record and displayed at bedside, was implemented in our SICU in July 2016...
November 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/30223533/rational-use-of-medicines-in-neonates-current-observations-areas-for-research-and-perspectives
#4
REVIEW
Karel Allegaert
A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported by robust evidence in neonates. This is at least in part due to the extensive variability in pharmacokinetics and subsequent effects of medicines in neonates. Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation...
September 14, 2018: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/30161269/impact-of-clinical-decision-support-on-empirical-antibiotic-prescribing-for-children-with-community-acquired-pneumonia
#5
Mona Mostaghim, Tom Snelling, Brendan McMullan, Yean H Ewe, Beata Bajorek
AIM: To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). METHODS: Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators...
August 30, 2018: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/30126584/role-of-technology-in-antimicrobial-stewardship
#6
REVIEW
Derek N Bremmer, Tamara L Trienski, Thomas L Walsh, Matthew A Moffa
Because of the increasing plague of antimicrobial resistance and antibiotic misuse, antimicrobial stewardship programs (ASPs) are now a mandatory entity in all US hospitals. ASPs can use technological advances, such as the electronic medical record and clinical decision support systems, to impact a larger patient population with more efficiency. Additionally, through the use of mobile applications and social media, ASPs can highlight and propagate educational information regarding antimicrobial utilization to patients and providers in a widespread and timely manner...
September 2018: Medical Clinics of North America
https://www.readbyqxmd.com/read/30124483/do-we-need-biomarkers-for-the-follow-up-and-shortening-of-antibiotic-treatment-duration
#7
Milagros Dianti, Carlos M Luna
PURPOSE OF REVIEW: Clinical and laboratory parameters are useful tools for the diagnosis, follow-up and evaluation of resolution, and to predict outcomes when measured at different time-points onset and serially during follow-up in patients with hospital-acquired pneumonia and/or ventilator-associated pneumonia (HAP/VAP). RECENT FINDINGS: Both, the 2017 ERS/ESICM/ESCMID/Asociación Latino Americana de Tórax (EEEAG) and the 2016 IDSA/ATS guidelines (IAG) for the management of HAP/VAP recommend using clinical criteria alone, rather than biomarkers for diagnosis...
October 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/30111341/effect-of-procalcitonin-guided-antibiotic-treatment-on-clinical-outcomes-in-intensive-care-unit-patients-with-infection-and-sepsis-patients-a-patient-level-meta-analysis-of-randomized-trials
#8
REVIEW
Yannick Wirz, Marc A Meier, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Stefan Schroeder, Vandack Nobre, Djillali Annane, Konrad Reinhart, Pierre Damas, Maarten Nijsten, Arezoo Shajiei, Dylan W deLange, Rodrigo O Deliberato, Carolina F Oliveira, Yahya Shehabi, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Evelien de Jong, Beat Mueller, Philipp Schuetz
BACKGROUND: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. METHODS: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30091490/-thrust-out-of-normality-how-adults-living-with-cystic-fibrosis-experience-pulmonary-exacerbations-a-qualitative-study
#9
Gabriela Schmid-Mohler, Ann-Louise Caress, Rebecca Spirig, Christian Benden, Janelle Yorke
AIM AND OBJECTIVES: To explore the experience of pulmonary exacerbation from the perspective of adults with cystic fibrosis. BACKGROUND: While management of pulmonary exacerbations is a pillar of cystic fibrosis care, little is known of patients' perspectives. Understanding the patient's experience is essential for developing and evaluating interventions in support of patient self-management. DESIGN: Qualitative study with longitudinal study in a subsample...
August 9, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/30081461/impact-of-clinical-decision-support-on-time-to-order-resolution-for-patients-with-documented-allergies
#10
Tenielle Watkins, Sandra M Aguero, Michael Jaecks
Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was ⁻21 min (95% CI (confidence interval), ⁻39 to ⁻2...
August 3, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/30074022/-acceso-vascular-en-apoyo-renal-agudo
#11
Armando Vázquez-Rangel
El acceso vascular es el primer eslabón para la terapia de apoyo extracorpórea renal. A diferencia de la terapia de reemplazo renal para pacientes con enfermedad renal crónica donde la fístula arteriovenosa es la primera opción, seguida del catéter tunelizado, en pacientes con lesión renal aguda el acceso vascular de elección es el catéter temporal. El presente estudio constituye una revisión narrativa de resumen de los estudios que analizan la elección, colocación y cuidados del acceso vascular temporal para apoyo renal agudo...
2018: Gaceta Médica de México
https://www.readbyqxmd.com/read/30046637/a-mixed-methods-approach-to-tailoring-evidence-based-guidance-for-antibiotic-stewardship-to-one-medical-system
#12
Emily S Patterson, Courtney M Dewart, Kurt Stevenson, Awa Mbodj, Mark Lustberg, Erinn M Hade, Courtney Hebert
Our objective is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. Clinical decision support tools are a promising technology for providing evidence-based guidance that incorporates data about patients from electronic health records. Nevertheless, congruence with policies and procedures and local experts' opinions, as well as taking into account local resistance data for the medical center's patient population, is needed when selecting and ordering the antibiotic medication options provided by pWISCA...
June 2018: Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare. International Symposium of Human Factors and Ergonomics in Healthcare
https://www.readbyqxmd.com/read/30032740/assessing-concordance-between-patient-preferences-in-advance-care-plans-and-in-hospital-care
#13
Nay Myo Oo, Ian A Scott, Raquel Maggacis, Nalaka Rajakaruna
Objective The aims of this study were to assess: (1) concordance between patient preferences stated in advance care plans (ACPs) and hospital care over the subsequent 12 months; (2) change in preferences over time; (3) justifications for discordant care; and (4) effects of ACP completion on hospital utilisation. Methods A retrospective study was conducted of 198 patients with an ACP form registered with an ACP registry and tagged with a hospital unique record number. Data collected from ACP forms and hospital records comprised ACP completion and revisions, care preferences, patient characteristics and hospital care...
July 23, 2018: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/30026919/recent-advances-in-understanding-and-managing-acute-pancreatitis
#14
REVIEW
Amar Mandalia, Erik-Jan Wamsteker, Matthew DiMagno
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS)...
2018: F1000Research
https://www.readbyqxmd.com/read/29982459/articulating-citizen-participation-in-national-anti-microbial-resistance-plans-a-comparison-of-european-countries
#15
Enrique Castro-Sánchez, Michiyo Iwami, Raheelah Ahmad, Rifat Atun, Alison H Holmes
Background: National action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions. Methods: Review and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June-September 2016)...
July 4, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29981885/a-decision-support-system-for-antibiotic-prescription-based-on-local-cumulative-antibiograms
#16
Antonio Morales, Manuel Campos, Jose M Juarez, Bernardo Canovas-Segura, Francisco Palacios, Roque Marin
BACKGROUND: Local cumulative antibiograms are useful tools with which to select appropriate empiric or directed therapies when treating infectious diseases at a hospital. However, data represented in traditional antibiograms are static, incomplete and not well adapted to decision-making. METHODS: We propose a decision support method for empiric antibiotic therapy based on the Number Needed to Fail (NNF) measure. NNF indicates the number of patients that would need to be treated with a specific antibiotic for one to be inadequately treated...
August 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29977963/improving-aztreonam-stewardship-and-cost-through-a-penicillin-allergy-testing-clinical-guideline
#17
Justin R Chen, Scott A Tarver, Kristin S Alvarez, Wenjing Wei, David A Khan
Background: Patients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs...
June 2018: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29950480/study-protocol-for-a-multicentre-cluster-randomised-superiority-trial-evaluating-the-impact-of-computerised-decision-support-audit-and-feedback-on-antibiotic-use-the-computerized-antibiotic-stewardship-study-compass
#18
Gaud Catho, Marlieke De Kraker, Brigitte Waldispühl Suter, Roberta Valotti, Stephan Harbarth, Laurent Kaiser, Luigia Elzi, Rodolphe Meyer, Enos Bernasconi, Benedikt D Huttner
INTRODUCTION: Inappropriate use of antimicrobials in hospitals contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) interventions aim to improve antimicrobial prescribing, but they are often resource and personnel intensive. Computerised decision supportsystems (CDSSs) seem a promising tool to improve antimicrobial prescribing but have been insufficiently studied in clinical trials. METHODS AND ANALYSIS: The COMPuterized Antibiotic Stewardship Study trial, is a publicly funded, open-label, cluster randomised, controlled superiority trial which aims to determine whether a multimodal CDSS intervention integrated in the electronic health record (EHR) reduces overall antibiotic exposure in adult patients hospitalised in wards of two secondary and one tertiary care centre in Switzerland compared with 'standard-of-care' AMS...
June 27, 2018: BMJ Open
https://www.readbyqxmd.com/read/29941365/comparison-of-clinical-performance-of-commercial-urine-growth-stabilization-products
#19
Peter Daley, Yuvraj Gill, William Midodzi
INTRODUCTION: Urine specimens for quantitative culture for the diagnosis of urinary tract infection may be unreliable due to bacterial overgrowth within 4 h after collection, at room temperature. Because specimen transportation may take longer than 4 h, urine preservatives may reduce overgrowth. Further evidence is needed to support a recommendation for use of preservative and to compare preservative products. METHODS: Consecutive midstream urine specimens submitted for culture were quantitatively cultured on receipt and then inoculated into 3 storage conditions [BD Urine Vacutainer (BD), Copan UriSwab (US), and refrigeration, with a room temperature control] for 72 h, with quantitative culture performed every 24 h...
November 2018: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/29939282/telling-the-truth-about-antibiotics-benefits-harms-and-moral-duty-in-prescribing-for-children-in-primary-care
#20
Benedict Hayhoe, Christopher C Butler, Azeem Majeed, Sonia Saxena
Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents...
September 1, 2018: Journal of Antimicrobial Chemotherapy
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