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Resistiveness to Care

Verónica Giubergia, María J Ramirez Farías, Verónica Pérez, Adriana González, Nancy Crespi, Nora Fridman, Claudio Castaños
INTRODUCTION: Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). OBJECTIVE: To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. METHODS: Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma...
April 1, 2018: Archivos Argentinos de Pediatría
A Janka, S Duschek
BACKGROUND: As an important group of health care professionals, paramedics accomplish sophisticated and frequently stressful tasks. DESIGN: The study investigated self-reported stress burden, self-reported health status, coping strategies, personality traits and psychophysiological reactivity in paramedics. METHODS: 30 paramedics were compared with 30 professionals from other disciplines, in terms of self-reported stress, physical complaints, coping strategies, personality traits and psychophysiological reactivity during aversive visual and acoustic stimuli, and cognitive challenge...
March 20, 2018: Anxiety, Stress, and Coping
Muge Yucel, Osman Akin, Mehmet Cayoren, Ibrahim Akduman, Alagappan Palaniappan, Bo Liedberg, Gurkan Hizal, Fatih Inci, Umit Hakan Yildiz
This study reports on a handheld volatilome analyzer for selective determination of clinically relevant biomarkers in exhaled breath. The sensing platform is based on electrospun polymer nanofiber-multi walled carbon nanotube (MWCNT) sensing micro-channels. Polymer nanofibers of poly(vinylidene fluoride) (PVDF), polystyrene (PS), and poly(methyl methacrylate) (PMMA) incorporated with MWCNT exhibits stable response to interferences of humidity and CO2 and provides selective deformations upon exposure of exhaled breath target volatilomes acetone and toluene, exhibiting correlation to diabetes and lung cancer, respectively...
March 20, 2018: Analytical Chemistry
Brad J Gemmell, Hernando P Bacosa, Ben O Dickey, Colbi G Gemmell, Lama R Alqasemi, Edward J Buskey
Field data from the first several days after an oil spill is rare but crucial for our understanding of a spill's impact on marine microbiota given their short generation times. Field data collected within days of the Texas City "Y" oil spill showed that exposure to crude oil can rapidly imbalance populations of marine microbiota, which leads to the proliferation of more resistant organisms. Vibrionales bacteria were up to 48 times higher than background concentrations at the most impacted sites and populations of the dinoflagellate Prorocentrum texanum increased significantly as well...
March 19, 2018: Ecotoxicology
Martin Mielke
Clinically relevant infections are the primary indication for the use of antimicrobial agents in human medicine. Consequently, the prevention of infections is the fundament of all measures to rationally reduce the use of antibiotics. A prevented infection must not be treated. For the prevention of several community-acquired infections, vaccines are available. In addition, several infections may be prevented on the basis of knowledge and responsible behavior. However, the prevention of nosocomial infections depends mainly on the responsibility of third parties in the context of medical procedures...
March 19, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Esther T van der Werf, Lorna J Duncan, Paschen von Flotow, Erik W Baars
OBJECTIVE: To determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England. DESIGN: Retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age-sex weighting Related Prescribing Unit) using NHS Digital data over 2016...
March 5, 2018: BMJ Open
Alessandro Russo, Simone Giuliano, Giancarlo Ceccarelli, Francesco Alessandri, Alessandra Giordano, Grazia Brunetti, Mario Venditti
Objectives: a significant cause of mortality in intensive care unit (ICU) is represented by multidrug-resistant (MDR) gram-negative bacteria, such as MDR Acinetobacter baumannii (MDR-AB) and Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). Aim of the present study was the comparison of clinical features, therapy and outcome of patients who developed septic shock due to either MDR-AB or KPC-Kp. Methods: were retrospectively analyzed patients admitted to the intensive care unit (ICU) of a teaching hospital, from November 2010 to December 2015, who developed septic shock due to MDR-AB or KPC-Kp infection...
March 19, 2018: Antimicrobial Agents and Chemotherapy
Cheisson Gaëlle, Jacqueminet Sophie, Cosson Emmanuel, Ichai Carole, Leguerrier Anne-Marie, Nicolescu-Catargi Bogdan, Ouattara Alexandre, Tauveron Igor, Valensi Paul, Benhamou Dan
Perioperative hyperglycaemia (>1.80g/L or 10 mmol/L) increases morbidity (particularly due to infection) and mortality. Hypoglycaemia can be managed in the perioperative period by decreasing blood sugar levels with insulin between 0.90 and 1.80g/l but it may occur more frequently when the goal is strict normoglycaemia. We propose continuous administration of insulin therapy via an electronic syringe (IVES) in type-1 diabetes (T1D) and type-2 diabetes (T2D) patients if required or in cases of stress hyperglycaemia...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
Bahare Salehi, Hossein Goudarzi, Bahram Nikmanesh, Hamidreza Houri, Mostafa Alavi-Moghaddam, Zohreh Ghalavand
RATIONALE: Acinetobacter baumannii is one of the antibiotic-resistant superbugs that threatens hospitalized patients. Emergence and spread of the multidrug-resistant (MDR) and extensively drug-resistant (XDR) clones cause erratic outbreaks following environmental contamination of hospital settings. OBJECTIVE: The present study intended to characterize the antimicrobial resistant profiles and the genotypes of clinical and environmental isolates of A. baumannii as a result of dissemination of resistant strains...
March 16, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Hajime Kanamori, David J Weber, Maria F Gergen, Lauren M DiBiase, Emily E Sickbert-Bennett, William A Rutala
BACKGROUND: Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care-associated outbreak investigations at an academic hospital during a 5-year period. METHODS: Health care-associated outbreak investigations at an academic hospital (2012-2016) were retrospectively reviewed through data on comprehensive hospital-wide surveillance and pulsed-field gel electrophoresis (PFGE) analysis...
March 16, 2018: American Journal of Infection Control
Yassir Sbitti, Adil Debbagh, Khaoula Slimani, Mohamed Mahi, Hassan Errihani, Mohamed Ichou
BACKGROUND: Long-term survival with durable response remains possible in the area of targeted therapies. Discontinuation of sunitinib could improve quality of life and reduce treatment costs in metastatic renal cell carcinoma with long-term disease stabilization. We discuss a case of successful interruption of antiangiogenic therapy in a patient with persisting evidence of metastases. The discontinuation of antiangiogenic therapy seems to be an option, even in indolent oligo-metastatic renal cell carcinoma with long disease stabilization before sunitinib...
March 20, 2018: Journal of Medical Case Reports
Zhi-Hui Zou, Dong Liu, Hong-Dong Li, Dan-Ping Zhu, Yu He, Ting Hou, Jia-Lin Yu
BACKGROUND: To explore the influences of prenatal antibiotic exposure, the intensity of prenatal and postnatal antibiotic exposure on gut microbiota of preterm infants and whether gut microbiota and drug resistant strains in the neonatal intensive care unit (NICU) over a defined period are related. METHODS: Among 28 preterm infants, there were two groups, the PAT (prenatal antibiotic therapy) group (12 cases), and the PAF (prenatal antibiotic free) group (12 cases)...
March 19, 2018: Annals of Clinical Microbiology and Antimicrobials
Lesley Price, Lucyna Gozdzielewska, Mairi Young, Fraser Smith, Jennifer MacDonald, Joanna McParland, Lynn Williams, Darren Langdridge, Mark Davis, Paul Flowers
Background: A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritized. Objectives: To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public. Methods: Five databases were searched between 2000 and 2016 for interventions to change the public's AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the Cochrane Effective Practice and Organization of Care (EPOC) criteria, non-controlled before-and-after studies and prospective cohort studies were considered eligible...
March 14, 2018: Journal of Antimicrobial Chemotherapy
Said Alyacoubi, Yousef Abuowda, Loai Albarqouni, Bettina Böttcher, Khamis Elessi
BACKGROUND: Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence. METHODS: Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively...
February 21, 2018: Lancet
Adham Abu Taha, Ayman Daoud, Sawsan Zaid, Sajida Sammour, Maram Belleh, Refqa Daifi
BACKGROUND: Active surveillance is important in infection control programmes, allowing the detection of patients colonised with multi-drug resistant organisms and preventing the spread of multi-drug resistant organisms. The aim of this study was to determine the rate of asymptomatic colonisation with multi-drug resistant organisms and the prevalence of each organism in patients transferred to An-Najah National University Hospital, Nablus, occupied Palestinian territory. METHODS: Patients transferred from other hospitals between January and December, 2015, were screened at time of admission by taking nasal, groin, and axillary swabs...
February 21, 2018: Lancet
Axel Pressler, Leonie Förschner, Jana Hummel, Bernhard Haller, Jeffrey W Christle, Martin Halle
Background Increased exercise capacity favourably influences clinical outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI randomised pilot trial, eight weeks of endurance and resistance training (training group, TG) shortly after transcatheter aortic valve implantation resulted in significantly improved exercise capacity, muscular strength and quality of life compared to usual care (UC). However, the long-term clinical benefits of such an intervention are unknown. Design A randomised controlled trial...
January 1, 2018: European Journal of Preventive Cardiology
Amir S Steinberg, Anish B Parikh, Sara Kim, Damaris Peralta-Hernandez, Talaat Aggour, Luis Isola
OBJECTIVES: Antibiotic stewardship is an integral aspect of hospital care, limiting the potential for resistance while working to minimize waste. A similar system is needed in oncology, given the rapid proliferation of new therapies and the challenges of navigating a complicated reimbursement environment. A "cancer therapy stewardship program" has never been described in the literature. Here, we detail our efforts to design and implement such a program and share lessons learned to inform future projects...
March 2018: American Journal of Managed Care
Mohammed Sami Alhaddad, Afnan Khalifah AlBarjas, Lolowah Ebraheem Alhammar, Abdullatif Sami Al Rashed, Lorina Ineta Badger-Emeka
Background: Acinetobacter baumannii , is an emerging nosocomial multidrug resistance pathogen with the rapid spread of clones being reported in health-care settings and hospitals worldwide. Carbapenem resistance in this bacterium has been attributed to D OXA β-lactamases with OXA-51-like β-lactamase, being present in all A. baumannii isolate. The present study looks into the antibiotics susceptibility and molecular characterization of clinical A. baumannii isolates from Intensive Care Unit (ICU) samples in Al-Hofuf, South-eastern region of Saudi Arabia...
January 2018: International Journal of Applied and Basic Medical Research
Philipp Wohlfarth, Amin T Turki, Joerg Steinmann, Melanie Fiedler, Nina K Steckel, Dietrich W Beelen, Tobias Liebregts
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) recipients frequently develop acute respiratory failure (ARF) with pulmonary infiltrates. Molecular and biomarker-based assays enhance pathogen detection, but data on their yield in this population are scarce. METHODS: Retrospective single-center study in 156 consecutive HSCT recipients admitted to the intensive care unit (ICU) between 05/2013 and 07/2017. Findings of a microbiological diagnostic work-up using currently available methods on bronchoalveolar lavage (BAL) and blood samples from 66 patients (age: 58 [45-64] years; HSCT to ICU: 176 [85-407] days) with ARF and pulmonary infiltrates were analyzed...
March 14, 2018: Biology of Blood and Marrow Transplantation
Maria Heckel, Stephanie Stiel, Franziska A Herbst, Johanna M Tiedtke, Alexander Sturm, Thomas Adelhardt, Christian Bogdan, Cornel Sieber, Oliver Schöffski, Frieder R Lang, Christoph Ostgathe
PURPOSE: Palliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. AIM: provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care. METHODS: Recommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts' comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations...
March 16, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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