1,721,032 research outputs found
Improving Decision Making in Empiric Antibiotic Selection (IDEAS)
Full text linkTimely initiation of adequate antibiotics has been associated improved patient. However, selecting adequate empiric antibiotics is difficult due to increasing resistance rates and the competing desire to apply antimicrobial stewardship principles. We developed, implemented and evaluated two interventions to optimize empiric antibiotics using prospective audit and feedback. The interventions included providing suggestions to prescribers at two points in the empiric period: (1) prior to availability of any culture results, empiric therapy was altered to ensure concordance with prior cultures that have predictive relevance for future infection (2) when Gram-negative bacteremia was identified, previously derived and validated multivariable models were used to recommend the most narrow-spectrum adequate antibiotic.
The first intervention improved time to concordant therapy, increased the proportion of patients receiving concordant empiric antibiotics, and reduced vancomycin use. The second intervention facilitated de-escalation of antibiotics and increased the proportion of patients receiving the narrowest adequate antibiotic at blood culture finalization.M.Sc
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Antimicrobial Treatment Duration for Bloodstream Infections in Critically Ill Children
Full text linkBACKGROUNDBloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children, but the optimal antimicrobial treatment duration is understudied. Adequate treatment duration is important to prevent clinical failure and infection relapse but treating for too long increase patients’ risks for developing adverse drug events, superinfections, and selection for antimicrobial resistance. This thesis describes preparatory work completed to justify and inform the design of a randomized controlled trial to evaluate antibiotic treatment durations for critically ill children with BSIs.
METHODS
We conducted four studies as preparatory work for a future trial: 1. Clinician practice survey to determine self-reported recommendations for antimicrobial treatment duration; 2. Retrospective observational study to describe actual treatment durations received by critically ill children with BSIs; 3. Systematic review of non-inferiority pharmacotherapy trials to examine prevailing non-inferiority margins used for mortality outcomes; 4. Retrospective observational study using PELOD-2 as an outcome measure to compare progression of organ dysfunction between children who received early or delayed adequate antimicrobial therapy.
RESULTS
In our survey, 64% to 99% respondents recommended 10 days of therapy for BSIs, depending on underlying source of infection. In our observational study, the median treatment duration was 15 (IQR 11-25) days. Longer durations were associated with greater severity of illness and central nervous system infections. The median non-inferiority margin size for mortality in non-inferiority trials was a 9% (IQR 4.2%-10%) absolute risk difference or 1.5 (IQR 1.3-1.7) relative to baseline mortality risks. We did not find an association between 3-hour delays of adequate antimicrobial therapy and change in PELOD-2 scores (0.05, 95% CI -0.76 – 0.87, p=0.9) between days 1 and 5 from the index BSI.
CONCLUSIONS
We found self-reported and actual practice heterogeneity on BSI treatment durations, and clinical equipoise to support a trial of shorter versus longer antimicrobial treatment in critically ill children. Current non-inferiority margins for mortality outcomes in published trials are large and variable. The use of organ dysfunction as an outcome measure for BSI trials requires further study.Ph.D
Risk Factors for Oral Antibiotic Therapy Failure in Cystic Fibrosis-related Pulmonary Exacerbations
Full text linkObjective: Risk factors were investigated to find associations with oral antibiotic failure in cystic fibrosis (CF) related pulmonary exacerbations (oPEx).
Methods: Patients from the Toronto CF Database were selected if they had ≥1 episode of oPEx (2009 to 2017). Failure to recover ≥90% of baseline lung function (non-response) was analyzed using a logistic regression within a generalized estimating equation.
Results: Overall, 605 patients had 2970 oPEx episodes and 567 (19.1%) episodes were associated with treatment non-response. The factors independently associated with increased risk of non-response were older age at oPEx, greater baseline lung function, lower BMI and chronic inhaled antibiotic use. Infections due to Achromobacter spp., Burkholderia cepacia complex infection and Staphylococcus aureus were also identified as risk factors of nonresponse after treatment.
Conclusions: Specific factors can help identify which patients with oPEx are at higher risk of oral antibiotic treatment failure and help decision making around management.M.Sc
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Risk Factors for Oral Antibiotic Therapy Failure in Cystic Fibrosis-related Pulmonary Exacerbations
No full textObjective: Risk factors were investigated to find associations with oral antibiotic failure in cystic fibrosis (CF) related pulmonary exacerbations (oPEx).
Methods: Patients from the Toronto CF Database were selected if they had ≥1 episode of oPEx (2009 to 2017). Failure to recover ≥90% of baseline lung function (non-response) was analyzed using a logistic regression within a generalized estimating equation.
Results: Overall, 605 patients had 2970 oPEx episodes and 567 (19.1%) episodes were associated with treatment non-response. The factors independently associated with increased risk of non-response were older age at oPEx, greater baseline lung function, lower BMI and chronic inhaled antibiotic use. Infections due to Achromobacter spp., Burkholderia cepacia complex infection and Staphylococcus aureus were also identified as risk factors of nonresponse after treatment.
Conclusions: Specific factors can help identify which patients with oPEx are at higher risk of oral antibiotic treatment failure and help decision making around management.M.Sc
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