86,577 research outputs found
A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra-Abdominal Infections
No full textAdequately controlling the source of infection and prescribing appropriately antibiotic therapy are the cornerstones of the management of patients with intra-abdominal infections (IAIs). Correctly classifying patients with IAIs is crucial to assessing the severity of their clinical condition and deciding the strategy of the treatment, including a correct empiric antibiotic therapy. Best practices in prescribing antibiotics may impact patient outcomes and the cost of treatment, as well as the risk of “opportunistic” infections such as Clostridioides difficile infection and the development and spread of antimicrobial resistance. This review aims to identify a correct classification of IAIs, guiding clinicians in the selection of the best antibiotic therapy in patients with IAIs
The “Torment” of Surgical Antibiotic Prophylaxis among Surgeons
No full textSurgical antibiotic prophylaxis (SAP) is one of the peri-operative measures for preventing surgical site infections (SSIs). Its goal is to counteract the proliferation of bacteria in the surgical site during intervention in order to reduce the risk of SSIs. SAP should be administered for surgical interventions where the benefit expected (prevention of SSIs) is higher compared to the risk (serious side effects, such as acute kidney injury, Clostridioides difficile infection, and the spread of antimicrobial resistance). In prescribing SAP, surgeons should have both the awareness necessary “to handle antibiotics with care”, and the knowledge required to use them appropriately
Epidemiology and Risk Factors for Superficial Surgical Site Infections after Appendectomy for Acute Appendicitis: A Secondary Data Analysis
No full textBackground: The identification of risk factors for superficial surgical site infections (SSSIs) associated with appendectomy is paramount in the management of patients with acute appendicitis (AA). Methods: This study was a secondary data analysis from a prospective multi-center observational study. It included all consecutive hospitalized patients with AA who underwent appendectomy and were monitored for complications at 30 days after the intervention. A case-control approach was used to evaluate risk factors associated with the occurrence of SSSI. Results: Among 2,667 patients, 156 (5.8%) developed an SSSI. The series included 1,449 males (54.3%) and 1,218 females with a median age of 29 years (interquartile range [IQR] 20-45 years). Antimicrobial therapy within the previous 30 days was reported by 170 patients (6.4%), and a C-reactive protein concentration (CRP) >50 mg/L was observed in 609 (22.8%). A total of 960 patients (36.0%) underwent open surgery, 1,699 (63.7%) laparoscopic surgery, and 8 (0.3%) another surgical intervention. In 2,575 patients (95.6%), a pathological appendix was detected during the operation. In 776 patients (29.1%), an intra-operative abdominal drain (IAD) was placed; 125 patients (4.7%) were admitted to the intensive care unit. The median hospital length of stay was 3 days (IQR 2-5 days). The overall mortality rate was 0.11%. Multinomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of SSSIs were antimicrobial therapy within the previous 30 days, CRP >50 mg/L, open surgical procedures, presence of IAD, and intra-operative findings of complex appendicitis. Conclusions: Knowledge of five easily recognizable variables, assessable at hospital admission or as soon as the surgical intervention is concluded, might identify patients with a greater risk of developing an SSSI
Epidemiology and risk factors for isolation of multi-drug-resistant organisms in patients with complicated intra-abdominal infections
No full textBackground: Patients with complicated intra-abdominal infections (cIAIs) caused by multi-drug-resistant organisms (MDROs) have been identified as being at increased risk for adverse outcomes. Prompt identification and stratification of these patients is essential in the clinical management, allowing the physician timely optimization of empiric antimicrobial therapy while awaiting results of intra-operative cultures to streamline antibiotic treatment. Methods: The study is a secondary analysis from two prospective multi-center color surveillance studies. It included all consecutively hospitalized adult patients undergoing surgical procedures, interventional drainage, or conservative treatment with cIAIs, with positive cultures performer on intra-operative samples of peritoneal fluid or purulent exudate/discrete abscesses. Patients with pancreatitis and primary peritonitis were excluded. A case-control approach has been used to evaluate the factors associated with the isolation of a MDRO in enrolled patients. Results: Among 1986 patients included in the study, a total of 3534 micro-organisms were isolated from intra-peritoneal fluid samples; in 46.5% of cultures, two or more pathogens were identified. The MDROs represented 9.8% of the total of isolated micro-organisms. The overall incidence rate of MDROs was 13.9%. The MDROs were more frequently isolated in patients with health-care-associated cIAIs (25.4%). Multi-nomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of MDROs were previous antimicrobial therapy administered within seven days before operation, presence of severe cardiovascular disease, white blood cell count <4000/mL or >12,000/mL, cIAI acquired in a healthcare setting, and inadequate source control. Conclusions: The study showed that knowledge of five easily recognizable variables - assessable on hospital admission or as soon as the surgical intervention is concluded - might guide the surgeon to identify patients with cIAIs caused by MDROs, and therefore to choose the most adequate empiric antimicrobial therapy for them
Infezioni delle vie urinarie associate a cateterismo vescicale: esperienza di sorveglianza attiva
No full textINTRODUZIONE: Il 40% delle infezioni correlate all’assistenza è rappresentato dalle infezioni delle vie urinarie. Le infezioni delle vie urinarie associate a cateterismo vescicale (IVUAC) sono la causa principale di sepsi nosocomiale, con una mortalità associata pari a circa il 10%, sono responsabili del prolungarsi dei tempi di degenza e determinano un notevole incremento dei costi di ospedalizzazione e del carico assistenziale. I principali fattori di rischio per IVUAC sono l’età avanzata, la suscettibilità dell’ospite, il diabete mellito, il sesso femminile, la durata della cateterizzazione, i dispositivi impiegati, il sistema di drenaggio utilizzato e la diversa gestione ospedaliera per i pazienti sottoposti a cateterizzazione. L’obiettivo dello studio è quello di presentare i risultati di un progetto di sorveglianza delle IVUAC in una specialità chirurgica. MATERIALI E METODI: Il processo di sorveglianza attiva e passiva delle IVUAC condotto in una Unità Operativa chirurgica dell’A.O.U. Ospedali Riuniti di Ancona ha permesso di raccogliere i dati di un periodo di dodici mesi, da gennaio a dicembre 2013, relativi a pazienti ricoverati per un periodo di tempo maggiore di 48 ore e sottoposti a cateterismo vescicale. Per la definizione di caso sono stati adottati i criteri forniti dai Centers for Disease Control and Prevention, escludendo i criteri non valutabili nei pazienti cateterizzati. Sono state incluse le infezioni delle vie urinarie insorte in paziente cateterizzato da almeno 48 ore e, comunque, i cui segni e sintomi clinici siano insorti entro 7 giorni dal posizionamento del catetere vescicale a permanenza. Sono stati calcolati la densità di incidenza cumulativa di IVUAC per 1000 giorni di degenza, la densità di incidenza di IVUAC per 1000 giorni-catetere, l’incidenza cumulativa di IVUAC per numero di pazienti cateterizzati e il tasso di cateterizzazione (numero di giorni-catetere per 100 giornate di degenza). L’associazione tra fattori di rischio noti ed incidenza cumulativa di IVUAC è stata valutata con test del chi-quadro. Il livello di significatività è stato fissato a 0,05. RISULTATI: Nel periodo di osservazione sono stati considerati 641 pazienti, di cui 40 (6,2%) hanno presentato una IVUAC,pari ad una densità di incidenza di 15,2/1000 giorni-catetere (IC95% 10,8-20,7/1000 giorni- catetere) e 8,8/1000 giornate di degenza (IC95% 6,3-11,9/1000 giornate di degenza). La distribuzione delle caratteristiche dei pazienti inclusi ha evidenziato alcuni aspetti importanti. Nei pazienti con IVUAC rispetto ai pazienti senza infezione è stata osservata una maggiore durata media della degenza, pari a 16,3 giorni (range 3-70) vs 6,5 giorni (2-37) e una maggiore durata della cateterizzazione, pari a 9,5 giorni (range 2-40) vs 3,8 giorni (2-24). L’incidenza cumulativa diIVUAC per numero di pazienti cateterizzati in media nel corso dei dieci mesi è stata pari a 6,2% (range 0-13.3%). Il tasso di cateterizzazione medio è risultato complessivamente pari al 57,8% (range 50,1-68,2). L’intervento chirurgico è risultato la principale indicazione alla cateterizzazione (87,4% sul totale). L’analisi dell’associazione dei principali fattori di rischio mostra una incidenza cumulativa maggiore nel sesso femminile, dopo il quarto giorno di cateterizzazione ed in seguito ad inserimento del catetere in ambiente diverso da quello della Sala Operatoria. La carta di controllo di processo ha permesso di evidenziare un processo contenuto entro i limiti dell’atteso in tutto il periodo di osservazione. I microrganismi più frequentemente isolati sono stati Escherichia coli, Enterococcus spp., Candida spp., Klebsiella spp. e Pseudomonas aeruginosa e sono risultati multiresistenti all’antibiogramma nell’82,5% dei casi. CONCLUSIONI: I risultati ottenuti non appaiono significativamente diversi da quelli riportati dalla letteratura internazionale, dove si nota una variabilità notevole nell’incidenza del fenomeno. L’adozione di linee guida consolidate, concernenti la corretta esecuzione della procedura di cateterizzazione e la corretta gestione del paziente, rappresenta un elemento imprescindibile per la prevenzione delle IVUAC
Variations on the Author
No full text“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
[Newspaper Clipping: Author Claims Evidence of Second JFK Assassin #1]
No full textNewspaper article titled "Author Claims Evidence of Second JFK Assassin." The article states that author Richard J. Whalen concluded "that there is circumstantial evidence to support the theory of a second assassin in the shooting of President John F. Kennedy.
Also By The Same Author: AKTiveAuthor, a Citation Graph Approach to Name Disambiguation
No full textThe desire for definitive data and the semantic web drive for inference over heterogeneous data sources requires co-reference resolution to be performed on those data. In particular, name disambiguation is required to allow accurate publication lists, citation counts and impact measures to be determined. This paper describes a graph-based approach to author disambiguation on large-scale citation networks. Using self-citation, co-authorship and document source analyses, AKTiveAuthor clusters papers, achieving precision of 0.997 and recall of 0.818 over a test group of eight surname clusters
John F. Kennedy telegram to Roosevelt
No full textJersey Homesteads (later the Borough of Roosevelt) was established in the 1930s as an agro-industrial cooperative community. It was established specifically for urban Jewish garment workers, many of whom had emigrated from Europe. President John F. Kennedy sent a telegram to the citizens of Roosevelt, New Jersey, apologizing for not being able to attend the memorial dedication in honor of former President Franklin Delano Roosevelt. (Jersey Homesteads became Roosevelt in 1945 in honor of the president.) President Kennedy expressed his gratitude to the people of Roosevelt for constructing the memorial, and commented that it will serve as a constant reminder of Roosevelt's good works
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