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A Cluster randomized clinical trial to change Antibiotic Prescribing behavior in Outpatient pediatric primary care setting in Italy (CAPO project) - focus on Respiratory Tract Infections
No full textreservedBACKGROUND
Le infezioni delle vie respiratorie rappresentano una delle cause più comuni di consulti pediatrici e prescrizioni antibiotiche. Nonostante la maggior parte dei casi sia di origine virale e vada incontro a risoluzione spontanea, l’abuso di antibiotici rimane diffuso, contribuendo alla crisi globale della resistenza antimicrobica (AMR). In Italia il problema della resistenza antibiotica è particolarmente rilevante, a causa dell’elevato uso di antibiotici.
OBIETTIVO DELLO STUDIO
Questo studio valuta l’impatto di un programma di stewardship antimicrobica (ASP) multifattoriale. Il Progetto CAPO mira a ottimizzare le pratiche di prescrizione antibiotica per le comuni infezioni pediatriche delle vie respiratorie.
MATERIALI E METODI
È stato condotto un trial randomizzato controllato in cluster tra pediatri di famiglia appartenenti alla rete Pedianet italiana. I pediatri sono stati assegnati a uno dei tre bracci: (A) hanno ricevuto un sistema di supporto decisionale clinico (CDSS) e un calcolatore per il dosaggio degli antibiotici (gruppo CP); (B) hanno ricevuto gli stessi strumenti del braccio A, più opuscoli educativi multilingua per i caregiver (gruppo CP+leaflet); (C) hanno costituito il gruppo di controllo senza alcun intervento. Il CDSS integrava le linee guida nazionali per la gestione di infezioni comuni, incluse otite media acuta, sinusite, faringite e polmonite acquisita in comunità. Le implementazioni sono state avviate a novembre 2024 e l’efficacia è stata valutata confrontando i tassi di prescrizione antibiotica nei periodi pre-intervento (novembre 2023–aprile 2024) e post-intervento (novembre 2024–aprile 2025). Lo studio ha valutato le variazioni nelle prescrizioni complessive di antibiotici e nell’utilizzo di antibiotici ad ampio spettro nei diversi gruppi di intervento, analizzando l’impatto degli strumenti tecnologici e dell’educazione ai caregiver sul processo decisionale clinico in ambito pediatrico territoriale.
RISULTATI
Sono stati analizzati 12.979 episodi di infezioni respiratorie. L’intervento basato su CDSS (con o senza opuscoli) è stato associato a un miglioramento nei comportamenti prescrittivi, in particolare con un aumento dell’uso di antibiotici a spettro ristretto (amoxicillina) e una riduzione degli agenti ad ampio spettro (amoxicillina-acido clavulanico, cefalosporine). Per l’otite media acuta, l’uso di amoxicillina è raddoppiato nel gruppo CP (IRR: 2.40, p = 0.005), mentre l’uso di cefalosporine è diminuito del 70% nel gruppo CP+leaflet (IRR: 0.30, p = 0.002). Nella faringite da streptococco beta-emolitico di gruppo A, l’uso di amoxicillina-acido clavulanico è diminuito significativamente nel gruppo CP+leaflet (IRR: 0.33, p = 0.025), riflettendo una maggiore aderenza alle linee guida. Tuttavia, nelle infezioni delle alte vie respiratorie (URTI), il gruppo CP ha mostrato un aumento inaspettato nell’uso di antibiotici ad ampio spettro: cefalosporine (IRR: 3.90, p = 0.0015) e macrolidi (IRR: 2.56, p = 0.027). Sono state osservate riduzioni nelle prescrizioni inappropriate per bronchiolite e polmonite in quasi tutti i gruppi, sebbene alcuni risultati post-intervento non abbiano raggiunto significatività statistica a causa del numero limitato di casi.
CONCLUSIONI
Il Progetto CAPO ha rappresentato un approccio pragmatico per rafforzare la stewardship antimicrobica nell’assistenza pediatrica territoriale italiana. Attraverso l’uso di tecnologie di supporto decisionale e il coinvolgimento dei caregiver tramite l’educazione, questa iniziativa mira a ridurre l’uso inappropriato di antibiotici, ridurre lo sviluppo di resistenze agli antibiotici e migliorare la qualità delle cure per i bambini con infezioni delle vie respiratorie.BACKGROUND
Respiratory tract infections are among the most common reasons for pediatric medical evaluations and antibiotic prescriptions. Despite most cases being viral and self-limiting, antibiotic overuse remains widespread, contributing the global crisis of antimicrobial resistance (AMR). Italy faces a significant burden of AMR, especially in the pediatric population, where inappropriate antibiotic use is prevalent.
STUDY AIM
This study evaluates the impact of a multifaceted antimicrobial stewardship program (ASP). The CAPO Project aimed at optimizing antibiotic prescribing practices for common pediatric infectious diseases involving the respiratory tract.
MATERIAL AND METHOD
A cluster-randomized controlled trial was conducted among family pediatricians in the Italian Pedianet network. Pediatricians were assigned to one of three arms: (A) received a Clinical Decision Support System (CDSS) tool and an antibiotic dosage calculator (CP group); (B) received the same tools as Arm A plus caregiver-focused educational leaflets in multiple languages (CP + leaflet group); and (C) served as the control group with no intervention. The CDSS integrated national guidelines for managing common infections, including acute otitis media, sinusitis, pharyngitis, and community acquired pneumonia. Interventions were implemented in November 2024, and their effectiveness was assessed by comparing antibiotic prescribing rates during the pre-implementation (November 2023–April 2024) and post-implementation (November 2024–April 2025) periods. The study aims to determine changes in overall antibiotic prescriptions and the use of broad-spectrum antibiotics across intervention arms, evaluating the impact of both technological tools and caregiver education on clinical decision-making in primary pediatric care.
RESULTS
The study analyzed 12,979 respiratory infection episodes. The CDSS-based intervention (with or without leaflets) was associated with improved prescribing behaviors, particularly increased use of first-line narrow-spectrum antibiotics (amoxicillin) and reduced use of broad-spectrum agents (amoxicillin-clavulanic acid, cephalosporins). For otitis media, amoxicillin use doubled in the CP group (IRR: 2.40, p = 0.005), while cephalosporin use fell by 70% in the CP+leaflet arm (IRR: 0.30, p = 0.002). In GAS pharyngitis, amoxicillin-clavulanic acid use decreased significantly in the CP+leaflet group (IRR: 0.33, p = 0.025), indicating improved alignment with guidelines. However, for upper respiratory tract infections (URTIs), the CP group showed an unintended increase in broad-spectrum prescriptions - cephalosporins (IRR: 3.90, p = 0.0015) and macrolides (IRR: 2.56, p = 0.027) - highlighting areas for further educational focus. Reductions in inappropriate prescribing for bronchiolitis and pneumonia were observed in most groups, though some post-intervention results lacked statistical significance due to low case numbers.
CONCLUSION
The CAPO Project represented a pragmatic approach to enhancing antimicrobial stewardship in Italian pediatric outpatient settings. By leveraging decision-support technologies and engaging caregivers through education, this initiative seeks to reduce inappropriate antibiotic use, mitigate AMR, and improve care quality for children with infections of the respiratory tract
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
Get PDF“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
Get PDFWe 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
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe 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
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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