1,721,133 research outputs found
Het rationeel gebruik van de antibiotica bij het kind in de ambulante zorg
No full textOp donderdag 2 juni 2016 organiseerde het RIZIV een consensusconferentie over het rationeel gebruik van de antibiotica bij het kind in de ambulante zorg.
Deze consensusvergadering is de vijfendertigste in de reeks.
Het behoort tot de taak van het Comité voor de Evaluatie van de Medische Praktijk inzake Geneesmiddelen (CEG) om tweemaal per jaar een consensusvergadering te organiseren. Die consensusvergaderingen zijn bedoeld om de medische praktijk inzake geneesmiddelen in een bepaalde
sector, in vergelijking met andere mogelijke behandelingen, te evalueren en om een synthese te maken van de beschikbare evidentie en adviezen van deskundigen.
Het voorkomen van multiresistente bacteriële stammen heeft vele landen ertoe aangezet om te streven naar een veel gematigder en gerichter gebruik van antibiotica. Er kunnen nog andere bijwerkingen aan die geneesmiddelen worden toegeschreven, die overigens onontbeerlijk zijn bij de
behandeling van ernstige infecties. Op nationaal niveau worden er nog (te) vaak antibiotica voorgeschreven, zeker wanneer vergeleken met hun potentieel bewezen belang bij de behandeling van verschillende infecties waaronder de meest voorkomende infecties die in de meeste gevallen spontaan genezen. Uit de gegevens blijkt dat vooral de doelgroep van kinderen (van 0 tot 15 jaar) tal van antibioticabehandelingen krijgt toegediend.
Tijdens de consensusvergadering van 2 juni 2016 wordt vooral aandacht besteed aan de verschillende vragen omtrent het rationeel gebruik van antibiotica bij kinderen (buiten het ziekenhuis). De vergadering moet consensuele antwoorden verschaffen op basis van de beste wetenschappelijke bewijzen die momenteel in de hieronder beschreven domeinen beschikbaar zijn:
- In welke exacte klinische situaties is een antibioticum doeltreffend (op het vlak van genezing,
preventie van complicaties, voorkomen van recidieven) en veilig?
- Welk antibioticum vormt de eerstekeuzetherapie en wat zijn eventuele alternatieven?
- Wat is de juiste dosis; hoe vaak en hoe lang worden antibiotica het best toegediend?
- Moet de aanpak verschillen naargelang de frequentie van de recidieven, van de persoonlijke context (recente behandeling, ...) en van de omgeving (crèche)?
- In welke gevallen is een doorverwijzing van het kind aangewezen?
Die vragen worden voor de meest courante infecties besproken: keelpijn, acute otitis media, rhinosinusitis, laryngitis, tracheïtis, bronchitis, pneumonie, cystitis, pyelonefritis, gastro-enteritis, huidinfecties en conjunctivitis.
Net als de vorige consensusvergaderingen die door het RIZIV en het CEG werden georganiseerd, spitst deze consensusvergadering zich toe op de eerstelijnsgezondheidszorg. De diagnostische evaluaties of
opvolging van behandelingen die in een ziekenhuisomgeving moeten worden verricht, komen derhalve niet aan bod.
Bepaalde onderwerpen worden bewust niet aangesneden wegens tijdsgebrek. Bepaalde aspecten komen dus niet aan bod tijdens de voordrachten door de sprekers. Dit is echter niet de beslissing van
een individuele spreker maar een beslissing van het organisatiecomité op basis van praktische haalbaarheid van literatuurstudie en programmatie. Tenslotte dient men ook rekening te houden met het feit dat de literatuurstudie twee maanden voor de consensusvergadering wordt afgesloten waardoor zeer recente publicaties soms niet opgenomen zijn in het literatuuroverzicht. Bovendien heeft het organisatiecomité van deze consensusvergadering beslist om het thema strikt te beperken tot het rationeel gebruik van antibiotica bij kinderen voor de meest courante infecties binnen de ambulante praktijk. Aspecten rond diagnostische oppuntstelling en de bredere therapeutische aanpak van deze aandoeningen, hoe belangrijk ook in de dagelijkse klinische praktijk, komen niet aan
bod tijdens deze consensusvergadering. De deelnemers aan deze consensusvergadering dienen hiertoe dan ook nog steeds beroep te doen op de bestaande praktijkrichtlijnen.status: Published onlin
C-reactive protein point-of-care testing and complementary strategies to improve antibiotic stewardship in children with acute respiratory infections in primary care
Full text linkThis paper provides the perspective of an international group of experts on the role of C-reactive protein (CRP) point-of-care testing (POCT) and complementary strategies such as enhanced communication skills training and delayed prescribing to improve antibiotic stewardship in the primary care of children presenting with an acute illness episode due to an acute respiratory tract infection (ARTI). To improve antibiotics prescribing decisions, CRP POCT should be considered to complement the clinical assessment of children (6 months to 14 years) presenting with an ARTI in a primary care setting. CRP POCT can help decide whether a serious infection can be ruled out, before deciding on further treatments or management, when clinical assessment is unconclusive. Based on the evidence currently available, a CRP value can be a valuable support for clinical reasoning and facilitate communication with patients and parents, but the clinical assessment should prevail when making a therapy or referral decision. Nearly half of children tested in the primary care setting can be expected to have a CRP value below 20 mg/l, in which case it is strongly suggested to avoid prescribing antibiotics when the clinical assessment supports ruling out a severe infection. For children with CRP values greater than or equal to 20 mg/l, additional measures such as additional diagnostic tests, observation time, re-assessment by a senior decision-maker, and specialty referrals, should be considered
Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care
Full text linkThe world faces the threat of increasing antimicrobial resistance, and there is growing consensus that swift action must be taken to improve the rational use of antibiotics and increase the stewardship of antibiotics to safeguard this key resource in modern healthcare. This paper provides the perspective of an international group of experts on the role of C-reactive protein point-of-care testing (CRP POCT) and other complementary strategies to improve antibiotic stewardship in primary care, with regards to the diagnosis and treatment of adult patients presenting symptoms of lower respiratory tract infections (LRTIs). It provides guidance regarding the clinical assessment of symptoms in combination with C-reactive protein (CRP) results, at the point of care, to support the management decision, and discusses enhanced patient communication and delayed prescribing as complementary strategies to decrease the inappropriate use of antibiotics. Recommendation: CRP POCT should be promoted to improve the identification of adults presenting with symptoms of LRTIs in primary care who might gain additional benefit from antibiotic treatment. Appropriateness of antibiotic use can be maximized when CRP POCT is used together with complementary strategies such as enhanced communication skills training and delayed prescribing in addition to routine safety netting.</p
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
C-reactive protein point-of-care testing in primary care—broader implementation needed to combat antimicrobial resistance
Full text linkThis study presents the perspective of an international group of experts, providing an overview of existing models and policies and guidance to facilitate a proper and sustainable implementation of C-reactive protein point-of-care testing (CRP POCT) to support antibiotic prescribing decisions for respiratory tract infections (RTIs) with the aim to tackle antimicrobial resistance (AMR). AMR threatens to render life-saving antibiotics ineffective and is already costing millions of lives and billions of Euros worldwide. AMR is strongly correlated with the volume of antibiotics used. Most antibiotics are prescribed in primary care, mostly for RTIs, and are often unnecessary. CRP POCT is an available tool and has been proven to safely and cost-effectively reduce antibiotic prescribing for RTIs in primary care. Though established in a few European countries during several years, it has still not been implemented in many European countries. Due to the complexity of inappropriate antibiotic prescribing behavior, a multifaceted approach is necessary to enable sustainable change. The effect is maximized with clear guidance, advanced communication training for primary care physicians, and delayed antibiotic prescribing strategies. CRP POCT should be included in professional guidelines and implemented together with complementary strategies. Adequate reimbursement needs to be provided, and high-quality, and primary care-friendly POCT organization and performance must be enabled. Data gathering, sharing, and discussion as incentivization for proper behaviors should be enabled. Public awareness should be increased, and healthcare professionals’ awareness and understanding should be ensured. Impactful use is achieved when all stakeholders join forces to facilitate proper implementation
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
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