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1.
Evan H. Allie Henry E. Dingle William N. Johnson Jeffrey R. Birnbaum Melissa A. Hilmes Sudha P. Singh Donald H. Arnold 《The American journal of emergency medicine》2018,36(5):769-773
Background
Acute asthma exacerbations (AAE) account for many Pediatric Emergency Department (PED) visits. Chest radiography (CXR) is often performed in these patients to identify practice-changing findings such as pneumonia (PNA). Limited knowledge exists to balance the cost and radiation dose of CXR with expected yield of clinically meaningful information.Objective
To determine in children with AAE with CXR, whether patient characteristics are associated with radiographic PNA; and significant practice change by initiation of antibiotic.Design/Methods
Retrospective chart review of AAE patients with CXR performed in a PED in 2014. We examined univariate associations between patient characteristics and PNA on CXR and administration of antibiotic. Multiple logistic regression models then subsequently examined adjusted associations between patient characteristics and both outcomes.Results
Of 288 patients, 43 (15%) had PNA on CXR and 51 (17.8%) received antibiotics. There were no statistically significant univariate associations between either outcome and age, race, gender, insurance status, mode of PED arrival, fever or hypoxia (all p > 0.11). Crackles were associated with antibiotic administration (p = 0.03), but not PNA on CXR (p = 0.07). Only previous antibiotic use within 7 days had both significant univariate associations (p = 0.002) and adjusted associations with both PNA on CXR (aOR 3.6) and antibiotic administration (aOR 3.3).Conclusion
CXR infrequently adds valuable information in children with AAE. Patients treated with antibiotic within 7 days are more likely to have PNA identified on CXR and receive antibiotics. A larger study is needed to examine potential significance of hypoxia and crackles. 相似文献2.
Hiroaki Takada Toru Hifumi Naoki Nishimoto Takashi Kanemura Hayato Yoshioka Ichiro Okada Nobuaki Kiriu Junichi Inoue Yuichi Koido Hiroshi Kato 《The American journal of emergency medicine》2017,35(2):245-248
Objectives
Several reports have compared the efficacy of linezolid (LZD) in Methicillin-resistant Staphylococcus aureus (MRSA) infections with that of vancomycin (VCM); however, these two antibiotics for the treatment of nosocomial MRSA pneumonia in elderly patients has not been well evaluated. The purpose of this study is to evaluate the efficacy and safety of LZD compared with VCM for the treatment of elderly patients with nosocomial MRSA pneumonia in a retrospective chart review of a cohort.Methods
We included 28 consecutive patients aged ≥ 65 years hospitalized with a confirmed diagnosis of MRSA pneumonia and treated with LZD (n = 11) or VCM (n = 17) between November 2010 and May 2015. We collected patient, disease, and laboratory data. The primary outcome was 30-day mortality. The secondary outcomes were the sequential organ failure assessment (SOFA) total, respiratory, renal, coagulation, hepatic, cardiovascular, and central nervous system scores on days 1, 3, 7, and 14.Results
There were no significant differences between the two groups with regard to baseline characteristics. The 30-day mortality rate was significantly lower in the LZD group than in the VCM group (0% vs. 41%, P = .02). The SOFA total score on days 3, 7, and 14 were significantly lower those at baseline in the LZD group (P < .05). The SOFA respiratory score on days 14 was also significantly lower than baseline in the LZD group (P < .05).Conclusion
LZD may be more efficacious than VCM for treating elderly patients with nosocomial MRSA pneumonia. 相似文献3.
Giancarlo Cicolini Carlo Della Pelle Valentina Simonetti Dania Comparcini Gianna Sepede Francesco Cipollone 《Archives of Psychiatric Nursing》2018,32(2):305-309
Purpose
To investigate the role of psychiatric dimensions, behavioral or substance addictions and demographical variables as determinants of pathological gambling among nursing students.Design
Multicenter cross-sectional study.Methods
From June to October 2015 a survey was carried out among Italian Nursing students. Data were collected using a six-section tool.Findings
Nursing students who completed the survey numbered 1083, 902 (83.3%) had some problems with gambling and 29 (2.7%) showed pathological gambling. Percentage of pathological gambling was significantly associate with illicit drug/alcohol use (65.5%; p = 0.001) and with male gender (58.6%) comparing to student nurse with non-pathological gambling (20%) and those with some problem (24.2%). Significant main effect was observed for IAT score (Beta = 0.119, t = 3.28, p = 0.001): higher IAT scores were associated with higher SOGS scores.Conclusions
Italian nursing students have some problems with gambling and pathological gambling problem, and males are those who have more problems. Results might be useful for faculties of health professionals to identify students at risk in an early stage, to direct prevention tailored interventions.Clinical relevance
Nursing faculties should be aware of the prevalence of Gambling among students.Prevention interventions should be planned to minimize the risk of gambling behavior in the future nurses' health care workers. 相似文献4.
Jordan R. Smith Jeremy J. Frens Cynthia B. Snider Kimberly C. Claeys 《Diagnostic microbiology and infectious disease》2018,90(1):50-54
Objectives
Staphylococcus aureus bacteremia (SAB) is an important cause of morbidity and mortality. Suboptimal treatment has been associated with poor patient outcomes. Our antimicrobial stewardship program (ASP) evaluated SAB management based on predefined performance measures both prior to and after instituting a “care package” intervention led by clinical pharmacists and infectious diseases physicians. The primary outcome included a 4-point “optimal care score” (OCS) consisting of targeted antibiotic therapy within 24 hours, repeating blood cultures, antibiotic duration assessment, and appropriate duration of therapy. The presence of an ID consult, SAB readmission and mortality were also assessed.Methods
This was a quasi-experimental, propensity score matched study of SAB management. Adult patients were retrospectively evaluated from October 2011 – October 2012, and intervention took place from November 2013 – December 2015. Intervention consisted of a clinical pharmacist contacting the primary team after identification of SAB to recommend (1) appropriate antibiotics within 24 hours, (2) repeat blood cultures to document clearance, (3) assessment for metastatic infection, (4) and appropriate duration of therapy. These constituted the 4-point OCS. ID consult was also recommended. Patients were propensity score matched 1:2 based on age, diabetes, presence of hardware, methicillin-resistant S. aureus (MRSA) isolate, and stratified infectious source. Patients ≥18 with SAB were included.Results
Intervention was associated with improved adherence to each metric within the OCS, and more patients in the intervention cohort achieved a perfect OCS of 4. Intervention was associated with a lower rate of readmission and mortality.Conclusion
A pharmacist-driven, ASP intervention on SAB therapy was associated with increased adherence to core SAB care metrics and reduced relapse and mortality. 相似文献5.
Rossana Rosa Lilian M. Abbo Kenley Raney Hansel E. Tookes Mark Supino 《The American journal of emergency medicine》2017,35(3):397-401
Objective
To calculate the emergency department (ED)-level Escherichia coli percentage of isolates susceptible to commonly used antibiotics and to determine the risk factors associated with inadequate empiric antibiotic therapy among patients treated for urinary tract infections (UTIs) in our ED.Methods
Retrospective cohort study conducted at a large tertiary teaching hospital. Participants included patients older than 18 years of age who had a urine culture with growth of > 100,000 colonies of E. coli. Demographic and therapeutic choices associated with inadequate empiric antibiotic therapy were explored. Antimicrobial susceptibility pattern of E. coli isolates recovered from ED patients were calculated, and stratified by gender and age.Results
A total of 300 unique patients had E. coli bacteriuria during the study period. Among patients who received at least one dose of antibiotic in the ED, variables independently associated with an increased risk of inadequate empiric therapy were age (relative risk [RR] 1.016; 95% confidence interval [CI] 1.001–1.031; P = 0.032), male gender (RR 2.507; 95% CI 1.470–4.486; P = 0.001), and use of fluoroquinolones (RR 2.128; 95% CI 1.249–3.624 P = 0.005). Sub-group analysis of patients discharged from the ED showed that definitive therapy with nitrofurantoin decreased the risk of inadequate empiric antibiotic therapy by 80% (RR 0.202; CI 0.065–0.638; P = 0.006). ED-level antibiograms showed differences in antimicrobial susceptibility of E. coli by age and gender.Conclusions
Development of ED-level antimicrobial susceptibility data and consideration of patients' clinical characteristics can help better guide selection of empiric antibiotic therapy for the treatment of UTIs. 相似文献6.
Di Zhang Jun Zhang Quan Gan Qiaoling Wang Nian Fan Rong Zhang Yayun Song 《Archives of Psychiatric Nursing》2018,32(1):57-61
Background
Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet.Objectives
The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context.Methods
After translation, back-translation, and expert discussion, 280 mothers at 1 to 18 months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested.Results
The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach's α coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing “arousal”, “avoidance” and “intrusion”) accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (χ2 = 76.40, p < 0.05).Implications for practice
The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening.Implications for research
Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture. 相似文献7.
Yuan Zhang Kai Sun Yuling Wang Yafei Qin Hui Li 《The American journal of emergency medicine》2018,36(8):1410-1417
Background
Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries.Purposes
To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic.Patients and methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to October 2017. Studies comparing the perioperative, postoperative outcomes of EFF with those of LFF patients with severe head and orthopedic injuries were included. Statistical heterogeneity was quantitatively evaluated by ×2 test with the significance set P < 0.10 or I2 > 50%.Results
Thirteen papers consisting of 2941 patients were included (1224EFF patients; 1717 LFF patients). The results showed that EFF was related to a greater increase in blood loss, intraoperative blood infusion, crystalloid, hypotension, hypoxia, length of surgery, non-neurologic complications and mortality(P < 0.1). No differences in ICU days, hospital days, neurologic complications and GCS on discharge scores (P > 0.1).Conclusions
Compared with LFF patients, EFF patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between EFF and LFF about patients with severe head and orthopedic injuries.Level of evidence
Level IV, therapeutic study. 相似文献8.
Yuji Shono Tomohiko Akahoshi Satomi Mezuki Kenta Momii Noriyuki Kaku Jun Maki Kentaro Tokuda Tetsuro Ago Takanari Kitazono Yoshihiko Maehara 《The American journal of emergency medicine》2017,35(12):1836-1838
Background and purpose
Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms.Methods
We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014.Results
We identified 59 TAAAD patients for the analysis (mean age, 67.3 ± 10.5 years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p < 0.0001). Initial systolic and diastolic blood pressure were lower (p = 0.003, and p = 0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p < 0.0001).Conclusion
Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings. 相似文献9.
10.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献11.
Asha R. Birmingham Nathan D. Mah Ran Ran Matthew Hansen 《The American journal of emergency medicine》2018,36(7):1242-1245
Objective
To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis.Methods
Retrospective review was performed among all patients presenting to the institution's emergency department (ED) with epistaxis between September 2014 and August 2016. Patients achieving hemostasis with standard of care agents, such as oxymetazoline, lidocaine, or epinephrine were excluded. The primary outcome was the ED length of stay (LOS). Secondary outcomes included the incidence of hospital admission, otolaryngologist consultation, nasal packing, prophylactic antibiotic use, and ED visit for rebleeding within seven days of treatment.Results
Among 122 patients, 30 received topical TXA (500 mg injectable solution soaked onto packing material and applied to the affected nostril) and 92 were managed with standard care. Nearly half (46.7%) of TXA-treated subjects received TXA either alone or in combination with standard of care agents as their initial treatment strategy. No significant difference was observed in the ED LOS (272 vs 232 min in TXA and standard care arms, respectively, p = 0.26). However, TXA was associated with a significant reduction in otolaryngologist consults (30.0% vs 65.2%, p = 0.002) and nasal packing (16.7% vs 23.9%, p = 0.003).Conclusions
This investigation did not demonstrate a significant difference in ED LOS among patients with acute epistaxis treated with topical TXA or standard care. However, this data does add to existing evidence that TXA may be associated with a reduction in resource utilization, suggesting it may provide more effective bleeding control. Overall, more data is needed to confirm the potential benefits of this practice. 相似文献12.
Sarah Jorgensen Mira Zurayk Samantha Yeung Jill Terry Maureen Dunn Paul Nieberg Annie Wong-Beringer 《The American journal of emergency medicine》2018,36(1):12-17
Background
Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI.Methods
A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30 days (ERVs).Results
We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72 h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P < 0.05) in patients with the following: age ≥ 65 years; pregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature ≥ 38 °C heart rate > 100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible).Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P = 0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P = 0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; P < 0.05).Conclusions
ERV in UTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. 相似文献13.
Diana Gritsenko Marianna Fedorenko Jorg J. Ruhe Jerry Altshuler 《Clinical therapeutics》2017,39(1):212-218
Purpose
Although vancomycin has been the mainstay of therapy for methicillin-resistant Staphylococcus aureus (MRSA) infections, its effectiveness has been challenged. Combination therapy may be used for patients with persistent MRSA bacteremia refractory to initial therapy. Studies have reported in vitro synergy between vancomycin and ceftaroline; however, clinical experience with this therapy is limited. Here, we report our experience with 5 cases of vancomycin-refractory MRSA bacteremia treated with the combination of vancomycin and ceftaroline.Methods
Between January 2014 and August 2016, 5 patients were identified who received vancomycin and ceftaroline combination therapy due to persistent bacteremia or deterioration of their clinical status on vancomycin alone (despite a vancomycin MIC within the susceptible range).Findings
Five patients presented with MRSA bacteremia secondary to endocarditis (n = 2), epidural abscess (n = 2), or left iliopsoas abscess (n = 1). Four of the 5 patients experienced microbiologic cure, and 1 patient transitioned to palliative care.Implications
This case series serves to describe additional clinical experience with vancomycin and ceftaroline combination therapy. This combination may be considered when vancomycin monotherapy does not lead to microbiological and/or clinical improvement in patients with metastatic MRSA bacteremia. Additional studies are warranted to further define its role in salvage therapy for persistent MRSA bacteremia. 相似文献14.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献15.
Yu Koon Chiu Chun Tat Lui Kwok Leung Tsui 《The American journal of emergency medicine》2018,36(1):79-83
Objective
To investigate the relationship between hypotension in the first 3 h after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest.Method
This retrospective cohort study occurred at two regional hospitals and included adult OHCA patients who experienced ROSC from July 1, 2014 to December 31, 2015. Hemodynamic and inotrope administration data were retrieved for 3 h after ROSC. We calculated the hypotensive exposure index (HEI) as the surrogate marker of the exposure of hypotension. The area under the ROC curve and multivariate logistic regression models were performed to analyze the effect of HEI on survival. Mean arterial pressure (MAP) was explored in the surviving and non-surviving patient groups using repeated measures MANCOVA, adjusted for the use of inotropes and down time.Results
A total of 289 patients were included in the study, and 29 survived. The median 1-hour HEI and 3-hour HEI were significantly lower in the survival group (p < 0.001). The area under the ROC curve for 3-hour HEI was 0.861. The repeated measures MANCOVA indicated that an interaction existed between post-ROSC time and downtime [F(5,197) = 2.31, p = 0.046]. No significant change in the MAP was observed in the 3 h after ROSC, except in the group with a prolonged down time. According to the tests examining the effects of the use of inotropes on the survival outcomes of the different subjects, the MAP was significantly higher in the surviving group [F(1,201) = 4.11; p = 0.044; ηp2 = 0.020].Conclusion
Among the patients who experienced ROSC after OHCA, post-ROSC hypotension was an independent predictor of survival. 相似文献16.
Payman Moharamzadeh Seyedhossein Ojaghihaghighi Mohsen Amjadi Farzad Rahmani Arezoo Farjamnia 《The American journal of emergency medicine》2017,35(12):1922-1925
Objective
Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department.Methods
This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24 h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine.Results
In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P = 0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24 h (P = 0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P ? 0.05).Conclusion
The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels. 相似文献17.
Xi Zhang Nicole Rowan Bethann Mangel Pflugeisen Sanjin Alajbegovic 《The American journal of emergency medicine》2017,35(4):594-598
Background
Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED.Methods
This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression.Results
Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR = 4.5, 95% CI: 1.2–17.2; p = 0.03) or nitrites (OR = 10.8, 95% CI: 1.7–68.1; p = 0.01) in the urine and age ≥ 75 (OR = 3.5, 95% CI: 1.2-9.6, p = 0.02).Discussion
Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients. 相似文献18.
B.M. Button A.E. Holland M.S. Sherburn J. Chase J.W. Wilson A.T. Burge 《Physiotherapy》2019,105(1):114-119
Objectives
To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD.Design
Prospective prevalence study; PT study in CLD subgroup.Setting
Tertiary metropolitan public hospital.Participants
Women with cystic fibrosis (CF, n = 38), chronic obstructive pulmonary disease (COPD, n = 27) and 69 healthy women without CLD. PT study — 10 women with CLD.Interventions
Five continence PT sessions over 3 months.Main outcome measures
Prevalence and impact of incontinence (questionnaire), number of leakage episodes (7-day accident diary), pelvic floor muscle function (ultrasound imaging) and quality of life (King’s Health Questionnaire).Results
The majority of women in all three groups reported episodes of incontinence (CF 71%; COPD 70%; healthy women 55%). Compared to age-matched healthy controls, women with CF reported more episodes of incontinence (P = 0.006) and more commonly reported stress incontinence (P = 0.001). A logistic regression model revealed that women with CLD were twice as likely to develop incontinence than healthy women (P = 0.05). Women with COPD reported significantly more ‘bother’ with incontinence than age-matched women with incontinence. There was a significant reduction in incontinence episodes following treatment, which was maintained after three months.Conclusions
The presence of CLD is an independent predictor of incontinence in women. In older women this is associated with more distress than in age-matched peers without CLD. Larger treatment studies are indicated for women with CLD and incontinence. 相似文献19.
Michael D. April Chase Donaldson Lloyd I. Tannenbaum Tyler Moore Jose Aguirre Alexander Pingree James H. Lantry 《The American journal of emergency medicine》2017,35(10):1474-1479
Background
Our objective was to compare in-hospital mortality among emergency department (ED) patients meeting trial-based criteria for septic shock based upon whether presenting with refractory hypotension (systolic blood pressure < 90 mm Hg after 1 L intravenous fluid bolus) versus hyperlactatemia (initial lactate ≥ 4 mmol/L).Methods
We conducted a retrospective cohort analysis by chart review of ED patients admitted to an intensive care unit with suspected infection during 1 August 2012–28 February 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotic administration in the ED. We excluded patients not meeting criteria for either refractory hypotension or hyperlactatemia. Trained chart abstractors blinded to the study hypothesis double entered data from each patient's record including demographics, clinical data, treatments, and in-hospital mortality. We compared in-hospital mortality among patients with isolated refractory hypotension, isolated hyperlactatemia, or both. We also calculated odds ratios (ORs) via logistic regression for in-hospital mortality based on presence of refractory hypotension or hyperlactatemia.Results
Of 202 patients included in the analysis, 38 (18.8%) died during hospitalization. Mortality was 10.9% among 101 patients with isolated refractory hypotension, 24.4% among 41 patients with isolated hyperlactatemia, and 28.3% among 60 patients with both (p = 0.01). Logistic regression analyses yielded in-hospital mortality OR for refractory hypotension of 1.3 (95% CI 0.5–3.8) versus OR for hyperlactatemia of 2.9 (95% CI 1.2–7.4).Conclusions
Hyperlactatemia appears associated with higher in-hospital mortality compared to refractory hypotension among ED patients with septic shock. 相似文献20.
Jennica Siddle Peter S. Pang Christopher Weaver Elizabeth Weinstein Daniel O&#x;Donnell Thomas P. Arkins Charles Miramonti 《The American journal of emergency medicine》2018,36(5):843-845
