To determine the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents.
Quality improvement study with randomized assignment.
Twenty-five nursing homes in United States were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation.
A 12-month trial of a low-intensity multifaceted antimicrobial stewardship intervention focused on uncomplicated cystitis in nursing home residents vs usual care. The outcome was the modified Medication Appropriateness Index as assessed by a blinded geriatric clinical pharmacist and consisted of an assessment of antibiotic effectiveness, dosage, drug-drug interactions, and duration.
There were 75 cases (0.15/1000 resident days) in intervention and 92 (0.22/1000 resident days) in control groups with a probable cystitis per consensus guidelines. Compared with cow-intensity intervention showed a trend toward improved appropriate antibiotic prescribing in nursing home residents with likely uncomplicated cystitis. Efforts to improve antibiotic prescribing in addition to the low-intensity intervention might include a consultant pharmacist in a nursing home to identify inappropriate prescribing practices.
A low-intensity intervention showed a trend toward improved appropriate antibiotic prescribing in nursing home residents with likely uncomplicated cystitis. Efforts to improve antibiotic prescribing in addition to the low-intensity intervention might include a consultant pharmacist in a nursing home to identify inappropriate prescribing practices.
This study aimed to develop an equation model combining physical fitness and anthropometric parameters and compare its results with those of bioelectrical impedance analysis (BIA)-measured lean mass (LM) using dual-energy X-ray absorptiometry (DXA)-measured appendicular muscle mass (AMM) as reference.
Observational analysis.
Healthy community-dwelling older subjects.
A total of 1020 participants were randomly allocated to the development group (development group, n=510) or the cross-validation group (validation group, n=510). Body composition was measured using both DXA and BIA, and physical fitness parameters, including grip strength, timed stepping test, sit-to-stand test, flexibility, and walking speed were also assessed. A prediction equation model of AMM by stepwise linear regression analysis that included or excluded 1 independent variable at each step, based on the P value of significance (P<.05), was developed.
Using weight, sex, height, and handgrip strength as independent variables, the equation AMM=-9.833+0.397×weight (kg)+4.433×sex+0.121×height (cm)+0.061×handgrip strength (kg) best predicts DXA-measured AMM (adjusted R
=0.914, SEE=2.062, P<.001). The predicted AMM was more highly correlated with DXA-measured AMM than the commonly used BIA-measured LM (R
= 0.9158 and 0.8427, respectively, both P<.001). Using DXA-measured AMM as reference, the Bland-Altman plot showed mean differences of-0.03kg and-0.12kg, with limits of agreement of-3.98 to 3.92kg and-5.97 to 5.73kg for the predicted AMM and BIA-measured AMM, respectively.
The proposed equation offers a practical alternative method for estimating AMM that is less facility-dependent and more easy to use and affordable than instrumental studies.
The proposed equation offers a practical alternative method for estimating AMM that is less facility-dependent and more easy to use and affordable than instrumental studies.
The purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction.
To explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives.
Semi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty.
Twelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. see more Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had miscondu and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.
Oral mineralocorticoid receptor antagonists have failed to prove their efficacy for decongestion and potassium homeostasis in acute heart failure. Intravenous mineralocorticoid receptor antagonists have yet to be studied.
The aim of this study was to confirm the safety of high-dose potassium canrenoate in association with classic diuretics in acute heart failure.
This retrospective single-centre study included consecutive patients who were hospitalized with acute heart failure between 2013 and 2018. One hundred patients with overload treated with the standardized diuretic protocol from the CARRESS-HF trial were included. There were no exclusion criteria relating to creatinine or kalaemia at the time of admission. Two groups were constituted on the basis of potassium canrenoate posology a low-dose group (<300mg/day) and a high-dose group (≥300mg/day); the groups were similar in terms of baseline characteristics.
Mean daily potassium canrenoate doses were 198mg/day (range 100-280mg/day) in the low-dose group and 360mg/day (range 300-600mg/day) in the high-dose group. There was no significant difference between the high-dose and low-dose groups in terms of mortality, dialysis, renal function, hyperkalaemia, haemorrhage, sepsis or confusion.
Potassium canrenoate at high doses can be used safely in association with standard diuretics in acute heart failure, even in patients with altered renal function. A prospective study is required to evaluate the efficacy of high-dose potassium canrenoate in preventing hypokalaemia and improving decongestion.
Potassium canrenoate at high doses can be used safely in association with standard diuretics in acute heart failure, even in patients with altered renal function. A prospective study is required to evaluate the efficacy of high-dose potassium canrenoate in preventing hypokalaemia and improving decongestion.see more
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