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Lambregts, Merel M. C., Roos Wijnakker, Alexandra T. Bernards, Leo G. Visser, Saskia le Cessie, and Mark G. J. de Boer. "Mortality After Delay of Adequate Empiric Antimicrobial Treatment of Bloodstream Infection." Journal of Clinical Medicine 9, no. 5 (May 7, 2020): 1378. http://dx.doi.org/10.3390/jcm9051378.
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Background: Timely empiric antimicrobial therapy is one of the cornerstones of the management of suspected bloodstream infection (BSI). However, studies about the effects of empiric therapy on mortality have reported inconsistent results. The objective of this study was to estimate the effect of delay of appropriate empiric therapy on early mortality in patients with BSI. Methods: Data for the propensity score matching (PSM) study were obtained from a cohort of patients with BSI. Inadequate empiric treatment was defined as in vitro resistance to the antimicrobial regimen administered <6 h after blood cultures were taken. The primary outcome measure was 14-day mortality. Thirty-day mortality and median length of stay (LOS) were secondary outcomes. PSM was applied to control for confounding. Results: Of a total of 893 included patients with BSI, 35.7% received inadequate initial empiric treatment. In the PSM cohort (n = 334), 14-day mortality was 9.6% for inadequate antibiotic treatment, compared to. 10.2% in adequate empiric treatment (p = 0.85). No prolonged median LOS was observed in patients who initially received inadequate therapy (10.5 vs. 10.7 days, p = 0.89). Conclusions: In this study, we found no clear effect of inadequate empirical treatment on mortality in a low-risk BSI population. The importance of early empiric therapy compared to other determinants, may be limited. This may not apply for specific subpopulations, e.g., patients with sepsis.
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Cortazar, Patricia, and Bruce E. Johnson. "Review of the Efficacy of Individualized Chemotherapy Selected by In Vitro Drug Sensitivity Testing for Patients With Cancer." Journal of Clinical Oncology 17, no. 5 (May 1999): 1625. http://dx.doi.org/10.1200/jco.1999.17.5.1625.
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PURPOSE: The purpose of this study is to review the potential efficacy of individualized chemotherapy selected by in vitro drug sensitivity testing (DST) compared with empiric regimens for patients with cancer. METHODS: MEDLINE and CANCERLIT were searched for articles published (in English) about prospective clinical trials in which patients were treated with chemotherapy that was selected with the use of in vitro DST. RESULTS: We identified 12 prospective studies that examined the benefit of chemotherapy selected by DST. Five hundred six patients (33%) were treated with chemotherapy that was selected with the use of in vitro DST. The mean response rate for patients treated with in vitro–selected therapy was 27% (range, 10% to 100%; n = 12 studies) compared with 18% (range, 0% to 100%; n = 7 studies) for patients treated with empiric therapy. Five studies (only one randomized) evaluated the impact of chemotherapy selected by in vitro DST on patient survival. Three studies showed that survival was 1 to 4 months longer for the 238 patients treated with empiric chemotherapy compared with that of the 65 patients treated with chemotherapy that was selected by in vitro testing. Two nonrandomized studies showed that survival was 4 or 19 months longer for 27 patients treated with chemotherapy selected by in vitro testing compared with that of 80 patients who were treated with empiric chemotherapy. CONCLUSION: Only one third of patients entered in prospective trials of in vitro DST were actually treated with an in vitro best regimen. The response rates seem to be better with in vitro selected chemotherapy regimens than with empiric regimens, but the impact on survival has not been adequately addressed.
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Hasanli, Azar. "Fiscal decentralization and economic growth: A dilemma between theory and empiricism." Khazar Journal of Humanities and Social Sciences 20, no. 3 (October 2017): 77–94. http://dx.doi.org/10.5782/2223-2621.2017.20.3.77.
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Abandoning fiscal decision-making, redistributing and dispersing authorities provided by central government in favor of local and regional-level governance bodies is one of the widely discussed issues across the world based on the theory of “fiscal decentralization”. Incumbent theoretical and empiric researches regarding to achieving economic growth in the light of global economic fragilities indicate that managerial allocation of public funds among central and local authorities casts significant attention in terms of optimizing economic efficiency. In the article, it is tried to introduce brief theoretical background and measurement techniques to depict empiric relationship between fiscal decentralization and economic growth. In addition to investigating empiric facts, an effort to reveal the impact of fiscal decentralization on acquiring economic growth is made. Based on the investigations conducted in the framework of the article, it becomes obvious that empirical approaches toward the issue can be differed in several aspects: the selection of different economies, the time period chosen, the economies’ level of development and the estimation methodology. However, there are few empirical studies that analyze the relationship between fiscal decentralization and economic growth, and unfortunately the evidence on this topic is inconclusive.
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Samson, David J., Jerome Seidenfeld, Kathleen Ziegler, and Naomi Aronson. "Chemotherapy Sensitivity and Resistance Assays: A Systematic Review." Journal of Clinical Oncology 22, no. 17 (September 1, 2004): 3618–30. http://dx.doi.org/10.1200/jco.2004.04.077.
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Purpose This systematic review evaluates evidence comparing therapy guided by chemotherapy sensitivity and resistance assays with empiric chemotherapy, emphasizing survival outcomes. Methods Prospective studies were sought comparing patients treated contemporaneously by assay-guided chemotherapy and empiric therapy. An initial MEDLINE search and a search performed by a Working Group of the American Society of Clinical Oncology were reviewed with attention to prespecified study selection criteria. Results This review identified 10 studies meeting selection criteria, plus one retrospective study, using seven different assays. Only two studies randomly assigned patients to assay-guided treatment or empiric treatment. Five of nine nonrandomized studies found significantly higher response rates for patients who received assay-guided therapy compared with those treated empirically. One of the two randomized trials found a significantly higher response rate in the assay-guided group. Four additional studies found response rates favoring assay-guided therapy, but comparisons did not achieve statistical significance. Two nonrandomized studies found overall survival to be significantly improved with assay-guided therapy. One randomized study used a cross-over design that made it difficult to determine whether survival differed between groups, while the other randomized trial found no difference in survival. Six studies provided no comparison of groups on baseline patient characteristics. Only one study reported adverse events data. Conclusion While higher response rates for assay-guided therapy have been observed, differences may be attributable to bias or confounding. Little evidence on survival is available. These results do not establish the relative effectiveness of assay-guided treatment and empiric treatment. Randomized trials are needed.
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Schommer, Jon C., Donald L. Sullivan, and Joseph B. Wiederholt. "Comparison of Methods Used for Estimating Pharmacist Counseling Behaviors." Journal of Pharmacy Technology 10, no. 6 (November 1994): 261–68. http://dx.doi.org/10.1177/875512259401000608.
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Objective: To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. Data Sources: Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. Study Selection: Empiric studies were selected for review if they reported the provision of at least three types of counseling information. Data Extraction: Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. Data Synthesis: Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. Conclusions: Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.
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Lamanauskas, Vincentas, Dalia Augienė, and Rita Makarskaitė-Petkevičienė. "UNIVERSITY STUDY PROBLEMS: STUDENTS` POSITION." ŠVIETIMAS: POLITIKA, VADYBA, KOKYBĖ / EDUCATION POLICY, MANAGEMENT AND QUALITY 4, no. 1 (April 15, 2012): 6–21. http://dx.doi.org/10.48127/spvk-epmq/12.4.06.
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Despite the fact, that quite a lot of empirical researches have been carried out, their shortage remains obvious. Constant situation observation, research and analysis are especially important seeking to perceive higher education’s state and change. The practice remains to carry out changes not preparing for this properly, not evaluating current situation. Basically, it can be claimed, that empiric researches is a perspective way seeking to improve higher education system’s functioning. On the other hand, it is wrong to refer to theoretical or/and empiric researches carried out only in other countries. It is necessary to evaluate concrete country’s context, carry out representative researches in Lithuanian university students’ population. Research University study problems is based on positivistic - quantitative approach. The authors hold the position, that measuring causative links between variables is very important. The opinions of the respondents and positions about the investigated object undoubtedly help to reveal important links between variables. The research was carried out between January-March, 2012. Two university (Siauliai – SU and Lithuanian Educology – LEU) bachelor study students participated in the research. 600 questionnaires were prepared. On the whole, 544 questionnaires were acknowledged acceptable. It can be stated, that the majority of students are satisfied with the study quality. Study quality is important for students regardless their sex. It has been stated, that first year students are most satisfied with the study quality, and later the attitude significantly changes. It is understandable, because taking part directly in the study process, the estimation is different: you are faced with objective and subjective problems; you have to consider personal expectations newly. Students are interested in Lithuanian higher education problems. However, the interest in European higher education questions is quite low. It has been stated, that better career possibilities determined university study choice best. Personal initiative and parents’ advice are also important determining factors. However, teachers and friends didn’t have any influence, in fact, choosing university studies. The possible reason for this can be insufficient attention to professional information and career education in comprehensive schools. It is interesting that university study choice is not related with high prestige. Pragmatic-practical interests are obviously significantly important. Key words: higher education, study quality, university studies.
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Rockette, Howard E., William L. Campbell, Cynthia A. Britton, J. Michael Holbert, Jill L. King, and David Gur. "Empiric assessment of parameters that affect the design of multireader receiver operating characteristic studies." Academic Radiology 6, no. 12 (December 1999): 723–29. http://dx.doi.org/10.1016/s1076-6332(99)80468-1.
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Gisselquist, David, and John J. Potterat. "Heterosexual transmission of HIV in Africa: an empiric estimate." International Journal of STD & AIDS 14, no. 3 (March 1, 2003): 162–73. http://dx.doi.org/10.1258/095646203762869160.
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For more than a decade, most experts have assumed that more than 90% of HIV in African adults results from heterosexual transmission. In this exercise, we show how data from studies of risk factors for HIV can be used to estimate the proportion from sexual transmission, and we present our estimates. Calculating two ways from available data, our two point estimates — we do not estimate confidence intervals — are that 25-29% of HIV incidence in African women and 30-35% in men is attributable to sexual transmission; these estimates assume 10% annual epidemic growth. These findings call for reconceptualization of research to more accurately assess routes of HIV transmission.
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Dykes, Kaitlyn C., Cassandra A. Johnson, Jerald Z. Gong, Steven E. McKenzie, and Holleh D. Husseinzadeh. "Bleeding and Thrombotic Adverse Events in Hospitalized Patients Under Empiric Treatment for Suspected Heparin-Induced Thrombocytopenia While Awaiting Confirmatory Testing." Clinical and Applied Thrombosis/Hemostasis 27 (January 1, 2021): 107602962199647. http://dx.doi.org/10.1177/1076029621996473.
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Empiric management in suspected heparin-induced thrombocytopenia (HIT) is challenging due to imperfect prediction models, latency while awaiting test results and risks of empiric therapies. When there is high clinical suspicion for HIT, cessation of heparin and empiric non-heparin anticoagulation with FDA-approved argatroban is recommended. Alternatively off-label fondaparinux or watchful waiting have been utilized in clinical practice. Outcomes of patients empirically managed for HIT have not been compared directly in clinical trials and patients that ultimately do not have HIT are often overlooked. Clinicians need studies investigating empiric management to guide decision making in suspected HIT. In this study, adverse events (AE) were categorized and compared in patients being evaluated for HIT while undergoing empiric management by non-heparin anticoagulation with argatroban or fondaparinux, both at therapeutic or reduced doses, or watchful waiting with or without heparin. AE were defined as new thrombosis confirmed on imaging or new bleeding event after HIT was first suspected. A retrospective chart review of 312 patients tested for HIT at an academic hospital was conducted. 170 patients met inclusion criteria. Patients were excluded if the 4Ts score was < 4. The 4Ts score is a pretest probability for HIT based on thrombocytopenia degree, timing, alternative causes and presence of thrombosis. Included patients were divided according to management groups and compared with logistic regression analysis. Bleeding risk significantly differed between management groups (p = 0.002). Despite adjustment for bleeding risk, fondaparinux was associated with increased AE, (p = 0.03, OR = 5.81), while argatroban was not. There was no difference in AE based on time to initiation of empiric treatment and no advantage to reduced dosing with either anticoagulant. These findings challenge assumptions surrounding empiric HIT management.
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Apisarnthanarak, Anucha, Galit Holzmann-Pazgal, Aaron Hamvas, Margaret A. Olsen, and Victoria J. Fraser. "Antimicrobial Use and the Influence of Inadequate Empiric Antimicrobial Therapy on the Outcomes of Nosocomial Bloodstream Infections in a Neonatal Intensive Care Unit." Infection Control & Hospital Epidemiology 25, no. 9 (September 2004): 735–41. http://dx.doi.org/10.1086/502469.
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AbstractObjective:To evaluate antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections (BSIs).Design:Prospective cohort study with nested case-control analysis.Setting:Neonatal intensive care unit (NICU).Methods:All patients weighing 2,000 g or less were enrolled. Data collection included risk factors for nosocomial BSI, admission severity of illness, microbiology, antimicrobial therapy, and outcomes. Inadequate empiric antimicrobial therapy was defined as the use of antibiotics for more than 48 hours after the day that blood cultures were performed that did not cover the microorganisms causing the bacteremia or administration of antibiotics that failed to cover resistant microorganisms.Results:Two hundred twenty-nine patients were enrolled. Forty-five developed nosocomial BSIs. The BSI rates were 11.2, 2.8, and 0 per 1,000 catheter-days for patients weighing 1,000 g or less, between 1,001 and 1,500 g, and between 1,501 and 2,000 g, respectively. After adjustment for severity of illness, the mortality in patients with nosocomial BSI receiving inadequate empiric antimicrobial therapy was higher than in those receiving adequate therapy (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI95], 1.2-23.2). By multivariate analysis, nosocomial BSI attributed to Candida species (AOR, 6.3; CI95, 1.4-28.0) and invasive procedure prior to onset of BSI (AOR, 6.4; CI95, 1.0-39.0) were associated with administration of inadequate empiric antimicrobial therapy.Conclusions:Administration of inadequate empiric antimicrobial therapy among NICU patients with nosocomial BSI was associated with higher mortality. Additional studies on the role of inadequate empiric antimicrobial therapy and the outcomes of BSIs among NICU patients are needed.
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O’Brien, Daniel J., Donald W. Walsh, Colleen M. Terriff, and Alan H. Hall. "Empiric Management of Cyanide Toxicity Associated with Smoke Inhalation." Prehospital and Disaster Medicine 26, no. 5 (October 2011): 374–82. http://dx.doi.org/10.1017/s1049023x11006625.
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AbstractEnclosed-space smoke inhalation is the fifth most common cause of all unintentional injury deaths in the United States. Increasingly, cyanide has been recognized as a significant toxicant in many cases of smoke inhalation. However, it cannot be emergently verified. Failure to recognize the possibility of cyanide toxicity may result in inadequate treatment. Findings suggestive cyanide toxicity include: (1) a history of an enclosed-space fire scene in which smoke inhalation was likely; (2) the presence of oropharyngeal soot or carbonaceous expectorations; (3) any alteration of the level of consciousness, and particularly, otherwise inexplicable hypotension (systolic blood pressure ≤90 mmHg in adults). Prehospital studies have demonstrated the feasibility and safety of empiric treatment with hydroxocobalamin for patients with suspected smoke inhalation cyanide toxicity. Although United States Food and Drug Administration (FDA)-approved since 2006, the lack of efficacy data has stymied the routine use of this potentially lifesaving antidote. Based on a literature review and on-site observation of the Paris Fire Brigade, emergency management protocols to guide empiric and early hydroxocobalamin administration in smoke inhalation victims with high-risk presentations are proposed.
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Hirschfeld, Cole, Shashi Kapadia, Joanna Bryan, Deanna Jannat-Khah, Benjamin May, Tamir Friedman, Ole Vielemeyer, and Ernie Esquivel. "Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?" Open Forum Infectious Diseases 4, suppl_1 (2017): S91. http://dx.doi.org/10.1093/ofid/ofx163.056.
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Abstract Background Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture. Methods We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported. Results We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases. Conclusion In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure. Disclosures All authors: No reported disclosures.
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Rabiei, Mohammad Mahdi, Keivan Asadi, Shervin Shokouhi, Mohammad Javad Nasiri, and Ilad Alavi Darazam. "Antipseudomonal β-Lactams Resistance in Iran." International Journal of Microbiology 2020 (December 15, 2020): 1–7. http://dx.doi.org/10.1155/2020/8818315.
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Over the last years, the mortality rate of Pseudomonas aeruginosa, which is one of the major reasons for severe infections, has been significantly increasing. This bacterium is highly resistant to many antibiotics, especially carbapenems, thanks to its complicated mechanism by which it can acquire exogenous genes. The purpose of this research is to have a review of empirical studies surveying the P. aeruginosa resistance to beta-lactams in Iran in order to investigate the most reliable methods by which the incidence of P. aeruginosa infections can be decreased and controlled. We performed a systematic review of all articles published from 2008 until 2018. Studies which did not address P. aeruginosa resistance to beta-lactams were excluded from the analysis. Studies with less than 10 cases were also excluded. Studies with more than ten cases, which did not have repetitive information, were taken into account for the final selection; 133 out of 893 articles were chosen. The resistance rate of P. aeruginosa among the articles was as follows: more than 72% of studies revealed >50% level of resistance to cefepime, followed by aztreonam (53.2%), ceftazidime (61%), piperacillin/tazobactam (54.5%), meropenem (48.3%), and imipenem (42.4%). The selection of empiric antipseudomonal antibiotics is absolutely uncertain and hazardous, and the risk of clinical failure may be more among cephalosporins and piperacillin-tazobactam as well as aztreonam. The results of this study illustrate that the methods enabling clinics to identify the bacterium resistance pattern and its genetic basis and to have the opportunity of empiric therapies through access to updated local data of antimicrobial susceptibility pattern are the most effective methods. However, the widespread usage of these approaches undoubtedly needs reliable molecular and nucleic acid-based devices, which are both affordable and available.
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Paul, Mical, Vered Shani, Eli Muchtar, Galia Kariv, Eyal Robenshtok, and Leonard Leibovici. "Systematic Review and Meta-Analysis of the Efficacy of Appropriate Empiric Antibiotic Therapy for Sepsis." Antimicrobial Agents and Chemotherapy 54, no. 11 (August 23, 2010): 4851–63. http://dx.doi.org/10.1128/aac.00627-10.
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ABSTRACT Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses (I 2 > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I 2 = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.
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Gat, Daniel. "Risk and return in residential spatial markets: An empiric and theoretic model." Journal of Real Estate Finance and Economics 9, no. 1 (July 1994): 51–67. http://dx.doi.org/10.1007/bf01153588.
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Mannix, Mary Kathryn, and Shamim Islam. "1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S679—S680. http://dx.doi.org/10.1093/ofid/ofaa439.1519.
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Abstract Background Studies have showed that 30% of antibiotics prescribed in the outpatient setting are unnecessary. Acute UTI constitutes a significant health burden in outpatient pediatrics affecting ~2.8% of children every year. Antibiotics are often started empirically when diagnosing UTI making pediatric UTIs an ideal target for outpatient stewardship. The primary objective was to reduce the use of broad-spectrum empiric antibiotics with a secondary objective to study antibiotic discontinuation in culture negative cases. Methods The electronic medical records of two pediatric practices were screened for patients aged 2 months to 18 years diagnosed with uncomplicated UTI using ICD-10 codes N39, R30 and R35. The definition of a positive urine culture was > 50,000 CFU/ml if catheterized and > 100,000 CFU/ml if clean-catch specimen. A two-year pre-intervention period began in January 2018. An audit and review of urine culture processes were studied at each site with a subsequent educational intervention, a direct, one-hour session focused on the use of cephalexin as first-line empiric therapy based on the local antibiogram. The post-intervention period began at each site after the intervention. A COVID-19 sub-analysis was performed for the post-intervention period. Results During the study, 515 encounters and 113 encounters were included during the pre- and post-intervention periods, respectively. 74.4% (383/515) of pre-intervention encounters had empirically prescribed antibiotics; higher-generation cephalosporins (i.e. cefdinir, cefprozil) most frequently. Antibiotics were empirically prescribed in 75.2% (85/113) of post-intervention encounters with a statistically significant increase in cephalexin use (32/85, 37.6%, p < 0.01) and reduction in higher-generation cephalosporin use (p < 0.01), Figure 1. In the COVID-19 analysis, empiric antibiotic prescribing trended towards baseline as providers were relying largely on telemedicine, Figure 2. Figure 1: Empiric Antibiotic Prescribing Pre- and Post-InterventionF Figure 2: Empiric Antibiotic Prescribing - % Table 1: Pre- and Post-Intervention Conclusion The educational intervention was effective in changing antibiotic prescribing with an increased use of narrow spectrum antibiotics. This change waned without reinforcement and reliance on telemedicine during COVID-19. Antibiotic discontinuation in culture-negative cases remains an important area for improvement. Disclosures All Authors: No reported disclosures
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Gasparella, V., E. Andretta, P. Bastianello, G. Artuso, P. Seren, S. Benzone, and G. Signorelli. "Painful bladder syndromes in the female: Pharmaceutical therapy." Urologia Journal 64, no. 1 (February 1997): 110–13. http://dx.doi.org/10.1177/039156039706400127.
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Treatment of painful bladder syndromes is only empiric. Intravesical therapy, with heparin or dimethylsulfoxide, has recently become the mainstay of treatment. Transient relief of symptoms after hydrodistension occurs in 50% of interstitial cystitis. Good results have been obtained with amitriptyline, nifedipine and antihistamines, but always in uncontrolled studies.
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Fitzgerald, Stephen Paul, and Nigel Geoffrey Bean. "The Relationship between Population T4/TSH Set Point Data and T4/TSH Physiology." Journal of Thyroid Research 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/6351473.
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Context. Population studies of the distribution of T4/TSH set points suggest a more complex inverse relationship between T4 and TSH than that suggested by physiological studies. The reasons for the similarities and differences between the curves describing these relationships are unresolved.Methods. We subjected the curve, derived from empiric data, describing the TSH suppression response to T4, and the more mathematically derived curve describing the T4 response to TSH, to the different possible models of population variation. The implied consequences of these in terms of generating a population distribution of T4/TSH equilibrium points (a “population curve”) were generated and compared to the empiric population curve. The physiological responses to primary hypothyroidism and hyperthyroidism were incorporated into the analysis.Conclusions. Though the population curve shows a similarly inverse relationship, it is describing a different relationship than the curve describing the suppression of TSH by T4. The population curve is consistent with the physiological studies of the TSH response to T4 and implies a greater interindividual variation in the positive thyroid T4 response to TSH than in the central inhibitory TSH response to T4. The population curve in the dysthyroid states is consistent with known physiological responses to these states.
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Pereira, Vanda, José Carlos Marques, Maria João Carvalho, Monchu Chen, Ricardo Sol, Catarina Novo, Lúcia Bilro, Paulo Antunes, Nélia Alberto, and João Lemos Pinto. "Multiparameter Optical Monitoring of Madeira Wine." International Journal of Online and Biomedical Engineering (iJOE) 9, S8 (December 4, 2013): 62. http://dx.doi.org/10.3991/ijoe.v9is8.3389.
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Madeira wine vinification process has been mostly empiric and requiring further studies. The present paper describes the existing pilot plant facility in Madeira University, with the installed controlled systems and safety devices. An advanced multi-parameter platform for real time monitoring and interactive data visualization is described and its potential use demonstrated.
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McGovern, Ruth, Patrick Conway, Isabell Pekrul, and Omar Tujjar. "The Role of Therapeutic Anticoagulation in COVID-19." Case Reports in Critical Care 2020 (August 27, 2020): 1–7. http://dx.doi.org/10.1155/2020/8835627.
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Coagulopathy has proven to be a common complication of the novel coronavirus SARS-CoV-2, with evidence of elevated D-dimers and fibrin degradation products associated with an increased incidence of thromboembolism. Despite emerging evidence describing the coagulopathy and its clinical relevance in COVID-19, fewer studies have addressed the potential role of empiric therapeutic anticoagulation in this setting. We report the case of a patient admitted to our intensive care unit (ICU) with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 whose clinical trajectory improved dramatically after initiation of a therapeutic dose of LMWH. The patient showed progressive elevation of fibrinogen and D-dimers despite a prophylactic dose of LMWH during her ICU stay. This was met with a moderate increase of troponin T-hs, an escalating need for vasopressors, and a progressive decrease in her P/F ratio despite preserved lung static compliance. Her platelet count was normal and had an elevated fibrinogen during the first week of ICU stay. The ECG was normal, and a bedside transthoracic echocardiogram showed no evidence of pulmonary embolism and a preserved EF with no regional wall motion abnormalities (RMWA). The chest X-ray was not dissimilar to previous exams, and the ABG showed hypoxia with normal pCO2 values. The decision was made to commence empiric therapeutic enoxaparin. The patient did not experience bleeding complications, and her clinical trajectory appeared to change dramatically. She was successfully extubated three days later and proceeded to clinical recovery and eventual discharge from the ICU. The available evidence shows that there is undoubtedly coagulopathy associated with COVID-19 with various subsequent forms of clinical manifestation described in the literature. Evidence also shows the benefits of heparin as an anticoagulant. From the discussion of this case report, however, it can be concluded that despite the plausible theoretical rationale, studies pertaining to the role of empiric therapeutic anticoagulation in this setting fall short of providing compelling evidence. Subsequently the role of empiric therapeutic anticoagulation in COVID-19 remains unclear with a pressing call for further research.
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Goetz, Matthew B., Stacey Hockett Sherlock, Cassie Goedken, Erin C. Balkenende, Charlesnika T. Evans, Eli Perencevich, Kelly Echevarria, et al. "2094. Acceptability of Antibiotic Substitutions for Fluoroquinolones and Third and Fourth-generation Cephalosporins: A Report from the VA-CDC Practice-Based Research Network (PBRN)." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S708. http://dx.doi.org/10.1093/ofid/ofz360.1774.
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Abstract Background Studies suggest fluoroquinolones (FQ), and third (3C) and fourth (4C) generation cephalosporins, agents often used for empiric therapy, place patients at higher risk for C. difficile infection. Substituting alternative antibiotics for empiric therapy might reduce risk. We surveyed inpatient physician (MD) and pharmacist (PharmD) antimicrobial stewardship champions to evaluate their preferred FQ, 3C and 4C substitutions for empiric therapy. Methods Semi-structured interviews were conducted with the antimicrobial stewardship MD and the PharmD champion from each of the 15 VA-CDC Practice Based Research Network (PBRN) sites. Interviewees were asked what empiric antibiotics for pneumonia and urinary tract infections would be recommended in local guidelines if all 3C, 4C and FQ were restricted. Respondents could list multiple antibiotics. Templated data collection and analysis were used to assist in rapid analysis of interviews. Results Narrow β-lactams were identified as appropriate options for CAP by 8 MD and 9 PharmD (table). Piperacillin/tazobactam was the preferred choice by MDs and PharmDs for HCAP (7 and 12, respectively) and HAP (10 and 12, respectively). For community-onset urinary tract infections (cUTI), numerous alternatives to FQ, 3C and 4C were identified. For hospital-onset (hUTI), piperacillin/tazobactam was most frequently mentioned by MD and PharmDs (7 and 9, respectively). 4 of 5 MDs and 5 of 7 PharmDs who chose 3C for CAP indicated that 3C were preferred over all other choices for CAP, few stewards indicated that 3C were the sole preferred agents for other conditions. Conclusion Antimicrobial stewardship MD and PharmD champions were readily able to find FQ substitutions for all indications; 3C and 4C substitutions were found for all indications with a notable exception of treatment of CAP. These results suggest considerable opportunity to reduce use of these antibiotic classes. Future studies should examine the appropriateness and acceptability of the substitutions identified by stewardship champions to providers and the impact of restriction of FQ, 3C and 4C on clinical outcomes. Disclosures All authors: No reported disclosures.
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Chiotos, Kathleen, Jennifer Blumenthal, Juri Boguniewicz, Debra Palazzi, Emily Berkman, Hillary Crandall, Erika Stalets, et al. "1134. Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10 Center Point Prevalence Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S403—S404. http://dx.doi.org/10.1093/ofid/ofz360.998.
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Abstract Background Antibiotics are prescribed in up to 80% of pediatric intensive care unit (PICU) patients, but multicenter studies systematically evaluating antibiotic indications and appropriateness in this high-utilizing population are lacking. Methods A multicenter point prevalence study was conducted at 10 geographically diverse tertiary care US children’s hospitals. All PICU patients < 21 years of age who were receiving systemic antibiotics at 8:00 AM on each study day were included. Study days occurred in February and March 2019. Data were abstracted by critical care and/or infectious diseases trained clinicians using standardized data collection forms and definitions of antibiotic appropriateness. Results 408 of 732 PICU patients (56%) received 618 antibiotics on the two study days. Empiric therapy for suspected bacterial infections without sepsis was the most common indication for antibiotics (22%), followed by treatment of community-acquired pneumonia and empiric therapy for septic shock (12% each, Figure 1). Overall, 194 antibiotic orders (32%) were classified as inappropriate and 158 patients (39%) received at least one inappropriate antibiotic. Vancomycin, cefepime, and ceftriaxone were the antibiotics most often inappropriately prescribed (Figure 2). Antibiotics prescribed inappropriately for the top 5 indications shown in Figure 1 accounted for 77% of all inappropriate antibiotic use. Prolonged ( >4 days) empiric therapy and prolonged ( >24 hours) post-operative prophylaxis were the most common reasons antibiotics prescribed for these indications were classified as inappropriate. Pneumonia and ventilator-associated infections were the most common infections for which antibiotics were prescribed inappropriately (46%). Reasons for inappropriate antibiotic use included lack of evidence supporting a bacterial infection (no radiographic infiltrate or significant increase in respiratory support) and use of unnecessarily broad antibiotics (Table 1). Conclusion Inappropriate antibiotic use is common in the PICU, particularly for pneumonia. Studies focused on defining optimal treatment strategies, as well as improved diagnostic approaches to curtail prolonged courses of empiric therapy, should be prioritized. Disclosures All authors: No reported disclosures.
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Schreiber, Richard, and Lawrence Garber. "Data Migration: A Thorny Issue in Electronic Health Record Transitions—Case Studies and Review of the Literature." ACI Open 04, no. 01 (January 2020): e48-e58. http://dx.doi.org/10.1055/s-0040-1710007.
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Abstract Objective To review the existing literature regarding data migration during electronic health record (EHR)-to-EHR transitions and add two case studies on this topic. Methods Very few publications exist that detail the processes and potential pitfalls of data migration during EHR transitions. One of the authors participated in a panel discussion at the American Medical Informatics Association symposium in 2015; at the time, only five empiric or experiential research articles on any aspect of EHR transitions were available. Of those, only two mentioned their experiences with data migration or conversions. A detailed PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) search in March 2019 yielded only one more article giving details about data migration. Results The two new case studies contrast starkly: one relied on manual abstraction and data entry, whereas the other leveraged several electronic tools. The literature reflects this diversity of approach: no two sites have reported the same approaches. The authors identify nine domains of potential consequences of the currently available techniques and offer mitigating strategies. Discussion Very little empiric information exists in the peer-reviewed literature regarding data migrations during EHR-to-EHR transitions; yet the case studies reflect that much remains suitable for a prospective study. Conclusion This report adds two new case studies to the six already reported in the literature. There is a wide disparity in techniques of data migration, each with its own set of pros and cons, which sites must consider during an EHR-to-EHR transition. Such transitions would benefit from prospective research on evaluation and knowledge discovery.
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Kleinberg, Michael. "Counterpoint: Routine Anti-Bacterial Prophylaxis Is Not Indicated in Neutropenic Patients With Hematological Malignancies." Journal of the National Comprehensive Cancer Network 2, no. 5 (September 2004): 445–51. http://dx.doi.org/10.6004/jnccn.2004.0035.
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Preventing bacterial infections by prescribing prophylactic antibiotics is seen by many as an important strategy for decreasing infectious mortality in the most profoundly immunosuppressed patients with hematologic malignancies. Comparative studies show consistently that neutropenic patients treated with prophylactic fluoroquinolone antibiotics develop fewer bacteremias than patients treated with placebo or less-potent antibacterials. However, these same studies fail to show increased survival rates in fluoroquinolone-treated patients. This repeated observation is the basis for the continued controversy concerning universal antibacterial prophylaxis of neutropenic patients, namely, the inability to translate the observed reduction in culture-proven bacterial infections with prophylaxis into improved clinical outcomes. The answer to this controversy lies in the effectiveness of empiric antibacterial therapy in response to neutropenic fevers. Mortality from bacterial infections is 1% or less for patients enrolled in empiric treatment trials who do not receive prophylactic antibacterials. Therefore, routine fluoroquinolone prophylaxis offers essentially no potential survival benefit to neutropenic patients with hematologic malignancies. In fact, the increasing potential for fluoroquinolones to select for resistant bacterial pathogens should give pause to the practice of routine prophylaxis of neutropenic patients.
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Pranzatelli, Michael R. "Oral Pharmacotherapy for the Movement Disorders of Cerebral Palsy." Journal of Child Neurology 11, no. 1_suppl (November 1996): S13—S22. http://dx.doi.org/10.1177/0883073896011001s03.
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Movement disorders are a well-recognized feature of some patients with cerebral palsy and often require treatment. However, treatments have been symptomatic and empiric, and there have been few pharmacologic studies. The major movement disorders in cerebral palsy are dystonia and the hyperkinesias choreoathetosis and myoclonus. They may occur in combination, often accompanied by spasticity and sometimes by epilepsy. Some drugs are useful treatments for all of these problems, but others may improve one while worsening another. Pitfalls in management include not diagnosing metabolic/degenerative disorders, which may mimic cerebral palsy, or not recognizing reversible complications of cerebral palsy, which may exacerbate symptoms. This review attempts to summarize empiric drug use and recommendations for therapy, drug studies in extrapyramidal cerebral palsy, and prospects for new drugs or models for the problem. Many new pharmacologic agents are available for study in cerebral palsy. Better methods of detecting basal ganglia injury after perinatal injury in asymptomatic infants may allow early intervention in the biologic process of recovery and adaptation. (J Child Neurol 1996;11(Suppl 1): S 13-S22).
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Pflugeisen, Bethann Mangel, and Jin Mou. "Empiric evidence of ethnic disparities in coronavirus positivity in Washington State." Ethnicity & Health 26, no. 1 (January 2, 2021): 36–48. http://dx.doi.org/10.1080/13557858.2020.1863922.
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Hamadah, Abdulaziz. "The Use of Intravenous Antibiotics at the Onset of Neutropenia In Patients Receiving Hematopoietic Stem Cell Transplants: A Pre-Emptive Strategy." Blood 116, no. 21 (November 19, 2010): 4516. http://dx.doi.org/10.1182/blood.v116.21.4516.4516.
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Abstract Abstract 4516 Background: Hematopoietic Stem Cell Transplant (HSCT) recipients are at risk for fatal bacterial infections during the engraftment period. Empirical antibiotic(s) at the onset of febrile neutropenia remain the standard of care. HSCT recipients began receiving intravenous once daily ceftriaxone at the onset of neutropenia (neutrophils< 1.0) regardless of fever as part of The Ottawa Hospital Blood and Marrow Outpatient Programme policy from Jan 2009; “pre-emptive” approach. We examined the impact of this policy on HSCT recipient outcomes. Methods: A retrospective “before-after” study was conducted to compare 2 cohorts [Jan 2008 - Dec 2008 (Empiric strategy) vs. Jan 09 - Dec 2009 (Pre-emptive strategy)] of patients receiving HSCT. Baseline characteristics between the groups were compared with 2 sample tests. Categorical variables and continuous variables were compared using Chi-squared and Wilcoxan rank-sum tests respectively. Results: There were 238 HSCTs performed between Jan 2008 and Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Baseline characteristics between the cohorts were similar. Infection related mortality at 100 days after HSCT and during the engraftment period was similar with a pre-emptive strategy compared to an empiric strategy (7.2% vs 10.2%; p=0.41 and 3.6% vs 7.1%; p=0.24) respectively. Further, there were no differences in ICU admissions or length of hospital stay. Both microbiologically (MDI) and clinically documented infections (CDI) were reduced (11.7% vs 29.1%; p=0.001 and 18.2% vs33.9%; p=0.007) with the pre-emptive strategy compared with an empiric strategy. Importantly, recipients of autologous HSCT appear to have a lower infection related mortality and reduced infection related ICU admissions during the engraftment period with the pre-emptive strategy compared to an empiric strategy (0% vs 6.8%; p=0.03 and 2.9% vs 12.2% p= 0.04). The need for escalation of antimicrobial treatments, resistance pattern of MDIs and cost of antimicrobial treatment were not different between the two groups. Conclusion: The use of once daily intravenous ceftriaxone at the onset of neutropenia in patients receiving HSCT is safe and effective particularly in patients receiving autologous HSCT. Further studies are warranted to study the impact of this “pre-emptive” strategy. Disclosures: No relevant conflicts of interest to declare.
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Autore, Giovanni, Luca Bernardi, Serafina Perrone, and Susanna Esposito. "Update on Viral Infections Involving the Central Nervous System in Pediatric Patients." Children 8, no. 9 (September 6, 2021): 782. http://dx.doi.org/10.3390/children8090782.
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Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.
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Hoomans, Ties, Silvia M. A. A. Evers, André J. H. A. Ament, Mariette W. A. Hübben, Trudy van der Weijden, Jeremy M. Grimshaw, and Johan L. Severens. "The Methodological Quality of Economic Evaluations of Guideline Implementation into Clinical Practice: A Systematic Review of Empiric Studies." Value in Health 10, no. 4 (July 2007): 305–16. http://dx.doi.org/10.1111/j.1524-4733.2007.00175.x.
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Graham, David Y., Syed Ussama Javed, Sara Keihanian, Suhaib Abudayyeh, and Antone R. Opekun. "Dual proton pump inhibitor plus amoxicillin as an empiric anti-H. pylori therapy: studies from the United States." Journal of Gastroenterology 45, no. 8 (March 2, 2010): 816–20. http://dx.doi.org/10.1007/s00535-010-0220-x.
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Mena Lora, Alfredo J., Julia Rodriguez Abreu, Claudia Blanco, Jacquelin de Lara, and Susan C. Bleasdale. "487. Prevalence of Antimicrobial Resistance in Gram-Negative Bacilli Bloodstream Infections at a Tertiary Teaching Hospital in the Dominican Republic." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S238. http://dx.doi.org/10.1093/ofid/ofz360.560.
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Abstract Background Bloodstream infections (BSI) with gram-negative bacilli (GNB) are a major cause of morbidity and mortality worldwide. Sepsis due to BSI can carry a mortality rate as high as 40%, with higher mortality in developing nations. Early and appropriate empiric therapeutic selection plays an important role in survival. The rising incidence of antimicrobial resistance (AMR) limits empiric treatment options. Local susceptibility patterns can vary per region, institution or setting. Understanding local AMR may help guide empiric treatment choices. We seek to describe resistance rates for GNB BSI in the Dominican Republic (DR). Methods This is a retrospective review of antimicrobial susceptibility patterns from bloodstream infections in a tertiary hospital in the DR. Susceptibility data from all adult inpatient blood cultures were collected from January 1 to December 31, 2017. Results A total of 124 blood cultures were reported. The most common organisms were Escherichia coli (43%) and Klebsiella pneumoniae (23%). Fluoroquinolone resistance was present in 70% of E. coli. Phenotypic susceptibility patterns consistent with extended-spectrum β-lactamase (ESBL) producing GNB were present in 46% of isolates. Carbapenem resistance was found in 4 samples and was most common in P. aeruginosa. Susceptibility profile is described on Table 1. Conclusion AMR was high in GNB BSIs in the DR. High rates of ESBL render common cephalosporins sub-optimal for empiric treatment. PTZ retains in vitro susceptibilities despite cefepime resistance but clinical efficacy is controversial. CTX-M ESBLs may cause these resistance pattern in vitro. Further studies are needed to determine genetic mechanisms of resistance. Establishing antimicrobial stewardship programs with rapid diagnostic testing that identify mechanisms of resistance may promote judicious use of carbapenems and reduce further the risk of further development of AMR. Disclosures All authors: No reported disclosures.
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Hainsworth, J. D., D. Talantov, T. Jatkoe, C. Meng, J. Baden, D. R. Spigel, A. Mazumder, Y. Wang, and F. A. Greco. "Gene profiling of tumor tissue in the diagnosis of patients with carcinoma of unknown primary site (CUP): Evaluation of the Veridex 10-gene molecular assay." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 21109. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.21109.
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21109 Background: Standard treatment for most patients with CUP involves empiric chemotherapy. Since specific treatment now exists for most types of advanced carcinoma, precise identification of the primary site could lead to improved therapy. Veridex developed an optimized set of 10 gene markers, for a qRTPCR assay to identify tissue of origin of metastatic carcinoma in formalin-fixed, paraffin-embedded (FFPE) tissue samples (J Mol Diagn 8:320, 2006). The assay includes markers for 6 primary sites: lung, pancreas, colon, breast, ovary, and prostate. In this retrospective study, we evaluated the Veridex assay in patients with CUP. Methods: We obtained FFPE tissue from diagnostic biopsies on 69 CUP patients previously enrolled in empiric chemotherapy studies. The Veridex assay was performed as previously described. Assay results were correlated with clinical features, pathologic features, and response to treatment. Results: The Veridex assay yielded provisional diagnoses in 42 of 69 patients (61%): lung (15), pancreas (11), colon (12 ), ovary (4), breast (0), and prostate, (0 ). Most patients with diagnoses of lung and pancreas cancer had clinical and pathologic features compatible with these diagnoses; response rates to empiric chemotherapy (usually taxane/platinum-based) in patients with these diagnoses were 29% and 9%, respectively. The 12 patients with colon cancer diagnoses had predominantly intra-abdominal metastases (liver, peritoneum); response rate to therapy (usually taxane/platinum- based) was low (8%). The 4 patients with ovarian cancer had atypical clinical and pathologic features, and only 1 of 4 had PR to first-line taxane/platinum therapy. Conclusions: In this retrospective study, the Veridex 10-gene molecular assay was feasible and provided provisional diagnoses in a majority of patients with CUP. The diagnoses made using this assay (except ovarian cancer) were compatible with clinicopathologic features. The efficacy of cancer-specific treatment in patients diagnosed by this assay will be evaluated in prospective studies. No significant financial relationships to disclose.
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Wilson, Debbie L. "Review of Tech-Check-Tech." Journal of Pharmacy Technology 19, no. 4 (July 2003): 159–69. http://dx.doi.org/10.1177/875512250301900405.
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Objective: To explore the legal implications of the empiric literature and relevant legal literature on tech-check-tech. Methods: Two reviews were made: one of the states' and US holdings' laws regarding technician credentialing and tech-check-tech, and another of the empiric literature on tech-check-tech. Data Sources/Selection: The International Pharmacy Abstracts database and PubMed were searched for articles using the following key words: Tech* & accuracy, Tech* & check, Tech* & error, and tech-check-tech. When searching PubMed, the term “pharmacy” was added in each search. This search was verified July 2, 2002, to ensure that no articles were missed. Full articles and meeting abstracts were included if they contained data that allowed for comparisons between pharmacists' and technicians' accuracy or error rates in checking. Primary, secondary, and tertiary sources were used. All articles included were searched on the Web of Science to find other relevant articles. The bibliographies of the included articles were also checked. Data Synthesis: Thirty-five of the 53 US states and holdings (66%) either license, register, certify, require Pharmacy Technician Certification Board certification, and/or have technician training or educational requirements. Four states (7.5%) allow tech-check-tech in some form. Ten empiric studies were found that investigated tech-check-tech. The error detection rate was available in only 2 of the studies and showed nearly the same rates (technicians 97%, pharmacists 94%). Conclusions: This work found no evidence suggesting that tech-check-tech should not be adopted for unit-dose cart fill in every state. The credentialing of technicians varies greatly from state to state. Tech-check-tech procedures are sparsely used in the US. Training may improve accuracy, and the average error detection rate was higher for technicians than for pharmacists.
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Britt, Rachel S., Monica V. Mahoney, Howard Gold, and Christopher McCoy. "2113. Evaluation of Empiric Antifungal Therapy in Critically Ill Patients with Liver Disease, Sepsis, and No Evidence of Active Fungal Infection." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S715. http://dx.doi.org/10.1093/ofid/ofz360.1793.
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Abstract Background While candidemia is uncommon in the immunocompetent, critically ill population, it is associated with longer lengths of stay (LOS), higher cost, and higher mortality. In critically ill patients with liver disease and sepsis of unknown origin, antifungals (AF) are commonly used empirically. Recent studies suggest that this practice may not improve clinical outcomes but had little representation of patients with liver disease. This study aims to evaluate clinical outcomes of critically ill patients with liver disease, sepsis, and no evidence of active fungal infection who received empiric AF vs. those who did not. Methods This was a single-center, retrospective review of adults with liver disease and sepsis, identified by ICD-10 codes, who were discharged from the intensive care unit (ICU) between October 1, 2015 and December 31, 2018. Patients with neutropenia, marrow or organ transplant, HIV infection, systemic immunosuppressants, or fungal infection at sepsis onset were excluded. The primary outcome was inpatient mortality. Secondary outcomes included ICU LOS, total LOS, and development of fungal bloodstream infection (BSI) > 48 hours after sepsis onset. Fisher’s exact and Wilcoxon rank-sum tests were used to compare baseline characteristics. Multivariable logistic regression models were used to compare outcomes. Model covariates were variables with P-values < 0.2 in univariate analysis. Results A total of 119 patients were included with 92 receiving empiric AF (micafungin or fluconazole) and 27 receiving no AF. Patients receiving empiric AF were more likely to have hepatic disease upon admission and less likely to have a bacterial infection. Both groups were similar in intubation and vasopressor requirements, febrile episodes, and Candida score. Unadjusted inpatient mortality for empiric vs. no AF was 70.4% vs. 70.7%. Unadjusted ICU LOS, total LOS, and development of a fungal BSI were 10 vs. 11 days, 19 vs. 19 days, and 63.0% vs. 2.2% (P < 0.001). In multivariable models, there was no difference in inpatient mortality between groups (OR 1.20, 95% CI 0.77–1.63). Conclusion In critically ill patients with liver disease, sepsis, and no evidence of active fungal infection, receipt of empiric antifungal therapy did not improve inpatient mortality, ICU LOS, or total LOS but did reduce fungal BSI. Disclosures All authors: No reported disclosures.
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Aldenhoff, J. "CS05-01 - Interpersonal therapy." European Psychiatry 26, S2 (March 2011): 1782. http://dx.doi.org/10.1016/s0924-9338(11)73486-1.
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Interpersonal therapy of depression was created and established in American psychiatry in the 80ties. At that time european and especially german psychiatry was still dominated by the concept of endogenous depression, which suggested a somehow biologically determined aetiology which was not very likely to be influenced by psychotherapeutic access.However, the empiric approach to evaluate therapy regardless of aetiology, which is very typical for IPT, produced strong evidence for the effectiveness of IPT in unipolar depression and many other psychiatric disorders.On this basis, a diversity of biological studies became possible which aimed to the elucidation of neurobiological mechanisms of psychotherapy.The first data indicate that biological state markers change when the patient responds, regardless if he received Psycho- or pharmacotherapy. However, no empirical findings suggested, how IPT might be linked to neurobiological phenomena.We followed the suggestion by E. Kandel, that the phosphorylation of cAMP-responsive-binding-protein (pCREB) could be a crucial factor in the process of psychic improvement. Therefore we studied pCREB in human T-lymphocytes under different treatment conditions in unipolar depression. The results will be presented.
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Freimane, Santa. "Sustainability of Riga 21st Century Apartment Complexes." Architecture and Urban Planning 13, no. 1 (December 1, 2017): 112–17. http://dx.doi.org/10.1515/aup-2017-0016.
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Abstract The research focuses on the sustainability of Riga 21st century apartment complexes, including the context of Riga, as well as sustainability assessment, results of the survey and SWOT analysis. Theoretical studies as well as empiric research methods were used. Research results show that there are some weaknesses, which do not allow achieving the best results, and should be improved in order to increase sustainability of residential environment and the city.
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Itzler, R. F., K. N. Simpson, A. K. Biddle, and J. E. Veney. "C28. Contribution of quasi-experimental research designs in pharmacoeconomic studies: empiric data from a case study of antiviral therapy." Clinical Therapeutics 18 (January 1996): 40. http://dx.doi.org/10.1016/s0149-2918(96)80138-x.
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Wolting, Stephan. ""Die Fremde ist nicht Heimat geworden, aber die Heimat Fremde."(Alfred Polgar)- Überlegungen zum Jahr des interkulturellen Dialogs 2008." Glottodidactica. An International Journal of Applied Linguistics 34 (November 5, 2018): 9–17. http://dx.doi.org/10.14746/gl.2008.34.1.
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The present article tries to attract attention to the connection between the idea of the European Commision to create in 2008 a Year of the interculturaal dialogue and empiric studies in researching of being abroad. It will be one of the most important purposes in future to develop the studies in intercultural communications in the premise of consulting, coaching and mediation for foreign assignment or a deployment abroad. In this fields there's no doubt that there's a need for focussing new researches on the public and private life of employers abroad or on that what's called the working migration.
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Bogochanova, Al'bina. "ЭТНОГРАФИЧЕСКИЕ ИССЛЕДОВАНИЯ В ОБЩЕСТВЕННОМ КРАЕВЕДЕНИИ АЛТАЯ (XIX – НАЧАЛО XX В.)." Proceedings of Altai State Academy of Culture and Arts, no. 2 (2021): 12–17. http://dx.doi.org/10.32340/2414-9101-2021-2-12-17.
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Drawing on the example of ethnographic studies of Altai, the paper traces a process of collecting initial empiric material – mostly by forces of local historians; that fact defined public format in this sector of scientific activity which substantially contributed to Russian ethnography, enriched this branch of science with facts considered as sources for theoretical analysis. The author considers methods, problems of ethnographic studies, a relation between them and tasks of public and state development that defines logic of scientific search. The paper shows a contribution made by researchers in creating ethnographic heritage of Altai, analyses scientific and humanistic value of the phenomenon.
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Despotis, George J., Glenn Gravlee, Kriton Filos, Jerrold Levy, and Dennis M. Fisher. "Anticoagulation Monitoring during Cardiac Surgery." Anesthesiology 91, no. 4 (October 1, 1999): 1122. http://dx.doi.org/10.1097/00000542-199910000-00031.
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The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB. This is best reflected by studies that have evaluated the impact of the ACT method on blood loss and transfusion outcomes. Inconsistent findings from studies that evaluated the impact of ACT monitoring may be related to either suboptimal study design (i.e., retrospective, unblinded, nonrandomized) or possibly the diagnostic inprecision of the ACT method used in these studies. There are a small number of well-controlled studies, some of which suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques, either by sustaining better anticoagulation during CPB or by optimizing protamine doses (i.e., when empiric protocols result in excessive protamine doses). More well-controlled studies are needed to better define the importance of anticoagulation management during CPB.
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Lobanova, Liudmila, Airina Palekaitė, and Justė Radzevičiūtė. "COMPETENCES OF HUMAN RESOURCE MANAGEMENT: EXPECTATIONS AND REALITY." Ekonomika 86 (January 1, 2009): 22–41. http://dx.doi.org/10.15388/ekon.2009.0.1057.
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The competence of human resources specialists becomes more important nowadays due to the knowledge-based development of society and economics. It affects not only the quality of their own work, but also the efficiency, capacity and motivation of all the employees in an organization. The article deals with the composition of competences of human resources management, the profiles, responsibilities and functions of personnel managers. By means of theoretical studies and empirical research, the functions of personnel management and the related competences have been analysed with the aim to reveal employees’ expectations regarding personnel managers. The analysis has revealed the current situation in organizations. The results of the empiric research have shown which actions of the personnel management that refer to the competence of human resources management are most acceptable by the employees and how they are affected by these actions.p>
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Muniraj, T., D. Yadav, J. N. Abberbock, S. Alkaade, S. T. Amann, M. A. Anderson, P. A. Banks, et al. "Increased awareness enhances physician recognition of the role of smoking in chronic pancreatitis." Herald of Pancreatic Club 48, no. 3 (July 31, 2020): 23–31. http://dx.doi.org/10.33149/vkp.2020.03.04.
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Background: We have previously reported that physicians under-recognize smoking as a chronic pancreatitis (CP) risk factor. We hypothesized that availability of empiric data will influence physician recognition of this relationship.
Methods: We analyzed data from 508 CP patients prospectively enrolled in the North American Pancreatitis Study-2 Continuation and Validation (NAPS2-CV) or NAPS2-Ancillary (AS) studies (2008–2014) from 26 US centers who self-reported ever-smoking. Information on smoking status, physician-defined etiology and identification of smoking as a CP risk factor was obtained from structured patient and physician questionnaires. We compared how often physician identified smoking as a CP risk factor in NAPS2-CV/NAPS2-AS studies with NAPS2-original study (2000–2006).
Results: Enrolling physician identified smoking as a risk factor in significantly (all p< 0.001) greater proportion of patients in NAPS2-CV/AS studies when compared with NAPS2-original study among ever (80.7 vs. 45.3%), current (91.3 vs. 53%), past (60.3 vs. 30.2%) smokers, in those who smoked ≤1 pack/day (79.3 vs. 39.5%) or ≥1 packs/day (83 vs. 49.8%). In multivariable analyses, the enrolling physician was 3.32–8.49 times more likely to cite smoking as a CP risk factor in the NAPS2-CV/NAPS2-AS studies based on smoking status and amount after controlling for age, sex, race and alcohol etiology. The effect was independent of enrolling site in a sub-analysis limited to sites participating in both phases of enrollment.
Conclusions: Availability of empiric data likely enhanced physician recognition of the association between smoking and CP. Wide-spread dissemination of this information could potentially curtail smoking rates in subjects with and those at risk of CP.
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Güez, Camila Martins, Emily Pansera Waczuk, Karina Braccini Pereira, Marcus Vinícius Morini Querol, João Batista Teixeira da Rocha, and Luís Flávio Souza de Oliveira. "In vivo and in vitro genotoxicity studies of aqueous extract of Xanthium spinosum." Brazilian Journal of Pharmaceutical Sciences 48, no. 3 (September 2012): 461–67. http://dx.doi.org/10.1590/s1984-82502012000300013.
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The use of plants as a source of palliative or cure for pathological conditions is quite common worldwide. Xanthium spinosum (Asteraceae), popularly known in Brazil as 'espinho de carneiro', is an annual weed from South America, which has been used by empiric medicine to treat neoplasias. Owing to the extensive use of the above-mentioned plant and to the lack of reports about the real effects of its infusion, current study evaluated the genotoxic potential of its aqueous extract at concentrations 0.02 g L-1, 0.1 g L-1 and 0.2 g L-1 by fish micronucleus test and by comet human leukocytes assay. The micronucleus test featured at least 50 cells with micronuclei to every 2,000 cells scored, as a mutagenic parameter. The comet assay was used as a parameter for assessing the level of cell damage and the damage index. Since no significant changes in strain cells exposed to the aqueous extract in the comet and micronucleus assays were reported, it seems that no genotoxicity evidence is extant at the concentrations and in the assays performed.
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Kim, Soyoon, Brady Moffett, Beth Pali, Jill D’Souza, and Ankhi Dutta. "1132. Evaluation of Broad-Spectrum Antimicrobial Therapy for Acute Mastoiditis in Pediatric Patients: An Antimicrobial Stewardship Perspective." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S402—S403. http://dx.doi.org/10.1093/ofid/ofz360.996.
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Abstract Background Acute mastoiditis (AM) continues to remain a serious complication of acute otitis media in children. There is a significant variation in antimicrobial management in children with AM. Recent studies and UptoDate recommends empiric coverage with vancomycin and antipseudomonal medication in patients with AM. The purpose of this study was to evaluate the epidemiology, management and outcome of AM in pediatric patients. Methods A retrospective, observational study was designed evaluating epidemiology and management of AM in hospitalized pediatric patients from July 1, 2011 to June 30, 2017. Patients between 6 months and 19 years of age admitted with a diagnosis of AM as per ICD 9/10 coded were included in the study. Information regarding demographic, clinical, laboratory, microbiological, radiological, antibiotic (Abx) usage, surgical intervention and outcome were collected from medical records. Results A total of 97 patients were evaluated (64% male, mean age 6.6 ± 4.3 years). Cultures (Cx) were obtained in 95 patients as in Figure 1. Of the patients who grew P.aeroginosa, 2 had intracranial extension, both of which were polymicrobial and 5 did not receive empiric antipseudomonal therapy but had no complications on follow-up. Table 1 shows the most common empiric Abx therapy. Fifty-nine patients (61.5%) had a change in Abx, the most common being a ceftriaxone or a combination of clindamycin and ceftriaxone. Except for those with complicated AM, none required definitive vancomycin therapy. Thirty-two patients (33%) had a complicated mastoiditis with epidural abscess, thrombosis, and/or intracranial extension. Eighty-six patients (86.8%) required surgical intervention. Mastoidectomy was performed in 34% while others had myringotomy and tympanostomy tube placement and/or drainage of subperiosteal abscesses without subsequent complications. Conclusion Group A Streptococcus, Streptococcus pneumoniae and Pseudomonas were the predominant pathogens in acute AM in children. Vancomycin and empiric antipseudomonal coverage may not be needed in patients with uncomplicated AM. Broader spectrum Abx with intracranial penetration should be reserved for those with complicated AM. Disclosures All authors: No reported disclosures.
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Zec, Simon, Aleksa Despotovic, Aleksandra Spurnic-Radovanovic, Ivana Milosevic, Milica Jovanovic, Mijomir Pelemis, and Goran Stevanovic. "Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia." Journal of Infection in Developing Countries 10, no. 10 (October 31, 2016): 1065–72. http://dx.doi.org/10.3855/jidc.8124.
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Introduction: Surveillance of antimicrobial resistance is essential in establishing treatment guidelines for urinary tract infections. The aim of this pilot study was to analyse resistance rates of pathogens, across different demographics and determine whether adjustments in empiric therapy should be considered for different age and gender groups. Methodology: A 5-year retrospective study included 256 patients hospitalised, under the initial diagnosis of Fever of Unknown Origin who were then subsequently diagnosed with a urinary tract infection at the Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia. Patients were evaluated using demographic, clinical, and antimicrobial resistance data with appropriate statistical analysis including ANOVA significance testing, univariate, and multivariate analysis. Results: Resistance rates were above the threshold of 20% for the majority of the antimicrobials tested, the only exception being carbapenems. Amikacin, cefepime, and norfloxacin were agents that could be effectively used as empiric therapy in younger adults with resistance rates of 4.2, 8.0, and 10.0%, respectively. Moderate resistance rates of 17.4% for amikacin and 19.1% for cefepime were observed in the age group 35-64 years. High resistance rates were observed for all antimicrobials among patients 65 years and over. Among male patients, resistance rates to most antimicrobials were high. In female patients, amikacin and cefepime had resistance rates less than 20%. Younger age presented as a negative risk factor for infection by a multi-drug resistant pathogen. Conclusion: Age and gender demonstrated to be significant factors for determining proper empiric therapy; large-scale studies from Serbia are needed to solidify these findings.
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Šarūnas, Tadas. "In Search for a Bourdieusian Approach to “Gentrification”: Looking through the Radiance of Academic Doxa." Socialinė teorija, empirija, politika ir praktika 22 (June 21, 2021): 74–87. http://dx.doi.org/10.15388/stepp.2020.30.
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Despite the potential of Pierre Bourdieu’s sociology to advance debates of urban studies, this potential is so far used only superficially. In this article I take arguments from the debate on gentrification as an example to show how Bourdieu’s sociology could help us look through the common sense notions of urban studies. But despite the critique for the debate on gentrification, I argue that we should keep on approaching these empiric locations. They enable us to produce sensitive stories on the effects that social forces have on our everyday lives in cities and – in particular – to show the role that housing policy has in the reproduction of power relations.
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Reeves, Penny, Zoe Szewczyk, Judith Proudfoot, Nyree Gale, Jennifer Nicholas, and Josephine Anderson. "Economic Evaluations of Stepped Models of Care for Depression and Anxiety and Associated Implementation Strategies: A Review of Empiric Studies." International Journal of Integrated Care 19, no. 2 (June 21, 2019): 8. http://dx.doi.org/10.5334/ijic.4157.
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Baker, K. C., E. Y. Ko, K. Siddiqi, R. E. Brannigan, and E. S. Sabanegh. "Influence of laboratory studies on choice of empiric medical therapy for idiopathic male factor infertility: a survey of us urologists." Fertility and Sterility 96, no. 3 (September 2011): S232. http://dx.doi.org/10.1016/j.fertnstert.2011.07.889.
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Ibrahim, Nazedah Ain, Mohd Makmor Bakry, Shareena Ishak, and Noraida Mohamed Shah. "A REVIEW OF ANTIBIOTIC USED IN SUSPECTED EARLY-ONSET NEONATAL SEPSIS FROM MALAYSIAN PERSPECTIVE: WHICH ONES TO CHOOSE AND HOW LONG TO GIVE?" Asian Journal of Pharmaceutical and Clinical Research 12, no. 1 (January 7, 2019): 529. http://dx.doi.org/10.22159/ajpcr.2018.v12i1.29489.
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Objective: Suspected early-onset sepsis is a common diagnosis among neonates which warrants admission to the neonatal intensive care unit. Prolonged empiric antibiotic is the biggest concern and treatment duration is still controversial. Antimicrobial stewardship (AMS) program promotes early antibiotic de-escalation to reduce unnecessary antibiotic exposure and its implementation in the intensive care setting seems to be feasible. The primary objective of this review was to compare the existing guidelines and review the literature regarding choice and duration of empiric antibiotic in managing suspected early-onset neonatal sepsis.Methods: Two Malaysian Ministry of Health guidelines were compared with guidelines from America (n=1), Australia (n=1), and United Kingdom (n=2). The literature search was conducted from January to June 2017 through open access journal and databases available at the author’s institution library (EBSCOHost, Ovid and Science Direct).Results: All guidelines recommended similar antibiotics range and suggested to review treatment at 36– 72 h post antibiotic exposure. A total of 113 abstracts and full articles were identified, and only 11 full-text articles published in English were related to the subject of interest. All studies show differences either in study design, choice of antibiotics, treatment duration or outcome measures; thus, a meta-analysis was not possible to be conducted.Conclusion: From this review, we found the potential to performed early empiric antibiotic de-escalation especially in clinically well-appearance neonates, and it is best to customize our guidelines based on local evidence which justify the need for more local research in this area.
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Ibrahim, Nazedah Ain, Mohd Makmor Bakry, Shareena Ishak, and Noraida Mohamed Shah. "A REVIEW OF ANTIBIOTIC USED IN SUSPECTED EARLY-ONSET NEONATAL SEPSIS FROM MALAYSIAN PERSPECTIVE: WHICH ONES TO CHOOSE AND HOW LONG TO GIVE?" Asian Journal of Pharmaceutical and Clinical Research 12, no. 1 (January 7, 2019): 529. http://dx.doi.org/10.22159/ajpcr.2019.v12i1.29489.
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Objective: Suspected early-onset sepsis is a common diagnosis among neonates which warrants admission to the neonatal intensive care unit. Prolonged empiric antibiotic is the biggest concern and treatment duration is still controversial. Antimicrobial stewardship (AMS) program promotes early antibiotic de-escalation to reduce unnecessary antibiotic exposure and its implementation in the intensive care setting seems to be feasible. The primary objective of this review was to compare the existing guidelines and review the literature regarding choice and duration of empiric antibiotic in managing suspected early-onset neonatal sepsis.Methods: Two Malaysian Ministry of Health guidelines were compared with guidelines from America (n=1), Australia (n=1), and United Kingdom (n=2). The literature search was conducted from January to June 2017 through open access journal and databases available at the author’s institution library (EBSCOHost, Ovid and Science Direct).Results: All guidelines recommended similar antibiotics range and suggested to review treatment at 36– 72 h post antibiotic exposure. A total of 113 abstracts and full articles were identified, and only 11 full-text articles published in English were related to the subject of interest. All studies show differences either in study design, choice of antibiotics, treatment duration or outcome measures; thus, a meta-analysis was not possible to be conducted.Conclusion: From this review, we found the potential to performed early empiric antibiotic de-escalation especially in clinically well-appearance neonates, and it is best to customize our guidelines based on local evidence which justify the need for more local research in this area.