Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One ...efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of
, carbapenem-resistant
, and
infections. Additionally, we highlight how to implement cumulative antibiograms and biomarkers to a sooner de-escalation of antibiotics.
To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic.
In this retrospective ...single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic.
In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group median (IQR), the second wave group was younger 57 (46-70) versus 67 (52-80) years; p<0.001, had a lower SAPS 3 Score 45 (42-52) versus 49 (43-57); p<0.001, lower SOFA Score on intensive care unit admission 3 (1-6) versus 4 (2-6); p=0.018, lower Charlson Comorbidity Index 0 (0-1) versus 1 (0-2); p<0.001, and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves.
In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission.
In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress ...syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).
The aim of this study was to evaluate the effects of sodium (Na) levels in the drinking water on the performance, carcass yield, and meat quality of slow-growing chickens. A completely randomized ...design with 4 treatments (4.90; 32.30; 60.53; and 101.0 mg/L of Na in water) and 6 replications, with 20 birds per experimental unit, was adopted. The treatments are evaluated in the following: 10 to 25, 10 to 39, and 10 to 54 days. For slow-growing chickens from 10 to 25 days, the Na levels in the drinking water promoted a quadratic effect for water and feed intake (
p
<0.05). The inclusion of Na in the drinking water offered to slow-growing chickens from 10 to 39 days resulted in a reduction in voluntary water intake (
p
<0.05). For slow-growing chickens from 10 to 54 days, the Na levels in the drinking water promoted a quadratic effect for water intake and feed conversion (
p
<0.05). After 54 days, the slow-growing chickens were slaughtered and it was observed that the Na inclusion in the drinking water offered to slow-growing chickens provided a quadratic effect for cold carcass, breast, and kidney weights and for kidney and liver yields (
p<
0.05). Liver weight was reduced with increasing Na levels in the drinking water (
p
<0.05). For the breast cut, the Na levels in the drinking water promoted a quadratic effect for pH24h, drip loss, cooking loss, protein, and fat and an increase in shear force (
p
<0.05). For the thigh cut, the Na levels in the drinking water increased the pH24h and reduced drip loss and shear force (
p
<0.05), and a quadratic effect was observed for moisture and fat (
p
<0.05). Levels of up to 60.53 mg/L of Na promote an increase in feed intake, which provided a higher breast weight and protein content with reduced fat and drip loss.
Assessing team effectiveness and affective learning in a datathon Piza, Felipe Maia de Toledo; Celi, Leo Anthony; Deliberato, Rodrigo Octavio ...
International journal of medical informatics (Shannon, Ireland),
April 2018, 2018-04-00, 20180401, Volume:
112
Journal Article
Peer reviewed
•Affective learning and team effectiveness skills were acquired by participants of a health datathon event in São Paulo, Brazil.•Successful teams are associated with higher affective learning gains ...for participants.•Effective leadership is essential for teamwork and is a significant predictor for learning.
Datathons are increasingly organized in the healthcare field. The goal is to assemble people with different backgrounds to work together as a team and engage in clinically relevant research or develop algorithms using health-related datasets. Criteria to assess the return of investment on such events have traditionally included publications produced, patents for prediction, classification, image recognition and other types of software, and start-up companies around the application of machine learning in healthcare. Previous studies have not evaluated whether a datathon can promote affective learning and effective teamwork.
Fifty participants of a health datathon event in São Paulo, Brazil at Hospital Israelita Albert Einstein (HIAE) were divided into 8 groups. A survey with 25 questions, using the Affective Learning Scale and Team-Review Questionnaire, was administered to assess team effectiveness and affective learning during the event. Multivariate regression models and Pearson’s correlation tests were performed to evaluate the effect of affective learning on teamwork.
Majority of the participants were male 76% (37/49); 32% (16/49) were physicians. The mean score for learning (scale from 1 to 10) was 8.38, while that for relevance of the perceived teamwork was 1.20 (scale from 1 to 5; “1” means most relevant). Pearson’s correlation between the learning score and perception of teamwork showed moderate association (r = 0.36, p = 0.009). Five learning and 10 teamwork variables were on average positively graded in the event. The final regression model includes all learning and teamwork variables. Effective leadership was strongly correlated with affective learning (β = −0.27, p < 0.01, R2 = 75%). Effective leadership, team accomplishment, criticism, individual development and creativity were the variables significantly associated with higher levels of affective learning.
It is feasible to enhance affective knowledge and the skill to work in a team during a datathon. We found that teamwork is associated with higher affective learning from participants’ perspectives. Effective leadership is essential for teamwork and is a significant predictor of learning.
Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of ...adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far. The aim of this study is to compare three transfusion strategies (routine coagulation test-guided - ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis.
Design and setting: a double-blinded, parallel-group, single-center, randomized controlled clinical trial in a tertiary private hospital in São Paulo, Brazil.
adults (aged 18 years or older) admitted to the intensive care unit with cirrhosis and an indication for central venous line insertion. Patients will be randomly assigned to three groups for blood transfusion strategy prior to central venous catheterization: standard coagulation tests-based, thromboelastometry-based, or restrictive. The primary efficacy endpoint will be the proportion of patients transfused with any blood product prior to central venous catheterization. The primary safety endpoint will be the incidence of major bleeding. Secondary endpoints will be the proportion of transfusion of fresh frozen plasma, platelets and cryoprecipitate; infused volume of blood products; hemoglobin and hematocrit before and after the procedure; intensive care unit and hospital length of stay; 28-day and hospital mortality; incidence of minor bleeding; transfusion-related adverse reactions; and cost analysis.
This study will evaluate three strategies to guide blood transfusion prior to central venous line placement in severely ill patients with cirrhosis. We hypothesized that thromboelastometry-based and/or restrictive protocols are safe and would significantly reduce transfusion of blood products in this population, leading to a reduction in costs and transfusion-related adverse reactions. In this manner, this trial will add evidence in favor of reducing empirical transfusion in severely ill patients with coagulopathy.
ClinicalTrials.gov, identifier: NCT02311985 . Retrospectively registered on 3 December 2014.
PDF
