Skin and soft tissue infections (SSTIs) carry significant economic burden, as well as morbidity and mortality, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Several ...new MRSA-active antibiotics have been developed, including semisynthetic glycopeptides (telavancin, dalbavancin and oritavancin). Of these, dalbavancin and oritavancin offer extended dosing intervals.
We performed a systematic review, network meta-analysis and cost analysis to compare the newer glycopeptides to standard care and to each other for the treatment of complicated SSTIs (cSSTI). A search for randomized controlled trials (RCTs) was conducted in Medline, Embase and the Cochrane Central Register of Controlled Trials. We also developed a model to evaluate the costs associated with dalbavancin and oritavancin from the third-party payer perspective.
Seven RCTs met the inclusion criteria. Network meta-analyses suggested that the clinical response to telavancin, dalbavancin and oritavancin was similar to standard care (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.90–1.33; OR 0.78, 95% CI 0.52–1.18; and OR 1.06, 95% CI 0.85–1.33, respectively). Head-to-head comparisons showed no difference in clinical response between oritavancin and dalbavancin (OR 1.36; 95% CI 0.85–2.18), oritavancin and telavancin (OR 0.98; 95% CI 0.72–1.31) or dalbavancin and telavancin (OR 0.72; 95% CI 0.45–1.13). Telavancin had a higher incidence of overall adverse events compared to standard care (OR 1.33; 95% CI 1.10–1.61). Compared to telavancin, there were fewer overall adverse events with dalbavancin (OR 0.58; 95% CI 0.45–0.76) and oritavancin (OR 0.71; 95% CI 0.55–0.92). Studies were of high quality overall. Our cost analyses demonstrated that dalbavancin and oritavancin were less costly compared to standard care under baseline assumptions and many scenarios evaluated. The use of dalbavancin could save third-party payers $1442 to $4803 per cSSTI, while the use of oritavancin could save $3571 to $6932 per cSSTI.
Dalbavancin and oritavancin demonstrate efficacy and safety comparable to standard care in well-designed RCTs and result in cost savings when standard care is treatment that covers MRSA.
Abstract We evaluated the clinical impact of implementing hydrogen peroxide vapour (HPV) for disinfecting rooms vacated by Clostridium difficile infection (CDI) patients. Breakpoint time series ...analysis indicated a significant reduction (p<0.001) in the rate of CDI that occurred at the time when HPV was implemented, resulting in a reduction in the rate of CDI from 1.0 to 0.4 cases per 1000 patient days in the 2 years before vs. the first 2 years of HPV usage. HPV should be considered to augment the terminal disinfection of rooms vacated by patients with CDI.
Pulmonary rehabilitation is beneficial for patients with chronic lung disease. However, long-term maintenance has been difficult to achieve after short-term treatment. We evaluated a telephone-based ...maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates. Subjects were randomly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions (n = 87) or standard care (n = 85) and followed for 24 months. Except for a slight imbalance between sexes, experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation. During the 12-month intervention, exercise tolerance (maximum treadmill workload and 6-minute walk distance) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days. There were no group differences for other measures of pulmonary function, dyspnea, self-efficacy, generic and disease-specific quality of life, and health care use. By 24 months, there were no significant group differences. Patients returned to levels close to but above prerehabilitation measures. We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation.
OBJECTIVE: Evaluate the reliability and validity of a new version of the University of California, San Diego Shortness of Breath Questionnaire (SOBQ), a 24-item measure that assesses self-reported ...shortness of breath while performing a variety of activities of daily living. DESIGN: Patients enrolled in a pulmonary rehabilitation program were asked to complete the SOBQ, the Quality of Well-Being Scale, the Center for Epidemiologic Studies Depression Scale, and a 6-min walk with modified Borg scale ratings of perceived breathlessness following the walk. SETTING: University medical center pulmonary rehabilitation program. Patients: Thirty-two male subjects and 22 female subjects with a variety of pulmonary diagnoses: COPD (n=28), cystic fibrosis (n=9), and postlung transplant (n=17). MEASUREMENTS AND RESULTS: The current version of the SOBQ was compared with the previous version, the format of which often resulted in a significant number of "not applicable" answers. The results demonstrated that the SOBQ had excellent internal consistency (alpha=0.96). The SOBQ was also significantly correlated with all validity criteria. CONCLUSIONS: The SOBQ is a valuable assessment tool in both clinical practice and research in patients with moderate-to-severe lung disease.
To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.
...Randomized clinical trial.
University medical center.
119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen.
Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training.
Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years.
Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents METS compared with +0.6 METS P < 0.001; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min P = 0.06), exercise endurance (+10.5 minutes compared with +1.3 minutes P < 0.001), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 P < 0.001) and muscle fatigue (score of -1.4 compared with -0.2 P < 0.01), shortness of breath (score of -7.0 compared with +0.6 P < 0.01), and self-efficacy for walking (score of +1.4 compared with +0.1 P < 0.05). There were slight but nonsignificant differences in survival (67% compared with 56% P = 0.32) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year P = 0.20). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up.
Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.
The D0 Run IIb luminosity measurement Casey, B.C.K.; Corcoran, M.; DeVaughan, K. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
01/2013, Letnik:
698
Journal Article
Recenzirano
Odprti dostop
An assessment of the recorded integrated luminosity is presented for data collected with the D0 detector at the Fermilab Tevatron Collider from June 2006 to September 2011 (Run IIb). In addition, a ...measurement of the effective cross-section for inelastic interactions, also referred to as the luminosity constant, is reported. This measurement incorporates new features that lead to a substantial improvement in the precision of the result. A luminosity constant of σLM=48.3±1.9±0.6mb is obtained, where the first uncertainty is due to the accuracy of the inelastic cross-section used by both CDF and D0, and the second uncertainty is due to D0 sources. The recorded luminosity for the highest ET jet trigger is Lrec=9.2±0.4fb−1, with a relative uncertainty of 4.3%.
The objective of this study was to test whether bioaugmentation with known pentachlorophenol (PCP)-degrading bacteria (Sphingobium chlorophenolicum and Burkholderia cepacia) could enhance remediation ...of PCP-contaminated groundwater. Groundwater PCP concentrations were determined by US Environmental Protection Agency (EPA) method 3510C and gas chromatography. Gene expression for PCP-degrading enzymes: pentachlorophenol 4-monooxygenase (pcpB; S. chlorophenolicum) and chlorophenol 4-monooxygenase (TftD; B. cepacia) was determined by real-time polymerase chain reaction (RT-PCR) using gene-specific primers. Bioaugmented treatments with S. chlorophenolicum and B. cepacia showed 32% and 49% decrease (p < .05) whereas un-bioaugmented (indigenous) treatment did not show significant decrease (p > .05) in average PCP concentration, respectively, over 72 days. Decreased PCP levels correlated strongly (r = −.82, p < .05) with increased PCP-tolerant bacteria in bioaugmented treatments, whereas no significant correlation was observed (r = −.22, p > .05) in un-bioaugmented treatment. In addition, a decrease in PCP levels also correlated significantly with an increase in gene expression of PCP-degrading enzymes, pcpB (r = −.77044) and TftD (r = −.87905) (p < .05). PCP concentrations decreased and pcpB or TftD expressions were higher in bioaugmented treatments with S. chlorophenolicum (50%, 7-fold) or B. cepacia (67%, 10.7-fold), respectively, than indigenous treatment. Therefore, bioaugmentation with known PCP-degrading bacteria enhanced remediation of PCP-contaminated groundwater than indigenous bacteria alone. Results of this study may provide a more efficient and environmentally friendly technique for on-site remediation of PCP-contaminated groundwater.
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