Ventilator associated pneumonia and infection control

Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20–75% according to the study population. Aspiration of colonized pathogenic microorganisms on the oropharynx and gastrointestinal tract is the main route for the development of VAP. On the other hand, the major risk factor for VAP is intubation and the duration of mechanical ventilation. Diagnosis remains difficult, and studies showed the importance of early initiation of appropriate antibiotic for prognosis. VAP causes extra length of stay in hospital and intensive care units and increases hospital cost. Consequently, infection control policies are more rational and will save money

Evaluation of fatigue-related kinesiophobia and associated factors in individuals with lung cancer with and without respiratory comorbidity

Aim: To investigate fatigue-related kinesiophobia and associated factors in individuals with lung cancer. Methods: A total of 52 individuals were included in the study and the individuals were divided into two groups, each consisting of 26 individuals. Charlson comorbidity index, Brief Fatigue Inventory, modified Medical Research Council dyspnea scale, Tampa Kinesiophobia Scale-Fatigue are applied as data collection tools. Results: The individuals in the study had similar demographic characteristics. There was no difference between the groups in the study in terms of fatigue-related kinesiophobia. There was a difference between the pain and performance status of the individuals in the study in activities of daily living (p<0.05). Conclusion: At the end of this study, it was observed that individuals with lung cancer with respiratory comorbidity had worse pain, fatigue and performance values in activities of daily living, while kinesiophobia values related to fatigue were similar

How Does Aggressive Working Capital Policy Affect Firm Performance? Heterogeneous Panel Data Analysis in The Case of ISE Food Companies

The working capital policies to be applied by enterprises provide important information to_x000D_ the interested parties about the ratio of short and long term debts to be used in financing_x000D_ current assets and investments to be made to these assets. Businesses' choice between_x000D_ profitability and risk is shaped by the aggressive or conservative working capital policy_x000D_ they adopt. In this context, the study was conducted to determine the working capital_x000D_ financing and investment strategies of food companies traded in ISE in the period 2009-_x000D_ 2018 and to investigate the impact of these strategies on business performance by panel_x000D_ data analysis. As a result of the analysis, it was determined that there was a significant_x000D_ relationship between working capital policies and return on assets. It was found that the_x000D_ businesses increase their profitability by adopting conservative policy and reduce their_x000D_ profitability by adopting aggressive policy.The working capital policies to be applied by enterprises provide important information to the interested parties about the ratio of short and long term debts to be used in financing current assets and investments to be made to these assets. Businesses' choice between profitability and risk is shaped by the aggressive or conservative working capital policy they adopt. In this context, the study was conducted to determine the working capital financing and investment strategies of food companies traded in ISE in the period 2009- 2018 and to investigate the impact of these strategies on business performance by panel data analysis. As a result of the analysis, it was determined that there was a significant relationship between working capital policies and return on assets. It was found that the businesses increase their profitability by adopting conservative policy and reduce their profitability by adopting aggressive policy

The Role of Information and Communication Technology in the Acculturation of Vietnamese Refugees

One of the most significant refugee populations in the United States is the Vietnamese. This group initially fled their native country to escape political oppression at the conclusion of the Vietnam War in 1975 and continued to flee in a series of separate waves that continued for more than three decades. As a relatively new immigrant group in the U.S., the Vietnamese still face a variety of challenges as they try to reestablish their lives and adapt in a new cultural environment. Acculturation is a complex process that is influenced by a number of factors. Throughout history, U.S. immigration policy has significantly affected the admission and adaptation of refugees. As shifts in the ideological frameworks, economic demands, and attitudes towards the rest of the world occurred in the twentieth century, which eventually brought the liberalization of immigration policy, this influence slowly decreased. This allowed for factors in the domestic political, economic, and social environments to become more powerful in affecting how refugees adapt in the U.S. Information and communication technologies (ICTs) have become integral aspects in both assisting and complicating the acculturation process for refugees. These technologies are helping Vietnamese refugees culturally adjust in American communities as well as maintain ties with their native culture; thus, illustrating the multifaceted nature of acculturation. However, the impact of ICTs is not uniform across all of the different waves of refugees who fled from Vietnam. This study demonstrates that interaction and communication are key aspects in cross-cultural adaptation and the importance of media in contemporary everyday life

Antimicrobial Stewardship on Patients with Neutropenia: A Narrative Review Commissioned by Microorganisms

Prescription optimization; Critically ill patients; Appropriate antibioticPrescripció antimicrobiana; Pacients crítics; Antibiòtic adequatPrescripción antimicrobiana; Pacientes críticos; Antibiótico adecuadoThe emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority

The first six years of surveillance in pediatric and neonatal intensive care units in Turkey

BACKGROUND: Patients in resourced-limited neonatal and pediatric intensive care units (NICU and PICU) are vulnerable to healthcare associated infections (HAI). We report the incidence of HAI, multidrug resistant microorganisms (MDROs) and the pattern of antibiotic usage in the first six years of a surveillance program in a teaching hospital in Turkey. METHODS: Between 2007 and 2012 surveillance data for HAI, MDROs and antibiotic usage were collected from the infection control department, pathology, hospital admissions and pharmacy. In 2009 hand hygiene auditing was introduced. Hand sanitizer usage was expressed as liters per 1000 patient-days. Antibiotic usage was presented as defined daily doses (DDD). Evidence of change in the incidence of HAI was tested using Poison regression modeling. RESULTS: The rate of gram negative MDRO in PICU increased significant between 2007 and 2012 (IRR 1.5, P = 0.033) but remained unchanged in NICU (P = 0.824). By 2012 ceftriaxone prescribing in PICU had decreased while carbapenem prescribing increased by 80 %. In NICU carbapenem decreased by 42 % and betalactam decreased by 29 %. Hand hygiene compliance significantly improved in PICU (IRR 1.9, p < 0.001) and NICU (IRR 2.2, p < 0.001) but compliance remained modest after three years with inconsistent levels across the 5 moments. CONCLUSION: The early years of our infection control program highlights the endemicity of HAI and MDROs in our NICU and PICU. The consistent pattern of antibiotic usage, endemic MROs in PICU and modest hand hygiene clearly provide strategic focuses for intervention

Incidence, risk factors and mortality of nosocomial pneumonia in Intensive Care Units: A prospective study

To determine the frequency, risk factors and mortality of nosocomial pneumonia a prospective study was conducted in the intensive care units. In the study period, 2402 patients were included. The nosocomial pneumonia was defined according to the Centers for Disease Control Criteria. Overall, 163 (6.8%) of the patients developed nosocomial pneumonia and 75.5% (n = 123) of all patients with nosocomial pneumonia were ventilator-associated pneumonia. 163 patients who were admitted to the intensive care unit during the same period but had no bacteriologic or histologic evidence of pneumonia were used as a control group. The APACHE II score, coma, hypoalbuminemia, mechanical ventilation, tracheotomy, presence of nasogastric tube were found as independent risk factors. Crude and attributable mortality were 65% and 52.6%, respectively. The mortality rate was five times greater in the cases (OR: 5.2; CI 95%: 3.2–8.3). The mean length of stay in the intensive care unit and hospital in the cases were longer than controls (p < 0.0001). Patients requiring mechanical ventilation have a high frequency of nosocomial pneumonia

Bone Marrow Transplantation and Medical Tourism at Erciyes University - A Single Center Experience

Medical tourism emerged when people were challenged with high costs and slow service in medical care. As a consequence of these issues, people started to look for medical treatment in other countries. Globalization accelerated the growth of medical tourism. Several “push” and “pull” factors play roles in the motivation of patients to become a medical tourist. This review addresses the different aspects of medical tourism in general, describes the development of medical tourism in Turkey, and describes experiences with medical tourism in the Bone Marrow Transplantation Center (BMTC) at Erciyes University, Kayseri, Turkey. Since January 2016, an international collaboration has existed between BMTC and the King Hamed University Hospital (KHUH) in Bahrain. Ten allogeneic stem cell transplantations (SCTs) have been performed on patients from Bahrain with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma, and myelofibrosis. Furthermore, ten autologous SCT have been conducted on patients from Bahrain with multiple myeloma (MM), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). In 2016, transplant-related mortality (TRM) at 100 days among Bahrain patients was 0% compared to 2.6% in all patients. Although these numbers are small, the first results show that the outcomes of international patients are similar to those of non-international patients. In our experience, the key to a successful collaboration between international hospitals is having close communication regarding the treatment of the international patient. The outcome of a large group of international compared with non-international patients should be further studied

Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647]

Background: The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis

TOp TEn resistant Microorganisms at intensive care unit: a 2018 global expert survey (TOTEM study protocol)

Background: This global survey will provide global expert ranking of the most urgent multidrug bacteria present at the intensive care units (ICU) that have become a threat in daily clinical practice. We believe efforts on education, investigation, funding and development of new antimicrobials or new antimicrobial approach should be directed in near future. The 2018 study protocol is reported here in. Methods: A global survey will be performed using an electronic platform (SurveyMonkey®). The survey will compile data on key aspects of the actual threat of antimicrobial-resistant bacteria globally in the ICU