An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units

Objectives Emerging evidence supports the use of therapeutic drug monitoring (TDM) of β-lactams for intensive care unit (ICU) patients to optimize drug exposure, although limited detail is available on how sites run this service in practice. This multicentre survey study was performed to describe the various approaches used for β-lactam TDM in ICUs. Methods A questionnaire survey was developed to describe various aspects relating to the conduct of β-lactam TDM in an ICU setting. Data sought included: β-lactams chosen for TDM, inclusion criteria for selecting patients, blood sampling strategy, analytical methods, pharmacokinetic (PK)/pharmacodynamic (PD) targets and dose adjustment strategies. Results Nine ICUs were included in this survey. Respondents were either ICU or infectious disease physicians, pharmacists or clinical pharmacologists. Piperacillin (co-formulated with tazobactam) and meropenem (100% of units surveyed) were the β-lactams most commonly subject to TDM, followed by ceftazidime (78%), ceftriaxone (43%) and cefazolin (43%). Different chromatographic and microbiological methods were used for assay of β-lactam concentrations in blood and other biological fluids (e.g. CSF). There was significant variation in the PK/PD targets (100% fT>MIC up to 100% fT>4×MIC) and dose adjustment strategies used by each of the sites. Conclusions Large variations were found in the type of β-lactams tested, the patients selected for TDM and drug assay methods. Significant variation observed in the PK/PD targets and dose adjustment strategies used supports the need for further studies that robustly define PK/PD targets for ICU patients to ensure a greater consistency of practice for dose adjustment strategies for optimizing β-lactam dosing with TD

A simple and rapid method for blood collection from walking catfish, Clarias batrachus (Linneaus, 1758)

Blood is collected from experimental animals for a wide range of scientific purposes including; hematology, clinical biochemistry parameters, immunology, studies in bacteriology, parasitology and investigations in reproductive performance and health. The number of methods employed to collect blood from fish include; the puncture of caudal vein, dorsal aorta or cardiac vessels and the severance of the caudal vein. Unfortunately, all these procedures are practically found to be slow and stressful to Clarias batrachus, including the popular caudal vein approach, likely due to the small size of caudal veins relative to the size of the species. In line with the universal ethical recommendations for taking blood from small research animals, we propose an alternative one-operator approach for C. batrachus that is simple, rapid and without the need to sacrifice the fish as with other methods. This procedure targets the dorsal aorta (a relatively larger blood vessel) in a sedated fish, punctured by inserting a needle directly from the anterior part of the anal fin about 2-5 mm behind the genital papilla, to draw the desired amount of blood. The technique is a one-operator procedure not requiring the help of an assistant or any special equipment to restrain the fish. The operation of the protocol is unique since it permits the continuous collection of blood from the same experimental fish over a varied time course and reduces the need for a large number of replicate animals. The advantages of the proposed protocol are also highlighted and discussed in detail

Marco de Competencias Básicas de Investigación para Clínicos de Cuidados Paliativos RESPACC

El proyecto financiado por RESPACC ERASMUS+ identificará las competencias de investigación básicas para clínicos de cuidados paliativos. La noción de competencia se refiere a la capacidad de aplicar conocimientos, destrezas y habilidades para realizar con éxito una actividad en el trabajo. Nos enfocamos en mejorar las competencias de investigación básicas en clínicos de equipos multidisciplinarios de cuidados paliativos, tanto a nivel de equipo como individual. Algunas competencias podrían considerarse imprescindibles para realizar una investigación en equipo, pero puede que no sean imprescindibles para todos los miembros del equipo, porque podría ser suficiente que sólo alguien del equipo cuente con dichas competencias para que se lleve a cabo la investigación. OBJETIVO: Identificar un conjunto de competencias de investigación básicas, necesarias para que el equipo paliativo multidisciplinario pueda llevar a cabo un estudio clínico exitoso

Herkules – Held zwischen Tugend und Hybris. Ein europäischer Erinnerungsort der Frühen Neuzeit?

This essay traces some of the contexts and media in which "Heracles-Hercules" - as a hero between virtue and hubris - was visible in European societies from the end of the middle ages onwards. It discusses whether this example of the reception, appropriation and transformation of classical myths in the early modern period can be understood as a European "lieu de mémoire", and to what extent the concept of "lieux de mémoire" (or sites of memory) can foster our understanding of a particular object of study (here the Heracles/Hercules myth). Against this backdrop, we conclude with some general questions about the more ambitious project* of a comprehensive register of European "lieux de mémoire". * * Published as: Boer, Pim den / Duchhardt, Heinz / Kreis, Georg / Schmale, Wolfgang (eds.): Europäische Erinnerungsorte, 3 vols., Munich 2011–201