6 research outputs found
Atraumatic (pencil-point) versus conventional needles for lumbar puncture:a clinical practice guideline
Is the needle tip configuration important when
performing a lumbar puncture for any indication? A
systematic review published in the Lancet in December 2017 suggests that it is. The review found that
using atraumatic (pencil-point) lumbar puncture
needles instead of conventional lumbar puncture
needles reduced the risk of post-dural-puncture
headache and of return to hospital for additional
pain control.1
This guideline recommendation aims
to promptly and transparently translate this evidence
to a clinical recommendation, following standards
for GRADE methodology and trustworthy guidelines.2
The BMJ Rapid Recommendations panel makes a
strong recommendation for the use of atraumatic
needles for lumbar puncture in all patients regardless
of age (adults and children) or indication instead of
conventional needles.3 4 Box 1 shows the article and
evidence linked to this Rapid Recommendation. The
main infographic provides an overview of the absolute benefits and harms (although none were present
here) of atraumatic needles. Table 1 below shows any
evidence that has emerged since the publication of
this guideline.publishedVersio
Caracterización del aceite microencapsulado de cardamomo (Elettaria cardamomum) extraído por fluidos supercríticos a escala semi-industrial
A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study
Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide