Outcomes of early switching from intravenous to oral antibiotics on medical wards

OBJECTIVES: To evaluate outcomes following implementation of a checklist with criteria for switching from intravenous (iv) to oral antibiotics on unselected patients on two general medical wards. METHODS: During a 12 month intervention study, a printed checklist of criteria for switching on the third day of iv treatment was placed in the medical charts. The decision to switch was left to the discretion of the attending physician. Outcome parameters of a 4 month control phase before intervention were compared with the equivalent 4 month period during the intervention phase to control for seasonal confounding (before-after study; April to July of 2006 and 2007, respectively): 250 episodes (215 patients) during the intervention period were compared with the control group of 176 episodes (162 patients). The main outcome measure was the duration of iv therapy. Additionally, safety, adherence to the checklist, reasons against switching patients and antibiotic cost were analysed during the whole year of the intervention (n = 698 episodes). RESULTS: In 38% (246/646) of episodes of continued iv antibiotic therapy, patients met all criteria for switching to oral antibiotics on the third day, and 151/246 (61.4%) were switched. The number of days of iv antibiotic treatment were reduced by 19% (95% confidence interval 9%-29%, P = 0.001; 6.0-5.0 days in median) with no increase in complications. The main reasons against switching were persisting fever (41%, n = 187) and absence of clinical improvement (41%, n = 185). CONCLUSIONS: On general medical wards, a checklist with bedside criteria for switching to oral antibiotics can shorten the duration of iv therapy without any negative effect on treatment outcome. The criteria were successfully applied to all patients on the wards, independently of the indication (empirical or directed treatment), the type of (presumed) infection, the underlying disease or the group of antibiotics being used

HiPE: Hierarchical Initialization for Pose Graphs

Pose graph optimization is a non-convex optimization problem encountered in many areas of robotics perception. Its convergence to an accurate solution is conditioned by two factors: the non-linearity of the cost function in use and the initial configuration of the pose variables. In this letter, we present HiPE, a novel hierarchical algorithm for pose graph initialization. Our approach exploits a coarse-grained graph that encodes an abstract representation of the problem geometry. We construct this graph by combining maximum likelihood estimates coming from local regions of the input. By leveraging the sparsity of this representation, we can initialize the pose graph in a non-linear fashion, without computational overhead compared to existing methods. The resulting initial guess can effectively bootstrap the fine-grained optimization that is used to obtain the final solution. In addition, we perform an empirical analysis on the impact of different cost functions on the final estimate. Our experimental evaluation shows that the usage of HiPE leads to a more efficient and robust optimization process, comparing favorably with state-of-the-art methods

Visual Place Recognition using LiDAR Intensity Information

Robots and autonomous systems need to know where they are within a map to navigate effectively. Thus, simultaneous localization and mapping or SLAM is a common building block of robot navigation systems. When building a map via a SLAM system, robots need to re-recognize places to find loop closure and reduce the odometry drift. Image-based place recognition received a lot of attention in computer vision, and in this work, we investigate how such approaches can be used for 3D LiDAR data. Recent LiDAR sensors produce high-resolution 3D scans in combination with comparably stable intensity measurements. Through a cylindrical projection, we can turn this information into a 360° panoramic range image. As a result, we can apply techniques from visual place recognition to LiDAR intensity data. The question of how well this approach works in practice has only partially been investigated. This paper provides an analysis of how such visual techniques can be with LiDAR data, and we provide an evaluation on different datasets. Our results suggest that this form of place recognition is possible and an effective means for determining loop closures

Point prevalence survey on antibiotic use in a Croatian Infectious Disease Hospital

Antibiotic use is the driving force for increasing antibiotic resistance. A large proportion of antibiotics in hospitals are used inadequately. The objective of this study was to evaluate antibiotic use at the Hospital for Infectious Diseases through point-prevalence surveys conducted in 2006, 2008, and 2009. Point prevalence surveys were part of the European Surveillance on Antimicrobial Consumption (ESAC) Hospital Care Subproject and patients' data were collected following ESAC protocol. Additionally, the adequacy of antimicrobial therapy and administration of the first line antibiotic according to the local guidelines were assessed by an infectious disease doctor and a clinical microbiologist. In the study period among the 599 patients admitted to hospital, 352 (58·8%) received antibiotics. Out of 448 antimicrobial treatments, 313 (69·9%) were administered parenterally and 135 (30·1%) orally. Altogether in years 2006, 2008, and 2009 the most commonly prescribed antibiotics were ceftriaxone (19·9%), co-amoxiclav (15·4%), ciprofloxacin (12·3%), narrow spectrum penicillins (6·5%), and penicillinase resistant penicillins (5·6%). Most (82·6%) of the treated infections were community acquired infections. The predominating diagnoses were urinary tract infections and infections with no primary site defined, followed by skin, soft tissue and bone and joint infections. The overall adequacy of antimicrobial therapy was 82% and the first line antibiotic according to the local guidelines was administered with high frequency for central nervous system and cardiovascular infections (100%), and low for ear, nose, and throat infections, urinary tract infections, lower respiratory tract and bone and joint infections (23·0%, 51·6%, 52·5%, 65·0%, respectively) which indicates a significant overuse of antibiotics for diagnoses listed. The results of an individual point prevalence survey provided reliable and representative data for the hospital. Point-prevalence surveys proved to be a valuable method for detecting targets for antibiotic prescribing improvement and they clearly showed that our local hospital guidelines offered too many choices of antibiotic treatment for each clinical indication and needed revision