Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments : a simulation study based on routine data

Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: [email protected]: Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands. OBJECTIVES: Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries. METHODS: We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying effect estimates on antibiotic prescription from the trial; and (2) varying both usage (50%-100%) and compliance (70%-100%) with the Feverkidstool's advice to withhold antibiotics in children at low/intermediate risk for bacterial LRTI (≤10%). RESULTS: Of 4938 children, 4209 (85.2%) were at low/intermediate risk for bacterial LRTI. Applying effect estimates from the trial, the Feverkidstool reduced antibiotic prescription from 33.5% to 24.1% [pooled risk difference: 9.4% (95% CI: 5.7%-13.1%)]. Simulating 50%-100% usage with 90% compliance resulted in risk differences ranging from 8.3% to 15.8%. Our simulations suggest that antibiotic prescriptions would be reduced in EDs with high baseline antibiotic prescription rates or predominantly (>85%) low/intermediate-risk children. CONCLUSIONS: Implementation of the Feverkidstool could reduce antibiotic prescriptions in children with suspected LRTIs in European EDs.publishersversionPeer reviewe

The automatic control of the Eindhoven A.V.F. Cyclotron, I: Measuring equipment

For the automatic control of the Eindhoven A.V.F. cyclotron the HF phase angle, the intensity, the extraction efficiency and the horizontal position of the external beam before the magnetic channel are measured continuously and without interception of the beam. For this purpose the signals from capacitive pick?up probes are measured using sampling and correlating techniques. With this experimental set?up intensities of 20 nA are measured and phase variations of 0.1 degree and position variations of 0.1 mm for a beam intensity of 10 ?A have been detected. The horizontal and vertical dimensions of the beam in the beam transport system are measured by means of a number of vibrating beam scanners with an accuracy of 0.2 mm down to intensities of 10 nA. The relation between cyclotron parameters and beam properties is assumed to be linear for small variations and is represented by a matrix. Some of the matrix elements can vary slowly in time. They are measured continuously by pulsing the cyclotron parameters involved and correlating the beam response with the small perturbing pulses. All measured data will be supplied to a PDP-9 computor via a CAMAC modular data handling system

Do synergies exist in related acquisitions? - A meta-analysis of acquisition studies

Mergers and Acquisitions (M&A) aim to increase wealth for shareholders of the acquiring company, in particular by creating synergies. It is often assumed that relatedness is a source of synergies. Our study distinguishes between business, cultural, technological and size relatedness. It discusses the reasons why these different forms of relatedness can lead to an acquisition success and conducts a meta-analysis of 67 prior M&A studies. Results indicate that positive effects can be expected under specific conditions only and have a limited overall impact on acquisition success. A moderator analysis finds that synergies stemming from relatedness depend on industry-, country-, and investor-characteristics

Cultural Diversity, Strategic Alliance Configurations, and Ecological Innovations of MNEs

© 2020 Palgrave Macmillan. This is a post-peer-review, pre-copyedit version of a chapter published in a book “Non-market Strategies in International Business : How MNEs capture value through their political, social and environmental strategies”. The final authenticated version is available online at: http://dx.doi.org/10.1007/978-3-030-35074-1_10.fi=vertaisarvioitu|en=peerReviewed