Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study.

BACKGROUND: Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. METHODS: This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0-60, 61-120, 121-180, 181-240, 241-360, and 361-1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with "hospital" as the grouping variable. RESULTS: Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55-189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48-164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39-180 min)] and longest in patients transferred from wards [120 min (62-226)]. Overall crude mortality was 23.4%, where patients in the 0-60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3-34.1%)], whereas those in the 61-120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5-26.6%)]. Differences in mortality were noted only between the 0-60 min and 61-120 min groups. CONCLUSIONS: We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis

Personality Traits of an Entrepreneur, Determinants of Successful Microenterprise in Ireland

Why do certain individuals become entrepreneur and are successful, whereas others do not? The researchers in the entrepreneurship field attempt to answer that question by studying the personality traits of entrepreneurs for decades. Many confirm that the personality traits have a positive correlation with entrepreneurial intention and performance. Various studies suggest that the main entrepreneurial characteristics are risk attitudes, need for achievement, internal locus of control, innovativeness, and self-efficacy. However, debate exist if the personality traits are born or inherited and if the entrepreneurs’ actions are influenced by factors such as family, culture, education and market conditions. Although these aspects will be reviewed the focus of this study is on entrepreneurs’ personality traits only. Consequently, the aim of this study is to identify which of the personality traits, and whether there are traits, that are associated with operating successful microenterprise, from a perspective of an owner-manager of an established business in Ireland. The findings of this research revealed that the participants perceive themselves as individuals who possess indirectly four out of five most cited traits in the literature, which are need for achievement, locus of control, innovativeness and self-efficacy. In addition, they mentioned ability to relate to others, being organized and perform a quality work as the most important characteristics of a successful business owner. Also, other factors of environment influenced the participants’ decision to become an entrepreneur and Ireland was perceived as an attractive country to set up a business. Still, most of the participants do not perceive themselves as a successful entrepreneur. In summary, the inconclusiveness of this study generate more questions than it provide answers, coupled with this study limitations it is suggested that additional and more extensive research is desired

Postintensive care syndrome family: A comprehensive review.

Publication status: PublishedFamilies of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F

Supplemental Material, Suppl_1 - Sepsis-Induced Coagulopathy and Japanese Association for Acute Medicine DIC in Coagulopathic Patients with Decreased Antithrombin and Treated by Antithrombin

<p>Supplemental Material, Suppl_1 for Sepsis-Induced Coagulopathy and Japanese Association for Acute Medicine DIC in Coagulopathic Patients with Decreased Antithrombin and Treated by Antithrombin by Toshiaki Iba, Makoto Arakawa, Jerrold H. Levy, Kazuma Yamakawa, Hiroyuki Koami, Toru Hifumi, and Koichi Sato in Clinical and Applied Thrombosis/Hemostasis</p