Assessment of the results of clinical pharmacists’ interventions on the use of antibiotics at a medical center in Vietnam between 2021 and 2022

Context: The rational use of antibiotics is a priority when antibiotic resistance has become severe. Clinical pharmacists’ interventions can help increase the rate of rational antibiotic use. Aims: To determine the effect of clinical pharmacists’ interventions on the use of antibiotics and factors related to inappropriate antibiotic use in inpatients at the Department of Surgery, Gia Rai Town Medical Center, Vietnam. Methods: An interventional and cross-sectional descriptive study was conducted from January 1, 2021, to June 30, 2022, at the Department of Surgery, Gia Rai Town Medical Center, Vietnam. Results: There were 710 patients (355 patients in pre-intervention and 355 patients in post-intervention) included in this study. The group of antibiotics used the most was beta-lactam (pre- and post-intervention rates were 60.2% and 61.0%, respectively). The parenteral route was the most commonly used (63.9% in pre-intervention and 60.7% in post-intervention). The rationality of the indication increased after the intervention (from 85.7% to 96.2%); the rationality of the dose increased after the intervention (from 90.5% to 95.2%); the rationality of the number of times of use increased after the intervention (from 90.4% to 98.4%); the rationality of the time increased after the intervention (from 94.8% to 95.1%); the general rationality increased after the intervention (from 66.5% to 85.6%). Infections were associated with inappropriate antibiotic use (p<0.05). Conclusions: Effective clinical pharmacists’ interventions helped raise the rate of rational use of antibiotics. Besides, inappropriate antibiotic use was found to be associated with infections, emphasizing the need for targeted interventions in this field

The association of peri-operative scores, including frailty, with outcomes after unscheduled surgery

Summary Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long‐term survival. We recorded in‐hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre‐operative frailty with the 7‐point Clinical Frailty Scale: 81 patients were ‘not vulnerable’ (frailty score 1–3) and 83 were ‘vulnerable or frail’ (frailty score urn:x-wiley:00032409:media:anae14269:anae14269-math-0001 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. Within 30 postoperative days 8/164 (5%) patients died, all with frailty scores urn:x-wiley:00032409:media:anae14269:anae14269-math-0002 4, p = 0.007. Postoperative morbidity was less frequent in patients categorised as ‘not vulnerable’ on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6–18 [2–221]) days for patients with frailty scores 1–3, and 22 (12–33 [2–270]) days for patients with score urn:x-wiley:00032409:media:anae14269:anae14269-math-0003 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E‐POSSUM, 0.74 (0.60–0.92), p = 0.007; ASA 2, 0.35 (0.13–0.98), p = 0.046, ASA 3, 0.17 (0.06–0.47), p = 0.001 and ASA 4/5, 0.08 (0.02–0.28), p < 0.001; operative severity ‘major +’, 0.69 (0.41–1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81–74.40), p = 0.08

A Retrospective Analysis of the Haemodynamic and Metabolic Effects of Fluid Resuscitation in Vietnamese Adults with Severe Falciparum Malaria

BACKGROUND: Optimising the fluid resuscitation of patients with severe malaria is a simple and potentially cost-effective intervention. Current WHO guidelines recommend central venous pressure (CVP) guided, crystalloid based, resuscitation in adults. METHODS: Prospectively collected haemodynamic data from intervention trials in Vietnamese adults with severe malaria were analysed retrospectively to assess the responses to fluid resuscitation. RESULTS: 43 patients were studied of whom 24 received a fluid load. The fluid load resulted in an increase in cardiac index (mean increase: 0.75 L/min/m(2) (95% Confidence interval (CI): 0.41 to 1.1)), but no significant change in acid-base status post resuscitation (mean increase base deficit 0.6 mmol/L (95% CI: -0.1 to 1.3). The CVP and PAoP (pulmonary artery occlusion pressure) were highly inter-correlated (r(s) = 0.7, p<0.0001), but neither were correlated with acid-base status (arterial pH, serum bicarbonate, base deficit) or respiratory status (PaO(2)/FiO(2) ratio). There was no correlation between the oxygen delivery (DO(2)) and base deficit at the 63 time-points where they were assessed simultaneously (r(s) = -0.09, p = 0.46). CONCLUSIONS: In adults with severe falciparum malaria there was no observed improvement in patient outcomes or acid-base status with fluid loading. Neither CVP nor PAoP correlated with markers of end-organ perfusion or respiratory status, suggesting these measures are poor predictors of their fluid resuscitation needs

Histoire naturelle d'un syndrome d'intolérance acquise aux odeurs chimiques (à propos de l'éther diéthylique dans un service hospitalier)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude des facteurs expliquant la durée de séjour longue d'un groupe homogène de malades chirurgical dans un hôpital universitaire

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF