Quantitative Antibiotic Use in Hospitals: Comparison of Measurements, Literature Review, and Recommendations for a Standard of Reporting

Abstract : Background: : Reports on antibiotic use often lack complete definitions of the units of measurement, hampering the comparison of data between hospitals or hospital units. Patients and Methods: : To compare methods of measures of in-hospital antimicrobial use, we determined aggregate in-hospital consumption data at a tertiary care university hospital using variations of nominators and denominators. Means of defined daily doses (DDD) of individual antimicrobials per 100 bed-days and per 100 admissions at each hospital and intensive care unit (ICU) were calculated. Furthermore, a literature review was performed for benchmarking purposes. Results: : Antibiotic use in different hospital units ranged from 0.105 to 323.37 DDD/100 bed-days and from 4.23 to 6737.92 DDD/100 admissions, respectively. Including the day of discharge in the denominator ‘bed-days' underestimated antibiotic use in various hospital wards by up to 27.7 DDD/100 bed-days (26.0%). Equating ‘numbers of patients admitted to the hospital' and ‘numbers of admissions' on a hospital level resulted in a difference of 192.6 DDD/100 admissions (64%) because patients transferred between hospital units accounted for multiple admissions. Likewise, reporting antimicrobial (Anatomical Therapeutic Chemical [ATC] group ‘J') instead of antibiotic (ATC group ‘J01') use led to a difference of 16.5 DDD/100 bed-days (19.3%). The literature review revealed underreporting of complete definitions of antibiotic use measurements. Conclusions: : Data on in-hospital antimicrobial use vary widely not only due to different antibiotic policies at different institutions but also due to different methods of measures. Adherence to the standard of reporting the methods of measurement is warranted for benchmarking and promotion of rational antimicrobial us

Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

<p>Abstract</p> <p>Background</p> <p>Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components.</p> <p>Case presentation</p> <p>We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA.</p> <p>Conclusions</p> <p>Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.</p

Potts model on recursive lattices: some new exact results

We compute the partition function of the Potts model with arbitrary values of $q$ and temperature on some strip lattices. We consider strips of width $L_y=2$, for three different lattices: square, diced and `shortest-path' (to be defined in the text). We also get the exact solution for strips of the Kagome lattice for widths $L_y=2,3,4,5$. As further examples we consider two lattices with different type of regular symmetry: a strip with alternating layers of width $L_y=3$ and $L_y=m+2$, and a strip with variable width. Finally we make some remarks on the Fisher zeros for the Kagome lattice and their large q-limit.Comment: 17 pages, 19 figures. v2 typos corrected, title changed and references, acknowledgements and two further original examples added. v3 one further example added. v4 final versio

Folding transitions of the triangular lattice with defects

A recently introduced model describing the folding of the triangular lattice is generalized allowing for defects in the lattice and written as an Ising model with nearest-neighbor and plaquette interactions on the honeycomb lattice. Its phase diagram is determined in the hexagon approximation of the cluster variation method and the crossover from the pure Ising to the pure folding model is investigated, obtaining a quite rich structure with several multicritical points. Our results are in very good agreement with the available exact ones and extend a previous transfer matrix study.Comment: 16 pages, latex, 5 postscript figure

Quantitative antibiotic use in hospitals: Comparison of measurements, literature review, and recommendations for a standard of reporting

BACKGROUND: Reports on antibiotic use often lack complete definitions of the units of measurement, hampering the comparison of data between hospitals or hospital units. METHODS: To compare methods of measures of in-hospital antimicrobial use, we determined aggregate in-hospital consumption data at a tertiary care university hospital using variations of nominators and denominators. Means of defined daily doses (DDD) of individual antimicrobials per 100 bed-days and per 100 admissions at each hospital and intensive care unit (ICU) were calculated. Furthermore, a literature review was performed for benchmarking purposes. RESULTS: Antibiotic use in different hospital units ranged from 0.105 to 323.37 DDD/100 bed-days and from 4.23 to 6737.92 DDD/100 admissions, respectively. Including the day of discharge in the denominator 'bed-days' underestimated antibiotic use in various hospital wards by up to 27.7 DDD/100 bed-days (26.0%). Equating 'numbers of patients admitted to the hospital' and 'numbers of admissions' on a hospital level resulted in a difference of 192.6 DDD/100 admissions (64%) because patients transferred between hospital units accounted for multiple admissions. Likewise, reporting antimicrobial (Anatomical Therapeutic Chemical [ATC] group 'J') instead of antibiotic (ATC group 'J01') use led to a difference of 16.5 DDD/100 bed-days (19.3%). The literature review revealed underreporting of complete definitions of antibiotic use measurements. CONCLUSIONS: Data on in-hospital antimicrobial use vary widely not only due to different antibiotic policies at different institutions but also due to different methods of measures. Adherence to the standard of reporting the methods of measurement is warranted for benchmarking and promotion of rational antimicrobial use

Biodiversity of Andean grains: balancing market potential and sustainable livelihoods

The publication aims at shedding light on the use, nutritional properties, market potential and contribution to local livelihoods of Andean grains (quinoa, cañahua and amaranth). It addresses some of the research gaps regarding knowledge of the use, as well as the market and non-market value of these crops and their associated traditional knowledge, taking into account local livelihood assets of people living in difficult environments. It also investigates what effects the change from subsistence to market production has on farming communities and their environment. It is hoped that this book, which focuses in particular on quinoa in Southern Bolivia, will be helpful in providing food for thought in the occasion of the UN 2013 International Year of Quinoa, and serve at the same time as guidance for the future promotion of other currently underutilized crops

Homogenized dynamics of stochastic partial differential equations with dynamical boundary conditions

A microscopic heterogeneous system under random influence is considered. The randomness enters the system at physical boundary of small scale obstacles as well as at the interior of the physical medium. This system is modeled by a stochastic partial differential equation defined on a domain perforated with small holes (obstacles or heterogeneities), together with random dynamical boundary conditions on the boundaries of these small holes. A homogenized macroscopic model for this microscopic heterogeneous stochastic system is derived. This homogenized effective model is a new stochastic partial differential equation defined on a unified domain without small holes, with static boundary condition only. In fact, the random dynamical boundary conditions are homogenized out, but the impact of random forces on the small holes' boundaries is quantified as an extra stochastic term in the homogenized stochastic partial differential equation. Moreover, the validity of the homogenized model is justified by showing that the solutions of the microscopic model converge to those of the effective macroscopic model in probability distribution, as the size of small holes diminishes to zero.Comment: Communications in Mathematical Physics, to appear, 200

Structure and properties of small sodium clusters

We have investigated structure and properties of small metal clusters using all-electron ab initio theoretical methods based on the Hartree-Fock approximation and density functional theory, perturbation theory and compared results of our calculations with the available experimental data and the results of other theoretical works. We have systematically calculated the optimized geometries of neutral and singly charged sodium clusters having up to 20 atoms, their multipole moments (dipole and quadrupole), static polarizabilities, binding energies per atom, ionization potentials and frequencies of normal vibration modes. Our calculations demonstrate the great role of many-electron correlations in the formation of electronic and ionic structure of small metal clusters and form a good basis for further detailed study of their dynamic properties, as well as structure and properties of other atomic cluster systems.Comment: 47 pages, 16 figure