Outpatient antibiotic prescription trends in the United States: A national cohort study

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589</jats:sec

Agronomic potential of “Dodzi”, an extra early-maturing maize cultivar

Production of short-cycle crop varieties reduces the risk of crop loss due to terminal droughts and ensures early harvest to fill the hunger gap. Two experiments were used to determine the yield potentials of elite extra-early (75- 80 days) maturing maize (Zea mays L.) varieties to recommend the best extra-early variety for commercial productionand use in Ghana. In the first experiment, two extra-early and eight early (90-95 days) maize varieties were evaluated in replicated field trials at 10 research stations in 1995 and 1996. In the second experiment, thetwo extra-early varieties, one recommended early variety, and the farmers’ check variety were evaluated at 38 and 28 farm sites in 1995 and 1996, respectively. Mean grain yields across the 10 on-station sites in 2 years were 3.5, 4.1, 4.6, and 3.4 t ha-1 for NAES EE W-SR (extraearly), NAES Pool 16 DT (extra-early), Dorke SR (early), and the farmers’ check variety, respectively. Mean yields of the four varieties across 66 farm sites in both years were 3.2, 3.4, 3.4, and 3.6 t ha-1, respectively. NAES EE W-SR was the earliest of all the varieties tested and the farmers’ variety was latest. Food preference tests showed that NAES EE W-SR was comparable to the farmers’ check variety in suitability for local dish preparations. The National Variety Release Committee subsequently approved and released NAES EE W-SR under the local name “Dodzi”. “Dodzi” is recommended for early planting and harvesting throughout Ghana

Does rebound tonometry probe misalignment modify intraocular pressure measurements in human eyes?

Purpose. To examine the influence of positional misalignments on intraocular pressure (IOP) measurement with a rebound tonometer. Methods. Using the iCare rebound tonometer, IOP readings were taken from the right eye of 36 healthy subjects at the central corneal apex (CC) and compared to IOP measures using the Goldmann applanation tonometer (GAT). Using a bespoke rig, iCare IOP readings were also taken 2 mm laterally from CC, both nasally and temporally, along with angular deviations of 5 and 10 degrees, both nasally and temporally to the visual axis. Results. Mean IOP ± SD, as measured by GAT, was 14.7±2.5 mmHg versus iCare tonometer readings of 17.4±3.6 mmHg at CC, representing an iCare IOP overestimation of 2.7±2.8 mmHg (P<0.001), which increased at higher average IOPs. IOP at CC using the iCare tonometer was not significantly different to values at lateral displacements. IOP was marginally underestimated with angular deviation of the probe but only reaching significance at 10 degrees nasally. Conclusions. As shown previously, the iCare tonometer overestimates IOP compared to GAT. However, IOP measurement in normal, healthy subjects using the iCare rebound tonometer appears insensitive to misalignments. An IOP underestimation of <1 mmHg with the probe deviated 10 degrees nasally reached statistical but not clinical significance levels. © 2013 Ian G. Beasley et al

Agronomic potentials of quality protein maize hybrids developed in Ghana

A quality protein maize (QPM) hybrid programme was started in 1991 to develop and promote high and stableyielding QPM hybrids to increase production of nutritionally superior maize varieties in Ghana. Six 3- way QPM hybrids developed from inbred lines originating from germplasm of the International Centre for Maize and Wheat Improvement (CIMMYT) were evaluated on research stations and in farmers\' fields in Ghana from 1995 to 1996. In the on-station evaluations, grain yields across 10 sites in both years averaged 6.0 ton ha-1 for the three hybrids (GH132-28, GH110-5 and GH2328-88), 5.22 ton ha-1 for Obatanpa, and 3.60 ton ha-1 for the local maize variety. In farmers\' fields, data from over 50 farm sites in 1995 and 1996 showed mean yields of 4.95 ton ha-1 for the three hybrids, and 4.28 ton ha-1 for Obatanpa compared to 3.59 ton ha-1 for farmers\' varieties. On the average, the hybrids were similar to Obatanpa in days to 50 per cent silking, but were shorter in plant height and ear placement. Consumer preference tests showed that the three hybrids were rated similar to the local variety in popular traditional food preparations such as ‘kenkey\' and ‘tuo zafi\'. In 1997, the National Variety Release Committee approved the release of GH132-28, GH110-5, and GH2328-88 under the local names Dadaba, Mamaba, and CIDA-ba, respectively. These hybrids are recommended for planting in all the major agro-ecologies to boost maize production in Ghana.Les variétés de maïs hybride (Zea mays L.) dont les plus sésirées que les variétés de pollinisation libre à cause de leur uniformté et leurs potentiels de rendement plus élevés. Pour augmenter la production de variétés de maïs nutritionnellement supérieures au Ghana, I\'Institut de Recherche de Cultures a mis en place un programme hybrid de maïs protéique de qualité (MPQ) en 1991 pour développer et promouvoir des hybrides de MPQ de rendement élevés et stable. Six hybrids en trois de MPQ développés d\'issu de la même souch provenant de germeplasmes de CIMMYT (Centre International pour I\'amélioration de maïs et de blé) étaient évalués aux stations de recherches et aux champs d\'agriculteurs au Ghana de 1995 à 1996. Dans les évaluations sur place, les rendements de grain à travers 10 sites dans les deux années ont atteint la moyenne de 6.0 ton ha-1 pour les trois hybrids (GH132-28, GH110-5 et GH2328-88), 5.22 ton ha-1 pour \'Obatanpa\' et 3.60 ton ha-1 pour la variétés de maïs local. Sur les champs d\'agriculteurs des données de plus que 50 sites de champs en 1995 et 1996 montraient les rendements moyens de 4.95 ton ha-1 pour les trois hybrids et 4.28 ton ha-1 pour les \'Obatanpa\' comparées à 3.59 ton ha-1 pour les variétés d\'agriculteurs. En moyenne, les hybrides étaient semblables à \'Obatanpa\' en jours jusqu à 50% d\'apparition de soie maïs étaient plus courtes en taille de plante et en placement d\'épi. Les essais de préférence de consommateur montraient que les trios hybrides étaient évalués semblables à la variété locale dans les préparations de nouriture traditionnelle populaire telle que \'kenkey\' et \'tuo zafi\'. En 1997, le comité pour la mise en vente de Variété Nationale a approuvé la mise en vente de GH132-28, GH110-5 et GH2328-88 sous les noms locaux respectifs de Dadaba, Mamaba, et CIDA-ba. Ce hybrides sont recommandés pour la popultion dans toutes les agroéclogies majeures pour stimuler la production de maïs au Ghana. Ghana Journal of Agricultural Science Vol. 40 (1) 2007: pp. 81-8

Cancer and thrombosis: Managing the risks and approaches to thromboprophylaxis

Patients with cancer are at increased risk of venous thromboembolism (VTE) compared with patients without cancer. This results from both the prothrombotic effects of the cancer itself and iatrogenic factors, such as chemotherapy, radiotherapy, indwelling central venous devices and surgery, that further increase the risk of VTE. Although cancer-associated thrombosis remains an important cause of morbidity and mortality, it is often underdiagnosed and undertreated. However, evidence is accumulating to support the use of low-molecular-weight heparins (LMWHs) in the secondary prevention of VTE in patients with cancer. Not only have LMWHs been shown to be at least as effective as coumarin derivatives in this setting, but they have a lower incidence of complications, including bleeding, and are not associated with the practical problems of warfarin therapy. Furthermore, a growing number of studies indicate that LMWHs may improve survival among patients with cancer due to a possible antitumor effect. Current evidence suggests that LMWHs should increasingly be considered for the long-term management of VTE in patients with cancer

Distinct genetic architectures and environmental factors associate with host response to the γ2-herpesvirus infections

Kaposi’s sarcoma-associated herpesvirus (KSHV) and Epstein-Barr Virus (EBV) establish life-long infections and are associated with malignancies. Striking geographic variation in incidence and the fact that virus alone is insufficient to cause disease, suggests other co-factors are involved. Here we present epidemiological analysis and genome-wide association study (GWAS) in 4365 individuals from an African population cohort, to assess the influence of host genetic and non-genetic factors on virus antibody responses. EBV/KSHV co-infection (OR = 5.71(1.58–7.12)), HIV positivity (OR = 2.22(1.32–3.73)) and living in a more rural area (OR = 1.38(1.01–1.89)) are strongly associated with immunogenicity. GWAS reveals associations with KSHV antibody response in the HLA-B/C region (p = 6.64 × 10−09). For EBV, associations are identified for VCA (rs71542439, p = 1.15 × 10−12). Human leucocyte antigen (HLA) and trans-ancestry fine-mapping substantiate that distinct variants in HLA-DQA1 (p = 5.24 × 10−44) are driving associations for EBNA-1 in Africa. This study highlights complex interactions between KSHV and EBV, in addition to distinct genetic architectures resulting in important differences in pathogenesis and transmission

Failure of recombinant factor VIIa in a patient with severe polymicrobial sepsis and postoperative uncontrolled intraabdominal bleeding

<p>Abstract</p> <p>Background</p> <p>This report discusses a case of unsuccessful treatment with recombinant factor VIIa (rFVIIa) in off-label use. The need for international guidelines concerning the off-label use of rFVIIa is outlined as well as the need for methods to control the efficacy of rFVIIa objectively.</p> <p>Case presentation</p> <p>54 year old male with severe polymicrobial sepsis due to a perforated diverticulitis of the sigmoid colon and consecutive overt disseminated intravascular coagulation. He suffered severe intraabdominal bleeding after abdominal surgery despite conventional haemostatic support. Repeated applications of factor VIIa temporarily improved coagulation essays but did not stop clinical bleeding. The patient died in multiorgan failure due to septic and haemorrhagic shock.</p> <p>Conclusion</p> <p>Off-label use of rFVIIa could result in more side effects than could be expected from literature because of a publication bias. However for most off-label applications large prospective, randomised and controlled trials to confirm the positive findings are missing. For the future, not only guidelines concerning the off-label use of rFVIIa are urgently needed but also guidelines for monitoring the efficacy of rFVIIa.</p

The health care setting rather than medical speciality impacts on physicians adherence to guideline-conform anticoagulation in outpatients with non-valvular atrial fibrillation: a cross sectional survey

BACKGROUND: In patients with non-valvular atrial fibrillation (NVAF) at high risk for stroke guidelines consistently recommend long-term oral anticoagulation (OAC) with a vitamin K antagonist. However recommendations remain ambiguous in respect to the precise OAC initiation regimens. Based on the clinical observation, that the initiation of OAC for NVAF varies considerably in daily practice, we aimed to assess the current practice in Switzerland. METHODS: Cross-sectional survey of randomly selected general practitioners, internists and cardiologists from different health care settings in an urban Swiss region that covers 1.4 million inhabitants. The main outcome measures were the preferred antithrombotic initiation regimen and long-term treatment in patients with newly diagnosed NVAF at high risk for stroke. RESULTS: We received 226 out of 388 (58.2%) surveys. Compared to physicians working in a hospital setting (33.6% of respondents) physicians in ambulatory care reported more years of experience and claimed lower-use (never or seldom) of guidelines in general (47.6 vs. 12.2%). Regarding long-term thromboembolic prophylaxis 93.7% of all responders followed current recommendation by choosing an OAC. When focussing on guideline-consistent correct OAC initiation (either low-dose initial OAC or a combination of LMWH and OAC) adherence dropped to 60.6% with hospital physicians demonstrating a significantly higher use of guideline-conform OAC regimens (79.7 vs. 51.0%). Medical speciality in non-hospital physicians was not related to correct guideline-use. Hospital setting remained independently associated with a guideline-conform OAC initiation regimen (OR 2.8, p = 0.023) when controlled for medical speciality, physicians' characteristics and clinical experience. Problems when starting an anticoagulation treatment were seldom reported (never or seldom accounting for 94.1% of all responses). CONCLUSIONS: The guideline adherence with respect to OAC initiation regimens in NVAF was significantly lower when compared to long-term treatment and health care setting rather than medical speciality explained guideline-conform OAC initiation. The majority of the physicians did not consider the initiation of anticoagulation to be a major obstacle in outpatient care

Increased risk of venous thromboembolism in patients with acute leukaemia

Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML