a prospective ‘before/after’ cohort study

Objectives Antibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long- term effects after implementation of a CDSS. Design This prospective ‘before/after’ cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation. Setting Five anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital. Participants Adult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12 965 ICU days. Intervention Implementation of a CDSS. Outcome measures The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence. Main results Adherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31). Conclusions Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality

Effects of monosodium-L-glutamate administration on serum levels of reproductive hormones and cholesterol, epididymal sperm reserves and testicular histomorphology of male albino rats

This study investigated the effects of administration of monosodium L-glutamate (MSG) on serum gonadotrophin-releasing hormone (GnRH), luteinising hormone (LH), testosterone and total cholesterol (TC), cauda epididymal sperm reserves (CESR) and testicular histomorphology of adult male albino rats. Eighty-four rats, randomly assigned to 7 groups of 12 rats each, were used for the study. Varying low doses (0.25, 0.50 or 1.00 g/kg body weight) of MSG were administered orally or subcutaneously at 48-h intervals for six weeks. Serum GnRH, LH, testosterone and TC, and CESR were evaluated on days 14, 28 and 42 of MSG administration. Testicular histomorphology was evaluated on day 42. The results showed that the mean serum GnRH, LH and testosterone levels, and the CESR of all the treated groups were significantly (P < 0.05) lower than those of the untreated control on days 14, 28 and 42 of MSG administration. The mean serum TC levels of all the treated groups were also significantly (P < 0.05) lower than those of the control group on days 14 and 28. No lesions were observed on sections of the testes. It was concluded that MSG administration for 14, 28 and 42 days led to significantly lower serum levels of GnRH, LH, testosterone and TC, and significantly lower CESR

Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application

Summary: Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included. Out of 675 patients screened, 125 received vancomycin therapy, 39% with intermittent and 61% with continuous administration. Patients with continuous administration achieved target serum levels significantly earlier (median day 3 versus 4, p = 0.022) and showed fewer sub-therapeutic serum levels (41% versus 11%, p < 0.001). ICU mortality rate, duration of ICU stay and duration of ventilation did not differ between groups. Acute renal failure during the ICU stay occurred in 35% of patients with intermittent infusion versus 26% of patients with continuous application (p = 0.324). In conclusion, continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed. This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration. Keywords: Vancomycin, Intensive care unit, Infection, Therapeutic drug monitorin

TRIUMF brown reports TRI-68-3

A study has been conducted for the purpose of developing a design for the TRIUMF main magnet coils which was to result in a minimum capital investment when the costs of the coils and the power supply were added together. Two basic designs were considered, one being the more conventional design employing extruded square hollow conductor, the other making use of rectangular conductor bars. The conventional design was found to be unsuitable for the TRIUMF coils due to lack of space for the large number of water circuits that would be needed in order to prevent excessive temperature rise and destructive shear forces to develop within the coil. In addition, the coils would have to be wound at the site due to their large size, making the fabrication work unduly expensive. The rectangular bar design permits the coils to be divided into segments, thus making it feasible to do the manufacturing work in a coil manufacturer’s plant. Minimum capital investment is achieved if the coils are made in 120-degree segments using extruded aluminum as conductor material. Sixty-degree segments are more expensive than 120-degree segments but offer certain advantages which are not found in the 60-degree segment version. Thus, the magnetic field irregularities produced in the segment junction areas occur in six places, which is preferable to having the field distortion in only three places. The 60-degree segments also provide a desirable flexibility between all magnet sectors permitting individual height adjustment of the magnets. The cost of power supplies with various output characteristics has been estimated. Two preliminary cost estimates were received from two power supply manufacturers. These estimates were based on a power supply with an output current of 16,000 amperes and an output power of 2 megawatts. As a result of the findings, it has been recommended that extruded bar aluminum conductor be employed in the fabrication of the coils and that 60-degree segments be used. The conductors should be insulated from each other and from ground by means of glass-epoxy laminates. It is also proposed that the insulation be reinforced by expoxy potting of the coil segments. The epoxy should be formulated to give maximum radiation resistance, and alumina grains should be used to further enhance this property. Bolted flexible copper connectors have been recommended for use between coil segments. The recommended coil design is shown on various figures and drawings included in the report along with graphs demonstrating power demands, capital investment costs and operating costs for different conductor materials and different number of coil turns. On title page: WMB&A-179-1R1TRIUMFUnreviewedResearche