Совершенствование механизмов формирования доходов бюджета АРК

Целью нашей работы является исследование механизмов формирования доходов бюджета Автономной Республики Крым и разработка мероприятий по их совершенствованию

Multicentre study found that adherence to national antibiotic recommendations for neonatal early-onset sepsis was low

Aim: Our aim was to evaluate adherence to the Dutch neonatal early-onset sepsis (EOS) guidelines, adapted from UK guidance. We also looked at the effect on antibiotic recommendations and duration. Method: This was a multicentre, prospective observational cross-sectional study carried out in seven hospitals in the Netherlands between 1 September 2018 and 1 November 2019. We enrolled 1024 neonates born at 32 weeks of gestation or later if they demonstrated at least one EOS risk factor or clinical signs of infection. Results: The Dutch guidelines recommended antibiotic treatment for 438/1024 (42.8%) of the neonates designated at risk, but only 186/438 (42.5%) received antibiotics. The guidelines advised withholding antibiotics for 586/1024 (57.2%) of neonates and in 570/586 (97.3%) cases the clinicians adhered to this recommendation. Blood cultures were obtained for 182/186 (97.8%) infants who started antibiotics and only four were positive, for group B streptococci. Antibiotic treatment was continued for more than 3 days in 56/178 (31.5%) neonates, despite a negative blood culture. Conclusion: Low adherence to the Dutch guidelines meant that the majority of neonates did not receive the antibiotic treatment that was recommended, while some antibiotic use was prolonged despite negative blood cultures. The guidelines need to be revised

Multi-centre study found that strict adherence to guidelines led to computed tomography scans being overused in children with minor head injuries

Aim: Our primary aim was to calculate the head computed tomography (CT) scan rate in children with a minor head injury (MHI) when the Dutch National guidelines were followed in clinical practice. The secondary aim was to determine the incidence of CT abnormalities and the guideline predictors associated with traumatic abnormalities. Methods: We performed a multi-centre, prospective observational cross-sectional study in the emergency departments of six hospitals in The Netherlands between 1 April 2015 and 31 December 2016. Results: Data on 1002 patients were studied and 69% of cases complied with the guidelines. The overall CT rate was 44% and the incidence of traumatic abnormal CT findings was 13%. CT scans were performed in 19% of children under two years of age, 48% of children between two and five years and 63% of children aged six years or more. Multivariate regression analysis for all age categories showed that CT abnormalities were predicted by a Glasgow Coma Scale of less than 15, suspicion of a basal skull fracture, vomiting and scalp haematomas or external lesions of the skull. Conclusion: Strict adherence to the Dutch national guidelines resulted in CT overuse. New guidelines are needed to safely reduce CT scan indications

The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded

textabstractFour clinical decision rules (CDRs) (Wells score, Revised Geneva Score(RGS), simplified Wells score and simplified RGS) safely exclude pulmonaryembolism (PE), when combined with a normal D-dimer test. Recently,an age-adjusted cut-off of the D-dimer (patient's age x 10 μg/l)safely increased the number of patients above 50 years in whom PEcould safely be excluded. We validated the age-adjusted D-dimer testand assessed its performance in combination with the four CDRs in patientswith suspected PE. A total of 414 consecutive patients with suspectedPE who were older than 50 years were included. The proportionof patients in whom PE could be excluded with an 'unlikely' clinicalprobability combined with a normal age-adjusted D-dimer test was calculatedand compared with the proportion using the conventionalD-dimer cut-off. We assessed venous thromboembolism (VTE) failurerates during three months follow-up. In patients above 50 years, a normalage-adjusted D-dimer level in combination with an 'unlikely' CDRsubstantially increased the number of patients in whom PE could besafely excluded: from 13-14% to 19-22% in all CDRs similarly. In patientsover 70 years, the number of exclusions was nearly four-foldhigher, and the original Wells score excluded most patients, with an increasefrom 6% to 21% combined with the conventional and age-adjustedD-dimer cut-off, respectively. The number of VTE failures was alsocomparable in all CDRs. In conclusion, irrespective of which CDR isused, the age-adjusted D-dimer substantially increases the number of patients above 50 years in whom PE can be safely excluded