EVALUATION OF THE APPROPRIATENESS OF INTRAVENOUS AMOXICILLIN/CLAVULANATE PRESCRIPTION IN A TEACHING HOSPITAL

ABSTRACT Background: Despite the implementation of strategies aiming at improving antimicrobial utilisation, inappropriate use remains an increasing problem with important consequences on both antibiotic resistance and hospital costs. Objective: To evaluate the appropriateness of prescribing the intravenous amoxicillin/clavulanate combination (Augmenti

Hyperbolicity preserving HLL solver for two-layer shallow-water equations applied to dam-break flows

River morphodynamics and sediment transportDebris and hyperconcentrated flow

METHODS

Temocillin (6-�-methoxy ticarcillin) is well known for its resistance to degradation by �-lactamases including most ESBL. 1,2 It is therefor

Geriatric pharmacotherapy : optimisation through integrated approach in the hospital setting

Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists offour steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient’s drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses

DIE WRACKS DER KRIEGSSCHIFFE AUS ZWEI WELTKRIEGEN AUF DEM MEERESGRUND VOR PAG

Na Jadranu su se tijekom dva svjetska rata odigrali brojni sukobi, te se stoga, posebice u Kvarneriću, na morskom dnu nalaze brojne olupine, od kojih su neke tek nedavno otkrivene i posjećene. Ova radnja prikazuje povijest dva torpedna napada talijanskih podmornica na austrougarske trgovačke brodove tijekom Prvoga svjetskog rata, uništenje jedne njemačke bojevne skupine u sukobu s britanskim razaračima u jesen 1944. godine, te gubitak jednog britanskog razarača nakon što je naišao na minu kod Paga. Na osnovi roniteljskih izvještaja i povijesnih podataka u dostupnoj literaturi bilo je moguće rekonstruirati zbivanja i utvrditi točan identitet olupina.An der Adria gab es in beiden Weltkriegen zahlreiche Gefechte, als Folge gibt es, vor allem in Kvarneric, mehrere Schiffswracks, die erst neulich entdeckt und besucht wurden. Diese Arbeit zeigt die Geschichte zweier Torpedierungen von österreichisch-ungarischen Handelsschiffen durch italienische Unterseeboote im I. Weltkrieg, die Vernichtung einer ganzen deutschen Kampfgruppe im Gefecht gegen britische Zerstörer im Herbst 1944, sowie den Verlust eines britischen Zerstörers nach dem Minentreffer vor Pag. Anhand von Taucherberichten und der Suche nach der Geschichte dieser Schiffe in der verfügbaren Literatur konnte man diese Ereignisse rekonstruieren und die Wracks eindeutig identifizieren

An International Consensus List of Potentially Clinically Significant Drug-Drug Interactions in Older People.

Objectives We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. Design A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. Setting and Participants Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. Measures For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. Results Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. Conclusion and Implications We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies.pre-print896 K

LABORATORY EXPERIMENTS OF PULSED SUBAQEOUS SEDIMENT DENSITY FLOWS: INTERNAL STRATIFICATION AND LAYERING

This paper reports on an experimental study which focuses on reproducing small scale sediment density flows in a laboratory flume. The observations are aimed at improving the parametrization of the relations that govern the transition between different phases of the flows. Dense mixtures of plastic sediment of variable grain size (thermoplastic polyurethane) and water were fed into the water-filled flume by gravity from a supply tank. Different grain-size and slope combinations were examined and the resulting velocity fields were obtained using UVP (Ultrasonic Velocity Profile) at various points along the channel. The flow was imaged through the transparent sidewall to track the velocity of the flow head for each test case. Image analysis also allowed a qualitative characterization of the vertical density stratification and water entrainment during runout. The runout distance and flow thickness are used to highlight the differences in the dynamic behavior of the flow for each test case. Data gathered from the experiments will be exploited in the further development of predictive numerical models for slide-induced debris flows transitioning to turbidity currents

Association between diabetes overtreatment in older multimorbid patients and clinical outcomes: an ancillary European multicentre study.

BACKGROUND Diabetes overtreatment is a frequent and severe issue in multimorbid older patients with type 2 diabetes (T2D). OBJECTIVE This study aimed at assessing the association between diabetes overtreatment and 1-year functional decline, hospitalisation and mortality in older inpatients with multimorbidity and polypharmacy. METHODS Ancillary study of the European multicentre OPERAM project on multimorbid patients aged ≥70 years with T2D and glucose-lowering treatment (GLT). Diabetes overtreatment was defined according to the 2019 Endocrine Society guideline using HbA1c target range individualised according to the patient's overall health status and the use of GLT with a high risk of hypoglycaemia. Multivariable regressions were used to assess the association between diabetes overtreatment and the three outcomes. RESULTS Among the 490 patients with T2D on GLT (median age: 78 years; 38% female), 168 (34.3%) had diabetes overtreatment. In patients with diabetes overtreatment as compared with those not overtreated, there was no difference in functional decline (29.3% vs 38.0%, P = 0.088) nor hospitalisation rates (107.3 vs 125.8/100 p-y, P = 0.115) but there was a higher mortality rate (32.8 vs 21.4/100 p-y, P = 0.033). In multivariable analyses, diabetes overtreatment was not associated with functional decline nor hospitalisation (hazard ratio, HR [95%CI]: 0.80 [0.63; 1.02]) but was associated with a higher mortality rate (HR [95%CI]: 1.64 [1.06; 2.52]). CONCLUSIONS Diabetes overtreatment was associated with a higher mortality rate but not with hospitalisation or functional decline. Interventional studies should be undertaken to test the effect of de-intensifying GLT on clinical outcomes in overtreated patients