135 research outputs found

    Cefepime/tazobactam compared with other tazobactam combinations against problem Gram-negative bacteria

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    Objectives: Piperacillin/tazobactam has long been a broad-spectrum ‚Äėworkhorse‚Äô antibiotic; however, it is compromised by resistance. One response is to re-partner tazobactam with cefepime, which is easier to protect, being less ő≤-lactamase labile, and to use a high-dose and prolonged infusion. On this basis, Wockhardt are developing cefepime/tazobactam (WCK 4282) as a 2+2 g q8h combination with a 90-min infusion.¬† Methods: The activity of cc cefepime/tazobactam was assessed, with other tazobactam combinations as comparators, against 1632 Enterobacterales, 745 Pseudomonas aeruginosa and 450 other non-fermenters, as submitted to the UK National Reference Laboratory. These were categorised by carbapenemase-gene detection and interpretive reading of phenotypes, with MICs determined by British Society for Antimicrobial Chemotherapy agar dilution.¬† Results: Although higher breakpoints may be justifiable, based on the pharmacodynamics, the results were reviewed against current cefepime criteria. On this basis, cefepime/tazobactam was broadly active against Enterobacterales with AmpC enzymes and extended-spectrum ő≤-lactamases (ESBLs), even when they had ertapenem resistance, suggesting porin loss. At 8+8 mg/L, activity extended to > 90% of Enterobacterales with OXA-48 and KPC carbapenemases, although the MICs for KPC producers belonging to the international Klebsiella pneumoniae ST258 lineage were higher; metallo-ő≤-lactamase producers remained resistant. Cefepime/tazobactam was less active than ceftolozane/tazobactam against Pseudomonas aeruginosa with AmpC de-repression or high-level efflux but achieved wider antipseudomonal coverage than piperacillin/tazobactam. Activity against other non-fermenters was species-specific.¬† Conclusion: Overall, cefepime/tazobactam had a spectrum exceeding those of piperacillin/tazobactam and ceftolozane/tazobactam and resembling or exceeding that of carbapenems. Used as a ‚Äėnew-combination of old-agents‚Äô it has genuine potential to be ‚Äėcarbapenem-sparing‚Äô

    A novel method for detecting extra-home range movements (EHRMs) by animals and recommendations for future EHRM studies.

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    Infrequent, long-distance animal movements outside of typical home range areas provide useful insights into resource acquisition, gene flow, and disease transmission within the fields of conservation and wildlife management, yet understanding of these movements is still limited across taxa. To detect these extra-home range movements (EHRMs) in spatial relocation datasets, most previous studies compare relocation points against fixed spatial and temporal bounds, typified by seasonal home ranges (referred to here as the "Fixed-Period" method). However, utilizing home ranges modelled over fixed time periods to detect EHRMs within those periods likely results in many EHRMs going undocumented, particularly when an animal's space use changes within that period of time. To address this, we propose a novel, "Moving-Window" method of detecting EHRMs through an iterative process, comparing each day's relocation data to the preceding period of space use only. We compared the number and characteristics of EHRM detections by both the Moving-Window and Fixed-Period methods using GPS relocations from 33 white-tailed deer (Odocoileus virginianus) in Alabama, USA. The Moving-Window method detected 1.5 times as many EHRMs as the Fixed-Period method and identified 120 unique movements that were undetected by the Fixed-Period method, including some movements that extended nearly 5 km outside of home range boundaries. Additionally, we utilized our EHRM dataset to highlight and evaluate potential sources of variation in EHRM summary statistics stemming from differences in definition criteria among previous EHRM literature. We found that this spectrum of criteria identified between 15.6% and 100.0% of the EHRMs within our dataset. We conclude that variability in terminology and definition criteria previously used for EHRM detection hinders useful comparisons between studies. The Moving-Window approach to EHRM detection introduced here, along with proposed methodology guidelines for future EHRM studies, should allow researchers to better investigate and understand these behaviors across a variety of taxa

    Framtidens sjuksköterskor : En kvantitativ studie om vad sjuksköterskestudenter värderar som viktigt hos framtida arbetsgivare

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    The Swedish labour market is facing major challenges with regard to supply of skilled staff and recruitment of new employees. This concerns especially the welfare sector where an important group to attract is nurses. The purpose of this study is to elucidate what factors students in the nursing program at Ume√• University value as important in future employers.The results from this study could be of value for the organisations to take into account; also,for employer branding. To find this out, an internet-based questionnaire was sent out via email to the nursing students attending semester 4‚Äď6. Based on the answers received, it is shown that the nursing students at Ume√• University value social work environment, a high salary and good leadership as the three most important in future employment. High wages were equally valued between the genders but all the other areas where more highly valued by women. This study shows similarities to previous research within the field and how it looks today in the nursing profession, that is the soft and post-materialistic values where highly valued. What contradicts,and even makes this study unique, is that the nursing students also valued the materialistic values a safe and secure employment and a high salary as an incredibly important factor in their future professional life. To attract these students future employers has to offer a good social work environment where they can have fun with colleagues and ask for help if needed. They must also be given an adequate salary that corresponds to what their work actually entails

    Framtidens sjuksköterskor : En kvantitativ studie om vad sjuksköterskestudenter värderar som viktigt hos framtida arbetsgivare

    No full text
    The Swedish labour market is facing major challenges with regard to supply of skilled staff and recruitment of new employees. This concerns especially the welfare sector where an important group to attract is nurses. The purpose of this study is to elucidate what factors students in the nursing program at Ume√• University value as important in future employers.The results from this study could be of value for the organisations to take into account; also,for employer branding. To find this out, an internet-based questionnaire was sent out via email to the nursing students attending semester 4‚Äď6. Based on the answers received, it is shown that the nursing students at Ume√• University value social work environment, a high salary and good leadership as the three most important in future employment. High wages were equally valued between the genders but all the other areas where more highly valued by women. This study shows similarities to previous research within the field and how it looks today in the nursing profession, that is the soft and post-materialistic values where highly valued. What contradicts,and even makes this study unique, is that the nursing students also valued the materialistic values a safe and secure employment and a high salary as an incredibly important factor in their future professional life. To attract these students future employers has to offer a good social work environment where they can have fun with colleagues and ask for help if needed. They must also be given an adequate salary that corresponds to what their work actually entails

    Framtidens sjuksköterskor : En kvantitativ studie om vad sjuksköterskestudenter värderar som viktigt hos framtida arbetsgivare

    No full text
    The Swedish labour market is facing major challenges with regard to supply of skilled staff and recruitment of new employees. This concerns especially the welfare sector where an important group to attract is nurses. The purpose of this study is to elucidate what factors students in the nursing program at Ume√• University value as important in future employers.The results from this study could be of value for the organisations to take into account; also,for employer branding. To find this out, an internet-based questionnaire was sent out via email to the nursing students attending semester 4‚Äď6. Based on the answers received, it is shown that the nursing students at Ume√• University value social work environment, a high salary and good leadership as the three most important in future employment. High wages were equally valued between the genders but all the other areas where more highly valued by women. This study shows similarities to previous research within the field and how it looks today in the nursing profession, that is the soft and post-materialistic values where highly valued. What contradicts,and even makes this study unique, is that the nursing students also valued the materialistic values a safe and secure employment and a high salary as an incredibly important factor in their future professional life. To attract these students future employers has to offer a good social work environment where they can have fun with colleagues and ask for help if needed. They must also be given an adequate salary that corresponds to what their work actually entails

    PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences

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    Positron emission tomography-computed tomography (PET-CT) has gained widespread acceptance as a staging investigation in the diagnostic workup of malignant tumours and may be used to visualize metabolic changes before the evolution of morphological changes. To make histology of PET findings without distinctive structural changes available for treatment decisions, we developed a protocol for multimodal image-guided interventions using an integrated PET-CT machine. We report our first experience in 12 patients admitted for staging and restaging of breast cancer, non-small cell lung cancer, cervical cancer, soft tissue sarcoma, and osteosarcoma. Patients were repositioned according to the findings in PET-CT and intervention was planned based on a subsequent single-bed PET-CT acquisition of the region concerned. The needle was introduced under CT guidance in a step-by-step technique and correct needle position in the centre of the FDG avid lesion was assured by repetition of a single-bed PET-CT acquisition before sampling. The metabolically active part of lesions was accurately targeted in all patients and representative samples were obtained in 92%. No major adverse effects occurred. We conclude that PET-CT guidance for interventions is feasible and may be promising to optimize the diagnostic yield of CT-guided interventions and to make metabolically active lesions without morphological correlate accessible to percutaneous intervention

    PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

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    Purpose: In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions. Methods: We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal image-guided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies. Results: Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate the appropriateness of targeted therapy options in 2 patients. Biopsies were technically successful in all patients. In 19 of 20 patients a definite histological diagnosis was possible. No complications or adverse effects occurred. The result of PET/CT-guided bone biopsies determined a change of the planned treatment in overall 56% of patients, with intramodality changes, e.g. chemotherapy with palliative instead of curative intent, and intermodality changes, e.g. systemic therapy instead of surgery, in 22 and 50%, respectively. Conclusion: PET/CT-guided bone biopsies are a promising alternative to conventional techniques to make metabolically active bone lesions‚ÄĒespecially without a distinctive morphological correlate‚ÄĒaccessible for histological verification. PET/CT-guided biopsies had a major clinical impact in patients who otherwise cannot be reliably stage grouped at the time of treatment decision

    Management of KPC-Producing Klebsiella pneumoniae Infections

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    Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas
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