5 results
Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital
- Priscilla Rupali, Prasannakumar Palanikumar, Divyashree Shanthamurthy, John Victor Peter, Subramani Kandasamy, Naveena Gracelin Princy Zacchaeus, Hanna Alexander, Premkumar Thangavelu, Rajiv Karthik, Ooriapadickal Cherian Abraham, Joy Sarojini Michael, Hema Paul, Balaji Veeraraghavan, Binila Chacko, Visalakshi Jeyaseelan, George Alangaden, Tyler Prentiss, Marcus J Zervos
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 40 / Issue 5 / May 2019
- Published online by Cambridge University Press:
- 14 May 2019, pp. 512-519
- Print publication:
- May 2019
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Objective:
Antimicrobial stewardship programs (ASPs) are effective in developed countries. In this study, we assessed the effectiveness of an infectious disease (ID) physician–driven post-prescription review and feedback as an ASP strategy in India, a low middle-income country (LMIC).
Design and setting:This prospective cohort study was carried out for 18 months in 2 intensive care units of a tertiary-care hospital, consisting of 3 phases: baseline, intervention, and follow up. Each phase spanned 6 months.
Participants:Patients aged ≥15 years receiving 48 hours of study antibiotics were recruited for the study.
Methods:During the intervention phase, an ID physician reviewed the included cases and gave alternate recommendations if the antibiotic use was inappropriate. Acceptance of the recommendations was measured after 48 hours. The primary outcome of the study was days of therapy (DOT) per 1,000 study patient days (PD).
Results:Overall, 401 patients were recruited in the baseline phase, 381 patients were recruited in the intervention phase, and 379 patients were recruited in the follow-up phase. Antimicrobial use decreased from 831.5 during the baseline phase to 717 DOT per 1,000 PD in the intervention phase (P < .0001). The effect was sustained in the follow-up phase (713.6 DOT per 1,000 PD). De-escalation according to culture susceptibility improved significantly in the intervention phase versus the baseline phase (42.7% vs 23.6%; P < .0001). Overall, 73.3% of antibiotic prescriptions were inappropriate. Recommendations by the ID team were accepted in 60.7% of the cases.
Conclusion:The ID physician–driven implementation of an ASP was successful in reducing antibiotic utilization in an acute-care setting in India.
Noise Pollution: Do We Need a Solution? An Analysis of Noise in a Cardiac Care Unit
- Kevin M. Ryan, Matthew Gagnon, Tyler Hanna, Brad Mello, Mustapha Fofana, Gregory Ciottone, Michael Molloy
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 4 / August 2016
- Published online by Cambridge University Press:
- 23 May 2016, pp. 432-435
- Print publication:
- August 2016
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Introduction
Hospitals are meant to be places for respite and healing; however, technological advances and reliance on monitoring alarms has led to the environment becoming increasingly noisy. The coronary care unit (CCU), like the emergency department, provides care to ill patients while being vulnerable to noise pollution. The World Health Organization (WHO; Geneva, Switzerland) recommends that for optimum rest and healing, sound levels should average approximately 30 decibels (dB) with maximum readings less than 40 dB.
ProblemThe purpose of this study was to measure and analyze sound levels in three different locations in the CCU, and to review alarm reports in relation to sound levels.
MethodsOver a one-month period, sound recorders (Extech SDL600; Extech Instruments; Nashua, New Hampshire USA) were placed in three separate locations in the CCU at the West Roxbury Veterans’ Administration (VA) Hospital (Roxbury, Massachusetts USA). Sound samples were recorded once per second, stored in Comma Separated Values format for Excel (Microsoft Corporation; Redmond, Washington USA), and then exported to Microsoft Excel. Averages were determined, plotted per hour, and alarm histories were reviewed to determine alarm noise effect on total noise for each location, as well as common alarm occurrences.
ResultsPatient Room 1 consistently had the lowest average recordings, though all averages were >40 dB, despite decreases between 10:00 pm and 7:00 am. During daytime hours, recordings maintained levels >50 dB. Overnight noise remained above recommended levels 55.25% of the period in Patient Room 1 and 99.61% of the same time period in Patient Room 7. The nurses’ station remained the loudest location of all three. Alarms per hour ranged from 20-26 during the day. Alarms per day averaged: Patient Room 1-57.17, Patient Room 7-122.03, and the nurses’ station - 562.26. Oxygen saturation alarms accounted for 33.59% of activity, and heart-related (including ST segment and pacemaker) accounted for 49.24% of alarms.
ConclusionThe CCU cares for ill patients requiring constant monitoring. Despite advances in technology, measured noise levels for the hospital studied exceeded WHO standards of 40 dB and peaks of 45 dB, even during night hours when patients require rest. Further work is required to reduce noise levels and examine effects on patient satisfaction, clinical outcomes, and length of stay.
,Ryan KM ,Gagnon M ,Hanna T ,Mello B ,Fofana M ,Ciottone G .Molloy M Noise Pollution: Do We Need a Solution? An Analysis of Noise in a Cardiac Care Unit . Prehosp Disaster Med.2016 ;31 (4 ):432 –435 .
5 - Radiotherapy planning 1: fundamentals of external beam and brachytherapy
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- By Andrew Tyler, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, Louise Hanna, South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 05 November 2015
- Print publication:
- 19 November 2015, pp 54-69
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Summary
Introduction
It is important to understand the basic techniques of radiotherapy planning because these will help when developing complex plans. These techniques, which are taught at the First FRCR level (Royal College of Radiologists), are used by the treatment centre's Physics Department for checking the validity of calculations before they are applied to patients, and anyone interpreting plans will need to be familiar with them to know whether it is worth adjusting treatment plans during review. Advanced radiotherapy techniques will be discussed in Chapter 6.
There are several useful reviews of radiotherapy physics in the literature. One by Shiu and Mellenberg (2001) includes sections on isodose planning. Another, by Purdy (2000), provides a perspective on future directions in 3D treatment planning. Radiotherapy is a rapidly developing field and it is important to ensure that new methods satisfy safety and effectiveness requirements before being adopted as routine treatments.
This chapter will deal with the general principles of developing isodose plans that are suitable for treatment and will use specific examples to highlight particular points. It will focus mainly on external beam radiotherapy with megavoltage photons; there will be shorter sections on the use of electrons and brachytherapy. Some aspects of radiotherapy planning using lower energy (kilovoltage) photons will be discussed in Chapter 36. The use of unsealed radiation sources for prostate, thyroid and childhood cancers are discussed in Chapters 22, 38 and 40, respectively.
Treatment planning overview
Radiotherapy planning can be divided into stages as follows.
• Patient preparation, position and immobilisation.
• Localisation method (e.g. orthogonal films, CT scanning, and image co-registration).
• Definition of target volumes and organs at risk.
• Radiotherapy technique, including beam arrangements, beam energy, size and shape, weighting, wedges and production of isodose plan.
• Prescription, including number of phases, dose, energy and fractionation.
• Verification (i.e. checking the geometrical set-up of the treatment). This can take place before treatment in the simulator or CT simulator, and/or during treatment using portal imaging.
Quality assurance (QA) is essential and it is of paramount importance for each member of the planning team to be familiar with the overall process.
Patient position and immobilisation
For radiotherapy to be effective it must be delivered accurately, and it is important to understand the methods of immobilisation and the inevitable uncertainties in the delivery of treatment.
Contributors
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- By Maricela Alarcón, Laura A. Baker, Trygve Bakken, Serena Bezdjian, Andrew W. Bergen, Laura J. Bierut, Andrew C. Chen, C. Robert Cloninger, David W. Craig, Anibal Cravchik, Raymond R. Crowe, Carlos Cruchaga, Joseph F. Cubells, Marcella Devoto, Stephen H. Dinwiddie, Howard J. Edenberg, Josephine Elia, Craig A. Erickson, Thomas V. Fernandez, Xiaowu Gai, Elliot Gershon, Daniel H. Geschwind, Alison M. Goate, Hugh M. D. Gurling, Hakon Hakonarson, Sarah M. Hartz, Akiko Hayashi-Takagi, Jinger Hoop, Hanna Jaaro-Peled, Atsushi Kamiya, John S. K. Kauwe, Walter H. Kaye, John R. Kelsoe, Karestan C. Koenen, Mary Jeanne Kreek, Francesca Lantieri, James F. Leckman, Ondrej Libiger, Falk W. Lohoff, Michael J. Lyons, Christopher J. McDougle, Andrew McQuillin, Kathleen Ries Merikangas, Maria G. Motlagh, Pablo R. Moya, Dennis L. Murphy, Eric J. Nestler, Alexander B. Niculescu, David A. Nielsen, Khendra I. Peay, Bernice Porjesz, James B. Potash, R. Arlen Price, Dmitri Proudnikov, Adrian Raine, Madhavi Rangaswamy, William Renthal, Akira Sawa, Nicholas J. Schork, Saurav Seshadri, Shelley D. Smith, Wanli W. Smith, Toshinobu Takeda, Ardesheer Talati, Yi-Lang Tang, Kiara Timpano, Ali Torkamani, Catherine Tuvblad, Myrna M. Weissman, Jens R. Wendland, Jennifer Wessel, Peter S. White, Vadim Yuferov, Tyler Zink
- Edited by John I. Nurnberger, Jr, Wade Berrettini, University of Pennsylvania School of Medicine
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- Book:
- Principles of Psychiatric Genetics
- Published online:
- 05 October 2012
- Print publication:
- 13 September 2012, pp vii-x
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4 - Radiotherapy planning
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- By Andrew Tyler, Medical Physicist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 23 December 2009
- Print publication:
- 24 January 2008, pp 39-54
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Summary
Introduction
It is important to understand the basic techniques of radiotherapy planning because these will help when developing complex plans. These techniques, which are taught at the FRCR Part I level (Royal College of Radiologists), are used by the treatment centre's Physics Department for checking the validity of calculations before they are applied to patients, and anyone interpreting plans will need to be familiar with them to know whether it is worth adjusting treatment plans during review.
There are several useful reviews of radiotherapy physics in the literature. One by Shiu and Mellenberg (2001) includes sections on isodose planning. Another, by Purdy (2000), provides a perspective on future directions in 3D treatment planning. Radiotherapy is a rapidly developing field and it is important to ensure that new methods satisfy safety and effectiveness requirements before being adopted as routine treatments.
This chapter will deal with the general principles of developing isodose plans that are suitable for treatment and will use specific examples to highlight particular points. It will focus mainly on external beam radiotherapy with megavoltage photons; there will be shorter sections on the use of electrons and brachytherapy. Some aspects of radiotherapy planning using lower energy (kilovoltage) photons will be discussed in Chapter 33 (see p. 382).
Treatment planning overview
Radiotherapy planning can be divided into stages as follows:
Patient preparation, position and immobilisation.
Localisation method (e.g. orthogonal films, CT scanning, and image co-registration).
Definition of target volumes and organs at risk.
Radiotherapy technique, including beam arrangements, beam energy, size and shape, weighting, wedges, and production of isodose plan.
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