4 results
Modified reporting of positive urine cultures to reduce inappropriate antibiotic treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) among inpatients, a randomized controlled trial
- Claire L. Pratt, Zahra Rehan, Lydia Xing, Laura Gilbert, Brenda Fillier, Brendan Barrett, Peter Daley
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 10 / October 2021
- Published online by Cambridge University Press:
- 04 June 2021, pp. 1221-1227
- Print publication:
- October 2021
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Objective:
To determine whether modified reporting of positive urine cultures collected from indwelling catheters improved treatment decisions without causing harm.
Design:Prospective, unblinded, randomized control trial.
Setting:Two tertiary-care hospitals.
Participants:Overall, 100 consecutive positive urine cultures collected from catheterized inpatients were randomized between standard and modified laboratory reporting between November 2018 and June 2019. Exclusion criteria were pregnancy, current antibiotic treatment, ICU or urology admission, or neutropenia.
Intervention:The modified report included significant growth without providing identification, quantification, or susceptibility. The standard report included identification, quantitation and susceptibility. Diagnosis of catheter-associated asymptomatic bacteriuria (CA-ASB) and catheter-associated urinary tract infection (CA-UTI) followed published criteria, using prospective chart review. The appropriate antibiotic treatment was defined as treatment of CA-UTI, and no treatment of CA-ASB. Patients were followed for 7 days.
Results:Of 543 urine cultures, 443 (82%) were excluded. Of 100 patients, 75 (75%) had CA-ASB and 25 (25%) had CA-UTI. Treatment was given to 45 of 75 CA-ASB patients (60%) and all 25 CA-UTI patients (100%). Appropriate treatment rate was higher in the modified reporting arm than in the standard reporting arm: 57% vs 50% (+7.4%; relative risk [RR], 1.15; P = .45). Untreated CA-ASB was higher in the modified reporting arm: 45% vs 33% (+12%; RR, 1.36; P = .30). The standard report was requested for 33% of modified reports. Furthermore, 4 deaths and 26.9% adverse events occurred in the modified reporting arm, and 3 deaths and 41.3% adverse events occurred in the standard reporting arm.
Conclusions:Modified reporting increased the appropriateness of treatment, and may be safe.
Clinical trials identifier: ClinicalTrials.gov#NCT03488355.
5 - The Middle Bronze Age
- Edited by John Barrett, Richard J. Bradley, Martin T. Green
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- Book:
- Landscape, Monuments and Society
- Published online:
- 07 May 2010
- Print publication:
- 22 February 1991, pp 143-226
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Summary
Introduction
It is during the Middle Bronze Age in southern Britain that archaeological field evidence for settlement and cultivation becomes readily available for study. This evidence comprises earthwork enclosures and lynchet systems. Childe regarded the apparent changes in agricultural practices indicated by these field remains as representative of an ‘agricultural revolution’. He evoked a comparison between an earlier state where the ‘warriorherdsman's wife’ had ‘tilled a little wheat and barley with the hoe’, with the emergence of ‘villages of a size and permanence hitherto unprecedented in Britain’ and their accompanying field systems (Childe 1947, 186–9).
The distinction between a prehistoric archaeology dominated by burial and ceremonial monuments, and one dominated by settlement sites and the earthwork remains of cultivation is still drawn today (Bradley 1984, 160). The explanation for the apparent transformation needs careful consideration. At base, this distinction is partly a matter of archaeological visibility. Settlements and cultivation have occurred in all the periods since the Neolithic, and whilst writers such as Childe and Curwen regarded Neolithic and Early Bronze Age settlement to be of a non-permanent and shifting character associated with a heavily pastoral economy (Childe 1947; Curwen 1938), this view is at least questioned, if not totally rejected today. We must be certain of the processes which render settlement and agriculture so visible in our later prehistory and then set about explaining those processes. This will be the main theme of this chapter.
6 - The Late Bronze Age and Iron Age
- Edited by John Barrett, Richard J. Bradley, Martin T. Green
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- Book:
- Landscape, Monuments and Society
- Published online:
- 07 May 2010
- Print publication:
- 22 February 1991, pp 227-242
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Summary
Introduction
It is now more than twenty years since the origin of the British Iron Age was debated in terms of either invasion or indigenous development. Hawkes (1959) established a subtle temporal and spatial classification of the British material, which mapped its suggested continental origins and indigenous development. However, the general application of the ‘Invasion Hypothesis’ was soon challenged (Clark 1966), and the specific treatment of the British Iron Age in these terms was criticised in detail by Hodson (1960 and 1964). Both Hodson and Hawkes accepted the basic premise, that analysis depended upon matching cultural traits over time and space. By this means Hodson established the claim that the British Iron Age contained a core of cultural traits (the ‘Woodbury Culture’), whose origins lay within the indigenous Bronze Age.
Not only did both writers accept that a ‘cultural’ analysis was the valid framework within which to work; they also operated within the terms of national archaeologies. It is from this perspective that movement of peoples between (say) Wessex and East Anglia may be presented as an ‘indigenous’ process, whilst movement between the Pays de Calais and Kent was an ‘invasion’. Neither set of assumptions stands particularly close scrutiny today. Our study of Cranborne Chase has been regionally based. This has not assumed that the region defines the spatial extent of some closed social system. Our treatment of the region has been to take it as a relatively arbitrary area of topography, within which certain social practices were executed, and through which we may examine the history of those practices. Such practices contributed towards local systems of social reproduction.
4 - The Early Bronze Age
- Edited by John Barrett, Richard J. Bradley, Martin T. Green
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- Book:
- Landscape, Monuments and Society
- Published online:
- 07 May 2010
- Print publication:
- 22 February 1991, pp 109-140
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Summary
Introduction
The rather traditional division drawn here between the Late Neolithic and Early Bronze Age is simply one of convenience. It allows us to focus upon the development of round barrows, the construction of which show an essential continuity with developments during the previous period. However, henge monuments are no longer constructed in our area, and the barrows evidence a monumentality with an almost exclusive emphasis upon the dead. It is the changing emphasis in the practices associated with monumentality which is the issue here, rather than a simple technological division in the artefact sequence (Fig. 4.1).
Burgess has suggested a series of period divisions for the second millennium be (Table 4.1) in which his Mount Pleasant Period (c. 2150–1700 be) sees the introduction of copper, and then the full adoption of bronze metallurgy (metal Stages I-IV), along with most of the ‘steps’ of Beaker development (n.d. [1980]; 1980, 71; 1986). Although there remain considerable doubts about the detail of the Beaker chronology in Britain (see Longworth in Wainwright 1979b, 90), it seems most likely that the main currency of this material pre-dates 1700 be. The Beaker and early metal finds from the region are discussed below and, although sparsely represented, they are likely to have been contemporary with the final history of the Wyke Down henge. It is also probable that they fall within the period of use of the Knowlton henges.