13 results
Tropical vegetation productivity and atmospheric methane over the last 40,000 years from model simulations and stalagmites in Sulawesi, Indonesia
- Claire E. Krause, Alena K. Kimbrough, Michael K. Gagan, Peter O. Hopcroft, Gavin B. Dunbar, Wahyoe S. Hantoro, John C. Hellstrom, Hai Cheng, R. Lawrence Edwards, Henri Wong, Bambang W. Suwargadi, Paul J. Valdes, Hamdi Rifai
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- Journal:
- Quaternary Research / Volume 118 / March 2024
- Published online by Cambridge University Press:
- 26 February 2024, pp. 126-141
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Recent research has shown the potential of speleothem δ13C to record a range of environmental processes. Here, we report on 230Th-dated stalagmite δ13C records for southwest Sulawesi, Indonesia, over the last 40,000 yr to investigate the relationship between tropical vegetation productivity and atmospheric methane concentrations. We demonstrate that the Sulawesi stalagmite δ13C record is driven by changes in vegetation productivity and soil respiration and explore the link between soil respiration and tropical methane emissions using HadCM3 and the Sheffield Dynamic Global Vegetation Model. The model indicates that changes in soil respiration are primarily driven by changes in temperature and CO2, in line with our interpretation of stalagmite δ13C. In turn, modelled methane emissions are driven by soil respiration, providing a mechanism that links methane to stalagmite δ13C. This relationship is particularly strong during the last glaciation, indicating a key role for the tropics in controlling atmospheric methane when emissions from high-latitude boreal wetlands were suppressed. With further investigation, the link between δ13C in stalagmites and tropical methane could provide a low-latitude proxy complementary to polar ice core records to improve our understanding of the glacial–interglacial methane budget.
Eating, sleeping and moving recommendations in clinical practice guidelines for paediatric depression: umbrella review
- Susan C. Campisi, Karolin R. Krause, Benjamin W. C. Chan, Darren B. Courtney, Kathryn Bennett, Daphne J. Korczak, Peter Szatmari
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- Journal:
- BJPsych Open / Volume 7 / Issue 6 / November 2021
- Published online by Cambridge University Press:
- 05 October 2021, e185
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Background
Current first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression.
AimsPaediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs.
MethodSearches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations.
ResultsTen paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature.
ConclusionsInterest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.
Non-replication of the association between 5HTTLPR and response to psychological therapy for child anxiety disorders
- Kathryn J. Lester, Susanna Roberts, Robert Keers, Jonathan R. I. Coleman, Gerome Breen, Chloe C. Y. Wong, Xiaohui Xu, Kristian Arendt, Judith Blatter-Meunier, Susan Bögels, Peter Cooper, Cathy Creswell, Einar R. Heiervang, Chantal Herren, Sanne M. Hogendoorn, Jennifer L. Hudson, Karen Krause, Heidi J. Lyneham, Anna McKinnon, Talia Morris, Maaike H. Nauta, Ronald M. Rapee, Yasmin Rey, Silvia Schneider, Sophie C. Schneider, Wendy K. Silverman, Patrick Smith, Mikael Thastum, Kerstin Thirlwall, Polly Waite, Gro Janne Wergeland, Thalia C. Eley
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- Journal:
- The British Journal of Psychiatry / Volume 208 / Issue 2 / February 2016
- Published online by Cambridge University Press:
- 02 January 2018, pp. 182-188
- Print publication:
- February 2016
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Background
We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome.
AimsTo replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).
MethodLogistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.
ResultsThere was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes.
ConclusionsThe association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples.
201 - Human babesiosis
- from Part XXIV - Specific organisms: parasites
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- By Tempe K. Chen, University of California Irvine, Choukri Ben Mamoun, Yale School of Medicine, Peter J. Krause, Yale School of Public Health
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 1295-1301
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Summary
Babesiosis is an emerging zoonotic disease caused by intraerythrocytic protozoa and transmitted by ticks. The first well-documented case of human Babesia infection was reported in 1957 in a splenectomized resident of Yugoslavia, who died after an acute illness marked by anemia, fever, hemoglobinuria, and renal failure. Intraerythrocytic parasites were noted and tentatively identified as Babesia bovis. Since then, other Babesia species have been found to cause disease in humans: Babesia microti, Babesia duncani, Babesia duncani-type, and Babesia divergens-like in North America; B. divergens, B. microti, and Babesia venatorum in Europe; and B. microti-like and KO-1 in Asia. The clustering of cases of human B. microti infection in the United States contrasts with the sporadic occurrence of the disease in Europe, Africa, and Asia. Rarely, babesiosis may be transmitted through blood transfusion or transplacentally.
Epidemiology
More than 90 species in the genus Babesia infect a wide variety of wild and domestic animals. Humans are an uncommon and terminal host for Babesia species, which depend on other species for their development and transmission. The most common cause for human babesiosis is B. imicroti, a babesia of rodents. The primary reservoir for B. microti in eastern North America is the white-footed mouse (Peromyscus leucopus). As many as two-thirds of P. leucopus have been found to be parasitemic in endemic areas. Babesia species are transmitted by hard-bodied (ixodid) ticks. The primary vector in eastern North America is Ixodes scapularis (also known as Ixodes dammini), which is the same tick that transmits Borrelia burgdorferi, the etiologic agent of Lyme disease, and Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis. Thus, simultaneous human infection with two or more of these pathogens may occur.
The science of EChO
- Giovanna Tinetti, James Y-K. Cho, Caitlin A. Griffith, Olivier Grasset, Lee Grenfell, Tristan Guillot, Tommi T. Koskinen, Julianne I. Moses, David Pinfield, Jonathan Tennyson, Marcell Tessenyi, Robin Wordsworth, Alan Aylward, Roy van Boekel, Angioletta Coradini, Therese Encrenaz, Ignas Snellen, Maria R. Zapatero-Osorio, Jeroen Bouwman, Vincent Coudé du Foresto, Mercedes Lopez-Morales, Ingo Mueller-Wodarg, Enric Pallé, Franck Selsis, Alessandro Sozzetti, Jean-Philippe Beaulieu, Thomas Henning, Michael Meyer, Giuseppina Micela, Ignasi Ribas, Daphne Stam, Mark Swain, Oliver Krause, Marc Ollivier, Emanuele Pace, Bruce Swinyard, Peter A.R. Ade, Nick Achilleos, Alberto Adriani, Craig B. Agnor, Cristina Afonso, Carlos Allende Prieto, Gaspar Bakos, Robert J. Barber, Michael Barlow, Peter Bernath, Bruno Bézard, Pascal Bordé, Linda R. Brown, Arnaud Cassan, Céline Cavarroc, Angela Ciaravella, Charles Cockell, Athéna Coustenis, Camilla Danielski, Leen Decin, Remco De Kok, Olivier Demangeon, Pieter Deroo, Peter Doel, Pierre Drossart, Leigh N. Fletcher, Matteo Focardi, Francois Forget, Steve Fossey, Pascal Fouqué, James Frith, Marina Galand, Patrick Gaulme, Jonay I. González Hernández, Davide Grassi, Matt J. Griffin, Ulrich Grözinger, Manuel Guedel, Pactrick Guio, Olivier Hainaut, Robert Hargreaves, Peter H. Hauschildt, Kevin Heng, David Heyrovsky, Ricardo Hueso, Pat Irwin, Lisa Kaltenegger, Patrick Kervella, David Kipping, Geza Kovacs, Antonino La Barbera, Helmut Lammer, Emmanuel Lellouch, Giuseppe Leto, Mercedes Lopez Morales, Miguel A. Lopez Valverde, Manuel Lopez-Puertas, Christophe Lovi, Antonio Maggio, Jean-Pierre Maillard, Jesus Maldonado Prado, Jean-Baptiste Marquette, Francisco J. Martin-Torres, Pierre Maxted, Steve Miller, Sergio Molinari, David Montes, Amaya Moro-Martin, Olivier Mousis, Napoléon Nguyen Tuong, Richard Nelson, Glenn S. Orton, Eric Pantin, Enzo Pascale, Stefano Pezzuto, Ennio Poretti, Raman Prinja, Loredana Prisinzano, Jean-Michel Réess, Ansgar Reiners, Benjamin Samuel, Jorge Sanz Forcada, Dimitar Sasselov, Giorgio Savini, Bruno Sicardy, Alan Smith, Lars Stixrude, Giovanni Strazzulla, Gautam Vasisht, Sandrine Vinatier, Serena Viti, Ingo Waldmann, Glenn J. White, Thomas Widemann, Roger Yelle, Yuk Yung, Sergey Yurchenko
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- Journal:
- Proceedings of the International Astronomical Union / Volume 6 / Issue S276 / October 2010
- Published online by Cambridge University Press:
- 10 November 2011, pp. 359-370
- Print publication:
- October 2010
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The science of extra-solar planets is one of the most rapidly changing areas of astrophysics and since 1995 the number of planets known has increased by almost two orders of magnitude. A combination of ground-based surveys and dedicated space missions has resulted in 560-plus planets being detected, and over 1200 that await confirmation. NASA's Kepler mission has opened up the possibility of discovering Earth-like planets in the habitable zone around some of the 100,000 stars it is surveying during its 3 to 4-year lifetime. The new ESA's Gaia mission is expected to discover thousands of new planets around stars within 200 parsecs of the Sun. The key challenge now is moving on from discovery, important though that remains, to characterisation: what are these planets actually like, and why are they as they are?
In the past ten years, we have learned how to obtain the first spectra of exoplanets using transit transmission and emission spectroscopy. With the high stability of Spitzer, Hubble, and large ground-based telescopes the spectra of bright close-in massive planets can be obtained and species like water vapour, methane, carbon monoxide and dioxide have been detected. With transit science came the first tangible remote sensing of these planetary bodies and so one can start to extrapolate from what has been learnt from Solar System probes to what one might plan to learn about their faraway siblings. As we learn more about the atmospheres, surfaces and near-surfaces of these remote bodies, we will begin to build up a clearer picture of their construction, history and suitability for life.
The Exoplanet Characterisation Observatory, EChO, will be the first dedicated mission to investigate the physics and chemistry of Exoplanetary Atmospheres. By characterising spectroscopically more bodies in different environments we will take detailed planetology out of the Solar System and into the Galaxy as a whole.
EChO has now been selected by the European Space Agency to be assessed as one of four M3 mission candidates.
199 - Human Babesiosis
- from Part XXIV - Specific Organisms – Parasites
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- By Tempe K. Chen, University of California, Peter J. Krause, University of Connecticut School of Medicine
- Edited by David Schlossberg
-
- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 1381-1388
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Summary
Babesiosis is an emerging zoonotic disease caused by intraerythrocytic protozoa and transmitted by ticks. The first well-documented case of human babesial infection was reported in 1957 in a splenectomized resident of Yugoslavia, who died after an acute illness marked by anemia, fever, hemoglobinuria, and renal failure. Intraerythrocytic parasites were noted and tentatively identified as Babesia bovis. Since then, six Babesia species have been found to cause disease in humans: Babesia microti, Babesia duncani (formerly known as WA1), and MO1 in North America; Babesia divergens and EU1 in Europe; and TW1 in Taiwan. The clustering of cases of human B. microti infection in the United States contrasts with the sporadic occurrence of the disease in Europe, Africa, and Asia. Rarely, babesiosis may be transmitted through blood transfusion or perinatally.
EPIDEMIOLOGY
More than 90 species in the genus Babesia infect a wide variety of wild and domestic animals. Humans are an uncommon and terminal host for Babesia species, which depend on other species for survival. The most common cause for human babesiosis is B. microti, a babesia of rodents. The primary reservoir for B. microti in eastern North America is the white-footed mouse (Peromyscus leucopus). As many as two-thirds of P. leucopus have been found to be parasitemic in endemic areas. Babesia species are transmitted by hard-bodied (ixodid) ticks. The primary vector in eastern North America is Ixodes scapularis (also known as Ixodes dammini), which is the same tick that transmits Borrelia burgdorferi, the etiologic agent of Lyme disease, and Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis.
Delays in the Application of Outbreak Control Prophylaxis for Influenza a in a Nursing Home
- Paul J. Drinka, Peggy Krause, Lori Nest, Stefan Gravenstein, Brian Goodman, Peter Shult
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 23 / Issue 10 / October 2002
- Published online by Cambridge University Press:
- 02 January 2015, pp. 600-603
- Print publication:
- October 2002
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Objective:
To identify delayed prophylaxis from a preexisting database and strategies to improve performance.
Setting:A skilled nursing facility with 14 floors (4 buildings). The “outbreak unit” was a 50- to 60-bed floor.
Methods:We performed surveillance during six seasons using one protocol. Prophylaxis was started when influenza was cultured in the building and 10% of residents on the floor had a new respiratory illness within 7 days. We defined delayed prophylaxis as four or more residents on a floor with positive cultures whose specimens had been collected within 5 days before the application of prophylaxis.
Results:We identified 14 examples of delayed prophylaxis. In three, delayed prophylaxis was related to the 3.9-day delay between culture collection and culture report. There was a high degree of commonality among building attack rates within a season. During six seasons, the first case in the last building occurred 27 to 64 days after the first case in the facility. The two seasons with the greatest activity (68 and 154 cases, respectively) began with explosive, multi-floor outbreaks in a single building. The match between the circulating strain and the vaccine was good, except in 1997-1998 when there were seven examples of delayed prophylaxis.
Conclusions:Influenza may involve buildings sequentially with a commonality of building attack rates. Explosive, multi-floor outbreaks early in the season could lead to a lower threshold for prophylaxis within a larger area when initial cases are encountered later in the season. This strategy could have prevented five examples of delayed prophylaxis. Rapid testing of multiple specimens while waiting for culture confirmation could have prevented three examples of delayed prophylaxis. (Infect Control Hosp Epidemiol 2002;23:600-603).
Reintroduction of Influenza A to a Nursing Building
- Paul J. Drinka, Stefan Gravenstein, Peggy Krause, Lori Nest, Margaret Dissing, Peter Shult
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 21 / Issue 11 / November 2000
- Published online by Cambridge University Press:
- 02 January 2015, pp. 732-735
- Print publication:
- November 2000
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We report an outbreak of influenza A from a four-building veterans' facility in King, Wisconsin. Influenza was isolated in 154 of 721 residents over a 121-day period. Building A had 2 cases, no isolates for 40 days, followed by 27 cases. Building B had 25 cases, no isolates for 75 days, followed by 4 cases. Building C had 23 cases, no isolates for 14 days, followed by 17 cases. Influenza A may be reintroduced to a nursing building. Surveillance with contingency plans for restarting of prophylaxis must continue for the duration of influenza in the community.
Mortality Following Isolation of Various Respiratory Viruses in Nursing Home Residents
- Paul J. Drinka, Stefan Gravenstein, Elizabeth Langer, Peggy Krause, Peter Shult
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 20 / Issue 12 / December 1999
- Published online by Cambridge University Press:
- 02 January 2015, pp. 812-815
- Print publication:
- December 1999
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Objective:
To compare mortality following isolation of influenza A to mortality following isolation of other respiratory viruses in a nursing home.
Setting:The Wisconsin Veterans Home, a 688-bed skilled nursing facility for veterans and their spouses.
Participants:All residents with respiratory viral isolates obtained between 1988 and 1999.
Design:Thirty-day mortality was determined following each culture-proven illness.
Results:Thirty-day mortality following isolation of viral respiratory pathogens was 4.7% (15/322) for influenza A 5.4% (7/129) for influenza B; 6.1% (3/49) for parainfluenza type 1; 0% (0/26) for parainfluenza types 2,3, and 4; 0% (0/26) for respiratory syncytial virus (RSV); and 1.6% (1/61) for rhinovirus.
Conclusions:Mortality following isolation of certain other respiratory viruses may be comparable to that following influenza A (although influenza A mortality might be higher without vaccination and antiviral agents). The use of uniform secretion precautions for all viral respiratory illness deserves consideration in nursing homes.
Quality Standard for the Treatment of Bacteremia
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 189-192
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to optimize the treatment of bacteremia in hospitalized patients by ensuring that the antibiotic given is appropriate in terms of the blood culture susceptibility of the pathogen. Although this standard may appear to be minimal in scope, it is needed because appropriate antimicrobial treatment is not given in 5% to 17% of cases. To implement the standard, physicians, pharmacists, and microbiologists will need to devise a coordinated strategy.
Options:We considered criteria for appropriate dosing, most cost-effective selection, proper antibiotic levels in serum, least toxicity, narrowest spectrum, specific clinical indications, and optimal duration of treatment. All these criteria were rejected as the basis for the standard because they were too controversial and too difficult to be applied by a nonphysician chart reviewer. In contrast, the selection of an antibiotic to which the pathogen is sensitive is a non-controversial criterion and easy for a chart reviewer to apply.
Outcomes:The standard is designed to reduce the incidence of adverse outcomes of septicemia such as renal failure, prolonged hos-pitalization, and death.
Evidence:Several well-designed clinical trials without randomization as well as case-controlled studies have confirmed the benefit of using an antibiotic that is appropriate in light of the susceptibility of the isolate in blood culture. Prospective, randomized, placebo-controlled trials are not available.
Values:Our premise is that the presence of bacteremia is a risk factor for serious adverse outcomes. We also believe that the administration of antibiotics must always be guided by the susceptibility report for the pathogen(s) obtained from blood cultures. This concern is more critical for pathogens from the blood than for those from most other body sites. We had evidence that susceptibility reports for pathogens from positive blood cultures were not always used properly. We used group discussion to reach a consensus among the members of the Quality Standards Subcommittee.
Benefits, Harms, and Costs:Through the implementation of this standard, at least 5% of bacteremias could be treated more appropriately. An unknown number of deaths would likely be prevented, and mortality from bacteremia treated inappropriately would probably be reduced. The primary undesirable feature of the standard is an increased workload of pharmacists and microbiologists.
Recommendations:Treatment of bacteremia with an antibiotic that is appropriate in terms of the pathogen's blood-culture susceptibility is a minimal standard of care for all patients.
Validation:We consulted more than 50 experts in infectious diseases from the fields of medicine, surgery, pediatrics, obstetrics and gynecology, nursing, epidemiology, pharmacology, and government. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists and were tested by one of the members of the Quality Standards Subcommittee.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. This standard is endorsed by the IDSA.
Consensus Development of Quality Standards
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 180-181
- Print publication:
- March 1994
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Quality Standard for Antimicrobial Prophylaxis in Surgical Procedures
- E. Patchen Dellinger, Peter A. Gross, Trisha L. Barrett, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 182-188
- Print publication:
- March 1994
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Objective:
The objectives of this quality standard are 1) to provide an implementation mechanism that will facilitate the reliable administration of prophylactic antimicrobial agents to patients undergoing operative procedures in which such a practice is judged to be beneficial and 2) to provide a guideline that will help local hospital committees formulate policies and set up mechanisms for their implementation. Although standards in the medical literature spell out recommendations for specific procedures, agents, schedules, and doses, other reports document that these standards frequently are not followed in practice.
Options:We have specified the procedures in which the administration of prophylactic antimicrobial agents has been shown to be beneficial, those in which this practice is widely thought to be beneficial but in which compelling evidence is lacking, and those in which this practice is controversial. We have examined the evidence regarding the optimal timing of drug administration, the optimal dose, and the optimal duration of prophylaxis.
Outcomes:The intended outcome is more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable. The result should be a reduction in rates of postoperative wound infection with a limitation on the quantities of antimicrobial agents used in circumstances where they are not likely to help.
Evidence:Many prospective, randomized, controlled trials comparing placebo with antibiotic and comparing one antibiotic with another have been conducted. In addition, some trials have compared the efficacy of different doses or methods of administration. Other papers have reported on the apparent efficacy of administration at different times and on actual practice in specific communities. Only a small group of relevant articles found through 1993 are cited herein. When authoritative reviews are available, these-rather than an exhaustive list of original references-are cited.
Values:We assumed that reducing rates of postoperative infection was valuable but that reducing the total amount of antimicrobial agents employed was also worthwhile. The cost of and morbidity attributable to postoperative wound infections should be weighed against the cost and potential morbidity associated with excessive use of antimicrobial agents.
Benefits, Harms, and Costs:More reliable administration of antimicrobial agents according to recognized guidelines should prevent some postoperative wound infections while lowering the total quantity of these drugs used. No harms are anticipated. The costs involved are those of the efforts needed on a local basis to design and implement the mechanism that supports uniform and reliable administration of prophylactic antibiotics.
Recommendations:All patients for whom prophylactic antimicrobial agents are recommended should receive them. The agents given should be appropriate in light of published guidelines. A short duration of prophylaxis (usually < 24 hours) is recommended.
Validation:More than 50 experts in infectious disease and 10 experts in surgical infectious disease and surgical subspecialties reviewed the standard. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Disease Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Disease Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.
Quality Standard for Assurance of Measles Immunity Among Health Care Workers
- Peter J. Krause, Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 193-199
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all healthcare workers who lack immunity to measles. Although the primary emphasis is on healthcare workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard.
Options:We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available.
Outcomes:The desired outcome is a reduction in the nosocomial transmission of measles.
Evidence:Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune healthcare workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization.
Values and Validation:We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus.
Benefits, Harms, and Cost:The consequences of the transmission of measles (and of mumps and rubella) in a healthcare institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to healthcare workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to healthcare workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks.
Recommendations:We recommend MMR vaccination of all healthcare workers who lack immunity to measles.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.