• 【英国医院使用的适当性: 实地活动回顾。】 复制标题 收藏 收藏
    DOI:10.1093/intqhc/7.3.239 复制DOI
    作者列表:O'Neill D,Pearson M
    BACKGROUND & AIMS: OBJECTIVE:This paper reviews experience, in both research and application, with measures of appropriateness applied to the utilization of hospital inpatient services in the UK. BACKGROUND:The evolution of different methods for measuring appropriateness of use and the associated reasons for misutilization are described. RESEARCH AND APPLICATION: Recent research developments and applications are outlined and discussed. CONCLUSION:Contemporary enthusiasm with "Diagnosis Independent Explicit Criteria Utilization Review Instruments" is observed and some of the underlying influences are explored.
    背景与目标:
  • 【使用多参数证据综合评估决策模型中数据和结构的适当性。】 复制标题 收藏 收藏
    DOI:10.1177/0272989X13480130 复制DOI
    作者列表:Epstein D,Mochón LG,Espín J,Soares MO
    BACKGROUND & AIMS: OBJECTIVES:Decision models for health technology appraisal are defined by their structure and data. Often there are alternatives for how the model might be specified and what data to include, and criteria are required to guide these choices. This study uses multiparameter evidence synthesis (MPES) to synthesize data from diverse sources and test alternative model structures. The methods are illustrated by a comparison of blood ketone testing versus urine ketone testing for young people with Type 1 diabetes. METHODS:Two approaches were compared. A simple statistical model (Model 1) was used to estimate the difference in the rates of adverse events from the outcome data of a randomized controlled trial (RCT). MPES (Model 2) was constructed to synthesize data on outcome and process variables from the RCT with data from nonrandomized studies on specificity and sensitivity. Sensitivity analyses were carried out using alternative model specifications for the MPES, and the consistency of the data was evaluated. RESULTS:Model 1 estimated that the mean difference in the rate of adverse events per day was 0.0011 (95% confidence interval 0.0005-0.00229) lower with blood ketone testing. Model 2 estimated a similar outcome but also estimated parameters for which there were no direct data, including the prevalence of high ketone levels and the sensitivity and specificity of the tests as used in the home. CONCLUSIONS:Model 1, which used only outcome data from an RCT, showed that blood ketone testing is more effective but did not explain why this is so. Model 2, estimated by MPES, suggested that the blood test is more accurate and that patients are more likely to comply with the protocol.
    背景与目标:
  • 【ACR适当性标准®感染液体收集的放射学管理。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2020.01.034 复制DOI
    作者列表:Expert Panel on Interventional Radiology.,Weiss CR,Bailey CR,Hohenwalter EJ,Pinchot JW,Ahmed O,Braun AR,Cash BD,Gupta S,Kim CY,Knavel Koepsel EM,Scheidt MJ,Schramm K,Sella DM,Lorenz JM
    BACKGROUND & AIMS: :Infected fluid collections are common and occur in a variety of clinical scenarios throughout the body. Minimally invasive image-guided management strategies for infected fluid collections are often preferred over more invasive options, given their low rate of complications and high rates of success. However, specific clinical scenarios, anatomic considerations, and prior or ongoing treatments must be considered when determining the optimal management strategy. As such, several common scenarios relating to infected fluid collections were developed using evidence-based guidelines for management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 感染的液体收集是常见的,发生在全身的各种临床场景中。由于并发症发生率低且成功率高,因此通常首选微创图像引导的感染液体收集管理策略,而不是更具侵入性的选择。但是,在确定最佳管理策略时,必须考虑特定的临床情况,解剖学考虑以及先前或正在进行的治疗。因此,使用基于证据的管理指南开发了与受感染的液体收集有关的几种常见方案。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床场景的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 【ACR适当性标准®妊娠早期出血。】 复制标题 收藏 收藏
    DOI:10.1097/RUQ.0b013e31829158c2 复制DOI
    作者列表:
    BACKGROUND & AIMS: :Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data. A failed pregnancy may be diagnosed when there is absence of cardiac activity in an embryo exceeding 7 mm in crown rump length or absence of an embryo when the mean sac diameter exceeds 25 mm. In a stable patient with no intrauterine pregnancy and normal adnexae, close monitoring is advised. The diagnosis of ectopic pregnancy should be based on positive findings rather than on the absence of an intrauterine sac above a threshold level of βHCG. Following abortion, ultrasound can discriminate retained products of conception from clot and arteriovenous fistulae. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    背景与目标: : 妊娠前三个月阴道出血并不少见。超声是评估孕囊和胚胎正常发育以及区分出血原因的最重要方法。尽管与定量 β hcg和临床表现的相关性至关重要,但超声检查标准允许诊断失败的妊娠,异位妊娠,妊娠滋养细胞疾病和自然流产。美国放射学学院的适当性标准指南已更新,以纳入最新数据。当胚胎中没有超过冠臀部长度7毫米的心脏活动或当平均囊直径超过25毫米时没有胚胎时,可以诊断出失败的妊娠。对于没有宫内妊娠且附件正常的稳定患者,建议密切监测。异位妊娠的诊断应基于阳性发现,而不是没有超过 β hcg阈值水平的宫内囊。流产后,超声可以将保留的受孕产物与凝块和动静脉瘘区分开。美国放射学学院适当性标准®是针对特定临床状况的循证指南,由多学科专家小组每两年审查一次。指南的制定和审查包括对来自同行评审期刊的当前医学文献的广泛分析,并应用完善的共识方法 (修改的Delphi) 来评估小组对成像和治疗程序的适当性。在缺乏证据或不确定证据的情况下,可以使用专家意见来建议成像或治疗。
  • 【动脉高血压中左心室质量与左心房大小和功能的适当性关系。】 复制标题 收藏 收藏
    DOI:10.2459/01.JCM.0000269718.41059.62 复制DOI
    作者列表:Mureddu GF,Cioffi G,Stefenelli C,Boccanelli A
    BACKGROUND & AIMS: OBJECTIVE:To investigate whether left ventricular mass (LVM) appropriateness may be related to left atrial changes in both size and performance in arterial hypertension. METHODS:Three hundred and thirty-five hypertensive outpatients were studied by Doppler echocardiography and divided into two groups on the basis of LVM appropriateness. Left ventricular mass was defined inappropriate when greater than 128% of the value predicted from age, sex and stroke work (95th percentile of normal distribution) and appropriate for values
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  • 【GI内窥镜手术的 “适当性” 或 “优先级”?】 复制标题 收藏 收藏
    DOI:10.1016/j.gie.2005.11.024 复制DOI
    作者列表:Andriulli A,Annese V,Terruzzi V,Grossi E,Minoli G
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【在2型糖尿病自我管理应用程序中,适当的行动提示低血糖和高血糖。】 复制标题 收藏 收藏
    DOI:10.1002/dmrr.3235 复制DOI
    作者列表:Lum E,Jimenez G,Huang Z,Thai L,Car J
    BACKGROUND & AIMS: BACKGROUND:Control of blood glucose levels is needed not only to alleviate symptoms of hypoglycaemia and hyperglycaemia, but also to prevent or delay diabetes-related complications. Advice for glucose control is usually provided to patients by members of the health care team. However, many diabetes apps claim to enhance self-management of blood glucose by providing decision support to patients when an out-of-range blood glucose level is recorded. In this study, we investigated the appropriateness of action prompts provided by diabetes apps for hypoglycaemia and hyperglycaemia against evidence-based guidelines. METHODS:We used methods previously reported to identify and select diabetes apps, which were downloaded and assessed against the American Diabetes Association (ADA) guidelines. Screenshots of action prompts corresponding to low or high out-of-range blood glucose values were subjected to content analysis. RESULTS:Of 371 diabetes self-management apps evaluated, only 217 and 216 apps alerted patients about hypoglycaemia and hyperglycaemia, respectively. Of these, 20.7% (45/217) and 15.3% (33/216) also provided action prompts. We found 5.1% of apps (hypoglycaemia: 11/217; hyperglycaemia: 11/216) provided prompts that were either too general to be helpful or not aligned with ADA guidelines. Overall, only 17.9% (39/217) and 14.8% (32/216) provided appropriate action prompts for hypoglycaemia and hyperglycaemia, respectively. CONCLUSION:Less than one fifth of apps provided evidence-based steps to guide patients through hypoglycaemia and hyperglycaemia. The majority of apps failed to provide just-in-time diabetes self-management education to prevent frequent or severe episodes of hypoglycaemia and hyperglycaemia. Our findings emphasize the need for better design and quality assurance of diabetes apps.
    背景与目标:
  • 【ACR适当性标准®软组织肿块。】 复制标题 收藏 收藏
    DOI:10.1016/j.jacr.2018.03.012 复制DOI
    作者列表:Expert Panel on Musculoskeletal Imaging:.,Kransdorf MJ,Murphey MD,Wessell DE,Cassidy RC,Czuczman GJ,Demertzis JL,Lenchik L,Motamedi K,Pierce JL,Sharma A,Walker EA,Ying-Kou Yung E,Beaman FD
    BACKGROUND & AIMS: :Imaging is an integral component of the evaluation of patients with a suspected soft-tissue mass. Imaging can not only confirm the presence of a mass but can provide essential information necessary for diagnosis, local staging, and biopsy planning. Although the objectives of the evaluation have not changed, the choices available for imaging of musculoskeletal masses have evolved dramatically in recent years. The purpose of this document is to identify the most common clinical scenarios and the most appropriate imaging for their assessment on the basis of the current literature and to provide general guidance for those scenarios that are not specifically addressed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
    背景与目标: : 成像是对怀疑有软组织肿块的患者进行评估的一个组成部分。成像不仅可以确认肿块的存在,还可以提供诊断,局部分期和活检计划所需的基本信息。尽管评估的目标没有改变,但近年来,用于肌肉骨骼肿块成像的选择已发生了巨大变化。本文件的目的是在现有文献的基础上确定最常见的临床情景和最适合其评估的影像学,并为那些没有具体解决的情景提供一般指导。美国放射学学院的适当性标准是针对特定临床状况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊中当前医学文献的广泛分析,以及对公认的方法 (RAND/UCLA适当性方法和建议评估,开发和评估或等级的分级) 的应用,以评估适当性特定临床场景的成像和治疗程序。在证据缺乏或模棱两可的情况下,专家意见可以补充现有证据以建议成像或治疗。
  • 【在巴布亚新几内亚选定的医疗机构开药的适当性。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czt012 复制DOI
    作者列表:Joshua IB,Passmore PR,Parsons R,Sunderland VB
    BACKGROUND & AIMS: OBJECTIVE:The objective of this study was to evaluate the level of appropriateness of prescribing to outpatients in selected healthcare facilities in Papua New Guinea (PNG), using health department guidelines as the benchmark. METHODS:A prospective study was carried out at Losuia Health Centre (LHC), Alotau Provincial Hospital (APH) and Port Moresby General Hospital (PMGH) in PNG. At each setting >300 consecutive prescriptions were evaluated in 2010. Diagnosis and prescribing data were collected from written prescription orders, patient health books and by patient interview. The appropriateness of prescribing was evaluated with respect to the relevant PNG Health Department guidelines. Differences in prescribing indices were evaluated using chi-squared tests as appropriate. RESULTS:There were 1090 patients (748 adults; 341 children) enrolled in the study with 356 at LHC, 318 at APH and 416 at PMGH. A total of 2495 medicines were prescribed. The most common were amoxicillins (355), paracetamol (344), artemether/artesunate (186) and chloroquine (162). The average number of drugs prescribed per patient was 2.3 (range: 1-7). The most common diseases treated were malaria (23.2%), acute soft tissue injuries (10.4%), anaemia (8.9%), respiratory problems (8.7%) and cough (5.9%). Overall, inappropriate prescribing was 33.4% in adults and 39.9% in children, the difference mainly arising from inappropriate drug dosage. There were statistically significant differences observed for the level of inappropriate prescribing by prescriber category on drug selection (P < 0.0001), drug dosage (P < 0.0001) and drug duration (P < 0.0001). CONCLUSION:The level of inappropriate prescribing was as high as 53.8% in the selected locations in PNG, which is of great concern with respect to the quality of PNG healthcare delivery. Appropriate interventions such as review/upgrade of the guidelines, supervision/oversight of compliance to guidelines and/or publication of ongoing supervision/audit oversight reports need to occur to address the underlying causes.
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  • 【普通内科住院患者外周插入中心导管使用的适当性: 使用常规收集数据的观察性研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjqs-2019-010463 复制DOI
    作者列表:Verma AA,Kumachev A,Shah S,Guo Y,Jung HY,Rawal S,Lapointe-Shaw L,Kwan JL,Weinerman A,Tang T,Razak F
    BACKGROUND & AIMS: BACKGROUND:Peripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). METHODS:This was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use. RESULTS:Among 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC. CONCLUSIONS:Clinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.
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  • 【经验性抗生素的适当性: ICU成年脓毒症患者的危险因素。】 复制标题 收藏 收藏
    DOI:10.1007/s11096-020-01005-4 复制DOI
    作者列表:Al-Sunaidar KA,Prof Abd Aziz N,Prof Hassan Y
    BACKGROUND & AIMS: :Background The appropriateness of antibiotics is the basis for improving the survival of patients with sepsis. Objective This study aimed to determine the appropriateness of empirical antibiotics, reasons for non-appropriate empirical antibiotics, risk factors of mortality, length of stay in intensive care unit (ICU-LOS) and Acute Physiology And Chronic Health Evaluation II (APACHE II) score predictors in adult patients with sepsis. Setting An adult ICU of a tertiary hospital in  Malaysia. Methods A retrospective cohort study was conducted amongst patients with sepsis. Data were retrieved from the patients' files and computer system. Each case was reviewed for the appropriateness of empirical antibiotics based on ICU local guidelines, bacterial sensitivity, dose, frequency, creatinine clearance and time of administration of empirical antibiotics. Multivariable logistic and Cox regression modelling were performed to compute the adjusted association of receiving appropriate or inappropriate empirical antibiotics with ICU mortality. Multivariable linear regression modelling was performed using ICU-LOS and APACHE II scores. Main outcome measures were ICU mortality, severity score (APACHE II scores) and ICU-LOS. Results The total mortality rate amongst the 228 adult ICU patients was 84.6%. Males showed a higher mortality rate (119 [52.2%]) than females (74 [32.5%]). Inappropriate empirical antibiotics were significantly associated with mortality and ICU-LOS (P < 0.005). Results from multivariable logistic regression showed that the appropriateness of empirical antibiotics model was a potential predictor for survival (OR 0.395, 95% CI 0.184-0.850, P < 0.005). Results from simple linear regression indicated that the appropriateness of empirical antibiotics model was a remarkable predictor of decreasing ICU-LOS (R2 = 0.055, 95% CI - 7.184 to - 2.114, P < 0.001). Results from simple Cox regression suggested that the appropriateness of empirical antibiotics was a protective factor for ICU mortality (HR 0.610, 95% CI 0.433-0.858, P = 0.005). Multivariable Cox regression revealed that the administration of antibiotics exceeding the recommended dose based on creatinine clearance was a protective factor (HR 0.186, 95% CI 0.040-0.868, P = 0.032). Conclusion The appropriateness of empirical antibiotics is a good predictor for improving survival and decreasing ICU-LOS. Effective appropriateness of empirical antibiotics use and close adherence to the recommended dose can prevent the early mortality of patients with sepsis and acute renal failure.
    背景与目标: 背景: 抗生素的适当性是改善脓毒症患者生存的基础。目的本研究旨在确定成人脓毒症患者经验性抗生素的适当性,不适当的经验性抗生素的原因,死亡的危险因素,重症监护病房 (ICU-LOS) 的住院时间以及急性生理与慢性健康评估II (APACHE II) 评分的预测因素。在马来西亚设置三级医院的成人ICU。方法对脓毒症患者进行回顾性队列研究。从患者的文件和计算机系统中检索数据。根据ICU局部指南,细菌敏感性,剂量,频率,肌酐清除率和经验性抗生素给药时间,对每个病例进行了经验性抗生素的适用性审查。进行了多变量logistic和Cox回归模型,以计算接受适当或不适当的经验性抗生素与ICU死亡率的校正相关性。使用ICU-LOS和APACHE II评分进行多变量线性回归建模。主要结局指标为ICU死亡率,严重程度评分 (APACHE II评分) 和ICU-LOS。结果228例成人ICU患者的总死亡率为84.6% 例。男性的死亡率 (119 [52.2%]) 高于女性 (74 [32.5%])。不适当的经验性抗生素与死亡率和ICU-LOS显著相关 (p  <  0.005)。多变量logistic回归结果表明,经验性抗生素模型的适当性是生存的潜在预测因素 (OR 0.395,95% CI 0.184-0.850,p  <  0.005)。简单线性回归结果表明,经验性抗生素模型的适用性是降低ICU-LOS的显著预测指标 (R2   =   0.055,95% CI -  7.184为-  2.114,p  <  0.001)。简单的Cox回归结果表明,经验性抗生素的适用性是ICU死亡率的保护因素 (HR 0.610,95% CI 0.433-0.858,p   =   0.005)。多变量Cox回归显示,超过基于肌酐清除率的推荐剂量的抗生素给药是一个保护因素 (HR 0.186,95% CI 0.040-0.868,p   =   0.032)。结论经验性抗生素的适用性是提高生存率和降低ICU-LOS的良好预测指标。经验性抗生素使用的有效适当性和对推荐剂量的严格遵守可以预防败血症和急性肾功能衰竭患者的早期死亡。
  • 【颈部疼痛驱动指数: 评级量表的适当性和战略、战术和作战水平的单维度。】 复制标题 收藏 收藏
    DOI:10.1016/j.apmr.2013.02.017 复制DOI
    作者列表:Takasaki H,Johnston V,Treleaven J,Jull G
    BACKGROUND & AIMS: OBJECTIVE:To establish an appropriate scoring system using Rasch scores for the strategic, tactical, and operational levels of the Neck Pain Driving Index (NPDI) and to refine the NPDI by testing the unidimensionality of each driving performance level using Rasch analysis. DESIGN:Cross-sectional. SETTING:Tertiary institution. PARTICIPANTS:Individuals with chronic whiplash-associated disorders (WAD) (N=123). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:The NPDI, which was developed to evaluate self-reported driving difficulty in people with chronic WAD. RESULTS:On the basis of Rasch analyses, modifications were made to the response format, changing it from a 0 to 4 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty, 4=unable to drive because of the injury) to a 0 to 3 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty and unable to drive because of the injury). Unidimensionality of the strategic and operational levels was confirmed. Modification of the tactical level was necessary to ensure its unidimensionality. After removing the tasks "driving near (your) collision site," "driving in a bad weather condition," and "driving at night," unidimensionality of the 4-item tactical level was confirmed. A 9-item NPDI was established. A table converting raw total scores into Rasch scores was created for each level. CONCLUSIONS:This study established the 9-item NPDI, and its 3 subsections (strategic, tactical, and operational levels) are unidimensional. The magnitude of self-reported driving difficulty at each of the 3 subsections can be assessed with the use of a 0 to 3 scale and Rasch scores.
    背景与目标:
  • 【肾清除和连续肾脏替代治疗对危重病患者推荐美罗培南给药方案的适当性的影响易感威胁生命的感染。】 复制标题 收藏 收藏
    DOI:10.1093/jac/dky370 复制DOI
    作者列表:Burger R,Guidi M,Calpini V,Lamoth F,Decosterd L,Robatel C,Buclin T,Csajka C,Marchetti O
    BACKGROUND & AIMS: Background:Meropenem plasma concentration above a pathogen's MIC over the whole dosing interval (100% ƒT>MIC) is a determinant of outcome in severe infections. Significant variability of meropenem pharmacokinetics is reported in ICU patients. Objectives:To characterize meropenem pharmacokinetics in variable CLCR or renal replacement therapy and assess the appropriateness of recommended regimens for MIC coverage. Methods:A pharmacokinetic analysis (NONMEM) was conducted with external model validation. Patient characteristics were tested on meropenem clearance estimates, differentiated according to the presence/absence of continuous renal replacement therapy (CRRT, CLCRRT or CLno-CRRT). Simulations evaluated the appropriateness of recommended dosing for achieving 100% fT>MIC in 90% of patients. Results:A total of 101 patients were studied: median 63 years (range 49-70), 56% male, SAPS II 38 (27-48). 32% had a CLCR >60 mL/min, 49% underwent CRRT and 32% presented severe sepsis or septic shock. A total of 127 pathogens were documented: 76% Gram-negatives, 24% Gram-positives (meropenem MIC90 2 mg/L, corresponding to EUCAST susceptibility breakpoint). Three hundred and eighty plasma and 129 filtrate-dialysate meropenem concentrations were analysed: two-compartment modelling best described the data. Predicted meropenem CLno-CRRT was 59% lower in impaired (CLCR 30 mL/min) compared to normal (CLCR 100 mL/min) renal function. Simulations showed that recommended regimens appropriately cover MIC90 in patients with CLCR <60 mL/min. Patients with CLCR of 60 to <90 mL/min need 6 g/day to achieve appropriate coverage. In patients with CLCR ≥90 mL/min, appropriate exposure is achieved with increased dose, frequency of administration and infusion duration, or continuous infusion. Conclusions:Recommended meropenem regimens are suboptimal in ICU patients with normal or augmented renal clearance. Modified dosing or infusion modalities achieve appropriate MIC coverage for optimized antibacterial efficacy in meropenem-susceptible life-threatening infections.
    背景与目标:
  • 【多种慢性病患者药物治疗适当性问卷的可靠性。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejim.2013.01.020 复制DOI
    作者列表:Galván-Banqueri M,de la Higuera-Vila L,Vega-Coca MD,Nieto Martín MD,Pérez-Guerrero C,Santos-Ramos B
    BACKGROUND & AIMS: BACKGROUND:The original Medication Appropriateness Index was validated for elderly and polymedicated patients, both in hospital and outpatient contexts. However, no studies have applied this questionnaire in patients with multiple chronic conditions. The objective of this study is to assess the reliability of a modified Medication Appropriateness Index questionnaire in a population of patients with multiple chronic conditions. METHODS:We selected patients with multiple chronic conditions who were included in an integrated care project conducted at the Hospital Universitario Virgen del Rocío. To determine inter-observer reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intra-observer reliability, each physician applied the tool at baseline and two months later. We measured inter- and intra-observer reliability using the kappa coefficient. The proportion of overall agreement was also determined. RESULTS:We obtained a weak overall kappa (k=0.38) for inter-observer reliability and moderate (k=0.52) and very good (k=0.84) values for intra-observer reliability of the internist and specialist in hospital pharmacy, respectively. The proportion of overall agreement is very high in all three situations: 96%, 98%, and 99%, respectively. CONCLUSIONS:Despite its limitations, the Medication Appropriateness Index questionnaire modified by our group can be used, as a reliable method, to assess the appropriateness of pharmacotherapy in patients with multiple chronic conditions.
    背景与目标:
  • 【车载信息系统警报: 烦恼、紧急和适当性。】 复制标题 收藏 收藏
    DOI:10.1518/001872007779598145 复制DOI
    作者列表:Marshall DC,Lee JD,Austria RA
    BACKGROUND & AIMS: OBJECTIVE:This study assesses the influence of the auditory characteristics of alerts on perceived urgency and annoyance and whether these perceptions depend on the context in which the alert is received. BACKGROUND:Alert parameters systematically affect perceived urgency, and mapping the urgency of a situation to the perceived urgency of an alert is a useful design consideration. Annoyance associated with environmental noise has been thoroughly studied, but little research has addressed whether alert parameters differentially affect annoyance and urgency. METHOD:Three 2(3) x 3 mixed within/between factorial experiments, with a total of 72 participants, investigated nine alert parameters in three driving contexts. These parameters were formant (similar to harmonic series), pulse duration, interpulse interval, alert onset and offset, burst duty cycle, alert duty cycle, interburst period, and sound type. Imagined collision warning, navigation alert, and E-mail notification scenarios defined the driving context. RESULTS:All parameters influenced both perceived urgency and annoyance (p < .05), with pulse duration, interpulse interval, alert duty cycle, and sound type influencing urgency substantially more than annoyance. There was strong relationship between perceived urgency and rated appropriateness for high-urgency driving scenarios and a strong relationship between annoyance and rated appropriateness for low-urgency driving scenarios. CONCLUSION:Sound parameters differentially affect annoyance and urgency. Also, urgency and annoyance differentially affect perceived appropriateness of warnings. APPLICATION:Annoyance may merit as much attention as urgency in the design of auditory warnings, particularly in systems that alert drivers to relatively low-urgency situations.
    背景与目标:

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