Outpatient parenteral antibiotic therapy (OPAT) at home in Attica, Greece

Outpatient parenteral antibiotic therapy (OPAT) is considered to be a cost-effective and safe alternative treatment strategy to hospitalization. We retrospectively evaluated data regarding the demographic and treatment characteristics of patients that sought medical advice from a network of physicians performing house-call visits and who received OPAT at home during a 17-month period (May 2009 to September 2010) in Attica, Greece. A total of 91 patients (69.2?% females) received intravenous antibiotic therapy at home during the evaluated period. The mean age [± standard deviation (SD)] of the patients was 85.3 (± 9) years. The main indications were pneumonia [46 patients (50.5?%)], urinary tract infection [25 (27.5?%)], and gastrointestinal tract infection [9 (9.9?%)]. Of the patients, 76.4?% received a beta-lactam, 17.5?% a fluoroquinolone, 15.3?% an imidazole, 8.7?% an aminoglycoside, and 5.4?% a lincosamide. The cure rate was 72.5?% and mortality was 27.5?%. The mean duration (± SD) of intravenous antibiotic treatment was 4.7 (± 3.3) days. The mean cost per patient was €637 and was comparable to the mean cost if the patient were to be hospitalized for the same infection. There was significant clinical effectiveness of OPAT at home in this mainly elderly population, at an acceptable cost.     

Outpatient parenteral antimicrobial therapy (OPAT) in the republic of Ireland: results of a national survey

Outpatient parenteral antimicrobial therapy (OPAT) services are not well developed in the Republic of Ireland. A national programme is being instituted to standardise care. This survey aims to assess the current use of outpatient intravenous antibiotics and to quantify the needs that physicians identify in the development of a national programme. General medical consultant physicians and clinical microbiology consultants were contacted through the Royal College of Physicians of Ireland (RCPI) from April to June 2012. Data were analysed using SPSS version 20. A total of 512 physicians were contacted, of which 55 (10.7 %) responded. The majority, 38/55 (69 %), practice general internal medicine in combination with a medical specialty, 2 (4 %) general internal medicine alone, 8 (15 %) clinical microbiology and 7 (13 %) a medical specialty alone. Of those practising a medical specialty, 12 (27 %) practice infectious diseases. Seventy-four percent reported having discharged patients with intravenous antibiotics; however, 47 % did not have a designated service available. Of those with no service, 100 % identified a need for these resources. Of those responsible for an OPAT service, 56 % had not audited their service. The most common indications were skin and soft tissue infections, osteomyelitis and respiratory tract infection. Flucloxacillin was the most commonly reported antibiotic. Eleven percent responded that they never monitor laboratory studies for patients discharged with intravenous antibiotics. While OPAT services in Ireland are not well developed, patients are being discharged with intravenous antibiotics. This survey underscores the need to develop the national programme to standardise care and ensure patients receive safe and efficient therapy.     

Outpatient parenteral antibiotic therapy (OPAT) of diabetic foot infections with piperacillin/tazobactam

Treatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to different degrees of severity according to Wagner's classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram - and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programmes     

Outpatient parenteral antibiotic treatment: the Italian model

Though constrained by the lack of standard criteria for patient selection and well defined therapeutic protocols, the Italian model of OPAT is characterized by the home treatment of infections also of moderate severity, chiefly of the lower respiratory tract by means of broad spectrum antibiotics (chiefly beta-lactams) administered intramuscularly. The selection of patient for OPAT remains an individual decision of GPs based on the severity of infection, concomitant diseases, age of the patient, reliability of patients and family, environ- mental and social factors. Such a model has gained broad consensus over the years from patients for different cultural reasons: first, the willingness of patients to participate in the OPAT programmes, second, the concept that home is better than hospital even when you are ill and, third, the fact that parenteral drugs are perceived as more effective than oral ones, probably in contrast with the culture and traditions of other countries (especially northern Europe) where hospitals are still considered the only proper site of care and intramuscular administration is regarded as almost unnatural. No private or insurance reimbursement based OPAT structure exists up to now in Italy or is go. ing to be developed. The main problems in Italy now seems to be: -to define clear protocols and easy criteria for selection of patients enable to OPAT, -to improve what existing by creating and/or qualifying new professionals involved with in- and outpatients (OPAT, early discharge,medical care for special populations.).     

The Italian SIdEM registry for apheresis: an overview of the 2005 statistics

Data collection on apheresis activities in Italy throughout 2005 including techniques, types of blood cell separators, clinical indications and adverse effects was performed by means of a standardized questionnaire. These data provided by 83 Apheresis Units from 16 Italian regions, albeit rough, are sufficiently informative, mainly in comparison with previous surveys on these statistics (1997 and 2000). In 2005 a total number of 204,746 apheresis procedures were carried out, with a clear-cut prevalence of apheresis production (87.7%), performed by 66 out of 83 Apheresis Units (79.5). Lombardy, Veneto and Tuscany were the most active regions for therapeutic apheresis (51.1% of the total national procedures). An increasing number in extracorporeal photochemotherapy as compared to the 2000 national survey (3,386 vs. 704 procedures) is the most striking observation to emerge from the 2005 data collection on therapeutic apheresis in Italy. Adverse effects, predominantly mild ones (i.e., paresthesia due to citrate-induced hypocalcemia), occurred in 0.12% of apheresis production and 6.04 of therapeutic sessions, particularly in the course of peripheral blood stem cell collection (20.79%), as already reported in the 2000 national survey.     

门诊森田疗法治疗失眠症的对照研究

目的探讨门诊森田疗法辅助药物治疗失眠症的近期疗效和远期疗效。方法将60例失眠症患者随机分为研究组和对照组各30例,两组患者均口服佐匹克隆治疗,研究组辅以门诊森田疗法,于治疗前、治疗4周后及随访3个月时,分别用匹兹堡睡眠质量指数(PSQI)评定近期和远期临床效果。结果治疗4周后,研究组PSQI中6个因子分低于对照组,差异有统计学意义(t=1.98~2.76,P0.05);随访3个月时,PSQI中6个因子分低于对照组,差异有统计学意义(t=2.35~4.09,P0.05)。结论门诊森田疗法辅助药物治疗失眠症的近期效果和远期效果均优于单纯药物治疗。     

Antibiotic policies in Italian hospitals: still a lot to achieve

A national survey was conducted using a mailed questionnaire in 2000 to quantify the prevalence in Italian hospitals of policies aimed to reduce the emergence and dissemination of resistant strains. The study population consisted of all of the Italian teaching and research hospitals, as well as all public hospitals with 300 beds or more; a 50% random sample of public hospitals smaller than 300 beds was selected. The overall response rate was 80% (428/535). Of the respondents, 9.6% claimed to have implemented a surveillance system of antimicrobial resistance and to be able to identify repeated isolations; 90% had a hospital formulary in place, 50% had a pharmacy committee, and 18% had an antibiotic policy subcommittee that met at least once a year in 1999. Forty-one percent implemented restriction policies based on written justifications for antibiotics, and 8% provided susceptibility results for first line antibiotics only. Antibiotic consumption was monitored by using the Defined Daily Dose, as a unit of measure, in 11% of the cases. Of the respondent hospitals, 251 (58.6%) claimed to have defined clinical practice guidelines for handwashing, 156 (36.4%) for isolation procedures, and seven (1.6%) for the control of methicillin-resistant Staphylococcus aureus (MRSA) infections. Our data demonstrates that intensive efforts are necessary to understand barriers better to change and to identify solutions to adopt uniform, comprehensive policies for antimicrobial resistance in Italy.     

Retrospective analysis of outcomes of outpatient parenteral antimicrobial therapy (OPAT) for necrotising otitis externa

European Journal of Clinical Microbiology & Infectious Diseases - Necrotising otitis externa (NOE) is an uncommon but life-threatening infection that requires prolonged systemic antimicrobial...     

Lessons from the catastrophic antiphospholipid syndrome (CAPS) registry

Although less than 1% of patients with the antiphospholipid syndrome (APS) develop the catastrophic variant, its potentially lethal outcome emphasizes its importance in clinical medicine today. However, the rarity of this variant makes it extraordinarily difficult to study in any systematic way. In order to put together all the published case reports as well as the new diagnosed cases from all over the world, an international registry of patients with catastrophic APS ("CAPS Registry") was created in 2000 by the European Forum on Antiphospholipid Antibodies. Currently, it documents the entire clinical, laboratory and therapeutic data of more than 300 patients whose data has been fully registered. This registry can be freely consulted at the Internet (www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) and it is expected that the periodical analysis of these data will allow us to increase our knowledge of this condition.     

Availability of HLA-allele-matched unrelated donors and registry size: Estimation from haplotype frequency in the Italian population

In Italy, an HLA-matched unrelated donor is currently the primary donor when a HLA matched sibling is not found for allogeneic haematopoietic stem cell transplantation (HSCT). Better outcomes for transplantation require optimal matching between donor and recipient at least at the HLA-A, -B, -C, and -DRB1 loci; therefore, the availability of HLA-matched unrelated donors is important. The enormous HLA polymorphism has always necessitated registries with a large number of individuals in order to be able to provide well-matched donors to a substantial percentage of patients. In order to increase the efficiency of the Italian Bone Marrow Donor Registry (IBMDR) in providing Italian patients with a suitable donor, the probability of finding an HLA-A, -B, -C, and -DRB1 allele-matched (8/8) or a single mismatch unrelated donor (7/8) was estimated in this study according to IBMDR size. Using a biostatistical approach based on HLA haplotype frequencies of more than 100,000 Italian donors enrolled in the IBMDR and HLA-typed at high-resolution level, the probability of finding an 8/8 HLA-matched donor was 23.8%; 33.4%; and 41.4% in simulated registry sizes of 200,000; 500,000; and 1,000,000 donors; respectively. More than 2 million recruited donors are needed to increase the likelihood of identifying an HLA 8/8 matched donor for 50% of Italian patients.If one single mismatch at HLA I class loci was accepted, the probability of finding a 7/8 HLA-matched donor was 62.8%; 73.7%; and 80.3% in 200,000 donors; 500,000; and 1,000,000 donors; respectively.Using the regional haplotype frequencies of IBMDR donors, the probability of recruiting a donor with a new HLA phenotype, in the different Italian regions, was also calculated. Our findings are highly relevant in estimating the optimal size of the national registry, in planning a cost-effective strategy for donor recruitment in Italy, and determining the regional priority setting of recruitment activity in order to increase the phenotypic variability of IBMDR as well as its efficiency.     

OPAT for cellulitis: its benefits and the factors that predispose to longer treatment

This retrospective study investigated the demographics and treatment outcomes of patients with cellulitis receiving outpatient parenteral antibiotic therapy (OPAT) between 2010 and 2014 in Cambridge University Hospitals. The rate of treatment failure (as indicated by the readmission to hospital) was low, at 5.5%. Risk factors associated with a longer duration of OPAT treatment included: immunosuppression, peripheral vascular disease, obesity, lymphoedema, previous cellulitis and diabetes.     

The German national registry for primary immunodeficiencies (PID)

In 2009, a federally funded clinical and research consortium (PID–NET, http://www.pid‐net.org ) established the first national registry for primary immunodeficiencies (PID) in Germany. The registry contains clinical and genetic information on PID patients and is set up within the framework of the existing European Database for Primary Immunodeficiencies, run by the European Society for Primary Immunodeficiencies. Following the example of other national registries, a central data entry clerk has been employed to support data entry at the participating centres. Regulations for ethics approvals have presented a major challenge for participation of individual centres and have led to a delay in data entry in some cases. Data on 630 patients, entered into the European registry between 2004 and 2009, were incorporated into the national registry. From April 2009 to March 2012, the number of contributing centres increased from seven to 21 and 738 additional patients were reported, leading to a total number of 1368 patients, of whom 1232 were alive. The age distribution of living patients differs significantly by gender, with twice as many males than females among children, but 15% more women than men in the age group 30 years and older. The diagnostic delay between onset of symptoms and diagnosis has decreased for some PID over the past 20 years, but remains particularly high at a median of 4 years in common variable immunodeficiency (CVID), the most prevalent PID.     

Family Therapy: A Comprehensive Overview (Book)

This study was designed to assess anxiety in visually handicapped children and youth using multiple measures. Seventy-five visually handicapped children and youth were assessed in special education programs in Illinois. The primary purpose was to replicate and extend the few studies in the area, by establishing reliability data on the scales, examining the interrelationship of the Self-Evaluation Questionnaire, Fear Survey Schedule for Children, and Children's Manifest Anxiety Scale on self-report. Reliability coefficients of .74 on the Self-Evaluation Questionnaire to .96 on the Fear Survey Schedule were found. These data show good internal consistency and suggest that a unitary construct is being measured. Second, the correlation between the total scores for all three measures and State-Trait factors of the Self-Evaluation Questionnaire were measured and proved that the two factors and total score on the scale were measuring a related construct. Conversely, the Fear Survey Schedule and Child Manifest Anxiety Scale correlated highly with each other, but not with the factor or total scores of the Self-Evaluation Questionnaire. Age and sex differences were also studied and some differences emerged. We consider the implications of these findings and directions for future research.     

Patient satisfaction in an outpatient parenteral antimicrobial therapy (OPAT) unit practising predominantly self-administration of antibiotics with elastomeric pumps

Self-administration of antibiotics using elastomeric pumps has become the most frequently used treatment modality at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne. However, it remains unknown how comfortable patients feel using this mode of treatment. A questionnaire was offered to all patients treated at the OPAT unit between June 2014 and December 2015. The questionnaire was distributed to 188 patients and 112 questionnaires were returned. Seventy-one patients were treated by self-administration, 21 attended the OPAT unit on a daily basis, and 20 received their antibiotics from home-care nurses. Overall, 83–97% of the patients gave the highest possible scores to the four items evaluating their global satisfaction. Subjects treated by self-administration gave a significantly better rating to 6 of the 17 semi-quantitative questions than the patients treated at the OPAT unit or by home-care nurses. There was no item which was more poorly rated by patients treated by self-administered OPAT than by the other treatment groups. In conclusion satisfaction was high in all patients treated by OPAT. The particularly high satisfaction of patients treated by self-administration of antibiotics with elastomeric pumps suggests that a significant number of patients are happy to take over some responsibility for their treatment. Patients’ capacity to appropriate their care themselves should not be underestimated by health care professionals.     

Prodrugs for Gene-Directed Enzyme-Prodrug Therapy (Suicide Gene Therapy)

This review focuses on the prodrugs used in suicide gene therapy.These prodrugs need to satisfy a number of criteria. They must be efficient and selective substrates for the activating enzyme, and be metabolized to potent cytotoxins preferably able to kill cells at all stages of the cell cycle. Both prodrugs and their activated species should have good distributive properties, sothat the resulting bystander effects can maximize the effectiveness of the therapy, since gene transduction efficiencies are generally low. A total of 42 prodrugs explored for use in suicide gene therapy with 12 different enzymes are discussed, particularly in terms of their physiocochemical properties. An important parameter in determining bystander effects generated by passive diffusion is the lipophilicity of the activated form, a property conveniently compared by diffusion coefficients (log P for nonionizable compounds and log D₇ for compounds containing an ionizable centre). Many of the early antimetabolite-based prodrugs provide very polar activated forms that have limited abilities to diffuse across cell membranes, and rely on gap junctions between cells for their bystander effects.Several later studies have shown that more lipophilic, neutral compounds have superior diffusion-based bystander effects. Prodrugs of DNA alkylating agents, that are less cell cycle-specific than antimetabolites and more effective againstnoncycling tumor cells, appear in general to be more active prodrugs, requiring less prolonged dosing schedules to be effective. It is expected that continued studies to optimize the bystander effects and other properties of prodrugs and theactivated species they generate will contribute to improvements in the effectiveness of suicide gene therapy.     

动物辅助疗法的发展应用(综述)

动物辅助疗法(Animal-Assisted Therapy,AAT)是一种以目标为导向的介入方式,在健康或社会服务领域的专家指导参与下,将某些符合特殊条件的动物作为治疗的手段[1]。1动物辅助疗法的回溯最早用动物进行治疗的记载可追溯到1699年,约翰·洛克指出“给孩子狗、松鼠、鸟等动物,让他们照顾,可以鼓励发展孩子们爱的情感和对他人的责任感。”[2]1792年,在英国夸克精神病疗养院中,患者可以照料花园的植物及拥有小动物,目的是通过让病人向依附于他们的生物显示关爱,从而学会自我控制。1867年,德国的贝特癫痫中心,相信动物是一种复原的力量,允许用狗…     

焦点解决短期治疗(SFBT)简介

一、SFBT产生背景 焦点解决短期治疗(Solution-focused Brief Therapy SFBT)是指以寻找解决问题的方法为核心的短程心理治疗技术.它是近二十年逐步发展成熟的心理治疗模式,是在二十世纪八十年代由美国威斯康星州米华基(Milwaukee)的短期家庭治疗中心(Brief Family Therapy Center)的创办者Steve de Shazer及其韩国裔夫人Inn Berg Kim共同发展起来的[1].