Impact of a checklist used by pharmacists on hospital antimicrobial use: a patient-level interrupted time series study.

BACKGROUND: Antimicrobial misuse leading to drug resistance is a growing concern for clinicians. Improving antimicrobial stewardship programmes through development of new tools could be part of the solution. AIM: To evaluate antimicrobial use in hospitalized patients after implementation of an antimicrobial checklist for ward-based clinical pharmacists. METHODS: A checklist based on quality indicators of optimal antimicrobial use was implemented to standardize hospital pharmacists' assessments of antimicrobial therapy. Antimicrobial use metrics from adults hospitalized during the control and intervention periods were assessed in an interrupted time series analysis of individual patient data. The primary endpoint was days of therapy (DOT) for all antimicrobials per 1000 days present for included patients. Secondary endpoints were the DOT of extended-spectrum antimicrobials (DOT-ES), length of therapy of all antimicrobials (LOT) and the number of pharmacist interventions. FINDINGS: One-thousand six-hundred and nineteen patients were included: 800 and 819 in the pre- and post-checklist implementation periods, respectively. As indicated by the point estimates and their 95% confidence intervals (CIs), there were no changes in trend for DOT, DOT-ES or LOT. A change in level was not found for the DOT, while a change of -118 DOT-ES [-209,-28] and -51 LOT [-97,-4] was documented. Furthermore, pharmacists' interventions regarding antimicrobials increased by 18.7% (14.0, 23.5) and progress notes by 32.3% (27.8, 36.8). CONCLUSION: An antimicrobial checklist used by ward-based clinical pharmacists did not decrease DOT for all antimicrobials, but decreased DOT-ES and LOT upon its implementation.

Ester hydrolysis with 2,6-di(pyrazol-3-yl)pyridines and their CoII complexes in homogeneous and micellar media.

The 1:1 complex of Co(ClO4)2 with the H2O-insoluble tridentate 2,6-di(1H-4,5,6,7-tetrahydroindazol-3-yl)pyridine (H21) was found to be an excellent catalyst for the hydrolysis of para-nitrophenyl acetate in aqueous buffers over the pH 7.05-7.90 range, with an estimated second-order rate constant of 0.50 M(-1) s(-1). The Co2+ complexes of the N,N'-di-1-dodecyl analogue in micellar media and the N,N'-di-(4-carboxyphenyl) analogue in aqueous media were much poorer catalysts, poorer than the free ligands. In all cases, the pH-rate profiles indicated that free base, deprotonated or hydroxo forms were the active species. The greater success with Co(H(2)1)2+ indicated a catalytic role for N-H deprotonation.

Statistical power for the two-factor repeated measures ANOVA.

Determining a priori power for univariate repeated measures (RM) ANOVA designs with two or more within-subjects factors that have different correlational patterns between the factors is currently difficult due to the unavailability of accurate methods to estimate the error variances used in power calculations. The main objective of this study was to determine the effect of the correlation between the levels in one RM factor on the power of the other RM factor. Monte Carlo simulation procedures were used to estimate power for the A, B, and AB tests of a 2 x 3, a 2 x 6, a 2 x 9, a 3 x 3, a 3 x 6, and a 3 x 9 design under varying experimental conditions of effect size (small, medium, and large), average correlation (.4 and .8), alpha (.01 and .05), and sample size (n = 5, 10, 15, 20, 25, and 30). Results indicated that the greater the magnitude of the differences between the average correlation among the levels of Factor A and the average correlation in the AB matrix, the lower the power for Factor B (and vice versa). Equations for estimating the error variance of each test of the two-way model were constructed by examining power and mean square error trends across different correlation matrices. Support for the accuracy of these formulae is given, thus allowing for direct analytic power calculations in future studies.

[Internalized and externalized disorders in children witness to conjugal violence and their associated variables: a literature review.]. / Les troubles extériorisés et intériorisés des enfants témoins de violence conjugale et leurs variables associées : une recension des écrits.

This article presents a literature review on externalized and internalized disorders in children who are witness to conjugal violence as well as the major variables associated with the development of these disorders. Among these variables, there are age and gender of the child, the type of violence they witness, maternal stress, educational skills of parents as well as physical and sexual abuse. The limits of major studies published over the last two decades are also exposed. Finally, new avenues of research that might shed new light on a more recent knowledge of the issue, are proposed.

Comparison of aero-bars versus traditional cycling postures on physiological parameters during submaximal cycling.

The purpose of this investigation was to quantify the difference in energy expenditure between traditional cycling handlebars and aero-bars during outdoor submaximal cycling. Eleven trained cyclists (age = 29.3 +/- 1.9 years, weight = 69.4 +/- 3.8 kg, VO2max = 58.1 +/- 2.0 ml.kg-1.min-1) were randomly assigned a sequence of three hand positions: brake hoods (BH), drop-bars (DB), and aero-bars (AB). Subjects cycled at 30 km.h-1 in one position for 5 minutes, then recovered until HR fell below 120 bpm. This was then repeated for the other hand positions. All cycling was completed on a standard racing bike fitted with aero-bars. Tire pressure was held constant for all trials. A portable telemetric system (Cosmed K-2) was used to measure VO2, VE and heart rate (HR) during the trials. No statistical differences were observed between AB and DB. Significant differences (p < .05) were found between BH (VE = 66.1 +/- 2.7 L.min-1; HR = 152 +/- 4 bpm; VO2 = 1.56 +/- .15 L.min-1) and AB (VE = 61.3 +/- 2.8 L.min-1; HR = 146 +/- 4 bpm; VO2 = 1.31 +/- .10 L.min-1). AB provides an energy savings over the traditional BH cycling posture.

Effects of liver disease on the pharmacokinetics of intravenous and oral chlordesmethyldiazepam.

We studied the pharmacokinetics of a single 0.5-mg i.v. dose of chlordesmethyldiazepam in 8 patients with liver disease and in 12 age-matched healthy controls. The kinetics were also studied of a single 1-mg oral dose in the patients with liver disease. After i.v. administration the kinetics of total chlordesmethyldiazepam in patients with liver disease differed from those in controls: elimination half-life was almost twice that in controls (395 and 204 h), as a consequence of a marked reduction in total clearance (0.13 and 0.25 ng.ml-1.h-1), whereas the apparent volume of distribution was similar in patients and controls (4.7 and 3.9 l/kg-1). The free fraction of the drug in patients was higher (5.5%) than in controls (2.9%). Correction for differences in protein binding revealed clearance in the patients was one-fifth (1.8 and 10.5 ng ml-1.kg-1) and volume of distribution one-half (65.0 and 118.4 l.kg-1) that in controls. The systemic availability of oral chlordesmethyldiazepam was high (110%) in spite of a relatively slow absorption rate. These results indicate a need for caution in the administration of chlordesmethyldiazepam to patients with liver disease.

Hypersensitivity with hepatotoxicity to mesalazine after hypersensitivity to sulfasalazine.

A 21-year-old woman with Crohn's disease of the colon developed a skin rash after 3 weeks of treatment with sulfasalazine. Administration of sulfasalazine was discontinued. When mesalazine was instituted 1 week later, she developed a severe hypersensitivity reaction characterized by fever, diarrhea, skin rash with subsequent desquamation, marked atypical lymphocytosis, and severe hepatotoxicity. Recovery was complete. The clinical and biological features as well as liver pathology of this case bear a striking resemblance to earlier reports of hypersensitivity reaction with severe hepatotoxicity to sulfasalazine. The authors urge caution when mesalazine is given to a patient with known hypersensitivity to sulfasalazine.