RESUMEN
Invasive fungal infections cause substantial morbidity and mortality in immunocompromised hosts. The response rate to therapy, in particular for invasive aspergillosis and invasive mould infections, has been poor. Recently a number of techniques to facilitate early diagnosis of these infections, in parallel with the development of a number of antifungals with increased potency and lower toxicity, have raised optimism that outcomes for invasive fungal infection can be improved upon. The availability of lipid formulations of amphotericin B, azoles with extended spectrum against filamentous fungi and the development of a new class of antifungal agents, the echinocandins, presents the clinician with a range of therapeutic choices. Recent clinical trials have provided important insights into how these agents should be used. In particular, voriconazole has demonstrated superior efficacy to amphotericin B in the management of invasive aspergillosis, posaconazole has been shown to have significant efficacy in the prophylaxis of invasive fungal infection in high-risk individuals and a role in salvage therapy of invasive aspergillosis, caspofungin has demonstrated efficacy in salvage therapy of invasive aspergillosis, and each of the echinocandins show activity without significant toxicity in invasive candidiasis. Nevertheless, many therapeutic areas of uncertainty remain, including the role of combination therapy, and will provide the focus for future studies.
Asunto(s)
Antifúngicos/uso terapéutico , Huésped Inmunocomprometido , Micosis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Azoles/uso terapéutico , Combinación de Medicamentos , Humanos , Micosis/diagnóstico , Péptidos Cíclicos/uso terapéutico , Fosfatidilcolinas/uso terapéutico , Fosfatidilgliceroles/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVES: Invasive pneumococcal disease (IPD) is associated with a high mortality despite antimicrobial therapy, but may be preventable by pneumococcal vaccination. The extent of previous exposure to pneumococcal capsular polysaccharide vaccination prior to an episode of IPD in hospitalised adults in the United Kingdom is unclear. METHODS: We conducted a retrospective cohort study in adults with IPD admitted to either of two teaching hospitals in Sheffield, United Kingdom during 1992-2000. Receipt of pneumococcal vaccination, risk factors for IPD, death and disability were determined. RESULTS: The number of cases of IPD was 552 and 187/230 patient records from one site were reviewed. According to UK pneumococcal vaccination guidelines 59% of patients should have received the vaccine and 76% of patients if updated guidelines, which include age>65 years as an indication, are applied. In patients with known risk factors, excluding age, only 8% had been vaccinated. The mortality from IPD was 21% and an additional 6% suffered major complications. CONCLUSIONS: In patients hospitalised with IPD there is a high rate of pre-existing risk factors and a low rate of administration of pneumococcal vaccination. IPD incurs significant mortality, morbidity and economic cost and there is potential for reducing this by improved uptake of pneumococcal vaccination.
Asunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Factores de Riesgo , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/aislamiento & purificación , Reino Unido/epidemiología , VacunaciónRESUMEN
The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book. We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.
Asunto(s)
Orientación Infantil/métodos , Servicios de Salud Comunitaria , Escolaridad , Educación en Salud/métodos , Padres/educación , Materiales de Enseñanza/provisión & distribución , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Kentucky , Masculino , Pediatría , Áreas de Pobreza , Evaluación de Programas y Proyectos de Salud/métodos , Estudios Prospectivos , Programas Médicos RegionalesRESUMEN
OBJECTIVE: To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning. DESIGN: Survey of mothers of infants =4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals. SETTING: A private practice (PP) serving predominantly white middle- and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky. PATIENTS: Fifty infants from each practice site. OUTCOME MEASURE: The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS). RESULTS: Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice. CONCLUSIONS: Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given.