Development and Implementation of a Pharmacist-managed Outpatient Parenteral Antimicrobial Therapy Program

Purpose The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described. Summary A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, and (5) acquisition of administrative support to approve the program. In this program, the OPAT pharmacist plays an integral role in the management and oversight of OPAT patients, working under a collaborative agreement with infectious diseases physicians. The OPAT pharmacist assists with appropriate patient and regimen selection, confirmation of orders on discharge, assuring that laboratory tests for safety surveillance are performed and evaluated, performing routine monitoring for adverse events and line complications, and assuring the removal of the vascular access device upon the completion of OPAT. Conclusion: The OPAT program provides structured monitoring, patient follow-up, and led to improvements in patient outcome with minimization of treatment and line-related adverse events

Correlation of Adherence to the 2012 Infectious Diseases Society of America Practice Guidelines with Patient Outcomes in the Treatment of Diabetic Foot Infections in an Outpatient Parenteral Antimicrobial Programme

Aim To evaluate adherence to the 2012 Infectious Diseases Society of America practice guidelines for the management of patients with diabetic foot infections and to determine an association between adherence and clinical outcome. Methods A retrospective chart review was performed to evaluate the management and clinical outcomes of patients with diabetic foot infections treated with outpatient parenteral antimicrobial therapy between 1 January 2011 and 30 June 2012 at Wishard Health Services/Eskenazi Health. Adherence to individual Infectious Diseases Society of America diabetic foot infection treatment guideline recommendations was measured, and then assessed in relation to clinical outcome. Results A total of 57 patients (61% male, mean age 54 years) with moderate to severe diabetic foot infection met the inclusion criteria. None of the treatment courses of these patients adhered to all the Infectious Diseases Society of America guideline recommendations. The recommendations most frequently adhered to were consultation of appropriate multidisciplinary teams (n=54, 94.7%) and performance of diagnostic imaging (n=52, 89.5%). The recommendations least frequently adhered to were diabetic foot wound classification scoring on admission (n=0, 0%), appropriate culture acquisition (n=12, 21.2%), surgical intervention when indicated (n=32, 46.2%) and appropriate empiric antibiotic selection (n=34, 59.7%). Of 56 patients, 52 (92.9%) experienced clinical cure at the end of outpatient parenteral antimicrobial therapy compared with 34 of 53 patients (64%) at 6 months after the completion of therapy. Adherence to individual guidelines was not associated with clinical outcome. Patients who experienced treatment failure were more likely to have severe diabetic foot infection or peripheral neuropathy. Conclusions Adherence to the Infectious Diseases Society of America diabetic foot infection guideline recommendations was found to be suboptimal in the present study. The effect of adhering to individual Infectious Diseases Society of America diabetic foot infection recommendations on clinical outcome needs to be investigated

Opening new dimensions for e-Tourism

In this paper we describe an e-Tourism environment that takes a community-driven approach to foster a lively society of travelers who exchange travel experiences, recommend tourism destinations or just listen to catch some interesting gossip. Moreover, business transactions such as booking a trip or getting assistance from travel advisors or community members are constituent parts of this environment. All these happen in an integrated, game-like e-Business application where each e-Tourist is impersonated as an avatar. More precisely, we apply 3D Electronic Institutions, a framework developed and employed in the area of multi-agent systems, to the tourism domain. The system interface is realized by means of a 3D game engine that provides sophisticated 3D visualization and enables humans to interact with the environment. We present "itchy feet", a prototype implementing this 3D e-Tourism environment to showcase first visual impressions. This new environment is a perfect research playground for examining heterogeneous societies comprising humans and software agents, and their relationship in e-Tourism. © Springer-Verlag London Limited 2006

Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516–2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity

Second Edition FRCSyn Challenge at CVPR 2024: Face Recognition Challenge in the Era of Synthetic Data

Synthetic data is gaining increasing relevance for training machine learning models. This is mainly motivated due to several factors such as the lack of real data and intra-class variability, time and errors produced in manual labeling, and in some cases privacy concerns, among others. This paper presents an overview of the 2nd edition of the Face Recognition Challenge in the Era of Synthetic Data (FRCSyn) organized at CVPR 2024. FRCSyn aims to investigate the use of synthetic data in face recognition to address current technological limitations, including data privacy concerns, demographic biases, generalization to novel scenarios, and performance constraints in challenging situations such as aging, pose variations, and occlusions. Unlike the 1st edition, in which synthetic data from DCFace and GANDiffFace methods was only allowed to train face recognition systems, in this 2nd edition we propose new sub-tasks that allow participants to explore novel face generative methods. The outcomes of the 2nd FRCSyn Challenge, along with the proposed experimental protocol and benchmarking contribute significantly to the application of synthetic data to face recognition

Tenants' campaigns for tenure neutrality and a general needs model of social housing: making universal claims

The policy of tenure neutrality championed by the International Union of Tenants as essential to a right to adequate housing advances a model of general needs or, in other words, universal social rented housing provision unrestricted by income limits or needs-based rationing. Support for this model has been severely undermined by recent European Commission rulings that have restricted access to social housing to those least capable of coping in a competitive market place. As general needs demand for affordable housing continues to swell, the challenge for adherents of tenure neutrality is to demonstrate that universal social housing can meet both the needs of the most vulnerable and the demands of those excluded from homeownership by price inflation and credit limits. This paper examines the promotion of universal social housing by tenants’ organisations and challenges the extent to which this model is intended ‘for all’. In a case study of the defence of municipal housing by English tenants’ movements, it identifies the exclusionary narratives that render the particular housing needs of advantaged social groups as universal. The paper concludes by reviewing strategies to resolve the tensions between the universal and the particular to reinvigorate support for tenure neutrality in arguments for widening access and supply of social housing