The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study.

BACKGROUND: In Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common infections in children and adults. METHODS: Hospital-based guidelines for oral community -based treatment of acute otitis media, sinusitis, tonsillopharyngitis, community-acquired pneumonia and afebrile urinary tract infection were identified in 2017 in an iterative process by contacting hospital pharmacists and infectious diseases specialists. Furthermore, newly available national guidelines published in 2019 were reviewed. Available pack sizes for recommended solid, dispersible and liquid antibiotic formulations were retrieved from the Swiss pharmaceutical register and compared with recommended regimens to determine optimal (no leftovers) and adequate (optimal +/- one dose) matches. RESULTS: A large variety of recommended regimens were identified. For adults, optimal and adequate packs were available for 25/70 (36%) and 8/70 (11%) regimens, respectively. Pack-regimen matching was better for WHO Watch (optimal: 15/24, 63%) than Access antibiotics (optimal: 7/39, 18%). For the four paediatric weight-examples and 42 regimens involving child-appropriate formulations, optimal and adequate packs were available for only 14/168 (8%) and 27/168 (16%), respectively. Matching was better for older children with higher body and for longer treatment courses > 7 days. CONCLUSIONS: Fixed antibiotic packs often do not match recommended treatment regimens, especially for children, potentially resulting in longer than necessary treatments and leftover doses in the community. As part of national stewardship, a move to an exact pill-count system, including for child-appropriate solid formulations, should be considered

Nosokomiale Harnwegsinfektionen des Erwachsenen

Zusammenfassung: Die Harnwegsinfektion ist die häufigste Infektion des Erwachsenen im Spital. Sie ist meistens mit dem Tragen von Harnwegskathetern assoziiert. Entscheidend sind daher die richtige Indikationsstellung für die Kathetereinlage, die frühzeitige Wiederentfernung des Katheters sowie die korrekte Diagnosestellung zur Vermeidung unnötiger antibiotischer Behandlungen. Die therapeutischen Überlegungen sollten die Komorbiditäten und potenzielle Behinderungen des Urinabflusses mit einschließen. In der Behandlung stehen Chinolone, Breitspektrumpenizilline und Cephalosporine der 3.Generation im Vordergrund. Bei den ökonomischen Überlegungen sollte v.a. der höhere Preis von i.v.-Antibiotika im Vergleich zu per os mit einfließe

Impfungen gegen Pneumokokken und Influenza: Wie groß ist die Evidenz?

Zusammenfassung: Durch Pneumokokken verursachte Infektionen und die Influenza können bei Kindern und älteren Personen sowie bei chronisch Kranken und Immunosupprimierten zu schweren, komplizierten Verläufen führen. Bei der alternden Bevölkerung in westlichen Ländern sind sie wichtige Ursachen für erhöhte Morbidität und Letalität. Weltweit unterstreicht die Antibiotikaresistenzentwicklung die Notwendigkeit der effektiven Impfung. Der 23-valente Polysaccharidimpfstoff gegen Pneumokokken wird kontrovers diskutiert. Neue Metaanalysen zeigten keine/wenig Wirksamkeit der Impfung in Bezug auf invasive Pneumokokkenerkrankungen oder Gesamtletalität. Jedoch dokumentierte eine neue Studie bei Pflegeheimbewohnern eine signifikante Reduktion von Pneumonie und Tod durch Pneumokokkenerkrankungen nach Impfungen. Der 7-valente Konjugatimpfstoff ist bei Kindern und bei Immunosupprimierten deutlich immunogener und effizienter und ist im schweizerischen Impfplan für Kinder integriert. In Deutschland wurde er bereits durch den 13-valenten Konjugatimpfstoff ersetzt. Influenzaimpfungen sind gut immunogen. Dies wird durch Adjuvanzien bei einer älteren Bevölkerung erhöht. Aufgrund der pandemischen Influenza H1N1 2009 wurden die Impfempfehlungen und die Zusammensetzung der Impfstoffe durch die WHO für den Herbst/Winter 2010/2011 entsprechend angepasst. Die Influenzaimpfung bietet zwar keinen guten Schutz gegen die Ansteckung, jedoch einen guten Schutz gegen Komplikationen der Influenz

The Utility of Trouble: Maximizing the Value of Our Human Services Dollars

Outlines recommendations to standardize service delivery areas and consolidate area offices of the state's seven largest human services agencies, as well as to close antiquated institutions. Projects benefits such as improved accessibility and savings

Finite-Volume Energy Spectrum, Fractionalized Strings, and Low-Energy Effective Field Theory for the Quantum Dimer Model on the Square Lattice

We present detailed analytic calculations of finite-volume energy spectra, mean field theory, as well as a systematic low-energy effective field theory for the square lattice quantum dimer model. The analytic considerations explain why a string connecting two external static charges in the confining columnar phase fractionalizes into eight distinct strands with electric flux $\frac{1}{4}$. An emergent approximate spontaneously broken $SO(2)$ symmetry gives rise to a pseudo-Goldstone boson. Remarkably, this soft phonon-like excitation, which is massless at the Rokhsar-Kivelson (RK) point, exists far beyond this point. The Goldstone physics is captured by a systematic low-energy effective field theory. We determine its low-energy parameters by matching the analytic effective field theory with exact diagonalization results and Monte Carlo data. This confirms that the model exists in the columnar (and not in a plaquette or mixed) phase all the way to the RK point.Comment: 35 pages, 16 figure

Irreversible reorganization in a supercooled liquid originates from localised soft modes

The transition of a fluid to a rigid glass upon cooling is a common route of transformation from liquid to solid that embodies the most poorly understood features of both phases1,2,3. From the liquid perspective, the puzzle is to understand stress relaxation in the disordered state. From the perspective of solids, the challenge is to extend our description of structure and its mechanical consequences to materials without long range order. Using computer simulations, we show that the localized low frequency normal modes of a configuration in a supercooled liquid are causally correlated to the irreversible structural reorganization of the particles within that configuration. We also demonstrate that the spatial distribution of these soft local modes can persist in spite of significant particle reorganization. The consequence of these two results is that it is now feasible to construct a theory of relaxation length scales in glass-forming liquids without recourse to dynamics and to explicitly relate molecular properties to their collective relaxation.Comment: Published online: 20 July 2008 | doi:10.1038/nphys1025 Available from http://www.nature.com/nphys/journal/v4/n9/abs/nphys1025.htm

A system to measure 3-directional relative displacements for a biomedical application

A micro system for measuring the relative displacements between a bone and an implant in a prosthetic hip of a human being has been realized. Novel are the small dimensions of the system combined with the possibility to measure relative displacements in three directions. The system consists of a microsensor body, a mechanical transducer element made by precision mechanics, electronics, and the final package. The realization and test results of a prototype system are presented. Typical ranges for these prototypes are ±500 μm for lateral directions and ±50 μm in axial direction

The facilitatory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons

INTRODUCTION AND HYPOTHESIS: Aim of this study was to investigate the excitability of sphincter motor neurons under the influence of pelvic floor muscle training (PFMT) and duloxetine. Due to their mechanisms of action, there might be a synergistic effect of duloxetine and PFMT in regard to the facilitation of spinal reflexes controlling urethral sphincter contractions and hence continence. METHODS: In ten healthy female subjects, clitoral electric stimulation (CES) and transcranial magnetic stimulation (TMS) were used to determine individual motor thresholds for external urethral sphincter (EUS) contractions before and after PFMT, duloxetine, and PFMT + duloxetine. RESULTS: PFMT and duloxetine alone significantly decreased the motor thresholds for EUS contractions during CES and TMS. However, the combined treatment reduced the motor threshold for EUS contractions significantly stronger compared to PFMT or duloxetine alone. CONCLUSIONS: The results are suggestive for a synergistic facilitatory effect of PFMT and duloxetine on sphincter motor neuron activation

Analysis of fast turbulent reconnection with self-consistent determination of turbulence timescale

We present results of Reynolds-averaged turbulence model simulation on the problem of magnetic reconnection. In the model, in addition to the mean density, momentum, magnetic field, and energy equations, the evolution equations of the turbulent cross-helicity $W$, turbulent energy $K$ and its dissipation rate $\varepsilon$ are simultaneously solved to calculate the rate of magnetic reconnection for a Harris-type current sheet. In contrast to previous works based on algebraic modeling, the turbulence timescale is self-determined by the nonlinear evolutions of $K$ and $\varepsilon$, their ratio being a timescale. We compare the reconnection rate produced by our mean-field model to the resistive non-turbulent MHD rate. To test whether different regimes of reconnection are produced, we vary the initial strength of turbulent energy and study the effect on the amount of magnetic flux reconnected in time.Comment: 10 pages, 7 figure

PathOrganic – Risks and Recommendations Regarding Human Pathogens in Organic Vegetable Production Chains

PathOrganic assesses risks associated with the consumption of fresh and minimally processed vegetables due to the prevalence of bacterial human pathogens in plant produce. The project evaluates whether organic production poses a risk on food safety, taking into consideration sources of pathogen transmission (e.g. animal manure). The project also explores whether organic versus conventional production practices may reduce the risk of pathogen manifestation. In Europe, vegetable-linked outbreaks are not well investigated. A conceptual model together with novel sampling strategies and specifically adjusted methods provides the basis for large-scale surveys of organically grown plant produce in five European countries. Critical control points are determined and evaluated and factors contributing to a food safety problem are analyzed in greenhouse and field experiments. The project aims at developing a quantitative risk assessment model and at formulating recommendations for improving food safety in organic vegetable production