Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists.

BackgroundMany US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist.MethodsThis retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals' antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions.ResultsEighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85-.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54-.70) and higher narrow-spectrum β-lactam use (1.43; 1.22-1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86-.99).ConclusionsPatients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship

Antibiotic stewardship implementation and patient-level antibiotic use at hospitals with and without on-site Infectious Disease specialists.

Many US hospitals lack Infectious Disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist. This retrospective VHA cohort included all acute-care patient-admissions during 2016. A mandatory survey was used to identify hospitals' antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy (DOT) per days-present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient-admissions. Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525,451 (95.8%) admissions at ID hospitals and 23,007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use [OR 0.92, (95% CI, 0.85-0.99)]. Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials [OR 0.61 (95% CI, 0.54-0.70)] and higher narrow-spectrum beta-lactam use [OR 1.43 (95% CI, 1.22-1.67)]. Total antibacterial exposure (inpatient plus post-discharge) was lower among patients at ID versus non-ID sites [OR 0.92 (95% CI, 0.86-0.99)]. Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship

Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study

BACKGROUND: Greater adherence to antibiotic-prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large. OBJECTIVE: To assess physician knowledge and acceptance of antibiotic-prescribing guidelines through the use of case vignettes. DESIGN: We conducted semistructured interviews with 30 inpatient physicians. Participants were asked to respond to 3 hypothetical case vignettes: (1) a skin and soft tissue infection (SSTI), (2) suspected hospital-acquired pneumonia (HAP), and (3) asymptomatic bacteriuria (ASB). All participants received feedback according to guidelines from the Infectious Diseases Society of America (IDSA) and were asked to discuss their level of comfort with following these guidelines. SETTING: Two acute care teaching hospitals for adult patients. INTERVENTION: None. MEASUREMENTS: Data from transcribed interviews were analyzed using emergent thematic analysis. RESULTS: Participants were receptive to guidelines and believed they were useful. However, participants' responses to the case vignettes demonstrated that IDSA guideline recommendations were not routinely followed for SSTI, HAP, and ASB. We identified 3 barriers to guideline-concordant care: (1) physicians' lack of awareness of specific guideline recommendations; (2) tension between adhering to guidelines and the desire to individualize patient care; and (3) skepticism of certain guideline recommendations. CONCLUSIONS: Case vignettes may be useful tools to assess physician knowledge and acceptance of antibiotic-prescribing guidelines. Using case vignettes, we identified 3 barriers to following IDSA guidelines. Efforts to improve guideline-concordant antibiotic prescribing should focus on reducing such barriers at the local level

The Effect of Contact Precautions for MRSA on Patient Satisfaction Scores

Contact precautions may have an adverse effect on a patient's hospital experience and the delivery of care. This case–control study compared patient satisfaction scores between 70 patients isolated for MRSA and 139 non-isolated patients. Based on an adjusted analysis, there was no difference in patient satisfaction between the two groups. Age and educational status were found to affect patient satisfaction

A new constitution of Gratian

The article offers an edition and commentary of a previously unknown constitution of Gratian, discovered on the final folio of Arras, Médiathèque Municipale MS 644 (CGM 572). Although severely abridged and difficult to read, this newly identified document addresses the status of formerly abandoned children (expositi) who have been taken in within an ecclesiastical context. It establishes that the biological father – or, in the case of slaves, the original master – can no longer reclaim them. This law is best understood within the broader context of late antique legislation on expositi, while early Christian sources illuminate the historical circumstances that may have prompted such legislation. Finally, the hypothesis that this law may have originated from the Theodosian Code is examined. An appendix highlights the utility of prose rhythm in establishing the text

Human voice and instrumental voice : an investigation of voicelikeness

This artistic research explores the relationships between human and instrumental voice (in the case of string instruments), seen from an embodied and performative point of view. The question originates from my experience of violinist and composer. Voice is a unique mark of human identity: if this is particularly true for vocal timbre, something similar is at play in the ‘instrumental voice’, as a unique expression of personal and musical identity. This research aims to uncover the importance of this vocal and instrumental relationship, acknowledging their common embodied nature and shared origins. As utterances directed at the ‘other’, both human and instrumental voice are deeply relational. From 2016 to 2022, I investigated the question of the voicelikeness between a musician’s voice and their own instrument through five multidisciplinary art projects: in Imaginary Spaces fragments of individual and collective voice inhabited a performative environment shared by musicians and audience; The end of no ending focused on the relationships between two female voices and their mutable surroundings; Between word and life explored the multiple relationships of voice and instrument in an electroacoustic space, de-multiplied by bringing in dance and video; Sounding Bodies gathered human and mechanical bodies to explore an unconventional space, inviting the audience to follow their path; Medusa was a music theatre work putting into perspective the question of voicelikeness by evoking Italian Early Baroque music, visual art, and dance. This artistic research was carried out through an artistic process, with supporting methods such as grounded theory, ethnography, and autoethnography, creating a virtuous cycle between practice and theory, with some interesting and unexpected changes taking place in my artistic journey. The research outcomes consist of a written part combined with a collection of traces, sounds, images, and video examples presented in the Research Catalogue. The theoretical framework for this inquiry includes recent studies in palaeoanthropology, human development, music psychology, and embodiment. Cavarero’s philosophy of voice, Arendt’s philosophy of the ‘in-between’, various philosophies of the ‘other’, as well as other contributions from psychoanalysis are put in mutual dialogue with my artistic practice. Among the research outcomes are the re-evaluation of vocal layers in personal and musical identity, considering music making as a relational practice, and an exploration of the porous boundaries between the roles of composer, performer, and listener. In this perspective, the new terms to ‘in-hear’ and to ‘co-hear’ respectively denote an attention to inner sounds, and towards one another in a community of listeners

From Latin to Greek and Back Again : Translations, Interpolations, and Abuses of a Law of Theodosius II (Cod.Theod. 16.5.66)

The translation history of a law of Theodosius II (abridged in Cod.Theod., Greek translation of the lost unabridged Latin original in the Acts of the Council of Ephesus, two Latin back-translations of the Greek) illustrates methods and mistakes in the fifth and sixth centuries in the context of the Three Chapters controversy

'Laudantes Elegi:' Ovid’s Exile and the Metamorphoses of Praise, Friendship, and Love in Late Latin Poetry

Taking a cue from the re-use of love themes as praise motives enacted by Ovid in his exile elegies, this paper illustrates the reception of such imagery in late antique Latin poetry. Touchstones for this enquiry are mainly the verse panegyrics by Claudian and the elegiac short poems by Venantius Fortunatus, considered as two different realisations of a common langue of praise in two different cultural and socio-historical milieus. More specifically, the aim of this paper is to show the increasing intermingling of languages of love, praise, and friendship (meant as the complex set of social relationships involved by the Latin amicitia): eventually, this highly stylised language survived until the early Middle Ages in the form of Christian spiritual friendship and ennobling love. Furthermore, when dealing with women patrons, this set of images results in intended literary overlaps, the most remarkableoutcomes being perhaps recognisable in Fortunatus’ elegies to St. Radegund

Comparative study on imaging quality in PET acquisition modes: validation of a protocol for reducing the radiation dose

OBJECTIVE: The present study is aimed at validating a 3D acquisition protocol for positron emission tomography as a replacement for the 2D mode, to reduce the radiation dose delivered to patients, without any loss in the quality of images. MATERIALS AND METHODS: The study comprised 27 simulations in a Discovery ST equipment with four-minute 2D acquisitions, and two-minute and four-minute 3D acquisitions, utilizing a chest phantom according to the National Electrical Manufacturers Association protocol. Six spheres with different diameters were inserted into this phantom as a means for determining the images quality. The images were blindly reviewed by three experienced nuclear physicians who did not know the acquisition modes. Each observer attributed a score 1 when one of the spheres was not identified, or 2 for visible spheres. RESULTS: The qualitative analysis based on generalized kappa coefficient demonstrated that the frequency of visible spheres was higher with four-minute 3D acquisitions (85%), with an also higher interobserver agreement (88.9%), generalized kappa = 0.725 [0.507;0.942]. CONCLUSION: The protocol with four-minute 3D acquisition with lower 18F-FDG activity can be utilized for patients with a biotype similar to the phantom, without any loss in the imaging quality.OBJETIVO: O presente experimento visa a validar um protocolo de aquisição em 3D na tomografia por emissão de pósitrons, em substituição ao modo 2D, de forma a reduzir a dose de radiação nos pacientes, sem perda da qualidade de imagens. MATERIAIS E MÉTODOS: Foram realizadas 27 simulações em equipamento Discovery ST, nos modos 2D com quatro minutos de aquisição e 3D com dois e quatro minutos. Utilizou-se um simulador do protocolo da National Electrical Manufacturers Association. No interior deste simulador estão inseridas seis esferas com diferentes diâmetros para a determinação da qualidade de imagem. As aquisições foram comparadas por três médicos nucleares, sem que eles identificassem o modo de aquisição. Cada observador atribuiu o valor igual a 1 quando alguma esfera não foi identificada ou valor 2 para esferas visíveis. RESULTADOS: A análise qualitativa pelo kappa generalizado demonstrou que a frequência de esferas visíveis foi maior no modo 3D com quatro minutos (85%) e a porcentagem de concordância também foi maior (88,9%), com kappa generalizado = 0,725 [0,507;0,942]. CONCLUSÃO: O modo 3D com quatro minutos de aquisição e com menores atividades de FDG-18F pode ser utilizado em pacientes com biótipo equivalente ao simulador, sem perda de qualidade de imagem.Hospital Albert Einstein Setor de Medicina NuclearUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemHospital Israelita Albert Einstein Setor de Medicina NuclearHospital Israelita Albert Einstein Departamento de ImagemUNIFESP, EPM, Depto. de Diagnóstico por ImagemSciEL

Bridging human and instrumental vocality. Lectio praecursoria.

My artistic research explores the relations between human and instrumental voice seen from embodied and performative perspectives, starting with my experience of violinist and composer. Voice is a unique mark of human identity: human and instrumental voice are both unique expression of personal and musical identity. I investigated the question of voicelikeness through five multidisciplinary art projects. The research proposes the re-evaluation of vocal layers in varying contexts