Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial.

Importance: Pneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.

Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial.

Importance: Urinary tract infection (UTI) is the second most common infection leading to hospitalization and is often associated with gram-negative multidrug-resistant organisms (MDROs). Clinicians overuse extended-spectrum antibiotics although most patients are at low risk for MDRO infection. Safe strategies to limit overuse of empiric antibiotics are needed.

Evaluation of medication administration timing variance using information from a large health system's clinical data warehouse.

Purpose: An analysis to determine the frequency of medication administration timing variances for specific therapeutic classes of high-risk medications using data extracted from a health-system clinical data warehouse (CDW) is presented.

Methods: This multicenter retrospective, observational analysis of medication administration data from 14 hospitals over 1 year was conducted using a large enterprise health-system CDW. The primary objective was to assess medication administration timing variance for focused therapeutic classes using medication orders and electronic medication administration records data extracted from the electronic health record (EHR).

Inpatient or day clinic treatment? Results of a multi-site-study.

Objective: This naturalistic study aimed to identify criteria which are of relevance for making a decision as to whether inpatient or day hospital treatment is indicated.

Methods: In 567 patients who were consecutively admitted to 10 departments of psychosomatic medicine (day hospital or inpatient setting) in Germany, symptom severity at admission and discharge was measured (Symptom-Check-List-90-R, Global Assessment of Functioning). Before admission, clinicians rated aspects that might be important for differential indication (Rating Scale of Indication Criteria).

[Differential indication of inpatient and day clinic treatment in psychosomatics].

Aim of the "DINSTAP"-study is to identify criteria that are of importance for a decision between inpatient or day clinic treatment in patients that are usually admitted to psychosomatic clinics in Germany. 299 inpatient and 268 day clinic treatment episodes from 10 clinics were included in the study. Next to basic data and diagnosis, severity of symptoms and impairment were evaluated (pre, post).

Metabolic alterations in trauma: lactate and pyruvate levels after aortic surgery.

Arterial lactate and pyruvate concentrations were measured in five patients undergoing abdominal aneurysmectomy. In all cases, a bimodal rise and fall in both lactate and pyruvate levels were observed. Hemodynamic data indicated that cardiac output as well as oxygen delivery and consumption were constant throughout this period.

Delayed pulmonary dysfunction in head-injured patients.

Intracranial pressure (ICP), cardiopulmonary function, and the degree of neurological dysfunction were measured in 13 patients with serious head injury to determine the relationship of these indices to the development of delayed pulmonary dysfunction. All patients had serious isolated head injury with Glasgow Coma Scale scores of 7 or less 6 hours after injury and elevated ICP at the time of admission to the protocol. Three patients developed arterial pO2 of less than or equal to 80 torr despite the initiation of elevated inspired oxygen fraction (FIO2 greater than or equal to 0.

Failure of red blood cell transfusion to increase oxygen transport or mixed venous PO2 in injured patients.

Post-trauma patients have an oxygen consumption which is proportional to oxygen delivery, suggesting that tissue oxygen consumption is limited by diffusion. Transfusion of packed red blood cells (RBC), which increases the oxygen-carrying capacity of blood, would be expected to increase mixed venous PO2, thereby improving tissue oxygenation. However, the low P50 of stored blood may increase the affinity of hemoglobin for oxygen and reduce oxygen consumption.