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Benralizumab is an anti-eosinophilic monoclonal antibody that reduces exacerbations and improves lung function for patients with severe, uncontrolled asthma with eosinophilic inflammation. We evaluated the impact of baseline factors on benralizumab efficacy for patients with severe asthma. This analysis used pooled data from the SIROCCO (ClinicalTrials.gov identifier NCT01928771) and CALIMA (ClinicalTrials.gov identifier NCT01914757) Phase III studies. Patients aged 12–75 years with severe, uncontrolled asthma receiving high-dosage inhaled corticosteroids plus long-acting β2-agonists received benralizumab 30 mg subcutaneously every 8 weeks (Q8W, first three doses every 4 weeks (Q4W)), Q4W or placebo. Baseline factors that influenced benralizumab efficacy were evaluated, including oral corticosteroid (OCS) use, nasal polyposis, pre-bronchodilator forced vital capacity (FVC), prior year exacerbations and age at diagnosis. Efficacy outcomes included annual exacerbation rate and change in pre-bronchodilator forced expiratory volume in 1 s at treatment end relative to placebo. Benralizumab Q8W treatment effect was enhanced with each baseline factor for all patients and those with ≥300 eosinophils·μL−1 relative to the overall population. OCS use, nasal polyposis and FVC, Key baseline factors can aid in identifying patients who may respond to benralizumab http://ow.ly/uPVX30ltHTF

One of hip arthroplasty complications is dislocation of the endoprosthesis head. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. This review analyzed the risk factors of dislocation and treatment tactics. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance and a some others. The problem of the biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option; type, fixation and position of endoprosthesis components, experience and surgical technique of a orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.

Background We compared our early experience of visual outcomes, operation time, and complications for two techniques of intrascleral intraocular lens (IOL) fixation: T-fixation and flanged IOL fixation. Methods Data from patients who underwent scleral fixation of an IOL between October 2017 and December 2018 were analyzed retrospectively. Intraoperative time for fixation steps, corneal endothelial cell density (ECD) rate reduction, and intraoperative/postoperative complications were compared between T-fixation (Group T, n = 4) and flanged IOL fixation (Group F, n = 6). Results Mean patient age was 73.7 ± 13.0 years. Intraoperative time was significantly longer for Group T (27.5 ± 9.7 min) than for Group F (13.0 ± 3.8 min; P=0.03, Mann-Whitney U-test). Intraoperative complications included iris damage from the 30-G needle in 2 eyes in Group F. Postoperative complications included iris capture by the IOL in 1 eye in Group F. No incidents of postoperative retinal detachment or IOL dislocation were identified. The ECD reduction rate did not significantly differ between groups. Conclusions Both techniques yielded favorable surgical outcomes. Flanged IOL fixation might be superior because of its shorter intraoperative time but could initially be technically difficult because of the need to perform angled sclerotomy with a 30-G needle to avoid iris injury.

Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication. Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation. Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs. Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible.

This study investigated effects of rate reduction and emphatic stress cues on second formant (F2) trajectories and articulatory movements during diphthong production in 11 typically developing school-aged children. F2 extent increased in slow and emphatic stress conditions, and tongue and jaw displacement increased in the emphatic stress condition compared to habitual speech. Tongue displacement significantly predicted F2 extent across speaking conditions. Results suggest that slow rate and emphatic stress cues induce articulatory and acoustic changes in children that may enhance clarity of the acoustic signal. Potential clinical implications for improving speech in children with dysarthria are discussed.

Objective To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. Materials and methods Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd−/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. Results The CS rate dropped from 33.05 to 26.06% after starting the interventions (p p p p p p = 0.010). Conclusions The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.

Objective. To study the rate of differentiated thyroid carcinomas, owing various characteristics and clinical indices of the disease course, basing on a twenty-year experience of the surgical clinic work in the Institute of Endocrinology and Metabolism named after V. P. Komisarenko NAMS of Ukraine. Materials and methods. Retrospective investigation was conducted, including data about 5526 patients, operated for differentiated thyroidal cancer in 1995 - 2014 yrs. Results. During 20 years the quantity of patients, suffering papillary carcinoma, operated in surgical clinic, have enhanced. Among them the rate of children, teenagers, men and the patients, suffering more aggressive tumors, have reduced. Clinical indices of the disease course, tactic of treatment and prognosis concerning these patients have improved essentially. The spreading, size, invasive and metastatic characteristic of follicular carcinoma through 20 years of observation did not changed essentially, but the rate of patients, suffering severe stages of the disease and those having the poorest prognosis raised. Simultaneously a mortality of patients, suffering follicular carcinomas, have lowered significantly due to the treatment optimization. Conclusion. The analysis performed have witnessed the rate reduction of potentially radio-induced papillary carcinomas, what demands a certain revision and further improvement of the patient’s treatment protocols.

Aim: To assess Ig20Gly tolerability in pediatric patients with primary immunodeficiencies. Patients & methods: Infusion parameters and tolerability were analyzed in pediatric patients (aged 2–5 years [n = 6], 6–11 years [n = 22] and 12–17 years [n = 22]) receiving Ig20Gly in two Phase II/III trials. Results: Of 2624 Ig20Gly infusions, >99% did not require any rate reduction, interruption or discontinuation due to adverse events (AEs). Median maximum infusion rates and volumes/site were higher in patients 12–17 years of age (30 ml/h/site; 30 ml/site) versus 6–11 years (20 ml/h/site; 15 ml/site) and 2–5 years (18 ml/h/site; 14 ml/site). Rates of causally related systemic and local AEs (0.009 and 0.063 AEs/infusion) were low. Conclusion: Ig20Gly infused at relatively high rates and volumes was well tolerated in children.

Introduction Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are common laboratory assays used as markers of inflammation. ESR suffers from higher false positive and false negative rates than CRP. To that end, the American Board of Internal Medicine's (ABIM's) Choosing Wisely campaign has recommended against ESR testing for those with undiagnosed conditions in favor of CRP testing. This study describes the impact of a computerized provider order entry (CPOE) decision support rule against ESR/CRP co-ordering within a community health system that predates the ABIM's Choosing Wisely national guidance. To demonstrate the potential impact of such a CPOE rule within other healthcare settings, ESR/CRP ordering data from a multi-site tertiary care practice and from the commercially insured population in the OptumLabs® Data Warehouse (OLDW) were analyzed and the relative reduction in ESR/CRP co-ordering achieved within the community health system was projected onto these populations. Materials and methods ESR and/or CRP orders from a community health system were assessed from 2012 to 2016. Co-ordering and test concordance rates between ESR and CRP were compared before and after CPOE decision support rule launch. Similarly, ESR/CRP co-ordering across three tertiary care sites from 2015 to 2016 and the OLDW from 2009 to 2013 were assessed and the co-ordering rate reduction achieved in the community health system was mathematically projected onto these populations. Estimated payer savings from the rule's effect were calculated within each population using Medicare reimbursement rates. Results The CPOE decision support rule realized an unadjusted 42% relative rate reduction in ESR/CRP co-ordering within the community health system yielding an annual payer savings of $15,000 with a modest increase in ESR/CRP concordance rates. Projecting a 40% relative reduction in ESR/CRP co-ordering rates from a similarly effective CPOE rule, annual payer cost reductions exceeding $100,000 within a multi-site tertiary care setting and $1,000,000 within the OLDW would be expected. Conclusion ESR/CRP co-ordering represents an opportunity to eliminate testing waste and reduce payer costs. A CPOE decision support rule stably reduces ESR/CRP co-ordering rates. Similar results may occur as one component of new commercially available decision support platforms.

Background Second-grade pupils in Israel have been vaccinated against influenza since the winter of 2016–2017. This study aims to appraise the rate reduction of seasonal influenza vaccine among vaccinated children and their household members, and that of the vaccinated cohort and their household members. Methods This retrospective cohort study was performed in winter 2016–2017 in Tel-Aviv District, Israel and compared second-grade pupils who were vaccinated at school, with third-grade pupils- who were not vaccinated at school. Parents in nine schools were asked to report prior vaccination against influenza and influenza-like illness (ILI) of their children and other household members. Rate reduction was defined as [(ILI among unvaccinated) – (ILI among vaccinated)] / (ILI among vaccinated) (%). Results Of 527 participants, 359 (68.1%) were unvaccinated and 168 (31.9%) vaccinated. Unvaccinated children reported more ILI compared with vaccinated children (19.5% vs. 7.7%), yielding a rate reduction of 60.5%. Unvaccinated children also had a greater number of physicians’ visits and missed school days (35.7% vs. 14.9 and 42.9% vs. 25.6%, respectively). The rate of ILI among household members of unvaccinated children was 34.5%, compared with 25.0% among household members of vaccinated children. The vaccinated cohort (defined as all children in second grade) reported less ILI compared with the unvaccinated cohort (defined as all children in third grade), with a rate reduction of 44.6%. Pupils of the unvaccinated cohort were more likely to miss school days (42.1% vs. 32.0%, respectively), and a higher rate of ILI was reported among household members of the unvaccinated cohort (35.4% vs. 27.3%, respectively). Conclusion Influenza vaccine administered in school setting reduced ILI among the vaccinated cohort and their household members by 60.5 and 27.5%, respectively, compared with the unvaccinated cohort. Expansion of the vaccination program in a school setting increased the public health benefit of influenza vaccines among both school children and their household members.

This paper implements the infection process of 2019 Novel Coronavirus Diseases (COVID-19) in an agent-based model and compares the effectiveness of multiple infection prevention measures. In the model, 1120 virtual residents agents live in two towns where they commute to office or school and visiting stores. The model simulates an infection process in which they were exposed to the risk of transmission of the novel coronavirus. The results of the experiments showed that individual infection prevention measures (commuting, teleworking, class closing, contact rate reduction, staying at home after fever) alone or partially combined them do not produce significant effects. On the other hand, if comprehensive measures were taken, it was confirmed that the number of deaths, the infection rate, and the number of severe hospitalised patients per day was decreased significantly at the median and maximum respectively.

In rural regions with limited resources, the provision of clean water remains challenging. The resulting high incidence of diarrhea can lead to acute kidney injury and death, particularly in the young and the old. Membrane filtration using recycled hemodialyzers allows water purification. This study quantifies the public health effects. Between 02/2018 and 12/2018, 4 villages in rural Ghana were provided with a high-volume membrane filtration device (NuFiltration). Household surveys were collected monthly with approval from Ghana Health Services. Incidence rates of diarrhea for 5-month periods before and after implementation of the device were collected and compared to corresponding rates in 4 neighboring villages not yet equipped. Data of 1,130 villagers over 10 months from the studied communities were studied. Incidence rates showed a decline following the implementation of the device from 0.18 to 0.05 cases per person-month (ppm) compared to the control villages (0.11 to 0.08 ppm). The rate ratio of 0.27 for the study villages is revised to 0.38 when considering the non-significant rate reduction in the control villages. Provision of a repurposed hemodialyzer membrane filtration device markedly improves health outcomes as measured by diarrhea incidence within rural communities.

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicentre, single-arm, hypothesis-driven phase 2 trial was planned to study the effect of Tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints). A cohort of patients consecutively enrolled after phase 2 was used as a validation dataset. A multivariable logistic regression was performed to generate hypotheses, while controlling for possible confounders.Resultsout of 301 patients in phase 2 intention-to-treat (ITT) analysis, 180 (59.8%) received tocilizumab. With 67 death events, lethality rates were 18.4% (97.5%CI: 13.6-24.0, P=0.52) and 22.4% (97.5%CI: 17.2-28.3, PConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Such result support the use of tocilizumab while waiting for ongoing phase 3 trials.RegistrationEudraCT (2020-001110-38);clinicaltrials.gov(NCT04317092)

BACKGROUND AND OBJECTIVES Although repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction. Subjects and. METHODS Forty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley's maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). RESULTS This study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p

Long Acting Beta2 Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil. This is a longitudinal large-scale real-life study. We calculated COPD HA rate and the number of subjects per 105 inhabitant who received LABA supplied by the government in each Brazilian municipality, between years 2004 and 2013. We used Poisson Multilevel Regression analysis to calculate the rate ratio between LABA dispensation rate and COPD HA rate. In Brazil, COPD HA rate reduced 59% among subjects between 40 and 59 years of age and 60% among subjects older than 59 years of age. Most of the 5506 Brazilian municipalities reduced COPD HA rate [4149 (75%) municipalities & 1357 (25%) municipalities]. The dispensation of LABA was greater among municipalities that reduced COPD HA rate. In the 40–59 age group, the gap in LABA dispensation between the two groups of municipalities increased during the study period from 90.40 to 614.28 subjects per 105 inhabitants. In the > 59 age group, the gap in LABA dispensation increased from 35.87 to 912.99 subjects per 105 inhabitants. For each one hundred subjects who received LABA there was less one HA (RR 0.99, 95 CI 0.99–0.99). COPD HA rate reduced in Brazil. LABA dispensation growth was associated with COPD HA rate reduction.

Background: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and use of INICC Surveillance Online System (ISOS) on ventilator-associated pneumonia (VAP) rates in Saudi Arabia from September 2013 to February 2017. Methods: A multicenter, prospective, before–after surveillance study on 14,961 patients in 37 intensive care units (ICUs) of 22 hospitals. During baseline, we performed outcome surveillance of VAP applying the definitions of the CDC/NHSN. During intervention, we implemented the IMA and the ISOS, which included: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on VAP rates and consequences and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using generalized linear mixed models to estimate the effect of intervention. Results: The baseline rate of 7.84 VAPs per 1000 mechanical-ventilator (MV)-days―with 20,927 MV-days and 164 VAPs―, was reduced to 4.74 VAPs per 1000 MV-days―with 118,929 MV-days and 771 VAPs―, accounting for a 39% rate reduction (IDR 0.61; 95% CI 0.5–0.7; P 0.001). Conclusions: Implementing the IMA was associated with significant reductions in VAP rates in ICUs of Saudi Arabia. Keywords: Hospital infection, Healthcare-acquired infection, Hospital-acquired pneumonia, Nosocomial pneumonia, Limited-resource countries, Surveillance

Background: Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear.Hypothesis: RPP and its components are associated with HFpEF outcomes.Methods: We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction >= 40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models.Results: After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm x mm Hg RPP; all P Conclusions: An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.

Omega-3 fatty acids have shown modest benefit in certain subgroups at higher cardiovascular risk. Ongoing trials are investigating cardiovascular event rate reduction with newer, more efficacious formulations with a focus on these higher risk patients. This article focuses on the previously demonstrated benefits of omega-3 fatty acid therapies, currently available formulations, and their current and future role in reducing cardiovascular risk.

A retrospective descriptive epidemiological study of an incidence rate and prophylaxis of tick-borne encephalitis (TBE) was carried out in the Republic of Khakassia over 2007–2016. Also, a relative risk (RR) of the incidence rate was assessed in the cohorts of vaccinated and unvaccinated population. Over the decade, 569 TBE cases were registered. There is a distinct tendency of TBE rate reduction (slope coefficient of the regression line b = –1.1 per annum, P < 0.05) as well as an expressed irregularity in the territorial distribution of longterm average annual rates in various towns and rural districts (from 0.9 up to 44.2 cases per 100 thousand people). In the vaccinated population cohort the TBE was registered 22.8 times less than in the unvaccinated one: χ2 = 23.78 (P < 0.001); RR = 3.1 (1.9–4.9). As the extend of mass-vaccination (b = 0.06 per annum, P < 0.05) and the area of acaricide treatments (b = 0.09 per annum, P < 0.05) were increasing, the number of virus-carrying ticks was reducing (b = –0.09 per annum, P < 0.001). The results of the comparison analysis of affect to the incidence of TBEcontrollable and uncontrollable factors in the territories with various rates of incidence prove the practicability of a risk-based approach to the prophylaxis of tick-borne encephalitis.

Background Recent efficacy studies of asthma biologics have included highly enriched patient populations. Using a similar approach, we examined factors that predict response to omalizumab to facilitate selection of patients most likely to derive the greatest clinical benefit from therapy. Methods Data from two phase III clinical trials of omalizumab in patients with allergic asthma were examined. Differences in rates of asthma exacerbations between omalizumab and placebo groups during the 16-week inhaled corticosteroid (ICS) dose-stable phase were evaluated with respect to baseline blood eosinophil counts (eosinophils

Objective. To estimate the efficacy of the tactics elaborated for the multimodal staged surgical treatment of an acute necrotic pancreatitis (ANP). Маterials and methods. There were studied the results of treatment of 317 patients, suffering ANP, to whom in 2013-2017 yrs a proposed tactics of the surgical interventions performance was applied. For estimation of the treatment efficacy there were analyzed the organ’s insufficiency, revealed for the first time after the operation, the intensive therapy duration, postoperative complications and lethality. Results. Application of tactics proposed have provided the performance rate of wide laparotomic necrsequestrectomy down to 14.5% and its deferment till after the fourth week from the disease beginning in 82.6% оperated patients. In postoperative period the complications were observed in 28.3% patients, general lethality have constituted 3.5%, while after performance of wide laparotomic necrsequestrectomies - 6.5%. Conclusion. Application of a multimodal staged surgical treatment of patients, suffering an ANP, provides the rate reduction for performance of wide laparotomic necrsequestectomy and a morbidity rate as well.

Introduction and Background: Before the European market approval, mepolizumab was made available in France as part of an early access program called Temporary Authorization for Utilization (ATU) for the treatment of severe eosinophilic asthma (SEA). GSK conducted a retrospective study to collect follow-up data in patients initiated within this program. Aims and Objectives: The aim of this study is to describe the patients’ baseline characteristics and outcomes (maximal follow-up of 24 months) and to generate the first set of real life data with mepolizumab in France. Methods: Data were collected from 147 patients out of the 183 initiated with mepolizumab within ATU, using medical records. Results: Patients had SEA (mean eosinophil count 719.5), received high doses of inhaled corticosteroids, associated with a long acting beta 2 agonist in 89.6%. The mean exacerbation rate in the previous year was 5.9 (4.4). Most patients (93%) were on maintenance oral corticosteroids (OCS), at a mean dose of 20.4 mg/day at treatment initiation. The annual exacerbation rate was reduced by 83%, and 90% at 12 and 24 months respectively. The reduction of the mean daily oral OCS dose was 60% at 12 months, and 71% at 24 months, 74% patients being OCS free at 24 months. Mean ACT score was improved from 10.2 at baseline to 18.7 at 24 months, predicted FEV1 was improved from 62% to 71%, after 24 months follow-up. Safety was consistent to that observed in clinical trials. Conclusions: Data from mepolizumab-treated SEA patients in the French early access program confirm mepolizumab effectiveness in real-life setting, with important exacerbation rate reduction and OCS sparing. Funding: GSK [207943]

Background: \ud In patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF).\ud \ud Methods: \ud We performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline.\ud \ud Results: \ud Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91), p

Clozapine treatment may have beneficial effects on behavioral outcomes in psychotic disorders, including violent offending. Although clozapine and other antipsychotics have been linked to lower levels of violent behavior, these have been primarily in small selected samples, and population-based estimates have been limited and imprecise. We aimed to assess the effect of clozapine treatment on the rate of violent and nonviolent offending. We carried out a within-person mirror-image study of the Swedish population with linked prescription, hospitalization, and sociodemographic registers. Outcomes were violent, nonviolent, and overall offences occurring before and after clozapine, or olanzapine, initiation. Comparison of effects of clozapine and olanzapine on key variables was modeled with interaction terms. We found periods of mirror-image observation time with clozapine treatment were associated with a much lower rate of violent offending compared to periods before treatment (rate ratio [RR]: 0.13 (95% CI: 0.05, 0.34). Reductions in nonviolent offences were smaller in magnitude (RR: 0.37, 95% CI: 0.17, 0.80). There was a statistically greater rate reduction effect on violent offences for clozapine than olanzapine (RR for interaction: 4.84, 95% CI: 1.56, 14.86, P = .002). In patients with psychotic disorders, clozapine treatment is associated with a lower rate of violent offending compared to olanzapine.

Recent literature has reported a higher prevalence of vitamin D deficiency among people with Graves’ disease. No study has examined the effect of vitamin D supplementation on the clinical outcomes of Graves’ disease. We aimed to evaluate whether daily vitamin D supplementation reduces Graves’ disease recurrence. We enrolled 210 subjects with Graves’ disease and vitamin D deficiency and followed them for at least one year after anti-thyroid drug (ATD) discontinuation. Among 210 individuals, 60 (29%) were amenable to taking vitamin D supplements, resulting in sufficient vitamin D levels (from 10.6 to 25.7 ng/mL), whereas the mean vitamin D level was 11.6 ng/mL in the 150 patients who did not take vitamin D supplements. The recurrence rate was similar in both groups (38% vs. 49%, P = 0.086). However, recurrence occurred earlier in the latter group (7 months vs. 5 months, P = 0.016). In the multivariate analysis, vitamin D levels and TSH-binding inhibitory immunoglobulin (TBII) titers at ATD discontinuation remained significant factors for recurrence. Vitamin D levels and TBII titers at ATD discontinuation exhibited a weak negative correlation (R = −0.143, P = 0.041). Vitamin D supplementation might have a protective effect against Graves’ disease recurrence with a borderline significant recurrence rate reduction.

OBJECTIVES: Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days. METHODS: This project spanned 4 time periods: baseline, epoch 1 (December 2010–May 2012), sustain, and epoch 2 (May 2015–December 2017) by using standard quality improvement methodology. Epoch 1 interventions included real-time analysis of UE events, standardization of taping, patient positioning and movement, accurate event reporting, and change in nomenclature. Epoch 2 interventions included reduction in daily chest radiographs (CXRs) and development of a high-risk tool. Patient and event characteristics were statistically compared across time points. RESULTS: Of the 612 UE events recorded over 10 years, 249 UEs occurred from May 2011 to 2017 involving 184 unique patients. UE rates decreased by 43% (from 1.75 to 0.99 per 100 ventilator days; epoch 1) and were sustained until a notable spike. Epoch 2 interventions led to a further 31% rate reduction. Single CXR use decreased by half. Median corrected gestational age at the time of an event was 35 weeks (interquartile range: 29–41). Seventy percent of infants experiencing an UE required reintubation, 29% had a previous event, and 9% had a code event. CONCLUSIONS: A decrease in UE below benchmarks can be achieved and sustained by standardization and mitigation interventions. This decline was also accompanied by a reduction in use of CXRs without increasing UE events.

Background: The natural history of cavernous malformations (CMs) has remained unclear. This lack of knowledge has made treatment decisions difficult. Indeed, the use of stereotactic radiosurgery is nowadays controversial. The purpose of this paper is to throw light on the effectiveness of Gamma Knife radiosurgery (GKRS) therapy. Methods: The authors reviewed data collected from a prospectively maintained database. A total of 95 patients (57 female and 38 male) underwent GKRS for high-surgical-risk CMs. A total of 76 cavernomas were deeply located (64 lesions in the brainstem and 12 lesions in the thalamus). All of them were located in eloquent regions. The median malformation volume was 1,570 mm3. The median tumor margin dose was 11.87 Gy, and the mean tumor maximum dose was 19.56 Gy. Results: Ninety-five cavernous CMs were managed from 1994 to 2014. All patients had experienced at least 1 symptomatic bleeding incident before treatment (only 1 hemorrhage event in 81%). The median length of follow-up review was 78 months. The pretreatment annual hemorrhage rate was 3.06% compared with 1.4% during the first 3-year latency interval, and 0.16% thereafter (p = 0.004). Four patients developed new location-dependent neurological deficits, and 3 patients had edema-related headache after radiosurgery. All of them presented full recovery. Conclusions: The best dosage range for preventing bleeding was identified as between 11 and 12 Gy in our series. Although the efficacy of radiosurgery in CMs remains impossible to quantify, a very significant reduction in the bleeding rate occurs after a 3-year latency interval. No permanent neurological morbidity is reported in our series. These results defend the safety of GKRS in surgical high-risk CM from the first bleeding event.

Quality problem Critical care patients often have several risk factors for pressure ulceration and implementing prevention interventions have been shown to decrease risk. Initial assessment We identified a high incidence of pressure ulcers in the four adult critical care units in our organization. Therefore, avoiding pressure ulceration was an important quality priority. Choice of solution We undertook a quality improvement programme aimed at reducing the incidence of pressure ulceration using an evidence-based bundle approach. Implementation A bundle of technical and non-technical interventions were implemented supported by clinical leadership on each unit. Important components were evidence appraisals; changes to mattresses; focussed risk assessment alongside mandating patients at very high risk to be repositioned two hourly; and staff training to increase awareness of how to prevent pressure ulcers. Evaluation Pressure ulcer numbers, incidence and categories were collected continuously and monitored monthly by unit staff. Pressure ulcer rates reduced significantly from 8.08/100 patient admissions to 2.97/100 patient admissions, an overall relative rate reduction of 63% over 4 years. The greatest reduction was seen in the most severe category of pressure ulceration. The average estimated cost saving was £2.6 million (range £2.1-£3.1). Lessons learned A quality improvement programme including technical and non-technical interventions, data feedback to staff and clinical leadership was associated with a sustained reduction in the incidence of pressure ulceration in the critically ill. Strategies used in this programme may be transferable to other critical care units to bring more widespread patient benefit.

International audience; Objective: To study recent epidemiologic trends of sudden unexpected death in infancy (SUDI) in Western Europe. Study design: Annual national statistics of death causes for 14 Western European countries from 2005 to 2015 were analyzed. SUDI cases were defined as infants younger than 1 year with the underlying cause of death classified as “sudden infant death syndrome,” “unknown/unattended/unspecified cause,” or “accidental threats to breathing.” Poisson regression models were used to study temporal trends of SUDI rates and source of variation. Results: From 2005 to 2015, SUDI accounted for 15 617 deaths, for an SUDI rate of 34.9 per 100 000 live births. SUDI was the second most common cause of death after the neonatal period (22.2%) except in Belgium, Finland, France, and the UK, where it ranked first. The overall SUDI rate significantly decreased from 40.2 to 29.9 per 100 000, with a significant rate reduction experienced for 6 countries, no significant evolution for 7 countries, and a significant increase for Denmark. The sudden infant death syndrome/SUDI ratio was 56.7%, with a significant decrease from 64.9% to 49.7% during the study period, and ranged from 6.1% in Portugal to 97.8% in Ireland. We observed between-country variations in SUDI and sudden infant death syndrome sex ratios. Conclusions: In studied countries, SUDI decreased during the study period but remained a major cause of infant deaths, with marked between-country variations in rates, trends, and components. Standardization is needed to allow for comparing data to improve the implementation of risk-reduction strategies.

Transvenous Implantable Cardioverter Defibrillator (TV-ICD) and subcutaneous ICD (S-ICD) devices are available for patients at risk of sudden cardiac death (SCD). Both devices sense ventricular arrhythmias with near 100% sensitivity (Gold et al., 2012) and have similar rates of inappropriate shocks (IAS) (2.5-4.8%). IAS due to supraventricular tachycardias (SVT) is higher for TV-ICDs and IAS due to cardiac over-sensing is higher for S-ICDs (Basu-Ray et al., 2017). The S-ICD's sensing signal is morphologically rich, resembling the surface electrocardiogram (ECG) signal. As such, correlation waveform analysis (CWA) is used by the S-ICD to compare the morphology of two signals to minimize S-ICD cardiac over-sensing and rhythm discrimination errors. Early experience showed that the S-ICD had a comparable overall incidence of IAS compared to TV-ICDs. Progressive improvements in S-ICD algorithms and programming strategies have resulted in overall IAS rate reduction to 4.3% (Theuns et al., 2018), substantiating the S-ICD as a viable choice for patients at risk of SCD.

Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%–80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a custom field in the ACS NSQIP workstation further revealed that indwelling catheters were overused, with 55.2% of patients receiving indwelling catheters in the same time period. These data were presented to the orthopaedic leadership group and surgeons at TWH in July 2016 to set the quality improvement target and create the working group. Nursing staff was provided education to strictly follow the institutional catheter-associated UTI prevention guidelines and change ideas based on the guidelines were implemented in July 2016. As a result, the rate of UTI decreased to 1.1% and the use of indwelling catheter decreased to 19.8% among 883 patients who were treated between July 2016 and March 2017. The study indicated that a systematic approach, engaging all front-line staff including nurse educators and nurse practitioners, helps to facilitate implementation of practice changes. We expect that ongoing reminders and education ensure that the changes are sustainable.

Objectives. This study aims to analyze the cesarean section (CS) rates and vaginal delivery rates in tertiary hospitals of China, explore the costs of two different deliveries, and examine the relative influencing factors of the costs in both CS and vaginal deliveries. Methods. 30,168 anonymized obstetric medical cases were selected from three sample tertiary hospitals in Chongqing Municipality from 2011 to 2013. Chi-square test was used to compare the distributions of CS and vaginal deliveries under different indicators. Mann–Whitney test and Kruskal-Wallis test were adopted to analyze the differences under different items. Multiple linear regression was used to determine the influencing factors of the costs of different delivery modes. Results. (1) The rates of CS were 69%, 65.5%, and 59.2% in the three sample tertiary hospitals in Chongqing from 2011 to 2013. (2) The costs and the length of stay of CS were greater than those of vaginal delivery, which had significant differences (P<0.005). (3) The areas, length of stay, age, medical insurance, and modes of delivery were the influencing factors of both CS and vaginal delivery costs. Discussion. The high CS rates in China must be paid significant attention. The indicators of two modes of delivery should be regulated strictly. CS rate reduction and saving medical resources will be the benefits if vaginal delivery is chosen by pregnant women.

BACKGROUND AND OBJECTIVE: Adoption and implementation of evidence-based measures for catheter care leads to reductions in central line–associated bloodstream infection (CLABSI) rates in the NICU. The purpose of this study is to evaluate whether this rate reduction is sustainable for at least 1 year and to identify key determinants of this sustainability at the NICU of the Floating Hospital for Children at Tufts Medical Center. METHODS: We reviewed the incidence of CLABSIs in the NICU temporally to the implementation of new practice policies and procedures, from July 2008 to December 2013. RESULTS: Adoption of standardized care practices, including bundles and checklists, was associated with a significant reduction of the CLABSI rate to zero for >370 consecutive days in our NICU in 2012. Overall, our CLABSI rates decreased from 4.1 per 1000 line days in 2009 (13 infections; 3163 line days) to 0.94 in 2013 (2 infections; 2115 line days), which represents a 77% reduction over a 5-year period. In the first quarter of 2013, there was a brief increase in CLABSI rate to 3.3 per 1000 line days; after a series of interventions, the CLABSI rate was maintained at zero for >600 days. Ongoing training, surveillance, and vigilance with catheter insertion and maintenance practices and improved documentation were identified as key drivers for success. CONCLUSIONS: High-quality training, strict compliance with evidence-based guidelines, and thorough documentation is associated with significant reductions in CLABSIs. Mindful organizing may lead to a better understanding of what goes into a unit’s ability to handle peak demands and sustain extraordinary performance in the long-term.

Background Online haemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality versus conventional haemodialysis (HD); however, it is not always available. In these situations, a novel class of membranes with a higher pore size, medium cut-off (MCO) dialysers, could be promising. The aim of this study is to evaluate the efficacy of an MCO dialyser in the removal of small and medium-size molecules and compare it with standard high-flux (HF) dialysers in HD and OL-HDF. Methods In this crossover study, 18 prevalent HD patients were studied in three single mid-week dialysis treatments during three consecutive weeks as follows: first week with OL-HDF with a standard HF dialyser, second week with conventional HD with a standard HF dialyser and third week with conventional HD with an MCO dialyser. Reduction ratios (RRs) of different-sized molecules and albumin losses were collected for the different dialysers. Results MCO HD provided a greater reduction of middle and larger middle molecules compared with standard HF HD [rate reduction (RR) β2-microglobulin 74.7% versus 69.7%, P=0.01; RR myoglobin 62.5% versus 34.3%, P=0.001; RR prolactin 60% versus 32.8%, P=0.001; RR α1-glycoprotein 2.8% versus −0.1%, P=0.01]. We found no difference in the clearance of small and larger middle molecules comparing MCO HD with OL-HDF. Albumin losses were 0.03 g/session with MCO HD and 3.1 g/session with OL-HDF (P=0.001). Conclusion MCO HD is superior to standard HF HD in the removal of middle and larger middle molecules and it is not inferior to OL-HDF in the clearance of small and larger middle molecules. Thus it could be an alternative in patients in which it is not possible to perform OL-HDF.

Introduction: The ureters stent has side effects that the complaint is called stent-related syndrome (SRS). The complaint is equal to Lower Urinary Tract Symptoms (LUTS) and overactive bladder (OAB). Alpha-blocker and antimuscarinic therapy used for benign prostatic hyperplasia (BPH) and OAB therapy can also be used to reduce complaints of SRS. The purpose of this research is to determine the effectiveness of Tamsulosin 0.4 mg/day compared with Mirabegron 50 mg/day against changes in LUTS complaints in patients after the installation of the Ureteric Stent. Methods: The design of this research uses a double-blinded experimental method. Samples taken randomly were 50 patients with Double-J (DJ) Stent post-installation LUTS complaints. Data collection is taking place from July to November 2019, using a tool measuring instrument ureteral stent symptom questionnaire (USSQ). Data were analyzed using SPSS 24.0. a P-value < 0.05 was considered to be statistically significant. Results: In the entire patient group, the average age of respondents is 44.86 ± 11.85 year, in groups with Tamsulosin 5 mg/day treatment compared with Mirabegron 50 mg/day gives a good effect in lowering the complaint score LUTS during 4 weeks post-installation of Double-J (DJ) Stent, in this case, Urinary Symptoms, pain, general circumstances, work activity, and other complaints (P < 0.05). The average rate reduction of USSQ Urinary Symptoms, pain, general circumstances, greater work activity in the Tamsulosin group. Conclusion: Tamsulosin Therapy 5 mg/day compared with Mirabegron 50 mg/day can effectively cure complaints of post-installation LUTS DJ Stent.

Objective: To study the efficacy of oral carvedilol in acute treatment of atrial fibrillation (AF) with fast ventricular rate. Materials and Methods: In an open-label, single-arm trial, oral carvedilol was administered to 35 patients of AF in escalating doses from 3.125 mg o.d. to 12.5 mg b.i.d. Results: A successful result was seen in 25 patients (71.4%) with 4 converting to sinus rhythm, rate control to less than 90 bpm in 16 and a 20% rate reduction in 5 patients. Two patients developed hypotension needing withdrawal of the drug. Conclusion: Escalating doses of oral carvedilol can be effectively and safely used in the acute treatment of AF with fast ventricular rate.

We have assessed the hypothetical impact of guideline-concordant osteoporosis screening on baseline behaviors utilizing two different guidelines and determined the relative ability of each to identify osteoporosis treatment candidates.We conducted secondary analyses from the Fracture Risk Perception Study, which enrolled patients aged 50 to 75 years to complete questionnaires about their bone health. We determined our baseline screening rates and detection of treatment candidates and then assessed the hypothetical impact of adherence to U.S. Preventive Services Task Force (USPSTF) and National Osteoporosis Foundation (NOF) criteria, particularly for women aged 50 to 64.Of 144 women aged 50 to 64 years screened, 14 (9.7%) were treatment candidates. Screening based on identification of one or more risks (NOF) would lead to testing of 102 of the 144 patients (71%) to identify 12 of 14 treatment candidates (86%). Applying USPSTF criteria (9.3% FRAX threshold) would test 45 of the same 144 women (31%) to identify 11 of 14 treatment candidates (79%). NOF risk-based criteria would result in a moderate absolute screening rate reduction (16%, p = .0011; 95% CI, 7%-25%), but only marginal improvement in identifying treatment candidates (odds ratio, 2.67; 95% CI, 0.57-12.47). Applying the more selective USPSTF criteria greatly reduced unnecessary testing (56% absolute screening rate reduction; p.0001; 95% CI, 47%-64%) while further improving the odds of identifying treatment candidates (odds ratio, 10.35; 95% CI, 2.72-39.35).When contemplating screening younger patients, systematic calculation of FRAX and ordering only when the 9.3% fracture risk threshold is reached may decrease unnecessary screening for many women while still identifying appropriate osteoporosis treatment candidates.

Introduction Subcutaneous immune globulin 20%, Ig20Gly, was well tolerated in the phase 2/3 North American study in patients with primary immunodeficiency diseases (PIDD). Here we analyze the safety, tolerability, and infusion parameters by age groups. Methods Patients aged ≥2 years with PIDD received weekly Ig20Gly infusions at volumes ≤60 mL/site and rates ≤60 mL/h/site for ∼1.3 years in the North American study (NCT01218438). Adverse events (AEs), tolerability, and infusion parameters were assessed in 74 patients (2- Results Overall, 71.6% (53/74) of patients achieved a maximum infusion rate ≥60 mL/h/site. Median maximum infusion rates and volumes/site were higher in adults (16–[60 mL/h/site; 45.3 mL/site]; ≥65 y [60 mL/h/site; 39 mL/site]) and adolescents aged 12–5–Percentages of infusions associated with causally related AEs were low among all pediatric age groups (0% [2–[5–12–3.1% [16–; there were no serious or severe causally related AEs. Ig20Gly infusions were well tolerated by all age groups; >99% of infusions were administered without an infusion rate reduction, interruption, or discontinuation due to AEs. Conclusions Ig20Gly infused at relatively high rates and volumes was well tolerated in patients of all ages with PIDD.

Introduction Heart failure (HF) is a progressive syndrome and previous studies have shown that HF patients are more likely to be hospitalized during colder winter months. These seasonal variations coincide with holidays and can cause an additional emotional burden on patients, family members, and caregivers. Historically, 1 out of 4 HF patients at our institution experienced multiple hospitalizations during this period compared to 1 out of 5 in all other months. Therefore, we created a Home for the Holidays campaign to engage interdisciplinary care teams (IDT) and patients. We hypothesized that these efforts, in conjunction with existing hospital readmission reduction program interventions, would reduce the 30-day all-cause HF readmission rate. Methods A readmission rate goal of less than 15% was established for 23 nursing units across 3 hospital campuses within a large, urban academic health system. Units that achieved this goal received recognition and breakfast with senior executive health system leadership. A toolkit consisting of a low sodium holiday menu, education workbook and magnet advertising the post-discharge helpline were distributed in a tote bag to all patients identified with acute decompensated HF (ADHF). IDT members focused on self-care management and early symptom recognition with patients and caregivers, as well as timely follow-up appointments. Results Between 2014 and 2017 the average 30-day all-cause HF readmission rate for the month of December was 24.3%. In December 2018, 235 patients were admitted for ADHF, 37 patients were subsequently readmitted within 30 days and the readmission rate was 15.7%. The Home for the Holidays campaign contributed to a 35.4% rate reduction (p= 0.046) and 9 units achieved the institutional goal of less than 15%. Conclusions Implementation of the toolkit, along with enhanced counseling and post-discharge follow-up, successfully reduce HF hospital readmissions. Health systems can easily integrate a seasonal campaign to increase awareness and stimulate transitional care and educational activities to keep patients healthy and at home for the holidays.

ObjectiveDirect-acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan.DesignAn age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators.SettingTotal Pakistan population.ParticipantsTotal Pakistan HCV-infected population.InterventionsHCV treatment programme scenarios from 2018 up to 2030.ResultsBy 2030 across the five HCV-TasP scenarios, 0.6–7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%–0.03%, incidence reduction ranged between 41% and 99%, program-attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%–18%. Number of treatments needed to prevent one new infection ranged between 4.7–9.8, at a drug cost of about US$900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US$708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade.ConclusionHCV-TasP is a highly impactful and potent approach to control Pakistan’s HCV epidemic and achieve elimination by 2030.

BACKGROUND: Bladder cancer accounts for 5-10% of all cancers in Europe and up to 85% patients presents a noninvasive tumor, whose treatment of choice is the transurethral bladder resection (TURB) paired with adjuvant intravesical chemotherapy or immunotherapy. Despite several clinical trials showed that this treatment is safe and decreases recurrences by 17% to 44% this practice is limited for many reasons. The study objective is to analyze the economical advantages of the single immediate post operative Mitomycin C instillation in Non Muscle-invasive Bladder Cancer (NMIBC) low-risk patients.METHODS: A cost-benefit analysis was performed evaluating the economical gain that would raised from a scenario with a single immediate post operative mitomycin C instillation in each low-risk NMIBC patient who underwent to TURB. Net present value and cost-benefit ratio were calculated and sensitivity analyses were performed. Base case analysis was performed considering tumor recurrence rate reduction of 11.7% and a TURB costs of 2,167.0 €, while sensitivity analyses were performed using a recurrence rate reduction of 19.2% and 15.0% and a TURB cost of 2,472.93 €. The discount rate was 2%.RESULTS: The single immediate post operative instillation of mitomycin C resulted to be cost-beneficial with a cost-benefit ratio that goes from 0.48 to 0.79 when compared to TURB alone raising a Net Present Value that goes from 660,284.39 € to 2,650,530.79 €.CONCLUSION: This study demonstrates that even assuming conservative parameters for recurrence rates reduction, a single immediate post operative mitomycin C instillation in low risk NMIBC patients would lower not only the recurrence rate but also the caring cost for bladder cancer.

Background Consistent hand hygiene is key to reducing health care-associated infections (HAIs) and assessing compliance with hand hygiene protocols is vital for hospital infection control staff. A new automated hand hygiene compliance system (HHCS) was trialed as an alternative to human observers in an intensive care unit and an intensive care stepdown unit at a hospital facility in the northeastern United States. Methods Using a retrospective cohort design, researchers investigated whether implementation of the HHCS resulted in improved hand hygiene compliance and a reduction in common HAI rates. Pearson χ 2 tests were used to assess changes in compliance, and incidence rate ratios were used to test for significant differences in infection rates. Results During the study period, the HHCS collected many more hand hygiene events compared with human observers (632,404 vs 480) and ensured that the hospital met its compliance goals (95%+). Although decreases in multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infection rates were observed, they represented nonsignificant differences. Discussion and conclusions Human hand hygiene observers may not report accurate measures of compliance. The HHCS is a promising new tool for fine-grained assessment of hand hygiene compliance. Further study is needed to examine the association between the HHCS and HAI rate reduction.

Objectives: To analyze the effectiveness of intravenous (IV) tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). Method: The population sample was composed of patients with a diagnosis of primary knee osteoarthritis. The patients undergoing TKA were divided in two groups. Group A: comprised patients who used IV TA and B group, formed by patients who did not use TA in the intra or post-operative period. For descriptive analysis, quantitative variables were represented by mean and standard deviations when their distribution was normal and interquartile ranges and medians for non-normal variables. Results: The mean age of patients was 68 years old, most of them were female and with involvement of the left knee. Postoperatively patients who had used IV TA showed less bleeding rate and less hemoglobin rate reduction. Conclusion: The use of IV TA in TKA reduces blood loss in peri- and postoperative periods. Regarding total blood loss reduction, hemoglobin rate and need for blood transfusions, IV TA should be used routinely during TKA since it has been shown to be safe with no increase in side effects as thromboembolic events. Level of Evidence III. Retrospective Comparative Study.

BACKGROUND. The Republic of Moldova was the first low- to middle-income country in the World Health Organization European Region to introduce rotavirus vaccine (July 2012). We aimed to assess the impact of the rotavirus vaccine program and estimate vaccine effectiveness (VE). METHODS. Surveillance for rotavirus gastroenteritis was conducted in 2 hospitals in the capital city of Chisinau starting in September 2009. Monthly rotavirus admissions by age were examined before and after introduction of rotavirus vaccination using interrupted time-series analyses. We performed a case-control study of VE by comparing rotavirus case patients with test-negative controls. RESULTS. Coverage with at least 1 dose of vaccine increased from 35% in year 1 to 55% in year 2 for children

The aim of this study was to discuss the value and significance of quality control circle (QCC) in the reduction of the surgical site infection (SSI). From January 2012 to December 2013, a total of 32 patients with surgical site infection were included in the study. Quality control circle was established to control the SSI in these patients. The tangible and intangible results of QCC were compared and analysed. On the tangible results, achievement and improvement index on internal error reduction, SSI rate reduction, patients satisfaction, working quality improvement was 97.84% ± 16.47%, 95.04% ± 50.33%, 90.58% ± 22.83%, 100.6% ± 22.8% and 31.12% ± 13.2%, 34.41% ± 22.96%, 40.22% ± 25.39%, 49.2% ± 25.4%. On the intangible results, one to two points improvement was found in 83% of the QCC members, and 12% of the QCC members have > 2 points improvement. Quality control circle could reduce the SSI rates, especially on the intangible and tangible results. Quality control circle could be employed as effective tool to improve the medical quality.