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201. Vacuum-Assisted Closure

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012

202. Critical Illness Related Corticosteroid Insufficiency

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

203. Cardiac Magnetic Resonance Imaging

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

204. Cerebral Perfusion Pressure

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

205. Coagulation, Monitoring at the Bedside

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

206. Closed Forequarter Amputation

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

207. Chest Pain: Differential Diagnosis

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

208. CO (Cardiac Output)

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

209. Ventricular Dysfunction and Failure

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012

210. Critical Illness Polyneuropathy/Myopathy

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

211. Continuous Positive Airway Pressure (CPAP)

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

212. Volume Responsiveness

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012

213. Continuous Arterio-venous Hemofiltration (CAVHF)

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

214. Variola Virus

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012

215. Contrast Medium-Induced Nephropathy

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

216. Chylous Pleural Effusion

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

217. CPP

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

218. Ventilator Hose

Author

Andrew Davenport, Todd W. Costantini, Raul Coimbra, Marc M. Sedwitz, A. Brent Eastman, David V. Feliciano, Thomas H. Cogbill, Jeremy Cordingley, Daryl Jones, Rinaldo Bellomo, Li Wan, Clive May, Anthony Gordon, Frank Bloos, Konrad Reinhart, Dean Hess, Andrew M. Morris, David Bacon, Barbara J. Philips, Alain Combes, Antoine Vieillard-Baron, Kiarash Shahlaie, J. Paul Muizelaar, Christoph K. Hofer, Andreas Zollinger, Charles-Edouard Luyt, Stuart L. Goldstein, David Osman, Xavier Monnet, and Jean-Louis Teboul

Published
2012

219. Consumption Coagulopathy

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

220. Cardiac Output Monitor

Author

Adeel Abbasi, Francis DeRoos, José Artur Paiva, J.M. Pereira, Brian G. Harbrecht, Donald P. Levine, Patricia D. Brown, Lara Wijayasiri, Andrew Rhodes, Maurizio Cecconi, Jonathan R. Egan, Marino S. Festa, Chadwick D. Miller, Daniel W. Entrikin, W. Gregory Hundley, James McCord, Giorgio Della Rocca, Maria Gabriella Costa, Nima Majlesi, Diane P. Calello, Richard D. Shih, Dominic W. K. Spray, Raghu R. Seethala, Benjamin S. Abella, Claudio Ronco, Mikko Haapio, Nagesh S. Anavekar, Andrew A. House, Rinaldo Bellomo, Andrew M. Morris, Scott E. Bell, Kathryn M. Beauchamp, Sarah E. Pinski, Arianne Boylan, Jens-Peter Witt, Todd F. VanderHeiden, Philip F. Stahel, Gorazd Voga, José Rodolfo Rocco, Daniel B. Craig, Suzanne M. Shepherd, William H. Shoff, Samuel Waller, Sonia Labeau, Dominique Vandijck, Stijn Blot, John Tobias Nagurney, Donald D. Trunkey, John C. Mayberry, Christopher M. Watson, Robert G. Sawyer, Laura J. Moore, Ares Krishna Menon, Rüdiger Autschbach, Werner Baulig, Donat R. Spahn, Michael T. Ganter, Jeffry L. Kashuk, Judd E. Hollander, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Lewis J. Kaplan, Roselle Crombie, Gina Luckianow, Derrick Sun, John H. Burton, Eric A. J. Hoste, Zhongping Huang, William R. Clark, Harold Litt, Jeremy Cordingley, Thomas J. Marrie, Lucido L. Ponce, Claudia S. Robertson, Carla Nester, Patrick D. Brophy, Anders Kallner, Brent P. Goodman, Oliver L. Hung, and Stefan Herget-Rosenthal

Published
2012

223. Very severe thrombocytopenia and fragmentation hemolysis mimicking thrombotic thrombocytopenic purpura associated with a giant intracardiac vegetation infected with Staphylococcus epidermidis: role of monocyte procoagulant activity induced by bacterial supernatant

Author

Irwin Walker, Irene Cybulsky, Petra Eichler, Theodore E. Warkentin, H. Alexander Heggtveit, Kathleen Selleng, Andreas Greinacher, and Andrew M Morris

Subjects
Hemolytic anemia, Male, medicine.medical_treatment, Thrombotic thrombocytopenic purpura, Hemolysis, Staphylococcus epidermidis, Medicine, Endocarditis, Humans, Platelet, Lymphocytes, Blood Coagulation, Cells, Cultured, biology, Purpura, Thrombotic Thrombocytopenic, business.industry, Platelet Count, Hematology, Heparin, Middle Aged, Staphylococcal Infections, biology.organism_classification, medicine.disease, Thrombocytopenia, Immunology, Factor Xa, Plasmapheresis, business, medicine.drug
Abstract

The pathogenesis of very severe thrombocytopenia in bacterial endocarditis is uncertain. We report a 50-year-old male with platelet counts < 10 x 10(9)/l and fragmentation hemolysis complicating Staphylococcus epidermidis pacemaker endocarditis with a giant vegetation. Antibiotics, corticosteroids, high-dose intravenous gammaglobulin, and plasmapheresis (for initially-suspected thrombotic thrombocytopenic purpura) failed to produce significant platelet count increase. However, therapeutic-dose heparin anticoagulation was associated with a platelet count increase from

Published
2006

226. Academic medicine: time for reinvention: Leadership and money are needed

Author

Andrew M. Morris

Subjects
Government, business.industry, media_common.quotation_subject, General Engineering, Profit motive, General Medicine, Public relations, Promotion (rank), Work (electrical), Health care, Disinvestment, General Earth and Planetary Sciences, Medicine, Letters, business, Productivity, Curriculum, General Environmental Science, media_common
Abstract

Editor—Clark and Smith's focus on internal and external funding and leadership is paramount in improving the state of academic medicine.1 Academic health care has deteriorated because academicians are poorly remunerated (compared with their peers) for their academic work, unless they partner with industry. Unfortunately, industry's raison d'etre seems to be the promotion of therapeutics or diagnostics rather than of education for education's sake. Thus all education partnered with industry is potentially tainted by the underlying profit motive. Additionally, research productivity is important for much of the academic advancement in faculties of medicine and health science. Because there has been a disinvestment from clinical research by government organisations, researchers who wish to proceed through the ranks via research must increasingly rely on industry funds to support their work. Again, all such work is potentially tainted by the profit motive. Yet the researchers who are able to forge the ties with industry are the educational leaders. Although all faculties of medicine and health science have expert educators and teachers, they often remain small cogs in a larger machine. They deliver well intentioned (and often important) research, curriculums, and teaching encounters but are usually overshadowed by the more powerful and better funded researchers who lead. These leading researchers speak to (and influence) medical students, postgraduate trainees, and practising clinicians. They ascend the academic ranks and make important policy decisions for divisions, departments, faculties, and the community. They are academic medicine. For academic medicine to revitalise it needs leadership and money. However, the money must be both substantial and independent of industry directives. Similarly, the leadership must consist of that extremely and increasingly rare breed: a visionary who sees research, education, and clinical teaching as equally important, who has been successful at some or all of these, and who has managed to be so without the strong ties that bind many of us to industry.

Published
2004

227. Coming Clean With Antibiotic Prophylaxis for Infective Endocarditis

Author

Andrew M Morris

Subjects
medicine.medical_specialty, Streptococcus, business.industry, Erythromycin, Clindamycin, Endocarditis, Bacterial, Antibiotic Prophylaxis, medicine.disease_cause, medicine.disease, Anti-Infective Agents, Bacteremia, Internal medicine, Infective endocarditis, Internal Medicine, medicine, Humans, Endocarditis, Vancomycin, Antibiotic prophylaxis, business, medicine.drug
Abstract

482. 28. Crespo A, Retter AS, Lorber B. Group B streptococcal endocarditis in obstetric and gynecologic practice. Infect Dis Obstet Gynecol. 2003;11: 109-115. 29. Ebnother C, Altwegg M, Gottschalk J, Seebach JD, Kronenberg A. Endocarditis after urinary tract infection. Infection. 2002;30:212. 30. Glauser MP, Francioli P. Relevance of animal models to the prophylaxis of infective endocarditis. J Antimicrob Chemother. 1987;20(suppl A): 87-98. 31. Overholser CD, Moreillon P, Glauser MP. Experimental bacterial endocarditis after dental extractions in rats with periodontitis. J Infect Dis. 1987; 155:107-112. 32. Bernard JP, Francioloi P, Glauser MP. Vancomycin prophylaxis of experimental Streptococcus sanguis: inhibition of bacterial adherence rather than bacterial killing. J Clin Invest. 1981;68:11131116. 33. Baltch AL, Schaffer C, Hammer MC, et al. Bacteremia following dental cleaning in patients with and without penicillin prophylaxis. Am Heart J. 1982; 104:1335-1339. 34. Hall G, Heimdahl A, Nord CE. Effects of prophylactic administration of cefaclor on transient bacteremia after dental extraction. Eur J Clin Microbiol Infect Dis. 1996;15:646-649. 35. Hall G, Nord CE, Heimdahl A. Elimination of bacteraemia after dental extraction: comparison of erythromycin and clindamycin for prophylaxis of infective endocarditis. J Antimicrob Chemother. 1996;37:783-795. 36. Hall G, Hedstrom SA, Heimdahl A, Nord CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis. 1993; 17:188-194. 37. Durack DT, Petersdorf RG. Chemotherapy of experimental streptococcal endocarditis, I: Comparison of commonly recommended regimens. J Clin Invest. 1973;52:592-598. 38. Imperiale TF, Horwitz RI. Does prophylaxis prevent postdental infective endocarditis? a controlled evaluation of protective efficacy. Am J Med. 1990;88:131-136. 39. Horstkotte D, Rosin H, Friedrichs W, Loogen F. Contribution for choosing the optimal prophylaxis of bacterial endocarditis. Eur Heart J. 1987; 8(suppl J):379-381. 40. Durack DT, Kaplan ET, Bisno AL. Apparent failures of endocarditis prophylaxis: analysis of 52 cases submitted to a national registry. JAMA. 1983; 250:2318-2322. 41. Seto TB, Thomas L, Baden LR, Manning WJ. Specialty and training differences in the reported use of endocarditis prophylaxis at an academic medical center. Am J Med. 2001;111:657-660. 42. Sanders GP, Yeon SB, Grunes J, Seto TB, Manning WJ. Impact of a specific echocardiographic report comment regarding endocarditis prophylaxis on compliance with American Heart Association recommendations. Circulation. 2002; 106:300-303.

Published
2007

228. Quality of antibiotic prescribing for pediatric community-acquired Pneumonia in outpatient care

Author

Ariana Saatchi, Manon R. Haverkate, Jennifer N. Reid, Salimah Z. Shariff, Marcus Povitz, David M. Patrick, Michael Silverman, Andrew M. Morris, James McCormack, and Fawziah Marra

Subjects
Antimicrobials, Community acquired Pneumonia, Outpatient care, Pediatrics, Stewardship, Appropriate prescribing, RJ1-570
Abstract

Abstract Background Antibiotics remain the primary treatment for community acquired pneumonia (CAP), however rising rates of antimicrobial resistance may jeopardize their future efficacy. With higher rates of disease reported in the youngest populations, effective treatment courses for pediatric pneumonia are of paramount importance. This study is the first to examine the quality of pediatric antibiotic use by agent, dose and duration. Methods A retrospective cohort study included all outpatient/primary care physician visits for pediatric CAP (aged

Published
2023
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229. The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections

Author

Matt Driedger, Nick Daneman, Kevin Brown, Wayne L. Gold, Sarah C.J. Jorgensen, Colleen Maxwell, Kevin L. Schwartz, Andrew M. Morris, Deva Thiruchelvam, Bradley Langford, Elizabeth Leung, and Derek MacFadden

Subjects
bloodstream infections, pandemic, COVID-19, blood cultures, epidemiology, Microbiology, QR1-502
Abstract

ABSTRACT The COVID-19 pandemic has likely influenced the epidemiology of bacterial infections through wide-ranging changes to clinical practices and infection control and prevention interventions. We sought to determine how the detection and incidence of bloodstream infections (BSIs) have been influenced by the pandemic. We performed a retrospective analysis of blood culture data in the province of Ontario, Canada, from 1 January 2017 to 31 December 2020. Outcomes included a weekly incidence of blood culture tests, BSIs, and contaminant results. Results were stratified by hospital, community, and long-term care (LTC) settings. An interrupted time series analysis using segmented regression models was used to determine changes in outcome incidence/prevalence during the pre- and peri-pandemic periods. Of the 14,083,853 individuals included, 129,329 (0.92%) developed a bloodstream infection. The blood culture ordering rate increased during the pandemic in the hospital setting only [Incidence rate ratio (IRR) 1.09, 95% confidence interval (CI) 1.01–1.19]. There was a decline in the incidence of community-acquired (IRR 0.95, 95% CI 0.91–0.99) and LTC-acquired (IRR 0.85, 95% CI 0.76–0.94) BSIs. Hospital-acquired BSIs were unchanged. The proportion of blood culture contaminants increased in the community (7% increase, P < 0.01) and LTC settings (14% increase, P < 0.05). There was decreased incidence of community-acquired Streptococcus pneumoniae (IRR 0.43, 95% CI 0.33–0.57) and Staphylococcus aureus (IRR 0.91, 95% CI 0.84–0.99) bacteremia. Pandemic-related changes in the performance of blood cultures and the epidemiology of BSIs have implications for current and future pandemic antimicrobial use, healthcare resource allocation, and hospital and laboratory policies. IMPORTANCE Bacterial infections are a significant cause of morbidity and mortality worldwide. In the wake of the COVID-19 pandemic, previous studies have demonstrated pandemic-related shifts in the epidemiology of bacterial bloodstream infections (BSIs) in the general population and in specific hospital systems. Our study uses a large, comprehensive data set stratified by setting [community, long-term care (LTC), and hospital] to uniquely demonstrate how the effect of the COVID-19 pandemic on BSIs and testing practices varies by healthcare setting. We showed that, while the number of false-positive blood culture results generally increased during the pandemic, this effect did not apply to hospitalized patients. We also found that many infections were likely under-recognized in patients in the community and in LTC, demonstrating the importance of maintaining healthcare for these groups during crises. Last, we found a decrease in infections caused by certain pathogens in the community, suggesting some secondary benefits of pandemic-related public health measures.

Published
2023
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230. Going local: Evaluating guideline adherence and appropriateness of antibiotic prescribing in patients with febrile neutropenia at an academic teaching hospital

Author

Rachel Liu, Melissa R. Gitman, Andrew M. Morris, and Miranda So

Subjects
Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Abstract Background: Febrile neutropenia (FN) is a medical emergency with significant morbidity and mortality for oncology patients, requiring comprehensive workup and timely antibiotic administration. We evaluated concordance with locally developed FN guidelines and outcomes of cancer patients admitted to general internal medicine at an academic teaching hospital. Methods: We conducted a retrospective observational cohort study of patients admitted between July 1, 2016, and June 30, 2017, for FN. Patients were classified as having low-risk or high-risk FN according to their malignancy and chemotherapy. Primary outcome was the proportion of patients receiving guideline-concordant antibiotics within 48 hours of admission to general internal medicine. Secondary outcomes were the proportion of patients in whom empirical antibiotics were active against pathogens isolated, rate of antibiotic-associated adverse events, and in-hospital mortality. We used logistic regression to model relationship between FN risk and guideline-concordant antibiotics. Results: Among 100 patients included, 34 (34%) were low-risk FN and 66 (66%) were high-risk. Proportion of guideline-concordant empirical antibiotics was significantly lower among low-risk FN patients than high-risk patients: 12 (35%) of 34 versus 47 (71%) of 66 (P = .001). Empirical antibiotics were active against 17 (94%) of 18 isolated pathogens. The mortality rate was 3%, and 16% of patients experienced antibiotic-associated adverse events. Hematological malignancy and infectious diseases–trained physician involvement were associated with guideline-concordant prescribing, with adjusted odds ratios of 3.76 (95% CI, 1.46–9.70; P = .006) and 3.71 (95% CI, 1.49–9.23; P = .005), respectively. Conclusions: Guideline concordance was low compared to published reports. Factors influencing appropriate antimicrobial prescribing in patients with FN warrant further exploration.

Published
2023
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231. Knowledge, perspectives and health outcome expectations of antibiotic therapy in hospitalized patients

Author

Linda Jorgoni, Erica Camardo, Lianne Jeffs, Yoshiko Nakamachi, Deborah Somanader, Chaim M. Bell, and Andrew M. Morris

Subjects
Antimicrobial resistance, Inpatient, Knowledge, Outcome expectations, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The World Health Organization (WHO) has recognized antimicrobial resistance (AMR) as a top threat to global health. However, the public has an incomplete understanding of AMR and its consequences. Aim: The aim of this study was to explore patients’ understanding, perspective and health outcome expectations for antibiotic therapy within an inpatient internal medicine population. Methods: A mixed methods study, combining a cross-sectional survey with qualitative methods. Fourteen questions (10 paper survey and four open ended interview questions) were used, and were completed by the participant in one sitting. Participants were recruited from General Internal Medicine units at two academic hospitals in Canada (convenience sample). Findings: Thirty participants were included. Out of a scale of 1–100%, participants indicated moderate concern (mean of 40%) about getting an infection that could not be cured by antibiotics. The majority agreed that they trusted their healthcare team to decide on appropriate antibiotic therapy (mean of 81%). The participants strongly agreed (mean of 90%) that it was important to understand the rationale for their antibiotic therapy. Three themes emerged from the qualitative analysis: 1) varying levels of knowledge; 2) viewing antibiotics as beneficial while emphasizing effectiveness; and 3) trusting the healthcare team with expectations for inclusion in decision making. Conclusion: The study results showed varying levels of patients’ antibiotic knowledge and large gaps in awareness related to AMR. Exploring the role and workflow of interdisciplinary healthcare professionals may be a potential strategy to minimize patients’ knowledge gap related to antimicrobial therapy and AMR.

Published
2022
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232. A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

Author

Warren McIsaac, Sahana Kukan, Ella Huszti, Leah Szadkowski, Braden O’Neill, Sophia Virani, Noah Ivers, Rosemarie Lall, Navsheer Toor, Mruna Shah, Ruby Alvi, Aashka Bhatt, Yoshiko Nakamachi, and Andrew M. Morris

Subjects
Antimicrobial stewardship, Primary care, Controlled trial, Medicine (General), R5-920
Abstract

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov ( NCT03517215 ).

Published
2021
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233. Presence of urinary symptoms in bacteremic urinary tract infection: a retrospective cohort study of Escherichia coli bacteremia

Author

Anthony D. Bai, Michael J. Bonares, Samuel Thrall, Chaim M. Bell, and Andrew M. Morris

Subjects
Escherichia coli, Bacteremia, Urinary tract infection, Diagnosis, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background It is important to understand clinical features of bacteremic urinary tract infection (bUTI), because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy. Escherichia coli is the most common and important uropathogen. The objective of our study was to characterize the clinical presentation of E coli bUTI. Methods Retrospective cohort study of consecutive adult patients admitted for community acquired E. coli bacteremia from January 1, 2015 to December 31, 2016 was conducted at 4 acute care academic and community hospitals in Toronto, Ontario, Canada. Logistic regression models were developed to identify E coli bUTI cases without urinary symptoms. Results Of 462 patients with E. coli bacteremia, 284 (61.5%) patients had a urinary source. Of these 284 patients, 161 (56.7%) had urinary symptoms. In a multivariable model, bUTI without urinary symptoms were associated with older age (age =85 years had OR of 2.95 95% CI 1.44–6.18 p = 0.0036) and delirium (OR of 2.12 95% CI 1.13–4.03 p = 0.0207). Sepsis by SIRS criteria was present in 274 (96.5%) of all bUTI cases and 119 (96.8%) of bUTI cases without urinary symptoms. Conclusion The majority of patients with E. coli bacteremia had a urinary source. A significant proportion of bUTI cases had no urinary symptoms elicited on history. Elderly and delirious patients were more likely to have bUTI without urinary symptoms. In elderly and delirious patients with sepsis by SIRS criteria but without a clear infectious source, clinicians should suspect, investigate, and treat for bUTI.

Published
2020
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234. A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

Author

Manon R. Haverkate, Derek R. Macfadden, Nick Daneman, Jenine Leal, Michael Otterstatter, Roshanak Mahdavi, Adam G. D’Souza, Elissa Rennert-May, Michael Silverman, Kevin L. Schwartz, Andrew M. Morris, Ariana Saatchi, David M. Patrick, and Fawziah Marra

Subjects
antibiotic prescribing, long-term care, COVID-19, time series analysis, epidemiology, Therapeutics. Pharmacology, RM1-950
Abstract

The COVID-19 pandemic affected access to care, and the associated public health measures influenced the transmission of other infectious diseases. The pandemic has dramatically changed antibiotic prescribing in the community. We aimed to determine the impact of the COVID-19 pandemic and the resulting control measures on oral antibiotic prescribing in long-term care facilities (LTCFs) in Alberta and Ontario, Canada using linked administrative data. Antibiotic prescription data were collected for LTCF residents 65 years and older in Alberta and Ontario from 1 January 2017 until 31 December 2020. Weekly prescription rates per 1000 residents, stratified by age, sex, antibiotic class, and selected individual agents, were calculated. Interrupted time series analyses using SARIMA models were performed to test for changes in antibiotic prescription rates after the start of the pandemic (1 March 2020). The average annual cohort size was 18,489 for Alberta and 96,614 for Ontario. A significant decrease in overall weekly prescription rates after the start of the pandemic compared to pre-pandemic was found in Alberta, but not in Ontario. Furthermore, a significant decrease in prescription rates was observed for antibiotics mainly used to treat respiratory tract infections: amoxicillin in both provinces (Alberta: −0.6 per 1000 LTCF residents decrease in weekly prescription rate, p = 0.006; Ontario: −0.8, p < 0.001); and doxycycline (−0.2, p = 0.005) and penicillin (−0.04, p = 0.014) in Ontario. In Ontario, azithromycin was prescribed at a significantly higher rate after the start of the pandemic (0.7 per 1000 LTCF residents increase in weekly prescription rate, p = 0.011). A decrease in prescription rates for antibiotics that are largely used to treat respiratory tract infections is in keeping with the lower observed rates for respiratory infections resulting from pandemic control measures. The results should be considered in the contexts of different LTCF systems and provincial public health responses to the pandemic.

Published
2022
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235. Prospective audit and feedback on antibiotic use in neonatal intensive care: a retrospective cohort study

Author

Nisha Thampi, Prakesh S. Shah, Sandra Nelson, Amisha Agarwal, Marilyn Steinberg, Yenge Diambomba, and Andrew M. Morris

Subjects
Prospective audit and feedback, Antibiotics, Neonatal, Intensive care, Antimicrobial stewardship, Pediatrics, RJ1-570
Abstract

Abstract Background Antimicrobial stewardship programs potentially lead to appropriate antibiotic use, yet the optimal approach for neonates is uncertain. Such a program was implemented in a tertiary care neonatal intensive care unit in October 2012. We evaluated the impact of this program on antimicrobial use and its association with clinical outcomes. Methods In a retrospective cohort study, we examined 1580 neonates who received antimicrobials in the 13-months before and 13-months during program implementation. Prospective audit and feedback was given 5 days a week on each patient who was receiving antibiotic. Pharmacy and microbiology data were linked to clinical data from the local Canadian Neonatal Network database. The primary outcome was days of antibiotic therapy per 1000 patient-days; secondary outcomes included mortality, necrotizing enterocolitis, and antibiotic duration for culture-positive and culture-negative late-onset sepsis. The breadth of antibiotic exposure was compared using the Antibiotic Spectrum Index. Results Overall antibiotic use decreased to 339 days of therapy per 1000 patient-days from 395 (14%, P

Published
2019
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236. Excess cost of care associated with sepsis in cancer patients: Results from a population-based case-control matched cohort

Author

Michelle Tew, Kim Dalziel, Karin Thursky, Murray Krahn, Lusine Abrahamyan, Andrew M. Morris, and Philip Clarke

Subjects
Medicine, Science
Abstract

Background Cancer patients are at significant risk of developing sepsis due to underlying malignancy and necessary treatments. Little is known about the economic burden of sepsis in this high-risk population. We estimate the short- and long-term healthcare costs of care of cancer patients with and without sepsis using individual-level linked-administrative data. Methods We conducted a population-based matched cohort study of cancer patients aged ≥18, diagnosed between 2010 and 2017. Cases were identified if diagnosed with sepsis during the study period, and were matched 1:1 by age, sex, cancer type and other variables to controls without sepsis. Mean costs (2018 Canadian dollars) for patients with and without sepsis up to 5 years were estimated adjusted using survival probabilities at partitioned intervals. We estimated excess cost associated with sepsis presented as a cost difference between the two cohorts. Haematological and solid cancers were analysed separately. Results 77,483 cancer patients with sepsis were identified and matched. 64.3% of the cohort were aged ≥65, 46.3% female and 17.8% with haematological malignancies. Among solid tumour patients, the excess cost of care among patients who developed sepsis was $29,081 (95%CI, $28,404-$29,757) in the first year, rising to $60,714 (95%CI, $59,729-$61,698) over 5 years. This was higher for haematology patients; $46,154 (95%CI, $45,505-$46,804) in year 1, increasing to $75,931 (95%CI, $74,895-$76,968). Conclusions Sepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden.

Published
2021

237. Barriers and Facilitators to Implementation of Antibiotic Stewardship Programmes in Hospitals in Developed Countries: Insights From Transnational Studies

Author

Magdalena Rzewuska, Eilidh M. Duncan, Jill J. Francis, Andrew M. Morris, Kathryn N. Suh, Peter G. Davey, Jeremy M. Grimshaw, and Craig R. Ramsay

Subjects
antimicrobial stewardship, systematic review, barriers and facilitators, theoretical domains framework, hospitals, behavior change, Sociology (General), HM401-1281
Abstract

Objectives: To identify perceived influences on implementation of antibiotic stewardship programmes (ASPs) in hospitals, across healthcare systems, and to exemplify the use of a behavioral framework to conceptualize those influences.Methods: EMBASE and MEDLINE databases were searched from 01/2001 to 07/2017 and reference lists were screened for transnational studies that reported barriers and/or facilitators to implementing actual or hypothetical ASPs or ASP-supporting strategies. Extracted data were synthesized using content analysis with the Theoretical Domains Framework as an organizing framework. Commonly reported influences were quantified.Results: From 3,196 abstracts 75 full-text articles were screened for inclusion. Eight studies met the eligibility criteria. The number of countries involved in each study ranged from 2 to 36. These studies included a total of 1849 participants. North America, Europe and Australasia had the strongest representation. Participants were members of special interest groups, designated hospital representatives or clinical experts. Ten of the 14 theoretical domains in the framework were present in the results reported in the included studies. The most commonly reported (≥4 out of 8 studies) influences on ASP implementation were coded in the domain “environmental context and resources” (e.g., problems with data and information systems; lack of key personnel; inadequate financial resources) and “goals” (other higher priorities).Conclusions: Despite an extensive transnational research effort, there is evidence from international studies of substantial barriers to implementing ASPs in hospitals, even in developed countries. Large-scale efforts to implement hospital antibiotic stewardship in those countries will need to overcome issues around inadequacy of information systems, unavailability of key personnel and funding, and the competition from other priority initiatives. We have enhanced the evidence base to inform guidance by taking a behavioral approach to identify influences on ASP uptake.Systematic review registration: PROSPERO registration number CRD42017076425.

Published
2020
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238. Appropriateness of Outpatient Antibiotic Use in Seniors across Two Canadian Provinces

Author

Ariana Saatchi, Jennifer N. Reid, Marcus Povitz, Salimah Z. Shariff, Michael Silverman, Andrew M. Morris, Romina C. Reyes, David M. Patrick, and Fawziah Marra

Subjects
antibiotics, antimicrobial drug resistance, outpatient care, inappropriate prescribing, Therapeutics. Pharmacology, RM1-950
Abstract

Antimicrobials are among the most prescribed medications in Canada, with over 90% of antibiotics prescribed in outpatient settings. Seniors prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. The extent of inappropriate antibiotic prescribing in outpatient Canadian medical practice, and the potential long-term trends in this practice, are unknown. This study is the first in Canada to examine prescribing quality across two large-scale provincial healthcare systems to compare both quantity and quality of outpatient antibiotic use in seniors. Population-based analyses using administrative health databases were conducted in British Columbia (BC) and Ontario (ON), and all outpatient, oral antimicrobials dispensed to seniors (≥65 years) from 1 January 2000 to 31 December 2018 were identified. Antimicrobials were linked to an indication using a 3-tiered hierarchy. Tier 1 indications, which always require antibiotics, were given priority, followed by Tier 2 indications that sometimes require antibiotics, then Tier 3, which never require antibiotics. Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and by patient demographics. Prescribing remained steady in both provinces, with 11,166,401 prescriptions dispensed overall in BC, and 27,656,014 overall in ON. BC prescribed at slightly elevated rates (range: 790 to 930 per 1000 residents), in comparison to ON (range: 745 to 785 per 1000 residents), throughout the study period. For both provinces, a Tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. Although Tier 3 indications remained the most prescribed-for diagnoses throughout the study period, a declining trend over time is encouraging, with much room for improvement remaining. Elevated prescribing to seniors continues across Canadian outpatient settings, and prescribing quality is of high concern, with 50% of all antimicrobials prescribed inappropriately for common infections that do not require antimicrobials.

Published
2021
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239. Quantifying the Gap between Expected and Actual Rates of Antibiotic Prescribing in British Columbia, Canada

Author

Ariana Saatchi, Ji-Won Yoo, Kevin L. Schwartz, Michael Silverman, Andrew M. Morris, David M. Patrick, James McCormack, and Fawziah Marra

Subjects
antibiotics, epidemiology, antimicrobial resistance (AMR), prescription, respiratory tract infections, outpatient care, Therapeutics. Pharmacology, RM1-950
Abstract

Despite decades of stewardship efforts to combat antimicrobial resistance and quantify changes in use, the quality of antibiotic use in British Columbia (BC) remains unknown. As the overuse and misuse of antibiotics drives antibiotic resistance, it is imperative to expand surveillance efforts to examine the quality of antibiotic prescriptions. In late 2019, Canadian expected rates of antibiotic prescribing were developed for common infections. These rates were utilized to quantify the gap between the observed rates of prescribing and Canadian expected rates for antibiotic use for the province of BC. The prescribing data were extracted and matched to physician billing systems using anonymized patient identifiers from 1 January 2000 to 31 December 2018. Outpatient prescribing was further subdivided into community and emergency department settings and stratified by the following age groups:

Published
2021
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