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Acute management and secondary prophylaxis of esophageal variceal bleeding: a western Canadian survey.

https://arctichealth.org/en/permalink/ahliterature167625
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Publication Type
Article
Date
Aug-2006
Author
Justin Cheung
Winnie Wong
Iman Zandieh
Yvette Leung
Samuel S Lee
Alnoor Ramji
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton.
Source
Can J Gastroenterol. 2006 Aug;20(8):531-4
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - therapeutic use
Anti-Bacterial Agents - therapeutic use
Canada
Endoscopy
Esophageal and Gastric Varices - complications - diagnosis - therapy
Gastroenterology - statistics & numerical data
Gastrointestinal Agents - therapeutic use
Gastrointestinal Hemorrhage - etiology - therapy
Guideline Adherence - trends
Health Care Surveys
Humans
Octreotide - therapeutic use
Physician's Practice Patterns
Questionnaires
Abstract
Acute esophageal variceal bleeding (EVB) is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.
Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire.
The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%).
Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences.
Notes
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PubMed ID
16955150 View in PubMed
Less detail

Acute rheumatic fever and poststreptococcal reactive arthritis: diagnostic and treatment practices of pediatric subspecialists in Canada.

https://arctichealth.org/en/permalink/ahliterature193938
Source
J Rheumatol. 2001 Jul;28(7):1681-8
Publication Type
Article
Date
Jul-2001
Author
N. Birdi
M. Hosking
M K Clulow
C M Duffy
U. Allen
R E Petty
Author Affiliation
Department of Pediatrics, University of Ottawa, Ontario, Canada.
Source
J Rheumatol. 2001 Jul;28(7):1681-8
Date
Jul-2001
Language
English
Publication Type
Article
Keywords
Acute Disease
Anti-Bacterial Agents - therapeutic use
Arthritis, Reactive - diagnosis - prevention & control - therapy
Canada
Child
Female
Humans
Male
Pediatrics
Professional Practice
Questionnaires
Rheumatic Fever - diagnosis - drug therapy - therapy
Abstract
We conducted a survey of pediatric specialists in rheumatology, cardiology, and infectious diseases to ascertain present Canadian clinical practice with respect to diagnosis and treatment of acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSReA), and to determine what variables influence the decision for or against prophylaxis in these cases.
A questionnaire comprising 6 clinical case scenarios of acute arthritis occurring after recent streptococcal pharyngitis was sent to members of the Canadian Pediatric Rheumatology Association, and to heads of divisions of pediatric cardiology and pediatric infectious diseases at the 16 university affiliated centers across Canada.
There is considerable variability with respect to diagnosis in cases of ReA following group A streptococcal (GAS) infection both within and across specialties. There is extensive variability regarding the decision to provide prophylaxis in cases designated as ARF or PSReA. Findings indicated that physicians are most comfortable prescribing antibiotic prophylaxis in the presence of clear cardiac risk and are less inclined to such intervention for patients diagnosed with PSReA. When prophylaxis was recommended for cases of PSReA, the majority of respondents prescribed longer term courses of antibiotics.
The lack of observed consistency in diagnosis and treatment in cases of reactive arthritis post-GAS infection likely reflects the lack of universally accepted criteria for diagnosis of PSReA and insufficient longterm data regarding carditis risk within this population. There is a need for clear definitions and treatment guidelines to allow greater consistency in clinical practice across pediatric specialties.
PubMed ID
11469479 View in PubMed
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Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients.

https://arctichealth.org/en/permalink/ahliterature139154
Source
Can J Surg. 2010 Dec;53(6):367-72
Publication Type
Article
Date
Dec-2010
Author
Kristopher M Lundine
Susan Nelson
Richard Buckley
Sven Putnis
Paul J Duffy
Author Affiliation
Division of Orthopaedics, Health Sciences Centre, 3330 Hospital Dr. NW, Calgary, Alberta. krislundine@hotmail.com
Source
Can J Surg. 2010 Dec;53(6):367-72
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis
Canada
Cephalexin - therapeutic use
Female
Fractures, Closed - surgery
Humans
Male
Medication Adherence - statistics & numerical data
Middle Aged
Penicillins - therapeutic use
Perioperative Care - standards
Questionnaires
Retrospective Studies
Surgical Wound Infection - prevention & control
Young Adult
Abstract
The goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. We also investigated what doses and durations of antibiotics are typically ordered, which patients actually receive antibiotics and factors causing the ordered antibiotic regimen to be altered.
We performed a retrospective review of 205 patient charts and sent a national survey to all surgeon members of the Canadian Orthopaedic Trauma Society (COTS) about antibiotic prophylaxis in the setting of surgical treatment for closed fractures.
In all, 93% (179 of 193) of patients received an appropriate preoperative dose of antibiotics, whereas less than 32% (58 of 181) of patients received their postoperative antibiotics as ordered. The most commonly stated reason for patients not receiving their postoperative antibiotics as ordered was patients being discharged before completing 3 postoperative doses. There was a 70% (39 of 56) response rate to the survey sent to COTS surgeons. A single dose of a first-generation cephalosporin preoperatively followed by 3 doses postoperatively is the most common practice among orthopedic trauma surgeons across Canada, but several surgeons give only preoperative prophylaxis.
Adherence to multidose postoperative antibiotic regimens is poor. Meta-analyses have failed to demonstrate the superiority of multidose regimens over single-dose prophylaxis. Single-dose preoperative antibiotic prophylaxis may be a reasonable choice for most orthopedic trauma patients with closed fractures.
Notes
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Cites: J Hosp Infect. 1999 Nov;43(3):195-20210582186
PubMed ID
21092428 View in PubMed
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[Agreement between clinical practice guidelines for management of community-acquired pneumonia. A retrospective study of 101 hospitalized patients].

https://arctichealth.org/en/permalink/ahliterature181855
Source
Rev Mal Respir. 2003 Dec;20(6 Pt 1):858-70
Publication Type
Article
Date
Dec-2003
Author
J. Labarère
M. Fourny
P. Pavese
P. Bedouch
C. Brambilla
P. François
Author Affiliation
Unité d'Evaluation Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. jlabarere@chu-grenoble.fr
Source
Rev Mal Respir. 2003 Dec;20(6 Pt 1):858-70
Date
Dec-2003
Language
French
Publication Type
Article
Keywords
Acute Disease
Aged
Anti-Bacterial Agents - therapeutic use
Canada
Community-Acquired Infections - drug therapy
Consensus
Europe
Female
Hospitalization
Humans
Male
Middle Aged
Pneumonia - drug therapy
Practice Guidelines as Topic
Retrospective Studies
United States
Abstract
Management guidelines for acute community acquired pneumonia vary considerably. The objective is to estimate by a retrospective study the uniformity of the recommendations for the management of patients and the choice of initial empirical antibiotic therapy.
Eight English and French language guidelines published between 1998 and 2001 were identified by a search of the literature. They were applied retrospectively to a sample of 101 patients admitted to a university hospital in 2000 with a diagnosis of pneumonia.
Hospital admission was advocated for between 61% and 95% and admission to intensive care for between 8% and 35% of the patients, depending on the guidelines under consideration. The actual management conformed to that advocated for between 34% and 94% of the patients (kappa=0.27 [0,19; 0,34]). Compliance of the empirical antibiotic therapy (drug, dose, mode of administration) with the recommendations varied from 0% to 68% of the patients depending on the guidelines considered (kappa=0.01 [-0,10; 0,12]).
The heterogeneity of the guidelines is manifest by important variations in the recommendations for management and initial empirical therapy. These differences are due, in part, to a paucity of evidence based data upon which to base the guidelines. It would appear essential to harmonise the guidelines in a way that is appropriate for the country of their intended use.
Notes
Comment In: Rev Mal Respir. 2003 Dec;20(6 Pt 1):841-314743083
PubMed ID
14743087 View in PubMed
Less detail

Antibiotic consumption in children prior to diagnosis of asthma.

https://arctichealth.org/en/permalink/ahliterature134050
Source
BMC Pulm Med. 2011;11:32
Publication Type
Article
Date
2011
Author
Fawziah Marra
Carlo A Marra
Kathryn Richardson
Larry D Lynd
Mark J Fitzgerald
Author Affiliation
University of British Columbia, BC, Canada. fawziah.marra@bccdc.ca
Source
BMC Pulm Med. 2011;11:32
Date
2011
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Asthma - diagnosis
Canada
Child
Child, Preschool
Cohort Studies
Diagnosis, Differential
Diagnostic Errors
Female
Follow-Up Studies
Humans
Longitudinal Studies
Male
Respiratory Tract Infections - diagnosis - drug therapy
Abstract
Asthma is difficult to diagnose in children and at times misdiagnosis of an infection can occur. However, little is known about the magnitude and patterns of antibiotic consumption in children with asthma relative to those without asthma.
Using population-based data, 128,872 children were identified with at least 6 years of follow-up. The adjusted rate-ratio (RR) of antibiotics dispensed to asthmatic as compared to non-asthmatic children was determined.
At age six, the RR of antibiotic consumption for asthmatics compared to non-asthmatics varied between, 1.66 to 2.32, depending on the year of asthma diagnosis. Of the 18,864 children with asthma at ages 2-8, 52% (n = 9,841) had antibiotics dispensed in the 6 months prior to their index date of asthma diagnosis. The RR of antibiotic consumption in the 1 month prior to asthma diagnosis compared to 5 months prior was 1.66 (95% CI 1.60-1.71). The RR was lower in males compared to females (1.58 vs 1.77), and lower in those who received antibiotics in the first year of life relative to those that did not (1.60 vs. 1.76).
There is higher antibiotic consumption in children with asthma compared to those without asthma. The pattern of antibiotic use suggests that diagnosis guidelines are difficult to follow in young children leading to misdiagnosis and over treatment with antibiotics.
Notes
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Cites: J Asthma. 1999 Jun;36(4):381-710386502
PubMed ID
21627795 View in PubMed
Less detail

Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: do they work?

https://arctichealth.org/en/permalink/ahliterature228303
Source
Can J Surg. 1990 Oct;33(5):385-8
Publication Type
Article
Date
Oct-1990
Author
M J Girotti
S. Fodoruk
J. Irvine-Meek
O D Rotstein
Author Affiliation
Department of Surgery, Toronto Hospital Corporation, University of Toronto, Ont.
Source
Can J Surg. 1990 Oct;33(5):385-8
Date
Oct-1990
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Canada
Drug Prescriptions - standards
Education, Medical, Continuing - methods
Humans
Premedication - standards
Abstract
The authors attempted to compare the value of two strategies--an educational (antibiotic handbook) and a control (perioperative pre-printed physician order form, which contained antibiotic orders)--in modifying physicians' patterns of antibiotic prophylaxis for preventing infection in patients who undergo elective surgery. They reviewed the charts of 240 such patients on five different surgical services in one teaching hospital. Use of the antibiotic handbook (educational strategy) increased overall compliance with the recommended regimens from 11% to 18% (p = 0.06). The control strategy (perioperative pre-printed physician order form) increased compliance from 17% to 78% (p less than 0.01).
PubMed ID
2224658 View in PubMed
Less detail

Antibiotic prophylaxis for childhood urinary tract infection: a national survey.

https://arctichealth.org/en/permalink/ahliterature154199
Source
J Paediatr Child Health. 2008 Oct;44(10):572-8
Publication Type
Article
Date
Oct-2008
Author
Isabelle Chevalier
Geneviève Benoît
Marie Gauthier
Véronique Phan
Anne-Claude Bernard Bonnin
Marc H Lebel
Author Affiliation
Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. isabelle.chevalier.hsj@ssss.gouv.qc.ca
Source
J Paediatr Child Health. 2008 Oct;44(10):572-8
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Amoxicillin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents, Urinary - therapeutic use
Antibiotic Prophylaxis - utilization
Canada
Child
Child, Preschool
Data Collection
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Nitrofurantoin - therapeutic use
Pediatrics
Physician's Practice Patterns - statistics & numerical data
Prescriptions - statistics & numerical data
Questionnaires
Trimethoprim-Sulfamethoxazole Combination - therapeutic use
Urinary Tract Infections - epidemiology - prevention & control
Vesico-Ureteral Reflux - drug therapy - epidemiology
Abstract
To describe attitudes of paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for urinary tract infection (UTI) and determine the factors associated with its use.
A self-administered questionnaire was mailed to Canadian paediatricians (1136) and paediatric nephrologists (42).
The response rate was 58.1% (684 physicians); 436 who had made a decision about antibiotic prophylaxis for childhood UTI in the previous year were included in the analysis. Of these, 407 (93.3%) were certified in paediatrics and 29 (6.7%) were paediatric nephrologists. Most respondents prescribed prophylaxis for children with grade III-V vesicoureteral reflux (VUR) (96.5%-98%); 69.8 and 92.8% prescribed it for children with grades I and II VUR, respectively. Factors significantly associated with use of prophylaxis for children with grade I VUR were frequency of decision-making about prophylaxis, city size and province. Fifteen percent of physicians felt that their practice regarding antibiotic prophylaxis for children with VUR was evidence based. A hundred one respondents (24.3%) prescribed prophylaxis for infants with a first febrile UTI in the absence of VUR. Nineteen percent felt that their practice regarding antibiotic prophylaxis for these infants was evidence based. Prescription of prophylaxis for children >12 months with recurrent UTI in the absence of VUR was influenced by frequency of pyelonephritis (88.5% of respondents) and presence of voiding dysfunction (53.8%). Nine percent of physicians felt that their practice for these children was evidence based.
Opinions of Canadian paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for UTI in children vary widely, probably because of the paucity of solid evidence about prophylaxis.
PubMed ID
19012629 View in PubMed
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Antibiotics for lower respiratory tract infections. Still too frequently prescribed?

https://arctichealth.org/en/permalink/ahliterature180328
Source
Can Fam Physician. 2004 Apr;50:569-75
Publication Type
Article
Date
Apr-2004
Author
Warren J McIsaac
Teresa To
Author Affiliation
Ray D Wolfe Department of Family Medicine, Mt Sinai Hospital, Toronto, Ont. wmcisaac@mtsinai.on.ca
Source
Can Fam Physician. 2004 Apr;50:569-75
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Bronchitis - drug therapy
Canada
Drug Utilization
Family Practice - standards
Female
Humans
Male
Middle Aged
Physician's Practice Patterns
Prospective Studies
Respiratory Tract Infections - diagnosis - drug therapy
Abstract
To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs).
Prospective assessment of adults with symptoms of LRTIs.
Offices of 120 community-based members of the College of Family Physicians of Canada.
Four hundred seven adults (16 years and older).
Clinical findings, diagnoses, tests ordered, and prescriptions for antibiotics were documented on a standardized form.
Antibiotics were prescribed to 58.4% of patients presenting with symptoms of LRTIs. Prescribing was higher (77.9%) for those diagnosed with acute bronchitis, which accounted for 70.3% of prescriptions. Physicians were often uncertain about the need for antibiotics, were concerned that patients could become sicker, and felt pressured by patients to prescribe antibiotics. Macrolides were most frequently prescribed; no tests were ordered in 85.0% of encounters.
The number of antibiotic prescriptions for adults with LRTIs remains high in Canada. Rates of prescribing are increased by diagnosis of acute bronchitis, clinical uncertainty, pressure from patients to receive antibiotics, and concern that patients will deteriorate if left untreated.
Notes
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Cites: Can Fam Physician. 2001 Jun;47:1217-2411421050
PubMed ID
15116802 View in PubMed
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Antibiotics in primary prevention of myocardial infarction among elderly patients with hypertension.

https://arctichealth.org/en/permalink/ahliterature185229
Source
Am Heart J. 2003 May;145(5):E20
Publication Type
Article
Date
May-2003
Author
Paul Brassard
Chantal Bourgault
James Brophy
Abbas Kezouh
Bruno Rainville
Marianne Xhignesse
Samy Suissa
Author Affiliation
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada. paul.brassard@clinepi.mcgill.ca
Source
Am Heart J. 2003 May;145(5):E20
Date
May-2003
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antihypertensive Agents - therapeutic use
Canada
Case-Control Studies
Chlamydia Infections - complications - drug therapy
Chlamydophila pneumoniae
Databases, Factual
Female
Humans
Hypertension - drug therapy
Male
Myocardial Infarction - microbiology - prevention & control
Odds Ratio
Regression Analysis
Abstract
Given the premise that certain bacteria (such as Chlamydia pneumoniae) may play a role in the etiology of atherosclerosis, subjects treated with antibiotics that have antibacterial activity against C pneumoniae may be at lower risk for the development of an acute myocardial infarction (MI) than untreated subjects.
A case-control design, nested within a cohort of 29,937 elderly subjects in whom antihypertensive therapy was initiated (1982-1995) was used, in which each subject who was hospitalized with a primary discharge diagnosis of MI between 1987 and 1995 (n = 1047) was matched on calendar time to 5 randomly selected control subjects for exposure contrasts. Conditional logistic regression analyses were conducted to adjust for predisposing factors for MI.
Although no clear consistent effect of antibiotics use was found in relation to MI, a trend was observed for a decreased risk of acute MI in patients receiving a prescription for antichlamydial antibiotics in the preceding 3 months (odds ratio 0.68, 95% CI 0.46-1.00). Antibiotics without antichlamydial activity showed no benefit in MI risk.
The beneficial effect of certain antichlamydial antibiotics in reducing the risk of MI cannot be excluded on the basis of this representative cohort of elderly patients in a routine clinical care setting. Larger prospective studies are required to confirm the usefulness of antibiotics in the primary prevention of MI.
PubMed ID
12766754 View in PubMed
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