Corneliussenhemmingsen7306

Furthermore, mass variation, drug content range and drug content uniformity of spironolactone of 2 mg, 4 mg and hydrochlorothiazide of 5 mg tablets split by pharmacists failed to comply with European Pharmacopoeia and Chinese Pharmacopoeia, while those of the three-dimensional printed subdivided tablets did. After the review of the ethics committee as a new technology for hospital dispensing, three-dimensional printed spironolactone subdivided tablets of 2 mg have been used in clinical inpatients and was accepted by pharmacists, nurses and patients. Compared with tablets subdivided split by pharmacists, three-dimensional printed spironolactone of 2 mg were more accurate, safer and more customized, which indicated considerable potential in using three-dimensional printing technology as a new method for hospital dispensing. V.BACKGROUND The prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) has globally increased and spread to the community. No clinical score is available to select carriers in whom these organisms can be empirically targeted at ICU admission. METHODS We prospectively assessed between 2009 and 2017 the prevalence of ESBL-PE infection in carriers at ICU admission. A logistic regression was used to determine independent risk factors associated with ESBL-PE infection, and to build a clinical risk score. RESULTS Of the 8,061 admissions over the study 7-year period, 745 (9%) patients were ESBL-PE carriers at admission, of whom 395 had infections at ICU admission including 59 (15%) who had culture-proven ESBL-PE related infection. By multivariable analysis, age >60 years, cirrhosis, being on broad-spectrum antibiotics within the past three months, urinary or intra-abdominal source of infection, and the absence of chronic pulmonary disease, were the five independent factors associated with ESBL-PE infection in carriers. A clinical risk score ranging from 0 to 7 was built based on these variables, with an area under the receiver operating characteristic curve (ROC) of 0.82 (95% CI 0.78-0.86); p  less then 0.001. The prevalence of ESBL-PE infection for clinical risk scores of 0-1, 2-3, 4-5, or 6-7 was 0%, 4%, 26%, and 49%, respectively. The negative predictive value when Mondor ESBL risk score is less then 4 was 97%. CONCLUSION ESBL-PE related infection was not common in carriers at ICU admission. A clinical risk score may spare ESBL-PE carriers with lower risk of ESBL-PE infection at ICU admission unnecessary empiric carbapenem therapy. BACKGROUND Circumferential resection margin (CRM) status is an important predictor of outcomes following rectal cancer surgery and influenced not only by operative technique, but also by incorporation of a multi-disciplinary treatment strategy. This study sought to develop a risk-adjusted quality metric, based on CRM status to assess hospital-level performance for rectal cancer surgery. STUDY DESIGN Retrospective observational cohort study of 58,374 patients with resected stage I-III rectal within 1,303 hospitals were identified from the National Cancer Database (2010-2015). SCR7 The hospital observed number of CRM positivity (≤ 1mm) was divided by risk-adjusted number of CRM positivity to form the observed-to-expected ratio (O/E ratio). Secondary outcome was overall survival (OS). RESULTS The overall rate of CRM positivity was 15.9%. Based on the O/E ratio for 1,139 hospital, 147(12.9%) and 103 (9.0%) were significantly worse and better performers, respectively. The majority of hospitals (n=570) performed as expected. Positive CRM using criteria of 0mm and 0.1-1mm were associated with a significantly shorter 5-year OS of 49% and 63.5% (HR 1.67, 95% CI 1.57-1.76 and HR1.19, 95% CI 1.12-1.26) than negative CRM >1mm of 74.1% (all p less then .001). CONCLUSIONS CRM-based O/E ratio is a robust hospital-based quality measure for rectal cancer surgery. It allows facilities to compare their performance with that of centers of similar characteristics and helps identify under-, "at risk," and high-performing centers. National quality improvement initiatives for rectal cancer should focus on ensuring high-quality data collection and providing ready access to risk-adjusted comparative metrics. BACKGROUND Coagulopathy is common in multi-trauma patients and repletion of procoagulant factor deficiency with fresh frozen plasma (FFP) improves hemostasis. Optimal kaolin-thromboelastography (TEG) thresholds for FFP transfusion in trauma patients haven't been well established. STUDY DESIGN Adult trauma patients with an injury severity score ≥ 15 were included in this retrospective observational cohort study. The primary outcome was area under the receiver operating characteristic curve (AUROC) for R-time to detect procoagulant factor deficiency, as reflected by an elevated INR or aPTT. Test characteristics for the optimal R-time threshold calculated in our study were compared against thresholds recommended by the American College of Surgeons for FFP transfusion. RESULTS 694 pairs of TEGs and conventional coagulation tests were performed in 550 patients, with 144 patients having additional pairs of tests after the first hour. R-time was able to detect procoagulant factor deficiency (AUROC INR≥1.5=0.80, 95% CI 0.75-0.85; AUROC aPTT≥ 40s=0.85, 95% 0.80-0.89) and severe procoagulant factor deficiency (AUROC INR≥2.0=0.82, 95% CI 0.73-0.99; AUROC aPTT≥60s=0.89, 95% CI 0.81-0.98) with good accuracy. Optimal thresholds to maximize sensitivity and specificity were 3.9 minutes for detection of INR≥1.5, 4.1 minutes for detection of aPTT≥40s, 4.3 minutes for detection of INR≥2.0, and 4.3 for detection of aPTT≥60s. Currently recommended R-time thresholds for FFP transfusion had 100% specificity for detecting procoagulant factor deficiency, but low sensitivity (3-7%). CONCLUSION R-time can detect procoagulant factor deficiency in multi-trauma patients with good accuracy, but currently recommended R-time thresholds for are highly specific and not sensitive. Use of low sensitivity thresholds may result in under-treatment of many patients with procoagulant factor deficiency.