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Le Touquet – Paris-Plage, France

Dyar O.J.,University of Oxford | Pulcini C.,Nice University Hospital Center | Pulcini C.,University of Nice Sophia Antipolis | Howard P.,Pharmacy | Nathwani D.,Infection Unit
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: To learn about medical students' knowledge of and perspectives on antibiotic prescribing and resistance, with the aim of helping to develop educational programmes. Methods: Final-year students at seven European medical schools were invited to participate in an online survey in 2012. Results: The response rate was 35% (338/961). Most students (74%) wanted more education on choosing antibiotic treatments. Students at all schools felt most confident in diagnosing an infection and least confident in choosing combination therapies, choosing the correct dose and interval of administration and not prescribing in cases of diagnostic uncertainty. Students felt that too many prescriptions and too much broad-spectrum antibiotic use were the most important contributors to resistance; some (24%) believed poor hand hygiene was not at all important. Most students (92%) believed that resistance is a national problem. Most (66%) felt that the antibiotics they would prescribe would contribute to resistance, and almost all (98%) felt that resistance would be a greater problem in the future. Most students (83%) incorrectly thought that rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia had significantly increased over the past decade in their countries. There was little appreciation of the relative burden of resistance in Europe compared with road traffic accidents (around two to three times greater mortality) and lung cancer (around 10 times greater mortality). Conclusions: Students wanted further education on antibiotic prescribing, and areas of lack of confidence were found. Students overestimated the current burden of resistant bacteria and were unaware of successes in reducing MRSA infections. Educational and stewardship programmes may benefit from including more cases of diagnostic uncertainty, and highlighting successes such as MRSA prevention, as evidence for the importance of current interventions. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

Batterink J.,Pharmacy
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Spironolactone is an aldosterone antagonist, considered fourth line therapy for hypertension in patients already treated with multiple medications. OBJECTIVES: Primary: to determine the effect of spironolactone on patient mortality, morbidity, and to quantify the magnitude of blood pressure lowering effect of spironolactone monotherapy.Secondary: to determine the prevalence of adverse reactions observed with spironolactone monotherapy and to determine if there is a blood-pressure lowering dose response with spironolactone. SEARCH STRATEGY: We searched the following databases: Cochrane Central Register of Controlled Trials (3rd Quarter 2009), MEDLINE (2005 - Sept. 2009), and EMBASE (2007 - Sept. 2009). References from retrieved studies were reviewed to identify any studies missed in the initial search. No language restrictions were applied. SELECTION CRITERIA: We selected RCTs studying patients with primary hypertension. We excluded studies of patients with secondary or gestational hypertension, and studies where patients were receiving multiple antihypertensives. DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed the search results for studies meeting our criteria. Three reviewers extracted data and assessed trial quality using a standardized data extraction form. Data synthesis and analysis was performed using RevMan 5. MAIN RESULTS: Meta-analysis of the 5 cross-over studies found a reduction in SBP of 20.09 mmHg (95%CI:16.58-23.06,p<0.00001) and a 6.75 mmHg (95%CI:4.8-8.69,p<0.00001) reduction in DBP. These results were statistically significant and there was no evidence of heterogeneity between the studies. There may be a dose response effect with spironolactone up to 50 mg/day, but the confidence intervals around the mean end-of-study blood pressure for doses ranging 25-500 mg/day all overlapped. In other words, it appears that doses >50mg/day do not produce further reductions in either SBP or DBP. One cross-over study found that spironolactone 25 mg/day did not statistically significantly change SBP or DBP compared to placebo, SBP: -9.9 (95%CI:-21.15,1.35); DBP -2.34 (95%CI:-7.92,3.06). AUTHORS' CONCLUSIONS: From the limited available evidence, spironolactone appears to lower blood pressure compared to placebo to a similar degree in patients with primary (essential) hypertension when doses of 100-500 mg/day are given. A dose of 25 mg/day did not statistically significantly reduce systolic or diastolic blood pressure, compared to placebo. Given the lack of a dose-response, coupled with a possible increased risk in adverse events with higher doses, doses of 25 to 100 mg/day are reasonable. There is no evidence of the effect of spironolactone on clinical outcomes in hypertensive patients. Source

Velazquez A.,Infectious Disease | Deryke C.A.,Pharmacy | Goering R.,Creighton University | Hoover V.,Microbiology | Wallace M.R.,Infectious Disease
Clinical Microbiology and Infection | Year: 2013

Daptomycin non-susceptible Staphylococcus aureus was rarely encountered at our medical centre until 2010, when 10 isolates (0.4% of S. aureus) were confirmed by E-test as non-susceptible. These isolates were not of the same strain type and there was no link between the 10 patients. Daptomycin non-susceptibility may be increasing. © 2013 European Society of Clinical Microbiology and Infectious Diseases. Source

Gao C.,Tianjin University | Yan T.,Pharmacy | Du J.,Tianjin University | He F.,Tianjin University | And 2 more authors.
Food Hydrocolloids | Year: 2014

Active packaging plays a role of a barrier to the outside environment to protect food products. The bacterial cellulose (BC) has the potential as active packaging for food due to its high purity of cellulose content and refined nanofibrous network structure mainly. In order to enhance the antibacterial activity of BC, the ε-polylysine (EPL), a natural coming peptide applied as safe food preservative, was introduced to the surfaces of BC nanofibers via crosslinking method by using procyanidins as crosslinker. Scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Fourier Transformed infrared spectroscopy (FTIR), were employed to characterize the structure of BC/EPL composite nanofibers. SEM and TEM observations revealed that EPL coatings on the surfaces of BC nanofibers were composed of EPL nanoparticles and the thickness of EPL coatings was proportional to the concentration of EPL solution. FTIR results indicated that - NH3+ groups were preserved after crosslinking process and the introduction of EPL had no influence on the original chemical structure of BC. In addition, BC/EPL composite nanofibers exhibited antibacterial activity against both Escherichia coli (Gram-negative bacteria) and Staphylococcus aureus (Gram-positive bacteria). The antibacterial activity was enhanced with the increase of concentration of EPL solution. © 2013 Elsevier Ltd. Source

Helou R.,Juel Hospital | Rhalimi M.,Pharmacy
Canadian Journal of Clinical Pharmacology | Year: 2010

Objective To evaluate whether Cholinesterase inhibitors (ChEI) are associated with an increased risk of pulmonary disorders (PD) in hospitalized dementia patients. Methods We conducted an observational cross-sectional study by examining the medical records of all the dementia patients hospitalized in the acute geriatric ward at the Bertinot Juel Hospital between January 1, 2005 and June 30, 2009. First, we examined whether there were any differences between the patients receiving ChEIs and those who were not. Second, we measured whether the patients had any type of PD outcome, including pneumonia, persistent cough, bronchitis, and asthma. Finally, we studied the association between ChEIs and PD. We used a logistic regression analysis preceded by a univariate analysis to adjust for other variables, such as age, weight, severity of dementia, length of stay in hospital, and history of asthma. Results The study included 183 patients with a mean age of 83 years. There were 131 females and 52 males. There were 55 patients with PD, including 37 with pneumonia, 11 with bronchitis, 4 with asthma, 2 with acute respiratory failure and 1 with a persistent cough. In 38 of these cases, the PD was present before hospitalization and was considered the cause of hospitalization. In 17 cases, the PD was not present at admission but occurred during hospitalization. Only ChEI treatment and age (> 80 years) were associated with an increased risk of pulmonary disorders. The adjusted relative risk was 1.98 [1.21, 3.23] for ChEI and 1.30 [1.10, 1.54] for age. Conclusion When prescribing ChEIs, physicians should be aware about the risk of PD. As well, withdrawing ChEIs in patients who present repeated PD should be discussed. Prospective studies need to be conducted to confirm our findings. © 2010 Canadian Society of Pharmacology and Therapeutics. Source

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