Integrating Randomized Comparative Effectiveness Research with Patient Care
Patients; Management; Medical Care; Usage; Care and treatment; Clinical Trials; Anti-Bacterial Agents/therapeutic use; Chlorhexidine - administration & dosage; Comparative Effectiveness Research - organization & administration; Comparative Effectiveness Research - standards; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Insulin - administration & dosage
The article discusses some of the features of comparativeness effectiveness trials in relation to patient care. Some of the successes as well as failures of various attempts to integrate randomized comparative effectiveness research with patient care are highlighted.
2016-06
Fiore LD; Lavori PW
The New England Journal Of Medicine
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/NEJMra1510057" target="_blank" rel="noreferrer">10.1056/NEJMra1510057</a>
High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis
Female; Humans; Male; Prospective Studies; Risk Factors; Intensive Care; Incidence; infant; Anti-Bacterial Agents/therapeutic use; England/epidemiology; Bacterial Infections/drug therapy/epidemiology; Bronchiolitis/epidemiology/virology; Lung Diseases/drug therapy/epidemiology/microbiology; Respiratory Syncytial Virus Infections/epidemiology
BACKGROUND: Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract infections (LRTI). Viral LRTI is a risk factor for bacterial superinfection, having an escalating incidence with increasing severity of respiratory illness. A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis, using paediatric intensive care unit (PICU) admission as a surrogate marker of severity, and to study the impact of the co-infection on morbidity and mortality. METHODS: A prospective microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons. RESULTS: One hundred and sixty five children (median age 1.6 months, IQR 0.5-4.6) admitted to the PICU with RSV bronchiolitis were enrolled in the study. Seventy (42.4%) had lower airway secretions positive for bacteria: 36 (21.8%) were co-infected and 34 (20.6%) had low bacterial growth/possible co-infection. All were mechanically ventilated (median 5.0 days, IQR 3.0-7.3). Those with bacterial co-infection required ventilatory support for longer than those with only RSV (p<0.01). White cell count, neutrophil count, and C-reactive protein did not differentiate between the groups. Seventy four children (45%) received antibiotics prior to intubation. Sex, co-morbidity, origin, prior antibiotics, time on preceding antibiotics, admission oxygen, and ventilation index were not predictive of positive bacterial cultures. There were 12 deaths (6.6%), five of which were related to RSV. CONCLUSIONS: Up to 40% of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia.
2006
Thorburn K; Harigopal S; Reddy V; Taylor N; van Saene HK
Thorax
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/thx.2005.048397" target="_blank" rel="noreferrer">10.1136/thx.2005.048397</a>
Bacteraemia and antibiotic use in respiratory syncytial virus infections
Child; Humans; infant; Intensive Care; Neonatal; adolescent; Preschool; infant; Newborn; Hospitalization/statistics & numerical data; Anti-Bacterial Agents/therapeutic use; Bacteremia/etiology; Community-Acquired Infections/etiology; Cross Infection/etiology; Equipment Contamination; Respiratory Syncytial Virus Infections/drug therapy/microbiology
AIMS: To examine the frequency of and risk factors for bacteraemia in children hospitalised with respiratory syncytial virus (RSV) infection; and to determine current use of antibiotics in hospitalised children with RSV infection. METHODS: Retrospective study of all children, aged 0-14 years, admitted to a tertiary children's hospital with proven RSV infection over a four year period. Children with concurrent bacteraemia and RSV infection were identified, and risk factors examined for bacteraemia. The case notes of a randomly selected comparison sample of 100 of these RSV infected children were examined to assess antibiotic use and population incidence of risk factors for severe RSV infection. RESULTS: A total of 1795 children had proven RSV infection, and blood cultures were sent on 861 (48%). Eleven (0.6%) of the 1795 RSV positive children had bacteraemia. RSV positive children had a significantly higher incidence of bacteraemia if they had nosocomial RSV infection (6.5%), cyanotic congenital heart disease (6.6%), or were admitted to the paediatric intensive care unit (2.9%). Forty five (45%) of the random comparison sample of RSV infected children received antibiotics. CONCLUSIONS: Bacteraemia is rare in RSV infection. Children with RSV infection are more likely to be bacteraemic, however, if they have nosocomial RSV infection, cyanotic congenital heart disease, or require intensive care unit admission.
2004
Bloomfield P; Dalton D; Karleka A; Kesson A; Duncan G; Isaacs D
Archives Of Disease In Childhood
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/adc.2003.035105" target="_blank" rel="noreferrer">10.1136/adc.2003.035105</a>
Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection
Child; Humans; Prospective Studies; Risk Factors; Preschool; infant; Anti-Bacterial Agents/therapeutic use; Bacterial Infections/etiology; Pneumonia/etiology; Respiratory Syncytial Viruses; Respiratory Tract Infections/complications/drug therapy; Respirovirus Infections/complications/drug therapy
Because infants hospitalized with respiratory syncytial virus (RSV) infection frequently receive antibiotics, our study was undertaken to determine what the actual risk of secondary bacterial infections in patients with RSV infection is and what effect antibiotic treatment might have on the course of illness. In a 9-year prospective study of 1706 children hospitalized with acute respiratory illnesses, 565 children had documented RSV infections. A subsequent bacterial infection rarely developed in those with RSV lower respiratory tract disease. The rate of subsequent bacterial infection was 1.2% in the total group of children infected with RSV, and 0.6% in the 352 children who received no antibiotics. A significantly greater proportion (4.5%) of subsequent bacterial infections occurred in infants who received parenteral antibiotics (p = 0.01), and especially in a subgroup who received parenteral antibiotics for 5 or more days (11%, p less than 0.001). We conclude that the risk of secondary bacterial infection appears to be low for most infants with RSV infection. In a few infants given parenteral broad-spectrum antibiotics the risk may be greater, but whether this is related to the antibiotic therapy or to other risk factors is not clear.
1988
Hall CB; Powell KR; Schnabel KC; Gala CL; Pincus PH
The Journal Of Pediatrics
1988
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0022-3476(88)80263-4" target="_blank" rel="noreferrer">10.1016/s0022-3476(88)80263-4</a>