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O'Riordan F, Shiely F, Byrne S, O'Brien D, Palmer B, Dahly D, O'Connor TM, Curran D, Fleming A. An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study. J Antimicrob Chemother 2020; 74:3352-3361. [PMID: 31325313 DOI: 10.1093/jac/dkz313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diagnostic uncertainty and a high prevalence of viral infections present unique challenges for antimicrobial prescribing for respiratory tract infections (RTIs). Procalcitonin (PCT) has been shown to support prescribing decisions and reduce antimicrobial use safely in patients with RTIs, but recent study results have been variable. METHODS We conducted a feasibility study of the introduction of PCT testing in patients admitted to hospital with a lower RTI to determine if PCT testing is an effective and worthwhile intervention to introduce to support the existing antimicrobial stewardship (AMS) programme and safely decrease antimicrobial prescribing in patients admitted with RTIs. RESULTS A total of 79 patients were randomized to the intervention PCT-guided treatment group and 40 patients to the standard care respiratory control group. The addition of PCT testing led to a significant decrease in duration of antimicrobial prescriptions (mean 6.8 versus 8.9 days, P = 0.012) and decreased length of hospital stay (median 7 versus 8 days, P = 0.009) between the PCT and respiratory control group. PCT did not demonstrate a significant reduction in antimicrobial consumption when measured as DDDs and days of therapy. CONCLUSIONS PCT testing had a positive effect on antimicrobial prescribing during this feasibility study. The successful implementation of PCT testing in a randomized controlled trial requires an ongoing comprehensive education programme, greater integration into the AMS programme and delivery of PCT results in a timely manner. This feasibility study has shown that a larger randomized controlled trial would be beneficial to further explore the positive aspects of these findings.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - B Palmer
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - D Dahly
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - T M O'Connor
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - D Curran
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Abstract
Over the last few decades, behaviorism as a philosophy of the science of psychology, especially in the field of behavior analysis and related areas, has diversified to the point that scholars from inside and outside the field are often confused about what exactly behaviorism is. The aim of this study is to analyze how such diversification of behaviorism has arisen over time and what factors might have contributed to it using evolutionary biology's concept of adaptive radiation as an analogical process. Diversification of behaviorism has occurred in many areas over time as behaviorism has extended its field of practice. Although some characteristics of behaviorism remained, other characteristics were modified. One such characteristic that went through extensive modification is the agent-free approach to the analysis of behavior: the agent problem. This approach has met criticism from inside and outside the field and has been under a strong selective pressure. The present article discusses how the agent problem in a different niche has shaped behaviorism into new forms that we see today.
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Affiliation(s)
- Sho Araiba
- Positive Behavior Supports Corporation, 1645 Ala Wai Blvd, Apt 508, Honolulu, HI 96815 USA
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Dixon MR, Whiting SW, Gunnarsson KF, Daar JH, Rowsey KE. Trends in Behavior-Analytic Gambling Research and Treatment. THE BEHAVIOR ANALYST 2015; 38:179-202. [PMID: 27606170 PMCID: PMC4883474 DOI: 10.1007/s40614-015-0027-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the present review was to analyze research outcomes for all gambling studies reported in the behavior analysis literature. We used the search term "gambling" to identify articles that were published in behaviorally oriented journals between the years 1992 and 2012 and categorized the content of each article as empirical or conceptual. Next, we examined and categorized the empirical articles by inclusion of an experimental manipulation and treatment to alleviate at least some aspect of pathological gambling, participant population used, type of gambling task employed in the research, whether the participants in the study actually gambled, and the behavioral phenomena of interest. The results show that the rate of publication of gambling research has increased in the last 6 years, and a vast majority of articles are empirical. Of the empirical articles, examinations of treatment techniques or methods are scarce; slot machine play is the most represented form of gambling, and slightly greater than half of the research included compensation based on gambling outcomes within experiments. We discuss implications and future directions based on these observations of the published literature.
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Affiliation(s)
- Mark R. Dixon
- />Southern Illinois University Carbondale, Carbondale, IL USA
- />Behavior Analysis and Therapy, Rehabilitation Institute, Southern Illinois University, Carbondale, 62901 IL USA
| | - Seth W. Whiting
- />Southern Illinois University Carbondale, Carbondale, IL USA
| | | | - Jacob H. Daar
- />Southern Illinois University Carbondale, Carbondale, IL USA
| | - Kyle E. Rowsey
- />Southern Illinois University Carbondale, Carbondale, IL USA
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Branche AR, Walsh EE, Vargas R, Hulbert B, Formica MA, Baran A, Peterson DR, Falsey AR. Serum Procalcitonin Measurement and Viral Testing to Guide Antibiotic Use for Respiratory Infections in Hospitalized Adults: A Randomized Controlled Trial. J Infect Dis 2015; 212:1692-700. [PMID: 25910632 PMCID: PMC4633755 DOI: 10.1093/infdis/jiv252] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 01/09/2023] Open
Abstract
Background. Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital. Methods. Three hundred patients hospitalized with nonpneumonic LRTI during October 2013–April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months. Results. Among the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008–2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect. Conclusions. Although antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies. Clinical Trials Registration. NCT01907659.
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Affiliation(s)
| | - Edward E Walsh
- Department of Medicine, University of Rochester Department of Medicine, Rochester General Hospital, New York
| | - Roberto Vargas
- Department of Laboratory Sciences, Rochester General Hospital, New York
| | - Barbara Hulbert
- Department of Laboratory Sciences, Rochester General Hospital, New York
| | - Maria A Formica
- Department of Medicine, Rochester General Hospital, New York
| | - Andrea Baran
- Department of Biostatistics and Computational Biology, University of Rochester
| | - Derick R Peterson
- Department of Biostatistics and Computational Biology, University of Rochester
| | - Ann R Falsey
- Department of Medicine, University of Rochester Department of Medicine, Rochester General Hospital, New York
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