The prognostic significance of excess small bowel gas on a plain abdominal radiograph has been assessed in 75 patients with Methodsand hydrocortisone enemas (100 mg bd) for five to seven days. The diagnosis of ulcerative colitis was based on clinical, radiological, endoscopic, and histological findings. Patients were seen daily by the physician (DPJ) in conjunction with one or other of two surgical teams with a special interest in inflammatory bowel disease.The plain abdominal radiographs of these 75 patients were reviewed retrospectively by two observers, one being a consultant radiologist. The observers were blind to the subsequent clinical outcome of the patients. Plain radiographs of the abdomen were carried out on the day of admission and were repeated every one to three days, depending upon the progress of the patients. Full blood counts and plasma electrolytes were measured daily and the erythrocyte sedimentation rate (ESR) was obtained initially and at five days. CRITERIA FOR RADIOLOGICAL DIAGNOSESSmall bowel distension was defined as the presence of three or more loops of gas filled small bowel on a plain abdominal radiograph (Fig 1). Small bowel dilatation was said to be present when the transverse diameter of the small bowel was greater than 3 cm. The extent of colonic disease was estimated by the criteria of Bartram,7 -namely, the extent of faecal residue, evidence
About half of the documented interventions by pharmacists were evaluated as clinically 'significant' or 'very significant'.
Current evidence supporting antimicrobial stewardship programs focused largely in inpatient setting. With the shift in cancer management from inpatient to ambulatory setting, it is crucial to examine the prevalence and predictors of inappropriate antibiotics prescribing. This is a retrospective cross-sectional study conducted at the National Cancer Centre Singapore (NCCS). Patients at least 21 years, with an active or past cancer diagnosis and prescribed with at least one oral antibiotic by a NCCS physician from 1st July to 30th September 2019 were included. Antibiotic appropriateness was assessed using institutional antibiotic guidelines or published clinical practice guidelines. For cases where antibiotics appropriateness cannot be ascertained using these guidelines, an independent three-member expert panel was consulted. A total of 815 patients were screened; 411 (59.4% females) were included with mean age of 62.4 years. The top three cancer diagnoses were breast (26.5%), lung (15.6%) and head and neck (13.6%). More than half (58.6%) received appropriate antibiotic choice. Of which, 235 (97.5%), 238 (98.8%) and 194 (80.5%) received appropriate dose, frequency and duration respectively. The presence of non-oncologic immunosuppressive comorbidities (OR 4.890, 95% CI 1.556-15.369, p-value = 0.007), antibiotic allergy (OR 2.352, 95% CI 1.178-4.698, p-value = 0.015) and skin and soft tissue infections (OR 2.004, 95% CI 1.276-3.146, p-value = 0.003) were associated with a higher incidence of inappropriate antibiotic choice. This study highlighted that inappropriate antibiotic prescribing is prevalent in the ambulatory oncology setting. Predicators identified can aid in the design of targeted strategies to optimise antibiotic use in ambulatory oncology patients.
A retrospective cohort study was conducted in Singapore General Hospital to study the safety and efficacy of biosimilar granulocyte-colony stimulating factor (G-CSF) Nivestim for chemo-mobilization of stem cells for autologous stem cell transplant (autoSCT). All patients who underwent an autoSCT between January 2011 and December 2016 were screened for eligibility. A total of 194 patients were screened, and 131 were included. Nivestim was used in 65 patients and the originator G-CSF (Neupogen) in 66. Patient characteristics were similar between both arms except for chemo-mobilization regimen used (p < 0.0001). Mobilization success rates were found to be comparable, at 96.9% (Nivestim) and 97% (Neupogen). Adverse events rates were also similar. Median duration of G-CSF use and hospitalization were both found to be shorter in the Nivestim arm. Median drug acquisition cost per mobilization cycle was significantly lower in the Nivestim arm at $533.40 (range $213.40–$1280.20) as compared to $1261.90 (range $574–$2755.20) in the Neupogen arm (p < 0.0001). No difference was observed for neutrophil and platelet engraftment after autoSCT. Nivestim was found to be safe and non-inferior to Neupogen for chemo-mobilization of stem cells for autoSCT, and associated with lower cost and shorter length of hospitalization.
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