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Introduction: Multidrug Resistant (MDR) organisms have become a major problem for the treatment of various infections and are imposing the greatest challenge to public health worldwide. Uncomplicated Urinary Tract Infections (UTIs) are treated empirically sometimes with broad spectrum antibiotics without performing drug susceptibility tests that adds to drug resistance in bacteria. Aim: To identify the current prevalence and evaluate phenotypic profile of antimicrobial resistance pattern of MDR uropathogens. Materials and Methods: This was a cross-sectional descriptive study conducted from January 2019 to July 2021 at Parul Sevashram Hospital Vadodara, Gujarat, India. Total 960 uropathogens were analysed for prevalence, their phenotypic antimicrobial resistance mechanism and antibiotic sensitivity pattern. Isolated organisms, their phenotypic resistance pattern and antibiotic sensitivity data was entered in Microsoft excel and data were analysed using Statistical Package for the Social Sciences (SPSS) 25.0 version. Results: During the study period, total 960 urinary isolates were analysed of which 891 (92.8%) were gram negative bacilli, 69 (7.2%) were gram positive cocci. Probable antimicrobial resistance pattern in gram negative isolates causing UTI were 317 (35.6%) of Extended Spectrum Beta Lactamase (ESBL) producer, While carbapenemase (+ or - ESBL) were 328 (36.8%) and impermeability carba (+ESBL or +High-Level Ampicillinase C (HL AmpC)) were 311 (34.9%). Amikacin was highly sensitive antibiotic in 378 (75.3%) of Escherichia coli (E. coli) and 111 (52.9%) of Klebsiella pneumoniae (K. pneumoniae) isolates causing UTI. Conclusion: The study concluded that carbapenem resistance was more in K. pneumoniae isolates causing UTI than E. coli. Aminoglycosides like amikacin was highly effective for the treatment of UTI caused by E.coli and K. pneumoniae. [ABSTRACT FROM AUTHOR]

Introduction: The airway management of patients with COVID- 19 is a high risk task for anaesthesiologists. Several innovations have been born as a result of this problem, including aerosol boxes and clear plastic sheets. Aim: To compare the timing and attempt of direct laryngoscopy with and without aerosol box for intubation in patients undergoing general anaesthesia during the COVID-19 pandemic. Materials and Methods: This was a randomised controlled study was conducted in Parul Sevashram Hospital, Parul University, Vadodara, Gujrat, India from April 2021 to September 2021. A total of 50 patients were randomly divided into two equal groups as group A was intubated with an aerosol box and a macintosh laryngoscope, while group B was intubated with a clear plastic sheet and macintosh laryngoscope. With proper airway precautions and Personal Protective Equipments (PPE) comparative assessment of patients undergoing surgery in general anaesthesia was done. Time to intubate, number of attempts, ease of Endotracheal Tube (ETT) tube insertion, quality of Laryngoscopy view and Cormack Lehane scores were assessed in both the groups. Results: The mean time for intubation was high at 29.72 seconds in group A, while it was 23.16 seconds in group B; the difference was significant. Overall, 20 out of 25 (80%) patients could be intubated in 1st attempt in group B as compared to 15 out of 25 (60%) in group A. Airway visualisation using Percentage of Glottic Opening (POGO) scoring and Cormack Lehane staging were suggestive of better visualisation in group B than group A. Difficulties encountered during intubation like laryngoscopy, glottic visualisation, arm movement restriction, ETT negotiation, and stylet removal were lesser in group A as compared to group B. The incidence of complications like sore throat and airway bleeding were lower in group B as compared to group A. Conclusion: In the COVID-19 era, aerosol box and clear plastic sheets are effective barrier measures for airway management to prevent the anaesthesiologists from the aerosol transmission. But airway management with clear plastic sheet is technically easier than aerosol box. [ABSTRACT FROM AUTHOR]

Objective: Evidence suggests using metered dose inhaler (MDI) to treat acute asthma in the Emergency Department reduces length of stay, though methods of implementation are lacking. We modified a treatment pathway to recommend use of MDI for mild-moderate asthma in a pediatric ED. Methods: A baseline review assessed discharged patients >2 years with an asthma diagnosis and non-emergent Emergency Severity Index triage assessment (3/4). Our multi-disciplinary team developed an intervention to increase MDI use instead of continuous albuterol (CA) using the following: (1) Redesign the asthma pathway and order set recommending MDI for ESI 3/4 patients. (2) Adding a conditional order for Respiratory Therapists to reassess and repeat MDI until patient reached mild assessment. The primary outcome was the percentage discharged within 3 hours, with a goal of a 10% increase compared to pre-intervention. Balancing measures included admission and revisit rates. Results: 7635 patients met eligibility before pathway change; 12,673 were seen in the subsequent 18 months. For target patients, the percentage discharged in <3 hours increased from 39% to 49%; reduction in median length of stay was 33 minutes. We identified special cause variation for reduction in CA use from 43% to 25%; Revisit rate and length of stay for higher-acuity patients did not change; overall asthma admissions decreased by 8%. Changes were sustained for 18 months. Conclusion: A change to an ED asthma pathway recommending MDI for mild-moderate asthma led to a rapid and sustained decrease in continuous albuterol use, length of stay, and admission rate. [ABSTRACT FROM AUTHOR]

Background: As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis.Methods: With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up. These protocols were initially implemented with a small interdisciplinary team, including 1 surgeon (Phase 1), and then were expanded to include a second surgeon and additional anesthesiology staff (Phase 2). We compared procedures performed with a dedicated team (the Dedicated Team cases) and procedures performed without a such a team (the Casual Team cases). Because of the heterogeneous nature of PSF for scoliosis, we developed a case categorization system: Category 1 was relatively homogeneous and indicated patients with fusion of ≤12 levels, no osteotomies, and a body mass index (BMI) of <25 kg/m, and Category 2 was more heterogeneous and indicated patients with fusion of >12 levels and/or ≥1 osteotomy and/or a BMI of ≥25 kg/m.Results: In total, 89 Casual Team and 78 Dedicated Team cases were evaluated: 71 were in Category 1 and 96 were in Category 2. Dedicated Team cases used significantly less OR time for both Categories 1 and 2 (p < 0.001). In Category-1 cases, the average reduction was 111.4 minutes (29.7%); in Category-2 cases, it was 76.9 minutes (18.5%). The effect of the Dedicated Team was scalable: the reduction in OR time was significant in both Phase 1 and Phase 2 (p < 0.001). The Dedicated Team cases had no complications. Cost reduction averaged approximately $8,900 for Category-1 and $6,000 for Category-2 cases.Conclusions: By creating a dedicated team and standardizing several aspects of PSFs for scoliosis, we achieved a large reduction in OR time. This increase in team efficiency was significant, consistent, and scalable. As a result, we can routinely complete 2 Category-1 PSFs in the same OR with the same team without exceeding standard block time. [ABSTRACT FROM AUTHOR]