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Keith S. Kaye - One of the best experts on this subject based on the ideXlab platform.

  • approaches to modifying the behavior of clinicians who are noncompliant with antimicrobial stewardship program guidelines
    Clinical Infectious Diseases, 2016
    Co-Authors: Ellie J C Goldstein, Keith S. Kaye, Debra A Goff, William Reeve, Snezana Naumovski, Erin Epson, Jonathan Mark Zenilman, Thomas M File
    Abstract:

    : Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier physicians' behavior. One must try to differentiate deviation from ASP norms from all other issues of outliers. Essential elements include identifying and understanding the local problems, planning, and achieving Hospital Administration and medical staff support. A successful ASP includes effective communication and acceptance of evidence-based recommendations, so that patient clinical outcomes will be optimized.

  • Demonstrating the Value of Antimicrobial Stewardship Programs to Hospital Administrators
    Clinical Infectious Diseases, 2014
    Co-Authors: Jerod Nagel, Edward H. Eiland, James G. Stevenson, Keith S. Kaye
    Abstract:

    : The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for Hospital Administration. Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures. This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey.

Thomas M File - One of the best experts on this subject based on the ideXlab platform.

  • approaches to modifying the behavior of clinicians who are noncompliant with antimicrobial stewardship program guidelines
    Clinical Infectious Diseases, 2016
    Co-Authors: Ellie J C Goldstein, Keith S. Kaye, Debra A Goff, William Reeve, Snezana Naumovski, Erin Epson, Jonathan Mark Zenilman, Thomas M File
    Abstract:

    : Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier physicians' behavior. One must try to differentiate deviation from ASP norms from all other issues of outliers. Essential elements include identifying and understanding the local problems, planning, and achieving Hospital Administration and medical staff support. A successful ASP includes effective communication and acceptance of evidence-based recommendations, so that patient clinical outcomes will be optimized.

A. W. J. Van ’t Hof - One of the best experts on this subject based on the ideXlab platform.

  • Pre-Hospital Administration of tirofiban in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: a sub-analysis of the On-Time 2 trial.
    Eurointervention, 2010
    Co-Authors: Jorik R. Timmer, Jur Ten Berg, A. A. C. M. Heestermans, Thorsten Dill, J. W. Van Werkum, H. Suryapranata, Jan Paul Ottervanger, Christian W. Hamm, A. W. J. Van ’t Hof
    Abstract:

    AIMS: Glycoprotein IIb/IIIa blocking agents seem to improve percutaneous coronary intervention (PCI) results in patients with ST-elevation myocardial infarction (STEMI). We aimed to compare the effect of pre-Hospital Administration of tirofiban in STEMI patients with and without diabetes mellitus (DM) treated with primary PCI. METHODS AND RESULTS: We performed a pre-specified sub-analysis of the randomised On-Time II trial (n=984) and it's open label run-in phase (n=414), which investigated pre-Hospital Administration of high dose tirofiban in STEMI patients treated with primary PCI. Two-hundred and twenty (16%) diabetic patients (known DM or Hba1C >/=6.2%) were included, 101 in the placebo group and 119 in the tirofiban group. In patients with DM, randomisation to tirofiban resulted in a lower residual ST deviation (5.1+/-8.5 mm vs. 6.2+/-5.6 mm, p=0.003), a reduced infarct size (CK 1694+/-1925 U/L vs. CK 2040+/-1829 U/L, p=0.02) and a trend towards lower one-year mortality (4.6% vs. 11.6%, p=0.07). The beneficial effects of tirofiban were more pronounced in diabetic patients compared to patients without diabetes. CONCLUSIONS: Pre-Hospital Administration of tirofiban in diabetic STEMI patients treated with primary PCI improves ST resolution and reduces myocardial infarct size. Tirofiban seems particularly beneficial in patients with diabetes.

Christian W. Hamm - One of the best experts on this subject based on the ideXlab platform.

  • Pre-Hospital Administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: A sub-analysis of the ATLANTIC trial.
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Enrico Fabris, Christian W. Hamm, Arnoud W J Van 't Hof, Frédéric Lapostolle, Jens Flensted Lassen, Shaun G. Goodman, Jurriën M. Ten Berg, Leonardo Bolognese, Angel Cequier, Mohamed Chettibi
    Abstract:

    OBJECTIVE We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-Hospital Administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM. BACKGROUND DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population. METHODS In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested. RESULTS A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (≥70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P < 0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62-4.85, P < 0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P < 0.01). No significant interaction between pre-Hospital ticagrelor vs in-Hospital ticagrelor Administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding. CONCLUSIONS DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-Hospital vs in-Hospital ticagrelor Administration and DM status. Further approaches for the treatment of DM patients are needed. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01347580.

  • Pre-Hospital Administration of tirofiban in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: a sub-analysis of the On-Time 2 trial.
    Eurointervention, 2010
    Co-Authors: Jorik R. Timmer, Jur Ten Berg, A. A. C. M. Heestermans, Thorsten Dill, J. W. Van Werkum, H. Suryapranata, Jan Paul Ottervanger, Christian W. Hamm, A. W. J. Van ’t Hof
    Abstract:

    AIMS: Glycoprotein IIb/IIIa blocking agents seem to improve percutaneous coronary intervention (PCI) results in patients with ST-elevation myocardial infarction (STEMI). We aimed to compare the effect of pre-Hospital Administration of tirofiban in STEMI patients with and without diabetes mellitus (DM) treated with primary PCI. METHODS AND RESULTS: We performed a pre-specified sub-analysis of the randomised On-Time II trial (n=984) and it's open label run-in phase (n=414), which investigated pre-Hospital Administration of high dose tirofiban in STEMI patients treated with primary PCI. Two-hundred and twenty (16%) diabetic patients (known DM or Hba1C >/=6.2%) were included, 101 in the placebo group and 119 in the tirofiban group. In patients with DM, randomisation to tirofiban resulted in a lower residual ST deviation (5.1+/-8.5 mm vs. 6.2+/-5.6 mm, p=0.003), a reduced infarct size (CK 1694+/-1925 U/L vs. CK 2040+/-1829 U/L, p=0.02) and a trend towards lower one-year mortality (4.6% vs. 11.6%, p=0.07). The beneficial effects of tirofiban were more pronounced in diabetic patients compared to patients without diabetes. CONCLUSIONS: Pre-Hospital Administration of tirofiban in diabetic STEMI patients treated with primary PCI improves ST resolution and reduces myocardial infarct size. Tirofiban seems particularly beneficial in patients with diabetes.

Mohamed Chettibi - One of the best experts on this subject based on the ideXlab platform.

  • Pre-Hospital Administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: A sub-analysis of the ATLANTIC trial.
    Catheterization and Cardiovascular Interventions, 2018
    Co-Authors: Enrico Fabris, Christian W. Hamm, Arnoud W J Van 't Hof, Frédéric Lapostolle, Jens Flensted Lassen, Shaun G. Goodman, Jurriën M. Ten Berg, Leonardo Bolognese, Angel Cequier, Mohamed Chettibi
    Abstract:

    OBJECTIVE We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-Hospital Administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM. BACKGROUND DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population. METHODS In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested. RESULTS A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (≥70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P < 0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62-4.85, P < 0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P < 0.01). No significant interaction between pre-Hospital ticagrelor vs in-Hospital ticagrelor Administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding. CONCLUSIONS DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-Hospital vs in-Hospital ticagrelor Administration and DM status. Further approaches for the treatment of DM patients are needed. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01347580.