Antibiotic resistance is a global health concern. Its increasing development is seemingly due to the irresponsible use of antibiotics and their availability. To ensure the correct treatment of patients and avoid unnecessary strain on the individual and society as a whole, it is vital to ensure access to both new and old antibiotics where there is a distinct need. Temocillin is an antibiotic used in the treatment of febrile UTIs. It is currently unavailable in Sweden, although being well-established and proven effective in other European countries. Hence, this report aims to investigate the introduction of temocillin to the Swedish or Scandinavian market in regards to the economic, technical, medical, and regulatory possibilities and barriers. The research is based on literature, internet, and database reviews and empirical data collection through interviews with people of expertise within the fields of antibiotic resistance and concerned aspects. This study emphasizes the great potential of introducing temocillin to Sweden. The evident conclusion drawn is that a production of the antibiotic is not possible in Sweden in the near future. Despite this, an identified supply chain in Europe can enable a role for Sweden as a distribution country. Through a performed break-even analysis, the calculated break-even point and profit margins indicated a low risk of financial loss for a MAH acting as the supplier of temocillin, such as the company Eumedica S.A.. Only 1 % of the Swedish market would have to be covered to break even, and regardless of the estimated volumes of usage upon introduction being either 50 % or 25 % of the total medical need, a profit is likely. In addition, temocillin holds a great medical and social value. However, the obvious obstacle observed is its out-dated documentation. The dossier is of the wrong format, which complicates the regulatory procedure. Thus, this needs to be taken into consideration for an introduction to be possible.

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23764号 / 医博第4810号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長尾 美紀, 教授 佐藤 俊哉, 教授 永井 洋士 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The main object of the research is to analyze the effect of the clinical intervention algorithms proposed for reducing antibiotic use for older adults in long-term care facilities (LTCFs) by managing urinary tract infections (UTIs). 20 paired nursing homes were enrolled in the 12-month study. Within each pair, one was randomized to use of the intervention algorithms and the other to use of regular management. Cluster-level paired t-tests (unweighted and weighted) and regression analyses (unweighted and weighted) were used in the analysis of the data. Paired t-tests show that the algorithms did not significantly reduce the antibiotic use, the number of urine cultures or the antibiotic use for urinary infections in most months. However, they did reduce the proportion of antibiotic use for urinary infections significantly in most months. Regression analysis indicates that the difference between the control group and intervention group has no significant increasing or decreasing trend with time (month). And the algorithms significantly reduced the antibiotic use for urinary infections, number of cultures and the proportions through the 12-month study. The analyses reached a similar conclusion using nonparametric methods and weighted analysis. / Thesis / Master of Science (MS)

INTRODUÇÃO - As manifestações clínicas da hiperplasia prostática benigna envolvem a interação entre três fatores: sintomas miccionais, aumento do volume prostático e obstrução infravesical. A relação entre estes fatores é complexa e parcialmente entendida. O objetivo do presente estudo foi avaliar os achados urodinâmicos de pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3, com ênfase nos parâmetros obstrução infravesical, hiperatividade detrusora e contratilidade detrusora. CASUÍSTICA E MÉTODOS - Os prontuários e exames urodinâmicos de 33 pacientes foram analisados retrospectivamente. A média de idade dos pacientes foi de 60,3 ± 9,3 anos, variando de 40 a 78 anos. Os sintomas do trato urinário inferior foram avaliados com o escore internacional de sintomas prostáticos (IPSS). O volume prostático e os seguintes parâmetros urodinâmicos foram analisados: fluxo máximo, capacidade cistométrica máxima, complacência, presença de hiperatividade detrusora, fluxo máximo no estudo fluxo/pressão, pressão detrusora no fluxo máximo, contratilidade detrusora e resíduo miccional. Analisou-se, também, o impacto da obstrução infravesical, hiperatividade detrusora e volume prostático nos sintomas miccionais e parâmetros urodinâmicos. RESULTADOS - As médias do volume prostático e IPSS foram 26,5 ± 6,9cm3 e 16,8 ± 5,0, respectivamente. Anormalidades urodinâmicas foram encontradas em 30 (90,9%) pacientes, sendo obstrução infravesical e hiperatividade detrusora os achados mais freqüentes, cada qual acometendo 16 (48,5%) pacientes. A prevalência da hiperatividade detrusora foi de 50,0% entre os pacientes obstruídos e de 47,0% nos pacientes sem obstrução infravesical (p = 0,99). Hipocontratilidade detrusora foi observada em 18,8% dos obstruídos e 64,7% dos pacientes sem obstrução (p = 0,013). O índice de contratilidade detrusora foi de 111,7 ± 20,8 nos pacientes obstruídos e de 92,9 ± 17,3 nos pacientes sem obstrução (p = 0,008). Nos pacientes com e sem hiperatividade detrusora, encontrou-se diferença estatisticamente significativa na complacência vesical, que foi de 15,4 ± 9,6ml/cmH2O nos pacientes com hiperatividade detrusora e de 28,8 ± 10,8ml/cmH2O nos pacientes sem hiperatividade detrusora (p = 0,007). CONCLUSÕES - O estudo urodinâmico identifica anormalidades vesicais na maioria dos pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3. Embora a obstrução infravesical seja um achado comum, mais da metade dos pacientes tiveram outras alterações vesicais responsáveis pelos seus sintomas, principalmente hiperatividade detrusora e diminuição da contratilidade detrusora, reforçando o valor dos exames urodinâmicos nesta população. / INTRODUCTION - The clinical manifestations of benign prostatic hyperplasia involve the correlation of three elements: voiding symptoms, prostate enlargement and bladder outlet obstruction. The interaction between these factors is complex and incompletely understood. The objective of this study was to evaluate the urodynamic findings in patients with lower urinary tract symptoms and prostate volumes less than 40cc, focusing on the parameters bladder outlet obstruction, detrusor overactivity and detrusor hypocontractility. PATIENTS AND METHODS - The records and urodynamic studies of 33 patients with lower urinary tract symptoms and prostate volumes less than 40cc were reviewed. Average age of the patients was 60.3 ± 9.3 years (range 40 to 78 years). Lower urinary tract symptoms were evaluated with the International Prostate Symptom Score (IPSS). Prostate volume and the following urodynamic parameters were analyzed: maximum flow rate, maximum cystometric capacity, compliance, presence of detrusor overactivity, maximum flow rate during pressure/flow studies, detrusor pressure at maximum flow rate, detrusor contractility e post void residual volume. We also evaluated the impact of bladder outlet obstruction, detrusor overactivity and prostate volume on the voiding symptoms and urodynamic parameters. RESULTS -Mean prostate volume and IPSS were 26.5 ± 6.9 cc and 16.8 ± 5.0, respectively. Urodynamic abnormalities were found in 30 (90.9%) patients, with a preponderance of bladder outlet obstruction and detrusor overactivity, each affecting 16 (48.5%) patients. The prevalence of detrusor overactivity was 50.0% in the obstructed patients and 47.0% in patients without bladder outlet obstruction (p = 0.99). Detrusor hypocontractility was present in 18.8% of the obstructed patients and 64.7% of the non-obstructed patients (p = 0.013). The detrusor contractility index was 111.7 ± 20.8 in the obstructed patients and 92.9 ± 17.3 in those without bladder outlet obstruction (p = 0.008). In the patients with and without detrusor overactivity there was a statistically significant difference in bladder compliance, which was 15.4 ± 9.6 ml/cmH2O in the patients with detrusor overactivity and 28.8 ± 10.8 ml/cmH2O in those without detrusor overactivity (p = 0.007). CONCLUSIONS - Urodynamic studies identify bladder abnormalities in most patients with lower urinary tract symptoms and prostate volumes less than 40cc. Although bladder outlet obstruction is a common diagnosis, more than half of the patients had other types of bladder dysfunction as the basis for their voiding symptoms, predominantly detrusor overactivity and decreased detrusor contractility, emphasizing the value of urodynamic studies in this population.

Tyrimo tikslas: išsiaiškinti slaugytojų vaidmenį su šlapimo pūslės kateterizacija susijusių šlapimo takų infekcijų išsivystyme ir profilaktikoje. Tyrimo uždaviniai: 1. Įvertinti slaugytojų, dirbančių reanimacijos ir intensyvios terapijos skyriuose, teorines žinias apie šlapimo takų infekcijas, jų rizikos veiksnius bei profilaktiką; 2. Įvertinti ar slaugytojos, dirbančios reanimacijos ir intensyvios terapijos skyriuose, žino kaip taisyklingai atlikti šlapimo pūslės kateterizaciją laikantis slaugos procedūrų metodikos reikalavimų; 3. Nustatyti, kokias profilaktikos priemones bei metodus taiko reanimacijos ir intensyvios terapijos skyrių slaugytojos, kad būtų išvengta šlapimo takų infekcijų; 4. Pateikti praktines rekomendacijas. Tiriamoji grupė: tyrime dalyvavo 104 slaugytojos, dirbančios KMUK, Kauno 2-osios klinikinės ligoninės, Kauno apskrities ligoninės ir Kauno Raudonojo Kryžiaus klinikinės ligoninės reanimacijos ir intensyvios terapijos skyriuose. Tyrimo metodai: anketinė apklausa ir statistinė duomenų analizė. Tyrimas buvo atliekamas 2009 m. vasario – kovo mėnesiais. Apklausai naudota nestandartizuota autorinė anketa, kuri buvo sudaryta remiantis literatūros analize ir Lietuvos Respublikos sveikatos apsaugos ministro įsakymu patvirtinta higienos norma HN 47-1:2008 “Sveikatos priežiūros įstaigos. Higieninės ir epidemiologinės priežiūros reikalavimai.“, ir tyrėjos paruoštas veiklos testas. Tyrimo metu gauti duomenys apdoroti naudojant SPSS 13.0 versijos statistinį duomenų... [toliau žr. visą tekstą] / The goal of the research – to find out what is the role of the nurses in the development and prophylaxis of the catheter – associated urinary tract infections. Research tasks: 1. Evaluate the theoretical knowledge about the urinary tract infections and their risk’s factors and prophylaxis of the nurses working in the units of Intensive care; 2. Evaluate do the nurses working in the units of Intensive care know how to do the urinary bladder catheterization properly according to the requirements of the methodology of the care procedures; 3. Estimate what preventive measures and methods are used by the nurses of Intensive care units in order to avoid the urinary tract infections; 4. Give the practical recommendations. Investigative group: 104 nurses working in the units of intensive care in Kaunas University Hospital, the Second Kaunas Clinical Hospital, Kaunas Regional Hospital and Kaunas Red Cross Hospital took part in this research. The methods of the research: questionnaire and statistical data analyses. The research was made from January to March in the year 2009. The nonstandard authorized questionnaire which was made according to the analyses of the literature and certified hygiene norm HN 47-1:2008 „Health Care Institutions. Sanitary and epidemiological care requirements.“ affirmed by the Minister of Health of the Republic of Lithuania and the test prepared by the researcher. The data received during the research chiseled using the SPSS 13.0 version of the... [to full text]

INTRODUÇÃO - As manifestações clínicas da hiperplasia prostática benigna envolvem a interação entre três fatores: sintomas miccionais, aumento do volume prostático e obstrução infravesical. A relação entre estes fatores é complexa e parcialmente entendida. O objetivo do presente estudo foi avaliar os achados urodinâmicos de pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3, com ênfase nos parâmetros obstrução infravesical, hiperatividade detrusora e contratilidade detrusora. CASUÍSTICA E MÉTODOS - Os prontuários e exames urodinâmicos de 33 pacientes foram analisados retrospectivamente. A média de idade dos pacientes foi de 60,3 ± 9,3 anos, variando de 40 a 78 anos. Os sintomas do trato urinário inferior foram avaliados com o escore internacional de sintomas prostáticos (IPSS). O volume prostático e os seguintes parâmetros urodinâmicos foram analisados: fluxo máximo, capacidade cistométrica máxima, complacência, presença de hiperatividade detrusora, fluxo máximo no estudo fluxo/pressão, pressão detrusora no fluxo máximo, contratilidade detrusora e resíduo miccional. Analisou-se, também, o impacto da obstrução infravesical, hiperatividade detrusora e volume prostático nos sintomas miccionais e parâmetros urodinâmicos. RESULTADOS - As médias do volume prostático e IPSS foram 26,5 ± 6,9cm3 e 16,8 ± 5,0, respectivamente. Anormalidades urodinâmicas foram encontradas em 30 (90,9%) pacientes, sendo obstrução infravesical e hiperatividade detrusora os achados mais freqüentes, cada qual acometendo 16 (48,5%) pacientes. A prevalência da hiperatividade detrusora foi de 50,0% entre os pacientes obstruídos e de 47,0% nos pacientes sem obstrução infravesical (p = 0,99). Hipocontratilidade detrusora foi observada em 18,8% dos obstruídos e 64,7% dos pacientes sem obstrução (p = 0,013). O índice de contratilidade detrusora foi de 111,7 ± 20,8 nos pacientes obstruídos e de 92,9 ± 17,3 nos pacientes sem obstrução (p = 0,008). Nos pacientes com e sem hiperatividade detrusora, encontrou-se diferença estatisticamente significativa na complacência vesical, que foi de 15,4 ± 9,6ml/cmH2O nos pacientes com hiperatividade detrusora e de 28,8 ± 10,8ml/cmH2O nos pacientes sem hiperatividade detrusora (p = 0,007). CONCLUSÕES - O estudo urodinâmico identifica anormalidades vesicais na maioria dos pacientes com sintomas do trato urinário inferior e volume prostático menor que 40cm3. Embora a obstrução infravesical seja um achado comum, mais da metade dos pacientes tiveram outras alterações vesicais responsáveis pelos seus sintomas, principalmente hiperatividade detrusora e diminuição da contratilidade detrusora, reforçando o valor dos exames urodinâmicos nesta população. / INTRODUCTION - The clinical manifestations of benign prostatic hyperplasia involve the correlation of three elements: voiding symptoms, prostate enlargement and bladder outlet obstruction. The interaction between these factors is complex and incompletely understood. The objective of this study was to evaluate the urodynamic findings in patients with lower urinary tract symptoms and prostate volumes less than 40cc, focusing on the parameters bladder outlet obstruction, detrusor overactivity and detrusor hypocontractility. PATIENTS AND METHODS - The records and urodynamic studies of 33 patients with lower urinary tract symptoms and prostate volumes less than 40cc were reviewed. Average age of the patients was 60.3 ± 9.3 years (range 40 to 78 years). Lower urinary tract symptoms were evaluated with the International Prostate Symptom Score (IPSS). Prostate volume and the following urodynamic parameters were analyzed: maximum flow rate, maximum cystometric capacity, compliance, presence of detrusor overactivity, maximum flow rate during pressure/flow studies, detrusor pressure at maximum flow rate, detrusor contractility e post void residual volume. We also evaluated the impact of bladder outlet obstruction, detrusor overactivity and prostate volume on the voiding symptoms and urodynamic parameters. RESULTS -Mean prostate volume and IPSS were 26.5 ± 6.9 cc and 16.8 ± 5.0, respectively. Urodynamic abnormalities were found in 30 (90.9%) patients, with a preponderance of bladder outlet obstruction and detrusor overactivity, each affecting 16 (48.5%) patients. The prevalence of detrusor overactivity was 50.0% in the obstructed patients and 47.0% in patients without bladder outlet obstruction (p = 0.99). Detrusor hypocontractility was present in 18.8% of the obstructed patients and 64.7% of the non-obstructed patients (p = 0.013). The detrusor contractility index was 111.7 ± 20.8 in the obstructed patients and 92.9 ± 17.3 in those without bladder outlet obstruction (p = 0.008). In the patients with and without detrusor overactivity there was a statistically significant difference in bladder compliance, which was 15.4 ± 9.6 ml/cmH2O in the patients with detrusor overactivity and 28.8 ± 10.8 ml/cmH2O in those without detrusor overactivity (p = 0.007). CONCLUSIONS - Urodynamic studies identify bladder abnormalities in most patients with lower urinary tract symptoms and prostate volumes less than 40cc. Although bladder outlet obstruction is a common diagnosis, more than half of the patients had other types of bladder dysfunction as the basis for their voiding symptoms, predominantly detrusor overactivity and decreased detrusor contractility, emphasizing the value of urodynamic studies in this population.

About 10 % of the adult women population in Sweden are treated annually for urinary tract infections. The increasing bacterial resistance towards antibiotics is classified by WHO (World Health Organization) and ECDC (European Centre for Disease Prevention and Control) as one of the greatest treats for human health in a global perspective. To find alternatives scientists are studying the possibility to use probiotics to reduce the frequency of recurring urinary tract infections. This literature study examines five randomized double blinded placebo controlled studies where different strains of Lactobacillus have been used as a prophylactic to women suffering from recurrent urinary tract infections and bacterial vaginosis. Overall the studies do not display enough promising results to recommend the use of probiotics as a prophylax or cure.

The graduation theses is about urinary tract infections and the preventive care that we are able to provide within nursing care of patients with urinary catheter. The theoretical part of graduation theses includes the chapters about general introduction to nosocomial infections, as well as epidemiology, pathogenesis, diagnosis and treatment of urinary tract infections. Furthermore, it relates to their antibiotic therapy and resistence to antibiotics. The main task is the prevention of urinary tract infections. Generally I have focused on the methods of urinary catheterization and their correct indications, the materials and design of urinary catheters, as well as on nursing care of urinary catheters. The thesis includes research aimed at providing preventive measures that are implemented in practice, comparing them to each other and comparison with the current studies and recommendations.. This research provides both positive and negative results. Some of the recommendations for preventive care of urinary tract infections are being followed, other are being omitted. There are also differences between respondents from different departments as well as among the departments. Nursing care procedures are not unified despite of presence of guidelines and standard procedures. keywords: nosocomial...