In an open, randomised, multicentre trial, the efficacy and tolerability of empirical meropenem monotherapy (1 g intravenously every 8 hours) and cefotaxime (2 g every 8 hours) plus metronidazole (0.5 g intravenously every 8 hours) for 5 to 10 days was compared in 94 patients with serious intra-abdominal infection who required surgery. Eighty-three patients had an evaluable clinical response. Significantly more patients in the meropenem group had a satisfactory clinical response at the end of treatment (41/43 [95.3%] vs 30/40 [75.0%]; p = 0.008). The bacteriological response was also higher in the meropenem group (31/33 vs 26/32). In the bacteriologically evaluable population, a satisfactory clinical response was observed in 31/33 of those who received meropenem compared to 24/32 of the cefotaxime/metronidazole recipients (p = 0.03). Empirical meropenem monotherapy should prove a useful alternative to the currently standard combination treatment for serious intraabdominal infections.

Adult↗

PubMedDate not supplied

An embodiment of some vertebrate command and control principles.

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Animals↗

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A semi-evolutive partially local filter for data assimilation.

The singular evolutive extended Kalman (SEEK) filter has been proposed recently by Pham et al. (1997) for data assimilation into numerical oceanic models. This filter has been applied in different realistic ocean frameworks and has provided satisfactory results (Pham et al., 1997; Verron et al., 1998). However, the SEEK filter remains expensive in real operational assimilation. To reduce cost and obtain a better representativity, we introduce the idea 'local correction basis'. Such basis however cannot be made to evolve according to the model without destroying its locality property. Therefore we shall keep this basis fixed and we augment it by a few global basis vectors which evolve. The resulting semi-evolutive partially local filter is much less costly to implement than the SEEK filter and yet can yield better results. In the first application, validation twin experiments are conducted in a realistic setting of the OPA model over the tropical Pacific Ocean.

Cost Control↗

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A combined ethics & psychiatric consultation.

A case presentation is used to illustrate how psychiatrists can contribute to clinical ethics. A 75-year-old man with end-stage COPD was admitted to the ICU. His condition deteriorated and he lost decision-making capacity without expressing his wishes about end-of-life care. Although he no longer needed care in the ICU his surrogate decision-maker objected to his being transferred. Seven months after the patient's admission an ethics consultation was carried out by a psychiatrist-ethicist. The following issues are discussed, elaborating on points previously made by the authors [1,2]: the absence of an advance directive, surrogate decision-making, the allocation of ICU beds, guidelines for discharge from the hospital, the lateness of the ethics consultation, and the interweaving of ethical questions with psychiatric factors. The psychiatrist-ethicist was ideally suited to address all these issues and to make a significant contribution to the care of the patient and his family.

Advance Directives↗