Utility of preoperative laboratory testing in ASA 1 & ASA 2 patients undergoing outpatient surgery in the United States

2022 ◽  
Vol 76 ◽  
pp. 110580
Author(s):  
Mishra Vikas ◽  
Kenneth John ◽  
Patricia Apruzzese ◽  
Mark C. Kendall ◽  
Gildasio De Oliveira
Keyword(s):  
United States ◽  
Laboratory Testing ◽  
Outpatient Surgery ◽  
The United States

scholarly journals Investigation and Containment of New Delhi Metallo-β-Lactamase (NDM)–Producing Carbapenem-Resistant Enterobacteriaceae (CRE) in a Hospital Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s305
Author(s):  
Karoline Sperling ◽  
Amy Priddy ◽  
Nila Suntharam ◽  
Adam Karlen
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Outpatient Surgery ◽  
The United States ◽  
Multidrug Resistant ◽  
New Delhi ◽  
Point Prevalence Study ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Carbapenem Resistant Enterobacteriaceae

Background: With increasing medical tourism and international healthcare, emerging multidrug resistant organisms (MDROs) or “superbugs” are becoming more prevalent. These MDROs are unique because they are resistant to antibiotics and can carry special resistance mechanisms. In April 2019, our hospital was notified that a superbug, New Delhi Metallo-β-lactamase(NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE), was identified in a patient who had been transferred to another hospital after being at our hospital for 3 weeks. Our facility had a CRE admission screening protocol in place since 2013, but this patient did not meet the criteria to be screened on admission. Methods: The infection prevention (IP) team consulted with the Minnesota Department of Health (MDH) and gathered stakeholders to discuss containment strategies using the updated 2019 CDC Interim Guidance for Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) to determine whether transmission to other patients had occurred. NDM CRE was classified under tier 2 organisms, meaning those primarily associated with healthcare settings and not commonly identified in the region, and we used this framework to conduct an investigation. A point-prevalence study was done in an intensive care unit that consisted of rectal screening of 7 patients for both CRE and Candida auris, another emerging MDRO. These swabs were sent to the Antibiotic Resistance Laboratory Network (ARLN) Central Regional Lab at MDH for testing. An on-site infection control risk assessment was done by the MDH Infection Control Assessment and Response (ICAR) team. Results: All 7 patients were negative for both CRE and C. auris, and no further screening was done. During the investigation, it was discovered that the patient had had elective ambulatory surgery outside the United States in March 2019. The ICAR team assessment provided overall positive feedback to the nursing unit about isolation procedures, cleaning products, and hand hygiene product accessibility. Opportunities included set-up of soiled utility room and updating our process to the 2019 MDH recommendation to screen patients for CRE and C. auris on admission who have been hospitalized, had outpatient surgery, or hemodialysis outside the United States in the previous year. Conclusions: Point-prevalence study results showed no transmission of CRE and highlighted the importance of standard precautions. This event supports the MDH recommendation to screen for CRE any patients who have been hospitalized, had outpatient surgery, or had hemodialysis outside the United States in the previous year.Funding: NoneDisclosures: None

Access through Altruism: A Community-based Free Outpatient Surgery Program for the Working Poor in the United States

2017 ◽  
Vol 27 (6) ◽  
pp. 141-144
Author(s):  
HR Nolan ◽  
B Christie
Keyword(s):  
United States ◽  
Outpatient Surgery ◽  
Healthcare Access ◽  
Large Population ◽  
Surgical Care ◽  
The United States ◽  
Community Based ◽  
Uninsured Adults ◽  
One Year ◽  
Working Uninsured

Despite healthcare reform, a large population in the United States is without healthcare coverage. The Surgery for People in Need (SPIN) program offers free outpatient surgical procedures to working, uninsured adults. Taking nearly one year to construct, the program has been operational for three years and has performed 22 procedures. Free surgery programs can improve healthcare access by providing interventions to patients who otherwise have no outlet for surgical care.

Design Recommendations for Controlling the Jam-Clearing Hazard on Recycling Industry Balers

2005 ◽  
Author(s):  
T. Mick ◽  
K. Means ◽  
J. Etherton ◽  
J. Powers ◽  
E. A. McKenzie
Keyword(s):  
United States ◽  
Laboratory Testing ◽  
Occupational Safety ◽  
The United States ◽  
Operating Conditions ◽  
Occupational Safety And Health ◽  
Hydraulic Pressure ◽  
Design Recommendations ◽  
Recycling Industry ◽  
Safety And Health

Between 1986 and 2002, there were 43 fatalities in the United States to operators of recycling industry balers. Of these fatalities, 29 involved horizontal balers that were baling paper and cardboard (Taylor, 2002). Balers often become jammed while the baling process is occurring, and the only way to remove the jam is manually. This requires an employee to place a limb of their body into the jamming area and remove the material that is causing the jam. While lockout and tagout procedures reduce the risk of hazardous energy being released, they can still be easily bypassed, ignored, or forgotten. Recent efforts to reduce machine-related injury and death involve the development of a control system for these machines that automatically detects hazardous operating conditions and responds accordingly. The system is being developed at the National Institute for Occupational Safety and Health (NIOSH). This system, JamAlert, automatically terminates the power to the machine when a jam is detected. JamAlert detects a jam by observing both the strain that is experienced by the shear bar of the baler and the hydraulic pressure at which the ram is operating. The strain that is experienced by the baler shear bar when a jam is initiated was calculated in this study through laboratory testing and finite element modeling. Design recommendations are presented on how best to tune the JamAlert’s operating program to most effectively control the jam-clearing hazard.

National Inventory of Clinical Laboratory Testing Services (NICLTS)

2000 ◽  
Vol 124 (8) ◽  
pp. 1201-1208 ◽  
Author(s):  
Steven J. Steindel ◽  
William J. Rauch ◽  
Marianne K. Simon ◽  
James Handsfield
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Laboratory Testing ◽  
Clinical Laboratory ◽  
The United States ◽  
High Complexity ◽  
Specimen Type ◽  
The Us ◽  
Clinical Laboratory Testing

Abstract Context.—A statistically valid inventory of the distribution, both geographic and by laboratory type, of clinical and anatomical laboratory testing in the United States is needed to assess the impact of the Clinical Laboratory Improvements Amendments of 1988 and to provide information for other health care and public health policy decisions. Objective.—To present initial US laboratory testing volume data compiled by the National Inventory of Clinical Laboratory Testing Services. Design.—Stratified random sample of laboratories performing testing in 1996 with data on the number of laboratory tests performed, identified by method and analyte. Data were collected by field tabulators (moderate- or high-complexity laboratories) or through a mail/telephone survey (waived or provider-performed microscopy laboratories) for each site. Participants.—Laboratories that were enrolled in the 1996 Online Certification Survey and Reporting System, maintained by the US Health Care Finance Administration, and that performed laboratory testing during 1996. Main Outcome Measure.—Laboratory testing distribution for 1996 in the United States by analyte, method, and specimen type. Results.—An overall response rate of 79% provided data from 757 moderate- or high-complexity laboratories and 1322 waived or provider-performed microscopy laboratories. The estimated total US testing volume for 1996 was 7.25 ± 1.09 billion tests. Laboratories performing complex testing, defined as greater than 16 method/analyte/specimen type combinations, comprised 16% of the US laboratories by survey site, but performed 80% (95% confidence limits, 43% to 100%) of the testing volume. Glucose analysis was the most frequently performed test. Automated hematology and chemistry analyzers were the most frequently used methods. Conclusions.—A statistically valid, consistent survey of the distribution of US laboratory testing was obtained. Simple analysis of these data by laboratory type and geographic region can provide insights into where laboratory testing is performed. The study design allows extensions that will facilitate collection of additional data of importance to public health and medical care delivery.

scholarly journals “A Good Habit”: Telehealth PrEP Users Find Benefit in Quarterly Monitoring Requirements

2020 ◽  
Vol 19 ◽  
pp. 232595822091926
Author(s):  
Kimberly A. Koester ◽  
Shana D. Hughes ◽  
Robert M. Grant
Keyword(s):  
United States ◽  
Delivery System ◽  
Laboratory Testing ◽  
The United States ◽  
Delivery Systems ◽  
Laboratory Monitoring ◽  
Good Habit ◽  
Exposure Prophylaxis ◽  
Depth Interviews ◽  
Clinic Visits

In the United States, uptake of daily oral pre-exposure prophylaxis (PrEP) to prevent HIV continues to grow albeit at a slower than desired pace. Innovations in PrEP delivery systems may partially address structural challenges related to PrEP uptake and PrEP persistence, such as difficulty in attending clinic visits or completing laboratory testing. To study PrEP services offered by a telehealth company called Nurx, we conducted 31 in-depth interviews with prospective or current patients. We hypothesized that patients would find the quarterly laboratory monitoring requirements to be onerous especially in light of receiving all other aspects of PrEP care through a telehealth delivery system. However, interviewees characterized navigating laboratory systems as relatively easy and complying with the quarterly monitoring as a supplementary benefit of PrEP use. Our research illustrates that quarterly monitoring requirements are meaningful to some telehealth PrEP users and may facilitate persistent engagement in receipt of PrEP care.

scholarly journals 1544. Sexually Transmitted Infection Laboratory Testing and Education Trends Among Physician Office Visits in the United States, 2009-2016

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S771-S771
Author(s):  
Amina R Zeidan ◽  
Kelly R Reveles
Keyword(s):  
United States ◽  
Laboratory Testing ◽  
The United States ◽  
Age Group ◽  
The South ◽  
Transmitted Infection ◽  
Sti Prevention ◽  
Prevention Education ◽  
Sexually Transmitted ◽  
Sti Testing

Abstract Background Rates of sexually transmitted infections (STIs) have been rising in the United States (US). Physician offices play an important role in providing both STI prevention and education, as well as STI laboratory testing options for patients who present at risk. However, few studies have documented the extent to which physician’s offices have contributed to prevention and testing efforts. We address this gap by evaluating STI testing and education provided in US physician offices from 2009 to 2016. Methods This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey (NAMCS) from 2009 to 2016. Data weights were applied to extrapolate sample data to national estimates. Testing for HIV, HPV, Chlamydia (2009 – 2016) and Hepatitis and Gonorrhea (2014 – 2016) were presented as testing visits per 1,000 total visits. Subgroup analyses were performed for age group, sex, and geographical region by individual STI test and receipt of STI prevention education. Results A total of 7.6 billion visits were included for analysis, of which 0.6% included an STI test. Testing rates increased over the study period for Chlamydia (R2=0.27), HPV (R2=0.28), and HIV (R2=0.51). Peak testing occurred in 2015 for all tests. STI prevention education was provided to 0.5% of patients. Females were tested at a higher rate for all STIs (4.2%) compared to males (0.4%). Females also received more STI prevention education overall (0.6% versus 0.4%, respectively). While the age group 25 – 24 accounted for highest Hepatitis (15.9%) and HPV (11.3%) testing rates, the 15 – 24 age group had the highest overall testing rate (9.4%). STI testing was highest in the South region (Figure 1). Conclusion STI testing in US physician offices increased in recent years. Females accounted for the majority of STI testing and STI prevention education. Testing was more frequent among patients 15 – 24 years old and those seen in the South region. Further research should be conducted to determine reasons for differences in testing and education amongst sex, age group, and geographic region. Disclosures All Authors: No reported disclosures

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