482 Defining drugs that are high-risk associations for drug reactions within the hospital setting

The objective of the study was to evaluate the risk of diabetes mellitus in elderlywith age above 20 years in a hospital setting using Indian Diabetes risk score and to provide patient counselling regarding their life style modifications and health related quality of life among participants with high risk of developing diabetes.A total of 125 non diabetic patients were interviewed with a pre designed selfstructured questionnaire (IDRS). Participants were chosen voluntarily and a written consent was obtained before the administration of the questionnaire from individual patients. In our study we observed that out of 125 patients,males 26[59%]and 18[41%] females were at high risk, males 39[58.2%] and 28[41.8%] females were at moderate risk, males 5[35.7%] and 9[64.3%] females were at low risk of developing diabetes mellitus.

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Cascade screening for glaucoma in high-risk family members of African-Caribbean glaucoma patients in an urban population in London

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317373 ◽

2020 ◽

pp. bjophthalmol-2020-317373

Author(s):

Anindyt Nagar ◽

Sam Myers ◽

Diana Kozareva ◽

Mark Simcoe ◽

Christopher Hammond

Keyword(s):

High Risk ◽

Genetic Diseases ◽

Family Doctor ◽

Family Members ◽

Hospital Setting ◽

High Risk Group ◽

Cascade Screening ◽

Specialist Referral ◽

High Risk Family ◽

African Caribbean

Background/aimsCascade screening has been used successfully in relatives of patients with inherited cancers and other genetic diseases to identify presymptomatic disease. This study was designed to examine if this approach would be successful in a high-risk group: first-degree relatives (FDR) of African-Caribbean glaucoma patients resident in London.MethodsAfrican-Caribbean patients (probands) with glaucoma from an inner London hospital setting in a deprived area were asked to disseminate personalised information to their FDR over the age of 30 and to arrange a free hospital-based screening. Data collected, including optical coherence tomography imaging, were reviewed by a glaucoma specialist and if glaucoma was diagnosed or suspected, local specialist referral via family doctor was made.Results203 probands were recruited from glaucoma clinics. 248 suitable FDR were identified as potentially eligible to attend screening. 57 (23%) FDR made contact with the research team of whom 18 (7%) attended a subsequent screening visit. No patients were diagnosed with glaucoma; one participant was diagnosed as glaucoma suspect. Reasons for poor uptake included reluctance by probands to involve their family members, and retirees spending significant time abroad.ConclusionCascade screening of FDR of African-Caribbean glaucoma patients in inner city London was unsuccessful. Research confidentiality guidance prohibiting research teams directly contacting family members was a barrier. Greater community engagement, community-based screening and permission to contact FDR directly might have improved uptake.

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Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis

Journal of Clinical Microbiology ◽

10.1128/jcm.01718-16 ◽

2016 ◽

Vol 54 (12) ◽

pp. 2969-2974 ◽

Cited By ~ 10

Author(s):

Laura Pérez-Lago ◽

Miguel Martínez-Lirola ◽

Sergio García ◽

Marta Herranz ◽

Igor Mokrousov ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

High Risk ◽

Primary Cultures ◽

Hospital Setting ◽

Drug Resistant ◽

Nucleotide Polymorphisms ◽

Content Type ◽

Extensively Drug Resistant ◽

Incident Cases ◽

Rule Out

Current migratory movements require new strategies for rapidly tracking the transmission of high-risk importedMycobacterium tuberculosisstrains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR BeijingM. tuberculosisstrains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis.

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1661. Using Social Media to Enhance an STI Screening Program in Wuhan, China

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1525 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S608-S608

Author(s):

Margaret E Newman McCort ◽

Yanmeng Feng ◽

Haojie Huang ◽

Jonathan Lio ◽

Renslow Sherer

Keyword(s):

Public Health ◽

Social Media ◽

High Risk ◽

Screening Program ◽

Hospital Setting ◽

Public Hospitals ◽

Public Health Services ◽

Transmitted Infection ◽

Hiv Test ◽

Rapid Hiv Test

Abstract Background 357 million people between the ages of 19 and 49 are infected each year with a sexually transmitted infection (STI). Wuhan, China is a unique setting for STI intervention as it has over 900,000 college students, a population at high risk for contracting HIV. Cultural attitudes toward premarital sex and homosexuality and poor sexual education are barriers to lowering STI rates. Additionally, 90% of Chinese healthcare is provided at large public hospitals with minimal privacy. Anonymous STI screening outside of the public hospital setting is highly desired by young adults and MSM populations. Methods Study investigators partnered with dating app Blued to advertise a nontraditional testing site where high-risk individuals were offered anonymous STI/HIV screening. With the assistance of the regional CDC and a community-based organization (CBO), rapid STI results were provided in a convenient and nonjudgmental setting. Information on sexual behavior and knowledge of STIs was surveyed for future public health interventions. Results Of 200 individuals screened for HIV, syphilis, gonorrhea, and chlamydia, 51 (25.5%) had a positive test result. Over 10% of rectal and pharyngeal tests were positive, compared with 1% of urine tests. 3/200 (1.5%) of had positive rapid HIV test results; all were connected to treatment. Among 41 (20.5%) who learned about the study through Blued, STI prevalence was higher (31.7% vs. 23.9%, P = 0.3), compared with participants recruited through advertisement by the CBO. Most (67.5%) identified as MSM. Survey data confirmed low underlying knowledge of STI transmission and risk factors, especially regarding pre-exposure prophylaxis (PrEP). Conclusion A discreet screening service at a nontraditional site, facilitated through dating application and social media advertisement, was well received by young adult and MSM communities in Wuhan, China. Triple-site STI screening found a significant number of infections among this population and should be routinely offered by public health services. The use of real-time, convenient diagnostic testing presents an opportunity to lower HIV incidence in Wuhan, a city with a large at-risk population. Disclosures All authors: No reported disclosures.

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Hospital-level high-risk antibiotic use in relation to hospital-associated Clostridioides difficile infections: Retrospective analysis of 2016–2017 data from US hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.236 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1229-1235 ◽

Cited By ~ 7

Author(s):

Ying P. Tabak ◽

Arjun Srinivasan ◽

Kalvin C. Yu ◽

Stephen G. Kurtz ◽

Vikas Gupta ◽

...

Keyword(s):

High Risk ◽

Hospital Setting ◽

Antibiotic Use ◽

The United States ◽

Fourth Generation ◽

Teaching Hospitals ◽

Clostridioides Difficile ◽

Positive Stool ◽

Days Of Therapy ◽

Assay Result

AbstractObjective:Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).Methods:We analyzed 2016–2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides. A CDI case was a positive stool C. difficile toxin or molecular assay result from a patient without a positive result in the previous 8 weeks. Hospital-associated (HA) CDI cases included specimens collected >3 calendar days after admission or ≤3 calendar days from a patient with a prior same-hospital discharge within 28 days. We used the multivariable Poisson regression model to estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, controlling for confounders.Results:The median days of therapy for high-risk antibiotic use was 241.2 (interquartile range [IQR], 192.6–295.2) per 1,000 days present; the overall HA CDI rate was 33 (IQR, 24–43) per 10,000 admissions. The overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), and higher correlation was observed in teaching hospitals (0.38; P = .002). For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04–1.21; P = .002) after adjusting for confounders.Conclusions:High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI.

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A Real-World, Multicenter Assessment of Drugs Requiring Weight-Based Calculations in Overweight, Adult Critically Ill Patients

The Scientific World JOURNAL ◽

10.1155/2013/909135 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Sandra L. Kane-Gill ◽

Nicholas P. Wytiaz ◽

Lisa M. Thompson ◽

Karina Muzykovsky ◽

Mitchell S. Buckley ◽

...

Keyword(s):

High Risk ◽

Adverse Drug Reactions ◽

Real World ◽

Drug Reactions ◽

Multicenter Observational Study ◽

Increased Risk ◽

The Us ◽

Overweight Adult ◽

Body Mass Indexes ◽

Prospective Multicenter Observational Study

Prescribing appropriate doses of drugs requiring weight-based dosing is challenging in overweight patients due to a lack of data. With 68% of the US population considered overweight and these patients being at an increased risk for hospitalization, clinicians need guidance on dosing weight-based drugs. The purpose of this study was to identify “real-world” dose ranges of high-risk medications administered via continuous infusion requiring weight-based dosing and determine the reasons for dosing changes (ineffectiveness or adverse drug reactions). A prospective, multicenter, observational study was conducted in four intensive care units at three institutions. A total of 857 medication orders representing 11 different high-risk medications in 173 patients were reviewed. It was noted that dosing did not increase in proportion to weight classification. Overall, 14 adverse drug reactions occurred in nine patients with more in overweight patients (9 of 14). A total of 75% of orders were discontinued due to ineffectiveness in groups with higher body mass indexes. Ineffectiveness leads to dosing adjustments resulting in the opportunity for medication errors. Also, the frequent dosing changes further demonstrate our lack of knowledge of appropriate dosing for this population. Given the medications’ increased propensity to cause harm, institutions should aggressively monitor these medications in overweight patients.

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