scholarly journals Ultrasound during Critical Care Simulation: A Randomized Crossover Study

CJEM ◽  
2015 ◽  
Vol 18 (3) ◽  
pp. 183-190 ◽  
Author(s):  
Paul A. Olszynski ◽  
Tim Harris ◽  
Patrick Renihan ◽  
Marcel D’Eon ◽  
Kalyani Premkumar
Keyword(s):  
Critical Care ◽  
Crossover Study ◽  
Primary Outcome ◽  
Clinical Performance ◽  
Image Interpretation ◽  
Post Intervention ◽  
Ultrasound Simulation ◽  
The Impact ◽  
Correct Image ◽  
Randomized Crossover Study

AbstractObjectivesWe sought to compare two ultrasound simulation interventions used during critical care simulation. The primary outcome was trainee and instructor preference for either intervention. Secondary outcomes included the identification of strengths and weaknesses of each intervention as well as overall merits of ultrasound simulation during high-fidelity, critical care simulation. The populations of interest included emergency medicine trainees and physicians.MethodsThis was a randomized crossover study with two ultrasound simulation interventions. 25 trainees and eight emergency physician instructors participated in critical-care simulation sessions. Instructors were involved in session debriefing and feedback. Pre- and post-intervention responses were analyzed for statistically significant differences usingttest analyses. Qualitative data underwent thematic analysis and triangulation.ResultsBoth trainees and instructors deemed ultrasound simulation valuable by allowing trainees to demonstrate knowledge of indications, correct image interpretation, and clinical integration (p<0.05). Trainees described increased motivation to develop and use ultrasound skills. The edus2 was the preferred intervention, as it enabled functional fidelity and the integration of ultrasound into resuscitation choreography. Instructors preferred the edus2, as it facilitated better assessment of trainees’ skills, thus influencing feedback.ConclusionsThese findings support the use of ultrasound simulation during critical care simulations. The increased functional fidelity associated with edus2 suggests that it is the preferred intervention. Further study of the impact on clinical performance is warranted.

scholarly journals 141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Grace Mortrude ◽  
Mary Rehs ◽  
Katherine Sherman ◽  
Nathan Gundacker ◽  
Claire Dysart
Keyword(s):  
Patient Satisfaction ◽  
Primary Outcome ◽  
Respiratory Infections ◽  
Asymptomatic Bacteriuria ◽  
Educational Interventions ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Stepped Wedge ◽  
Post Intervention ◽  
The Impact

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance in the United States. The objective of this study was to design, implement and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the outpatient setting. Methods This randomized, stepped-wedge trial evaluated the impact of educational interventions to providers on adult patients presenting to primary care (PC) clinics for ARIs and ASB from 10/1/19 to 1/31/20. Data was collected by retrospective chart review. An antibiotic prescribing report card was provided to PC providers, then an educational session was delivered at each PC clinic. Patient education materials were distributed to PC clinics. Interventions were made in a step-wise (figure 1) fashion. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper-respiratory infection otherwise unspecified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes included individual components of the primary outcome, a composite safety endpoint of related hospital, emergency department or primary care visit within 4 weeks, antibiotic appropriateness, and patient satisfaction surveys. Figure 1 Results There were 887 patients included for analysis (405 pre-intervention, 482 post-intervention). Baseline characteristics are summarized in table 1. After controlling for type 1 error using a Bonferroni correction the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for bronchitis (20.99% vs 12.66%; p=0.0003). Appropriateness of prescriptions for sinusitis (OR 4.96; CI 1.79–13.75; p=0.0021) and pharyngitis (OR 5.36; CI 1.93 – 14.90; p=0.0013) was improved in the post-intervention group. The composite safety outcome and patient satisfaction survey ratings did not differ between groups. Table 1 Conclusion Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visit or patient satisfaction surveys. Disclosures All Authors: No reported disclosures

scholarly journals Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Vi Am Dinh ◽  
Paresh C. Giri ◽  
Inimai Rathinavel ◽  
Emilie Nguyen ◽  
David Hecht ◽  
...  
Keyword(s):  
Critical Care ◽  
Point Of Care ◽  
Image Interpretation ◽  
Fellowship Training ◽  
Multiple Organ ◽  
Critical Care Echocardiography ◽  
Organ Systems ◽  
Critical Care Ultrasound ◽  
Written Test ◽  
The Impact

Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows.Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course.Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course.Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men

2010 ◽  
Vol 108 (2) ◽  
pp. 241-247 ◽  
Author(s):  
Emmanuel Chartier-Kastler ◽  
Philippe Ballanger ◽  
Jacques Petit ◽  
Marc Fourmarier ◽  
Stéphane Bart ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Crossover Study ◽  
Patient Preference ◽  
The Impact ◽  
Randomized Crossover Study

scholarly journals 993. Pharmacist-driven Penicillin Allergy Assessment in the Emergency Department – Antimicrobial Stewardship at the Point of Prescription

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S349-S350
Author(s):  
Samantha Campbell ◽  
Pavithra Srinivas ◽  
Gregory Hauler ◽  
Ellen Immler ◽  
Susan Seiti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Primary Outcome ◽  
Antibiotic Use ◽  
Assessment Process ◽  
Allergic Reactions ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background Β-lactam allergy assessment is endorsed by the IDSA as an antimicrobial stewardship tool to enhance the use of first-line agents. We evaluated the impact of pharmacist-driven penicillin (PCN) allergy assessment at the point of prescription on antibiotic use in our emergency department (ED). Methods Retrospective, quasi-experimental study of adult patients with a PCN allergy receiving antibiotics at a community hospital ED. The intervention comprised an ED pharmacist performing allergy assessment and discussing therapy options with providers at the point of prescription. The primary outcome was to evaluate impact on guideline-preferred antibiotic prescription in the ED pre-intervention (March 1, 2017–August 31, 2017) vs. post-intervention (March 1, 2018–August 31, 2018). Secondary outcomes included types of reported allergic reactions, safety of allergy assessment process, and impact on downstream antibiotic use. Results Overall, 381 patients were evaluated (256 pre-intervention, 125 post-intervention). The median age was similar between groups and 85% of patients presented to the ED from the community. Most common infectious syndromes encountered in the ED were UTIs (35%), respiratory tract infections (25%), and skin/soft-tissue infections (18%). The proportion of guideline-preferred antibiotic prescriptions in the ED increased from 37% pre to 44% post (P = 0.171). Proportion of fluoroquinolone (FQ) prescriptions in the ED was reduced from 37.5% pre to 26% post (P = 0.021). Proportion of cephalosporin prescriptions increased from 26% pre to 42% post (P = 0.002). Types of reported allergic reactions were similar between groups and 55% of patients had tolerated a β-lactam agent since the listed allergy. Overall, 70% of patients were hospitalized from the ED. Similar trends in antibiotic use were observed at admission – decreased FQs (38% pre vs. 27% post, P = 0.059), increased cephalosporins (24% pre vs. 38.4% post, P = 0.021). Two patients (1.6%) experienced a nonsevere reaction within 24 hours of β-lactam administration post-allergy assessment. Conclusion Pharmacist-driven PCN allergy assessment at the point of prescription in the ED was safe and effective at improving the use of guideline-preferred antibiotics and reducing FQ use. Disclosures All authors: No reported disclosures.

Medication appropriateness on an acute geriatric care unit: the impact of the removal of a clinical pharmacist

2020 ◽  
Author(s):  
Michael Khazaka ◽  
◽  
Jeanne Laverdière ◽  
Chen Chen Li ◽  
Florence Correal ◽  
...  
Keyword(s):  
Clinical Pharmacist ◽  
Primary Outcome ◽  
Geriatric Care ◽  
Inappropriate Drug ◽  
Geriatric Ward ◽  
Post Intervention ◽  
Secondary Outcomes ◽  
The Impact ◽  
Acute Geriatric Care ◽  
Medication Appropriateness

Abstract Background evidence is largely available indicating benefits to adding a pharmacist on acute care wards. The benefits of maintaining pharmacotherapeutic consultant services on a geriatric ward remain unexplored. Objectives to determine the impact of the removal of a clinical pharmacist from an acute geriatric ward on patients’ Medication Appropriateness Index (MAI) scores, admission-related outcomes and drug burdens. Methods researchers consulted the archives for records of patients admitted to the geriatric care unit before and after the pharmacist’s withdrawal. The primary outcome of differential MAI scores and secondary outcomes of rehospitalisations, emergency department visits, durations of hospitalisation and differential drug count were compared pre- and post-intervention. An interrupted time series analysis regression model was used for the primary outcome. Results a total of 305 patients admitted before (n = 208) and after (n = 97) the pharmacist’s withdrawal were included in the study. The intervention had a significant impact on the primary outcome, increasing the relative differential MAI score (adjusted mean) by 9.3 points (95% confidence interval 3.9–14.6). As for the secondary outcomes, differences in admission-related outcomes were non-significant but the mean differential drug count significantly increased post-intervention from 0.02 to 1.36 (P &lt; 0.001). Conclusion the removal of the pharmacist led to an increase in inappropriate drug prescription. Careful consideration should be given to decisions regarding the removal of the pharmacist from acute geriatric care teams.

scholarly journals EVALUATING THE IMPACT OF STAR-VA ON VETERANS’ PSYCHOTROPIC MEDICATION USE IN CLCS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S632-S632
Author(s):  
Kevin McConeghy ◽  
Kim Curyto ◽  
Jenefer M Jedele ◽  
Jennifer Mach ◽  
Orna Intrator ◽  
...  
Keyword(s):  
Drug Use ◽  
Psychotropic Drug ◽  
Psychotropic Medication ◽  
Fixed Effects ◽  
Primary Outcome ◽  
Post Intervention ◽  
Difference In Differences ◽  
Eligibility Criteria ◽  
Psychotropic Drug Use ◽  
The Impact

Abstract The impact of STAR-VA on psychotropic drug use among residents with behavioral symptoms of dementia was evaluated through a difference-in-differences framework. STAR-VA residents enrolled 2013-2017 were evaluated longitudinally pre-post intervention. The primary outcome was the number of as needed administrations with an indication of ‘anxiety’ or ‘agitation’. The analytical cohort included 214 training cases and 1,870 controls from untrained sites meeting eligibility criteria. STAR-VA cases were less white (48% vs. 54%), less black (11% vs. 14%), and had significantly longer median length of stay (830 vs. 261 days), respectively. STAR-VA cases had on average 3.5 as needed doses/month of psychotropic medication before the intervention and 1.7 after, controls averaged 1.8 doses/month. After adjustment for person-time-fixed effects, enrollment was associated with 55% (95% CI:30, 68) reduction or an average 0.8 as needed psychotropic doses/month. Findings demonstrate effectiveness in decreasing as-needed psychotropic drug use among CLC residents, supporting continued implementation of STAR-VA.

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