Quality of inpatient antimicrobial use in hematology and oncology patients

2021 ◽  
pp. 1-10
Author(s):  
Abby P. Douglas ◽  
Lisa Hall ◽  
Rodney S. James ◽  
Leon J. Worth ◽  
Monica A. Slavin ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Neutropenic Fever ◽  
Antibacterial Prophylaxis ◽  
Separate Analysis ◽  
Prescribing Practices ◽  
Oncology Patients ◽  
Antimicrobial Prescribing ◽  
Using Data ◽  
To Receive

Abstract Objectives: To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. Design: Retrospective comparative analysis of a national prospectively collected database. Methods: Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. Results: In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). Conclusions: This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.

scholarly journals 1010. Exploring Antimicrobial Prescriptions in a National Audit of Hematology/Oncology Inpatients Compared with the General Inpatient Population: Targeted Analysis Highlights Key Areas for Targeted Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S355-S355
Author(s):  
Abby Douglas ◽  
Lisa Hall ◽  
Rodney James ◽  
Leon Worth ◽  
Monica Slavin ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Separate Analysis ◽  
Prescribing Practices ◽  
Prevalence Survey ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Antimicrobial Prescribing ◽  
Targeted Analysis ◽  
Appropriate Prescribing ◽  
To Receive

Abstract Background Little is known about the antimicrobial prescribing practices in hematology and oncology (haemonc) populations. We aimed to explore antimicrobial prescribing practices in haemonc patients compared with other acute inpatients, in order to target areas for intervention. Methods In Australia, facilities nationwide participate in an annual point-prevalence survey of antimicrobial prescribing in hospitalized patients (Hospital National Antimicrobial Prescribing Survey (Hospital NAPS)). The results for adult inpatients from 2015–2018 were analyzed. Assessments of appropriateness were undertaken by local antimicrobial stewardship teams according to a structured algorithm, and defined as: 1 (optimal); 2 (adequate); 3 (suboptimal); 4 (inadequate); 5 (not assessable). A score of 1 or 2 is considered to be”appropriate’ and 3 or 4 ‘inappropriate’; those not assessable were excluded. Antimicrobial class, indication and appropriateness were compared between haemonc and other acute inpatient populations. Using logistic regression analysis, factors associated with appropriate prescribing of antibacterials were explored. Results The survey comprised 95809 antibiotic prescriptions for 63668 adult inpatients (4097 haemonc, 59571 other inpatients) in 423 acute facilities. The top treatment and prophylactic indications for all classes of antimicrobials were highly disparate between haemonc and other inpatients (table). Of note in the haemonc group, vancomycin use was high, and amphotericin B was used frequently for antifungal treatment. In multivariate analysis, haemonc patients were strongly associated with antibacterial appropriateness compared with other inpatients (adjusted OR 1.72, 95% CI 1.59–1.87, P < 0.001); factors associated with inappropriate prescription included antibiotic allergies and prophylactic indications. Conclusion Haemonc patients were more likely to receive appropriate antimicrobials compared with other inpatients. However, we have identified key areas for targeted interventions (prophylaxis use, antimicrobial allergy labels, vancomycin and amphotericin B treatment). Separate analysis of haemonc populations is necessary to identify key areas of concern specific to this patient group. Disclosures All authors: No reported disclosures.

Challenges in Antenatal Corticosteroid Prescribing: A Retrospective Study

2020 ◽  
Vol 16 (4) ◽  
pp. 327-333
Author(s):  
Shannon Armstrong-Kempter ◽  
Lucinda Beech ◽  
Sarah J. Melov ◽  
Adrienne Kirby ◽  
Roshini Nayyar
Keyword(s):  
Retrospective Study ◽  
Obstetric Care ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Optimal Timing ◽  
Prescribing Practices ◽  
Antenatal Corticosteroids ◽  
Term Infants ◽  
Preterm Premature Rupture ◽  
To Receive

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging. Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period. Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed. Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]). Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

scholarly journals PSYCHOLOGICAL PROFILE OF PATIENTS ELIGIBLE FOR BARIATRIC SURGERY

2016 ◽  
Vol 29 (suppl 1) ◽  
pp. 27-30 ◽  
Author(s):  
Graziela Aparecida Nogueira de Almeida RIBEIRO ◽  
Helenice Brizolla GIAMPIETRO ◽  
Lídia Barbieri BELARMINO ◽  
Wilson SALGADO-JÚNIOR
Keyword(s):  
Bariatric Surgery ◽  
Binge Eating ◽  
Average Score ◽  
Psychological Profile ◽  
Psychosocial Characteristics ◽  
The Mean ◽  
Low Levels ◽  
Using Data ◽  
Binge Eating Scale ◽  
To Receive

Abstract Background: The psychologist who works in bariatric surgery has a role to receive, evaluate, prepare and educate the patient who will undergo the surgical procedure. Psychological evaluation becomes important in so far as allows us to obtain data on personal and familiar history and allow tracing of possible psychopathology. Aim: To collect data on psychological evaluations of patients in a bariatric surgery service of a public hospital in order to describe the psychological profile of patients in this service. Method: Data were collected from 827 patients between 2001 and 2015, using data from an interview, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Binge Eating Scale (BES). Results: The mean age of patients before surgery was 39 years+/- 10, the mean BMI was 51 kg/m²+7, and most patients (81%) were female. The average score on the BDI was 14.8+8 and women had significantly higher scores than men. On the BAI the average score was 11+8 and on the ECAP was 14+8, both with no difference between groups. Conclusions: Psychosocial characteristics of the patients points to the significant presence of indicators of depression, with low levels of anxiety and binge eating.

Antifungal Prophylaxis in Bone Marrow Transplant

1995 ◽  
Vol 29 (9) ◽  
pp. 921-924 ◽  
Author(s):  
Harriet H Lam ◽  
Betsy L Althaus
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Marrow Transplant ◽  
Antifungal Prophylaxis

Product Proliferation under Rational Inattention: Application to Health Insurance

2021 ◽  
Vol 111 ◽  
pp. 554-559
Author(s):  
Zach Y. Brown ◽  
Jihye Jeon
Keyword(s):  
Health Insurance ◽  
Prescription Drug ◽  
Market Share ◽  
Information Acquisition ◽  
Rational Inattention ◽  
Drug Insurance ◽  
Acquisition Costs ◽  
Using Data ◽  
Product Proliferation ◽  
To Receive

In markets with complicated products such as insurance, why do firms offer many products even when consumers appear to receive little benefit? We show that when consumers face information acquisition costs, firms may have an incentive to introduce many undifferentiated products. This allows firms to gain market share and increase markups. We document initial evidence consistent with the model using data from Medicare prescription drug insurance. Insurers that offer more duplicate or similar plans have higher-cost plans. These results suggest a role for policymakers to restrict product proliferation in markets with complicated products.

The influence of race on financial toxicity among cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1525-1525
Author(s):  
John Panzone ◽  
Christopher Welch ◽  
Ruben Pinkhasov ◽  
Joseph M Jacob ◽  
Oleg Shapiro ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Cross Sectional Study ◽  
Financial Toxicity ◽  
Cancer Awareness ◽  
Cross Sectional ◽  
History Of ◽  
Using Data ◽  
National Trends ◽  
To Receive

1525 Background: Studies show that cancer patients and survivors are likely to endure financial toxicity long after being diagnosed. Methods: To examine the influence of race on financial toxicity among individuals with a history of cancer, a US based cross sectional study was conducted using data on 1,328 cancer patients collected from the Health Information National Trends Survey. Multivariable logistic regression analyses were used to analyze the relationship between race and financial toxicity, adjusting for known confounders. Results: Blacks, Hispanics and other races were shown to have a lower rate of insurance compared to Whites. Whites were also more likely to receive cancer treatment than other races (6.1% received no treatment vs 15.0% of Blacks, 17.8% of Hispanics, and 9.7% of other races, p<0.001). Considerably more Whites underwent surgical treatment of their cancer (77%) vs. 60% of Blacks, 55% of Hispanics and 74.2% of other races, p<0.001. Blacks were found to be over 5 times more likely to be denied insurance (OR 5.003, 95% CI 2.451-10.213, p<0.001) and more than twice as likely to be hurt financially than Whites (OR 2.448, 95% CI 1.520-3.941, p<0.001). Other racial minorities were also more than twice as likely to be hurt financially than Whites (OR 2.421, 95% CI 1.248-4.698, p=0.009) (Table). Conclusions: These data suggest that race is significantly associated with increased rates of being hurt financially and being denied insurance due to cancer. Awareness of race inequality should be raised so that equal cancer treatment can be provided, irrespective of race, gender or socioeconomic status.[Table: see text]

scholarly journals The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 107 ◽  
Author(s):  
Jeffrey W. Hall ◽  
Jeannette Bouchard ◽  
P. Brandon Bookstaver ◽  
Matthew S. Haldeman ◽  
Peter Kishimbo ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Community Pharmacies ◽  
Prescribing Practices ◽  
University Of South Carolina ◽  
Antimicrobial Prescribing ◽  
Resistance Rates ◽  
The University ◽  
New Generation

Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

scholarly journals A comparison of filtered leukocyte-reduced and cytomegalovirus (CMV) seronegative blood products for the prevention of transfusion- associated CMV infection after marrow transplant [see comments]

Blood ◽  
1995 ◽  
Vol 86 (9) ◽  
pp. 3598-3603 ◽  
Author(s):  
RA Bowden ◽  
SJ Slichter ◽  
M Sayers ◽  
D Weisdorf ◽  
M Cays ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Marrow Transplant ◽  
Disease Rate ◽  
Blood Products ◽  
Cmv Infection ◽  
Primary Analysis ◽  
Probability Of Survival ◽  
Transplant Patients ◽  
Cmv Disease ◽  
To Receive

We performed a prospective, randomized trial in CMV seronegative marrow recipients to determine if filtered blood products were as effective as CMV-seronegative blood products for the prevention of transfusion- transmitted CMV infection after marrow transplant. Before transplant, 502 patients were randomized to receive either filtered or seronegative blood products. Patients were monitored for the development of CMV infection and tissue-documented CMV disease between days 21 and 100 after transplant. Infections occurring after day 21 from transplant were considered related to the transfusion of study blood products and, thus, were considered evaluable infections for the purpose of this trial. In the primary analysis of evaluable infections, there were no significant differences between the probability of CMV infection (1.3% v 2.4%, P = 1.00) or disease (0% v 2.4%, P = 1.00) between the seronegative and filtered arms, respectively, or probability of survival (P = .6). In a secondary analysis of all infections occurring from day 0 to 100 post-transplant, although the infection rates were similar, the probability of CMV disease in the filtered arm was greater (2.4% v 0% in the seronegative arm, P = .03). However, the disease rate was still within the prestudy clinically defined acceptable rate of < or = 5%. We conclude that filtration is an effective alternative to the use of seronegative blood products for prevention of transfusion- associated CMV infection in marrow transplant patients.

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