The Introduction of Key Working within the Inpatient Setting of St Patrick's University Hospital

Abstract BackgroundPost viral anosmia has been reported in human coronavirus infections. In this current pandemic, olfactory dysfunction (OD) has emerged as a common key presenting symptom of COVID-19 infection. In this study, we describe OD assessment in the inpatient setting of patients both suspected of and with confirmed COVID-19 infection via University of Pennsylvania Smell Identification Test (UPSIT) objective assessment and a simple self-reported 3-item questionnaire.MethodsThirty patients admitted to the isolation wards of the National University Hospital, Singapore for either suspected or confirmed COVID-19 infection from April to May 2020 were recruited to this study. 10 patients who tested negative for SARS-CoV-2 were recruited as control subjects. The 20 patients with COVID-19 infection were divided into two groups (10 had olfactory testing performed during the first week of illness, 10 in the second week of illness). A simple 3-question survey was administered to each participant - to rank the severity, state the onset and duration of their hyposmia. Olfactory testing was performed using an English version of the UPSIT.ResultsLoss of smell was reported in 2 participants from the control group, 6 participants from the in the first week of illness and 5 participants from the second week of illness. Two COVID-19 patients have anosmia on the UPSIT. COVID-19 patients were more likely to have severe hyposmia or anosmia by objective assessment, a difference that was statistically significant (P = 0.0485). The differences in degree of OD among COVID-19 patients in their first and second week of illness were not statistically significant (P= 0.6563).ConclusionSelf-reported anosmia was higher among COVID-19 patients compared to controls who were admitted to isolation wards for respiratory symptoms but were tested negative for SARS-CoV-2 infection. On objective assessment by the UPSIT, COVID-19 patients were found to have higher rates of severe hyposmia or anosmia, a difference that was statistically significant (P = 0.0485). A limitation of this study is the odorants used in UPSIT which may be less familiar to the primarily Asian participants in this study, owing to cultural differences.

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Protocol of a prospective, multicentre phase I study to evaluate the safety, tolerability and preliminary efficacy of the bispecific PSMAxCD3 antibody CC-1 in patients with castration-resistant prostate carcinoma

BMJ Open ◽

10.1136/bmjopen-2020-039639 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039639

Author(s):

Jonas S Heitmann ◽

Juliane S Walz ◽

Martin Pflügler ◽

Joseph Kauer ◽

Richard F Schlenk ◽

...

Keyword(s):

Prostate Cancer ◽

Time Course ◽

Tumour Response ◽

Maximum Tolerated Dose ◽

University Hospital ◽

Inpatient Setting ◽

Castration Resistant Prostate Cancer ◽

Liquid Biopsies ◽

Multicentre Phase ◽

Castration Resistant

IntroductionProstate cancer is the second most common cancer in men worldwide. When the disease becomes resistant to androgen-deprivation therapy, treatment options are sparse. To address the high medical need in castration-resistant prostate cancer (CRPC), we generated a novel PSMAxCD3 bispecific antibody termed CC-1. CC-1 binds to prostate-specific membrane antigen that is expressed on prostate cancer cells and tumour vessels, thereby allowing a dual anticancer effect.Methods and analysisThis first in human clinical study is a prospective and multicentre trial which enrols patients with metastatic CRPC after failure of established third-line therapy. CC-1 is applied after prophylactic interleukin-6 receptor blockade with tocilizumab (once 8 mg/kg body weight). Each patient receives at least one cycle of CC-1 over a time course of 7 days in an inpatient setting. If clinical benefit is observed, up to five additional cycles of CC-1 can be applied. The study is divided in two parts: (1) a dose escalation phase with intraindividual dose increase from 28 µg to the target dose of 1156 µg based on a modified fast titration design by Simon et al to determine safety, tolerability and the maximum tolerated dose (MTD) as primary endpoints and (2) a dose expansion phase with additional 14 patients on the MTD level of part (1) to identify first signs of efficacy. Secondary endpoints compromise overall safety, tumour response, survival and a translational research programme with, among others, the analysis of CC-1 half-life, the induced immune response, as well as the molecular profiling in liquid biopsies.Ethics and disseminationThe PSMAxCD3 study was approved by the Ethics Committee of The University Hospital Tübingen (100/2019AMG1) and the Paul-Ehrlich-Institut (3684/02). Clinical trial results will be published in peer-reviewed journals.Trial registration numbersClinicalTrials.gov Registry (NCT04104607) and ClinicalTrials.eu Registry (EudraCT2019-000238-20).

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Impact of the inpatient infectious disease consultations at a tertiary care university hospital

The International Arabic Journal of Antimicrobial Agents ◽

10.3823/844 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Rami Waked ◽

Danielle Jaafar ◽

Marie Chedid ◽

Gebrael Saliba ◽

Elie Haddad ◽

...

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Tertiary Care ◽

Hospitalized Patients ◽

University Hospital ◽

Inpatient Setting ◽

Therapeutic Approaches ◽

Infectious Diseases Consultation ◽

Disease Specialist

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

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Contingency Contracts for Weight Gain of Patients with Anorexia Nervosa in Inpatient Therapy: Practice Styles of Specialized Centers

Journal of Clinical Medicine ◽

10.3390/jcm7080215 ◽

2018 ◽

Vol 7 (8) ◽

pp. 215

Author(s):

Katrin Ziser ◽

Katrin Giel ◽

Gaby Resmark ◽

Christoph Nikendei ◽

Hans-Christoph Friederich ◽

...

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Mental Health Professionals ◽

Multimodal Treatment ◽

University Hospital ◽

Inpatient Setting ◽

Negative Consequences ◽

Survey Results ◽

High Degree ◽

Contingency Contract

The treatment of patients with anorexia nervosa (AN) is often challenging, due to a high degree of ambivalence towards recovery and weight gain these patients often express. One part of the multimodal treatment is the utilization of treatment contracts (i.e., contingency contracts) that aim to motivate patients to gain weight by applying positive and negative consequences for the (non-)achievement of weight goals. The main aim of this study is to assess and analyze current standards of contingency contracts’ utilization in German eating disorder centers. n = 76 mental health professionals of twelve specialized university centers in Germany that are currently or were formerly treating patients with AN in an inpatient setting participated. Most experts use contingency contracts in their clinic with weekly weight goals ranging between 500 and 700 g. Overall effectiveness and significance of contingency contracts for the inpatient treatment of patients with AN was rated high. Typical characteristics of a contingency contract in specialized German university hospital centers, such as the most frequent consequences, are described. The survey results assist the planning of further studies aiming to improve the multimodal treatment of patients with AN. For clinical practice, using external motivators such as contingency contracts as well as targeting internal motivation (e.g., by using motivational interviewing) is proposed.

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1006. Do Antibiotic Choices Made in the ED Influence Inpatient Therapy?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.870 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S354-S354

Author(s):

Travis M Jones ◽

Elizabeth Dodds Ashley ◽

Melissa D Johnson ◽

Rebekah W Moehring ◽

Christina Sarubbi ◽

...

Keyword(s):

Antibiotic Use ◽

Transitions Of Care ◽

University Hospital ◽

Day Length ◽

Clinical Indication ◽

Inpatient Setting ◽

Prescribing Practices ◽

Entry Length ◽

Abdominal Infection ◽

Intra Abdominal Infection

Abstract Background Inappropriate antibiotic use (AU) is common among inpatients and may begin in the emergency department (ED). ED clinicians often make the first antibiotic decisions in patient care, but it is unknown whether or not these decisions influence inpatient AU. Understanding prescribing practices at transitions of care is critical for implementing effective stewardship initiatives. Methods We performed a retrospective cohort study of AU in patients admitted to Duke University Hospital through the ED between July and December 2018. Included encounters had a minimum 2-day length of stay and received an antibiotic in both the ED and inpatient setting. Individual encounter IDs were used to link ED and inpatient AU reports generated from the DASON Antimicrobial Stewardship Assessment Portal. We compared the last ED administration date/time to the first inpatient unit administration for each agent. An antibiotic started in the ED was considered continued upon admission if the first inpatient administration occurred within 30 hours following the last ED administration. Demographic, clinical indication on order entry, length of therapy, and prescriber data were also collected. Results We included 3,336 encounters and 2,940 unique patients in the analysis. The median (IQR) patient age was 60 (42–72) years, and the most common indications for AU in the ED were sepsis (23.1%), pneumonia (17.8%), ABSSSI (15.5%), and intra-abdominal infection (12.8%). At least one antibiotic initiated in the ED was continued upon admission within 30 hours in 2,495 (74.8%) encounters. The most common antibiotics continued upon admission were piperacillin/tazobactam (32.8%), vancomycin (24.9%), and ceftriaxone (13.7%). The most common indications for agents continued upon admission were pneumonia (18%), intra-abdominal infection (15%), and ABSSSI (15%). Two or more antibiotics were continued upon admission in 916 (27.4%) encounters. Conclusion In our retrospective review of ED antibiotic encounters resulting in admission for at least 2 days, three out of four encounters had at least one antibiotic continued upon admission. This finding highlights the importance of initial appropriate antibiotic selection and suggests stewardship interventions should target EDs as well as inpatient prescribing. Disclosures All authors: No reported disclosures.

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Referrals to a perinatal specialist palliative care consult service in Ireland, 2012–2015

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313183 ◽

2017 ◽

Vol 103 (6) ◽

pp. F573-F576 ◽

Cited By ~ 3

Author(s):

Des L McMahon ◽

Marie Twomey ◽

Maeve O’Reilly ◽

Mary Devins

Keyword(s):

Palliative Care ◽

Chromosomal Abnormalities ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

University Hospital ◽

Dose Titration ◽

Inpatient Setting ◽

Specialist Palliative Care ◽

Symptom Profile

ObjectiveTo analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile.DesignA retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015.SettingA consultant-led paediatric SPCS at Our Lady’s Children’s Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin.Results83 perinatal referrals were received in a 4-year period. Chromosomal abnormalities accounted for 35% of diagnoses, congenital heart disease 25%, complex neurological abnormalities 11% and renal agenesis 4%. 22 referrals (26.5%) were made antenatally, with 61 (73.5%) postnatally. Of the postnatal referrals, 27 (44%) were asymptomatic on referral. An opioid medication was recommended (regularly or as required) in 46 cases. Symptom control was achieved without dose titration in 43 of these cases (93%). Of 47 deaths in this group referred postnatally, 22 of these (47%) died at home with support from community teams. Discharge home for best supportive care required complex interagency communication and cooperation.ConclusionsPerinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.

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An Ultrastructural Study of the Proliferation Patterns of the Reserve Cells of the Human Cervix Uteri

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100093651 ◽

1972 ◽

Vol 30 ◽

pp. 80-81

Author(s):

Takanori Sohda ◽

Hiroshi Saito ◽

Goro Asano ◽

Katsunari Fukushi ◽

Katsuya Suzuki ◽

...

Keyword(s):

Ultrastructural Study ◽

Age Groups ◽

Point Of View ◽

University Hospital ◽

Cervix Uteri ◽

Morphological Aspect ◽

Functional Aspect ◽

Pathological Conditions ◽

Human Cervix ◽

Morphological Patterns

Recently, the functional aspect as well as morphological aspect of the reserve cells in the cervix uteri drew much attention in view of the carcinogenesis in squamocolumunar junction. In this communication, the authors elucidate the ultrastructural features of the reserve cells in patients of various age groups visiting our university hospital and affiliated hospital.From conventional light microscopic point of view, the reserve cells tend to be pronounced in various pathological conditions, such as the persisting inflammation, proliferative disorders and irritation of hormones. The morphological patterns of the reserve cells from various stage and degree of irritation were observed.

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