Association Between Mucositis Severity and Vancomycin-Resistant Enterococcal Bloodstream Infection in Hospitalized Cancer Patients

1999 ◽  
Vol 20 (10) ◽  
pp. 660-663 ◽  
Author(s):  
Matthew J. Kuehnert ◽  
John A. Jernigan ◽  
Amy L. Pullen ◽  
David Rimland ◽  
William R. Jarvis
Keyword(s):  
Cancer Patients ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Vancomycin Resistant ◽  
Increasing Risk ◽  
Oncology Unit

AbstractObjective:To determine the role of mucositis severity in the development of vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI).Setting:A tertiary-care university medical center.Participants:Hematology-oncology-unit inpatients.Design:Patients with VRE BSI (case-patients) were compared with VRE-colonized (control) patients from September 1994 through August 1997. Oral mucositis severity was recorded on the day of VRE BSI for case-patients and on hospital day 22 (median day of hospitalization of case-patient VRE BSI) for controls. There were 19 case-patients and 31 controls.Results:In univariate analysis, case-patients were significantly more likely than controls to have a higher mucositis severity score, diarrhea, or a higher severity of illness score. In multivariate analysis, only mucositis remained as an independent risk factor, and increasing mucositis score was significantly associated with VRE BSI.Conclusions:Mucositis severity was independently associated with an increasing risk for VRE BSI. Interventions to alter mucositis severity may help to prevent VRE BSI in hospitalized cancer patients.

Central line-associated bloodstream infection (CLABSI) in Cancer patients: Role of central line insertion practices and audit system in prevention

2018 ◽  
Vol 23 ◽  
pp. S19-S20
Author(s):  
Hitender Gautam ◽  
Abdul Hakim Choudhary ◽  
Sarita Mohapatra ◽  
Seema Sood ◽  
Bimal Kumar Das ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Bloodstream Infection ◽  
Central Line ◽  
Central Line Insertion ◽  
Audit System ◽  
Line Insertion

scholarly journals FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA

2018 ◽  
Vol 11 (3) ◽  
pp. 272
Author(s):  
Melissa Sherrel Pereira ◽  
Chandrashekar Udyavara Kudru ◽  
Sreedharan Nair ◽  
Girish Thunga ◽  
Vijayanarayana Kunhikatta ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Hospital Setting ◽  
Severity Of Illness ◽  
Southern India ◽  
Severe Dengue ◽  
Care Hospital ◽  
Factors Associated

 Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue.Methods: A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue.Conclusion: This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions.

scholarly journals Detection of Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers

2008 ◽  
Vol 29 (7) ◽  
pp. 583-589 ◽  
Author(s):  
Graham M. Snyder ◽  
Kerri A. Thorn ◽  
Jon P. Furuno ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Routine Care ◽  
Inpatient Setting ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant

Objective.To assess the rate of and the risk factors for the detection of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).Methods.We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.Results.Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%–24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P< .05), HCW contact with the head and/or neck of a patient (P< .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P< .05) were associated with an increased risk of acquiring these organisms.Conclusions.The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.

scholarly journals 2249. Impact of Minimum Inhibitory Concentration on Clinical Outcomes of Daptomycin for VRE Bloodstream Infection Among Neutropenic Oncology Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S769-S769
Author(s):  
Elisabeth Caulder ◽  
Elizabeth Palavecino ◽  
James Beardsley ◽  
James Johnson ◽  
Vera Luther ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Clinical Success ◽  
Medical Center ◽  
Academic Medical Center ◽  
Charlson Comorbidity Index Score ◽  
Multivariable Logistic Regression Analysis ◽  
Oncology Patients ◽  
Oncology Unit ◽  
Record Review ◽  
The Impact

Abstract Background Vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) is a significant cause of morbidity and mortality in immunocompromised patients. This study aimed to assess the impact of daptomycin (DAP) MIC on outcomes of treatment for VRE BSI in neutropenic oncology patients. Methods This was a retrospective, observational, single-center, cohort study at an academic medical center. Included: age ≥ 18, neutropenia, admitted to oncology unit, and DAP for VRE BSI. Excluded: death within 24 hours after initiation of DAP, polymicrobial BSI, and linezolid use for > 48 hours before DAP initiation. Patients with VRE BSI 2008–2018 were identified using a report from the micro lab. Data were collected by electronic medical record review. The primary outcome of the study was clinical success, defined as culture sterilization, hypotension resolution, defervescence, and no need to change DAP due to persistent signs/symptoms of infection. Patients were analyzed according to DAP MIC ≤ 2 vs. ≥ 4 mg/L. Multivariable logistic regression analysis was performed to identify factors associated with clinical success. Results 44 patients met study criteria (MIC ≤ 2, n = 26; MIC ≥ 4, n = 18). Mean age was 58 years, 59% were male, and median ANC was 0. Median Charlson Comorbidity Index Score and Pitt Bacteremia Score (Pitt) were 5 and 1, respectively. 34% required ICU admission. More patients achieved clinical success with MIC ≤ 2 (88% vs. 56%; P = 0.03). Time to success (2.4 vs. 4 days, P = 0.02) and time to culture sterilization (2.2 vs. 2.9 days, P = 0.24) were shorter with MIC ≤ 2. Mortality was similar between groups (31% vs. 33%). Time to culture sterilization (P = 0.008), neutropenia resolution (P = 0.02), MIC group (P = 0.096), and Pitt (P = 0.52) were included in the multivariable model. Conclusion DAP MIC should be considered when choosing therapy for VRE BSI among neutropenic oncology patients, particularly those expected to have prolonged neutropenia and those with persistently positive cultures. Disclosures All authors: No reported disclosures.

Building the “Fable Hospital”—The CEO's Perspective

2012 ◽  
Vol 5 (3) ◽  
pp. 12-20 ◽  
Author(s):  
David A. Tam
Keyword(s):  
Health System ◽  
Construction Projects ◽  
Positive Impact ◽  
Medical Center ◽  
Tertiary Care ◽  
Chief Executive ◽  
Patient Satisfaction Scores ◽  
Hospital Construction ◽  
New Facilities

Hospital construction is a significant event in any health system. The financial implications are great, especially at a time of shrinking capital resources. Personnel are affected, as are the processes to perform their tasks. Often, new facilities are catalysts that change organizational culture; it has been clearly shown that new facilities have a positive impact on patient satisfaction scores. The members of the C-suite of a hospital/health system play important roles in construction projects. However, no one is more critical to the success of such major endeavors than the chief executive officer (CEO). The CEO sets the tone for the project, giving direction to the design and construction process that may have implications for the rest of the organization. Palomar Pomerado Health (PPH) is the largest public health district in California. In 2002, the PPH governing board authorized the creation of a new facility master plan for the district, which included the construction of a replacement facility for its tertiary care trauma center. The new Palomar Medical Center is slated to open in August 2012. HERD had the opportunity to speak with PPH CEO Michael H. Covert on the role of the CEO in the building of this “fable hospital.”

scholarly journals Caregiver burden among family members of patients diagnosed with cancer in Jimma medical center oncology unit, south west Ethiopia.

2022 ◽  
Author(s):  
Bikila Dereje Fufa ◽  
Misgana Bezabih Bezabih ◽  
Desalew Tilahun Beyene
Keyword(s):  
Cancer Patients ◽  
Caregiver Burden ◽  
Medical Center ◽  
General Level ◽  
P Value ◽  
Multivariable Logistic Regression Model ◽  
Psychological Burden ◽  
South West ◽  
Oncology Unit ◽  
South West Ethiopia

Abstract Background Cancer is a type of disease defined by uncontrolled growth and spread of abnormal cells, which can result in death. Globally, around 25 million people are surviving with it. The burden of cancer is growing in developing countries and it frequently comprises patient’s vitality. In addition, it has emotional, economical, physical and psychological burden on family, friends, significant others, community and other social resource. Objective To assess caregiver burden of cancer patients in Jimma medical center oncology unit, South west Ethiopia. Method An institutional based cross-sectional study design was employed. The study was done on 141 respondents using simple random sampling. A pretested semi structured interviewer administered questionnaire was used to collect the data. The collected data was entered in to EPI data version 3.1 then transferred to SPSS version 23 for data analysis. Multivariable logistic regression model was fitted, Adjusted Odds Ratio (AOR) at 95% confidence interval and p-value <0.05 were estimated to determine statistically association between predictors and outcome variables. Results The data were collected from the total of 141 respondents with 100% response rate. The mean ±SD age of cancer patients and care givers were 46.4 ±12.406 and 32 ± 11.23 years, respectively. The general level of caregiver burden in this study was mild to moderate (71.6%) with ZBI total score of 30 and by using CBI114 (80.9%) had some burden. Caregivers whose their age is greater than 40 years were 4.01 times more likely have high burden than those age between 20-40 old age [AOR=4.01, 95%CI (1.58, 10.17)]. Conclusion The study disclosed a moderate level of caregiver burden among family caregivers.

Patient-reported oncology readmission factors.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 48-48
Author(s):  
Shreya Kangovi ◽  
Tracey L. Evans ◽  
Nandita Mitra
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
University Of Pennsylvania ◽  
Oncology Patients ◽  
Logistic Regression Models ◽  
Patient Reported ◽  
Important Quality ◽  
Hospital To Home

48 Background: Reducing the risk of readmissions is an important quality goal for hospitals. Little is known of the perspectives of patients on underlying challenges that may lead to readmission. The objective of this study was to elicit perspectives of readmitted oncology patients on barriers to a successful transition from hospital to home. Methods: As part of a larger survey of readmitted inpatients, a 36-item survey was administered to 197 oncology patients readmitted to the hospital within 30 days of discharge to home. Surveys were administered at The Hospital of the University of Pennsylvania (an urban tertiary care academic medical center) and Penn Presbyterian Medical Center (an affiliated urban community hospital), both located in Philadelphia. Responses were entered in real-time into the electronic medical record (EMR) and used by the care team to address patient concerns and improve quality. Results: 45.2% of readmitted oncology patients reported challenges during the transition from hospital to home which they perceived as contributing to readmission. The most commonly reported transition challenges within the oncology population included difficulty with activities of daily living (ADLs) (17.8%), feeling unprepared for discharge (14.2%) and difficulty adhering to medications (7.1%). 15.2% of patients could not identify any modifiable factor contributing to readmission and reported returning simply because of symptoms from progressive illness. After adjusting for potential confounders (age, gender and severity of illness) using multivariable logistic regression models, uninsured and Medicaid patients were more likely than other patients to attribute readmission to difficulty accessing medications (OR 4.5, 95%CI 1.0, 19.9) and performing ADLs (OR 2.7, 95%CI 1.18, 6.1). Conclusions: Understanding challenges reported by readmitted oncology patients may enable inpatient oncologists to tailor transitions interventions to patient needs. Specifically, ensuring patients are able to perform necessary ADLs, are prepared for discharge and have assistance with medication adherence may help prevent unplanned readmissions. Uninsured and Medicaid patients may require additional assistance with accessing medications and ADLs.

Oncology consults in admitted cancer patients: The ways to reduce length of stay.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13516-e13516
Author(s):  
Bohdan Baralo ◽  
Muhammad Hanif ◽  
Archen Krupadev ◽  
Sabah Iqbal ◽  
Navyamani Kagita ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Hospice Care ◽  
Medical Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
Charlson Score ◽  
Primary Malignancy ◽  
Number Of Patients ◽  
Significant Difference

e13516 Background: The cancer patients, while being admitted to the hospital often have an oncologist consult (OC) through the admission. The goal of the study is to assess, whether OC impact the length of stay (LOS) and to define the group of cancer patients in whom omitting the OC can decrease LOS. Methods: We reviewed 415 admissions of cancer patients from 1/1/2018 to 11/30/2020 to the both campuses of Mercy Catholic Medical Center. We included patients who are 18 years or older with confirmed malignancy. We excluded COVID positive, patients who died during admission, were transferred to tertiary care institutions, or were recommended hospice care, but decided to continue treatment despite poor prognosis. Patient with hematologic disorders were excluded as well. The LOS of stay in cancer patients with and without OC will be compared using two tailed unpaired t-test and Mann-Whitney test ( < 20 admissions in each group, or one of the groups had a largely skewed data). Sub-analysis will be done accounting for Charlson score, spread of the disease and reason of admission (cancer vs non-cancer related). Statistical software Prism 9 will be used for analysis. Results: 290 admissions were selected using inclusion and exclusion criteria. Throughout all admission 234 admission had OC and mean LOS was 4.86 day compare to 4.23 in 56 patients, who did not have OC. Patients with non-cancer related (non-CR) admissions who had Charlson score ≤6 and no OC had shorter LOS (13 admission with median LOS 3 days) compared to those who had OC (11 admissions with LOS 7days), p 0.0462. Also, patient with non-CR admission and localized cancer tend have shorter LOS when no OC involved (15 admission with median LOS 6 days) compare to OC (16 admissions with median LOS 2.5 days), p 0.0365. No other significant difference in LOS were observed (Table). Conclusions: The cancer patients admitted for the reasons not related to their primary malignancy and who have either localized disease or Charlson score < 6 have shorter length of stay when OC not done. The limitation of the current study is the small number of patients in analysis subgroups, as well as fact that patients who had OC may have more severe disease during admission, despite the fact that patient had same extend of disease and comorbidities. Study with larger number of admissions may be necessary to confirm findings of this study.[Table: see text]

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care

2021 ◽  
pp. 000348942110457
Author(s):  
Mohamad Issa ◽  
Nadeem El-Kouri ◽  
Sara Mater ◽  
Jonathan Y. Lee ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
High Volume ◽  
Care Team ◽  
Consulting Services ◽  
Tertiary Care Facility

Introduction: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). Methods: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. Results: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. Conclusion: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

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