Correlates of Antibiotic Use in Taiwan Hospitals

2001 ◽  
Vol 22 (9) ◽  
pp. 565-571 ◽  
Author(s):  
L. Clifford McDonald ◽  
Hui Tzu Yu ◽  
Hsiao Chun Yin ◽  
Chao Agnes Hsiung ◽  
Chien-Ching Hung ◽  
...  
Keyword(s):  
Medical Records ◽  
First Generation ◽  
Medical Center ◽  
Pearson Correlation ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Patient Demographics ◽  
Surgical Services ◽  
Medical Centers ◽  
Regional Hospitals

AbstractObjective:To determine factors that correlate with increased antibiotic use among adult inpatients in Taiwan.Design:Retrospective survey of medical records.Setting:14 acute-care hospitals (8 regional hospitals, 6 medical centers) in Taiwan.Participants:A systematic probability sample from each hospital, totaling 663 adult inpatients who were discharged or had died in early 1999.Measurements:Infectious disease physicians at the 14 hospitals collected data from medical records regarding patient demographics, hospitalization, discharge diagnosis, and antibiotics received.Results:A total of 447 (67%) patients received antibiotics for an overall rate of 813 antibiotic-days (number of days patients received each antibiotic)/1,000 patient-days. Both the proportion of beds in intensive care units ([ICUs] Pearson correlation coefficient [r], 0.67; 95% confidence interval [CI95], 0.36-0.89;P<.01) and the proportion of patients admitted to surgical services (r,0.66; CI95, 0.20-0.88;P=.01) correlated with the mean patient rate of antibiotic-days/hospital-day (MPAUD). In contrast, we found no correlation between the proportion of patients who received antibiotics and the MPAUD. Using multiple linear regression, medical center status was the only independent predictor for increased MPAUD (regression coefficient [b], 0.15; CI95, 0.05-0.24;P<.01). There was no correlation between pooled rates of antibiotic-days/hospital-day and any hospital demographic factors. First-generation cephalosporin (39%) and aminoglycoside (24%) use accounted for the majority of antibiotic-days.Conclusions:Antibiotic use is greater in medical centers than in regional hospitals and appears to be independent of surgical case mix or the proportion of ICU beds. Determination of multiple, independent measures of antibiotic use may be necessary to understand the relation between antibiotic use and resistance in hospitals.

scholarly journals Bed-to-Bed Transfer Program Among Patients Who Need Hospitalization in a Crowded Emergency Department in Taiwan

2021 ◽  
Author(s):  
Nai-Wen Ku ◽  
Chu-Lin Tsai ◽  
Shyr-Chyr Chen ◽  
Chien-Hua Huang ◽  
Cheng-Chung Fang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Medical Records ◽  
Medical Center ◽  
Transfer Program ◽  
Medical Centers ◽  
Regional Hospitals

Background: Emergency department (ED) crowding is a universal issue. In Taiwan, patients with common medical problems prefer to visit ED of medical centers, resulting in overcrowding. Thus, a bed-to-bed transfer program has been implemented since 2014. However, there was few studies that compared clinical outcomes among patients who choose to stay in medical centers to those being transferred to regional hospitals. The aim of this study was to explore the transfer rate, delineate the factors related to patient transfer, and clarify the influence upon the program outcomes. Methods: A retrospective cohort study was conducted using demographic and clinical disease factors from the patient electronic referral system, electronic medical records (EMRs) of a medical center in Taipei, and response to referrals from regional hospitals. The study included adult patients who were assessed as appropriate for transfer in 2016. We analyzed the outcomes (length of stay and mortality rate) between the referrals were accepted and refused using propensity score matching. Results: Of the 1759 patients eligible for transfer to regional hospitals, 420 patients (24%) accepted the referral. Medical records were obtained from the regional hospitals for 283 patients (67%). After propensity score matching, the results showed that interhospital transfer resulted in similar median total length of stay (8.7 days in the medical center vs 7.9 days in regional hospitals; P=.245). In-hospital mortality was low for both groups (3.1% in the medical center vs 1.3% in regional hospitals; P=.344). Conclusion: Transfer from an overcrowded ED in a medical center to regional hospitals in eligible patients results in non-significant outcome of total length of stay. With the caveat of an underpowered sample, we did not find statistically significant differences in in-hospital mortality. This healthcare delivery model may be used in other cities facing similar problems of ED overcrowding.

scholarly journals Evolution of a Glaucoma Fellow's Surgical Training: Improvements in Tube Shunt Case Times during the Academic Year

2021 ◽  
Vol 13 (02) ◽  
pp. e119-e123
Author(s):  
Cason B. Robbins ◽  
Khalid Aldaas ◽  
Sanjay Asrani ◽  
Stuart McKinnon ◽  
David Fleischman ◽  
...  
Keyword(s):  
Medical Center ◽  
Start Time ◽  
Patient Demographics ◽  
Surgical Case ◽  
Medical Centers ◽  
Operative Case ◽  
Academic Medical ◽  
Duke University ◽  
Academic Year ◽  
Tube Shunt

Abstract Purpose The aim of the study is to report changes in tube shunt placement surgical case times for glaucoma fellows during the course of the academic year. Patients and Methods Electronic health records were retrospectively reviewed to determine patient demographics, surgical case times (defined as procedure start time to procedure end time), and glaucoma fellow involvement. Only cases with a glaucoma fellow as the primary surgeon were included. Operative case times were compared by first and second halves of the academic year (beginning in July and ending in June) using a two-tailed t-test. Results Five hundred and seventy-three individual tube shunt surgeries (385 Ahmed, 188 Baerveldt) performed by 28 glaucoma fellows (17 females, 11 males) at Duke University Eye Center and University of North Carolina Medical Center were included. Overall, case times were significantly shorter in the second half of the academic year as compared with the first (55.3 ± 17.1 minutes vs. 61.0 ± 17.4 minutes, p <0.001). Both male (57.3 ± 16.8 minutes vs. 63.2 ± 18.6 minutes, p = 0.008) and female (53.5 ± 17.3 minutes vs. 59.3 ± 16.4 minutes, p = 0.003) fellows demonstrated shorter case times over the academic year; additionally, female fellows trended toward shorter case times than male fellows in both the first half (p = 0.072) and second half (p = 0.053) of the academic year. Fellows also exhibited shorter case times with both Ahmed implants (54.1 ± 16.2 minutes vs. 59.3 ± 15.8 minutes, p = 0.002) and Baerveldt implants (57.8 ± 18.9 minutes vs. 64.2 ± 20.0 minutes, p = 0.025) cases over the academic year. Baerveldt case times were significantly longer than Ahmed cases in the first half (p = 0.028) and trended toward being longer than Ahmed cases in the second half (p = 0.070). Conclusion Across 5 years at two academic institutions, glaucoma fellows had shorter primary tube shunt surgical case times in the second half of the academic year. These findings reflect improvement in surgical efficiency throughout glaucoma fellowship. These findings should be taken into consideration when scheduling trainee surgeries at academic medical centers at different points in the academic year.

scholarly journals Topical Rifamycin Prophylaxis in Gynecological and Obstetric Surgery

2021 ◽  
pp. 1-6
Author(s):  
Nahit Ata ◽  
Mehmet Kulhan ◽  
Nur Gozde Kulhan ◽  
Can Turkler ◽  
Ahmet Bilgi ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
First Generation ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Site Infection ◽  
Group 2 ◽  
Obstetric Surgery ◽  
Systemic Antibiotics

OBJECTIVE: Antibiotic prophylaxis is one of the most important steps to reduce surgical site infections. First-generation cephalosporin (cefazolin) is used prophylactically in the majority of operations. Rifamycin is a broad-spectrum semisynthetic antibiotic that is bactericidal against gram (+) and gram (˗) microorganisms. To the best of our knowledge, there are no studies on the use of rifamycin in antibiotic prophylaxis. In this study, we aimed to analyze whether there is a difference between the use of only cefazolin and only rifamycin in terms of surgical site infections. STUDY DESIGN: One hundred patients were included in this case-control study during the last quarter period of 2017. These patients (n=100) were divided into two groups according to their antibiotic use; 50 patients who received only 1 g cefazolin constituted Group 1, 50 patients who received only 250 mg topical rifamycin over the incision line based on surgeon’s preference constituted Group 2. RESULTS: The use of prophylactic topical rifamycin reduced the incidence of wound infection. compared with cefazolin. Surgical site infection was detected in 5 (10%) of the patients who received cefazolin, whereas surgical site infection was not observed in patients who received rifamycin (p=0.022). CONCLUSIONS: The use of topical rifamycin is effective but does not imply that systemic antibiotics should replace prophylaxis. The use of rifamycin would aid in systemic antibiotic prophylaxis.

scholarly journals Facilitators and Barriers to Antibiotic Stewardship: A Qualitative Study of Pharmacists’ Perspectives

2018 ◽  
Vol 54 (4) ◽  
pp. 250-258 ◽  
Author(s):  
Haley J. Appaneal ◽  
Megan K. Luther ◽  
Tristan T. Timbrook ◽  
Kerry L. LaPlante ◽  
David M. Dosa
Keyword(s):  
New England ◽  
Organizational Structure ◽  
Antibiotic Stewardship ◽  
Medical Center ◽  
Qualitative Interviews ◽  
Antibiotic Use ◽  
Term Care ◽  
Protected Time ◽  
Medical Centers ◽  
Core Elements

Background: The Veterans Affairs (VA) is a leader in the implementation and advancement of antibiotic stewardship programs throughout the nation. The Centers for Disease Control and Prevention (CDC) has also led national antibiotic stewardship efforts and has outlined core elements to improve antibiotic use in hospitals, long-term care, and outpatient settings. Many facilities still face challenges to the implementation and maintenance of successful programs, particularly in nonacute care settings. The objective of this study was to identify barriers and facilitators to antibiotic stewardship within the VA medical centers through qualitative interviews with pharmacists. Methods: Eight semi-structured telephone interviews were conducted with pharmacists from 6 VA medical centers within VA New England Healthcare System. Pharmacist respondents were either pharmacy champions (for medical centers with established programs) or pharmacists with responsibilities in making antibiotic recommendations (locations without established programs). All interviews were audio recorded and transcribed verbatim. NVivo 8 was used for data coding and analysis. Results: Pharmacists from all 8 medical centers were contacted for interviews and pharmacists from 6 medical centers agreed to interviews (75% VA New England medical center participation). Three main themes regarding antibiotic stewardship were identified from the interviews with pharmacists. Respondents described the importance of (1) a supportive organizational culture, (2) protected time for antibiotic stewardship, and (3) a cohesive organizational structure in the success of antibiotic stewardship programs. Conclusions: Our findings support the CDC core elements for antibiotic stewardship, in particular the importance of leadership commitment in the creation of a culture that supports antibiotic stewardship and in ensuring staff are given sufficient time for antibiotic stewardship efforts. Although a strong supportive culture has been built, strategies focused on fostering increased protected time for antibiotic stewardship and a cohesive organizational structure may be helpful in advancing and sustaining successful antibiotic stewardship programs that improve patient outcomes.

A Canadian Survey of Prophylactic Antibiotic Use Among Hip-Fracture Patients

1999 ◽  
Vol 20 (11) ◽  
pp. 752-755 ◽  
Author(s):  
Dick Zoutman ◽  
Laurence Chau ◽  
James Watterson ◽  
Thomas Mackenzie ◽  
Marina Djurfeldt
Keyword(s):  
Hip Fracture ◽  
Medical Records ◽  
Prophylactic Antibiotic ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Prosthetic Material ◽  
Antibiotic Administration ◽  
Process Of Care ◽  
Effective Manner

AbstractObjective:To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.Design:Retrospective chart review of randomly selected medical records.Setting:Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.Patients:Patients admitted in 1990 with a diagnosis of hip fracture.Methods:Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.Results:247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases.Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.Conclusions:Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.

Clinical and Molecular Epidemiology of Methicillin-ResistantStaphylococcus aureusamong Patients in an Ambulatory Hemodialysis Center

2011 ◽  
Vol 32 (9) ◽  
pp. 881-888 ◽  
Author(s):  
Gopi Patel ◽  
Stephen G. Jenkins ◽  
José R. Mediavilla ◽  
Barry N. Kreiswirth ◽  
Brian Radbill ◽  
...  
Keyword(s):  
Molecular Analysis ◽  
First Generation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Indirect Evidence ◽  
Generation Cephalosporin ◽  
Hemodialysis Patients ◽  
High Rate ◽  
Academic Medical ◽  
History Of

Objective.To describe the epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) carriage and transmission in an ambulatory hemodialysis population.Design.Prospective cohort study.Setting.Outpatient hemodialysis facility affiliated with a large academic medical center.Participants.Of the 170 facility patients, 103 (61%) participated in the study.Methods.Swab specimens of the nares, axillae, and vascular access site were collected from participants weekly for 3 weeks and then monthly for 5 months. Demographic and clinical data were collected monthly for 12 months. Molecular analysis of MRSA isolates was performed.Results.The baseline MRSA carriage prevalence was 12%. Factors associated with MRSA carriage included a history of MRSA; failed renal transplantation; hospital admission within 6 months; and receipt of a first-generation cephalosporin, cefepime, or vancomycin. Six subjects acquired MRSA after enrollment (incidence, 1.2 per 100 patient-months at-risk; overall prevalence, 18%). Molecular analysis suggested that transmission occurred within the facility. The incidence of MRSA infection among carriers was 1.76 per 100 patient-months. Community-associated strains (ie, USA300) were isolated from 28% of carriers and at least 25% of infections.Conclusions.The prevalence of MRSA carriage and the incidence of infection among carriers were high among ambulatory hemodialysis patients, and community-associated MRSA was responsible for a large portion of the MRSA burden. A relatively high rate of MRSA acquisition was observed, with indirect evidence of intrafacility transmission. Additional studies are needed to confirm these findings and to identify effective and feasible methods to prevent MRSA transmission and infection among hemodialysis patients.

JOINT COMMISSION INTERNATIONAL (JCI) IN THE PEDIATRIC INTENSIVE CARE UNIT (PICU): PREVENTING MEDICATION INCIDENTS THROUGH REMOTE CONTROL

2015 ◽  
Vol 101 (1) ◽  
pp. e1.25-e1
Author(s):  
Moran Lazaryan ◽  
Sofia Berkovitch ◽  
Michal Toledano ◽  
Noa Rosenfeld- Yehoshua ◽  
Ibraim Abu-Kishk ◽  
...  
Keyword(s):  
Medical Records ◽  
Pediatric Intensive Care ◽  
Considerable Effect ◽  
Review Time ◽  
Patient Demographics ◽  
Medical Centers ◽  
Quality Of Patient Care ◽  
Joint Commission International ◽  
Medication Incidents

IntroductionMany medical centers worldwide try to get JCI accreditation in order to improve safety and quality of patient care. Review of medication orders for appropriateness is one of the JCI standards. This process is usually performed by clinical pharmacists joining physician rounds. However, in many medical centers there is a shortage of pharmacists.ObjectivesTo prospectively investigate the process of remote reviewing of medication orders in the PICU, with a pharmacist located at the pharmacy, without joining physician rounds. To characterize pharmacist recommendations (PR) and decisions taken by the physician.MethodsThe study was carried out from 6.3.14–6.10.14 in the PICU (7 beds). Patient demographics, diagnosis and medications prescribed were recorded.Results186 review forms were filled in by the pharmacist, regarding 117 admissions(109 children). In 57 (30.6%) forms there was at least one PR. Most common PRs concerned significant interactions (34.5%), dose (26.2%), technical inappropriateness (22.6%) and contraindications (8.3%). Out of all PRs, 51.2% were accepted by the physician, 11.9% rejected and in 36.9% there was no comment. The estimated review time for one medical record was 8.9 min (95% CI, 6.9–10.9), as every additional medication prescribed increased the total review time by 0.8 min (95% CI, 0.49–1.11). Using Monte-Carlo simulation, 108.42 min per day were needed to review all medical records in 95% of the cases.ConclusionsHospitals facing budget shortages can perform a daily remote review of several departments by an experienced pharmacist instead of participation in physician rounds, and still have a considerable effect on patient safety.

“Your Child Has Cerebral Palsy”: Parental Understanding and Misconceptions

2021 ◽  
pp. 088307382199130
Author(s):  
Mugdha Mohanty ◽  
Forrest Beaulieu ◽  
Spoorthi Sampath ◽  
Dimira Tambunan ◽  
Shivangi Kataria ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Medical Center ◽  
Pearson Correlation ◽  
Primary Caregivers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Telephone Surveys ◽  
Children With Cerebral Palsy

Importance: Caregivers of children with cerebral palsy can best help their child if they understand the disorder and the correct terminology. Objective: To assess caregiver understanding of cerebral palsy. Design: This was a cross-sectional study from a large tertiary medical center in Boston, to assess understanding of the term cerebral palsy by primary caregivers of children and adolescents with cerebral palsy. All cases were obtained from hospital electronic medical records. Telephone surveys were conducted. Caregiver understanding of cerebral palsy was assessed by open-ended responses (50%) and success in answering true/false questions about cerebral palsy (50%). Participants: Primary caregivers of children 18 years and younger with cerebral palsy. Results: Thirty-three percent of caregivers denied ever being told that their child had cerebral palsy. Most caregivers identified cerebral palsy as a brain problem (79%), lifelong condition (73%), often caused by a perinatal (60%) or gestational (40%) insult. Fifty-two percent knew that cerebral palsy was nonprogressive. Sixty-two percent of caregivers believed they had a good, very good, or excellent understanding of cerebral palsy, whereas the investigators found 69% of caregivers had a good, very good, or excellent understanding of cerebral palsy (P = .006). Most caregivers rated very good or excellent the setting where cerebral palsy was discussed (58%), the explanations provided (55%), and the amount of time spent (45%), yet using a Pearson correlation coefficient, most important was the time spent ( r = 0.53). Conclusions: Following discussion with their child’s physician, most primary caregivers of children with cerebral palsy have a good, very good, or excellent understanding of cerebral palsy. Most critical to a good understanding of cerebral palsy was the time spent in explaining the diagnosis.

Assessment of indicators of nervous and emotional stress in medical center personnel depending on the characteristics of their professional activity

2020 ◽  
Vol 60 (10) ◽  
pp. 650-657
Author(s):  
Irina V. Fedotova ◽  
Tatyana N. Vasilyeva ◽  
Tatyana V. Blinova ◽  
Irina A. Umnyagina ◽  
Yuliya V. Lyapina ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Emotional Stress ◽  
Functional State ◽  
Working Conditions ◽  
Medical Staff ◽  
Medical Center ◽  
The Body ◽  
Office Workers ◽  
Glutathione System ◽  
Medical Centers

Introduction. Digital technologies are actively used in the work of specialists of medical centers of various profiles, which causes the impact on employees of a number of professional factors that determine the characteristics of their work. The aim of the study is to evaluate the influence of professional factors on the functional state of the employees' body and the glutathione system as an objective indicator of stress based on the analysis of the subjective perception of the medical center employees of the specifics of working with personal computers and psychophysiological testing. Materials and methods. The study involved 109 specialists of medical centers (25 ophthalmologists, 31 representatives of the secondary medical staff - nurses and paramedics, 53 office employees). The anonymous survey concerned the assessment of working conditions and their impact on the functional state of the body of the respondents. Performance and stress tolerance indicators were evaluated using three standard questionnaires. The study of 66 subjects' levels of glutathione in the blood: total, reduced, oxidized and the ratio of reduced and oxidized - was used to analyze the relationship of the neuro-emotional nature of labor with the reaction of oxidative stress. Statistical processing of the obtained data was carried out using traditional methods of variation statistics and calculating the value of the odds ratio (OR) with a 95% confidence interval (CI). Results. The survey revealed a significant proportion of people in all groups of respondents who constantly use computer technology in their work. Describing the quality of the processed information, doctors more than representatives of other groups note its complexity, importance, negative emotional color, a high degree of responsibility and tension. Doctors more often than average medical staff and office workers associate the manifestation of fatigue with an uncomfortable state of the visual organ, nervous system, and musculoskeletal system. The subjects showed reduced performance and stress tolerance with the most pronounced negative trends in the group of doctors. Changes in the glutathione system were detected, indicating the presence of oxidative stress in 40% of ophthalmologists and office workers, and in half of nurses. Conclusions. The work of specialists of medical centers of various profiles in accordance with their assessment is characterized by high nervous and emotional stress, due to the need to process a significant amount of complex and important professionally significant information. Subjectively noted by respondents the influence of working conditions on the functional state of the body is confirmed by indicators of the glutathione system, which can be used as indicators of nervous and emotional stress.

scholarly journals Liquid materials for biomedical research: a highly IT-integrated and automated biobanking solution

2019 ◽  
Vol 43 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Daniela Popp ◽  
Romanus Diekmann ◽  
Lutz Binder ◽  
Abdul R. Asif ◽  
Sara Y. Nussbeck
Keyword(s):  
Life Cycle ◽  
Medical Center ◽  
Research Results ◽  
Long Term Storage ◽  
Medical Centers ◽  
It Systems ◽  
Complete Life Cycle ◽  
The University ◽  
Term Storage

Abstract Various information technology (IT) infrastructures for biobanking, networks of biobanks and biomaterial management are described in the literature. As pre-analytical variables play a major role in the downstream interpretation of clinical as well as research results, their documentation is essential. A description for mainly automated documentation of the complete life-cycle of each biospecimen is lacking so far. Here, the example taken is from the University Medical Center Göttingen (UMG), where the workflow of liquid biomaterials is standardized between the central laboratory and the central biobank. The workflow of liquid biomaterials from sample withdrawal to long-term storage in a biobank was analyzed. Essential data such as time and temperature for processing and freezing can be automatically collected. The proposed solution involves only one major interface between the main IT systems of the laboratory and the biobank. It is key to talk to all the involved stakeholders to ensure a functional and accepted solution. Although IT components differ widely between clinics, the proposed way of documenting the complete life-cycle of each biospecimen can be transferred to other university medical centers. The complete documentation of the life-cycle of each biospecimen ensures a good interpretability of downstream routine as well as research results.

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