Improvement in adherence to antibiotic duration of therapy recommendations for uncomplicated cystitis: a quasi-experimental study

2019 ◽  
Author(s):  
Stephanie E Giancola ◽  
John M Higginbotham ◽  
Deena E Sutter ◽  
Steven E Spencer ◽  
James K Aden ◽  
...  

Abstract Background Acute uncomplicated cystitis is one of the most common diagnoses for which antibiotic treatment is prescribed in the outpatient setting. Despite the availability of national guidelines, there remains a wide pattern in prescriber choices for therapy. Recent data portray a picture of consistently longer durations than recommended prescribed in outpatient settings. Objective The objective was to evaluate the effect of a system-based intervention on adherence to guideline-recommended durations of therapy for uncomplicated cystitis in the outpatient setting. Methods This quasi-experimental study included women aged 18–64 years who were seen at five family medicine clinics at an academic medical centre and were prescribed targeted antibiotics for uncomplicated cystitis (nitrofurantoin monohydrate/macrocrystals 100 mg, trimethoprim-sulfamethoxazole 160/800 mg or ciprofloxacin 250 mg). The intervention involved revising or adding pre-filled, but modifiable, default prescribing instructions in the electronic health record (EHR) for the targeted antibiotics. We evaluated adherence to guideline-recommended duration of therapy as well as days of therapy (DOT) before and after the intervention. Results A total of 787 pre-intervention and 862 post-intervention cases were included. Adherence to recommended duration of therapy increased from 29.4% to 76.3% (P < 0.01). The average DOT decreased by 23% from 6.6 to 5.1 (P < 0.01). Conclusion A stewardship intervention consisting of revising/adding default prescribing instructions to targeted antimicrobials in an EHR was associated with increased adherence to recommended durations of therapy for uncomplicated cystitis and reduction of unnecessary antibiotic exposure. More studies are needed to confirm effectiveness across multiple medical record platforms.

2020 ◽  
Author(s):  
Saidath Gato ◽  
Francois Biziyaremye ◽  
Catherine M. Kirk ◽  
Chiquita Palha De Sousa ◽  
Alain Mukuralinda ◽  
...  

Abstract Background: Early initiation of breastfeeding after birth and ongoing exclusive breastfeeding for the first 6 months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding, aligned with the Baby Friendly Hospital Initiative for small and sick newborns.Methods: A pre-post quasi experimental study was conducted at two District hospital NCUs in rural Rwanda from October 2017–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data was extracted from patient charts for clinical and demographic characteristics, feeding throughout admission, and patient outcomes. Bivariate analyses were conducted using Fisher’s exact and Wilcoxon rank sum tests. Logistic regression was used to evaluate factors associated with exclusive breastfeeding at discharge following a backwards stepwise procedure.Results: Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in the post-intervention period. The percentage of infants who were exclusively breastfed on their day of birth, or day-of-life zero (DOL0) increased from 5.4% to 35.9% (p<0.001). For newborns discharged alive, the proportion exclusively breastfeeding increased from 69.6% to 87.0% (p<0.001). The mortality rate for all admitted newborns decreased from 16.1% to 10.5% (p<0.019). Factors associated with greater odds of exclusive breastfeeding at discharge included post-intervention time point (Odds Ratio (OR): 4.91, 95% Confidence Interval (CI) 1.99-12.11, p<0.001), and admission for infection (OR 2.99, 95%CI 1.13-7.93, p=0.027). Home deliveries (OR 0.15, 95%CI 0.05-0.47, p=0.001), preterm delivery (OR 0.36, 95%CI 0.15-0.87, p=0.0260 and delayed first breastmilk feed (OR=0.04 for DOL3 vs. DOL0, 95%CI 0.01, 0.35, p=0.004) reduced odds of exclusive breastfeeding at discharge. Conclusion: Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns should be expanded and adapted in similar settings to improve outcomes for these infants.


2020 ◽  
Vol 9 (4) ◽  
Author(s):  
Wit Wichaidit ◽  
Sommanas Naknual ◽  
Nanta Kleangkert ◽  
Tippawan Liabsuetrakul

We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the post-intervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general.


2020 ◽  
Vol 16 (7) ◽  
pp. e563-e572
Author(s):  
Rachel Bartash ◽  
Kelsie Cowman ◽  
Wendy Szymczak ◽  
Yi Guo ◽  
Belinda Ostrowsky ◽  
...  

PURPOSE: Inappropriate vancomycin for febrile neutropenia (FN) is an ideal antimicrobial stewardship target. To improve vancomycin prescribing, we instituted a multifaceted intervention, including an educational guideline with audit for compliance; an antibiotic use audit; and an assessment of local burden of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. MATERIALS AND METHODS: We conducted a quasi-experimental pre-post intervention review of vancomycin initiation for FN on a 32-bed hematology/oncology unit. A retrospective chart review was conducted from November 2015 to May 2016 (preintervention period). In January 2017, we implemented an institutional FN guideline emphasizing criteria for appropriate use. Vancomycin audit was conducted from February 2017 to October 2017 (postintervention period). The primary outcome was appropriateness of vancomycin initiation. We then compared average antibiotic use (days of therapy per 1,000 patient days) for vancomycin and cefepime before and after intervention. Finally, unit-wide MRSA screening cultures were obtained upon admission and bimonthly for 6 weeks (October 2, 2017, to November 9, 2017). Screened patients were followed for 12 months for clinical MRSA infection. RESULTS: Forty-three (49%) of 88 preintervention patients were started on empiric vancomycin appropriately, compared with 59 (66%) of 90 postintervention patients ( P = .02). There was a significant decrease in vancomycin use after intervention. Six (7.1%) of 85 patients screened positive for MRSA colonization. During the 12-month follow-up, no colonized patients developed clinical MRSA infections (positive predictive value, 0.0%). Of the 79 noncolonized patients, 2 developed a clinically significant infection (negative predictive value, 97.5%). CONCLUSION: Guideline-focused education can improve vancomycin appropriateness in FN and should be bundled with education and feedback about local MRSA epidemiology and antibiotic use rates for maximal stewardship impact.


2021 ◽  
Vol 30 ◽  
Author(s):  
Carlene Souza Silva Manzini ◽  
Vanessa Almeida Maia Damasceno ◽  
Diana Gabriela Mendes dos Santos ◽  
Milton Miranda Neto ◽  
Clemente Neves de Sousa ◽  
...  

ABSTRACT Objectives to assess health-related quality of life and resilience among hemodialyzed patients in the city of Porto, Portugal, before and after the Relaxation, Mental Images and Spirituality psychotherapeutic intervention, and identify factors interfering in these patients’ levels of resilience. Method a quasi-experimental study was conducted from November 2018 to April 2019 among 17 patients attending two dialysis centers located in Porto, Portugal. A questionnaire addressing sociodemographic and clinical information was applied together with the Kidney Disease Quality of Life-Short Form, a resilience scale, and a brief psychotherapeutic intervention. Each patient attended three intervention sessions, and the instruments were applied before and after the intervention. The Shapiro-Wilk test was performed to verify the normality of data, while the Student’s t-test and Wilcoxon test were performed to compare the means, and linear regression was used to identify resilience-associated factors. Results after the intervention, quality of life perception improved in virtually all the scale’s domains, with statistically significant differences in the physical function (p=0.006) and emotional function (p=0.021). The resilience assessment revealed a statistically significant improvement in the post-intervention (p=0.002); linear regression analyses showed that having a religion, other pathologies, or a history of transplant is related to increased resilience levels while taking antidepressants or anti-hypertensive medications negatively affect it. Conclusion the intervention contributed to improving resilience and some domains concerning the patients’ quality of life. Thus, it can be implemented among patients undergoing hemodialysis.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures


Author(s):  
Jennifer L Cole ◽  
Sarah E Smith

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention strategy on inpatient steroid prescribing in patients with acute exacerbations of COPD (AECOPD). Summary Investigators implemented a 3-part stewardship initiative consisting of (1) an anonymous survey for providers on steroid prescribing in a simplified case of AECOPD, (2) face-to-face education and review of survey results, and (3) prospective audit and feedback from a clinical pharmacist. This was a quasi-experimental before-and-after study evaluating hospitalized adults diagnosed with AECOPD in two 12-month study periods before (April 2019-March 2020) and after (May 2020-April 2021) implementation. The primary outcome was mean inpatient steroid dosing. Secondary outcomes were duration of therapy, length of stay (LOS), 30-day readmissions, 30-day mortality, and incidence of hyperglycemia. Per power analysis, there were 27 patients per cohort. The interventions resulted in a significant reduction in prednisone equivalents during hospitalization: 118 mg vs 53 mg (P = 0.0003). This decrease was similar in ICU (160 mg vs 61 mg, P = 0.008) and non-ICU (102 mg vs 49 mg, P = 0.004) locations. There was no significant difference in duration of therapy (8 days vs 7 days, P = 0.44), length of stay (3.3 days vs 3.9 days, P = 0.21), 30-day mortality (4% vs 7%, P = 0.55), 30-day readmissions (15% vs 7%, P = 0.39), or rate of hyperglycemia (48% vs 44%, P = 0.78). Conclusion A multifaceted stewardship intervention significantly reduced steroid dosing in hospitalized AECOPD patients. This reduction was not associated with known deleterious effects.


2016 ◽  
Vol 55 (6) ◽  
pp. 339 ◽  
Author(s):  
Hartono Gunadi ◽  
Rini Sekartini ◽  
Retno Asti Werdhani ◽  
Ardi Findyartini ◽  
Muhammad Arvianda Kevin Kurnia

Background Immunization is recognized as one of the strategiesto reduce vaccine preventable diseases. Competency related toimmunization are consequently important for medical students andthe medical school needs to assure the competence acquisition.Objective To assess competence related to immunization andits retention following lectures with simulations compared tolectures only.Methods A quasi-experimental study was conducted to the 5th yearstudents of University of Indonesia Medical School during the ChildAdolescent Health Module in 2012-2013. The intervention grouphad lectures with simulations and the control group had lecturesonly. Immunization knowledge was assessed with a 30 multiplechoice question (MCA) items performed before and after themodule. Competence retention was assessed by MCQ (knowledge)and OSCE (skills) 2-6 months afterwards.Results Sixty eight subjects for each group with similarcharacteristics were analyzed. There was significant differenceafter module MCQ score between two groups. Competenceretention in 2-6 months after module completion was betterin intervention group, both for the knowledge (median MCQscore of 70.00 (range 37-93) vs. mean score of 58.01 (SD 12.22),respectively; P<0.001) and skill (OSCE mean scores of 75.21 (SD10.74) vs. 62.62 (SD 11.89), respectively; P < 0.001). Proportionof subjects in the intervention group who passed both the MCQand OSCE were also significantly greater.Conclusion Lectures with simulations are proved to bemore effective in improving medical students’ immunizationcompetence as well as its retention compared to lectures onlyapproach.


Author(s):  
Nathália Suellen Valeriano Cardoso ◽  
Jonia Alves Lucena ◽  
Zulina Souza de Lira ◽  
Silvio José de Vasconcelos ◽  
Leonardo Wanderley Lopes ◽  
...  

Purpose: This study aimed to analyze the immediate effect on a singer's voice of a flexible silicone tube immersed in water combined with ascending and descending vocalise scales compared with ascending and descending vocalise scales alone. Method: A pre- and post-intervention quasi-experimental study was conducted. Thirty adult singers between 18 and 45 years old with no laryngeal disorders performed the two techniques for 3 min each on different days. Acoustic measurements of frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, smoothed cepstral peak prominence (CPPS), maximum phonation time (MPT), voice range profile, and self-perceived vocal effort (Borg Category Ratio 10-BR Scale adapted for vocal effort) were assessed before and after performing the techniques. Results: The results indicated an increase in singers' CPPS and MPT values and a decrease in shimmer and noise when performing with a flexible silicone tube immersed in water combined with vocalise. The singers reported a perception of decreased vocal effort after both methods. However, the diminished perceived vocal effort became more pronounced with the tube phonation technique combined with vocalise. Conclusions: Phonation in tubes combined with vocalise improved the vocal acoustic parameters (including cepstral measurements), increased MPT, and diminished perceived vocal effort. Although using vocalise alone diminished perceived vocal effort, this decrease was more pronounced in the tube phonation technique combined with vocalise.


2020 ◽  
Vol 19 (3) ◽  
pp. 1-35
Author(s):  
Ana Paula Amaral ◽  
Josiane Uchoa Sampaio ◽  
Fátima Regina Ney Matos ◽  
Margarida Tenente Santos Pocinho ◽  
Rafael Fernandes de Mesquita ◽  
...  

Objetivo: Desarrollar, implementar y evaluar un programa de prevención del suicidio dirigido a adolescentes.Materiales y Métodos: Estudio cuasi experimental, del tipo antes y después, con adolescentes de una institución educativa en São Luís, Maranhão, Brasil. El estudio siguió las etapas de desarrollo, implementación y evaluación de un programa de intervención para la prevención del suicidio. Se administraron tres instrumentos de evaluación antes y después de la intervención: la escala de ideación suicida de Beck; el Inventario de Depresión de Beck y la Escala de Desesperanza de Beck.Resultados: Antes de la intervención, participaron 102 adolescentes, 30 (29.4%) tenían ideación suicida y síntomas depresivos. Después de la intervención, los instrumentos se aplicaron a los 30 adolescentes seleccionados, 12 (40.0%) continuaron con la ideación. Antes de la intervención, el Inventario de depresión promedio fue de 23.83 y luego de 7.17 (p <0.0001). En cuanto a la desesperanza, el promedio obtenido antes fue 7.23 y luego 2.17 (p <0.0001); Con respecto a la ideación suicida, el promedio obtenido antes fue de 10.50 y luego de 2.57 (p <0.0001).Conclusión: Hubo una disminución en los síntomas depresivos, la desesperanza y la ideación suicida después de la implementación del elaborado programa de intervención. Objective: To develop, implement and evaluate a suicide prevention program aimed at adolescents.Material and Methods: A quasi-experimental study, before and after, with adolescents from an educational institution in São Luís, Maranhão, Brazil. The study followed the stages of development, implementation and evaluation of a suicide prevention intervention program. Three assessment instruments were administered before and after the intervention: Beck's Suicidal Ideation Scale; Beck's Depression Inventory and Beck's Hopelessness Scale. Results: Before the intervention, 102 adolescents participated, 30 (29.4%) had suicidal ideation and depressive symptoms. After the intervention the instruments were applied to the 30 selected adolescents, 12 (40.0%) continued with ideation. Prior to intervention, the average Depression Inventory was 23.83 and then 7.17 (p <0.0001). As for hopelessness, the average obtained before was 7.23 and then 2.17 (p <0.0001); Regarding suicidal ideation, the average obtained before was 10.50 and then 2.57 (p <0.0001). Conclusion: There was a decrease in depressive symptoms, hopelessness and suicidal ideation after the implementation of the elaborated intervention program.


2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Thais Marques Lima ◽  
◽  
Ana Izabel Oliveira Nicolau ◽  
Francisco Herlânio Costa Carvalho ◽  
Camila Teixeira Moreira Vasconcelos ◽  
...  

ABSTRACT Objective: to test the effects of behavioral and educational intervention by telephone on adherence of women with inappropriate periodicity to colpocytological examination. Method: quasi-experimental study with a sample of 524 women, selected with the following inclusion criteria: be aged between 25 and 64 years, have initiated sexual activity, have inappropriate periodicity of examination and have mobile or landline phone. The women were divided into two groups for application of behavioral and educational intervention by telephone. It was used an intervention script according to the principles of Motivational Interviewing. Results: on comparing the results before and after the behavioral and educational interventions, it was found that there was a statistically significant change (p = 0.0283) with increase of knowledge of women who participated in the educational intervention. There was no change in the attitude of women of any of the groups and there was an increase of adherence to colpocytological examination in both groups (p < 0.0001), with greater adherence of women participating in the behavioral group (66.8%). Conclusion: the behavioral and educational interventions by phone were effective in the adherence of women to colpocytological examination, representing important strategies for permanent health education and promotion of care for the prevention of cervical cancer.


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