scholarly journals Transplant Centers That Measure Frailty as Part of Clinical Practice Have Better Outcomes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 534-535
Author(s):  
Xiaomeng Chen ◽  
Yi Liu ◽  
Nadia Chu ◽  
Jeremy D Walston ◽  
Dorry Segev ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mortality Rate ◽  
Graft Loss ◽  
National Registry ◽  
Adverse Outcomes ◽  
Clinical Practices ◽  
Frailty Assessment ◽  
Rate Ratios ◽  
The Impact ◽  
Waitlist Mortality

Abstract Frailty predicts adverse outcomes for kidney transplant (KT) patients; yet the impact of clinical assessments of frailty on center-level outcomes remains unclear. We sought to test whether KT centers that measure frailty as part of clinical practice have better pre- and post-KT outcomes. We conducted a survey of US transplant centers (11/2017-4/2018), 132 KT centers (response rate=65.3%) reported frequencies of frailty assessment at candidacy evaluation and KT admission. Center characteristics and clinical outcomes were gleaned from the national registry (2017-2019). Poisson regression was used to estimate incidence rate ratios (IRRs) of waitlist mortality rate and transplantation rate in candidates and graft loss rates in recipients by frequency of frailty assessment. All models were adjusted for case mix and center characteristics. Given similar center characteristics, centers assessing frailty at evaluation had a lower waitlist mortality rate (always=3.5, sometimes=3.2, never=4.1 deaths per 100 person-years). After adjustment, centers assessing frailty at evaluation had a lower rates of waitlist mortality (always IRR=0.91, 95% CI:0.84-0.99; sometimes=0.89, 95% CI:0.83-0.96) and transplantation (always IRR=0.94, 95% CI:0.91-0.97; sometimes=0.88, 95% CI:0.85-0.90) than those never assessing frailty. Centers that always assessed frailty at KT admission had 0.71 (95% CI:0.54-0.92) times the rate of death-censored graft loss than their counterparts never assessing frailty. Assessing frailty at evaluation is associated with lower transplantation rate but better waitlist survival; centers always assessing frailty at admission are likely to have better graft survival. Research is needed to explore how routine assessment of frailty in other clinical practices benefits broader patient populations.

Master Counselors as Teachers: Clinical Practices of Counselor Educators

2014 ◽  
Vol 36 (1) ◽  
pp. 78-94 ◽  
Author(s):  
Dee Ray ◽  
Kimberly Jayne ◽  
Raissa Miller
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Qualitative Analysis ◽  
Negative Relationship ◽  
Counselor Educators ◽  
Clinical Practices ◽  
Mixed Methods Design ◽  
Counselor Educator ◽  
The Impact

Using a mixed methods design, we surveyed 117 counselor educators to explore their clinical practices and their perceptions of the impact of clinical practice on teaching, supervision, research, and service. The results indicate that clinical practice had the greatest influence on their supervision and teaching. A negative relationship between years served as a counselor educator and hours engaged in counseling was found. Through qualitative analysis, we identified several themes related to counselor educators' decisions to engage in clinical practice, among them staying relevant, enhancing teaching and supervision, and staying current in the field. Implications for counselors and counselor educators are discussed.

Drug interactions with aprepitant or fosaprepitant: Review of literature and implications for clinical practice

2016 ◽  
Vol 23 (4) ◽  
pp. 296-308 ◽  
Author(s):  
Anna Dushenkov ◽  
Julie Kalabalik ◽  
Antonia Carbone ◽  
Paiboon Jungsuwadee
Keyword(s):  
Clinical Practice ◽  
Drug Interactions ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Serum Levels ◽  
Inhibitory Effect ◽  
Adverse Outcomes ◽  
Therapeutic Window ◽  
Intravenous Route ◽  
The Impact

Purpose Aprepitant and its parenteral formulation fosaprepitant are widely used for the prevention of chemotherapy-induced nausea and vomiting. Aprepitant exerts modest inhibitory effect on CYP3A4 and modest inductive effect on CYP2C9 substrates such as some antineoplastics and multiple other medications. This article is aimed to provide pharmacists and other healthcare professionals with an updated summary of drug–drug interactions of aprepitant/fosaprepitant and implications for clinical practice. Method We reviewed publications reporting drug–drug interactions between aprepitant/fosaprepitant and other medications. Results Coadministration of aprepitant with antineoplastics or opiods may result in significant elevations in the serum levels of the agents metabolized via CYP3A4, with the best documentation for cyclophosphamide, ifosfamide, erlotinib and oxycodone. These alterations did not translate into adverse outcomes and/or necessitate dosing adjustments. The levels of warfarin were significantly decreased by aprepitant requiring prolonged monitoring after discontinuation of aprepitant. Among direct oral anticoagulants, a theoretical interaction between aprepitant and rivaroxaban or apixaban exists. Interactions between aprepitant and quetiapine or diltiazem or sirolimus required dose reductions to avoid adverse outcomes. The intravenous route had a weaker inhibitory effect on CYP3A4 than the oral pathway. Conclusion The evidence on drug interactions of aprepitant with other medications is limited, and the impact on therapeutic outcomes remains to be determined. The intravenous regimen may be a preferred option. As utilization of aprepitant is expanding, practitioners and patients need to be educated about the potential for drug interactions and a need for careful monitoring of patients concurrently receiving aprepitant and CYP2C9 or CYP3A4 substrates, especially those with a narrow therapeutic window.

scholarly journals EUROPEAN OLDER ADULTS FRAIL: FINDINGS FROM THE SURVEY OF HEALTH, AGEING AND RETIREMENT IN EUROPE (SHARE)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S681-S681
Author(s):  
Giulia Manfredi ◽  
Luís Midão ◽  
Constança Paúl ◽  
Clara Cena ◽  
Mafalda Duarte ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Population Based ◽  
European Population ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Frailty Status ◽  
Frailty Assessment ◽  
Final Sample ◽  
Loss Of Appetite ◽  
The Impact

Abstract Frailty is a geriatric multidimensional syndrome whose signs and symptoms are predictors of increased vulnerability to minor stress events and risk of adverse outcomes such as falls, fractures, hospitalisation, disability and death. In this work, we aimed to update the data of frailty status in European community dwelling population, based on the latest data released (wave 6) of SHARE database, and to study the impact of each criterion on frailty assessment. Frailty status was assessed applying a version of the Fried Phenotype operationalised for SHARE. We included all participants who answered all the questions used in a frailty assessment and who disclosed their gender and, further, whose age was 50 or more. Our final sample was 60816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38497 (56.4%) were female. The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia) and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along age and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. With this work, we demonstrated that more than 50% of the 50+ European population are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, reducing the burden associated with it.

scholarly journals Tethered cord syndrome: nationwide inpatient complications and outcomes

2007 ◽  
Vol 23 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Shivanand P. Lad ◽  
Chirag G. Patil ◽  
Christopher Ho ◽  
Michael S. B. Edwards ◽  
Maxwell Boakye
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Spinal Surgery ◽  
Adverse Outcome ◽  
Tethered Cord ◽  
The United States ◽  
Adverse Outcomes ◽  
Tethered Cord Syndrome ◽  
Hospital Charges ◽  
The Impact

Object Previous investigations of health outcome after spinal surgery for tethered cord syndrome (TCS) have been single-institution studies. The aim of this study was to report inpatient complications and outcomes on a nationwide level. Methods The Nationwide Inpatient Sample (NIS) was used to identify patients who underwent spinal surgery for TCS in the US between 1993 and 2002. Patients who had a primary diagnosis of TCS (ICD-9 742.59) and also underwent spinal laminectomies were included in this study. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on variables such as mortality rate, nonfatal complications, LOS, and adverse outcomes in general (defined as death or discharge to an institution rather than home). Results The NIS sample included data on 9733 patients with TCS who underwent surgery. The means for mortality rate, complication rate, and LOS, respectively, were 0.0005%, 9.48%, and 5.6 days. Postoperative hemorrhages or hematomas (mean rate 2.3%) were the most common complications reported. Age and complications were the only significant predictors of adverse outcome on multivariate analysis. Patients older than 65 years had a threefold increase in risk of adverse outcome compared with patients 18 to 44 years of age. On average, one postoperative complication led to a 3-day increase in mean LOS and added more than $9000 to hospital charges. Conclusions This study provides a national perspective on inpatient complications and outcomes after spinal surgery for TCS in the United States. The authors have demonstrated the impact of age, complications, and medical comorbidities on the outcome of surgery for patients with this common disorder.

scholarly journals COVID-19 in pregnancy: What do we really know?

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 362
Author(s):  
Jerome Bouaziz ◽  
Marc Even ◽  
Frederique Isnard-Bogillot ◽  
Eli Vesale ◽  
Mariam Nikpayam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pregnant Women ◽  
Current Knowledge ◽  
Case Reports ◽  
Case Series ◽  
Adverse Outcomes ◽  
Health Concern ◽  
Case Control Studies ◽  
Increased Risk ◽  
The Impact

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

scholarly journals SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sara Mahdibeiraghdar ◽  
Abbas Ghazanfar ◽  
Sarah Heap ◽  
Abul Siddiky ◽  
Claire Fraser Taylor ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Jugular Vein Thrombosis ◽  
Post Transplant ◽  
Significant Difference ◽  
The Impact

Abstract Aims The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year. Methods Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year. Results A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection. A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic. Conclusions It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.

scholarly journals Incidence, Risk Factors, and Sequelae of Post-kidney Transplant Delirium

2018 ◽  
Vol 29 (6) ◽  
pp. 1752-1759 ◽  
Author(s):  
Christine E. Haugen ◽  
Alexandra Mountford ◽  
Fatima Warsame ◽  
Rachel Berkowitz ◽  
Sunjae Bae ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Length Of Stay ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Graft Loss ◽  
National Registry ◽  
Adverse Outcomes ◽  
Skilled Nursing ◽  
Incidence Risk

Background Frail kidney transplant (KT) recipients may be particularly vulnerable to surgical stressors, resulting in delirium and subsequent adverse outcomes. We sought to identify the incidence, risk factors, and sequelae of post-KT delirium.Methods We studied 125,304 adult KT recipients (1999–2014) to estimate delirium incidence in national registry claims. Additionally, we used a validated chart abstraction algorithm to identify post-KT delirium in 893 adult recipients (2009–2017) from a cohort study of frailty. Delirium sequelae were identified using adjusted logistic regression (length of stay ≥2 weeks and institutional discharge [skilled nursing or rehabilitation facility]) and adjusted Cox regression (death-censored graft loss and mortality).Results Only 0.8% of KT recipients had a delirium claim. In the cohort study, delirium incidence increased with age (18–49 years old: 2.0%; 50–64 years old: 4.6%; 65–75 years old: 9.2%; and ≥75 years old: 13.8%) and frailty (9.0% versus 3.9%); 20.0% of frail recipients aged ≥75 years old experienced delirium. Frailty was independently associated with delirium (odds ratio [OR], 2.05; 95% confidence interval [95% CI], 1.02 to 4.13; P=0.04), but premorbid global cognitive function was not. Recipients with delirium had increased risks of ≥2-week length of stay (OR, 5.42; 95% CI, 2.76 to 10.66; P<0.001), institutional discharge (OR, 22.41; 95% CI, 7.85 to 63.98; P<0.001), graft loss (hazard ratio [HR], 2.73; 95% CI, 1.14 to 6.53; P=0.03), and mortality (HR, 3.12; 95% CI, 1.76 to 5.54; P<0.001).Conclusions Post-KT delirium is a strong risk factor for subsequent adverse outcomes, yet it is a clinical entity that is often missed.

scholarly journals The Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk

2021 ◽  
pp. 1-13
Author(s):  
Ann Kearney ◽  
Jeff Searl ◽  
Elizabeth Erickson-DiRenzo ◽  
Philip C. Doyle
Keyword(s):  
Clinical Practice ◽  
Online Survey ◽  
Virus Transmission ◽  
Early Time ◽  
Early Response ◽  
The United States ◽  
Transmission Risk ◽  
Clinical Practices ◽  
Speech Language Pathologists ◽  
The Impact

Purpose This study assessed and described potential clinical practice changes secondary to COVID-19 that emerged as an early response to the pandemic for speech-language pathologists (SLPs) engaged in voice, alaryngeal, and swallowing activities that may increase the risk of virus transmission. Method SLPs from the United States and Canada ( n = 665) who were engaged in clinical activities that might elevate the risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included potential clinical service modifications, COVID-19 testing and health, and potential financial impacts in the early time period of the pandemic. Results The percentage of SLPs completing the most endoscopic procedures prepandemic (≥ 10/week) was reduced from 39% of respondents to 3% due to the pandemic. Those who completed the most tracheoesophageal puncture voice prosthesis changes (≥ 5/week) reported a reduction in frequency from 24% to 6%. Twenty-five percent of SLPs reported that they were tested for COVID-19, and 6% reported a positive result. Descriptive statistics suggest that COVID-19 testing rates of SLPs, the percentage of SLPs experiencing a financial impact, and the percentage who were furloughed varied across SLP work setting. Conclusions These findings provide the first data characterizing the impact on COVID-19 on clinical practice for SLPs engaged in procedures such as endoscopy and laryngectomy care. The results indicate that, as frontline workers, SLPs were directly impacted in their practice patterns, personal health, safety, and financial security, and that these reported impacts occurred differently across SLP work settings.

scholarly journals Nursing students’ experiences of bullying in clinical practice

2019 ◽  
Vol 10 (3) ◽  
pp. 89
Author(s):  
Florence L. Luhanga ◽  
Vivian A. Puplampu ◽  
Sherry Arvidson ◽  
Adeyemi Ogunade
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Mixed Methods Research ◽  
Online Survey ◽  
Nursing Program ◽  
Clinical Practices ◽  
Tertiary Institution ◽  
Individual Interviews ◽  
Undergraduate Nursing ◽  
The Impact

Bullying is a major concern in the nursing profession because of its implications for patients’ safety, the health of nurses and nursing students, as well as on the workforce in the healthcare system. The purpose of the study was to explain the incidence and state of bullying experienced by nursing students in the undergraduate nursing program during clinical practice. Fifty-five undergraduate nursing students participated in the mixed methods research conducted in a tertiary institution in Western Canada. Participants completed an online survey and an individual interview. Survey data were analyzed using descriptive statistics while thematic analysis was employed for the open-ended questions on the survey and individual interviews. The findings from the study showed that a small number of students four (7.7%) frequently experienced bullying in the clinical setting with clinical instructors and practicing nurses being the main perpetrators. Students reported anxiety connected with going for clinical practice however a unique finding from this study was that the affected students continued to go for clinical practice and decided to remain in the program because of their goal to become registered nurses. Peers from the program were one of the key support systems for the students when they experienced the negative behavior. Irrespective of the low incidence of bullying at the research site, the impact of the behavior aligns with the literature. The findings from this study has the potential to inform clinical practices and policies in undergraduate nursing programs.

Impact of the Economic Crisis on Endocarditis Mortality in Spain: A Nationwide Study

2021 ◽  
pp. 002073142110123
Author(s):  
Christian Ortega-Loubon ◽  
Gema Ruiz López del Prado ◽  
María F. Muñoz-Moreno ◽  
Esther Gómez-Sánchez ◽  
Rocío López-Herrero ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Economic Crisis ◽  
Kidney Injury ◽  
Economic Recession ◽  
Adverse Outcomes ◽  
Mortality Trends ◽  
Mortality Hazard ◽  
Incidence And Mortality ◽  
The Impact ◽  
Mortality Hazard Ratio

Economic recession has dire consequences on overall health. None have explored the impact of economic crisis (EC) on infective endocarditis (IE) mortality. We conducted a retrospective, nationwide, temporal trend study analyzing mortality trends by age, sex, and adverse outcomes in patients diagnosed with IE in Spain from 1997 to 2014. Data were divided into two subperiods: pre-EC (January 1997-August 2008) and post-EC (September 2008-December 2014). A total of 25 952 patients presented with IE. The incidence increased from 301.4 to 365.1 per 10 000 000 habitants, and the mortality rate rose from 24.3% to 28.4%. Those aged >75 years experienced more adverse outcomes. Complications due to sepsis, shock, acute kidney injury requiring dialysis, and heart failure increased after the EC onset, and expenditures soared to €16 216. Expenditure per community was related to mortality ( P < .001). The EC resulted as an independent predictor for mortality (hazard ratio 1.06; 95% confidence interval 1.01-1.11). Incidence and mortality rate in patients with IE after the onset of the EC have increased as a result of rising adverse outcomes despite an overall increased investment.

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