A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009

BACKGROUNDGuidelines published by professional associations of midwives, obstetricians, and nurses in the United States recommend against using continuous cardiotocography (CTG) in low-risk patients. In the United States, CTG or electronic fetal/uterine monitoring (EFM) rather than auscultation with a fetoscope or Pinard horn is the norm. Interpretation of the fetal heart rate (FHR) and uterine activity (UA) tracings provided by continuous EFM may be associated with the decision for a cesarean birth. Typically, consent is not sought in the decision about type of monitoring. No studies were identified where women's attitudes about the need to consent to the type of fetal monitoring used during labor have been explored. Therefore, the purpose of this research was to examine women's attitudes about the use of EFM in a healthcare setting.METHODSWe asked a sample of women aged 18–50 years to respond to one of three monitoringscenarios. The scenarios were used to distinguish between attitudes about monitoring in general, monitoring the health of a mother in labor, and monitoring the health of the fetus during labor. Wemeasured their level of interest in being monitored and their opinions about whether healthcare providers should be required to obtain consent for the monitoring described in the scenario.RESULTSInterest in receiving monitoring (across all three scenarios) was moderate, with the highest level of interest in monitoring the fetus during labor and the least interest in monitoring a general health context. Across all scenarios, 82% of respondents believed that practitioners should obtain consent for monitoring, 14% were unsure, and 4% said there should not be a requirement for consent. While low (6%), the percentage responding that consent was not needed was highest in monitoring a fetus in labor.CONCLUSIONSWomen in our study expressed a strong preference for the opportunity to consent to the use of monitoring regardless of the healthcare scenario. There is findings suggest the need for further research exploring what women do and do not know about CTG and what their informed performance are a pressing need to rethink the role of a pressing need to rethink the role of shared decision-making and informed consent about the type of monitoring use during labor.

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731. The Emergence of Mobile Colistin Resistance (mcr) Genes among Enteric Pathogens in the United States — 2008–2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.923 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S416-S416

Author(s):

Farrell A Tobolowsky ◽

Cindy R Friedman ◽

Matthew Ryan ◽

Meseret Birhane ◽

Jessica Chen ◽

...

Keyword(s):

United States ◽

Healthcare Setting ◽

The United States ◽

Multidrug Resistant ◽

Enteric Pathogens ◽

Urgent Care ◽

Emergency Rooms ◽

Colistin Resistance ◽

E Coli ◽

Bacterial Sources

Abstract Background Colistin, once seldom used clinically, has resurged as a “last resort antibiotic” for multidrug-resistant infections and is still used in animal agriculture in countries outside the United States. During 2015–2018, 8 plasmid-mediated, mobile colistin resistance genes (mcr-1 to mcr-8) were each found in one or more clinical, animal, food, and environmental bacterial sources. We describe the epidemiology of mcr genes in enteric pathogens from US patients. Methods State public health laboratories have performed whole-genome sequencing on enteric bacterial pathogens since 2015, and some have sequenced older isolates. We screened sequences of isolates collected through 2019 for mcr genes using a workflow based on ResFinder 3.0. State health officials interviewed patients for clinical and epidemiologic information, including demographics, hospitalization, and travel history. Results We identified 41 patient isolates with mcr genes collected from stool, urine, and blood during 2008–2019. These included 37 nontyphoidal Salmonella (31 mcr-1, 6 mcr-3), 2 Vibrio (both mcr-4), and 2 Shiga toxin-producing E. coli (both mcr-1). The median patient age was 34 years (interquartile range: 24–54) and 54% were female. Of 23 patients with comorbidity data, 2 (9%) had immunodeficiency, 2 (9%) had past abdominal surgeries, and 1 (4%) had cancer. Patients sought care at doctor’s offices (46%), emergency rooms (35%), and urgent care clinics (19%); 24% were hospitalized for the enteric illness. None died. Among 36 with information, 35 (97%) travelled internationally in the 12 months before illness; 30 (94%) of 32 traveled in the 7 days before. Only 4 (15%) of 27 had contact with a healthcare setting during their trip; common destinations were the Dominican Republic (35%), Vietnam (24%), Thailand (15%), and China (12%). Conclusion The data strongly suggest that many patients acquired infection abroad. Nearly one in four were hospitalized, raising concerns that plasmids carrying mcr genes could spread among patients hospitalized with infections caused by multidrug-resistant pathogens for which colistin is the only available treatment. The acquisition of mcr genes by US travelers highlights the need for a global approach to antimicrobial stewardship. Disclosures All Authors: No reported disclosures

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Christians’ Perceptions of Receiving Spiritual Care in the Bible Belt of the United States: A Qualitative Study of Care Provided in the Healthcare Setting

Religions ◽

10.3390/rel8070127 ◽

2017 ◽

Vol 8 (7) ◽

pp. 127 ◽

Cited By ~ 2

Author(s):

◽

Keyword(s):

United States ◽

Qualitative Study ◽

Spiritual Care ◽

Healthcare Setting ◽

The United States ◽

Bible Belt ◽

The Bible

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Drive-through Satellite Testing: An Efficient Precautionary Method of Screening Patients for SARS-CoV-2 in a Rural Healthcare Setting

Journal of Primary Care & Community Health ◽

10.1177/2150132720947963 ◽

2020 ◽

Vol 11 ◽

pp. 215013272094796

Author(s):

Paul E. Molling ◽

Tanner T. Holst ◽

Benjamin G. Anderson ◽

Kevin Fitzgerald ◽

Megan Eddy ◽

...

Keyword(s):

United States ◽

Rural Community ◽

Community Setting ◽

Healthcare Setting ◽

The United States ◽

Community Based ◽

Global Pandemic ◽

Large Patient ◽

Community Transmission ◽

Testing Site

The first documented case of COVID-19 in the United States occurred on January 30th, 2020. Soon after, a global pandemic was declared in March 2020 with each state issuing stay at home orders based on population, risk for community transmission and current number of positive cases. A priority for each region was to develop efficient systems for testing large patient volumes in a safe manner to reduce the risk of community transmission. A community based United States health care system in the upper mid-west implemented a drive through testing site in an attempt to divert suspected cases of COVID-19 away from larger patient areas while protecting staff and patients. This commentary outlines the planning, work flow and challenges of implementing this drive through testing site in a rural community setting.

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PDG66 METFORMIN DOSAGE PATTERNS IN TYPE 2 DIABETES PATIENTS IN A REAL-WORLD HEALTHCARE SETTING IN THE UNITED STATES

Value in Health ◽

10.1016/j.jval.2019.04.745 ◽

2019 ◽

Vol 22 ◽

pp. S173-S174

Author(s):

R. Mahabaleshwarkar ◽

A. DeSantis

Keyword(s):

United States ◽

Type 2 Diabetes ◽

Real World ◽

Healthcare Setting ◽

The United States ◽

Diabetes Patients

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A Novel Approach for a Novel Pathogen: Using a Home Assessment Team to Evaluate Patients for COVID-19

Clinical Infectious Diseases ◽

10.1093/cid/ciaa256 ◽

2020 ◽

Vol 71 (16) ◽

pp. 2211-2214 ◽

Cited By ~ 4

Author(s):

Chloe Bryson-Cahn ◽

Jeffrey Duchin ◽

Vanessa A Makarewicz ◽

Meagan Kay ◽

Krista Rietberg ◽

...

Keyword(s):

Public Health ◽

United States ◽

Resource Utilization ◽

Healthcare Setting ◽

The United States ◽

Innovative Approach ◽

Specimen Collection ◽

Novel Approach

Abstract Thousands of people in the United States have required testing for SARS-CoV-2. Evaluation for a special pathogen is resource intensive. We report an innovative approach to home assessment that, in collaboration with public health, enables safe evaluation and specimen collection outside the healthcare setting, avoiding unnecessary exposures and resource utilization.

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Influence of drug class and healthcare setting on systemic antifungal expenditures in the United States, 2005–15

American Journal of Health-System Pharmacy ◽

10.2146/ajhp160943 ◽

2017 ◽

Vol 74 (14) ◽

pp. 1076-1083 ◽

Cited By ~ 4

Author(s):

Margaret A. Fitzpatrick ◽

Katie J. Suda ◽

Charlesnika T. Evans ◽

Robert J. Hunkler ◽

Frances Weaver ◽

...

Keyword(s):

United States ◽

Drug Class ◽

Healthcare Setting ◽

The United States

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Norovirus and Other Viral Causes of Medically Attended Acute Gastroenteritis Across the Age Spectrum: Results from the MAAGE Study in the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciab033 ◽

2021 ◽

Author(s):

Rachel M Burke ◽

Claire Mattison ◽

Zachary Marsh ◽

Kayoko Shioda ◽

Judy Donald ◽

...

Keyword(s):

United States ◽

Active Surveillance ◽

Acute Gastroenteritis ◽

Stool Specimen ◽

Healthcare Delivery ◽

Healthcare Setting ◽

The United States ◽

Healthcare Delivery System ◽

Kaiser Permanente ◽

Antibiotics Use

Abstract Background Acute gastroenteritis (AGE) causes a substantial burden in the United States, but its etiology frequently remains undetermined. Active surveillance within an integrated healthcare delivery system was used to estimate the prevalence and incidence of medically attended norovirus, rotavirus, sapovirus, and astrovirus. Methods Active surveillance was conducted among all enrolled members of Kaiser Permanente Northwest during July 2014 – June 2016. An age-stratified, representative sample of AGE-associated medical encounters were recruited to provide a stool specimen to be tested for norovirus, rotavirus, sapovirus, and astrovirus. Medically attended AGE (MAAGE) encounters for a patient occurring within 30 days were grouped into one episode, and all-cause MAAGE incidence was calculated. Pathogen- and healthcare setting-specific incidence estimates were calculated using age-stratified bootstrapping. Results The overall incidence of MAAGE was 40.6 episodes per 1000 person-years (PY), with most episodes requiring no more than outpatient care. Norovirus was the most frequently detected pathogen, with an incidence of 5.5 medically attended episodes per 1000 PY. Incidence of norovirus MAAGE was highest among children aged <5 years (20.4 episodes per 1000 PY), followed by adults aged ≥65 years (4.5 episodes per 1000 PY). Other study pathogens showed similar patterns by age, but lower overall incidence (sapovirus: 2.4 per 1000 PY, astrovirus: 1.3 per 1000 PY, rotavirus: 0.5 per 1000 PY). Conclusions Viral enteropathogens, particularly norovirus, are an important contributor to MAAGE, especially among children <5 years of age. The present findings underline the importance of judicious antibiotics use for pediatric AGE and suggest that an effective norovirus vaccine could substantially reduce MAAGE.

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