scholarly journals P1132EXIT-SITE CARE PROTOCOLS IN PORTUGAL AND ITS ASSOCIATION WITH CATHETER-RELATED INFECTIONS RATE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Cristina Pinto Abreu ◽  
Marta Sofia Henriques Pereira ◽  
Anabela Rodrigues ◽  
Anabela Malho Guedes ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Lower Incidence ◽  
Nasal Carriage ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
The Other ◽  
National Study ◽  
Exit Site ◽  
Occlusive Dressing ◽  
Lower Incidence Rate

Abstract Background and Aims Exit-site infections (ESi) are frequent complications in peritoneal dialysis (PD) patients and their prevention and treatment are key aspects to lower peritonitis’ risk. The aim of this study was to evaluate the annual incidence rate of ESi and peritonitis in Portugal and to study possible associations between exit-site (ES) care protocols in each Portuguese unit and the number / rate of ESi and peritonitis. Method We performed a national study using two questionnaires at each Portuguese PD Unit: one about the incidence of catheter-related infections, the other characterizing patients’ education and ES care protocols. ESi and peritonitis were defined according to ISPD guidelines. Associations between variables were performed using T-student test or pairwise correlation test. STATA software was used. Results Of the 23 Portuguese PD Units, 14 units answered both questionnaires. In the last two years (2017 & 2018), those units followed 1453 patients. Portuguese ESi incidence rate was 0.41 episodes per year [1 episode per 29.2 months (MSSA incidence rate 0.13; MRSA incidence rate 0.03; Pseudomonas incidence rate 0.07)] and the peritonites incidence rate was 0.37 (1 episode per 32.5 months). We found a trend between the absolute number of ESi episodes and the number of peritonites in each unit (r=0.5, p=0.05). Although ESi prevention guidelines were known by 100% of the Portuguese units, only three out of 5 of the selected guidelines for this study were followed by 100% of the units: monitoring catheter-related infections on a yearly basis; using antibiotic prophylaxis at time of catheter placement and treating nasal carriage of S. aureus. The other 2 guidelines have variable implementation: 12 out of 14 units (86%) perform screening of nasal carriage of S. aureus and only 6 out of 14 (43%) of the units recommend daily topic antibiotic cream at the ES. We didn’t find associations between those differences and ESi incidence. Whenever S. aureus carriage is detected, 100% of the units proceed treating with mupirocine using different posology (twice or three times a day, 5 or 7 or 21 days, with/out chlorexidine). Also, the screening of nasal carriage of S. aureus is different: only pre catheter implantation (n=4); annually (n=4); semi annually (n=3); bimonthly (n=2). Oral antibiotics are prescribed after catheter placement in 4 units. We didn’t find statistical differences in ESi / peritonitis, comparing those practices. Regarding to ES care protocols, ESi rate was lower with non-occlusive dressing (0.38 vs. 0.57) immediately after catheter insertion. ESi and peritonitis rate were lower in units where bathing without ES dressing is advocated (n=9, 0.58 & 0.37 vs. 0.32 & 0.34). The use of bath sponge is associated with higher ESi rate (0.57 vs. 0.34). The use of colostomy bags in beach baths was associated with lower incidence rate of ESi compared to regular dressing or waterproof dressing (o.32 vs. 0.54). 100% of units use two different empirical antibiotics for initial ESi treatment. In the presence of chronic ESi, 3 units don’t perform shaving of external cuff and peritonitis rate is higher in those who do not apply this procedure (0.38 vs. 0.31). Conclusion in Portuguese PD units there is a wide variability in ISPD guidelines implementation and ES care protocols. We found that using non-occlusive dressing immediately after catheter insertion, removing ES dressing before shower, bathing not using a sponge and using colostomy bags at beach baths were associated with lower incidence rate of ESi. Shaving of the external cuff was associated with lower incidence rate of peritonitis. A regular national audit of PD Units is an important tool of quality improvement to clarify the best procedures for reduction of catheter-related infections in PD.

The presence of Listeria spp. in raw milk in Ontario

1988 ◽  
Vol 34 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Jeffrey M. Farber ◽  
Gregory W. Sanders ◽  
Stephen A. Malcolm
Keyword(s):  
Incidence Rate ◽  
Lower Incidence ◽  
Raw Milk ◽  
Listeria Innocua ◽  
The Other ◽  
Eastern Region ◽  
Milk Samples ◽  
Single Procedure ◽  
Listeria Species ◽  
Lower Incidence Rate

Raw milk samples from bulk tanks in Ontario were analyzed for the presence of Listeria species. The overall incidence of Listeria species in raw milk was 12.4%. Listeria innocua was most frequently isolated and was found in 9.7% (43/445) of the raw milk samples, while L. monocytogenes and L. welshimeri were each found in 1.3% (6/455) of the samples. No other species of Listeria was found. Of five regions in Ontario that were examined, the eastern region had a significantly higher incidence rate of Listeria species than the western, northern, or northwestern regions. There was also a significantly lower incidence rate of Listeria species in winter than in the other three seasons. A comparison of several cold enrichment and shortened enrichment procedures demonstrated that no single procedure was totally satisfactory in isolating Listeria species.

Cytogenetic and Molecular Profile Analysis in Hispanic Chronic Myelomonocytic Leukemia Patients From Puerto Rico

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S106-S106
Author(s):  
Nawar Matti ◽  
Ruifang Zheng ◽  
Khalid Algarrahi ◽  
Albert Alhatem ◽  
Xinlai Sun ◽  
...  
Keyword(s):  
Puerto Rico ◽  
Incidence Rate ◽  
Lower Incidence ◽  
Patient Population ◽  
Chronic Myelomonocytic Leukemia ◽  
Wild Type ◽  
Cytogenetic Abnormalities ◽  
Molecular Profiles ◽  
Lower Incidence Rate ◽  
Myelomonocytic Leukemia

Abstract Objectives Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with both myelodysplastic and myeloproliferative features. The clinical and pathological features of CMML are highly heterogeneous. It was reported that Hispanic whites had an age-adjusted lower incidence rate of CMML compared to non-Hispanic whites. The aim of this study is to define the cytogenetic and genomic landscape of Hispanic CMML patients and explore their potential clinical significance. Methods Clinically relevant cytogenetic results and 40-gene molecular profiles of Hispanic CMML patients in Puerto Rico (PR) from 2009 to 2018 were obtained retrospectively. Results Total 111 Hispanic CMML patients from PR were diagnosed in our institute from 2009 to 2018. The age range was from 46 to 96 years with a median age of 74. Sixty-five were male and 46 were female. The epidemiological features are similar to that in a general CMML patient population. In total, 107 patients had karyotypes available; 17 patients had abnormal karyotype (17/107, ~16%). Compared with general CMML patients, Hispanic CMML patients had a significantly lower rate of cytogenetic abnormalities (30% vs 16%). Among total 111 Hispanic CMML patients, 40-gene myeloid molecular profiles were performed in 56 CMML patients. Fifty-five out of 56 patients had mutations identified (~98.2%). The most frequent mutated genes were TET2, SRSF2, ASXL1, NRAS, and ZRSR2. Twenty-six of 56 patients (~46.4%) had mutated TET2/wild-type ASXL1. Previous studies indicated that mutated ASXL1, NRAS, RUNX1, and SETBP1 likely associate with an unfavorable prognosis in a general CMML patient population. Mutated TET2 with wild-type ASXL1 (muTET2/wtASXL1) may associate with a favorable prognosis. Compared with general CMML patients, Hispanic CMML patients in this study had relatively lower mutational rates in ASXL1 (30.4% vs 37.0%), NRAS (10.7% vs 11.7%), RUNX1 (5.3% vs 7.9%), and SETBP1 (5.3% vs 8.9%) and a higher rate of muTET2/wtASXL1 (46.4% vs 37.8%). Conclusion Hispanic CMML patients from PR had a significantly lower rate in cytogenetic abnormalities; relatively lower mutational rates in ASXL1, NRAS, RUNX1, and SETBP1; and a higher mutational rate in muTET2/wtASXL1. The findings raise a possibility of a better prognosis in Hispanic CMML patients and could be one of the explanations of a lower incidence rate of CMML in Hispanic population.

scholarly journals The Association Between Cardiac Rehabilitation Attendance and Hospital Readmission

2016 ◽  
Vol 12 (6) ◽  
pp. 513-520 ◽  
Author(s):  
Chad M. House ◽  
Mary A. Anstadt ◽  
Logan H. Stuck ◽  
William B. Nelson
Keyword(s):  
Cardiac Rehabilitation ◽  
Incidence Rate ◽  
Lower Incidence ◽  
Hospital Readmission ◽  
Primary Analysis ◽  
Readmission Rates ◽  
Lower Incidence Rate ◽  
The Impact ◽  
The Relationship ◽  
Additional Session

Purpose: Cardiac rehabilitation is associated with improved clinical outcomes, but the impact of individual cardiac rehabilitation sessions on readmission rates is less studied. Methods: A retrospective evaluation of the relationship between the number of cardiac rehabilitation sessions completed and all-cause and cardiac readmission rates at 1 year was conducted. The 1-year cardiac readmission counts were modeled via Poisson regression. Results: Of the 347 patients included in the primary analysis, 227 (65%) completed all assigned cardiac rehabilitation sessions. At 1 year, 135 patients (39%) had at least 1 cardiac readmission, and 155 patients (45%) had at least 1 all-cause readmission. The primary result was that every additional cardiac rehabilitation session completed was associated with a 1.75% lower incidence rate of 1-year cardiac readmission (P = .01) and a 2% lower incidence rate of all-cause hospital readmission (P = .001). Conclusion: Regardless of the number of cardiac rehabilitation sessions assigned, each additional session attended was associated with reduced cardiac readmission by 1.75% and all-cause readmission by 2%.

Comparison of health care utilization among users of public and private community health centres in urban China

2020 ◽  
Vol 37 (6) ◽  
pp. 738-743
Author(s):  
Menghan Shen ◽  
Wen He ◽  
Linyan Li ◽  
Yushan Wu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Community Health ◽  
Incidence Rate ◽  
Lower Incidence ◽  
Care Utilization ◽  
Community Health Centres ◽  
Outpatient Visits ◽  
Health Centres ◽  
Lower Incidence Rate

Abstract Background In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. Objective We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. Methods This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. Results Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI): 30.1–21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI: 19.8–5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI: 21.4–19.5%) and 22.3% higher odds of hospitalization (95% CI: 3.5–44.7%). Conclusion Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

1992 ◽  
Vol 3 (1) ◽  
pp. 103-107
Author(s):  
N S Nahman ◽  
D F Middendorf ◽  
W H Bay ◽  
R McElligott ◽  
S Powell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Seldinger Technique ◽  
First Episode ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Percutaneous Approach ◽  
Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 06-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
P Value ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

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