scholarly journals Adherence to Treatment Guideline Improves Patient Outcomes in a Prospective Cohort of Adults Hospitalized for Community-Acquired Pneumonia

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Grace Lui ◽  
Heather K W To ◽  
Nelson Lee ◽  
Renee W Y Chan ◽  
Timothy Li ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Community Acquired Pneumonia ◽  
Adherence To Treatment ◽  
Beta Lactam ◽  
Multivariable Logistic Regression Model ◽  
Prolonged Hospitalization ◽  
Atypical Pathogens ◽  
The Impact

Abstract Background Understanding local epidemiology and etiologies of community-acquired pneumonia in hospitalized patients is crucial for determining the appropriateness of treatment guidelines. We aim to determine the etiologies, severity, and outcomes in adults hospitalized for community-acquired pneumonia and to study the impact of empirical antibiotic therapy on patient outcomes. Methods We performed a prospective observational cohort study involving adults hospitalized for community-acquired pneumonia in Hong Kong. Sputum, nasopharyngeal aspirate, blood, and urine were collected for bacterial culture, molecular tests for detection of viruses and atypical pathogens, and antigen tests. Multivariable logistic regression model and Cox proportional hazard models were performed to determine independent factors associated with prolonged hospitalization and mortality. Results From February 2017 to July 2018, 258 patients were enrolled. The median age was 73 (interquartile range, 61–80) years, 66% were male, 57% had underlying chronic illnesses, 13% had CURB-65 score ≥3, and 10% had higher 1-year mortality. Pathogens were identified in 45% of patients; 20% had viral, 15% had bacterial, and 9% had polymicrobial pneumonia. Streptococcus pneumoniae (12%), influenza virus (12%), and Mycoplasma pneumoniae (1.2%) were the most common bacterial, viral, and atypical pathogens, respectively. Nonadherence to local empirical antibiotic treatment guidelines (primarily recommending beta-lactam and doxycycline) was observed in 25% and was independently associated with prolonged hospitalization (≥7 days) and higher mortality, after adjustment for age, underlying chronic illness, and disease severity. Conclusions Adherence to treatment guidelines was associated with shorter hospitalization and improved survival. We provided evidence for the use of doxycycline for coverage of atypical pathogens in nonsevere pneumonia.

Family interventions in psychosis

2020 ◽  
pp. 531-537
Author(s):  
Juliana Onwumere ◽  
Elizabeth Kuipers
Keyword(s):  
Patient Outcomes ◽  
Family Involvement ◽  
Lived Experiences ◽  
Treatment Guidelines ◽  
Well Being ◽  
Evidence Base ◽  
Family Interventions ◽  
Improved Outcomes ◽  
The Impact

Families can play an important role in supporting individuals living with psychosis disorders and helping to facilitate their improved outcomes. This chapter, offered by Juliana Onwumere and Elizabeth Kuipers, provides an overview of the literature reporting on family involvement in the care of adults with lived experiences of psychosis, the impact of the caregiving role on carer well-being, and the predictive links between caregiving relationships and key patient outcomes including relapse. The chapter reports on the application of family interventions, the evidence base supporting its application and inclusion in treatment guidelines, and implementation issues.

scholarly journals 1139. Multidisciplinary Initiative to Increase Guideline-Concordant Antibiotic Prescriptions at Discharge for Hospitalized Children with Uncomplicated Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S405-S406
Author(s):  
Alexandra B Yonts ◽  
Michael Jason Bozzella ◽  
Matthew Magyar ◽  
Laura O’Neill ◽  
Nada Harik
Keyword(s):  
Infectious Diseases ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Community Acquired Pneumonia ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Median Percentage ◽  
Common Diagnosis ◽  
The Impact

Abstract Background Community-acquired pneumonia (CAP) is the most common diagnosis in hospitalized children. The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America published evidenced-based clinical practice guidelines for the management of CAP in children 3 months of age or older in 2011. These guidelines are not consistently followed. Our objective was to evaluate if quality improvement (QI) methods could improve guideline-concordant antibiotic prescribing, specifically addressing the use of oral third-generation cephalosporins, at hospital discharge for children with uncomplicated CAP. Methods QI interventions, implemented at a single tertiary care children’s hospital in Washington, D.C., focused on key drivers targeting hospital medicine resident teams. Multiple plan-do-study-act (PDSA) cycles were performed. Initial interventions included educational sessions (in small group and lecture formats) aimed at pediatric resident physicians, as well as visual job aids (Figure 1) and guideline summaries posted in resident physician work areas. Interventions were implemented in series to allow for statistical analysis via run chart. Medical records of eligible patients were reviewed monthly after each intervention to determine the impact on appropriate discharge antibiotic prescribing. Results At baseline, the median percentage of children with a diagnosis of uncomplicated CAP discharged with guideline-concordant antibiotics was 50%. Median rates of guideline-concordant antibiotic prescribing improved to 87.5% after initial interventions (Figure 2). Conclusion A fellow-led multidisciplinary QI initiative was successful in decreasing rates of non-guideline-concordant antibiotic prescribing at discharge. These interventions can be tailored for use at other institutions and for other infectious processes with established treatment guidelines. To ensure sustained improvement in guideline-concordant prescribing, future planned interventions include additional educational sessions with residents, faculty, and pharmacists, EMR order set modification and physician benchmarking. These tactics are intended to address the anticipated challenge of resident/faculty turnover and automate antibiotic choice for uncomplicated CAP. Disclosures All authors: No reported disclosures.

scholarly journals Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa

2020 ◽  
Author(s):  
LUFUNO MAKHADO ◽  
Mashudu Davhana-Maselesele ◽  
Rachel Tsakani Lebese ◽  
Sonto Maria Maputle
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Treatment Guidelines ◽  
Behavioural Change ◽  
Treatment Guideline ◽  
Hiv Treatment ◽  
World Health ◽  
Adherence To Treatment ◽  
Continuous Training ◽  
Training Support

Abstract Background: Globally the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% with 3% global health workforce and this an alarming rate that World Health Organization (WHO) declared African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for these countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The purpose of the study was to determine factors facilitating trained nurse-initiated management of antiretroviral therapy (NIMART) nurses’ adherence to TB/HIV treatment guidelines in KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa.Design: The study was qualitative, explorative and descriptive in nature. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussion was conducted. Data analysis was through the used of ATLAS T.I. software program (version 7.0) and followed the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and ethical consideration were ensured.Results: The following one theme namely; marked identified needs to be met to promote adherence to treatment guidelines and sub-themes emerged from raw data: Expected positive attitudinal needs outlined and an outline of a positive behavioural change. Conclusion: Factors such as continuous training, support supervision and improved relationships with colleagues need to be enhanced to enable NIMART nurses to adhere to treatment guideline.

scholarly journals Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa

2020 ◽  
Author(s):  
LUFUNO MAKHADO ◽  
Mashudu Davhana-Maselesele ◽  
Rachel Tsakani Lebese ◽  
Sonto Maria Maputle
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Treatment Guidelines ◽  
Behavioural Change ◽  
Treatment Guideline ◽  
Hiv Treatment ◽  
World Health ◽  
Adherence To Treatment ◽  
Continuous Training ◽  
Training Support

Abstract Background: Globally the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% with 3% global health workforce and this an alarming rate that World Health Organization (WHO) declared African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for these countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The purpose of the study was to determine factors facilitating trained nurse-initiated management of antiretroviral therapy (NIMART) nurses’ adherence to TB/HIV treatment guidelines in KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa.Design: The study was qualitative, explorative and descriptive in nature. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussion was conducted. Data analysis was through the used of ATLAS T.I. software program (version 7.0) and followed the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and ethical consideration were ensured.Results: The following one theme namely; marked identified needs to be met to promote adherence to treatment guidelines and sub-themes emerged from raw data: Expected positive attitudinal needs outlined and an outline of a positive behavioural change. Conclusion: Factors such as continuous training, support supervision and improved relationships with colleagues need to be enhanced to enable NIMART nurses to adhere to treatment guideline.

scholarly journals Patient Outcomes According to Adherence to Treatment Guidelines for Rhythm Control of Atrial Fibrillation

2015 ◽  
Vol 4 (4) ◽  
Author(s):  
Dingxin Qin ◽  
George Leef ◽  
Mian Bilal Alam ◽  
Rohit Rattan ◽  
Mohamad Bilal Munir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Outcomes ◽  
Treatment Guidelines ◽  
Rhythm Control ◽  
Adherence To Treatment

scholarly journals Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status

2014 ◽  
Vol 134 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Robert E. Bristow ◽  
Jenny Chang ◽  
Argyrios Ziogas ◽  
Hoda Anton-Culver ◽  
Veronica M. Vieira
Keyword(s):  
Ovarian Cancer ◽  
Socioeconomic Status ◽  
Spatial Analysis ◽  
Treatment Guidelines ◽  
Advanced Stage ◽  
Adherence To Treatment ◽  
The Impact

scholarly journals Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa

2020 ◽  
Author(s):  
Lufuno Makhado ◽  
Mashudu Davhana-Maselesele ◽  
Rachel Tsakani Lebese ◽  
Sonto Maria Maputle
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Treatment Guidelines ◽  
Behavioural Change ◽  
Treatment Guideline ◽  
Hiv Treatment ◽  
World Health ◽  
Adherence To Treatment ◽  
Continuous Training ◽  
Training Support

Abstract Background: Globally the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% with 3% global health workforce and this an alarming rate that World Health Organization (WHO) declared African region as critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for these countries with high health workforce shortages. The strategy aimed at redistribution of health care tasks to available workers. The purpose of the study was to determine factors facilitating trained NIMART nurses’ adherence to TB/HIV treatment guidelines in KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa.Design: The study was qualitative, explorative and descriptive in nature. Population comprised of 24 participants who were purposively selected. In-depth one-on-one interview was conducted. Data analysis was through the used of ATLAS T.I. software program (version 7.0) and followed the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and ethical consideration were ensured.Results: The following one theme namely; marked identified needs to be met in order to promote adherence to treatment guidelines and sub-themes emerged from raw data: Expected positive attitudinal needs outlined and an outline of a positive behavioural change. Conclusion: Factors such as continuous training, support supervision and improved relationships with colleagues need to be enhanced to enable NIMART nurses to adhere to treatment guideline.

scholarly journals 38. Impact of Antimicrobial Stewardship Interventions on Adherence to Clostridioides difficile Treatment Guidelines

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Elizabeth Neuner ◽  
Tamara Krekel ◽  
Michael Durkin ◽  
Erik R Dubberke ◽  
Kevin Hseuh
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Small Sample ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Research Support ◽  
Post Intervention ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Facility-specific treatment guidelines are a priority intervention recommended in the CDC Core Elements of Hospital Antimicrobial Stewardship Programs (ASPs). Our ASP sought to improve adherence to the facility C. difficile infection (CDI) treatment guideline by implementing prospective audit and feedback of CDI cases, changing fidaxomicin from being restricted to Infectious Diseases consult use, to only requiring prospective audit and feedback, and allowing fidaxomicin and oral vancomycin orders only through the order set. This study reviews the impact of these interventions. Methods This single-center retrospective quasi-experimental study evaluated inpatient CDI lab events 3 months pre-intervention (10/1/2019-12/31/2019) and post-intervention (10/14/2020-1/14/2021). Patient and treatment data was evaluated via chart review. The primary outcome was adherence to CDI treatment guideline. ASP intervention types were categorized. Statistical analyses were performed using Chi-squared or Fischer’s exact, where appropriate. Results Baseline characteristics were well matched between the 58 and 70 patients pre and post intervention respectively (Table 1). ASP interventions resulting from the prospective audit and feedback are described in Table 2 and overall acceptance rates were high (88%). Guideline adherence improved significantly from 71% pre to 90% post-intervention (p=0.005). Reasons for non-adherence included vancomycin dose incorrect for the severity of illness (9 pre vs 2 post), inappropriate duration (4 pre vs 0 post), use of combination therapy in non-fulminant disease (5 pre vs 3 post), and not using fidaxomicin for recurrent disease (3 pre vs 2 post). Clinical outcomes pre and post intervention were not different in this small sample size: colectomy 1 (2%) vs 1 (1%) p=1, 60 day all- cause mortality 15 (26%) vs 14 (20%) p=0.43, and CDI recurrence at day 60 9/43 (21%) vs 5/56 (9%) p=0.131. Conclusion A bundle of ASP interventions including prospective audit and feedback of CDI cases improved adherence to facility-specific CDI treatment guidelines. Disclosures Tamara Krekel, PharmD, BCPS, BCIDP, Merck (Speaker’s Bureau) Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant)

scholarly journals Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: A vital matter in the management of TB/HIV treatment in South Africa

2020 ◽  
Author(s):  
LUFUNO MAKHADO ◽  
Mashudu Davhana-Maselesele ◽  
Rachel Tsakani Lebese ◽  
Sonto Maria Maputle
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Treatment Guidelines ◽  
Behavioural Change ◽  
Treatment Guideline ◽  
Hiv Treatment ◽  
World Health ◽  
Adherence To Treatment ◽  
Continuous Training ◽  
Training Support

Abstract Background: Globally the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% with 3% global health workforce and this an alarming rate that World Health Organization (WHO) declared African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for these countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The purpose of the study was to determine factors facilitating trained nurse-initiated management of antiretroviral therapy (NIMART) nurses’ adherence to TB/HIV treatment guidelines in KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa.Design: The study was qualitative, explorative and descriptive in nature. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussion was conducted. Data analysis was through the used of ATLAS T.I. software program (version 7.0) and followed the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and ethical consideration were ensured.Results: The following one theme namely; marked identified needs to be met to promote adherence to treatment guidelines and sub-themes emerged from raw data: Expected positive attitudinal needs outlined and an outline of a positive behavioural change. Conclusion: Factors such as continuous training, support supervision and improved relationships with colleagues need to be enhanced to enable NIMART nurses to adhere to treatment guideline.

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