scholarly journals 1166. Evaluating the Impact of the 2016 Candidemia Guidelines on the Incidence of Ocular Complications of Candidemia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S609-S609
Author(s):  
Molly Hillenbrand ◽  
Senu Apewokin
Keyword(s):  
Vision Loss ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Prescribing Patterns ◽  
Ocular Complications ◽  
Ocular Penetration ◽  
Significant Difference ◽  
Before And After ◽  
Eye Exams ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections has risen over the last several decades. Complications of candidemia include endogenous fungal endophthalmitis which can result in devastating outcomes including vision loss. In 2015, the IDSA guidelines were updated to recommend echinocandins as initial therapy for candidemia. Given the poor ocular penetration of echinocandins there has been some concern this change may portend an increased incidence of ocular complications in candidemic patients. We sought to examine whether patients who received empiric echinocandin therapy developed higher rates of ophthalmic complications of candidemia. Methods We identified patients in our healthcare system who had blood cultures positive for Candida species and a completed ophthalmology consult between January 1, 2014 and April 30, 2019. Chi-squared analysis was used to compare antifungal prescribing patterns before and after release of the updated IDSA guidelines. We assessed whether the switch to empiric echinocandin therapy as directed by the guidelines was associated with higher rates of abnormal eye exams. Results 47 patients treated before the guideline change were compared to 57 patients treated after the guideline change. There was no significant difference in age, gender, or comorbid diabetes and hypertension between the groups. Before the guideline change, 24/47 (51%) of patients received eye-penetrating antifungals. This decreased to 21/57 after the updated guideline (37%, p=0.21). The percentage of patients with positive eye exams was nearly equal before and after the updated guidelines, 10/47 (21%) before vs 13/57 (22%) after (p=1). After the guideline change, 7/21 (33%) of the patients treated with penetrating antifungals had positive eye exams vs 6/36 (16%) who received echinocandins (p=0.19). Conclusion Echinocandins are known to have poor ocular penetration yet our data demonstrate no change in the incidence of ophthalmic complications of candidemia after the 2016 guideline endorsed echinocandins as empiric therapy. The prevalence of positive eye exams throughout our study period was 22%, suggesting ongoing utility for these exams. Ongoing investigation is necessary to confirm and further study these findings. Disclosures All Authors: No reported disclosures

P42 The impact of a change to hospital guidelines on prescribing practices of nebulised 3% w/v ‘hypertonic’ saline

2018 ◽  
Vol 103 (2) ◽  
pp. e1.47-e1 ◽  
Author(s):  
Semple Diarmaid ◽  
McNally Paul ◽  
Fitzpatrick Anne ◽  
Adeyemi Kenny ◽  
McGrory Niamh ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Clinical Guideline ◽  
Controlled Trial ◽  
Inappropriate Prescribing ◽  
Prescribing Patterns ◽  
List Type ◽  
Guideline Compliance ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

AimsRecent conclusive evidence has suggested that, contrary to previous limited evidence, there is no benefit to the use of 3% hypertonic saline (3% HS) in the treatment of bronchiolitis in infants.1,2 This led to a change in the clinical guideline during the 2015/2016 bronchiolitis season. We hypothesised that the use of hypertonic saline was preventing the use of other un-necessary treatments and that inappropriate prescribing would increase following the advice not to give hypertonic saline.The primary aim of the study was to determine if the removal of 3% hypertonic saline from the institutional clinical guideline would result in reduced prescribing patterns. A secondary aim was to evaluate the overall prescribing compliance with the guideline including in the prescribing of antibiotics and bronchodilators, and identify if the change in the clinical guideline impacted the prescribing of other agents in children admitted with a diagnosis of bronchiolitis.MethodsData on medical treatments and hospital outcomes were prospectively collected on all infants in the 2015/2016 season both before and after the change in guideline. Details of all medicines prescribed on the patients Medication Record particularly bronchodilators, antimicrobials and inhaled agents were collected. Patient demographics were collected from medical notes. Results were analysed using chi square and Mann Whitney in Excel and Stata.Results128 children (86 before, 42 after the change in guideline) were recruited to the study. Baseline demographics were similar except for a higher proportion of children with RSV in the pre-group. Overall guideline compliance was achieved by 2 infants pre, and 3 infants post guideline change (4%). The use of hypertonic saline decreased significantly after the change in guideline but did not cease (90% pre, 71% post p<0.01). Bronchodilators were used in one in 4 infants and antibiotics in one in 3 infants, and there was no significant difference in these rates before or after the change in guidelines.ConclusionThe change to the guideline reduced the use of 3%HS, however overall guideline compliance in children with bronchiolitis is poor. Hypertonic saline use decreased when the guideline changed but a significant portion of children before and after the guideline change received medications not indicated in the treatment of bronchiolitis, including bronchodilators and antibiotics. It appears that it remains difficult to ‘do nothing’ for bronchiolitis. Poor clinical practice remains and education of clinical staff is necessary in this regard.ReferencesGuidance: Bronchiolitis in children: diagnosis and management, NICE (NG9) Published date: June 2015.Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% hypertonic saline versus normal saline in inpatient bronchiolitis: A randomised controlled trial. Paediatrics2015;136:1036–1043.

Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

2021 ◽  
pp. 1-7
Author(s):  
Carlos Mena Canata ◽  
Rebeca Noemí Ruiz Vallejos
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rural Areas ◽  
Urban Areas ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population

2018 ◽  
Vol 103 (9) ◽  
pp. 1314-1319 ◽  
Author(s):  
Eva K Fenwick ◽  
Ryan E K Man ◽  
Alfred Tau Liang Gan ◽  
Neelam Kumari ◽  
Charlene Wong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Well Being ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Significant Difference ◽  
Related Quality ◽  
The Impact

Background/aimsTo assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population.MethodsThe Singapore Chinese Eye Study (n=3353; 2009–2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the ‘Reading’, ‘Mobility’ and ‘Emotional’ domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models.ResultsOf the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR.ConclusionsWe documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.

scholarly journals How is Satiety Affected When Consuming Food While Working on A Computer?

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1545 ◽  
Author(s):  
Lily Ding ◽  
Nazimah Hamid ◽  
Daniel Shepherd ◽  
Kevin Kantono
Keyword(s):  
Energy Intake ◽  
Eating Behavior ◽  
Normal Weight ◽  
Restrained Eating ◽  
Computer Work ◽  
Meal Intake ◽  
Significant Difference ◽  
Before And After ◽  
And Control ◽  
The Impact

More people working at offices are choosing to eat meals at their desks, making “desktop dining” an increasingly common phenomenon. Previous studies have reported that environmental distractors, such as television viewing, can influence meal intake and subsequent snack intake. However, the impact of stressful mental tasks on eating behavior has received relatively less attention, focusing only on subsequent meal intake or concurrent snack intake. This study sets out to determine whether eating while working influenced current meal energy intake. This research also examined the relationship between dietary restraint status and energy intake. A crossover experimental design was employed requiring participants (14 males and 29 females) to eat pizza quietly and at rest (control), and while working on a computer (work). Measurements included BMI, energy intake, state anxiety, restrained eating behavior, stress levels (pre- and post-eating), and appetite (before and after both work and control sessions). The findings showed that consuming food while working on a computer significantly increased stress but had no influence on energy intake compared to the control condition. However, post-eating hunger levels were significantly higher in the work condition compared to the control condition. As expected, satiety levels decreased significantly from pre- to post-eating for both work and control conditions. In addition, no significant relationship was observed between restrained eating behavior and energy intake in both work and control conditions. These results suggest that eating while working affected satiety of normal weight participants, as indicated by the significant difference in post-meal satiety levels between work and control conditions.

scholarly journals Impact of the Emerging COVID-19 Pandemic on the Consumption of Multivitamins (C, D and Zinc) by the Saudi Arabian Population

2021 ◽  
pp. 11-20
Author(s):  
Duaa Mohamed Bakhshwin ◽  
Abdulaziz Bakhshwin
Keyword(s):  
Vitamin D ◽  
Vitamin C ◽  
World Health ◽  
Saudi Population ◽  
Viral Spread ◽  
Significant Difference ◽  
Before And After ◽  
Zinc Supplements ◽  
Vitamin D Supplements ◽  
The Impact

Background: On March 11, 2020, the World Health Organization (WHO) announced the Coronavirus outbreak officially as a pandemic. This pandemic has led to new measurements to prevent viral spread. The measures included decreasing the person’s mobility outside homes with subsequent changes in the lifestyles, particularly in physical activity and eating habits. It has been noticed that consumption of some vitamins may help in preventing or reducing the symptoms of viral infection. Those vitamins include vitamin C, D and zinc. There is a common observation that the general public believes that the use of vitamins, especially vitamins C, D and zinc, reduces the chance of acquiring COVID-19. Objectives: The aim of this study was to determine the impact of COVID-19 pandemic on taking vitamins supplements by the Saudi general population in order to explore their believes regarding the protective value of these vitamins against COVID-19 infection. Subjects and Methods: This cross-sectional study was conducted using a self-administrated questionnaire that was designed, uploaded to the Google form and distributed online to the general Saudi population through the social media (Whatsapp, Twitter) as well as through email between August and December 2020. Statistical Packaged of Social Sciences program (SPSS) for Windows (version 17.0., Chicago: SPSS Inc) was used to analyze the data. A significant difference was considered when the p value is < 0.05. Student t-test and Chi-square (χ2) test were used to compare the studied variables as appropriate. Results: A total of 1043 participants were included in this study (64.9% females, 35.1% males). The mean age for them was 35.3±14.78 years. Only 9.3% (97 participants) were diagnosed to have COVID-19. About 28% of the participants were in contact with COVID-19 cases. Among participants diagnosed to have COVID-19 infection, (13% versus 29%) were taking vitamin C and (2% versus 15%) were taking zinc supplements daily during the 6 months before and after the pandemic, respectively, while (20% versus 25%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic, respectively. Among participants who were in contact with COVID-19 cases, (8% versus 20%) and (3% versus 11%) were taking vitamin C and zinc supplements daily during the 6 months before and after the pandemic, respectively, while (14% versus 16%) were taking vitamin D supplements weekly during the 6 months before and after the pandemic Conclusion: The interest of taking multivitamin by Saudi population, such as vitamins C and D, zinc increased during and after the pandemic compared to that before it. There is no scientific evidence based on previous studies confirmed the role of dietary supplementation and multivitamins in preventing COVID-19 infection, therefore, effective education on the rationale use of vitamins during COVID-19 pandemic should be emphasized at local and/or national levels.

scholarly journals SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Elkadi ◽  
Eleanor Dodd ◽  
Theodore Poulton ◽  
William Bolton ◽  
Joshua Burke ◽  
...  
Keyword(s):  
Wound Healing ◽  
Local Anaesthetic ◽  
Surrogate Endpoints ◽  
Incision And Drainage ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Before And After ◽  
The Impact

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p &lt; 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

scholarly journals Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment

2021 ◽  
Author(s):  
Sara Catherine Pearson ◽  
Kristin O’Connor ◽  
Kimberly Keller ◽  
T J Hodge ◽  
Ross Nesbit
Keyword(s):  
Glucose Level ◽  
Standard Dose ◽  
Additional Treatment ◽  
Treatment Pathway ◽  
Reduced Dose ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Stage Renal Disease ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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 Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

scholarly journals Ethnocentrism, Theoretical Awareness, and Intellectual Resistance in University Students’ Reading Behaviour

2021 ◽  
Vol 9 (4) ◽  
pp. 228
Author(s):  
Brahim Hiba
Keyword(s):  
Critical Pedagogy ◽  
Basic Function ◽  
General Idea ◽  
Critical Reading ◽  
Reading Habits ◽  
Convenience Sample ◽  
Significant Difference ◽  
Before And After ◽  
Post Test ◽  
The Impact

This paper discusses the insightful and illuminating findings of teaching critical reading within the theoretical framework of critical pedagogy. More specifically, this paper examines the impact of a critical-reading course on students’ reading skills and beliefs about discourse production and interpretation. The course was conducted according to the principles of transformative participatory action research and, thus, a corpus of 50 essays, written by a convenience sample of 25 post-graduate students in the pre-test and post-test phases, was analyzed to examine the effect of the course on students’ reading-habits and their representations of different discourses. Pretest findings showed that most students used to think that discourses are innocent and ideology-free and that reading a text consists in understanding its general idea, extracting its writer’s viewpoint, making sense of its vocabulary, and paraphrasing it. As far as text’s function is concerned, most students used to believe that a text’s basic function is delivering information. In addition, most of them were unaware of the fact that a text has ideological and socio-political functions. Post-test findings revealed that students’ discourse awareness and reading habits have become more critical and developed at two levels: the worldview level and the meta-language level. The t-test statistics suggest that there is a significant difference of p˂.001 between students’ reading scores before and after the intervention. Therefore, the null hypothesis which says that there is no significant difference between studying critical reading from a critical pedagogy perspective and studying it from a functional or conventional perspective is false.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

scholarly journals A pilot interventional study to evaluate the impact of cholecalciferol treatment on HbA1c in type 1 diabetes (T1D)

2017 ◽  
Vol 6 (4) ◽  
pp. 225-231 ◽  
Author(s):  
R Perchard ◽  
L Magee ◽  
A Whatmore ◽  
F Ivison ◽  
P Murray ◽  
...  
Keyword(s):  
Vitamin D ◽  
Type 1 Diabetes ◽  
South Asian ◽  
Negative Relationship ◽  
Late Winter ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Background Higher 25(OH)D3 levels are associated with lower HbA1c, but there are limited UK interventional trials assessing the effect of cholecalciferol on HbA1c. Aims (1) To assess the baseline 25(OH)D3 status in a Manchester cohort of children with type 1 diabetes (T1D). (2) To determine the effect of cholecalciferol administration on HbA1c. Methods Children with T1D attending routine clinic appointments over three months in late winter/early spring had blood samples taken with consent. Participants with a 25(OH)D3 level <50 nmol/L were treated with a one-off cholecalciferol dose of 100,000 (2–10 years) or 160,000 (>10 years) units. HbA1c levels before and after treatment were recorded. Results Vitamin D levels were obtained from 51 children. 35 were Caucasian, 11 South Asian and 5 from other ethnic groups. 42 were vitamin D deficient, but 2 were excluded from the analysis. All South Asian children were vitamin D deficient, with mean 25(OH)D3 of 28 nmol/L. In Caucasians, there was a negative relationship between baseline 25(OH)D3 level and HbA1c (r = −0.484, P < 0.01). In treated participants, there was no significant difference in mean HbA1c at 3 months (t = 1.010, P = 0.328) or at 1 year (t = −1.173, P = 0.248) before and after treatment. One-way ANCOVA, controlling for age, gender, ethnicity, BMI and diabetes duration showed no difference in Δ HbA1c level. Conclusion We report important findings at baseline, but in children treated with a stat dose of cholecalciferol, there was no effect on HbA1c. Further studies with larger sample sizes and using maintenance therapy are required.

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