scholarly journals 122. Dalbavancin Use in Patients with Substance Use Disorders

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S189-S190
Author(s):  
Amber C Streifel ◽  
Jina Makadia ◽  
Strnad Luke ◽  
Alyse Douglass ◽  
Heather Mayer ◽  
...  
Keyword(s):  
Substance Use ◽  
High Risk ◽  
Clinical Outcomes ◽  
Discharge Planning ◽  
Treatment Options ◽  
Vertebral Osteomyelitis ◽  
Causative Organism ◽  
Icd 10 ◽  
History Of ◽  
Severe Infections

Abstract Background Dalbavancin, a lipoglycopeptide antibiotic, has an extended half-life that allows for weekly dosing and is an alternative to daily intravenous (IV) antibiotics. The dosing interval has the potential to expand treatment options for more severe infections in patients with substance use disorder (SUD), houselessness, and other complex social determinants of health where treatment of severe infections with long courses of IV antibiotics can have a high risk of failure. Questions remain regarding clinical outcomes for this indication and patient population. Methods We conducted a retrospective review of dalbavancin use for any patient with documented SUD either by ICD-10 or in chart notes. We identified all patients > 18 years who received > 1 dose of dalbavancin via medication records. Results 53 patients with documented SUD received dalbavancin as part of their treatment regimen (Table 1). The most common indication was osteomyelitis, including 14 cases of vertebral osteomyelitis (Table 2). The most common causative organism was Staphylococcus aureus, 23 (43%) cases due to MRSA and 10 (18%) due to MSSA. The majority of patients (41,77%) had a documented history of IV drug use (IDU) and 19% had alcohol use disorder. A structured, RN-lead multi-disciplinary discharge planning conference to discuss antibiotic options, risk factors for outpatient parenteral antibiotic therapy, and PICC safety in the community was held for 17 (32%). Concern about outpatient PICC safety in patients with history of IDU, unsafe home environment, and prior non-adherence to outpatient antibiotics were common reasons for choosing dalbavancin. Ten (19%) patients were lost to follow-up. The 30 and 90-day readmission rates were 13% and 19% respectively but were due to relapse or recurrence of infection in only 3 (6%) at 30 days and 2 (4%) additional at 90 days. There was only one death at 90 days ant it was unrelated to infection. (Table 3) Table 2. Dalbavancin Use Conclusion Dalbavancin was well tolerated and = a viable alternative for patients with SUD who often have social factors and preferences that make continuation of outpatient IV therapy high risk or impractical. Further data on clinical outcomes in complex infections is needed. Disclosures All Authors: No reported disclosures

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of <17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P<0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
Brian S W Chong ◽  
Christopher J Brereton ◽  
Alexander Gordon ◽  
Joshua S Davis
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vertebral Osteomyelitis ◽  
Index Admission ◽  
Causative Organism ◽  
Microbiological Diagnosis ◽  
Treatment Pathways ◽  
Pyogenic Vertebral Osteomyelitis

Abstract Background Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial. Methods We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years. Results Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission. Conclusions Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

Clinical vigilance for progressive multifocal leukoencephalopathy in the context of natalizumab use

2009 ◽  
Vol 15 (4_suppl) ◽  
pp. 16-25 ◽  
Author(s):  
Carlo Tornatore ◽  
David B Clifford
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Clinical Outcomes ◽  
Treatment Options ◽  
Current Treatment ◽  
Recent History ◽  
Clinical Guidance ◽  
Disease States ◽  
History Of

Natalizumab therapy for patients with multiple sclerosis (MS) has been associated with both improved clinical outcomes and an increased incidence of progressive multifocal leukoencephalopathy (PML). We provide details of the etiology and recent history of PML as associated with immunosuppressive disease states, including MS. Furthermore, it offers clinical guidance on differentiating PML from a MS relapse and a review of the current treatment options for patients suspected of having developed the complication.

scholarly journals Surgical Management of Thoracic Osteomyelitis due to Escherichia Coli Sepsis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Mark K. Lyons ◽  
Maziyar Kalani ◽  
Matthew T. Neal ◽  
Naresh P. Patel
Keyword(s):  
Escherichia Coli ◽  
Case Report ◽  
Surgical Management ◽  
Treatment Options ◽  
Vertebral Osteomyelitis ◽  
Immunocompetent Adult ◽  
Spinal Stabilization ◽  
Neurologic Recovery ◽  
History Of ◽  
Systemic Symptoms

Case Report. Escherichia coli is a rare cause of vertebral osteomyelitis. It is more common in adults and males. We present a case of an immunocompetent adult male presenting with a several month history of progressive systemic symptoms and subsequent neurologic compromise. We discuss the neurosurgical evaluation of a patient with a progressive vertebral osteomyelitis and treatment options. Surgical debridement and spinal stabilization were performed and confirmed the diagnosis. The patient successfully completed a prolonged antimicrobial therapy course. The patient made a complete neurologic recovery. We discuss the presentation of a patient with Escherichia coli vertebral osteomyelitis and the successful surgical management.

scholarly journals M92. THE OVERLAP BETWEEN PSYCHOTIC SYMPTOMS, SUBSTANCE USE, AND ADVERSITY HISTORY: A SYSTEMATIC REVIEW

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S169-S170
Author(s):  
Victoria Patterson ◽  
Alissa Pencer ◽  
Philip Tibbo
Keyword(s):  
Systematic Review ◽  
Substance Use ◽  
Adverse Event ◽  
Adverse Events ◽  
Psychotic Disorder ◽  
Substance Misuse ◽  
Psychotic Disorders ◽  
Treatment Options ◽  
Psychotic Symptoms ◽  
History Of

Abstract Background Research has found that adversity and substance use individually influence the onset of psychosis and its clinical outcomes, though there has been little examination of a potential three-way interaction. An estimated 30–75% of individuals with psychosis have experienced at least one adverse event that predates their psychotic symptoms, and substance misuse is estimated to exceed 55% in individuals with psychosis. The current systematic review is the first attempt to review the temporal ordering of adversity, psychosis, and substance misuse, as well as examining the effect of type (e.g., type of adversity, type of substance) on the association between these variables. Methods Following PRISMA guidelines, a comprehensive search strategy and review of studies against strict inclusion and exclusion criteria was completed. Studies published between 2000 and 2020 were included from PsycINFO, PubMed, CINAHL, EMBASE, Scopus, Web of Science, and the grey literature. Inclusion criteria, all of which must be met within a single study, included a diagnosed psychotic disorder, experiencing at least one adverse event, and current or past problematic substance use (i.e., substance misuse). High-risk and prodromal studies were excluded. We used search term combinations such as (schizophrenia OR schizoaffective) AND (adversity or trauma OR abuse) AND (“substance abuse” OR cannabis OR cocaine). Results Our initial search found 7,183 papers examining psychotic disorders, substance misuse, and adversity. Preliminary results for included studies indicate that 13 studies met criteria for inclusion. Across studies, the prevalence of experiencing at least one adverse event ranged from 24.8 to 100%, with significant variation in rates among studies due to variance in definitions of adversity, instruments used, and types of adverse events assessed. It is noteworthy that people with a psychotic disorder and a substance use disorder experienced more adverse events compared to people with a psychotic disorder and no substance use disorder. Moreover, individuals with a psychotic disorder, substance misuse, and a history of adversity are more likely to experience reduced functional outcomes, lower rates of remission of psychotic symptoms, and increased post-traumatic stress symptoms and diagnoses. Across studies, adversity appeared to precede substance misuse, which preceded psychotic disorder onset. Discussion Our results suggest that individuals affected by psychotic disorders, substance misuse, and a history of adversity fare worse than those without a history of adversity, even once enrolled in a treatment program for psychosis. Moreover, adversity appeared to precede both substance misuse and psychotic disorders, however, the role of additional adverse events within this relationship was not well-studied and should be examined in the future. Findings suggest that assessing for substance use and a history of adversity within psychosis treatment programs is a critical first step in the recovery for people affected by these psychiatric comorbidities and specific treatment options addressing these factors would be critical for recovery. Moreover, treatment options should be capable of targeting maintenance mechanisms (e.g., avoidance, hopelessness) shared by all three constructs to provide an integrated treatment approach.

LIFETIME HISTORY OF SUBSTANCE USE PREDICTS TRANSITION TO PSYCHOSIS IN ULTRA-HIGH RISK INDIVIDUALS

2008 ◽  
Vol 102 (1-3) ◽  
pp. 51
Author(s):  
Miriam Schäfer ◽  
Konstantinos Papageorgiou ◽  
Jana Becker ◽  
Patrick McGorry ◽  
Paul Amminger
Keyword(s):  
Substance Use ◽  
High Risk ◽  
Lifetime History ◽  
Ultra High Risk ◽  
History Of

Abstract 13323: Identifying the Culprit Lesion in a Symptomatic Patient With Physiologically Corrected Transposition of the Great Arteries

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nael Aldweib ◽  
Ada Stefanescu ◽  
Ami Bhatt ◽  
Christopher P Learn ◽  
Doreen D Yeh
Keyword(s):  
High Risk ◽  
Medical Management ◽  
Systolic Function ◽  
Stress Test ◽  
Systolic Dysfunction ◽  
Treatment Options ◽  
Symptomatic Patient ◽  
Systemic Right Ventricle ◽  
History Of ◽  
Corrected Transposition

Introduction: Physiologically corrected transposition of the great arteries [(S,L,L) TGA] is a rare congenital heart disease characterized by atrioventricular and ventriculoarterial discordance. Case Presentation: A 28-year-old man with (S,L,L) TGA, pulmonary valve (PV) stenosis, ventricular septal defect (VSD), and history of Kawasaki disease who presented for a gradual decline in exercise tolerance. Oxygen saturation was 96% at rest and dropped to 86% with ambulation. Hemoglobin was 17.7 g/dl, EKG showed no bradyarrhythmias. On stress test, peak heart rate was 159 beats/minute, and peak VO 2 22.6 ml/kg/min (83%, and 57% of predicted value respectively). Spirometry was normal. Transthoracic echocardiogram revealed biventricular hypertrophy with normal systolic function, a bicuspid PV with severe stenosis (peak and mean gradient of 155 and 90 mmHg respectively), large inlet VSD with bidirectional flow and mild systemic TV regurgitation. Coronary CTA showed no coronary artery aneurysms. Cardiac catheterization suggested hypoxia due to pulmonary-to-systemic shunting across the VSD with Q p /Q s = 0.86 (Figure). Consideration should be given to performing a high-risk surgical repair versus medical management. Conclusions: Natural history, symptoms, and timing of intervention are determined by the associated cardiac anomalies and the progressive dysfunction of the systemic right ventricle (SRV). Anatomic repair to restore the left ventricle as a systemic pump is a very high-risk procedure in adults. Functional repair maintains SRV, repair the VSD, and PV stenosis has a poor late outcome. Medical management ensures iron stores are repleted, provide empirical use of pharmacological heart failure therapy, and referral to heart transplantation when SRV systolic dysfunction ensues. Clinicians need to know the potential complications in both unoperated patients and following various surgical repairs to recommend appropriate treatment options.

scholarly journals Toward clinical equipoise: the current case for carotid angioplasty and stent placement

2005 ◽  
Vol 18 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Elad I. Levy ◽  
Robert D. Ecker ◽  
James J. Thompson ◽  
Peter A. Rosella ◽  
Ricardo A. Hanel ◽  
...  
Keyword(s):  
High Risk ◽  
Stent Placement ◽  
Treatment Options ◽  
Occlusive Disease ◽  
Clinical Equipoise ◽  
Current Case ◽  
Asymptomatic Patients ◽  
Risk Patients ◽  
History Of ◽  
Distal Protection

Recent advances in carotid artery (CA) stent placement procedures have propelled this technology into the forefront of treatment options for both symptomatic and asymptomatic patients with CA stenosis. Until recently, endarterectomy was the only surgical option for patients with CA occlusive disease. For high-risk surgical candidates, periprocedural stroke rates remained unacceptable and were significantly higher than those associated with the natural history of the disease. Advances in stent technology and improvements in antiplatelet and antithrombotic regimens, in conjunction with distal protection devices, have significantly lowered the risk of periprocedural complications for high-risk surgical candidates requiring CA revascularization. In this paper the authors review data gleaned from the important recent CA stent trials and address questions concerning the safety, efficacy, and durability of stent-assisted angioplasty for extracranial CA occlusive disease. Additionally, they review the role of noninvasive imaging modalities for the diagnosis and surveillance of CA disease in these high-risk patients.

scholarly journals Predicting Dropout from Inpatient Substance Use Disorder Treatment: A Prospective Validation Study of the OQ-Analyst

2019 ◽  
Vol 13 ◽  
pp. 117822181986618
Author(s):  
Hanne H Brorson ◽  
Espen Ajo Arnevik ◽  
Kim Rand
Keyword(s):  
Substance Use ◽  
High Risk ◽  
Substance Use Disorder ◽  
Bayes Factor ◽  
Predictive Accuracy ◽  
Predictive Ability ◽  
Random Intercept ◽  
Icd 10 ◽  
Patients At Risk ◽  
Prospective Longitudinal

Background and Aims: There is an urgent need for tools allowing therapists to identify patients at risk of dropout. The OQ-Analyst, an increasingly popular computer-based system, is used to track patient progress and predict dropout. However, we have been unable to find empirical documentation regarding the ability of OQ-Analyst to predict dropout. The aim of the present study was to perform the first direct test of the ability of the OQ-Analyst to predict dropout. Design: Patients were consecutively enlisted in a naturalistic, prospective, longitudinal clinical trial. As interventions based on feedback from the OQ-Analyst could alter the outcome and potentially render the prediction wrong, feedback was withheld from patients and therapists. Setting: The study was carried out during 2011–2013 in an inpatient substance use disorder clinic in Oslo, Norway. Participants: Patients aged 18 to 28 years who met criteria for a principal diagnosis of mental or behavioural disorder due to psychoactive substance use (ICD 10; F10.2–F19.2). Measurements: Red signal (predictions of high risk) from the Norwegian version of the OQ-Analyst were compared with dropouts identified using patient medical records as the standard for predictive accuracy. Findings: A total of 40 patients completed 647 OQ assessments resulting in 46 red signals. There were 27 observed dropouts, only one of which followed after a red signal. Patients indicated by the OQ-Analyst as being at high risk of dropping out were no more likely to do so than those indicated as being at low risk. Random intercept logistic regression predicting dropout from a red signal was statistically nonsignificant. Bayes factor supports no association. Conclusions: The study does not support the predictive ability of the OQ-Analyst for the present patient population. In the absence of empirical evidence of predictive ability, it may be better not to assume such ability.

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