scholarly journals 703. Do Patients with Drug Use-Associated Infective Endocarditis Receive Differential Care?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S402-S403
Author(s):  
Ashley Ceniceros ◽  
Uriel Felson ◽  
Aaron Fox
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
A Priori ◽  
Differential Treatment ◽  
People Who Use Drugs ◽  
Odds Ratios ◽  
Related Factors ◽  
Study Objective ◽  
Unstable Housing ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is the preferred modality for long term intravenous antibiotics for infections such as infective endocarditis (IE). People with drug use-associated (DUA) infections achieve similar outcomes as those with non-DUA-infections when treated using OPAT. The study objective was to compare OPAT use between cohorts of patients with DUA-IE and non-DUA-IE. Methods This retrospective cohort study compared OPAT use for DUA-IE vs. non-DUA-IE in adults hospitalized between 1/1/15 and 9/1/19 at three Bronx, NY hospitals. We used multivariable logistic regression to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariates that were decided a priori. Additional models excluded patients with unstable housing and those who left against medical advice (AMA). Figure 1: Flow chart of inclusion and exclusion criteria Results The cohort included 457 patients (346 non-DUA-IE, 111 DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (mean age 54.9 years), more commonly male (65.8%), Hispanic (44.1%), Medicaid insured (40.5%), and undomiciled (9%). In models adjusting for age, sex, race/ethnicity, insurance, year of admission, length of stay, socioeconomic status, Charlson Comorbidity Index, MICU admissions, and infectious disease consults, DUA-IE patients had significantly lower odds of being discharged with OPAT than non-DUA-IE patients (aOR 0.16, 95% CI 0.08, 0.34). Odds of being discharged with OPAT remained lower for DUA-IE patients after excluding unstably housed patients (aOR 0.17, 95% CI 0.09, 0.38) and patients who left AMA (aOR 0.23, 95% CI 0.11, 0.47). Table 1: Non-DUA-IE and DUA-IE Patient Characteristics Table 2: Unadjusted and Adjusted Odds Ratios for Discharge with OPAT Table 3: Odds Ratios for Discharge with OPAT Among Patients Stably Housed and Retained in Care Conclusion Patients with DUA-IE were discharged with OPAT significantly less than those with non-DUA-IE, and patients having unstable housing or leaving AMA did not account for these differences. These data do not elucidate whether differential treatment was clinically appropriate, but other studies have demonstrated safety and effectiveness of OPAT in DUA-infections. Understanding whether addressable clinician-related factors, including their attitudes toward people who use drugs, contribute to differential treatment is an important next step in this research. Disclosures All Authors: No reported disclosures

scholarly journals Low Use of Outpatient Parenteral Antimicrobial Therapy for Drug Use-Associated Infective Endocarditis in an Urban Hospital System

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Ashley G Ceniceros ◽  
Nupur Shridhar ◽  
Melissa Fazzari ◽  
Uriel Felsen ◽  
Aaron D Fox
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Antimicrobial Therapy ◽  
The United States ◽  
Urban Hospital ◽  
Hospital System ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Intravenous Antibiotics ◽  
Multivariable Regression ◽  
Clinically Significant

Abstract Background The opioid crisis in the United States has led to increasing hospitalizations for drug use-associated infective endocarditis (DUA-IE). Outpatient parenteral antimicrobial therapy (OPAT), the preferred modality for intravenous antibiotics for infective endocarditis, has demonstrated similar outcomes among patients with DUA-IE versus non-DUA-IE, but current studies suffer selection bias. The utilization of OPAT for DUA-IE more generally is not well studied. Methods This retrospective cohort study compared OPAT use for DUA-IE versus non-DUA-IE in adults hospitalized between January 1, 2015 and September 1, 2019 at 3 urban hospitals. We used multivariable regression analysis to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariables. Results The cohort included 518 patients (126 DUA-IE, 392 non-DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (53.0 vs 68.2 years, P < .001) and more commonly undomiciled (9.5% vs 0.3%, P < .01). Patients with DUA-IE had a significantly lower odds of discharge with OPAT than non-DUA-IE patients (adjusted odds ratio [aOR] = 0.20; 95% confidence interval [CI], 0.10–0.39). Odds of discharge with OPAT remained lower for patients with DUA-IE after excluding undomiciled patients (aOR = 0.22; 95% CI, 0.11–0.43) and those with patient-directed discharges (aOR = 0.27; 95% CI, 0.14–0.52). Conclusions Significantly fewer patients with DUA-IE were discharged with OPAT compared to those with non-DUA-IE, and undomiciled patients or patient-directed discharges did not fully account for this difference. Efforts to increase OPAT utilization among patients with DUA-IE could have important benefits for patients and the healthcare system.

scholarly journals 58. Cost-Effectiveness of Emerging Antibiotic Strategies for the Treatment of Drug-Use Associated Infective Endocarditis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S40-S40
Author(s):  
Joella W Adams ◽  
Alexandra Savinkina ◽  
Mam Jarra Gai ◽  
Allison Hill ◽  
James Hudspeth ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Clinical Outcomes ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Status Quo ◽  
Opioid Use ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Status

Abstract Background Drug use-associated infective endocarditis (DUA-IE) is typically treated with 4-6 weeks of in hospital intravenous antibiotics (IVA). Outpatient parenteral antimicrobial therapy (OPAT) and partial oral antibiotics (PO) may be as effective as IVA, though long-term outcomes and costs remain unknown. We evaluated the clinical outcomes and cost-effectiveness of four antibiotic treatment strategies for DUA-IE. Methods We used a validated microsimulation model to compare: 1) 4-6 weeks of inpatient IVA along with opioid detoxification, status quo (SQ); 2) 4-6 weeks of inpatient IVA along with inpatient addiction care services (ACS) which offers medications for opioid use disorder (SQ with ACS); 3) 3 weeks of inpatient IVA with ACS followed by OPAT (OPAT); and 4) 3 weeks of IVA with ACS followed by PO antibiotics (PO). We derived model inputs from clinical trials and observational cohorts. All patients were eligible for either in-home or post-acute care OPAT. Outcomes included life years (LYs), discounted costs, incremental cost-effectiveness ratios (ICERs), proportion of DUA-IE cured, and mortality attributable to DUA-IE. Costs (&US) were annually discounted at 3%. We performed probabilistic sensitivity analyses (PSA) to address uncertainty. Results The SQ scenario resulted in 18.64 LY at a cost of &416,800/person with 77.4% hospitalized DUA-IE patients cured and 5% of deaths in the population were attributable to DUA-IE. Life expectancy was extended by each strategy: 0.017y in SQ with ACS, 0.011 in OPAT, and 0.024 in PO. The PO strategy provided the highest cure rate (80.2%), compared to 77.9% in SQ with ACS and 78.5% in OPAT and X in SQ. OPAT was the least expensive strategy at &412,300/person, Compared to OPAT, PO had an ICER of &141,500/LY. Both SQ strategies provided worse clinical outcomes for money invested than either OPAT or PO (dominated). All scenarios decreased deaths attributable to DUA-IE compared to SQ. Findings were robust in PSA. Table 1 Selected cost and clinical outcomes comparing treatment strategies for drug-use associated infective endocarditis including the status quo, status quo with addiction care services, outpatient parenteral antimicrobial therapy, and partial oral antibiotics. Conclusion Treating DUA-IE with OPAT along with ACS increases the number of people completing treatment, decreases DUA-IE mortality, and is cost-saving compared to the status quo. The PO strategy also improves clinical outcomes, but may not be cost-effective at the willingness-to-pay threshold of &100,000. Disclosures Simeon D. Kimmel, MD, MA, Abt Associates for a Massachusetts Department of Public Health project to improve access to medications for opioid use disorder in nursing facilities (Consultant)

scholarly journals A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253923
Author(s):  
Ellen C. Rowlands Snyder ◽  
Lisa M. Boucher ◽  
Ahmed M. Bayoumi ◽  
Alana Martin ◽  
Zack Marshall ◽  
...  
Keyword(s):  
Drug Use ◽  
Community Integration ◽  
Individual Characteristics ◽  
Self Report ◽  
People Who Use Drugs ◽  
Cross Sectional ◽  
Housing Status ◽  
Unstable Housing ◽  
Factors Associated ◽  
Stable Housing

Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.

scholarly journals “Running myself ragged”: stressors faced by peer workers in overdose response settings

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Zahra Mamdani ◽  
Sophie McKenzie ◽  
Bernadette Pauly ◽  
Fred Cameron ◽  
Jennifer Conway-Brown ◽  
...  
Keyword(s):  
Drug Use ◽  
Focus Groups ◽  
Mixed Methods Research ◽  
Financial Burden ◽  
People Who Use Drugs ◽  
Frequency Distributions ◽  
Sequential Mixed Methods ◽  
Health Quality ◽  
Mental Health Effects ◽  
Perception Of Health

Abstract Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

Experimental Evaluations of a Model of Mental Workload

1989 ◽  
Vol 33 (18) ◽  
pp. 1233-1237 ◽  
Author(s):  
P. A. Hancock ◽  
M. H. Chignell ◽  
M. Vercruyssen ◽  
M. Denhoff
Keyword(s):  
Path Length ◽  
Mental Workload ◽  
Movement Time ◽  
A Priori ◽  
Independent Effect ◽  
Subjective Perception ◽  
Performance Task ◽  
Related Factors ◽  
Task Goal ◽  
Systematic Effects

The present experiments were designed to test predictions from a model of mental workload. The model predicts non-linear increases in mental workload as perceived distance from a task goal grows and effective time for action is reduced. Diminution of mental workload is achieved by application of effort which brings the task goal into the region of acceptable time/distance constraints for successful resolution. Two experiments are reported which tested these assertions using the timepools performance task. Timepools is unique as a performance task in that it generates a spatial representation of a shrinking temporal target. The independent effects of path length, i.e., the number of sequential targets to be acquired, and shrink rate, i.e., the collapse time during which the circle is halved in area, may be assessed using performance variables such as reaction time (RT), movement time (MT), error rate (E), and the subjective perception of workload. Data from Experiment 1, indicate systematic effects for task related factors across performance and workload measures, although such a pattern was not isomorphically mapped to the a priori assumed difficulty of the task. In Experiment 2, shrink rate and path length had independent effect on RT and MT respectively, which were reflected in components of the individual workload scales. The ramifications with respect to the model are elaborated.

Infective endocarditis secondary to injection drug use: A survey of Canadian cardiac surgeons

2021 ◽  
Author(s):  
Kevin R. An ◽  
Jessica G.Y. Luc ◽  
Derrick Y. Tam ◽  
Olina Dagher ◽  
Rachel Eikelboom ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Cardiac Surgeons

scholarly journals Injection Drug Use–Associated Infective Endocarditis

JAMA ◽  
2018 ◽  
Vol 320 (18) ◽  
pp. 1939 ◽  
Author(s):  
David Phillip Serota ◽  
J. Deanna Wilson ◽  
Jessica S. Merlin
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug

scholarly journals Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003759
Author(s):  
Dan Lewer ◽  
Brian Eastwood ◽  
Martin White ◽  
Thomas D. Brothers ◽  
Martin McCusker ◽  
...  
Keyword(s):  
Drug Use ◽  
Hospital Admission ◽  
Crossover Study ◽  
Hospital Admissions ◽  
Conditional Logistic Regression ◽  
Early Discharge ◽  
Odds Ratios ◽  
Drug Poisoning ◽  
Case Crossover ◽  
Increased Risk

Background Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.

The Lived Experience of Nurses Caring for Patients Diagnosed With Intravenous Drug Use–Associated Infective Endocarditis in Appalachia: A Phenomenological Study

2021 ◽  
pp. 107839032110377
Author(s):  
Kendrea L. Todt ◽  
Sandra P. Thomas
Keyword(s):  
Substance Use ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Substance Use Disorder ◽  
Phenomenological Study ◽  
Care Delivery ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Central Theme ◽  
Number Of Patients

BACKGROUND: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. OBJECTIVE: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. METHOD: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. RESULTS: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. CONCLUSIONS: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses.

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