scholarly journals 1365. Clinical and Financial Implication of Dalbavancin Utilization on Length of Stay Avoidance in Acute Bacterial Skin and Skin Structure Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S768-S769
Author(s):  
Sonia S Kim ◽  
Brandon Chen ◽  
Karan Raja ◽  
Mitesh Patel ◽  
Mona Philips
Keyword(s):  
Single Dose ◽  
Length Of Stay ◽  
Prospective Study ◽  
Drug Cost ◽  
Hospital Cost ◽  
Primary Outcome ◽  
Skin Structure ◽  
Cost Avoidance ◽  
Avoidable Admissions ◽  
Secondary Outcomes

Abstract Background Our institution admits 650 patients annually for acute bacterial skin and skin structure infection (ABSSSI). These patients may require intravenous antibiotics, potentially complicated by social factors and loss to follow up. Dalbavancin is a long-acting lipoglycopeptide given as a single dose regimen for ABSSSI. A previous review conducted at our institution identified 117 potential avoidable hospital days over 4 months with outpatient dalbavancin use. The objective of this prospective study was to evaluate the clinical and financial impact of avoided admissions with outpatient dalbavancin use. Methods The Institutional Review Board approved this single-site, prospective study. All patients who presented to the emergency department (ED) with ABSSSI from December 15, 2020 to April 15, 2021 were included in the study. Dalbavancin eligibility criteria were given to providers. Eligible patients were given a single dose of dalbavancin and then discharged. The primary outcome was the difference between percentage of avoidable admissions from the ED with dalbavancin use in the retrospective cohort and prospective cohort. The secondary outcomes were estimated length of stay avoidance, percentage of treatment success without ED re-visit within 30 days, estimated hospital cost avoidance and drug cost reimbursement. The primary outcome was assessed using the Chi-square test. Descriptive statistics were used for the secondary outcomes. Results Fourteen patients received dalbavancin and avoided hospital admissions. The percentages of admissions avoided in the retrospective and prospective cohorts were 16.02% and 6.67%, respectively (Figure 1). A difference of 9.35% was found to be statistically significant (p=0.01). The total estimated length of stay avoidance was 50 days. No patients re-visited the ED within 30 days with treatment failure. The total estimated hospital cost avoidance was &148,852 (Table 1). The net reimbursement for dalbavancin over drug cost was &5,100 (Table 2). Conclusion Dalbavancin use decreased avoidable admissions. At our institution, annual hospital cost savings can reach &1,015,794 if dalbavancin was utlilized to all eligible patients. Disclosures All Authors: No reported disclosures

scholarly journals LO45: Does the use of point of care ultrasonography improve survival in emergency department patients with undifferentiated hypotension? The first Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED1) Study; an international randomized controlled trial

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S43
Author(s):  
P.R. Atkinson ◽  
J. Milne ◽  
L. Diegelmann ◽  
H. Lamprecht ◽  
M. Stander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Length Of Stay ◽  
Diagnostic Accuracy ◽  
Standard Care ◽  
Primary Outcome ◽  
Point Of Care ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Secondary Outcomes

Introduction: Point of care ultrasound (PoCUS) is an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). While PoCUS protocols have been shown to improve early diagnostic accuracy, there is little published evidence for any mortality benefit. We report the findings from our international multicenter randomized controlled trial, assessing the impact of a PoCUS protocol on survival and key clinical outcomes. Methods: Recruitment occurred at 7 centres in North America (4) and South Africa (3). Scans were performed by PoCUS-trained physicians. Screening at triage identified patients (SBP<100 or shock index>1), randomized to PoCUS or control (standard care and no PoCUS) groups. Demographics, clinical details and study findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. The primary outcome measure was 30-day/discharge mortality. Secondary outcome measures included diagnostic accuracy, changes in vital signs, acid-base status, and length of stay. Categorical data was analyzed using Fishers test, and continuous data by Student T test and multi-level log-regression testing. (GraphPad/SPSS) Final chart review was blinded to initial impressions and PoCUS findings. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no difference between groups for the primary outcome of mortality; PoCUS 32/129 (24.8%; 95% CI 14.3-35.3%) vs. Control 32/129 (24.8%; 95% CI 14.3-35.3%); RR 1.00 (95% CI 0.869 to 1.15; p=1.00). There were no differences in the secondary outcomes; ICU and total length of stay. Our sample size has a power of 0.80 (α:0.05) for a moderate effect size. Other secondary outcomes are reported separately. Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We did not find any mortality or length of stay benefits with the use of a PoCUS protocol, though a larger study is required to confirm these findings. While PoCUS may have diagnostic benefits, these may not translate into a survival benefit effect.

The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 784-793 ◽  
Author(s):  
Dipankar Mukherjee ◽  
Devon T Collins ◽  
Chang Liu ◽  
Neul Ha ◽  
Jeffrey Jim
Keyword(s):  
Myocardial Infarction ◽  
Length Of Stay ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Transient Ischemic Attack ◽  
Primary Outcome ◽  
Composite Outcome ◽  
Reversal Time ◽  
Secondary Outcomes ◽  
Ischemic Attack

Objective The primary purpose of this study was to examine any potential difference in clinical outcomes between transcarotid artery revascularization performed under local anesthesia compared with general anesthesia by utilizing a large national database. Methods The primary outcome of the study was a composite endpoint of postoperative in-hospital stroke, myocardial infarction and mortality following transcarotid artery revascularization for the index procedure. Secondary outcomes included a composite outcome of postoperative in-hospital stroke, transient ischemic attack, myocardial infarction and mortality along with several subsets of its components and each individual component, flow reversal time (min), radiation dose (GY/cm2), contrast volume utilized (mL), total procedure time (min), extended total length of stay (>1 day) and extended postoperative length of stay (>1 day). Statistical analyses employed both descriptive measures to characterize the study population and analytic measures such as multivariable mixed-effect linear and logistic regressions using both unmatched and propensity-score matched cohorts. Results A total of 2609 patients undergoing transcarotid artery revascularization between the years 2016 and 2018 in the US were identified, with 82.3% performed under general anesthesia and 17.7% under local anesthesia. The primary composite outcome was observed in 2.3% of general anesthesia patients versus 2.6% of local anesthesia patients ( p = 0.808). The rate of postoperative transient ischemic attack and/or myocardial infarction was 1.6% with general anesthesia versus 1.1% with local anesthesia ( p = 0.511). For adjusted regression analysis, general anesthesia and local anesthesia were comparable in terms of primary outcome (OR: 0.72; 95% CI: 0.27–1.93, p = 0.515). As for the secondary outcomes, no significant differences were found except for contrast, where the results demonstrated significantly less need for contrast with procedures performed under general anesthesia (coefficient: 4.94; 95% CI: 1.34–8.54, p = 0.007). A trend towards significance was observed for lower rate of postoperative transient ischemic attack and/or myocardial infarction (OR: 0.33; 95% CI: 0.09–1.18, p = 0.088) and lower flow reversal time under local anesthesia (coefficient: –0.94: 95% CI: –2.1–0.22, p = 0.111). Conclusions Excellent outcomes from transcarotid artery revascularization for carotid stenosis were observed in the VQI database between the years 2016 and 2018, under both local anesthesia and general anesthesia. The data demonstrate the choice of anesthesia for transcarotid artery revascularization does not appear to have any effect on clinical outcomes. Surgical teams should perform transcarotid artery revascularization under the anesthesia type they are most comfortable with.

scholarly journals Effects of photobiomodulation therapy combined with static magnetic field (PBMT-sMF) in patients with severe COVID-19 requiring intubation: a pragmatic randomized placebo-controlled trial

2020 ◽  
Author(s):  
Thiago De Marchi ◽  
Fabiano Frâncio ◽  
João Vitor Ferlito ◽  
Renata Monteiro Weigert ◽  
Cristiane Aparecida de Oliveira ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Invasive Mechanical Ventilation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Secondary Outcomes ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

ABSTRACTBackgroundPhotobiomodulation therapy (PBMT) when used isolated or combined with static magnetic field (PBMT-sMF) has been proven benefits on skeletal muscle increasing performance and reducing fatigue, increasing oxygen saturation, and modulating inflammatory process. However, it is unknown whether the effects observed with this therapy on respiratory muscles will be similar to the effects previously observed on skeletal muscles.ObjectiveWe aimed to investigate whether PBMT-sMF is able to decrease the length of stay in the intensive care unit (ICU) and to reduce the mortality rate of patients with severe COVID-19 requiring invasive mechanical ventilation, increasing the respiratory function and modulating the inflammatory process.MethodsWe conducted a prospectively registered, pragmatic, triple-blinded (patients, therapists and outcome assessors), randomized, placebo-controlled trial of PBMT-sMF in patients with severe COVID-19, requiring invasive mechanical ventilation, admitted to the ICU. Patients were randomly assigned to receive either PBMT-sMF (6 sites at the lower thorax – 189 J total, and 2 sites at the neck area – 63 J total) or placebo PBMT-sMF daily during all the ICU stay. The primary outcome was length of stay in the ICU defined by either discharge or death. The secondary outcomes were survival rate, muscle function of diaphragm, change in blood tests, change in mechanical ventilation parameters and change in arterial blood gas analysis.ResultsA total of 30 patients underwent randomization (with 15 assigned to PBMT-sMF and 15 to placebo) and were analyzed. The length of stay in the ICU for the placebo group was 23.06 days while for the PBMT-sMF group was 16.26. However, there was no statistically difference between groups for the length of stay in the ICU (mean difference - MD = - 6.80; 95% CI = - 18.71 to 5.11). Regarding the secondary outcomes were observed statistically differences in favor of PBMT-sMF for diaphragm thickness, fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen ratio, C-reactive protein, lymphocytes count, and hemoglobin (p<0.05).ConclusionAmong patients with severe COVID-19 requiring invasive mechanical ventilation, PBMT-sMF was not statistically different than placebo to the length of stay in the ICU. However, it is important to highlight that our sample size was underpowered to detect statistical differences to the primary outcome. In contrast, PBMT-sMF increased muscle function of diaphragm, improved ventilatory parameters, decreased C-reactive protein levels and hemoglobin count, and increased lymphocytes count.

scholarly journals Improved economic and clinical outcomes with oritavancin versus a comparator group for treatment of acute bacterial skin and skin structure infections in a community hospital

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248129
Author(s):  
Kimberly Saddler ◽  
Jason Zhang ◽  
Jennifer Sul ◽  
Pruthvi Patel ◽  
Miriams Castro-Lainez ◽  
...  
Keyword(s):  
Single Dose ◽  
Hospital Cost ◽  
Average Length ◽  
Group Versus ◽  
Readmission Rates ◽  
Average Hospital ◽  
Skin Structure ◽  
Secondary Endpoints ◽  
Antibiotic Agents

Background Oritavancin is a lipoglycopeptide antibiotic with in vitro bactericidal activity against gram-positive pathogens indicated for use in adults with acute bacterial skin and skin structure infections (ABSSSI). Its concentration-dependent activity and prolonged half-life provide a convenient single-dose alternative to multi-dose daily therapies for ABSSSI. This retrospective cohort study was conducted to quantify the clinical and economic advantages of using oritavancin compared to other antibiotic agents that have been historically effective for ABSSSI. Methods Seventy-nine patients received oritavancin who had failed previous outpatient antibiotic therapy (OPAT) for cellulitis or abscess and were subsequently readmitted to the hospital as an inpatient between 2016 and 2018. These patients were compared to a cohort of 28 patients receiving other antibiotics following OPAT failure and subsequent hospitalization for these two infection types. The primary clinical end point was average length of stay (aLOS) and secondary endpoints included readmission rates for the same indication at 30 and 90 days after discharge and the average hospital cost (aHC). Results A total of 107 patients were hospitalized for treatment of cellulitis or abscess. Demographic characteristics of both the oritavancin and comparator groups were similar except for the presence of diabetes. The primary clinical endpoint showed a non-significant decrease in aLOS between the oritavancin group versus comparator (2.12 days versus 2.59 days; p = 0.097). The secondary endpoints revealed lower readmission rates associated with oritavancin treatment at 30 and 90 days; the average hospital cost was 5.9% lower for patients that received oritavancin. Conclusion The results of this study demonstrate that oritavancin provides not only a single-dose alternative to multi-day therapies for skin and skin structure infections, but also a clinical and economic advantage compared to other antibiotic agents.

scholarly journals The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study

2019 ◽  
Vol 46 (3) ◽  
pp. 573-582
Author(s):  
Marjolein A. M. Mulders ◽  
Monique M. J. Walenkamp ◽  
Nico L. Sosef ◽  
Frank Ouwehand ◽  
Romuald van Velde ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Radiographic Examination ◽  
Implementation Study ◽  
Wrist Trauma ◽  
Absolute Reduction ◽  
Physician Compliance ◽  
Before And After ◽  
Secondary Outcomes

Abstract Purpose While most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the effect of the implementation of the AWR at the Emergency Department (ED). Methods In a before-and-after comparative prospective cohort study, all consecutive adult patients with acute wrist trauma presenting at the ED of four hospitals were included. Primary outcome was the number of wrist radiographs before and after implementation of the AWR. Secondary outcomes were the number of clinically relevant missed fractures, the overall length of stay in the ED, physician compliance regarding the AWR, and patient satisfaction and experience with the care received at the ED. Results A total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% (p < 0.001). One clinically irrelevant fracture was missed. Non-fracture patients without wrist radiography due to the AWR spent 34 min less time in the ED compared with non-fracture patients who had a wrist radiograph (p = 0.015). The physicians adhered to the AWR in 36% of patients. Of all patients who did not receive a radiographic examination of the wrist, 87% were satisfied. Conclusion Implementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.

scholarly journals Outcomes of Alvimopan Use in Laparoscopic Intra-abdominal Surgery: A Retrospective Review

2021 ◽  
Vol 12 (4) ◽  
pp. 12
Author(s):  
Aamir A. Kokan ◽  
Sahil Sheth ◽  
Katherine Rogers
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Postoperative Ileus ◽  
Primary Outcome ◽  
Bowel Resection ◽  
Retrospective Chart Review ◽  
Abdominal Distension ◽  
Secondary Outcomes ◽  
The Impact ◽  
Oral Diet

Background: Postoperative ileus is a transient cessation of bowel motility, occurring after bowel resection, characterized by abdominal distension and pain, nausea, vomiting, and an accumulation of gas/fluids in the bowel. It is associated with a greater incidence of postoperative morbidity and increased length of stay or readmission. Alvimopan, a novel peripheral mu receptor antagonist, is indicated for preventing postoperative ileus in patients undergoing intra-abdominal surgery or bowel resection. The objective of this study was to assess the impact of alvimopan use in laparoscopic abdominal surgeries. Objective: To assess alvimopan use’s impact in laparoscopic abdominal surgeries. Methods: A retrospective chart review was conducted of 84 patients who underwent laparoscopic procedures that received alvimopan (September 1, 2018 to October 31, 2018) and compared to patients that did not receive alvimopan (May 1, 2018 to June 30, 2018, due to a national shortage of the medication). The primary outcome was the rate of postoperative ileus. Secondary outcomes included rate of 30-day readmission, length of stay (LOS), postoperative opioid and laxative use, time to initiation of oral diet, and return of bowel function (ROBF) as demonstrated by recorded bowel movement. Results: There was no statistical difference observed in primary outcome of postoperative ileus between alvimopan and no alvimopan groups (2.7% vs 4.3%, p=1). Secondary outcomes such as length of stay (5.4 days vs 5.4 days, p=0.49), length of postoperative stay (5 vs 4.9, p=0.44), days to oral diet (0.9 vs 0.4, p=0.16), time to BM (1.8 vs 2.2, p=0.32), and 30-day readmission were also similar between the two groups. Conclusion: The similar outcome profiles in all primary and secondary outcomes do not support the use of alvimopan in the setting of laparoscopic intra-abdominal surgery.

scholarly journals Bisphosphonate Versus Bisphosphonate and Calcitonin for the Treatment of Moderate to Severe Hypercalcemia of Malignancy

2020 ◽  
pp. 106002802095704
Author(s):  
Attiya A. Khan ◽  
Payal K. Gurnani ◽  
Gary D. Peksa ◽  
William L. Whittier ◽  
Joshua M. DeMott
Keyword(s):  
Primary Outcome ◽  
Hospital Length ◽  
Bisphosphonate Therapy ◽  
Hospital Length Of Stay ◽  
Combination Group ◽  
Cost Avoidance ◽  
Hypercalcemia Of Malignancy ◽  
Severe Hypercalcemia ◽  
Substantial Clinical Benefit ◽  
Secondary Outcomes

Background Historically, intravenous (IV) bisphosphonates with calcitonin are the treatment of choice for hypercalcemia of malignancy. However, evidence is lacking. Objective The objective of this study was to compare the use of bisphosphonate versus bisphosphonate with calcitonin for moderate to severe hypercalcemia of malignancy. Methods This was a retrospective study evaluating patients who received bisphosphonate and/or calcitonin for treatment of moderate to severe hypercalcemia of malignancy. Patients received usual care plus either (1) bisphosphonate or (2) bisphosphonate with calcitonin. The primary outcome was change in corrected serum calcium concentrations 48 hours after treatment. Secondary outcomes included corrected calcium levels, incidence of normocalcemia and hypocalcemia, time to normocalcemia, hospital length of stay, and cost avoidance. Results The 48-hour decrease in corrected calcium was less in the bisphosphonate group than in the combination group (2.4 [1.6-3.4] vs 3.9 [3.5-5.3]; P < 0.001). However, initial calcium levels in the combination group were higher than in the bisphosphonate group, and calcium levels at 24, 48, and 72 hours were similar. Secondary outcomes did not differ. Average cost avoidance with bisphosphonate monotherapy was $11 248 per patient and $291 448 per year. Conclusions and Relevance In the treatment of moderate to severe hypercalcemia of malignancy, IV bisphosphonate in combination with calcitonin resulted in a higher difference in corrected calcium levels at 48 hours compared with bisphosphonate therapy alone. However, corrected calcium levels in the first 72 hours, time to normocalcemia, and clinical outcomes were similar. The addition of calcitonin increases cost without substantial clinical benefit, and providers may consider avoiding calcitonin.

scholarly journals Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

2021 ◽  
Author(s):  
Sharon A. Simpson ◽  
Elinor Coulman ◽  
Dunla Gallagher ◽  
Karen Jewell ◽  
David Cohen ◽  
...  
Keyword(s):  
Weight Management ◽  
Healthy Eating ◽  
Primary Outcome ◽  
Intervention Group ◽  
Control Group ◽  
Risky Drinking ◽  
Management Intervention ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Weight Management Intervention

Abstract Objective To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth. Methods Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined. Interventions Women attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy. Results Mean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds. Conclusions There was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking. Trial registration: Current Controlled Trials ISRCTN25260464.

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