scholarly journals 59. Impact of Pharmacist-Led De-Escalation of MRSA Therapy Using MRSA Nasal PCR

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S148-S148
Author(s):  
Marc Salvatus ◽  
Hemi Jung ◽  
Romic Eskandarian ◽  
Su Lee
Keyword(s):  
Los Angeles ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Care Community ◽  
Medication Costs ◽  
Protocol Group ◽  
Number Of Patients ◽  
The Impact

Abstract Background Experts suggest that a highly sensitive MRSA nasal PCR can be used to rule out MRSA pneumonia with a negative predictive value greater than 95%. At Adventist Health Glendale (AHGL), the MRSA nasal PCR had a 97% negative predictive value. Pharmacist-led de-escalation of MRSA therapy using MRSA nasal PCR may reduce unnecessary MRSA coverage, patient adverse events, and medication costs. The purpose of this study was to assess the impact on duration of antimicrobial therapy of pharmacist-driven de-escalation of MRSA-targeted antibiotics in pneumonia using MRSA nasal PCR. Methods This was a prospective quasi-experimental study (Oct 2018 – Mar 2019 vs. Oct 2019 – Mar 2020) at AHGL, a 515-bed acute care community hospital in Los Angeles, CA, which included adults on MRSA pneumonia agents (either IV vancomycin or IV/PO linezolid). Upon receiving CPOE orders of these MRSA-targeted therapies for pneumonia, the pharmacist ordered a MRSA nasal PCR per protocol for eligible patients, followed up with the results of the MRSA nasal PCR, and recommended to discontinue MRSA therapy if the MRSA nasal PCR was negative. This study received an exemption determination from AHGL IRB. Results The total number of patients in the pre-protocol group was 97, and 155 in the post-protocol group. There was a statistically significant decrease in the median duration of MRSA pneumonia agents from the pre-protocol group compared to the post-protocol group (3 days vs. 2 days, P-value = 0.0004). Additionally, there was a statistically significant decrease in the median hospital length of stay from the pre-protocol group compared to the post-protocol group (9 days vs. 7 days, P-value = 0.02). Conclusion Implementation of a protocol involving pharmacist-led de-escalation of MRSA-targeted antibiotics for pneumonia utilizing MRSA nasal PCR led to significant decreases in both duration of therapy of MRSA-targeted antibiotics and length of hospital stay. Disclosures All Authors: No reported disclosures

scholarly journals The impact of surgeon-based ultrasonography for parathyroid disease on a British endocrine surgical practice

2012 ◽  
Vol 94 (1) ◽  
pp. 17-23 ◽  
Author(s):  
SR Aspinall ◽  
S Nicholson ◽  
RD Bliss ◽  
TWJ Lennard
Keyword(s):  
Minimally Invasive Surgery ◽  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Negative Predictive Value ◽  
Invasive Surgery ◽  
Predictive Value ◽  
Surgical Practice ◽  
Parathyroid Disease ◽  
Operative Findings ◽  
The Impact

INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

scholarly journals Histopathological Changes in Helicobacter pylori Associated Gastritis and Scope of Special Stain and Immunohistochemistry as Diagnostic Aids

2020 ◽  
Vol 7 (50) ◽  
pp. 3027-3032
Author(s):  
Ruby Elizabeth Elias ◽  
Bindiya Gisuthan ◽  
Sreeganesh A.S
Keyword(s):  
Helicobacter Pylori ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Chronic Gastritis ◽  
Predictive Value ◽  
Diagnostic Methods ◽  
P Value ◽  
Special Stain ◽  
Frequent Finding ◽  
H Pylori

BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry

scholarly journals F.E.M. Stress-Investigation of Scolios Apex

2018 ◽  
Vol 12 (1) ◽  
pp. 51-71 ◽  
Author(s):  
A. Daghighi ◽  
H. Tropp ◽  
N. Dahlström ◽  
A. Klarbring
Keyword(s):  
Vertebral Column ◽  
Parameter Extraction ◽  
Surrounding Tissue ◽  
P Value ◽  
Shear Stresses ◽  
Response Variable ◽  
Geometric Models ◽  
Number Of Patients ◽  
Distortion Energy ◽  
The Impact

Background:In scoliosis, kypholordos and wedge properties of the vertebrae should be involved in determining how stress is distributed in the vertebral column. The impact is logically expected to be maximal at the apex.Aim:To introduce an algorithm for constructing artificial geometric models of the vertebral column from DICOM stacks, with the ultimate aim to obtain a formalized way to create simplistic models, which enhance and focus on wedge properties and relative tilting.Material/Methods:Our procedure requires parameter extraction from DICOM image-stacks (with PACS,IDS-7), mechanical FEM-modelling (with Matlab and Comsol). As a test implementation, models were constructed for five patients with thoracal idiopathic scoliosis with varying apex rotation. For a selection of load states, we calculated a response variable which is based upon distortion energy.Results:For the test implementation, pairwise t-tests show that our response variable is non-trivial and that it is chiefly sensitive to the transversal stresses (transversal stresses where of main interest to us, as opposed to the case of additional shear stresses, due to the lack of explicit surrounding tissue and ligaments in our model). Also, a pairwise t-test did not show a difference (n = 25, p-value≈0.084) between the cases of isotropic and orthotropic material modeling.Conclusion:A step-by-step description is given for a procedure of constructing artificial geometric models from chest CT DICOM-stacks, such that the models are appropriate for semi-global stress-analysis, where the focus is on the wedge properties and relative tilting. The method is inappropriate for analyses where the local roughness and irregularities of surfaces are wanted features. A test application hints that one particular load state possibly has a high correlation to a certain response variable (based upon distortion energy distribution on a surface of the apex), however, the number of patients is too small to draw any statistical conclusions.

Impact of COVID-19 Lockdown on Ocular Trauma in Benghazi, Libya

2021 ◽  
pp. 53-57
Author(s):  
Mariam Gebril ◽  
Bahjah Esehiyb ◽  
Suliman Masoud
Keyword(s):  
Statistical Difference ◽  
Surgical Intervention ◽  
Ocular Trauma ◽  
Public Health Problem ◽  
P Value ◽  
Eye Trauma ◽  
Number Of Patients ◽  
The World ◽  
The Impact ◽  
Similar Incidence

Background. COVID-19 is a new pandemic that spread over the world in 2020, for which most countries imposed rigorous lockdown to reduce its upsurge and thus its socioeconomics’ sever effects. Global measures include isolation, social distancing, lockdown any nonemergency facilities, local and international travelling restrictions. But these rules are implacable in case of trauma in general and more with ocular trauma, which represents a serious public health problem and leading cause of visual impairment. The aim of this study was to evaluate the impact of COVID -19 lock down on number of ocular traumas acquiring surgery. Methods. A retrospective study in Aljala trauma hospital in the period from 18 March to 18 April 2020 on patients who underwent surgical intervention for non-war eye trauma. Results. A total number of patients seen in emergency department were 350 patients in 2020 with four patients needed hospital admission and surgical intervention making a 1.14% of total number. While number of patients seen at the same time in 2019 were 965 patients and three patients needed surgical intervention (0.31%). There was no statistical difference in the amount of patient acquiring surgical intervention in the two periods with the P value of >0.05 Conclusion. Although total emergency eye visits decreased during the covid-19 lockdown period, similar incidence of surgery needed ocular trauma persisted.

Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

2005 ◽  
Vol 103 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Vadim Nisanevich ◽  
Itamar Felsenstein ◽  
Gidon Almogy ◽  
Charles Weissman ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Body Weight ◽  
Hospital Stay ◽  
Fluid Management ◽  
Postoperative Outcome ◽  
Protocol Group ◽  
Number Of Patients ◽  
Secondary Endpoints ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
The Impact

Background The debate over the correct perioperative fluid management is unresolved. Methods The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days. Results The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P &lt; 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P &lt; 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P &lt; 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG. Conclusions In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

scholarly journals Copeptin to rule out myocardial infarction in Blacks versus Caucasians

2018 ◽  
Vol 8 (5) ◽  
pp. 395-403 ◽  
Author(s):  
Neil Beri ◽  
Lori B Daniels ◽  
Allan Jaffe ◽  
Christian Mueller ◽  
Inder Anand ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Troponin I ◽  
Black Population ◽  
P Value ◽  
St Segment Elevation ◽  
Incremental Value ◽  
St Segment ◽  
Rule Out

Background: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. Methods: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn. Results: One hundred and forty-nine patients were diagnosed with myocardial infarction (54 Black and 95 Caucasian). The negative predictive value of copeptin at a cut-off of 14 pmol/l (as in the CHOPIN study) for myocardial infarction was higher in Blacks (98.0%, 95% confidence interval (CI) 96.2–99.1%) than Caucasians (94.1%, 95% CI 92.1–95.7%). The sensitivity at 14 pmol/l was higher in Blacks (83.3%, 95% CI 70.7–92.1%) than Caucasians (53.7%, 95% CI 43.2–64.0%). After controlling for age, hypertension, heart failure, chronic kidney disease and body mass index in a logistic regression model, the interaction term had a P value of 0.03. A cut-off of 6 pmol/l showed similar sensitivity in Caucasians as 14 pmol/l in Blacks. Conclusions: This is the first study to identify a difference in the performance of copeptin to rule out myocardial infarction between Blacks and Caucasians, with increased negative predictive value and sensitivity in the Black population at a cut-off of 14 pmol/l. This also holds true for non-ST-segment elevation myocardial infarction and, although numbers were small, similar trends exist in the normal troponin population. This may have significant implications for early rule-out strategies using copeptin.

scholarly journals Investigating the impact of disease and health record duration on the eMERGE algorithm for rheumatoid arthritis

2020 ◽  
Vol 27 (4) ◽  
pp. 601-605
Author(s):  
Vanessa L Kronzer ◽  
Liwei Wang ◽  
Hongfang Liu ◽  
John M Davis ◽  
Jeffrey A Sparks ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Index Date ◽  
Model Performance ◽  
Area Under The Curve ◽  
Population Based ◽  
Health Record ◽  
The Impact

Abstract Objective The study sought to determine the dependence of the Electronic Medical Records and Genomics (eMERGE) rheumatoid arthritis (RA) algorithm on both RA and electronic health record (EHR) duration. Materials and Methods Using a population-based cohort from the Mayo Clinic Biobank, we identified 497 patients with at least 1 RA diagnosis code. RA case status was manually determined using validated criteria for RA. RA duration was defined as time from first RA code to the index date of biobank enrollment. To simulate EHR duration, various years of EHR lookback were applied, starting at the index date and going backward. Model performance was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC). Results The eMERGE algorithm performed well in this cohort, with overall sensitivity 53%, specificity 99%, positive predictive value 97%, negative predictive value 74%, and AUC 76%. Among patients with RA duration &lt;2 years, sensitivity and AUC were only 9% and 54%, respectively, but increased to 71% and 85% among patients with RA duration &gt;10 years. Longer EHR lookback also improved model performance up to a threshold of 10 years, in which sensitivity reached 52% and AUC 75%. However, optimal EHR lookback varied by RA duration; an EHR lookback of 3 years was best able to identify recently diagnosed RA cases. Conclusions eMERGE algorithm performance improves with longer RA duration as well as EHR duration up to 10 years, though shorter EHR lookback can improve identification of recently diagnosed RA cases.

scholarly journals Volume of sputum to detect acid-fast bacilli as a measure of quality for the diagnosis of pulmonary tuberculosis at the Dr George Mukhari Hospital, South Africa

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
Iqbal Rashid ◽  
Langalibalele H. Mabuza ◽  
Indiran Govender ◽  
Deidre Pretorius
Keyword(s):  
South Africa ◽  
Pulmonary Tuberculosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
P Value ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Predictive Values ◽  
Acid Fast Bacilli

Background: Optimum sputum results for acid-fast bacilli (AFB) microscopy are linked to a sputum quantity of at least 5.0 mL. This study was aimed at establishing the effect of sputum quantity in the pick-up rate of AFB microscopy by comparing sputum samples of 5.0 mL and 2.0 mL.Methods: An analytical cross-sectional study was carried out at the Dr George Mukhari Hospital (DGMH) in Pretoria, South Africa, from 05 January 2007 to 04 January 2008.Two sputum samples, 5.0 mL and 2.0 mL, were collected from each of the 330 adult PTB (pulmonary tuberculosis) suspects. Fluorescence microscopy was used in the sputum analysis. The yield through microscopy of the 2.0 mL specimen versus the 5.0 mL specimen was compared and analysed, using culture results as the gold standard.Results: From a sample of 330 specimens, 77 tested AFB positive on microscopy. In the 5.0 mL samples, the sensitivity was 76.6% (95% CI, 66.0% – 84.7%), specificity 99.6% (95% CI 97.8% – 99.9%), positive predictive value (PV+) 98.3% (95% CI 91.1% – 99.7%), negative predictive value (PV-) 93.3% (95% CI 89.7% – 95.7%), the likelihood ratio (LR) for a positive microscopy 192 and the LR for a negative test was 0.23. In the 2.0 mL specimens, the sensitivity was 75.3% (95% CI 64.6% – 83.6%), specificity 99.2% (95% CI 97.1% – 99.8%), positive predictive value (PV+) 96.7% (95% CI 88.6% – 99.1%), negative predictive value (PV-) 93.0% (95% CI 89.3% – 95.4%), the LR for a positive microscopy was 94 and 0.25 for a negative microscopy. There was a statistically significant association (p-value < 0.001) between the microscopy and culture tests in both the 5.0 mL and the 2.0 mL specimen categories. The strength of association between the microscopy and culture, as indicated by the kappa test was 0.83 and 0.81 in the 5.0 mL and 2.0 mL categories, respectively.Conclusion: Compared to the 2.0 mL specimen category, the yield for AFB microscopy in the 5.0 mL specimen category was consistently superior, as indicated by the higher sensitivity, specificity, predictive values and the likelihood ratios in the 5.0 mL specimen category. It is recommended that sputum specimen collection for AFB microscopy should aim for a minimum volume of 5.0 mL.

scholarly journals Interleukin 21 as a diagnostic marker of rheumatoid arthritis.

2019 ◽  
Vol 26 (08) ◽  
pp. 1229-1232
Author(s):  
Khadija Kiran ◽  
Amtul Huda ◽  
Zuhair Bhatti
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Marker ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Medical College ◽  
Sensitivity Specificity

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.

scholarly journals Pleural Fluid Cholesterol Level in Differentiating Exudate from Trasudate Pleural Effusion

2020 ◽  
Vol 11 (4) ◽  
pp. 6478-6485
Author(s):  
Babu Rajendran ◽  
Suwetha Babu ◽  
Sheju Jonathan Jha J
Keyword(s):  
Pleural Effusion ◽  
Positive Predictive Value ◽  
Cholesterol Level ◽  
Negative Predictive Value ◽  
Pleural Fluid ◽  
Predictive Value ◽  
P Value ◽  
Cholesterol Levels ◽  
Specificity And Sensitivity

Correlation of pleural fluid cholesterol level with light’s criteria to differentiate exudate from transudate pleural effusion. Classification of transudate and exudate clinically was done independently based on the light's criteria. Pleural fluid cholesterol levels of 100 selected patients were obtained. The cholesterol levels were compared with the earlier obtained data to study its specificity and sensitivity in differentiating exudate from transudate effusion. It was found that pleural fluid cholesterol in comparison to protein values in differentiating exudate from transudate showed a sensitivity of 79.55%, specificity of 91.07%, the positive predictive value of 87.50%, the negative predictive value of 85.00%, with a P-value of <0.001. Comparison of pleural fluid cholesterol with LDH values showed a sensitivity of 86.36% specificity of 94.64%, the positive predictive value of 92.68%, the negative predictive value of 89.83%, with a P-value of <0.001. Also, a comparison of pleural fluid cholesterol to light's criteria showed a sensitivity of 100% and 86.4% in the transudative group and sensitivity of 100% and 91.1 % in the exudative group, respectively. Routine measurement of pleural fluid cholesterol may serve as a valuable diagnostic indicator for differentiating exudate from transudate effusion.

Sign in / Sign up

Export Citation Format

Share Document