scholarly journals 234. Dalbavancin versus Outpatient Parenteral Antimicrobial Therapy with Vancomycin for Treatment of Bone and Joint Infections in a Veteran Population

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S226-S226
Author(s):  
Emily A Gibbons ◽  
Teri L Hopkins ◽  
Manuel R Escobar ◽  
Linda Yang ◽  
Elizabeth Walter ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Chart Review ◽  
Small Sample Size ◽  
Small Sample ◽  
Size Difference ◽  
Veterans Health ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Baseline Characteristics ◽  
Picc Line

Abstract Background Dalbavancin is a long-acting lipoglycopeptide with broad gram-positive activity. A long half-life makes it an attractive treatment option for bone and joint infections (BJI). Previous studies have demonstrated efficacy of dalbavancin in the treatment of BJI. Based on these studies, our institution established a protocol for using dalbavancin as an alternative to IV antibiotics via PICC line. Methods Chart review was performed to compare outcomes of patients who were treated with dalbavancin versus vancomycin for BJI from 8/2017 –7/2020. Patients that received two doses of dalbavancin for BJI were compared with patients who received OPAT with vancomycin during the same time period. Patients were excluded if they were bacteremic or received dalbavancin for another indication. Data was collected from the Veterans Health Administration’s Corporate Data Warehouse and retrospective chart review. No statistical analyses were performed due to the descriptive nature of this study. Results A total of 59 patients were included; 25 received dalbavancin and 34 received vancomycin. Relevant differences in baseline characteristics included a higher proportion of patients with osteomyelitis (88% vs 74%) and refractory infection (64% vs 44%) in the dalbavancin group. More patients in the dalbavancin group (38% vs 24%) were readmitted for the same infection within one year, required (29% vs 21%) additional surgical intervention, and had increased CRPH on follow-up labs (32% vs 3%). Dalbavancin use likely expedited discharge in at least 5 cases where vancomycin levels were not therapeutic. No significant adverse effects due to dalbavancin were noted, aside from one patient with an increase in serum creatinine. In the vancomycin group, 8 patients changed antibiotics due to adverse effects or difficulty managing levels and 3 patients had ED visits for PICC line care. Conclusion Dalbavancin may be a safe PICC-sparing treatment for BJI, particularly in cases where compliance is of concern, or there are logistical or tolerability issues with vancomycin. Our findings do raise concern for worse outcomes with dalbavancin, but the small sample size, difference in baseline characteristics between groups and descriptive nature of the study preclude any conclusions from being drawn. Disclosures All Authors: No reported disclosures

Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients

2019 ◽  
Vol 23 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Meghan L. McPhie ◽  
Alanna C. Bridgman ◽  
Mark G. Kirchhof
Keyword(s):  
Disease Severity ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Small Sample Size ◽  
Demographic Data ◽  
Severe Disease ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Combination Therapies

Background: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. Objectives: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. Methods: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Results: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. Conclusions: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

Gemcitabine/docetaxel (GD) versus gemcitabine/cisplatin (GC) in stage III/IV non-small cell lung cancer (NSCLC): Preliminary results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17116-17116 ◽  
Author(s):  
M. Gamaz ◽  
T. Makhloufi ◽  
S. Taright ◽  
R. Baba-Ahmed ◽  
R. Amrane ◽  
...  
Keyword(s):  
Squamous Cell ◽  
Small Sample Size ◽  
Locally Advanced ◽  
Small Sample ◽  
Stage Iiib ◽  
Metastatic Nsclc ◽  
Randomized Phase Ii ◽  
Significant Toxicity ◽  
Baseline Characteristics ◽  
The Difference

17116 Background: This study was designed to compare the response rates and toxicities of the standard GC regimen versus GD, a non-platin regimen, in locally advanced and metastatic NSCLC. Methods: In both arms, gemcitabine 1250 mg/m2 was administered on days 1 and 8. In the GD arm, docetaxel 75 mg/m2 was given on day 8. In the GC arm, cisplatin 70 mg/m2 was given on day 1. Both regimens were repeated every 3 weeks. Results: From September 2004 to September 2005, 47 patients were enrolled In the GD arm (N = 25), the median age was 54.6 years (range, 45–70), and 22 (88.0%) were male. The majority of patients had either squamous cell (52.0%) or adenocarcinoma (44.0%), and stage IIIB disease (64.0%). In the GC arm (N = 22), the median age was 60.9 years (range, 42–74), and 20 (90.9%) were male. Most patients also had either squamous cell (50.0%) or adenocarcinoma (31.8%), and stage IIIB disease (59.1%). The difference in age between arms was significant (p = 0.046), but the differences in the remaining baseline characteristics and demographics were not significant. Toxicity and response results are in the table below. Conclusions: Overall response rate was numerically higher in the GC arm than the GD arm, but the difference was not significant because of the small sample size in each arm. The toxicity profile was significantly better in the GC arm for fatigue and nausea/vomiting. We think that GC regimen will remain the standard in treatment for advanced and metastatic NSCLC; however, we will confirm these findings in a randomized phase II study. [Table: see text] No significant financial relationships to disclose.

scholarly journals A Matching-Adjusted Indirect Comparison of Sonidegib and Vismodegib in Advanced Basal Cell Carcinoma

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Dawn Odom ◽  
Deirdre Mladsi ◽  
Molly Purser ◽  
James A. Kaye ◽  
Eirini Palaka ◽  
...  
Keyword(s):  
Basal Cell ◽  
Comparative Effectiveness ◽  
Small Sample Size ◽  
Objective Response ◽  
Locally Advanced ◽  
Indirect Comparison ◽  
Small Sample ◽  
Curative Surgery ◽  
Adjusted Indirect Comparison ◽  
Baseline Characteristics

Objectives. Based on single-arm trial data (BOLT), sonidegib was approved in the US and EU to treat locally advanced basal cell carcinomas (BCCs) ineligible for curative surgery or radiotherapy. Vismodegib, the other approved targeted therapy, also was assessed in a single-arm trial (ERIVANCE). We examined the comparative effectiveness of the two drugs using a matching-adjusted indirect comparison (MAIC) versus an unadjusted indirect comparison. Methods. After comparing trials and identifying potential prognostic factors, an MAIC was conducted to adjust for differences in key patient baseline characteristics. Due to BOLT’s small sample size, the number of matching variables was restricted to two. Efficacy results for sonidegib were generated so that selected baseline characteristics matched those from ERIVANCE and were compared with published ERIVANCE results. Results. Matching variables were baseline percentages of patients receiving prior radiotherapy and surgery. After weighting, sonidegib objective response rate (ORR) and median progression-free survival (PFS) were effectively unchanged (prematched versus postmatched ORR and PFS, 56.1% versus 56.7% and 22.1 versus 22.1 months, resp.). Vismodegib’s ORR and PFS were 47.6% and 9.5 months. Conclusions. Comparative effectiveness of sonidegib versus vismodegib remains unchanged after adjusting BOLT patient-level data to match published ERIVANCE baseline percentages of patients receiving prior surgery and radiotherapy.

scholarly journals Time in Therapeutic Range Using a Nomogram for Dose Adjustment of Warfarin in Patients on Hemodialysis With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
pp. 205435812110460
Author(s):  
Kimberly Defoe ◽  
Jenny Wichart ◽  
Kelvin Leung
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Time In Therapeutic Range ◽  
Increased Risk ◽  
Chi Square Analysis

Background: Patients treated with hemodialysis and prescribed warfarin typically have lower time in therapeutic range (TTR) compared to the general population. This may result in less benefit or increased risk of over anticoagulation in these patients. Objective: To assess effectiveness of use of an electronic nomogram for the management of warfarin therapy in patients treated with hemodialysis. Design: Retrospective chart review. Setting: Adult patients treated with hemodialysis. Patients: Patients on hemodialysis receiving warfarin for the management of atrial fibrillation (AF) with therapy managed by nursing led electronic nomogram. Measurements: Time in therapeutic range (as fraction and Rosendaal). Methods: Retrospective chart review over 1 year of international normalized ratio (INR) results was completed, and TTR was calculated. Comparison of patients with TTR greater than 60% to those less than 60% was completed using chi-square analysis. Results: Of 43 patients with warfarin therapy managed by the nomogram, the mean TTR was 55.2% (calculated by fraction method) or 61.2% (calculated by Rosendaal method). More than half of the patients (63.5%) had moderate to good control, defined as TTR greater than 60%. Female sex, liver disease, or history of substance use and more medication holds were associated with lower TTR. Limitations: Small sample size and retrospective nature of review. Conclusions: The results of this review supports the use of an electronic, nursing-led nomogram for the maintenance management of warfarin therapy in stable patients treated with hemodialysis, as use results in TTR greater than 60% for more than half of patients.

Abstract TP277: Stroke Related Limb Weakness Confers Thrombotic Complications With PICC Lines

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammad Ibrahim ◽  
Ravjot Sodhi ◽  
Aaron Nizam ◽  
Nabiha Khakoo ◽  
Siddhart Mehta ◽  
...  
Keyword(s):  
Predictive Value ◽  
Small Sample Size ◽  
Subsequent Development ◽  
Small Sample ◽  
Stroke Patients ◽  
Dvt Prophylaxis ◽  
Line Placement ◽  
Line Insertion ◽  
Increased Risk ◽  
Picc Line

Introduction: A peripherally inserted central catheter (PICC line) is a form of intravenous access that can be used for a prolonged period, which lowers the rate of infection. Our study aims to prove that PICC line insertion predicts a higher rate of Deep Vein Thrombosis (DVT), especially in those receiving the PICC line in a weaker arm. Methods: We conducted a retrospective analysis of stroke patients admitted to NeuroICU between September 2010 and October 2011 at a community teaching hospital. Patient records were evaluated for PICC line placement, DVT, Pulmonary Embolism (PE) development, and anticoagulant status. Odds ratios were calculated for the development of DVT and PE for PICC patients, as well as the outcomes for PICC line patients based on arm strength as defined with motor strength scale using SPSS software version 20. Results: The study included a total of 307 patients (mean age = 62.5 +/- 17.2, 51% female). Ninety-nine patients had a PICC line inserted, 22 of which developed DVT, including 10 patients who appeared to have PICC Line Related Large Venous Thrombosis. The presence of a PICC line conferred an increased risk (OR= 5.18, 95% CI, 2.40-11.2) for the development of a DVT. Patients who had a PICC line placed in a weaker arm (mean strength = 2.17) were more likely to develop a DVT than patients with a PICC line in a stronger arm (mean strength = 3.07) p<0.05. Patients given DVT prophylaxis were less likely to develop a DVT (OR = 0.32, 95% CI, .004 - .252) p < 0.05. Twenty-one patients had a CT chest angiogram performed, including six patients who had evidence of a PE. Of these six patients, one patient had a PICC line placement with subsequent development of DVT followed by PE. PICC line placement and DVT had no predictive value on the development of PE due to the small sample size. Conclusions: Our data suggests that patients who had a PICC line placed into a weaker strength arm had an increased risk of DVT in the same arm and that DVT prophylaxis significantly decreases this risk. Further studies should evaluate the predictive value of PICC line insertion with the risk of developing PE in stroke patients.

A long wait: barriers to discharge for long length of stay patients

2018 ◽  
Vol 94 (1116) ◽  
pp. 546-550 ◽  
Author(s):  
Emma Jane Zhao ◽  
Apurva Yeluru ◽  
Lakshman Manjunath ◽  
Lei Ray Zhong ◽  
Hsiao-Tieh Hsu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Healthcare Staff ◽  
Care Capacity ◽  
Improve Cost

IntroductionReducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.MethodsWe conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.ResultsDischarge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.ConclusionTogether with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

scholarly journals Effectiveness of prevention programmes for obesity and chronic diseases among immigrants to developed countries – a systematic review

2009 ◽  
Vol 13 (3) ◽  
pp. 438-450 ◽  
Author(s):  
Andre MN Renzaho ◽  
David Mellor ◽  
Kelly Boulton ◽  
Boyd Swinburn
Keyword(s):  
Small Sample Size ◽  
Target Population ◽  
Skinfold Thickness ◽  
Developed Countries ◽  
Poor Quality ◽  
Small Sample ◽  
Anthropometric Data ◽  
Culturally Tailored ◽  
Population Type ◽  
Baseline Characteristics

AbstractObjectiveTo determine whether interventions tailored specifically to particular immigrant groups from developing to developed countries decrease the risk of obesity and obesity-related diseases.DesignDatabases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.ResultsThirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).ConclusionsDue to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.

Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial

2011 ◽  
Vol 23 (4) ◽  
pp. 179-183 ◽  
Author(s):  
Ho-Kyoung Yoon ◽  
Yong-Ku Kim ◽  
Changsu Han ◽  
Young-Hoon Ko ◽  
Heon-Jeong Lee ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Rating Scale ◽  
Small Sample Size ◽  
Pilot Trial ◽  
Small Sample ◽  
Open Label ◽  
Open Label Study ◽  
Label Study ◽  
Before And After ◽  
The Status

Yoon H-K, Kim Y-K, Han C, Ko Y-H, Lee H-J, Kwon D-Y, Kim L. Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial.Objective: Delirium is a life-threatening neuropsychiatric syndrome characterised by disturbances in consciousness, attention, cognition and perception. Antipsychotics are considered the drugs of choice in managing the symptoms of delirium. Paliperidone is a benzisoxazole derivative and the principal active metabolite of risperidone. In this study, we aimed to evaluate the efficacy of paliperidone for the treatment of delirium.Methods: A prospective open-label study of paliperidone for delirium treatment was performed with 6-day follow-up. Fifteen patients who met Diagnostic and Statistical Manual of Mental disorders, Fourth Edition criteria for delirium and had a score of 13 on the Delirium Rating Scale were recruited. The starting dose was 3 mg once a day and the dose was adjusted depending on the status of delirium. Daily assessments of the severity of delirium were evaluated using Memorial Delirium Assessment Scale (MDAS).Results: The mean daily maintenance dose of paliperidone was 3.75 ± 1.06. The MDAS scores before and after treatment (day 7) were 23.60 ± 6.31 and 11.33 ± 5.45 (t = 6.78, p < 0.001), respectively. The intensity of delirium showed a statistically significant reduction in MDAS scores from the first day of treatment. No serious adverse effects were observed, and none of the patients discontinued paliperidone because of adverse effects.Conclusions: This study shows that low-dose paliperidone is effective in reducing behavioural disturbances and symptoms in delirium and is well tolerated in delirious patients. This trial is an open-label study with a small sample size, and further controlled studies will be necessary.

Abstract WP301: Timing of Occurrence of MRI DWI Abnormalities in Patients with Spontaneous Intracerebral Hemorrhages: A Subgroup Analysis from The SHRINC Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jorge Kawano-Castillo ◽  
Navdeep Sangha ◽  
Ellie Eun Ju Choi ◽  
Rebecca Martinez ◽  
Teslyn Kauffman ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Small Sample Size ◽  
Randomized Study ◽  
Small Sample ◽  
Chronic Patients ◽  
Treatment Allocation ◽  
Intracerebral Hemorrhages ◽  
Baseline Characteristics ◽  
Underlying Mechanisms ◽  
Prospective Database

BACKGROUND MRI DWI abnormalities have been reported in 22-35% of patients with intracerebral hemorrhage (ICH). The mechanism underlying these changes is unknown. The timing of development of DWI changes has not been well described. We evaluated the time at which DWI changes occurred in a prospective database of patients with spontaneous ICH in the Safety of Pioglitazone for Hematoma Resolution In Intracerebral Hemorrhage trial (SHRINC). We also sought to examine if clinical features might predict the time at which DWI changes occurred. METHODS SHRINC is an ongoing prospective, randomized study evaluating the safety of pioglitazone versus placebo in patients with ICH. Patients undergo serial MRI on Day (D)1, D2, D7/14, D28, and D42. We captured the occurrence of DWI lesions on MRI and categorized patients into 4 groups according to the time of onset of DWI lesions: observed on admission (hyperacute), D2 (acute), D7 or 14 (subacute) or >28 days (chronic). Patients were excluded if they did not have an MRI for comparison on the selected days. Baseline characteristics were collected prospectively on admission and compared between groups. RESULTS: Thirty patients had complete imaging; 17 (56.67%) had DWI abnormalities in total. Characteristics are included in Table 1. Seven patients (23.33%) had DWI abnormalities remote from the ICH. There were no differences in the baseline characteristics between the groups except INR was significantly lower in the hyperacute group compared to the chronic group (p<0.05). CONCLUSION: Our data demonstrate that DWI lesions are more frequently seen at the time of initial ICH. The occurrence of DWI lesions at later time points suggests there may be different mechanisms accounting for these changes. Our study is limited by the small sample size and blinded nature of treatment allocation. Further study is needed to understand the underlying mechanisms of these DWI changes and their clinical relevance.

scholarly journals Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Abdullah Alajaji ◽  
Jagannath Chandra Shekaran ◽  
Omar Mohammed Aldhabbah ◽  
Hajar Abdullah Alhindi ◽  
Nouf Salem Almazyad ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Mortality Rate ◽  
Toxic Epidermal Necrolysis ◽  
Chart Review ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Life Threatening

Background. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening conditions caused by drug reactions. There are multiple causative drugs and different risk factors associated with SJS/TEN. Objectives. To study the epidemiology of SJS/TEN and associated mortality rate in Qassim region, Saudi Arabia. Methodology. A retrospective chart review of all patients with the diagnosis of SJS/TEN who were admitted to King Fahad Specialist Hospital (KFSH) in Qassim region, Saudi Arabia, for the period between Jan 2014 to Jan 2019. The Careware information health system is used at KFSH, and patients were identified searching the diagnosis SJS/TEN. Results. Total of 10 patients with diagnosis of SJS/TEN were admitted to KFSH for the period from Jan 2014 to Jan 2019. Antibiotics were the culprit in 5 out of 10 patients. 9 out of 10 patients survived with good outcome. One patient with the diagnosis of TEN died, given extensive skin involvement complicated by sepsis. Conclusion. Despite the limitation of this study given small sample size, this is the first study of its kind that discusses the epidemiology of SJS/TEN in Saudi Arabia. We found the estimated incidence rate of SJS/TEN in Qassim region to be 7.6 cases per million person-years. Antibiotics and antiepileptics were the culprits in 8 out of 10 patients.

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