scholarly journals 602. Intravenous Push Versus Intravenous Piggyback Administration of Cephalosporin Antibiotics: Impact on Safety, Workflow, and Cost

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S403-S404
Author(s):  
Ryan Lee ◽  
Thuong Tran ◽  
Susanna Tan ◽  
Patricia Chun
Keyword(s):  
Median Time ◽  
Cost Savings ◽  
Primary Objective ◽  
Long Beach ◽  
Pharmacy Staff ◽  
Chi Square ◽  
Short Infusion ◽  
Potential Benefits ◽  
Dose Combination ◽  
Time To Onset

Abstract Background IV piggyback (IVPB) infusion has been the standard method of administration of IV antibiotics since the 1970s. Literature has demonstrated that the IV push (IVP) method has similar pharmacokinetic exposures and risk for complications as short infusion IVPB, and may have potential benefits. The primary objective is to evaluate the incidence of infusion-related complications in patients receiving cefazolin, ceftriaxone, and cefepime administered via IVP versus short infusion IVPB at the Veteran Affairs Long Beach Healthcare System. The secondary objectives include evaluating the time-to-onset of complications, time-to-first-dose combination vancomycin in the emergency department (ED), cost, and nursing and pharmacy staff preference between IVP and IVPB. Methods This is a retrospective, single-center cohort study. Patients who received ceftriaxone, cefepime, or cefazolin between April 1st, 2019 – December 31st, 2019, and April 1st, 2020 – December 31st, 2020 were included. Patients who received the study antibiotics via IVPB during the IVP period were excluded. Statistical analyses were performed using the chi-square, fisher’s exact, Mann-Whitney U, and unpaired t-tests where appropriate. Complications associated with IVP or IVPB administration were assessed via chart review of electronic health records. Surveys to nursing and pharmacy staff were distributed using Microsoft Forms. Results 366 treatment episodes were evaluated for 355 unique patients. Complications occurred in 13 out of 183 (7.1%) treatment episodes in the IVP group compared to 18 out of 183 (9.8%) treatment episodes in the IVPB group (P = 0.35). The median time to complications was 2 days for both groups. IVP cefepime and ceftriaxone reduced the median time-to-first-dose vancomycin in the ED by 25 minutes. The use of cefazolin, ceftriaxone, and cefepime as IVP yielded a quarterly cost savings of &38,890.04. 55% of nursing staff and 85% of pharmacy staff prefer IVP administration for cefazolin, ceftriaxone, and cefepime. Conclusion Cefazolin, ceftriaxone, and cefepime given as IVP were observed to be as safe as IVPB while reducing time-to-first dose vancomycin in the ED and cost, and is the preferred method of administration among nursing and pharmacy staff. Disclosures All Authors: No reported disclosures

scholarly journals TELEVANGELISM AND THE SOCIO-POLITICAL MOBILIZATION OF PENTECOSTALS IN PORT HARCOURT METROPOLIS: A KAP SURVEY

2011 ◽  
Vol 5 (1) ◽  
pp. 61-80
Author(s):  
Godwin Okon
Keyword(s):  
Church Growth ◽  
Political Development ◽  
Political Mobilization ◽  
Primary Objective ◽  
Policy Framework ◽  
Chi Square ◽  
Kap Survey ◽  
Port Harcourt ◽  
Chi Square Test ◽  
Potential Benefits

This study was borne out of the need to ascertain the extent to which televangelists in Port Harcourt; deploy media content towards issues that border on socio-political development. The primary objective was to empirically determine if a correspondence exists between advocacy by televangelists and compliance by Pentecostals as manifested in Knowledge, Attitude and Practice (KAP). The study necessitated triangulation with the Weighted Mean Score (WMS) as the basis for quantitative analysis. Findings revealed televangelism to revolve around the pastor (p), message (m) and church (c). Though an association link was found between ideologies expressed by televangelists and adoption by Pentecostals, this link only found expression in the concepts of secularism and fundamentalism. Survey also revealed a dismal rating of televangelism as regards socio-political mobilization. The chi-square test showed the x2 computed to be greater than the x2 critical thus showing a disconnect between knowledge on the potential benefits of televangelism and the deployment of such benefits towards socio-economic mobilization by televangelists. It was therefore recommended that televangelism should not be used for self aggrandizement and church growth but should complement the socio-political mobilization process. It was further recommended that a policy framework should be put in place to ensure compliance by televangelists.

Do Second-Time Users of Topical Imiquimod have a More Rapid Onset of Clinical Response?

2018 ◽  
Vol 2 (3) ◽  
pp. 156-161
Author(s):  
Stacy L McMurray ◽  
Matthew Reynolds ◽  
Matthew S Dinehart ◽  
Scott M Dinehart
Keyword(s):  
Clinical Response ◽  
Time Use ◽  
Γδ T Cells ◽  
Rapid Onset ◽  
Primary Objective ◽  
Imiquimod Cream ◽  
Actinic Keratoses ◽  
Topical Imiquimod ◽  
Primary Endpoints ◽  
Time To Onset

Introduction: Topical imiquimod is commonly used in dermatology for treatment of actinic keratoses (AK). Prior studies in humans and mice have suggested the potential for immune recall with imiquimod based on higher degrees of AK clearance and activation of memory γδ T-cells in a mouse model. Anecdotal reports suggest a more rapid time-to-onset of clinical response with second time use of imiquimod. However, the potential for immune recall demonstrated by time-to-onset of clinical response has not been formally investigated.Objective:  The primary objective of this study was to determine if there is a difference in time-to-onset of clinical response between naïve and prior users of topical imiquimod for the treatment of actinic keratoses.Methods:  A total of 92 patients were treated with 5% imiquimod cream for actinic keratoses of the head and neck. Patients were instructed to apply 5% imiquimod cream to the affected areas once daily until reaching a therapeutic endpoint of crusting/scabbing. The primary endpoints in the study were time (days) to onset of erythema and time to onset of crusting/scabbing. Results were self-reported.Results:  The average time (days) to onset of erythema was 5.48 ± 3.19 days in naïve users and 4.7 ± 2.91 days in prior users (p= 0.22). Average time to onset of crusting/scabbing was 9.2 ± 4.34 days in naïve users and 9.02 ± 3.65 days in prior users (p=0.35).Conclusion:  Our study revealed there is no difference in time-to-onset of erythema or scabbing/crusting with second-time use of imiquimod.  While immune recall may be possible with use of imiquimod, the results of this study indicate that it may be independent of time-to-onset of clinical response.  

scholarly journals Gene Therapy in Hemophilia: Recent Advances

2021 ◽  
Vol 22 (14) ◽  
pp. 7647
Author(s):  
E. Carlos Rodríguez-Merchán ◽  
Juan Andres De Pablo-Moreno ◽  
Antonio Liras
Keyword(s):  
Gene Therapy ◽  
Adverse Events ◽  
Factor Viii ◽  
Coagulation Factor ◽  
Cost Savings ◽  
Factor Ix ◽  
Clotting Factors ◽  
Advanced Therapies ◽  
Potential Benefits

Hemophilia is a monogenic mutational disease affecting coagulation factor VIII or factor IX genes. The palliative treatment of choice is based on the use of safe and effective recombinant clotting factors. Advanced therapies will be curative, ensuring stable and durable concentrations of the defective circulating factor. Results have so far been encouraging in terms of levels and times of expression using mainly adeno-associated vectors. However, these therapies are associated with immunogenicity and hepatotoxicity. Optimizing the vector serotypes and the transgene (variants) will boost clotting efficacy, thus increasing the viability of these protocols. It is essential that both physicians and patients be informed about the potential benefits and risks of the new therapies, and a register of gene therapy patients be kept with information of the efficacy and long-term adverse events associated with the treatments administered. In the context of hemophilia, gene therapy may result in (particularly indirect) cost savings and in a more equitable allocation of treatments. In the case of hemophilia A, further research is needed into how to effectively package the large factor VIII gene into the vector; and in the case of hemophilia B, the priority should be to optimize both the vector serotype, reducing its immunogenicity and hepatotoxicity, and the transgene, boosting its clotting efficacy so as to minimize the amount of vector administered and decrease the incidence of adverse events without compromising the efficacy of the protein expressed.

scholarly journals The Impact of COVID-19 on Informal Caregivers’ Health Behaviors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 959-959
Author(s):  
Mary Greaney ◽  
Zachary Kunicki ◽  
Megan Drohan ◽  
Steven Cohen
Keyword(s):  
Health Behaviors ◽  
Fruits And Vegetables ◽  
Sedentary Time ◽  
Vegetable Intake ◽  
Informal Caregivers ◽  
Cost Savings ◽  
Positive Health ◽  
Chi Square ◽  
Unpaid Care ◽  
The Impact

Abstract The population of older adults aged 65+ in the US is projected to increase from 15% to 21% in the next 30 years. Aging in place provides cost-savings and familiarity to the older adult, but often requires informal caregivers. Informal caregivers, individuals who provide unpaid care of assistance to family members and friends may have been uniquely impacted by the COVID-19 pandemic and shelter-at-home orders. Research is needed to examine how the pandemic impacted caregivers’ caregiving responsibilities and health behaviors (e.g., physical activity, sedentary time, fruit and vegetable intake, snacking, etc.) as this information will be invaluable to determine if health promotion interventions are needed for informal caregivers. Self-reported data were gathered from informal caregivers providing care to someone aged 50+ (n=835) through Amazon’s Mechanical Turk. Respondents reported their current and pre-pandemic health behaviors and demographics. Chi-square tests were used to examine bivariate associations between pandemic time (pre vs. post) and each examined behavior. The analysis identified some positive health behavior changes due to the pandemic: caregivers felt since the pandemic they ate more fruits and vegetables (p < .001), walked more, exercised more (p < .001), increased amounts of sleep (p < .001), and higher sleep quality (p < .001). However, respondents also had more screen time (p < .001) and sedentary time (p < .001). Future planned analyses will focus on examining whether these changes were consistent across all sociodemographic subgroups of caregivers and whether they persist after the pandemic recedes.

scholarly journals 1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S658-S658
Author(s):  
Andrew H Karaba ◽  
Paul W Blair ◽  
Kevin M Martin ◽  
Mustapha O Saheed ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Virus Disease ◽  
Case Fatality ◽  
Cost Savings ◽  
Primary Objective ◽  
Neurological Deficits ◽  
West Nile ◽  
Hospital System ◽  
Elisa Testing ◽  
Before And After

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.

Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma

2016 ◽  
Vol 30 (4) ◽  
pp. 400-405 ◽  
Author(s):  
Sarah S. Evans ◽  
Arpita S. Gandhi ◽  
Amber B. Clemmons ◽  
David L. DeRemer
Keyword(s):  
Chart Review ◽  
Hospital Admissions ◽  
Antiviral Agents ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Cost Comparison ◽  
Non Hodgkin Lymphoma ◽  
Institutional Review ◽  
Stimulating Factor

Background: Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin’s lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study’s primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH. Methods: A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution’s financial department. Descriptive statistics were utilized for analysis. Results: A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (<50%). Overall, 27 (31.4%) of 86 cycles did not receive granulocyte colony-stimulating factor support. Outpatient EPOCH administration was associated with a cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance. Conclusion: EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.

scholarly journals The potential impacts of a digital preoperative assessment service on appointments, travel-related CO2 emissions, and user experience: a case study (Preprint)

2021 ◽  
Author(s):  
Madison Milne-Ives ◽  
John Leyden ◽  
Inocencio Maramba ◽  
Ray Jones ◽  
Arunangsu Chatterjee ◽  
...  
Keyword(s):  
Co2 Emissions ◽  
Preoperative Assessment ◽  
Service Evaluation ◽  
Primary Objective ◽  
Face To Face ◽  
Patient Feedback ◽  
Potential Benefits ◽  
Set Up ◽  
Evaluation Of Data

BACKGROUND The NHS cannot keep up with the demand for operations and procedures. Preoperative assessments, which can last 30 minutes to 2 hours, could be conducted online to save patient and clinician time, reducing wait times for operations. MyPreOp is a cloud-based platform where patients can set up an account and complete their preoperative questionnaires. This data is reviewed by a nurse, who determines if they need a subsequent face-to-face appointment. OBJECTIVE The primary objective was to describe the potential impact of MyPreOp® (Ultramed Ltd, Penryn, UK) the number of face-to-face appointments. Secondary objectives were to examine the time spent on preoperative assessments completed using MyPreOp in everyday use in NHS Trusts and user ratings of usability and acceptability. METHODS A case study service evaluation of data collected by the MyPreOp system from two NHS Trusts (Guy’s and St Thomas’ and Royal United Hospitals Bath) and the private BMI Bath Clinic during the four-month period of September to December 2020. MyPreOp is delivered by the hospital conducting the preoperative assessment but is typically completed at home at the patients’ convenience. Participants were adults of any age and health status at the participating hospitals who used MyPreOp to complete a preoperative assessment before a scheduled surgery. The primary outcome was the number of face-to-face appointments avoided by patients who used MyPreOp. Secondary outcomes were the length of time spent by nurses completing preoperative assessments, associated travel-related CO2 emissions, and quantitative user feedback. RESULTS Data from 2,500 participants was included. Half of the patients assessed did not need a further face-to-face appointment and required a median of only 5.3 minutes of nurses’ time. The reduction in appointments was associated with a small saving of CO2e emissions (9.05 tonnes). Patient feedback was generally positive: 80% of respondents rated MyPreOp as easy or very easy to use and 85% thought the overall experience was good or very good. CONCLUSIONS This evaluation demonstrated potential benefits of MyPreOp. However, further research using rigorous scientific methodology and a larger sample of NHS Trusts and users is needed to provide strong evidence of MyPreOp’s efficacy, usability, and cost-effectiveness.

scholarly journals Combination Therapy with Tenofovir Disoproxil Fumarate/Emtricitabine/Elvitegravir/Cobicistat Plus Darunavir Once Daily in Antiretroviral-Naive and Treatment-Experienced Patients: A Retrospective Review

2018 ◽  
Vol 17 ◽  
pp. 232595741775226 ◽  
Author(s):  
Mark J. Naccarato ◽  
Deborah M. Yoong ◽  
Ignatius W. Fong ◽  
Kevin A. Gough ◽  
Marian A. Ostrowski ◽  
...  
Keyword(s):  
Reverse Transcriptase ◽  
Tenofovir Disoproxil Fumarate ◽  
Retrospective Chart Review ◽  
Transcriptase Inhibitor ◽  
Primary Objective ◽  
Fixed Dose ◽  
Drug Resistant ◽  
Once Daily ◽  
Dose Combination ◽  
Hiv 1

Background: Patients with drug-resistant HIV often require complex antiretroviral regimens. However, combining fixed-dose combination tablets such as tenofovir–disoproxil–fumarate, emtricitabine, and cobicistat-boosted elvitegravir (TDF/FTC/EVG/cobi) with darunavir (DRV) can provide a simple, once-daily (QD), 2-tablet regimen for patients with drug-resistant HIV. Primary objective was to determine the percentage of patients with HIV-1 RNA <40 copies/mL at 48 weeks. Methods: We performed a retrospective chart review of patients initiated on TDF/FTC/EVG/cobi plus DRV. Results: Among the 21 included patients, prior resistance showed a median of 2 nucleoside reverse transcriptase inhibitor mutations, 1 nonnucleoside reverse transcriptase mutation, and 1 protease inhibitor mutation. At week 48, 14 (67%) patients achieved HIV-1 RNA <40 copies/mL, 1 patient experienced viral rebound, and 6 (29%) had missing data or discontinued therapy. No patient discontinued for adverse events. Conclusion: According to this observational study, QD TDF/FTC/EVG/cobi plus DRV is considered safe, well tolerated, and generally effective in suppressing HIV drug-resistant virus.

A-102 Performance Validity Testing in Telehealth Research: A VA Traumatic Brain Injury Model Systems Study

2021 ◽  
Vol 36 (6) ◽  
pp. 1151-1151
Author(s):  
Justin O'Rourke ◽  
Robert J Kanser ◽  
Marc A Silva
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Digit Span ◽  
Secondary Analysis ◽  
Primary Objective ◽  
Model Systems ◽  
Performance Validity ◽  
Cut Scores ◽  
Chi Square ◽  
Severe Tbi

Abstract Objective Studies on Performance Validity Tests (PVTs) for tele-neuropsychology (TeleNP) are sparse. Verbal PVTs appear to better translate to TeleNP, so the primary objective of this study was to provide initial data on two well-established, verbal PVTs administered via TeleNP for research participants with traumatic brain injury (TBI). Methods This secondary analysis of the Veterans Affairs TBI Model Systems data included 53 participants enrolled in a PVT module study (3/01/2020–09/20/2020) with documented moderate-to-severe TBI per Glasgow Coma Score (M = 6.5, SD = 4.4), posttraumatic amnesia duration (M = 42.7 days, SD = 47.1), and/or time to follow commands (M = 10.5 days, SD = 16.3). Participants completed two PVTs—Reliable Digit Span (RDS) and the 21-Item Test (21-IT)—alongside telephone-based cognitive assessment 1–7 years after TBI. Descriptive analyses were performed to compare PVT performances to previously established cut scores. Chi square analyses were employed to examine 21-IT and RDS as dichotomous outcomes (pass/fail) at selected cutoffs. Results RDS ranged from 5 to 16 (M = 10.5, SD = 2.4). 21-IT ranged from 7 to 21 (M = 16.4, SD = 3.1). For RDS, 9.8% were invalid with a cutscore of ≤7 and 19.6% using a cutscore of ≤8. For the 21-IT, 7.8% were in invalid using a cutscore of ≤11, and 13.7% using a cutscore of ≤12. Conclusion(s) Using previously established cut scores, telephone-administered RDS and 21-IT resulted in relatively low rates of invalid performance among individuals with moderate-to-severe TBI. These findings provide preliminary support for the RDS and 21-IT in TeleNP.

Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

2022 ◽  
Author(s):  
Shazia Damji ◽  
Jerrold Perrott ◽  
Salomeh Shajari ◽  
Jennifer Grant ◽  
Titus Wong ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Median Time ◽  
Broad Spectrum ◽  
Health Authority ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Primary Objective ◽  
Solid Organ ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics

BACKGROUND: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8–15.6 days). CONCLUSIONS: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

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