scholarly journals 619. Current State of Infectious Diseases Pharmacist OPAT/COpAT Practice in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S412-S412
Author(s):  
Christina G Rivera ◽  
Keenan L Ryan ◽  
Kristin Mara ◽  
Monica V Mahoney ◽  
Monica V Mahoney
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
The United States ◽  
Research Network ◽  
Inpatient Setting ◽  
Full Time ◽  
Current State ◽  
Collaborative Practice Agreement ◽  
Wide Variability

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is the process of administering intravenous (IV) antimicrobials outside the acute inpatient setting. Oral antimicrobials for complex infections are referred to as complex outpatient antimicrobial therapy (COpAT). OPAT/COpAT programs are expanding, as are the opportunities for clinical Infectious Diseases (ID) pharmacists (RPHs) involvement. The current state of clinical (non-dispensing) role and the functions being performed by RPHs in OPAT/COpAT is unknown. Methods To define the current state of OPAT/COpAT pharmacy practice across the United States (US), specifically the clinical functions performed by RPHs, design of RPH involved OPAT/COpAT clinics, and compare training of RPHs who practice in OPAT/COpAT to ID RPHs who do not, a survey of a possible 31 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) email list. Results were focused on US-based respondents. Results Eighty-seven RPHs responded with 27 practicing in OPAT/COpAT. Training background did not differ between groups. Programs with an OPAT/COpAT RPH were more likely to have a formal OPAT team compared to those without an OPAT/COpAT RPH (p < 0.001). OPAT/COpAT RPHs were early in their careers, with roughly half practicing < 5 years in ID, and 66.7% practicing < 5 years in OPAT/COpAT. Most OPAT/COpAT RPHs (66.7%) practiced at an academic medical center with a median full time equivalent (FTE) of 1 RPH. Most (63%) utilized a collaborative practice agreement and 81.5% shared job functions with other ID RPH roles, most commonly antimicrobial stewardship. Few (28%) OPAT/COpAT programs involved a dispensing component. The average daily census was 42 patients followed by an OPAT/COpAT RPH. There was wide variability in the types of tasks ID RPH performed in OPAT/COpAT, the three most important tasks are listed in Figure 1. OPAT Pharmacists Task Ranking by Importance There was wide variability in the types of tasks ID pharmacist performed in OPAT/COpAT. The most OPAT/COpAT pharmacists responded that adjusting medications based on lab values was in their top 3 most important clinical tasks. When ranking the top three most important tasks, selecting the initial OPAT/COpAT regimen was ranked first most often, followed by review of review of OPAT appropriateness for discharge, then adjusting medications based on lab values. Conclusion This is the largest known survey of OPAT/COpAT RPHs. RPH involvement in OPAT/COpAT in the US is an emerging trend with wide variability in program structure. Tasks performed by OPAT/COpAT RPHs varied significantly; however, OPAT/COpAT RPH respondents’ functions are largely clinical in nature. Disclosures All Authors: No reported disclosures

scholarly journals Ice-Breaking Fleets of the United States and Canada: Assessing the Current State of Affairs and Future Plans

2021 ◽  
Vol 13 (2) ◽  
pp. 703
Author(s):  
Megan Drewniak ◽  
Dimitrios Dalaklis ◽  
Anastasia Christodoulou ◽  
Rebecca Sheehan
Keyword(s):  
United States ◽  
The United States ◽  
Maritime Transportation ◽  
The Arctic ◽  
Polar Ice ◽  
Northwest Passage ◽  
Ice Cap ◽  
Ice Coverage ◽  
Current State ◽  
State Of Affairs

In recent years, a continuous decline of ice-coverage in the Arctic has been recorded, but these high latitudes are still dominated by earth’s polar ice cap. Therefore, safe and sustainable shipping operations in this still frozen region have as a precondition the availability of ice-breaking support. The analysis in hand provides an assessment of the United States’ and Canada’s polar ice-breaking program with the purpose of examining to what extent these countries’ relevant resources are able to meet the facilitated growth of industrial interests in the High North. This assessment will specifically focus on the maritime transportation sector along the Northwest Passage and consists of four main sections. The first provides a very brief description of the main Arctic passages. The second section specifically explores the current situation of the Northwest Passage, including the relevant navigational challenges, lack of infrastructure, available routes that may be used for transit, potential choke points, and current state of vessel activity along these routes. The third one examines the economic viability of the Northwest Passage compared to that of the Panama Canal; the fourth and final section is investigating the current and future capabilities of the United States’ and Canada’s ice-breaking fleet. Unfortunately, both countries were found to be lacking the necessary assets with ice-breaking capabilities and will need to accelerate their efforts in order to effectively respond to the growing needs of the Arctic. The total number of available ice-breaking assets is impacting negatively the level of support by the marine transportation system of both the United States and Canada; these two countries are facing the possibility to be unable to effectively meet the expected future needs because of the lengthy acquisition and production process required for new ice-breaking fleets.

scholarly journals 1665. Using Electronic Health Records to Describe TB in Community Health Settings: a Cohort Analysis in a Large Safety-Net Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S819-S820
Author(s):  
Jonathan Todd ◽  
Jon Puro ◽  
Matthew Jones ◽  
Jee Oakley ◽  
Laura A Vonnahme ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Electronic Health Records ◽  
Safety Net ◽  
The United States ◽  
Research Network ◽  
Health Records ◽  
Treatment Regimens ◽  
Data Source ◽  
Electronic Health

Abstract Background Over 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers. Methods From the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI. Results Among 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35). Conclusion This study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations. Disclosures All Authors: No reported disclosures

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

Biosurveillance: A Modern Look

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
James Lee Brooks
Keyword(s):  
United States ◽  
Homeland Security ◽  
The United States ◽  
First Century ◽  
Direct Result ◽  
Current State ◽  
Twenty First Century ◽  
Security Operations

AbstractThe early part of the twenty-first century saw a revolution in the field of Homeland Security. The 9/11 attacks, shortly followed thereafter by the Anthrax Attacks, served as a wakeup call to the United States and showed the inadequacy of the current state of the nation’s Homeland Security operations. Biodefense, and as a direct result Biosurveillance, changed dramatically after these tragedies, planting the seeds of fear in the minds of Americans. They were shown that not only could the United States be attacked at any time, but the weapon could be an invisible disease-causing agent.

scholarly journals Learning to Detain Asylum Seekers and the Growth of Mass Immigration Detention in the United States

2021 ◽  
pp. 1-29
Author(s):  
Smita Ghosh ◽  
Mary Hoopes
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Cognitive Dissonance ◽  
Media Coverage ◽  
Asylum Seekers ◽  
Ad Hoc ◽  
The United States ◽  
Critical Component ◽  
Immigration Detention ◽  
Important Shift

Drawing upon an analysis of congressional records and media coverage from 1981 to 1996, this article examines the growth of mass immigration detention. It traces an important shift during this period: while detention began as an ad hoc executive initiative that was received with skepticism by the legislature, Congress was ultimately responsible for entrenching the system over objections from the agency. As we reveal, a critical component of this evolution was a transformation in Congress’s perception of asylum seekers. While lawmakers initially decried their detention, they later branded them as dangerous. Lawmakers began describing asylum seekers as criminals or agents of infectious diseases in order to justify their detention, which then cleared the way for the mass detention of arriving migrants more broadly. Our analysis suggests that they may have emphasized the dangerousness of asylum seekers to resolve the dissonance between their theoretical commitments to asylum and their hesitance to welcome newcomers. In addition to this distinctive form of cognitive dissonance, we discuss a number of other implications of our research, including the ways in which the new penology framework figured into the changing discourse about detaining asylum seekers.

A Nationwide Survey of COVID-19 Testing in LGBTQ+ Populations in the United States

2021 ◽  
pp. 003335492110181
Author(s):  
Richard J. Martino ◽  
Kristen D. Krause ◽  
Marybec Griffin ◽  
Caleb LoSchiavo ◽  
Camilla Comer-Carruthers ◽  
...  
Keyword(s):  
United States ◽  
Gay Men ◽  
Antibody Test ◽  
Nationwide Survey ◽  
The United States ◽  
Sociodemographic Characteristics ◽  
Full Time ◽  
Test Results ◽  
Antibody Testing ◽  
And Gender

Objectives Lesbian, gay, bisexual, transgender, or queer and questioning (LGBTQ+) people and populations face myriad health disparities that are likely to be evident during the COVID-19 pandemic. The objectives of our study were to describe patterns of COVID-19 testing among LGBTQ+ people and to differentiate rates of COVID-19 testing and test results by sociodemographic characteristics. Methods Participants residing in the United States and US territories (N = 1090) aged ≥18 completed an internet-based survey from May through July 2020 that assessed COVID-19 testing and test results and sociodemographic characteristics, including sexual orientation and gender identity (SOGI). We analyzed data on receipt and results of polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2 and symptoms of COVID-19 in relation to sociodemographic characteristics. Results Of the 1090 participants, 182 (16.7%) received a PCR test; of these, 16 (8.8%) had a positive test result. Of the 124 (11.4%) who received an antibody test, 45 (36.3%) had antibodies. Rates of PCR testing were higher among participants who were non–US-born (25.4%) versus US-born (16.3%) and employed full-time or part-time (18.5%) versus unemployed (10.8%). Antibody testing rates were higher among gay cisgender men (17.2%) versus other SOGI groups, non–US-born (25.4%) versus US-born participants, employed (12.6%) versus unemployed participants, and participants residing in the Northeast (20.0%) versus other regions. Among SOGI groups with sufficient cell sizes (n > 10), positive PCR results were highest among cisgender gay men (16.1%). Conclusions The differential patterns of testing and positivity, particularly among gay men in our sample, confirm the need to create COVID-19 public health messaging and programming that attend to the LGBTQ+ population.

Medication Administration Practices in United States’ Schools: A Systematic Review and Meta-synthesis

2021 ◽  
pp. 105984052110263
Author(s):  
Ashley A. Lowe ◽  
Joe K. Gerald ◽  
Conrad Clemens ◽  
Cherie Gaither ◽  
Lynn B. Gerald
Keyword(s):  
United States ◽  
Systematic Review ◽  
Public Schools ◽  
Medication Management ◽  
The United States ◽  
Medication Administration ◽  
Full Time ◽  
Level Of Training ◽  
K 12 ◽  
Keyword Searches

Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.

scholarly journals The United States’ Regulatory Environment Is Evolving to Accommodate a Coming Boom in Gene Therapy Research

2019 ◽  
Vol 24 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Daniel Eisenman
Keyword(s):  
United States ◽  
Gene Therapy ◽  
Clinical Trials ◽  
The United States ◽  
Regulatory Environment ◽  
Evidence Based ◽  
Regulatory Structure ◽  
Regulatory Changes ◽  
Current State ◽  
Therapy Field

Introduction: A dramatic increase in the number of clinical trials involving gene-modified cell therapy and gene therapy is taking place. The field is on the verge of a boom, and the regulatory environment is evolving to accommodate the growth. Discussion: This commentary summarizes the current state of the field, including an overview of the growth. The United States (US) regulatory structure for gene therapy will be summarized, and the evolution of the oversight structure will be explained. Conclusion: The gene therapy field has recently produced its first FDA-approved therapeutics and has a pipeline of other investigational products in the final stages of clinical trials before they can be evaluated by the FDA as safe and effective therapeutics. As research continues to evolve, so must the oversight structure. Biosafety professionals and IBCs have always played key roles in contributing to the safe, evidence-based advancement of gene therapy research. With the recent regulatory changes and current surge in gene therapy research, the importance of those roles has increased dramatically.

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