scholarly journals 685. Evaluating the Role of Medication-assisted Treatment (MAT) in the Management of Infectious Endocarditis in People Who Inject Drugs (PWID)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S445-S445
Author(s):  
Allison Gorseth ◽  
William Nolan ◽  
Monica Cluff ◽  
David O'Sullivan ◽  
Casey J Dempsey
Keyword(s):  
Infectious Disease ◽  
Primary Outcome ◽  
People Who Inject Drugs ◽  
Management Service ◽  
Post Hoc Analysis ◽  
Medication Assisted Treatment ◽  
Study Population ◽  
Multidisciplinary Group ◽  
Secondary Outcomes ◽  
Post Hoc

Abstract Background An estimated 1.29-2.59 million people practice intravenous drug use (IVDU) in the United States making it a growing risk factor for infective endocarditis (IE). In people who inject drugs (PWID), IE accounts for 5-10% of total yearly deaths. IE often requires weeks of intravenous therapy with extensive medical follow-up. The purpose of this study was to evaluate if medication-assisted treatment (MAT) increased treatment retention and survival to optimize addiction assistance and IE treatment efforts. Methods A single-center, retrospective chart review was approved for patients admitted with an ICD-10 code of IE. A multidisciplinary group was created in April, 2019 aimed to improve endocarditis patient outcomes, formed of complex case coordination, infectious disease, cardiology, and pharmacy pain management service members. The historical period was January 1, 2018-March 31, 2019 and the IE pathway (IEP) group was April 1, 2019-June 30, 2020. Patients were excluded if there was no documentation of IVDU (Figure 1). The primary outcome was successful endocarditis therapy, defined per study protocol. Secondary outcomes include: against medical advice (AMA) departures, discharge naloxone prescriptions, clinical opioid withdrawal score (COWS) and patient reported pain. Figure 1. Study Population Methods for study population inclusion and exclusion Results A total of 419 IE patients were evaluated with 166 patients meeting inclusion criteria. The primary outcome was achieved in 51.2% of historical group and 48.8% of the IEP group (p=0.302). AMA departures and inpatient mortality were similar between the two groups. There was increased presence of the pharmacy pain management service with decreased time to consult in the IEP group (Figure 2). Last documented COWS were increased in the IEP group (p=0.002), while last reported patient pain scores decreased (p=0.030). More patients were started on MAT and discharged with naloxone in the IEP group (Table 3). Readmission was found to be higher in the IEP group (p=0.046). Post hoc analysis evaluating outcomes for patients seen by the endocarditis pathway team were similar between the two groups (Table 4). Figure 2. Secondary Outcome (Consult Services) The secondary outcomes of the study population are described comparing the presence and time to various consult services. **P-value indicates statistical significance. Abbreviations: n, number; ID, infectious disease; CT, cardiothoracic Table 3. Secondary Outcomes Table 4. Post Hoc Analysis Conclusion The multidisciplinary group was effective helping to guide the inpatient care of PWID and improve symptom management, but this did not translate to increased successful IE therapy or fewer readmissions. Disclosures All Authors: No reported disclosures

scholarly journals Risk Factors for the Completion of the Cold Loop Hysteroscopic Myomectomy in a One-Step Procedure: A Post Hoc Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ivan Mazzon ◽  
Alessandro Favilli ◽  
Mario Grasso ◽  
Stefano Horvath ◽  
Vittorio Bini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Cohort ◽  
Agonist Therapy ◽  
Hysteroscopic Myomectomy ◽  
Post Hoc Analysis ◽  
Step Procedure ◽  
Study Population ◽  
One Step ◽  
Post Hoc ◽  
Multiple Step

Introduction. The aim of the study was to analyze which variables influenced the completion of a cold loop hysteroscopic myomectomy in a one-step procedure in a large cohort of patients. Materials and Methods. A retrospective cohort study of 1434 cold loop resectoscopic myomectomies consecutively performed. The study population was divided into two groups according to the number of procedures needed to accomplish the treatment. Variables influencing the completion of hysteroscopic myomectomy in a one-step procedure were investigated. Results. A total of 1434 resections were performed and 1690 myomas in total were removed. The procedure was accomplished in a one-step procedure in 1017 patients (83.7%), whereas 198 women (16.3%) needed a multiple-step procedure. The multivariate analysis showed that the size, the number of myomas, and the age of patients were significantly correlated with the risk of a multiple-step procedure. No correlation was revealed with the grading of myomas, parity, and the use of presurgical GnRH-agonist therapy. Conclusions. In case of multiple fibroids, the intramural development of submucous myomas did not influence the completion of cold loop hysteroscopic myomectomy in a one-step procedure. The size of myomas and the age of patients were significantly correlated with the need to complete the myomectomy in a multiple-step procedure.

scholarly journals 747 Long-term effects of pharmacological treatment in patients with takotsubo syndrome with or without hypertension: a report from the takotsubo Italian network

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Angelo Silverio ◽  
Serena Migliarino ◽  
Giuseppe Iuliano ◽  
Eduardo Bossone ◽  
Michele Bellino ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Lower Risk ◽  
Primary Outcome ◽  
Takotsubo Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Study Population ◽  
Secondary Outcomes

Abstract Aims Hypertension (HT) is one of the most frequent comorbidities reported in patients with Takotsubo syndrome (TTS). However, the clinical outcome as well as the effect of pharmacological treatment on long-term follow-up have never been investigated in this cohort. To investigate the impact of the pharmacological treatment with beta-blocker (BB) and/or renin–angiotensin–aldosterone system inhibitor (RAASi) on long-term outcome of TTS patients with and without HT. Methods and results This study included TTS patients prospectively included in the Takotsubo Italian Network register from January 2007 to December 2018. The study population was divided in two groups according to the presence or not of HT. The effect of BB and RAASi at discharge was evaluated in these groups. The primary outcome was the composite of all-cause death and TTS recurrence; secondary outcomes were the single components of the primary outcome. The propensity score weighting technique was employed to account for potential selection bias in treatment assignment at discharge. The study population included 825 patients [median age 72 (63–78) years; 8.1% were males]; 525 (63.6%) patients had history of HT and 300 (36.4%) patients did not. At median follow-up of 24.0 months (11.0–38.0), the primary outcome occurred in 102 patients (12.4%); all-cause death and TTS recurrence were reported in 76 (9.2%) and 33 (4.0%), respectively. There were no differences in terms of the primary outcome (adjusted HR: 1.082; 95% CI: 0.689–1.700; P = 0.733), all-cause death (adjusted HR: 1.214; 95% CI: 0.706–2.089; P = 0.483) and TTS recurrence (adjusted HR: 0.795; 95% CI: 0.373–1.694; P = 0.552) between patients with vs. without HT. Among patients with HT, those receiving BB at discharge showed a significantly lower risk of the primary outcome (adjusted HR: 0.375; 95% CI: 0.228–0.617; P < 0.001) compared with patients not receiving BB. There was also a significantly lower risk of all-cause death (adjusted HR: 0.381; 95% CI: 0.217–0.666; P < 0.001) and TTS recurrence (adjusted HR: 0.393; 95% CI: 0.155–0.998; P = 0.049) in patients treated with BB. Among patients without HT, there was no significant association of BB treatment with any of the study outcomes. RAASi treatment showed no significant effect on the primary and secondary outcomes. These results were consistent between patients with and without HT. Conclusions TTS patients with HT patients experienced a survival benefit from BB treatment in terms of both all-cause death and TTS recurrence; this effect was not confirmed in patients without HT. Conversely, RAASi did not affect long-term outcome, independently from the coexistence of HT. Albeit hypothesis-generating, a such evidence supports a tailored pharmacological therapy after discharge in TTS patients taking into account the coexistence of HT.

Evaluation of Time Spent by Pharmacists and Nurses Based on the Location of Pharmacist Involvement in Medication History Collection

2018 ◽  
Vol 32 (4) ◽  
pp. 394-398 ◽  
Author(s):  
Anmol Chhabra ◽  
Andrea Quinn ◽  
Amanda Ries
Keyword(s):  
Medication Reconciliation ◽  
Primary Outcome ◽  
Medication History ◽  
Admission Process ◽  
End Points ◽  
Post Hoc Analysis ◽  
Patient Groups ◽  
Time Savings ◽  
Clinically Significant ◽  
Post Hoc

Background: Accurate history collection is integral to medication reconciliation. Studies support pharmacy involvement in the process, but assessment of global time spent is limited. The authors hypothesized the location of a medication-focused interview would impact time spent. Methods: The objective was to compare time spent by pharmacists and nurses based on the location of a medication-focused interview. Time spent by the interviewing pharmacist, admitting nurse, and centralized pharmacist verifying admission orders was collected. Patient groups were based on whether the interview was conducted in the emergency department (ED) or medical floor. The primary end point was a composite of the 3 time points. Secondary end points were individual time components and number and types of transcription discrepancies identified during medical floor interviews. Results: Pharmacists and nurses spent an average of ten fewer minutes per ED patient versus a medical floor patient ( P = .028). Secondary end points were not statistically significant. Transcription discrepancies were identified at a rate of 1 in 4 medications. Post hoc analysis revealed the time spent by pharmacists and nurses was 2.4 minutes shorter per medication when interviewed in the ED ( P < .001). Discussion: The primary outcome was statistically and clinically significant. Limitations included inability to blind and lack of cost-saving analysis. Conclusion: Pharmacist involvement in ED medication reconciliation leads to time savings during the admission process.

Abstract P502: Significance of Asymptomatic Hemorrhage After Mechanical Thrombectomy: A Post-Hoc Analysis of the Best Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michael Feldman ◽  
Steven Roth ◽  
Matthew Fusco ◽  
Shadi Yaghi ◽  
Tapan V Mehta ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Regression Models ◽  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Logistic Regression Models ◽  
Post Hoc Analysis ◽  
Conflicting Evidence ◽  
The Us ◽  
Post Hoc

Introduction: Intracerebral hemorrhage (ICH) occurs in 20-30% of the stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. Methods: In this post-hoc analysis of our multi-center, prospective, “Blood Pressure after Endovascular Therapy (BEST)” study, we determined the rates of patients with aICH and symptomatic ICH (sICH; any ICH associated with ≥4 points deterioration in the baseline NIH Stroke scale). Their associations with a primary outcome of 90-day modified Rankin Scores (mRS) 0-2 vs 3-6 and early neurological recovery (ENR; NIHSS of 0-1 or ≥8-point improvement at 24 hours from baseline) was determined using univariable and multivariable logistic regression models (adjusted for age, NIH stroke scale, ASPECT score, age, thrombolytic administration, and successful recanalization defined as mTICI ≥2b). Results: Of 485 patients included in BEST at 12 comprehensive stroke centers across the US, 446 patients had a 90-day follow-up available. Of these, 92 (20.6%) developed aICH and 18 (4%) developed sICH. The aICH was not associated with worse 90-day outcome or lower ENR (OR 1.19 [0.74-1.88], p=0.45, aOR 1.19 [0.69-2.06], p= 0.53 for 90-day mRS 3-6; OR 0.77 [0.48-1.23], p=0.30, aOR 0.72 [0.43-1.22] for ENR).A higher proportion of patients with aICH had mTICI ≥2b compared to those without any ICH (97%vs 87%, p=0.01, Table). The aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2b (OR 1.28 [0.79-2.08], p=0.32 for 90-day mRS 3-6; OR 0.89 [0.69-1.12], p=0.14 for ENR). Conclusion: We found insufficient evidence that aICH associated with worse outcomes in EVT-treated patients, including those with successful recanalization. Interestingly, aICH was more frequent in patients with successful recanalization. Further validation of our findings in other large cohort studies of EVT-treated patients is warranted.

Clinical Pharmacist Management of Bacteremia in a Community Hospital Emergency Department

2017 ◽  
Vol 51 (6) ◽  
pp. 465-472 ◽  
Author(s):  
C. Dustin Waters ◽  
Bryce J. Bitton ◽  
Annie Torosyan ◽  
Kevin P. Myers
Keyword(s):  
Infectious Disease ◽  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Community Hospital ◽  
Mortality Data ◽  
High Morbidity ◽  
Hospital Emergency ◽  
Appropriate Treatment ◽  
Secondary Outcomes

Background: Bacteremia is a serious condition that leads to high morbidity and mortality. Data describing pharmacist involvement in the management of bacteremia in the emergency department are lacking. Objective: To determine if pharmacist involvement in the management of bacteremia in the emergency department (ED) led to an increase in appropriate treatment of bacteremia as well as improvements in patient outcomes. Methods: The primary outcome of this retrospective cohort study was the rate of appropriate treatment of bacteremia. Secondary outcomes included the rate of unplanned, infectious disease–related 90-day admission or readmission to the ED or hospital as well as infectious disease–related 90-day mortality. All patients seen in the ED and subsequently discharged who had a positive blood culture determined not to be a contaminant were included in the study. Patients were analyzed in 2 cohorts: those that were physician managed (107 patients) and those that were pharmacist managed (138 patients). Results: In the physician-managed cohort, 50 of 107 (47%) patients were treated appropriately compared with 131 of 138 (95%) patients in the pharmacist-managed cohort ( P < 0.0001). There was also a decrease in attributable 90-day admission or readmission in pharmacist-managed patients, which occurred in 4 of 138 patients (2.9%) versus the physician-managed patient cohort in which 13 of 107 patients (12.1%) were readmitted ( P = 0.01). There was no difference in mortality between the groups ( P = 0.8337). Conclusion: Pharmacist involvement in the management of bacteremia in the ED was associated with higher rates of appropriate treatment and a corresponding decrease in the rates of attributable 90-day admission or readmission to the hospital or ED.

scholarly journals Nalmefene in the treatment of pathological gambling: multicentre, double-blind, placebo-controlled study

2010 ◽  
Vol 197 (4) ◽  
pp. 330-331 ◽  
Author(s):  
Jon E. Grant ◽  
Brian L. Odlaug ◽  
Marc N. Potenza ◽  
Eric Hollander ◽  
Suck Won Kim
Keyword(s):  
Pathological Gambling ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Symptom Control ◽  
Primary Outcome Measure ◽  
Controlled Study ◽  
Double Blind ◽  
Intention To Treat ◽  
Secondary Outcomes ◽  
Post Hoc

SummaryPathological gambling is a disabling disorder experienced by about 1% of adults. We randomised 233 participants (41.6% women) 1:1:1 to nalmefene (20 or 40 mg) or placebo. In analyses performed using an intention-to-treat (ITT) population, nalmefene failed to show statistically significant differences from placebo on primary and secondary outcomes. Post hoc analyses of only participants who received a full titration of the medication for at least 1 week demonstrated that nalmefene 40 mg/day resulted in significantly greater reductions on the primary outcome measure. These findings suggest that medication dosing may be an important consideration in achieving symptom control.

Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2

2019 ◽  
Vol 11 (10) ◽  
pp. 964-969 ◽  
Author(s):  
Masatomo Miura ◽  
Shinichi Yoshimura ◽  
Nobuyuki Sakai ◽  
Hiroshi Yamagami ◽  
Kazutaka Uchida ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Scale Score ◽  
Endovascular Therapy ◽  
Treatment Effects ◽  
Primary Outcome ◽  
Functional Independence ◽  
National Institutes Of Health ◽  
Multivariable Logistic Regression Analysis ◽  
Post Hoc Analysis ◽  
Post Hoc

ObjectiveTo compare the efficacy of endovascular therapy (EVT) with that of medical treatment in ’real-world ’patients with M2 occlusion.MethodsThis was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0–2 at 90 days) using forest plots of treatment effects.ResultsOverall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9–19] vs 10 [5–16]) and earlier onset to hospital door time (110 [50–258] vs 150 [60–343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.ConclusionIn patients with M2 occlusion, our registry suggests that EVT is effective and safe.

scholarly journals Long-term effect of aripiprazole lauroxil on health-related quality of life in patients with schizophrenia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph P. McEvoy ◽  
Peter J. Weiden ◽  
Paul H. Lysaker ◽  
Xiaowu Sun ◽  
Amy K. O’Sullivan
Keyword(s):  
General Population ◽  
Trial Registration ◽  
Post Hoc Analysis ◽  
Related Quality ◽  
Health Related ◽  
Study Population ◽  
Post Hoc ◽  
Registration Date

Abstract Background This post hoc analysis of clinical trial data evaluated long-term, self-reported mental and physical health-related quality of life (HRQoL) scores in schizophrenia patients receiving aripiprazole lauroxil (AL), an atypical long-acting injectable (LAI) antipsychotic approved for the treatment of schizophrenia in adults. Methods The study population included 291 stable schizophrenia outpatients enrolled in 2 consecutive long-term safety studies of AL given every 4 weeks for up to 124 weeks. HRQoL was measured using the SF-36v2® Health Survey (SF-36v2) over the course of the follow-up. The primary outcome was change in SF-36v2 mental component summary (MCS) and physical component summary (PCS) scores from baseline to 124 weeks. To contextualize these scores, descriptive analyses were conducted to compare the scores with available scores for the general population as well as for other populations with chronic medical (ie, hypertension and type 2 diabetes) or psychiatric (ie, depression) conditions. Results Results from this post hoc analysis indicated that the mean MCS score for patients continuing AL improved significantly from baseline over 124 weeks (P < .05, all timepoints), while mean PCS score showed little change over 124 weeks. At baseline, patients had lower (worse) MCS scores than the normed general population, but by week 124, patients had MCS scores comparable to those in the general population. This pattern of change was not observed with PCS scores. Comparison of study MCS scores with those associated with other diseases showed that this schizophrenia cohort had lower scores than those with chronic medical conditions but higher scores than those with depression. PCS scores were higher in the study population than published scores for all reference populations at baseline and week 124. Conclusions In this post hoc analysis, outpatients with schizophrenia who continued the LAI antipsychotic AL showed gradual and sustained improvement in self-reported mental HRQoL over several years of follow-up, whereas self-reported physical HRQoL did not change. By the end of follow-up, mental health scores of study patients with schizophrenia were comparable to those of the general population and better than those of patients with depression. Trial registration ClinicalTrials.gov (NCT01626456 [trial registration date: June 15, 2012] and NCT01895452 [trial registration date: July 5, 2013]).

scholarly journals Aerosol Box Decreases Aerosol Exposure only in Depressurized Rooms on Intubation and Extubation

2020 ◽  
Author(s):  
Wataru Sakai ◽  
Gen Hasegawa ◽  
Tomohiro Chaki ◽  
Shunsuke Tachibana ◽  
Michiaki Yamakage
Keyword(s):  
High Resolution ◽  
Medical Staff ◽  
Clinical Settings ◽  
Particle Sizes ◽  
Aerosol Model ◽  
Post Hoc Analysis ◽  
Aerosol Exposure ◽  
Secondary Outcomes ◽  
Post Hoc ◽  
Visual Assessments

Abstract The aim was to assess the effectiveness of an aerosol box objectively in several clinical settings with our experimental model.Cake flour as an aerosol model was expelled with our experimental cough model. The primary outcomes were the number of 0.3-10-µm-sized particles. Secondary outcomes were high-resolution videography of aerosol dispersal during intubation and extubation with an aerosol box in a pressurized or depressurized room.On post hoc analysis, counts of all particle sizes at the physician position, medical staff position, and in the environment were significantly lower in a depressurized room with an aerosol box than in a pressurized room without an aerosol box during intubation (p<0.05 in all situations and all particle sizes). Counts of all particle sizes at the physician and medical staff positions were significantly lower in the depressurized room with an aerosol box than in a pressurized room without an aerosol box during extubation (p<0.05 in both situations and all particle sizes). Visual assessments supported the results of the primary outcomes and showed that an aerosol box in a depressurized room could effectively decrease aerosol exposure of the physician, medical staff, and environment.In conclusion, an aerosol box decreased aerosol exposure only in a depressurized room.

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