scholarly journals Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Jennifer L Adema ◽  
Laurel N Lake ◽  
Ryan W Stevens ◽  
Breann M Hogan ◽  
Audrey N Schuetz ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chart Review ◽  
Susceptibility Testing ◽  
Retrospective Chart Review ◽  
Mixed Methods Study ◽  
Clinical Microbiology Laboratory ◽  
Optimal Dosing ◽  
Enterococcus Spp ◽  
Dose Dependent ◽  
Question Survey

Abstract Background In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (SDD) was intended to guide practice toward optimal dosing, the understanding and application of daptomycin SDD breakpoints for enterococci were unknown. Methods This mixed-methods study combined a clinician survey with a retrospective pre–post prescribing analysis. An 8-question survey was distributed to infectious diseases (ID) and internal medicine (IM) clinicians. A retrospective chart review of hospitalized adults with infections due to Enterococcus spp. was conducted before (pre-SDD) and after (post-SDD) adoption of SDD reporting for enterococci. Results Survey response rates were 40 of 98 (41%) for IM and 22 of 34 (65%) for ID clinicians. ID clinicians scored significantly higher than IM clinicians in knowledge of SDD. Chart review of 474 patients (225 pre- vs 249 post-SDD) showed that daptomycin dosage following susceptibility testing was significantly higher post-SDD compared with pre-SDD (8.5 mg/kg vs 6.4 mg/kg; P < .001) with no difference in empiric dosing (6.3 mg/kg vs 6.2 mg/kg; P = .67). Definitive daptomycin use varied between the pre- and post-SDD periods (35.1% vs 16.9%; P < .001). Conclusions The survey revealed that ID clinicians placed more importance on and had more confidence in the SDD category over IM clinicians. SDD reporting was associated with a change in definitive daptomycin dosing. ID specialist involvement is recommended in the care of infections due to enterococci for which daptomycin is reported as SDD given their expertise.

scholarly journals Enterococcal Bacteremia in a Tertiary Care Centre in Winnipeg

1999 ◽  
Vol 10 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Tariq AA Madani ◽  
Amin Kabani ◽  
Pamela Orr ◽  
Lindsay Nicolle
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clinical Microbiology Laboratory ◽  
Tertiary Care Centre ◽  
Vancomycin Resistant ◽  
Polymicrobial Bacteremia ◽  
High Level ◽  
Enterococcal Bacteremia ◽  
Overall Mortality

OBJECTIVE: To review experience with enterococcal bacteremia before the emergence of vancomycin-resistant enterococcus at a tertiary care teaching hospital.DESIGN: Retrospective chart review of episodes of enterococcal bacteremia identified through the clinical microbiology laboratory from January 1990 to December 1994. Antimicrobial susceptibilities were performed for all isolates and pulsed-field gel electrophoresis for genetic typing of selected strains.RESULTS: One hundred and twenty-six episodes of bacteremia were identified in 109 patients: 108Enterococcus faecalis, 13Enterococcus faecium, four bothE faecalisandE faecium, and oneEnterococcus durans. Enterococcal isolates occurred with polymicrobial bacteremia in 62 (49%) episodes. The most common sites of infection were central venous catheters (45%) and the urinary tract (21%). Enterococcal bacteremia was usually nosocomially acquired (88%), and associated with older age, instrumentation, and prior or current antimicrobial therapy. Overall mortality was 22%, and 7.2% was partially or fully attributable to enterococcal bacteremia. Resistance to ampicillin, high level gentamicin and high level streptomycin were 0%, 32% and 31% forE faecalis, respectively, and 44%, 0% and 47% forE faecium, respectively.CONCLUSIONS: During this review, the frequency and impact of enterococcal bacteremia at this institution was relatively limited. Isolates resistant to ampicillin and aminoglycosides were emerging, but differences in patient outcomes were similar for resistant and susceptible isolates.

PP19 Use and impact of the pre-hospital 12-lead electrocardiogram in the primary PCI era (PHECG2): mixed methods study protocol

2019 ◽  
Vol 36 (10) ◽  
pp. e9.1-e9
Author(s):  
Lucia Gavalova ◽  
Mary Halter ◽  
Helen Snooks ◽  
Chris Gale ◽  
Clive Weston ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomised Trial ◽  
Retrospective Chart Review ◽  
Coronary Intervention ◽  
Population Based ◽  
Mixed Methods Study ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Audit Project

BackgroundThe pre-hospital 12-lead electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found PHECG was associated with improved 30-day survival, but a third of ACS patients under EMS care did not have PHECG. Such patients tended to be female, older and/or with comorbidities. This previous study was undertaken when thrombolytic treatment was the main treatment for ST segment elevation myocardial infarction (STEMI); practice has since shifted to a predominant interventional strategy – primary percutaneous coronary intervention (pPCI). Moreover, the previous study relied solely on data collected by the Myocardial Ischaemia National Audit Project (MINAP), which does not include information on symptoms, EMS personnel gender, and other factors that may influence decision-making. The PHECG2 study addresses the following research questions: a) Is there a difference in 30-day mortality and reperfusion between those who do and do not receive PHECG? b) Has the proportion of eligible patients who receive PHECG changed since the introduction of pPCI networks? c) Are patients that receive PHECG different from those that do not in social and demographic factors, and in pre-hospital clinical presentation? d) What factors do EMS clinicians report as influencing their decision to perform PHECG?MethodsExplanatory sequential Quan-Qual mixed methods study comprising 4 Work Packages (WPs): WP1 a population based, linked data analysis of MINAP from 2010–2017 (n=510,000); WP2 retrospective chart review of EMS records from 3 EMS; WP3 focus groups with personnel from 3 EMS. WP4 will synthesise findings from WP1-3.ConclusionsGaining an understanding into the clinical and non-clinical factors influencing EMS clinicians’ decisions to record PHECG will enable us to develop (and later test through a randomised trial) an intervention to improve PHECG uptake and patient outcomes following an ACS event.

scholarly journals Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037557
Author(s):  
Mary Halter ◽  
Vari Drennan ◽  
Chao Wang ◽  
Carly Wheeler ◽  
Heather Gage ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Mixed Methods ◽  
Emergency Departments ◽  
Primary Outcome ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Mixed Methods Study ◽  
Secondary Outcome ◽  
Structured Interviews

ObjectivesTo compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training.DesignMixed-methods study: retrospective chart review using 4 months’ anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates.SettingThree emergency departments in England.ParticipantsThe records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation.Primary and secondary outcome measuresThe primary outcome was unplanned re-attendance at the same emergency department within 7 days. Secondary outcomes: consultation processes, clinical adequacy of care, and staff and patient experience.ResultsRe-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients’ charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role.ConclusionsPhysician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies.

scholarly journals Mixed Methods Evaluation of Simulation-Based Training for Postpartum Hemorrhage Management in Guatemala

2021 ◽  
Author(s):  
Pooja S. Parameshwar ◽  
Katherine Bianco ◽  
Elizabeth B. Sherwin ◽  
Pamela K. Meza ◽  
Alisha Tolani ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Postpartum Hemorrhage ◽  
Chart Review ◽  
Qualitative Interviews ◽  
Retrospective Chart Review ◽  
Provider Attitudes ◽  
Mixed Methods Approach ◽  
Balloon Tamponade ◽  
Simulation Based ◽  
Uterine Balloon Tamponade

Abstract Background To assess if simulation-based training (SBT) of B-lynch suture and uterine balloon tamponade (UBT) for the management of postpartum hemorrhage (PPH) impacted provider attitudes, practice patterns, and patient management in Guatemala, using a mixed-methods approach. Methods We conducted an in-country SBT course on the management of PPH in a governmental teaching hospital in Guatemala City, Guatemala. Participants were OB/GYN providers (n = 39) who had or had not received SBT before. Surveys and qualitative interviews evaluated provider knowledge and experiences with B-lynch and UBT to treat PPH. In addition, a retrospective chart review was performed to evaluate management of PPH over a 2-year period before and after the introduction of SBT. Results Multiple-choice surveys indicated that providers who received SBT were more comfortable performing and teaching B-lynch compared to those who did not (p = 0.003 and 0.005). Qualitative interviews revealed increased provider comfort with B-lynch compared to UBT and identified multiple barriers to uterine balloon tamponade implementation. Chart review demonstrated an increased use of UBT after the introduction of simulation-based training, though not statistically significant (p = 0.06) in contrast to no change in B-lynch use. Conclusions Simulation-based training had a stronger impact on provider comfort with B-lynch compared to uterine balloon tamponade. Qualitative interviews provided insight into the challenges that hinder uptake of uterine balloon tamponade, namely resource limitations and decision-making hierarchies. Capturing data through a mixed-methods approach allowed for more comprehensive program evaluation in low and middle income countries (LMICs).

scholarly journals High Dose Infliximab in the Treatment of Refractory Uveitis: Does Dose Matter?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Sukesh Sukumaran ◽  
Katherine Marzan ◽  
Bracha Shaham ◽  
Andreas Reiff
Keyword(s):  
Los Angeles ◽  
Disease Control ◽  
Dose Escalation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Dose ◽  
Topical Steroids ◽  
Optimal Dosing ◽  
Control Disease ◽  
Achieve Disease Control

Background. Infliximab (INF) has been shown to be beneficial in treating refractory uveitis, however, no data exist on optimal dosing and the efficacy of higher dosing. Objectives. To compare the efficacy of low-dose (LD) (<10 mg/kg), moderate-dose (MD) (≥10–15 mg/kg), and high-dose (HD) INF (≥15–20 mg/kg) in the treatment of uveitis. Methods. Retrospective chart review children with uveitis diagnosed at Childrens Hospital Los Angeles and Millers Children’s Hospital, CA, USA. Results. Of the 34 INF-treated children, 6 patients received LD, 19 received MD, and 9 received HD. Average disease duration prior to therapy was 10.6, 24.6, and 37.1 months each group, respectively. Topical steroids were discontinued after an average of 3 months, 9.5 months, and 10.2 months in the LD, MD, and HD groups, respectively. We found that 66% of patients receiving LD, 42% of MD, and 66% receiving HD INF failed therapy and required either dose escalation or alternate medication for disease control. Conclusions. INF is beneficial in the treatment of uveitis, and dose escalation up to 4 times above the approved dose is often necessary to achieve disease control in patients with uveitis. Doses < 10 mg/kg every 4 weeks may not be sufficient to control disease.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

2019 ◽  
Vol 28 (3) ◽  
pp. 660-672
Author(s):  
Suzanne H. Kimball ◽  
Toby Hamilton ◽  
Erin Benear ◽  
Jonathan Baldwin
Keyword(s):  
Mixed Methods ◽  
Verbal Behavior ◽  
Coping Strategies ◽  
Mixed Methods Study ◽  
Self Report ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Emotional Tone ◽  
Explanatory Mixed Methods ◽  
Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

EXPERIENCES, FRUSTRATIONS, AND BARRIERS, OF IPAD USAGE IN THE SPECIAL EDUCATION: LIFE SKILLS CLASSROOM FROM EDUCATORS PERSPECTIVE

2018 ◽  
pp. 61-67
Author(s):  
D. J. Sullivan ◽  
S. Labby ◽  
A. Koptelov ◽  
S. L. Sullivan
Keyword(s):  
Special Education ◽  
Mixed Methods ◽  
Communication Systems ◽  
Life Skills ◽  
Mixed Methods Study ◽  
Educational Tool ◽  
Special Educator ◽  
Communications Systems ◽  
Communication Device ◽  
Communication Devices

The purpose of this mixed methods study was to determine the barriers that special educator teachers encounter when using iPads within the Life Skills classroom. The research investigates the experiences, frustrations, and barriers through educators’ perceptions of iPad implementation. The influence of these issues suggests why iPad usage is not a device that special education classrooms are using in a widespread daily manner. Exploration of iPads as an educational tool and as a communication device is also discussed, along with considerations of other communications systems such as Picture Exchange Communication Systems and Alternative and Augmented Communication Devices is considered. Recommendations for further possible research are also discussed.

Rapid Evaluation of the Special Measures for Quality and Challenged Provider Regimes: A mixed-methods study

2020 ◽  
Author(s):  
Naomi Fulop ◽  
Estela Capelas Barbosa ◽  
Melissa Hill ◽  
Jean Ledger ◽  
Pei Li Ng ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Rapid Evaluation
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