Patients with serious injection drug use related infections who experience patient directed discharges on oral antibiotics have high rates of antibiotic adherence but require multidisciplinary outpatient support for retention in care

Abstract Background Persons who inject drugs (PWID) are frequently admitted for serious injection related infections (SIRI). Outcomes and adherence to oral antibiotics for PWID with patient directed discharge (PDD) remain understudied. Methods We conducted a prospective multicenter bundled quality improvement project of PWID with SIRI at 3 hospitals in Missouri. All PWID with SIRI were offered multidisciplinary care while inpatient, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). All patients were offered oral antibiotics in the event of a PDD either at discharge, or immediately after discharge through an ID telemedicine clinic. Additional support services included health coaches, therapist, case manager, free clinic follow up, and medications in an outpatient bridge program. Patient demographics, comorbidities, 90-day readmissions, and substance use disorder clinic follow up were compared between PWID with PDD on oral antibiotics and those that completed IV antibiotics, using an as treated approach. Results Of 166 PWID with SIRI, 61 completed IV antibiotics inpatient (37%) while 105 had a PDD on oral antibiotics (63%). There was no significant difference in 90-day readmission rates between groups (p=0.819). For PWID with a PDD on oral antibiotics, 7.6% had documented non-adherence to antibiotics, 67% had documented adherence and 23% were lost to follow-up. Factors protective against readmission included antibiotic and MOUD adherence, engagement with support team, and clinic follow up. Conclusions PWID with SIRI who experience a PDD should be provided with oral antibiotics. Multidisciplinary outpatient support services are needed for PWID with PDD on oral antibiotics.

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Opioid Consumption Following Outpatient Foot and Ankle Surgery: A Prospective Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00029 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0002

Author(s):

Erick M. Heiman ◽

Kevin Wu ◽

Alexander J. Idarraga ◽

Daniel D. Bohl ◽

Johnny Lin ◽

...

Keyword(s):

Pain Control ◽

Smoking Status ◽

Study Cohort ◽

Foot And Ankle ◽

Opioid Use ◽

Prescription Patterns ◽

Analgesic Regimen ◽

Ankle Surgery ◽

Significant Difference

Category: Prescription Practices Introduction/Purpose: Opioid abuse has recently reached the conscience of the US healthcare system and news cycle. This epidemic is in part propagated by surgeon over-prescription for common procedures. The purpose of this study is to examine postoperative opioid use following outpatient foot and ankle surgery in order to potentially guide prescription patterns of postoperative narcotics. Methods: Patients undergoing outpatient foot or ankle surgery, performed by one of four fellowship-trained orthopedic foot and ankle surgeons from a single institution, were prospectively enrolled from January to November 2018. Subjects were consented to participate in a phone interview within 7 days of their surgery, with subsequent interviews as needed for continued monitoring. Information collected included: age, gender, procedure, smoking status, payor type, analgesic regimen, number of tablets remaining, pain scale, pain control satisfaction, additional analgesic medications taken, reason for stopping opioid medications, and any adverse reactions encountered. Results: A total of 94 subjects were consented to participate. Of these, 11 were lost to follow up and 2 withdrew from the study, leaving 81 (86%) subjects for analysis. The mean (± standard deviation) number of opioid pills prescribed was 52.2 (±16.4; range: 6-80) pills. Subjects were satisfied or somewhat satisfied with their pain control in 91% of cases. On average, 18.4 (±14.9) pills were consumed by subjects, stopping consumption on post-operative day 4.8 (±3.6). There was no statistically significant difference in narcotic medications consumed whether undergoing ankle surgery (16.4, ±13.7) or foot surgery (20.7, ±15.9) (p=0.11). Overall, an average of 34.3 (±19.3) pills remained unconsumed at the completion of narcotic use, equaling a total of 2,706 excessively prescribed pills in the study cohort. Conclusion: There is a substantial excess of opioid pain medication prescribed to patients for outpatient foot and ankle surgeries, with a wide variation in prescription patterns. Based on our institutional data, a prescription of 35 opioid pills should be sufficient for approximately two-thirds of outpatient procedures and 50 pills should be sufficient for approximately 95% of patients regardless of whether the procedure is for the ankle or foot. This quality improvement assessment has influenced physician practice in our group and prospective follow-up analysis after intervention is warranted.

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709. Multidisciplinary Drug Use Endocarditis Team (DUET): Results From an Academic Center Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.901 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S405-S407

Author(s):

Darshali A Vyas ◽

Lucas Marinacci ◽

Thoralf Sundt ◽

Arminder Jassar ◽

Benjamin Bearnot ◽

...

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Statistical Significance ◽

Panel Member ◽

Retrospective Chart Review ◽

Multidisciplinary Care ◽

Cardiothoracic Surgery ◽

Opioid Use ◽

Addiction Medicine ◽

Native Valve

Abstract Background Guidelines recommend multidisciplinary models for the management of infective endocarditis but have failed to incorporate the unique challenges of treating drug-use associated infective endocarditis (DUA-IE). Given the drug use and overdose epidemic with rising cases of DUA-IE, we created a multidisciplinary Drug Use Endocarditis Team (DUET), which convened monthly case conferences among the specialties involved, including Infectious Diseases, Cardiothoracic Surgery, Cardiology and Addiction Medicine. Objective: To conduct a retrospective cohort study of the patients presented at the DUET conferences from August 2018 to February 2020 to (1) assess clinical and demographic characteristics and (2) describe clinical outcomes. Methods A retrospective chart review was conducted to analyze 57 patient cases, including descriptive statistical analyses of demographics, clinical characteristics, and outcomes. Results Among our DUET cohort, 43.8% represented isolated right-sided endocarditis, and 84% involved native valve. Methicillin-susceptible Staphylococcus aureus was the most common microorganism isolated. ID was consulted in 94.7% of cases and overall 43.9% completed the planned antimicrobial course. The 7 patients who developed relapse/recurrent IE were initially managed medically, and 5 did not complete the initial antimicrobial course. Formal cardiothoracic surgery consultation was obtained in 57.9% and 24.6% were managed operatively. Of the patients managed operatively, 64.3% completed the antimicrobial course. The rate of antibiotic completion was higher among patients managed operatively but did not reach statistical significance (p=0.08). Formal addiction medicine consultation was obtained in 85.9% of cases, with 63.1% discharged on medications for opioid use disorder (MOUD). The rate of MOUD on discharge was not significantly different between patients managed operatively and non-operatively. Figure 1: Patient Characteristics Figure 2: Infection Characteristics Figure 3: Outcome Analyses Conclusion ID is nearly universally involved in the care of patients with DUA-IE, but this patient population requires input from numerous sub-specialties. Multidisciplinary care teams provide a promising framework for DUA-IE to enhance and integrate nuanced decision-making. Disclosures Sarah E. Wakeman, MD, Celero Systems (Advisor or Review Panel member)Optum Labs (Grant/Research Support)UpToDate (Other Financial or Material Support, Author)

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199. Prospective Observational Cohort Of Transition to Oral Antibiotics in Persons Who Inject Drugs with Invasive Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.401 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S207-S208

Author(s):

Sophia Lewis ◽

Laura Marks ◽

Liang Stephen ◽

Nathan Nolan ◽

Michael Durkin

Keyword(s):

Bacterial Infections ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Readmission Rates ◽

Persons Who Inject Drugs ◽

Increased Risk ◽

Significant Difference ◽

Health Coaches ◽

Observational Cohort ◽

The Impact

Abstract Background Persons who inject drugs (PWID) are at increased risk of invasive bacterial infections. Increasing data supports the efficacy of transition to oral antibiotic therapy to complete treatment of invasive bacterial infections including osteomyelitis and endocarditis. The aim of this study is to evaluate the impact of transition to oral antibiotics on a prospective observational cohort of PWID. Methods We prospectively analyzed PWID admitted 2/2020 - 2/2021 at Barnes-Jewish Hospital in St. Louis with osteomyelitis, endocarditis, epidural abscesses or septic arthritis. All patients were offered multidisciplinary support during their inpatient hospitalization including addiction medicine consultation and medications for opioid use disorder, if appropriate. Health coaches and case managers met with patients during their hospitalization and followed patients for up to 90 days after discharge. Patients were offered the option of transition to oral antibiotics if they were not able to complete recommended IV antibiotics. Patients discharged on oral antibiotics were offered post-discharge infectious diseases follow-up. Antibiotic adherence was documented by health coaches through phone out-reach. We collected data on demographics, comorbidities, microbiologic data, antibiotic selection, mortality and readmission rates. We compared 90-day readmission rates between PWID who completed IV antibiotics inpatient and those who discharged early with oral antibiotics. Results Of 166 PWID, 61 completed IV antibiotics inpatient (37%) while 105 were discharged with oral antibiotics (63%). Causative pathogens were not significantly different between inpatient IV vs oral antibiotics; MSSA (34.4% vs 35.2%, p= 0.92), MRSA (34.4% vs. 28.6%, p=0.43), or streptococcal species (26.6% vs. 24.8%, p=0.85). Of patients discharged on oral antibiotics 7.6% had documented non-adherence to therapy, 23% had unknown adherence and 67% had documented adherence. There was no significant difference in all-cause 90-day readmission rates (p=0.819) (Figure 1). All-cause readmissions by antibiotic strategy Conclusion Oral antibiotic regimens provided similar efficacy to IV antibiotics in our prospective cohort analysis of PWID. Disclosures All Authors: No reported disclosures

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Preoperative opioid education has no effect on opioid use in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00414 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0041

Author(s):

David Klein ◽

Kirk Campbell ◽

Laith Jazrawi ◽

David Bloom ◽

Samuel Baron

Keyword(s):

Pain Management ◽

Rotator Cuff ◽

Controlled Trial ◽

Opioid Analgesics ◽

Control Group ◽

Opioid Use ◽

Significant Difference ◽

Arthroscopic Rotator Cuff ◽

Experimental Group

Objectives: Opioid analgesics are frequently utilized among orthopaedic surgeons to mitigate postoperative pain. These drugs are well-known for their addictive potential and recent literature has suggested that preoperative patient-focused education on narcotic consumption may decrease post-operative opioid use. The purpose of this study was to determine whether preoperative opioid education reduces consumption following arthroscopic rotator cuff (ARTC) repair in the context of our current environment of limiting post-operative narcotic consumption. Methods: This is a single center randomized controlled trial. Opioid-naïve patients undergoing ARTC repair were randomized into one of two groups. Preoperatively, the control group received our institution’s standard of care for pain management education while the experimental group was shown a brief educational video on the proper use and dangers of opioids. All patients were discharged with 30 tabs of oxycodone-acetaminophen (5mg/325mg) prescribed as 1-2 tablets every 4-6 hours as needed for pain. They were contacted daily and asked to report opioid use, VAS pain, and satisfaction with overall pain management. A chart review was conducted at 3 months post-op to see if patients had been given narcotic refills after the initial postoperative period. Results: Our institution enrolled 106 patients, 87 of whom completed the study (41 control, 46 experimental). There were no statistically significant differences (p>0.05) with respect to patient demographics between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (p=0.85) or at 1-week follow up (p=0.29). Additionally, patients in each group were equally satisfied with their post-operative pain medication management (p=0.71). Patients in the education group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (14.74 pills experimental vs. 13.71 pills control, p=0.68). At 3-month follow up, patients in the experimental group (n=9) were equally likely to have utilized at least one narcotic prescription refill as the control group (n=5) (odds ratio 1.65, p=0.56). Conclusion: The findings of this study suggest that preoperative video-based opioid education may have no effect on reducing the number of narcotic pills consumed following ARTC repair. As such, this form of intervention may not be of use with respect to mitigating the current opioid crisis.

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The Effectiveness of Local Antibiotics in Treating Chronic Osteomyelitis in a Cohort of 50 Patients with an Average of 4 Years Follow-Up

The Open Orthopaedics Journal ◽

10.2174/1874325001509010372 ◽

2015 ◽

Vol 9 (1) ◽

pp. 372-378 ◽

Cited By ~ 10

Author(s):

Andraay H.C. Leung ◽

Benjamin R. Hawthorn ◽

A. Hamish R.W. Simpson

Keyword(s):

Chronic Osteomyelitis ◽

Average Length ◽

Free Probability ◽

Oral Antibiotics ◽

Recurrence Rates ◽

Local Antibiotics ◽

Historical Cohort ◽

Significant Difference ◽

Systemic Antibiotics

The treatment of chronic osteomyelitis requires both appropriate surgical and antibiotic management. Prolonged intravenous antibiotic therapy followed by oral therapy is widely utilised. Despite this, the long-term recurrence rate can be up to 30%. A cohort of 50 patients from a 7-year period, 2003 to 2010, with chronic osteomyelitis was identified. This cohort was treated by surgical marginal resection in combination with local application of antibiotics (Collatamp G - gentamicin in a collagen fleece), a short course of systemic antibiotics post-operatively and conversion to oral antibiotics on discharge. Information was retrieved from case notes and computerized records. Outcomes from this cohort were compared with a historical cohort treated with marginal resection followed by 6 weeks of systemic antibiotics and 6 weeks of oral antibiotics. The mean follow-up duration was 3.2 years (SD 1.8). The average length of admission was 9.8 days (SD 11.4). 6 patients (12%) suffered recurrence of infection requiring further treatment. We used the Cierny and Mader classification to stratify the patients. 'A' hosts had a shorter duration of admission (7.1 days) than 'B' hosts (12.3 days). There was no significant difference between recurrence rates of 'A' and 'B' hosts. Where available, we found pre-operative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels had no correlation with disease recurrence. Disease-free probability for this cohort compared favourably with the historical cohort. We believe local administration of gentamicin in a collagen fleece is a useful component in the management of chronic osteomyelitis.

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A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

BMC Emergency Medicine ◽

10.1186/s12873-021-00443-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David Wiercigroch ◽

Patricia Hoyeck ◽

Hasan Sheikh ◽

Jennifer Hulme

Keyword(s):

Current Knowledge ◽

Opioid Use Disorder ◽

Opioid Withdrawal ◽

Barriers And Facilitators ◽

Provider Education ◽

Opioid Use ◽

Structured Interviews ◽

Addiction Medicine ◽

Allied Health Professionals

Abstract Background Emergency departments (EDs) across Canada are increasingly prescribing buprenorphine for opioid use disorder (OUD). The objective of this study was to identify the current knowledge, attitudes, and behaviours of ED physicians on the management of OUD in the ED, including barriers and facilitators to prescribing buprenorphine. Methods We purposefully selected emergency physicians from one ED in Toronto which had recently received education on OUD management and had a new addiction medicine follow-up clinic, to participate in semi-structured interviews. We used semi-structured interviews to explore experiences with patients with OUD, conceptions of role of the ED in addressing OUD, and specifically ask about perceptions and experience on using buprenorphine for opioid withdrawal. Our analysis was informed by constructivist grounded theory to help uncover contextualized social processes and focus on what people do and why they do it. Two researchers independently coded transcripts using an iterative constant comparative and interpretative approach. Results Results fell broadly into facilitators and barriers. Generally, management of OUD in the ED varied significantly. Physician-level facilitators to treating opioid withdrawal with buprenorphine included: knowledge about OUD an7d buprenorphine, positive experiences with substitution therapy in the past, and the presence of physician champions. Systems-level facilitators included timely access to follow-up care and pre-printed order sets. Barriers included provider inexperience, lack of feedback on treatment effectiveness, limited time to counsel patients, and pressure to discharge patients quickly. Additional barriers included concerns about precipitating withdrawal, prescribing a chronic medication in acute care, and patient attitudes. Conclusion This study describes barriers and facilitators to addressing OUD and prescribing buprenorphine in a Canadian ED. These findings suggest a role for additional provider education, involvement of allied health professionals in counseling, and mentorship by physician champions in the department.

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A-153 Working Memory Performance and Brain Activity in the context of Opioid Withdrawal and Relapse

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.153 ◽

2020 ◽

Vol 35 (6) ◽

pp. 947-947

Author(s):

Surprenant B ◽

Grimone K ◽

Wagner T ◽

Sarles-Whittlesey H ◽

Jones E ◽

...

Keyword(s):

Working Memory ◽

Brain Activity ◽

Memory Performance ◽

Brain Activation ◽

Opioid Use Disorder ◽

Opiate Withdrawal ◽

Opioid Use ◽

Behavioral Measures ◽

Significant Difference

Abstract Objective Working memory (WM) deficits are associated with opioid use disorder (OUD). However, little research addresses WM during withdrawal. We used the N-back WM paradigm to assess whether differences exist between persons in withdrawal versus stable opioid doses. We also examined whether N-back performance or associated brain activity during either withdrawal or satiation predict subsequent abstinence versus relapse. Method We evaluated N-Back performance and associated brain function of 20 OUD patients during 3 T fMRI. Participants were actively using opioids during the first scan (SOWS M = 8.10, SD = 9.22) and abstained 24 hours before the second scan (SOWS M = 28.26, SD = 11.64), buprenorphine treatment began afterwards. Twelve participants (age: M = 33.92, SD = 5.99) completed both scans and were included in within-subject contrasts. Sixteen participants (age: M = 34.38, SD = 5.38) completed at least one scan and were evaluated on whether brain activation or performance was associated with relapse. Results Paired-sample t-tests revealed no significant difference on N-back accuracy (0-back: t = 0.78, p = .45, d = 0.23; 2-back: t = −0.28, p = .78, d = 0.08) or brain activation (2-back versus 0-back) across regions of interest (ROIs) associated with WM in prior studies between satiated and abstinent assessments (ts < 0.5, ps > .05). Contrasting relapsing and abstinent groups at follow-up revealed no significant difference in N-back accuracy (0-back: t = −0.30, p = .77, d = 0.14; 2-back: t = 0.43, p = .67, d = 0.22) or associated ROI brain activation (ts < 1.29, ps > .05). Conclusion This is the first investigation of brain and behavioral measures of WM in opiate withdrawal and relapse. No significant differences were found, and effect sizes were small. Further research that investigates direct (compensatory activation) and task-indirect systems (default network, motivation) during cognitive challenges is needed.

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Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0038-1632238 ◽

2000 ◽

Vol 39 (01) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

S. P. Müller ◽

Ch. Reiners ◽

A. Bockisch ◽

Katja Brandt-Mainz

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Roc Analysis ◽

Tsh Suppression ◽

Significant Difference ◽

Test Specificity ◽

The Relationship ◽

Tumor Scintigraphy ◽

Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

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Melatih Kepemimpinan Perangkat Desa Kebonharjo Kulonprogo: Membangun Sikap Anti Korupsi

Proceeding of Community Development ◽

10.30874/comdev.2017.16 ◽

2018 ◽

Vol 1 ◽

pp. 107

Author(s):

Adi Heryadi ◽

Evianawati Evianawati

Keyword(s):

Transformational Leadership ◽

Data Collection ◽

Paired Samples ◽

Significant Difference ◽

Before And After ◽

Post Test ◽

Sample Test ◽

Corruption Perception ◽

Measuring Tool

This study aims to prove whether transformational leadership training is effective for building anti-corruption attitudes of villages in Kebonharjo village, subdistrict Samigaluh Kulonprogo. This research is an experimental research with one group pre and posttest design.Subject design is 17 people from village of 21 candidates registered. Measuring tool used in this research is the scale of anti-corruption perception made by the researcher referring to the 9 anti-corruption values with the value of reliability coefficient of 0.871. The module used as an intervention made by the researcher refers to the transformational leadership dimension (Bass, 1990). The data collected is analyzed by statistical analysis of different test Paired Sample Test. Initial data collection results obtained sign value of 0.770 which means> 0.05 or no significant difference between anti-corruption perception score between before and after training. After a period of less than 1 (one) month then conducted again the measurement of follow-up of the study subjects in the measurement again using the scale of anti-corruption perception. The results of the second data collection were analysed with Paired Samples Test and obtained the value of 0.623 sign meaning p> 0.05 or no significant difference between post test data with follow-up data so that the hypothesis of this study was rejected.

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SUBLINGUAL VITAMIN D3 DRUG THERAPY IN VITAMIN D DEFICIENCY PATIENTS AT PRAVARA RURAL HOSPITAL

International Journal of Clinical and Biomedical Research ◽

10.31878/ijcbr.2019.54.05 ◽

2019 ◽

pp. 18-20

Author(s):

Sanjeeva Kumar Goud T ◽

Rahul Kunkulol

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D3 ◽

Serum Vitamin ◽

Cross Sectional ◽

Serum Vitamin D ◽

Significant Difference ◽

Before And After

The present study was aimed to study the effect of Sublingual Vitamin D3 on Serum Vitamin D level in Vitamin D deficiency patients. This was a cross-sectional and interventional study. All the Vitamin D deficiency patients of age 18-60years and either gender, willing to participate in the study were included. Patients who had greater than 20 ng/ml were excluded from the study. The total number of participants in our study was 200, out of these 111 males and 89 females, the mean age in our study was 51.07 ± 7.39Yrs. All volunteers were given sublingual vitamin D3 (60,000IU) in six doses every fifteen days of follow up for 3 months. The subject’s serum 25(OH)D levels were estimated before and after the treatment of sublingual vitamin D3. There was a statistically significant difference in serum vitamin D3 level before 16.61±6.71 ng/ml and after 35.80±7.80 ng/ml after treatment with Sublingual Vitamin D3. Six doses of 60,000IU of Vitamin D3 sublingual route having improved the role of serum 25(OH)D levels in the treatment of Vitamin D3 deficiency patients.Keywords: Vitamin D3; Sublingual route

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