Electronic Medical Record-Based Automated Inpatient Screening Tool for Targeted Pneumococcal Immunization With Pneumococcal Conjugate Vaccine (PCV13) and Polysaccharide Vaccine (PPSV23) in High Risk Patients

Abstract We developed a “virtual clinic” to improve pneumococcal vaccination among asplenic adults. Using an electronic medical record, we identified patients, assessed their vaccination status, entered orders, and notified patients and providers. Within 180 days, 38 of 76 patients (50%) received a pneumococcal vaccination. A virtual clinic may optimize vaccinations among high-risk patients.

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Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0040-1718580 ◽

2020 ◽

Author(s):

Rupsa C. Boelig ◽

Mariam Wanees ◽

Tingting Zhan ◽

Vincenzo Berghella ◽

Amanda Roman

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

High Risk ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Screening Tool ◽

Adjusted Risk ◽

High Risk Patients ◽

Risk Patients ◽

One Year

Objective This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. Study Design One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11–13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis. Results Pre- (n = 156) and postscreen (n = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors (p < 0.001). Postscreen, provider recommendation of aspirin improved to 95% (p < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25–0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13–0.88]) postscreening tool implementation. Conclusion Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes. Key Points

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Immunogenicity and Tolerance of a 7-Valent Pneumococcal Conjugate Vaccine in Nonresponders to the 23-Valent Pneumococcal Vaccine

Infection and Immunity ◽

10.1128/iai.68.3.1435-1440.2000 ◽

2000 ◽

Vol 68 (3) ◽

pp. 1435-1440 ◽

Cited By ~ 47

Author(s):

S. Zielen ◽

I. Bühring ◽

N. Strnad ◽

J. Reichenbach ◽

D. Hofmann

Keyword(s):

Antibody Response ◽

Conjugate Vaccine ◽

Patient Group ◽

Pneumococcal Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Polysaccharide Vaccine ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Pneumococcal Polysaccharide Vaccine ◽

Risk Patients

ABSTRACT There is still a lack of effective vaccination strategies for patients with a deficient antibody response to bacterial polysaccharide antigens. In an open trial, we evaluated the immunogenicity and tolerance of a new 7-valent pneumococcal conjugate vaccine in 22 infection-prone nonresponders to pneumococcal polysaccharide vaccine and 21 controls. In the patient group, nonresponsiveness was confirmed by repeated vaccination with a 23-valent pneumococcal polysaccharide vaccine. The study protocol provided two doses of the pneumococcal conjugate vaccine, given 4 to 6 weeks apart, for both groups. The antibody response was determined before each vaccination and on follow-up by an enzyme-linked immunosorbent assay and compared to the response in a functional opsonophagocytosis assay. Patients showed a significantly lower postvaccination immune response for all serotypes than did controls. The postvaccination response was serotype dependent. A median titer of >1 μg/ml in patients was recorded only for serotypes 4, 9V, 14, and 19F, which are known to be more immunogenic than serotypes 6B, 18C, and 23F. In the patient group, 70% responded to serotype 19F (Pnc 19F), 65% responded to Pnc 14 and 4, 60% responded to Pnc 9V, 55% responded to Pnc 18C, 50% responded to Pnc 23F, and 25% responded to Pnc 6B. In the control group >95% of individuals showed a titer of >1 μg/ml to every serotype. The vaccine was tolerated well, and no major side effects have been reported. The new pneumococcal conjugate vaccine is clearly more immunogenic in previous nonresponders than is the 23-valent pneumococcal vaccine. Immunization with a pneumococcal conjugate vaccine should be considered as a strategy to protect high-risk patients.

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Anal Pap Smear in High-Risk Patients: A Poor Screening Tool

Southern Medical Journal ◽

10.1097/smj.0b013e318186b202 ◽

2008 ◽

Vol 101 (11) ◽

pp. 1185-1186 ◽

Cited By ~ 3

Author(s):

Ambra Ferraris ◽

Kanakasabai Narasimhan ◽

Ifad Rahman ◽

Irving Jorge

Keyword(s):

High Risk ◽

Pap Smear ◽

Screening Tool ◽

High Risk Patients ◽

Risk Patients ◽

Anal Pap Smear

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PERFORMANCE OF HBA1C VERSUS ORAL GLUCOSE TOLERANCE TEST (OGTT) AS A SCREENING TOOL TO DIAGNOSE DYSGLYCEMIC STATUS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i6.1175 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Diwakar . ◽

Banumathi .

Keyword(s):

High Risk ◽

Screening Tool ◽

Plasma Lipid ◽

Oral Glucose ◽

Diabetes Group ◽

Related Disorder ◽

High Risk Patients ◽

Kappa Value ◽

Risk Patients ◽

History Of

Background: Increasing global prevalence of type 2 diabetes (T2D) has resulted in concerted efforts to improve predictors for development of this obesity-related disorder. Establishing markers that identify prediabetes, an intermediary state of glycaemia above that of healthy individuals but below frank T2D, is an important focus. The objectives of this study were to examine the diagnostic accuracy of HbA1c using OGTT as a reference standard to identify subjects of dysglycemic status and also evaluate the agreement between HbA1c and OGTT in diagnosing dysglycemic status among high-risk Indian patients. Methods: We reviewed a sample of high-risk adult, aged 18 Yrs and older, who underwent 75-g OGTT and had an HbA1c value. Data were collected on baseline characteristics such as, age, sex, blood pressure, BMI, WC, history of diabetes in first-degree relatives, previously documented cardiovascular diseases, history of smoking, hypertension, plasma lipid profiles, and statin usage. Results: We evaluated the agreement represented by the ROC curves between the classification of prediabetes and diabetes defined by OGTT and HbA1c. In diabetes group, the AUC was 0.73 indicating that HbA1c was an acceptable test to diagnose diabetes. The agreement, represented by kappa value of 0.312 , was considered a fair agreement between the two tests. However in diagnosing prediabetes, AUC from the ROC curve is 0.52. Thus, HbA1c could not be used to discriminate subjects with IGT. The Kappa value of 0.153, indicated that there was no agreement between the two tests in diagnosing prediabetes. Conclusion: Our study found that diabetes prevalence is higher when diagnosed using OGTT than when using HbA1c which implies the limitations of HbA1c as a screening tool for diabetes in high-risk patients. This is the first study to explore the role of HbA1c in diagnosing dysglycemic status in high-risk patients. OGTT should continue to advocate as a screening tool for identification of dysglycemic status in particular population. Keywords: HbA1c, OGTT, Dysglycemia.

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Utilizing an Equitable and Multifaceted Zika Screening Tool to Identify At-Risk Individuals For Testing and Education: Successes, Challenges, and Lessons Learned in Harris County, Texas.

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.699 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S303-S303

Author(s):

Aisha Haynie ◽

Diana Martinez ◽

Sherry Jin ◽

Tamisha Piper ◽

Brian Reed ◽

...

Keyword(s):

High Risk ◽

Low Income ◽

Screening Tool ◽

Lessons Learned ◽

Successful Implementation ◽

Harris County ◽

Response Effort ◽

Screening Process ◽

High Risk Patients ◽

Risk Patients

Abstract Background Harris County Public Health (HCPH) is the health department for Harris County, Texas jurisdiction, representing 2.3 million residents. Located in the nation’s Third most populous county, HCPH’s 13 wellness clinics and WIC centers provide services for over 100,000 patients annually. Since late 2015, HCPH confirmed 46 individuals with Zika infection/disease, including two infants with microcephaly and congenital disease. Over two-thirds of these infections were in individuals of Hispanic origin, including all twelve infected pregnant women, two of whom were unaccompanied minors. Due to Harris County’s geographic vulnerability to Zika, highly mobile residents, and HCPH’s largely low-income Hispanic and refugee clinic population, equitably screening and educating patients about Zika exposure is of paramount importance. Methods Using U.S. CDC guidelines, HCPH developed a multifaceted Zika Screening Tool (ZST) for use within clinics. Front desk staff, outreach workers, nursing staff, and clinical providers all participate in various portions of the education-based screening process. The ZST is updated as new CDC guidance becomes available. Results All pregnant and high-risk patients received Zika education. Forty-five patients, mostly pregnant females, were additionally referred for testing and further care. Conclusion HCPH’s ZST successfully identified high-risk patients for education and testing. This presentation will explore HCPH’s equity-based rationale for education-oriented screening, the ZST’s evolution over time, and describe ZST forms and their integration into the clinic visit. Successful implementation strategies, challenges, and lessons learned will also be discussed, along with the role of the ZST as an integral part of HCPH’s overall multidisciplinary Zika response effort. Disclosures All authors: No reported disclosures.

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