scholarly journals 1909. Do Infectious Disease Services Save Money? Accounting Analysis Before and After Introduction of a New Clinical Infectious Disease Service at a Tertiary Hospital in New Zealand

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S549-S549
Author(s):  
Paul Huggan ◽  
Sarah Shirley ◽  
Tracey Kunac ◽  
Graham Mills
Author(s):  
Tat Ming Ng ◽  
Sock Hoon Tan ◽  
Shi Thong Heng ◽  
Hui Lin Tay ◽  
Min Yi Yap ◽  
...  

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 856.1-856
Author(s):  
C. Lao ◽  
D. Lees ◽  
D. White ◽  
R. Lawrenson

Background:Osteoarthritis of the hip and knee is one of the most common causes of reduced mobility. It also causes stiffness and pain. Opioids can offer pain relief but is usually used for severe acute pain caused by major trauma or surgery. The use of opioids for relief of chronic pain caused by arthritis has increased over the last few decades.[1]Objectives:This study aims to investigate the use of strong opiates for patients with hip and knee osteoarthritis before and after joint replacement surgery, over a 13 years period in New Zealand.Methods:This study included patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017 in New Zealand. These records were identified from the National Minimum Dataset (NMD). They were cross referenced with the NZJR data to exclude the admissions not for primary hip or knee replacement surgeries. Patients without a diagnosis of osteoarthritis were excluded.The PHARMS dataset was linked to the NMD to identify the use of strong opiates before and after surgeries. The strong opiates available for community dispensing in New Zealand and included in this study are: dihydrocodeine, fentanyl, methadone, morphine, oxycodone and pethidine. Use of opiate within three months prior to surgery and within 12 months post-surgery were examined by gender, age group, ethnicity, Charlson Comorbidity Index score and year of surgery. Differences by subgroup was examined with Chi- square test. Logistic regression model was used to calculate the adjusted odds ratios of strong opiate use before and after surgery compared with no opiate use.Results:We identified 53,439 primary hip replacements and 50,072 primary knee replacements with a diagnosis of osteoarthritis. Of patients with hip osteoarthritis, 6,251 (11.7%) had strong opiate before hip replacement surgeries and 11,939 (22.3%) had opiate after surgeries. Of patients with knee osteoarthritis, 2,922 (5.8%) had strong opiate before knee replacement surgeries and 15,252 (30.5%) had opiate after surgeries.The probability of patients with hip and knee osteoarthritis having opiate decreased with age, increased with Charlson comorbidity index score, and increased over time both before and after surgeries. Male patients with hip and knee osteoarthritis were less likely to have opiate than female patients both before and after surgeries. New Zealand Europeans with hip and knee osteoarthritis were more likely to receive opiate than other ethnic groups prior to surgeries, but were less likely to have opiate than Asians post-surgeries.Patients who had opiate before surgeries were more likely to have opiate after surgeries than those who did not have opiate before surgeries. The odds ratio was 8.34 (95% confidence interval (CI): 7.87-8.84) for hip osteoarthritis and 11.94 (95% CI: 10.84-13.16) for knee osteoarthritis after adjustment for age, gender, ethnicity, year of surgery and Charlson comorbidity index score. Having opiate prior to surgeries also increased the probability of having opiate for 6 weeks or more after surgeries substantially. The adjusted odds ratio was 21.46 (95% CI: 19.74-23.31) for hip osteoarthritis and 27.22 (95% CI: 24.95-29.68) for knee osteoarthritis.Conclusion:Preoperative opiate holidays should be encouraged. Multiple strategies need to be used to develop analgesic plans that allow adequate rehabilitation, without precipitating a chronic opiate dependence. Clinicians would also benefit from clear guidelines for prescribing strong opiates.References:[1] Nguyen, L.C., D.C. Sing, and K.J. Bozic,Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.J Arthroplasty, 2016.31(9 Suppl): p. 282-7.Disclosure of Interests:None declared


2017 ◽  
Author(s):  
Andreas Kääb ◽  
Bas Altena ◽  
Joseph Mascaro

Abstract. Satellite measurements of coseismic displacements are typically based on Synthetic Aperture Radar (SAR) interferometry or amplitude tracking, or based on optical data such as from Landsat, Sentinel-2, SPOT, ASTER, very-high resolution satellites, or airphotos. Here, we evaluate a new class of optical satellite images for this purpose – data from cubesats. More specific, we investigate the PlanetScope cubesat constellation for horizontal surface displacements by the 14 November 2016 Mw7.8 Kaikoura, New Zealand, earthquake. Single PlanetScope scenes are 2–4 m resolution visible and near-infrared frame images of approximately 20–30 km × 9–15 km in size, acquired in continuous sequence along an orbit of approximately 375–475 km height. From single scenes or mosaics from before and after the earthquake we observe surface displacements of up to almost 10 m and estimate a matching accuracy from PlanetScope data of up to ±0.2 pixels (~ ±0.6 m). This accuracy, the daily revisit anticipated for the PlanetScope constellation for the entire land surface of Earth, and a number of other features, together offer new possibilities for investigating coseismic and other Earth surface displacements and managing related hazards and disasters, and complement existing SAR and optical methods. For comparison and for a better regional overview we also match the coseismic displacements by the 2016 Kaikoura earthquake using Landsat8 and Sentinel-2 data.


2020 ◽  
Author(s):  
J Wailling ◽  
Brian Robinson ◽  
M Coombs

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.


2021 ◽  
Author(s):  
Ester Amorim ◽  
Marton Kaique Andrade Cavalcante ◽  
Ailton Alvaro Silva ◽  
Vanessa Lucília Silveira Medeiros ◽  
Maria Edileuza Felinto Brito ◽  
...  

Abstract Cutaneous leishmaniasis is an infectious disease that presents an immune response marked by the activation of lymphocytes and production of cytokines, including those of the IL-1 family, which act as an important trigger for the activation of an effector immune response. Despite this, inflammation exacerbation is sometimes also attributed to IL-1 cytokines, although some others down-regulate inflammation or produce Th2 responses, which need to be further clarified in the CL. Assessing the gene and protein expression of IL-1 cytokines associated with different immune response profiles in PBMCs from patients with active and healed lesions, this study demonstrated that stimulation by L. braziliensis positively regulates inflammatory and anti-inflammatory IL-1 cytokines, as IL-1α/β and IL-37, while there was a marked inhibition of IL-1Ra and IL-18 genes in patients treated with antimony, which perhaps contributes to the mechanisms of resistance that control Leishmania infection.


2017 ◽  
Vol 98 (6) ◽  
pp. 1029-1033 ◽  
Author(s):  
A M Galieva ◽  
A Yu Vafin ◽  
I E Kravchenko ◽  
A N Galiullin

Aim. To conduct analysis of resource provision for medical care for patients with infectious pathology and to study primary infectious morbidity at the level of municipal districts of the Republic of Tatarstan. Methods. Study of primary infectious morbidity according to official statistics of the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being in the Republic of Tatarstan based on form No. 2 with extracting data in 495 units, annual reports of Infectious Disease Service of the Ministry of Health of the Republic of Tatarstan for 2005-2015 - 66 units. The analysis of resource provision according to the central regional hospitals data, with extracting data in 70 units. Results. During the period of 2005-2015 the highest rates of primary infectious morbidity were observed in municipal districts where the administrative center is a city (13 054.01 per 100 000 population), the lowest - in rural areas (7953.6). The level of infectious morbidity in municipal districts is significantly lower than in average across the Republic of Tatarstan (р ˂0.05). 3 municipal districts having different types of administrative center are studied: Zainsky (urban population 72%), Apastovsky (rural people 73.9%), Drozhzhanovsky (rural people 100%) districts. The highest level of infectious morbidity in Zainsky District (2005 - 10 510; 2015 - 11 800.85 per 100 000 population), Apastovsky (7600.0 and 3612.44) and Drozhzhanovsky district (1629.68 and 4765.84). Differences in resource provision for infectious disease service are established: Zainsky district (there is an infectiologist, infectious beds, infectious disease office, specialized laboratory), Apastovsky district (service in infectious disease office is provided by part-time infectiologist), Drozhzhanovsky district (service in infectious disease office is provided by a nurse). In Drozhzhanovsky and Apastovsky districts there are no infectious beds and specialized laboratories. Conclusion. Level of infectious morbidity in municipal districts of the Republic of Tatarstan is closely related to the type of municipal district and resource provision for infectious disease service.


2021 ◽  
Author(s):  
◽  
Roald Egbert Harro Bomans

<p>Introduced mammalian predators, namely possums, stoats and rats, are the leading cause of decline in native avifauna in New Zealand. The control of these species is essential to the persistence of native birds. A major component of mammal control in New Zealand is carried out through the aerial distribution of the toxin sodium monofluoroacetate (otherwise known as 1080). The use of this toxin, however, is subject to significant public debate. Many opponents of its use claim that forests will ‘fall silent’ following aerial operations, and that this is evidence of negative impacts on native bird communities. With the continued and likely increased use of this poison, monitoring the outcomes of such pest control operations is necessary to both address these concerns and inform conservation practice. The recent growth in autonomous recording units (ARUs) provides novel opportunities to conduct monitoring using bioacoustics. This thesis used bioacoustic techniques to monitor native bird species over three independent aerial 1080 operations in the Aorangi and Rimutaka Ranges of New Zealand.  In Chapter 2, diurnal bird species were monitored for 10-12 weeks over two independent operations in treatment and non-treatment areas. At the community level, relative to non-treatment areas, the amount of birdsong recorded did not decrease significantly in treatment areas across either of the operations monitored. At the species level, one species, the introduced chaffinch (Fringilla coelebs), showed a significant decline in the prevalence of its calls in the treatment areas relative to non-treatment areas. This was observed over one of the two operations monitored. Collectively, these results suggest that diurnal native avifaunal communities do not ‘fall silent’ following aerial 1080 operations.  The quantity of data produced by ARUs can demand labour-intensive manual analysis. Extracting data from recordings using automated detectors is a potential solution to this issue. The creation of such detectors, however, can be subjective, iterative, and time-consuming. In Chapter 3, a process for developing a parsimonious, template-based detector in an efficient, objective manner was developed. Applied to the creation of a detector for morepork (Ninox novaeseelandiae) calls, the method was highly successful as a directed means to achieve parsimony. An initial pool of 187 potential templates was reduced to 42 candidate templates. These were further refined to a 10-template detector capable of making 98.89% of the detections possible with all 42 templates in approximately a quarter of the processing time for the dataset tested. The detector developed had a high precision (0.939) and moderate sensitivity (0.399) with novel recordings, developed for the minimisation of false-positive errors in unsupervised monitoring of broad-scale population trends.  In Chapter 4, this detector was applied to the short-term 10-12 week monitoring of morepork in treatment and non-treatment areas around three independent aerial 1080 operations; and to longer-term four year monitoring in two study areas, one receiving no 1080 treatment, and one receiving two 1080 treatments throughout monitoring. Morepork showed no significant difference in trends of calling prevalence across the three independent operations monitored. Longer-term, a significant quadratic effect of time since 1080 treatment was found, with calling prevalences predicted to increase for 3.5 years following treatment. Collectively, these results suggest a positive effect of aerial 1080 treatment on morepork populations in the lower North Island, and build on the small amount of existing literature regarding the short- and long-term response of this species to aerial 1080 operations.</p>


2014 ◽  
Vol 53 (1) ◽  
pp. 278-281 ◽  
Author(s):  
Jeannette Guarner ◽  
Eileen M. Burd ◽  
Colleen S. Kraft ◽  
Wendy S. Armstrong ◽  
Kenya Lenorr ◽  
...  

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions;P= 0.0001). The modules accessed by more than 30 residents included those related toClostridium difficile, anaerobes,Candidaspp.,Streptococcus pneumoniae, influenza,Mycobacterium tuberculosis, andNeisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation.


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