scholarly journals 675. Current Physician Knowledge, Attitudes, and Clinical Practice Regarding Legionnaires’ Disease in the Aftermath of the Flint Water Crisis in Genesee County, Michigan

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S244-S244
Author(s):  
Katanya C Alaga ◽  
Jewel M Konja ◽  
Abdulbaset Salim ◽  
Pete Levine ◽  
Sherry Smith ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Guidelines ◽  
Tap Water ◽  
The United States ◽  
Medical Society ◽  
Healthcare Personnel ◽  
Monthly Bulletin ◽  
Attitudes And Practices ◽  
Legionnaires Disease ◽  
Genesee County

Abstract Background Legionnaires’ disease (LD) is a respiratory illness caused by the inhalation of aerosolized water contaminated with Legionella bacteria. For reasons not yet understood, the incidence of LD has steadily increased across the United States during the past 10 years. In 2014 and 2015, the City of Flint in Genesee County (GC), Michigan underwent a change in the city’s water source, which resulted in the third largest recorded LD outbreak in American history and over 100,000 residents being exposed to contaminated water. In order to reduce the incidence of LD in at-risk populations it is imperative that we evaluate and improve LD knowledge and clinical practice among healthcare personnel. Methods This investigation surveyed clinicians practicing in Genesee County who are also members of the Genesee County Medical Society (GCMS). A survey was designed to assess current clinical knowledge, attitudes, and practices related to LD, in addition to measuring the uptake and utility of the LD clinical guidelines. The survey and the LD clinical guidelines were distributed to all GCMS members over a 6-month period. Prompts to complete the survey using Qualtrics programming were emailed to GCMS members and posted in the GCMS monthly bulletin. In addition, surveys were distributed to members at GCMS meetings. Completed responses were entered into Qualtrics software and exported into MS Excel and SPSS statistical software for analysis. Results In total, 95 healthcare personnel responded. Of those surveyed, 79.5% have been in practice for more than 10 years and 55% identified as practicing in family, internal or emergency medicine. Despite, the well-publicized LD outbreak in GC, 45% of respondents did not believe or were unsure if LD was a current public health issue, and 65% have either not received, have received but are not interested, or have received but not read the LD clinical guidelines. Despite this, 47% and 61% of respondents were able to correctly identify the symptoms and risk factors for LD, respectively. In addition, 34% of participants believe that drinking tap water is a risk factor for contracting LD. Conclusion This survey underscores the continuing need for comprehensive physician education to improve the clinical recognition and evaluation of patients with LD. Disclosures All authors: No reported disclosures.

Overview of Current Approaches to Aural Rehabilitation for Adults With Cochlear Implants

2020 ◽  
Vol 5 (5) ◽  
pp. 1175-1187
Author(s):  
Rachel Glade ◽  
Erin Taylor ◽  
Deborah S. Culbertson ◽  
Christin Ray
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Cochlear Implants ◽  
Practice Patterns ◽  
The United States ◽  
Care Providers ◽  
Aural Rehabilitation ◽  
Starting Point ◽  
Clinical Models ◽  
Hearing Health

Purpose This clinical focus article provides an overview of clinical models currently being used for the provision of comprehensive aural rehabilitation (AR) for adults with cochlear implants (CIs) in the Unites States. Method Clinical AR models utilized by hearing health care providers from nine clinics across the United States were discussed with regard to interprofessional AR practice patterns in the adult CI population. The clinical models were presented in the context of existing knowledge and gaps in the literature. Future directions were proposed for optimizing the provision of AR for the adult CI patient population. Findings/Conclusions There is a general agreement that AR is an integral part of hearing health care for adults with CIs. While the provision of AR is feasible in different clinical practice settings, service delivery models are variable across hearing health care professionals and settings. AR may include interprofessional collaboration among surgeons, audiologists, and speech-language pathologists with varying roles based on the characteristics of a particular setting. Despite various existing barriers, the clinical practice patterns identified here provide a starting point toward a more standard approach to comprehensive AR for adults with CIs.

Dormancy-breaking Studies on Echinacea angustifolia

HortScience ◽  
1998 ◽  
Vol 33 (3) ◽  
pp. 456f-457 ◽  
Author(s):  
Ali O. Sari ◽  
Mario R. Morales ◽  
James E. Simon
Keyword(s):  
Native Americans ◽  
Seed Germination ◽  
Tap Water ◽  
The United States ◽  
Market Demand ◽  
Dormancy Breaking ◽  
Echinacea Angustifolia ◽  
Native Populations ◽  
Percent Germination ◽  
Dry Heating

Echinacea is a medicinal plant native to North America. It was used extensively by native Americans in the treatment of their ailments. It is presently one of the most popular medicinal plants in the United States. Its popularity has created a large market demand for the roots and foliage of the plant. The gathering of echinacea from the wild is leading to the reduction of native populations and the destruction of its genetic diversity. Cultivation of medicinal echinaceas is hindered by a low seed germination. Dormancy breaking studies were done on freshly harvested seeds of Echinacea angustifolia. Seed lots were placed under light at a constant temperature of 25 °C and at alternate temperatures of 25/15 °C for 14/10 h, respectively. Germination was more rapid and uniform and percent germination higher at 25 °C than at 25/15 °C. Seed tap-water soaking, dry heating, and sharp heating alteration did not increase germination. The application of 1.0 mM ethephon (2-chloroethylphosphoric acid) increased seed germination to 94% at 25 °C and 86% at 25/15 °C. Untreated seeds gave 65% germination at 25 °C and 11% at 25/15 °C. The application of 2500 mg·L–1 and 3500 mg·L–1 of GA to dry seeds and 2500 mg·L–1 to seeds that have been soaked under tap water and then dried increased germination to 82%, 83%, and 83% at 25 °C and 64%, 78%, and 64% at 25/15 °C, respectively.

Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages

2019 ◽  
pp. 135-143
Author(s):  
Yoon Seop Kim ◽  
Yoonsuk Lee ◽  
Sun Ju Kim ◽  
Sung Oh Hwang ◽  
Yong Sung Cha ◽  
...  
Keyword(s):  
Critically Ill ◽  
Hyperbaric Oxygen ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Developed Countries ◽  
The United States ◽  
Medical Society ◽  
Hyperbaric Medicine ◽  
Therapy Center ◽  
Hbo2 Therapy

Purpose: Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center. Methods: In this retrospective observational study we collected data on HBO2 patients treated at our center between October 2016 and June 2018 after HBO2 was conducted by HBO2-certified physicians. We then compared demographic data of patients with data from January 2011 to September 2015 – before HBO2 operations were conducted by HBO2-certified physicians. Result: A total of 692 patients received 5,130 treatments. Twelve indicated diseases were treated using HBO2 therapy. Fifty-six critically ill patients with intubation received HBO2. Although two patients experienced seizure due to oxygen toxicity during the study period, certified physicians and inside attendant took immediate corrective action. Conclusion: After the establishment of the HBO2 center operated by physicians with certification, more patients, including critically ill patients, received HBO2 safely for various diseases. In order to improve the practice of hyperbaric medicine in Korea, the Korean Academy of Undersea and Hyperbaric Medicine (KAUHM), an advanced and well-organized academic society, should communicate often with HBO2 centers, with the aim to set Korean education programs at UHMS course levels and increase reimbursement for HBO2 therapy.

scholarly journals Verification of Healthcare Personnel Immunity as a Strategy for Measles Preparedness

2020 ◽  
Vol 41 (S1) ◽  
pp. s431-s432
Author(s):  
Rachael Snyders ◽  
Hilary Babcock ◽  
Christopher Blank
Keyword(s):  
Infectious Diseases ◽  
Multidisciplinary Team ◽  
The United States ◽  
Transmission Risk ◽  
Healthcare Personnel ◽  
Serological Tests ◽  
Preparedness Plan ◽  
Vaccine Preventable Diseases ◽  
Measles Outbreaks ◽  
Centralized Database

Background: Immunization resistance is fueling a resurgence of vaccine-preventable diseases in the United States, where several large measles outbreaks and 1,282 measles cases were reported in 2019. Concern about these measles outbreaks prompted a large healthcare organization to develop a preparedness plan to limit healthcare-associated transmission. Verification of employee rubeola immunity and immunization when necessary was prioritized because of transmission risk to nonimmune employees and role of the healthcare personnel in responding to measles cases. Methods: The organization employs ∼31,000 people in diverse settings. A multidisciplinary team was formed by infection prevention, infectious diseases, occupational health, and nursing departments to develop the preparedness plan. Immunity was monitored using a centralized database. Employees without evidence of immunity were asked to provide proof of vaccination, defined by the CDC as 2 appropriately timed doses of rubeola-containing vaccine, or laboratory confirmation of immunity. Employees were given 30 days to provide documentation or to obtain a titer at the organization’s expense. Staff with negative titers were given 2 weeks to coordinate with the occupational heath department for vaccination. Requests for medical or religious accommodations were evaluated by occupational heath staff, the occupational heath medical director, and the human resources department. All employees were included, though patient-interfacing employees in departments considered higher risk were prioritized. These areas were the emergency, dermatology, infectious diseases, labor and delivery, obstetrics, and pediatrics departments. Results: At the onset of the initiative in June 2019, 4,009 employees lacked evidence of immunity. As of November 2019, evidence of immunity had been obtained for 3,709 employees (92.5%): serological evidence of immunity was obtained for 2,856 (71.2%), vaccine was administered to 584 (14.6%), and evidence of previous vaccination was provided by 269 (6.7%). Evidence of immunity has not been documented for 300 (7.5%). The organization administered 3,626 serological tests and provided 997 vaccines, costing ∼$132,000. Disposition by serological testing is summarized in Table 1. Conclusions: A measles preparedness strategy should include proactive assessment of employees’ immune status. It is possible to expediently assess a large number of employees using a multidisciplinary team with access to a centralized database. Consideration may be given to prioritization of high-risk departments and patient-interfacing roles to manage workload.Funding: NoneDisclosures: None

scholarly journals Systematic review of international clinical guidelines for the promotion of physical activity for the primary prevention of cardiovascular diseases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
N. Aerts ◽  
D. Le Goff ◽  
M. Odorico ◽  
J. Y. Le Reste ◽  
P. Van Bogaert ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Primary Prevention ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Guidelines ◽  
Prevention Programs ◽  
Prevention Of Cardiovascular Disease

Abstract Background Cardiovascular diseases are the world’s leading cause of morbidity and mortality. An active lifestyle is one of the cornerstones in the primary prevention of cardiovascular disease. An initial step in guiding primary prevention programs is to refer to clinical guidelines. We aimed to systematically review clinical practice guidelines on primary prevention of cardiovascular disease and their recommendations regarding physical activity. Methods We systematically searched Trip Medical Database, PubMed and Guidelines International Network from January 2012 up to December 2020 using the following search strings: ‘cardiovascular disease’, ‘prevention’, combined with specific cardiovascular disease risk factors. The identified records were screened for relevance and content. We methodologically assessed the selected guidelines using the AGREE II tool. Recommendations were summarized using a consensus-developed extraction form. Results After screening, 27 clinical practice guidelines were included, all of which were developed in Western countries and showed consistent rigor of development. Guidelines were consistent about the benefit of regular, moderate-intensity, aerobic physical activity. However, recommendations on strategies to achieve and sustain behavior change varied. Multicomponent interventions, comprising education, counseling and self-management support, are recommended to be delivered by various providers in primary health care or community settings. Guidelines advise to embed patient-centered care and behavioral change techniques in prevention programs. Conclusions Current clinical practice guidelines recommend similar PA lifestyle advice and propose various delivery models to be considered in the design of such interventions. Guidelines identify a gap in evidence on the implementation of these recommendations into practice.

scholarly journals Social Media Use Among Foot and Ankle Orthopedic Surgeons

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142098192
Author(s):  
Garret Garofolo-Gonzalez ◽  
Cesar R. Iturriaga ◽  
Jordan B. Pasternack ◽  
Adam Bitterman ◽  
Gregory P. Guyton
Keyword(s):  
Social Media ◽  
Clinical Practice ◽  
Media Use ◽  
The United States ◽  
Foot And Ankle ◽  
Social Media Use ◽  
Social Media Platform ◽  
Orthopedic Surgeons ◽  
Media Platform ◽  
Social Media Presence

Background: Digital media is an effective tool to enhance brand recognition and is currently referenced by more than 40% of orthopedic patients when selecting a physician. The purpose of this study was to evaluate the use of social media among foot and ankle (F&A) orthopedic surgeons, and the impact of that social media presence on scores of a physician-rated website (PRW). Methods: Randomly selected F&A orthopedic surgeons from all major geographical locations across the United States were identified using the AAOS.org website. Internet searches were then performed using the physician’s name and the respective social media platform. A comprehensive social media use index (SMI) was created for each surgeon using a scoring system based on social media platform use. The use of individual platforms and SMI was compared to the F&A surgeon’s Healthgrades scores. Descriptive statistics, unpaired Student t tests, and linear regression were used to assess the effect of social media on the PRW scores. Results: A total of 123 board-certified F&A orthopedic surgeons were included in our study demonstrating varying social media use: Facebook (48.8%), Twitter (15.4%), YouTube (23.6%), LinkedIn (47.9%), personal website (24.4%), group website (52.9%), and Instagram (0%). The mean SMI was 2.4 ± 1.6 (range 0-7). Surgeons who used a Facebook page were older, whereas those using a group website were younger ( P < .05). F&A orthopedic surgeons with a YouTube page had statistically higher Healthgrades scores compared to those without ( P < .05). Conclusion: F&A orthopedic surgeons underused social media platforms in their clinical practice. Among all the platforms studied, a YouTube page was the most impactful social media platform on Healthgrades scores for F&A orthopedic surgeons. Given these findings, we recommend that physicians closely monitor their digital identity and maintain a diverse social media presence including a YouTube page to promote their clinical practice. Level of Evidence: Level IV.

scholarly journals Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s62-s62
Author(s):  
Timileyin Adediran ◽  
Anthony Harris ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
Loren Miller ◽  
...  
Keyword(s):  
United States ◽  
Secondary Analysis ◽  
Positive Culture ◽  
The United States ◽  
Healthcare Personnel ◽  
Surveillance Culture ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Multicenter Prospective Cohort Study ◽  
Epidemiological Significance

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.Funding: NoneDisclosures: None

scholarly journals Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 261
Author(s):  
Priya Patel ◽  
Andrew Houck ◽  
Daniel Fuentes
Keyword(s):  
Clinical Practice ◽  
Nurse Practitioners ◽  
Pilot Project ◽  
The United States ◽  
Institution Type ◽  
Respiratory Therapists ◽  
Respiratory Management ◽  
Surfactant Administration ◽  
Practice Variations ◽  
Almost All

Variability in neonatal clinical practice is well recognized. Respiratory management involves interdisciplinary care and often is protocol driven. The most recent published guidelines for management of respiratory distress syndrome and surfactant administration were published in 2014 and may not reflect current clinical practice in the United States. The goal of this project was to better understand variability in surfactant administration through conduct of health care provider (HCP) interviews. Questions focused on known practice variations included: use of premedication, decisions to treat, technique of surfactant administration and use of guidelines. Data were analyzed for trends and results were communicated with participants. A total of 54 HCPs participated from June to September 2020. In almost all settings, neonatologists or nurse practitioners intubated the infant and respiratory therapists administered surfactant. The INSURE (INtubation-SURrfactant-Extubation) technique was practiced by 83% of participants. Premedication prior to intubation was used by 76% of HCPs. An FiO2 ≥ 30% was the most common threshold for surfactant administration (48%). In conclusion, clinical practice variations exist in respiratory management and surfactant administration and do not seem to be specific to NICU level or institution type. It is unknown what effects the variability in clinical practice might have on clinical outcomes.

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