scholarly journals 2041. Impact of an Infectious Disease Specialist-led Post-Prescription Carbapenem Intervention in a Large Japanese Tertiary Hospital: A Before–After Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S686-S687
Author(s):  
Takashi Matono ◽  
Moritsugu Uchida ◽  
Hidenobu Koga ◽  
Naoya Kanatani ◽  
Yoshimi Furuno ◽  
...  
Keyword(s):  
Infectious Disease ◽  
The United States ◽  
Baseline Period ◽  
Tertiary Hospital ◽  
Intervention Period ◽  
Protected Time ◽  
Innovative Solution ◽  
E Mail ◽  
Appropriate Antimicrobial Use

Abstract Background There are fewer board-certified infectious disease (ID) specialists in Japan (n = 1494) than in the United States (n = 8535); therefore, we have insufficient protected time for antimicrobial stewardship activities, and thus, there is a need for an innovative solution. Methods This study compared carbapenem consumption between a 24-month baseline period and a 12-month intervention period at the Iizuka Hospital with 1048 inpatient beds in Japan. During the intervention period, a board-certified ID specialist provided daily feedback to prescribers against prolonged carbapenem use (≥14 days) through conversations and medical records. Additionally, we reported through e-mail the weekly point prevalence surveillance data of the long-term carbapenem users for 7–13 and ≥14 days, which were aggregated by each department. Results We provided a total of 106 feedbacks regarding carbapenem use for ≥14 days during the intervention period. After the initiation of intervention, the trend of monthly carbapenem consumption changed (coefficient: −0.62; 95% CI: −1.15 to −0.087, P = 0.024), and its overall consumption has decreased (coefficient: −0.098; 95% CI: −0.16 to −0.039, P = 0.002, Figure 1) without a change in the in-hospital mortality (P = 0.53) as revealed by segmented regression analysis. Interestingly, the number of monthly carbapenem users, but not the duration of carbapenem use, significantly decreased (coefficient: −3.02; 95% CI: −4.63 to −1.42, P = 0.001, Figure 2). An annual estimated saving after the intervention was $82,266 with a cost reduction of 22%. Conclusion Our ID specialist-led daily intervention in carbapenem prescription and weekly feedback for long-term carbapenem use were effective in reducing this antibiotic’s consumption and consequently the number of carbapenem users. These feedbacks may be useful in changing the behavior of prescribers and promoting appropriate antimicrobial use even in resource-poor settings. Disclosures All authors: No reported disclosures.

scholarly journals Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

2020 ◽  
Author(s):  
Takashi MATONO ◽  
Yuichi Umeda ◽  
Moritsugu Uchida ◽  
Hidenobu Koga ◽  
Naoya Kanatani ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Tertiary Hospital ◽  
Intervention Period ◽  
Resource Limited Settings ◽  
Prescribing Behavior ◽  
Resource Limited ◽  
Feedback Acceptance ◽  
E Mail ◽  
Disease Specialist

Abstract Background: There are a few infectious disease (ID) specialists in Japan. A solution to promote the implementation of antimicrobial stewardship activities under these resource-limited settings is required.Methods: We compared carbapenem consumption between a 24-month baseline and 12-month intervention periods. During the intervention period, an ID specialist provided daily advises through a chart review and ID consultation service to prescribers against all prolonged carbapenem use (≥ 14 days). Additionally, we send an aggregated table containing the weekly point prevalence amount of each departmental carbapenem use for 7–13 and ≥ 14 days through e-mail to all doctors.Results: Among the 1,241 carbapenem courses during the intervention period, the ID specialist provided a total of 96 instances of feedback regarding carbapenem use for ≥ 14 days, and the feedback acceptance rate was 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction.Conclusions: Our ID specialist-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.

Norwel Equipment Co. Limited Partnership (L.P.) Internet Upgrade

2011 ◽  
pp. 179-195
Author(s):  
Kenneth R. Walsh
Keyword(s):  
Internet Access ◽  
The United States ◽  
Construction Equipment ◽  
The Internet ◽  
Limited Partnership ◽  
Computing Services ◽  
Heavy Equipment ◽  
Internet Connections ◽  
E Mail

Norwel Equipment Co. Limited Partnership (L.P.) is a Louisiana business retailer of construction equipment specializing in John Deere heavy-equipment and has secured exclusive John Deere rights for most of the State of Louisiana. Founded in 1972, Norwel is the sixth largest John Deere construction equipment dealer in the United States. This case illustrates business and technology issues facing Norwel. In mid-1999, the October 1st deadline for John Deeres requirement to communicate by e-mail was approaching and the response time of the Norwels primary computers system, an AS/400, was increasing to the point where users were not satisfied with performance. Also users were requesting new computing services such as e-mail, document sharing, and Internet access. For example, the Parts Operations Manger suggested selling parts online and the Manager of the Used Equipment Division suggest supporting the sales staff through Internet connections. Managing Partner, Richard Hevey decided an upgrade to the networks and a connection to the Internet were needed. He is faced with both short-term and long-term decisions about Norwels infrastructure.

Teleconsultation Program for Deployed Soldiers and Healthcare Professionals in Remote and Austere Environments

2008 ◽  
Vol 23 (3) ◽  
pp. 210-216 ◽  
Author(s):  
John McManus ◽  
Jose Salinas ◽  
Melinda Morton ◽  
Charles Lappan ◽  
Ron Poropatich
Keyword(s):  
Infectious Disease ◽  
Healthcare Providers ◽  
Pediatric Intensive Care ◽  
The United States ◽  
Medical Department ◽  
Us Army ◽  
Call Schedule ◽  
Mail System ◽  
E Mail ◽  
Austere Environments

AbstractBackground: In April 2004, the US Army Medical Department approved the use of the Army Knowledge Online (AKO) electronic e-mail system as a teleconsultation service for remote teledermatology consultations from healthcare providers in Iraq, Kuwait, and Afghanistan to medical subspecialists in the United States. The success of the system has resulted in expansion of the telemedicine program to include 11 additional clinical specialty services: (1) burn-trauma; (2) cardiology; (3) dermatology; (4) infectious disease; (5) nephrology; (6) ophthalmology; (7) pediatric intensive care; (8) preventive and occupational medicine; (9) neurology; (10) rheumatology; and (11) toxicology. The goal of the program is to provide a mechanism for enhanced diagnosis of remote cases resulting in a better evacuation system (i.e., only evacuation of appropriate cases). The service provides a standard practice for managing acute and emergent care requests between remote medical providers in austere environments and rear-based specialists in a timely and consistent manner.Methods: Consults are generated using the AKO e-mail system routed through a contact group composed of volunteer, on-call consults. The project manager receives and monitors all teleconsultations to ensure Health Insurance Portability and Accountability Act compliance and consultant's recommendations are transmitted within a 24-hour mandated time period. A subspecialty “clinical champion” is responsible for recruiting consultants to answer teleconsultations and developing a call schedule for each specialty. Subspecialties may have individual consultants on call for specific days (e.g., dermatology and toxicology) or place entire groups on-call for a designated period of time (e.g., ophthalmology).Results: As of May 2007, 2,337 consults were performed during 36 months, with an average reply time of five hours from receipt of the teleconsultation until a recommendation was sent to the referring physician. Most consultations have been for dermatology (66%), followed by infectious disease (10%). A total of 51 known evacuations were prevented from use of the program, while 63 known evacuations have resulted following receipt of the consultants' recommendation. A total of 313 teleconsultations also have been performed for non-US patients.Conclusions: The teleconsultation program has proven to be a valuable resource for physicians deployed in austere and remote locations. Furthermore, use of such a system for physicians in austere environments may prevent unnecessary evacuations or result in appropriate evacuations for patients who initially may have been “underdiagnosed.”

scholarly journals Current Clinical Practice for the Use of Hypnotics to Manage Primary Insomnia in Adults in a Tertiary Hospital in Saudi Arabia: An Audit Study

Pharmacy ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 15 ◽  
Author(s):  
Ali Dobia ◽  
Kath Ryan ◽  
Daniel Grant ◽  
Ahmed BaHammam
Keyword(s):  
Saudi Arabia ◽  
Current Practice ◽  
Behavioral Therapy ◽  
The United States ◽  
Tertiary Hospital ◽  
Current Clinical Practice ◽  
National Guidelines ◽  
The Us ◽  
Using Data

Despite the risks associated with hypnotics and their recent increased use in Saudi Arabia, there are no specific national guidelines for using these medicines to treat insomnia nor are there any data on how these medicines are currently prescribed. There is the potential, however, that some physicians might be adhering to the United States guidelines. The current audit study was aimed to assess the current practice in treating insomnia with hypnotics in Saudi Arabia, and to evaluate its agreement with the US guidelines. The audit was conducted using data collected between April 2012 and March 2017 at King Fahad Central Hospital (KFCH; Jazan), of patients who were either prescribed benzodiazepines (BZDs) or Z-drugs or diagnosed with insomnia. The audit criteria followed two US guidelines for the management of insomnia in adults. Data included documented diagnosis, use of CBT-I (Cognitive Behavioral Therapy for Insomnia), use of BZDs and Z-drugs including treatment regimen, and whether physicians prescribed anti-histamines for insomnia. The data were analyzed using STATA 14 after transcription to a MS XL file. Of the 504 records reviewed, 379 patients (75%) were prescribed BZDs or Z-drugs; only 182 (48%) of them had clearly documented indications for their use. Three hundred and seven patients (60%) were diagnosed with insomnia; none of them received CBT-I as initial treatment. No patients on long-term use of hypnotics were reviewed by their physicians after they began using the medication. More than 43% of patients were prescribed anti-histamines for insomnia. No records met all (or even six) of the seven criteria. KFCH physicians do not follow US guidelines. Therefore, the Ministry of Health (MOH) should improve its administrative systems including documentation, and instead of using international guidelines that are seldom followed, physicians should be trained in prescribing hypnotics and national guidelines need to be developed.

Norwel Equipment Co. Limited Partnership (L.P.) Internet Upgrade

2011 ◽  
pp. 292-308
Author(s):  
Kenneth R. Walsh
Keyword(s):  
Internet Access ◽  
The United States ◽  
Construction Equipment ◽  
The Internet ◽  
Limited Partnership ◽  
Computing Services ◽  
Heavy Equipment ◽  
Internet Connections ◽  
E Mail

Norwel Equipment Co. Limited Partnership (L.P.) is a Louisiana business retailer of construction equipment specializing in John Deere heavy-equipment and has secured exclusive John Deere rights for most of the State of Louisiana. Founded in 1972, Norwelis the sixth largest John Deere construction equipment dealer in the United States. This case illustrates business and technology issues facing Norwel. In mid-1999, the October 1st deadline for John Deere’s requirement to communicate by e-mail was approaching and the response time of the Norwel’s primary computers system, an AS/400, was increasing to the point where users were not satisfied with performance. Also users were requesting new computing services such as e-mail, document sharing, and Internet access. For example, the Parts Operations Manger suggested selling parts online and the Manager of the Used Equipment Division suggest supporting the sales staff through Internet connections. Managing Partner, Richard Hevey decided an upgrade to the networks and a connection to the Internet were needed. He is faced with both short-term and long-term decisions about Norwel’s infrastructure.

scholarly journals The influence of school accountability incentives on Advanced Placement access: Evidence from Pennsylvania

2019 ◽  
Vol 27 ◽  
pp. 138
Author(s):  
Paul Beach ◽  
Keith Zvoch ◽  
Michael Thier
Keyword(s):  
Advanced Placement ◽  
Interrupted Time Series ◽  
Baseline Period ◽  
School Accountability ◽  
Initial Increase ◽  
Policy Intervention ◽  
Intervention Period ◽  
Demographic Differences ◽  
Course Offerings

This study employed hierarchical piecewise growth modeling and two interrupted time series models to examine the effect of introducing an Advanced Placement (AP) school accountability incentive on AP access in Pennsylvania. Specifically, we examined whether adoption of an advanced course access accountability indicator was associated with an increase in AP course offerings initially and in the three years after the policy intervention. We also analyzed if the indicator differentially affected schools we hypothesized as sensitive or nonsensitive to the policy and examined demographic differences between those school groups. Pennsylvania’s AP accountability incentive was associated with an initial increase in schools’ AP course offerings, but the trajectory of change during the post-policy intervention period did not differ from the pre-policy baseline period. Also, the sizeable gap between schools with the most and fewest AP course offerings did not narrow across time. Instead, the gap widened. Our results suggest that adoption of AP school accountability incentives may not be a long-term solution to improving AP access for all schools or narrowing disparities in access between schools. We call for examinations in other states to determine if, and under what conditions, AP accountability incentives increase AP course offerings while narrowing access disparities.

scholarly journals Providing Research Results to Participants: Attitudes and Needs of Adolescents and Parents of Children With Cancer

2009 ◽  
Vol 27 (6) ◽  
pp. 878-883 ◽  
Author(s):  
Conrad Vincent Fernandez ◽  
Jun Gao ◽  
Caron Strahlendorf ◽  
Albert Moghrabi ◽  
Rebecca Davis Pentz ◽  
...  
Keyword(s):  
Public Awareness ◽  
The United States ◽  
Phone Call ◽  
Main Concern ◽  
Children With Cancer ◽  
Research Results ◽  
Multicenter Survey ◽  
Increasing Demand ◽  
E Mail

Purpose There is an increasing demand for researchers to provide research results to participants. Our aim was to define an appropriate process for this, based on needs and attitudes of participants. Methods A multicenter survey in five sites in the United States and Canada was offered to parents of children with cancer and adolescents with cancer. Respondents indicated their preferred mode of communication of research results with respect to implications; timing, provider, and content of the results; reasons for and against providing results; and barriers to providing results. Results Four hundred nine parents (including 19 of deceased children) and 86 adolescents responded. Most parents (n = 385; 94.2%) felt that they had a strong right to research results. For positive results, most wanted a letter or e-mail summary (n = 238; 58.2%) or a phone call followed by a letter (n = 100; 24.4%). If the results were negative, phone call (n = 136; 33.3%) or personal visits (n = 150; 36.7%) were preferred. Parents wanted the summary to include long-term sequelae and suggestions for participants (n = 341; 83.4%), effect on future treatments (n = 341; 83.4%), and subsequent research steps (n = 284; 69.5%). Understanding the researcher was a main concern about receiving results (n = 145; 35.5%). Parents felt that results provide information to support quality of life (n = 315; 77%) and raise public awareness of research (n = 282; 68.9%). Adolescents identified similar preferences. Conclusion Parents of children with cancer and adolescents with cancer feel strongly that they have a right to be offered research results and have specific preferences of how and what information should be communicated.

Oxygen radicals participate in alloxan-induced pulmonary EDEMA

1990 ◽  
Vol 48 (3) ◽  
pp. 298-299
Author(s):  
Tomoo Kawada ◽  
Michio Arakawa ◽  
Kenjiro Kambara ◽  
Takashi Segawa ◽  
Fumio Ando ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Oxygen Radicals ◽  
Bolus Injection ◽  
Physiological Saline ◽  
Baseline Period ◽  
Alveolar Epithelial Cells ◽  
Control Group ◽  
Intervention Period ◽  
Lung Water ◽  
Electron Microscopic

We know that alloxan causes increased-permeability pulmonary edema and that alloxan generates oxygen radicals (H2O2, O2−, ·OH) in blood. Therefore, we hypothesize that alloxan-generated oxygen radicals damage pulmonary capillary endothelial cells, and, possibly, alveolar epithelial cells as well. We examined whether oxygen radical scavengers, such as catalase or dimethylsulfoxide (DMSO), protected against alloxaninduced pulmonary edema.Five dogs in each following group were anesthetized: control group: physiological saline (20ml/kg/h); alloxan group: physiological saline + alloxan (75mg/kg) bolus injection at the beginning of the experiment; catalase group: physiological saline + catalase (150,000u/kg) bolus injection before injection of alloxan; DMSO group: physiological saline + DMSO (0.4mg/kg) bolus injection before alloxan. All dogs had 30-min baseline period and 3-h intervention period. Hemodynamics and circulating substances were measured at the specific points of time. At the end of intervention period, the dogs were killed and had the lungs removed for electron microscopic study and lung water measurement with direct destructive method.

Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

2012 ◽  
Vol 2 (1) ◽  
pp. 11-18
Author(s):  
Melissa A. Pierce
Keyword(s):  
United States ◽  
Special Education ◽  
Peace Corps ◽  
People With Disabilities ◽  
Communication Disorders ◽  
The United States ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

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