scholarly journals 2188. Provider Education and Rapid Antigen Detection Test Use in Private and Academic Pediatric Clinics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S744-S745
Author(s):  
Steven Dahl ◽  
Emily A Hurley ◽  
Brian R Lee ◽  
Jason Newland ◽  
Andrea Bradley-Ewing ◽  
...  
Keyword(s):  
Sample Size ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Antigen Detection ◽  
Control Group ◽  
Healthy Children ◽  
Provider Education ◽  
Care Clinic ◽  
The Impact ◽  
Gas Exposure

Abstract Background Rapid antigen detection testing (RADT) is needed to differentiate Group A Streptococcal (GAS) pharyngitis from viral pharyngitis. Guidelines do not recommend RADT in patients with viral symptoms or in children <3 years old without GAS exposure. Reduction in unnecessary RADT use may impact inappropriate antibiotic use by decreasing prescriptions in children likely colonized with GAS. We examined the impact of guideline concordant education of appropriate RADT and antibiotic use in pharyngitis on providers’ (physician and APRN) use of RADT in an academic and private pediatric primary care clinic. Methods Retrospective chart review of 1,085 healthy children, age 1–5 years old, seen in clinics between September 2015 and March 2019 (355 pre- and 730 post-education; 211 academic and 874 private). Education occurred in 3/2017. Cases selected had either complaint of sore throat, RADT, or diagnosis of GAS pharyngitis or pharyngitis. Data collected included the presence of viral symptoms (e.g., cough, rhinorrhea), RADT/GAS culture results, diagnosis, and prescribed antibiotics. RADT was deemed unnecessary for all children < 3 years old without GAS exposure, in patients with ≥ 2 viral symptoms, or in patients ≥ 3 years old without pharyngitis. Results Overall, RADT use decreased from pre to post intervention (72.1% vs. 23.4% of patients, P ≤ 0.0001). Unnecessary RADT use decreased overall (50.4% vs. 16.2%, P ≤ 0.0001), in all clinics (private: 56.2% vs. 16.0%, P ≤ 0.0001; academic: 38.1% vs. 17.4%, P = 0.0012), and with all providers (physician: 41.6% vs. 18.3%, P ≤ 0.0001; APRN: 58.8% vs. 14.1%, P ≤ 0.0001). Unnecessary RADT use decreased for children <3 years old (28.1% vs. 7.4%, P ≤ 0.0001) and ≥2 viral symptoms (65.7% vs. 16.5%, P ≤ 0.0001). Conclusion Unnecessary RADT use decreased in the post-education period overall (34%), in children <3 years old (21%), and in patients with ≥ 2 viral symptoms (49%). Reductions were also seen in both academic (21%) and private (40%) clinics as well as with both physicians (23%) and ARPNs (45%). Limitations include lack of a control group and sample size variance by the clinic. We observed positive trends in RADT reduction following provider education in private and academic settings; however, further research including control and optimal sample size is needed to confirm any direct impact. Disclosures All authors: No reported disclosures.

Structured Encounter Form: The Impact on Provider Performance and Recording of Well-Child Care

PEDIATRICS ◽  
1990 ◽  
Vol 85 (1) ◽  
pp. 104-113 ◽  
Author(s):  
Anne Kaszuba Duggan ◽  
Barbara Starfield ◽  
Catherine DeAngelis
Keyword(s):  
Child Care ◽  
Primary Care Clinic ◽  
Study Data ◽  
Control Group ◽  
Process Of Care ◽  
Care Clinic ◽  
Provider Performance ◽  
Well Child Care ◽  
Hospital Pediatric ◽  
The Impact

The impact of record format on provider performance and recording of the process of care and their concordance were examined in this study. The process of care was defined by existing sets of explicit criteria developed for quality assessment. The study was conducted in an urban teaching hospital pediatric primary care clinic. Housestaff were encouraged, but not required, to use the clinic's structured, age-specific forms for recording well-child care. Performance and recording were compared during required well-child visits using the structured form and those using the basic clinic form. Study data from 1031 visits to 68 housestaff during a 14-month period were collected using medical record abstracting of all visits and direct observation of 243 of them. Twenty-three of the providers were assigned randomly to an unobserved control group to assess the effect of observation on recording. Use of the structured form was associated with significantly higher levels of both recorded and observed performance. When performance could be merely checked off to document performance, overdocumentation was found. Record-based estimates of performance were more accurate during visits when the structured form was used. Record format can improve provider performance and recording of the process of care.

MHealth Applications for People with Cognitive Impairment and Their Caregivers: A Scoping Review (Preprint)

2020 ◽  
Author(s):  
Qing Zhao ◽  
Pei Chen ◽  
Yu Zhang ◽  
Haining Liu ◽  
Xianwen Li
Keyword(s):  
Cognitive Impairment ◽  
Sample Size ◽  
Research Design ◽  
Scoping Review ◽  
Life Support ◽  
Small Sample ◽  
Mobile Technologies ◽  
Control Group ◽  
Caregiver Support ◽  
The Impact

BACKGROUND Mobile health application has become an important tool for healthcare systems. One such tool is the delivery of assisting in people with cognitive impairment and their caregivers. OBJECTIVE This scoping review aims to explore and evaluate the existing evidence and challenges on the use of mHealth applications that assisting in people with cognitive impairment and their caregivers. METHODS Nine databases, including PubMed, EMBASE, Cochrane, PsycARTICLES, CINAHL, Web of Science, Applied Science & Technology Source, IEEE Xplore and the ACM Digital Library were searched from inception through June 2020 for the studies of mHealth applications on people with cognitive impairment and their caregivers. Two reviewers independently extracted, checked synthesized data independently. RESULTS Of the 6101 studies retrieved, 64 studies met the inclusion criteria. Three categories emerged from this scoping review. These categories are ‘application functionality’, ‘evaluation strategies’, ‘barriers and challenges’. All the included studies were categorized into 7 groups based on functionality: (1) cognitive assessment; (2) cognitive training; (3) life support; (4) caregiver support; (5) symptom management; (6) reminiscence therapy; (7) exercise intervention. The included studies were broadly categorized into four types: (1) Usability testing; (2) Pilot and feasibility studies; (3) Validation studies; and (4) Efficacy or Effectiveness design. These studies had many defects in research design such as: (1) small sample size; (2) deficiency in active control group; (3) deficiency in analyzing the effectiveness of intervention components; (4) lack of adverse reactions and economic evaluation; (5) lack of consideration about the education level, electronic health literacy and smartphone proficiency of the participants; (6) deficiency in assessment tool; (7) lack of rating the quality of mHealth application. Some progress should be improved in the design of smartphone application functionality, such as: (1) the design of cognitive measurements and training game need to be differentiated; (2) reduce the impact of the learning effect. Besides this, few studies used health behavior theory and performed with standardized reporting. CONCLUSIONS Preliminary results show that mobile technologies facilitate the assistance in people with cognitive impairment and their caregivers. The majority of mHealth application interventions incorporated usability outcome and health outcomes. However, these studies have many defects in research design that limit the extrapolation of research. The content of mHealth application is urgently improved to adapt to demonstrate the real effect. In addition, further research with strong methodological rigor and adequate sample size are needed to examine the feasibility, effectiveness, and cost-effectiveness of mHealth applications for people with cognitive impairment and their caregivers.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

scholarly journals How to Predict the Impact of Methylphenidate on Cardiovascular Risk in Children with Attention Deficit Disorder: Methylphenidate Improves Autonomic Dysfunction in Children with ADHD

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Reiner Buchhorn ◽  
Christian Müller ◽  
Christian Willaschek ◽  
Kambiz Norozi
Keyword(s):  
Sudden Cardiac Death ◽  
Attention Deficit ◽  
Attention Deficit Disorder ◽  
Cardiac Death ◽  
Control Group ◽  
Healthy Children ◽  
Children With Adhd ◽  
Heart Defect ◽  
Adhd Children ◽  
The Impact

Background. Although stimulants have long been touted as treatments for attention deficit disorder with or without hyperactivity (ADHD), in recent years, increasing concerns have been raised about the cardiovascular safety of these medications. We aimed to prove if measurements of autonomic function with time domain analysis of heart rate variability (HRV) in 24-hour Holter ECG are useful to predict the risk of sudden cardiac death in ADHD children and adolescents. Methods. We analysed HRV obtained from children with the diagnosis of ADHD prior to (N=12) or during medical therapy (N=19) with methylphenidate (MPH), aged 10.8±2.0 years (mean ± SD), who were referred to our outpatient Paediatric Cardiology Clinic to rule out heart defect. As a control group, we compared the HRV data of 19 age-matched healthy children without heart defect. Results. Average HRV parameters from 24-hour ECG in the ADHD children prior to MPH showed significant lower values compared to healthy children with respect to rMSSD (26±4 ms versus 44±10 ms, P≤0.0001) and pNN50 (6.5±2.7% versus 21.5±9.0%, P≤0.0001). These values improved in MPH-treated children with ADHD (RMSSD: 36±8 ms; pNN50: 14.2±6.9%). Conclusion. Children who suffer from ADHD show significant changes in HRV that predominantly reflects diminished vagal tone, a well-known risk factor of sudden cardiac death in adults. In our pilot study, MPH treatment improved HRV.

scholarly journals THE IMPACT OF ASTHMAAND ITS MEDICATIONS ON DENTAL CARIES STATUS AND STREPTOCOCCUS MUTANS COUNT IN CHILDREN: A CROSS-SECTIONAL STUDY

2020 ◽  
pp. 20-23
Author(s):  
Sneha Upadhyay ◽  
Jyoti Bhavthankar ◽  
Mandakini Mandale ◽  
Nivedita Kaorey
Keyword(s):  
Dental Caries ◽  
Streptococcus Mutans ◽  
Cross Sectional Study ◽  
Control Group ◽  
Healthy Children ◽  
Sectional Study ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Significant Difference ◽  
The Impact

Background: Asthma and its medications have been linked to oral diseases in asthmatic children. Aim: Assessment of the dental caries status, salivary Streptococcus mutans count and S. mutans colony score in children receiving inhaled anti asthmatic medications and their comparison in healthy children Material and Method: A cross-sectional study was performed on 40 asthmatic children and 40 healthy children in the age group of 6-14 years. DMFT/deft indices were calculated and saliva samples were collected. Diluted saliva was inoculated on MSB agar plates. S. mutans count and colony score were analysed after 24-48 hours of inoculation. Results: Statistically significant difference was observed in the mean DMFT/deft index, salivary S. mutans load and S. mutans colony score in children of the asthmatic group and control group. Conclusion: Prevalence of dental caries and cariogenic bacteria is higher in asthmatic children.

scholarly journals The impact of visual impairment on nutritional status: A systematic review

2018 ◽  
Vol 36 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Nabila Jones ◽  
Hannah Bartlett
Keyword(s):  
Nutritional Status ◽  
Visual Impairment ◽  
Sample Size ◽  
Visually Impaired ◽  
Small Sample Size ◽  
Small Sample ◽  
Control Group ◽  
Visually Impaired People ◽  
Impaired People ◽  
The Impact

The aim of this review was to evaluate the literature that has investigated the impact of visual impairment on nutritional status. We identified relevant articles through a multi-staged systematic approach. Fourteen articles were identified as meeting the inclusion criteria. The sample size of the studies ranged from 9 to 761 participants. It was found that visual impairment significantly affects nutritional status. The studies reported that visually impaired people have an abnormal body mass index (BMI); a higher prevalence of obesity and malnutrition was reported. Visually impaired people find it difficult to shop for, eat, and prepare meals. Most studies had a small sample size, and some studies did not include a study control group for comparison. The limitations of these studies suggest that the findings are not conclusive enough to hold true for only those who are visually impaired. Further studies with a larger sample size are required with the aim of developing interventions.

scholarly journals Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Sophia Jung ◽  
Mary Elizabeth Sexton ◽  
Sallie Owens ◽  
Nathan Spell ◽  
Scott Fridkin
Keyword(s):  
Antibiotic Prescription ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Multivariable Logistic Regression Analysis ◽  
Comorbid Condition ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Care Clinic ◽  
The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

scholarly journals 2057. Outpatient Antibiotic Stewardship “Bundles up” in Winter with Peer Comparison, URI Order Set and Education: Is It Enough to Weather the Storm?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S693-S693
Author(s):  
Okan I Akay ◽  
Rohini Dave ◽  
Amit Khosla ◽  
CherylAnn Kraska ◽  
Brian J Hopkins ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Drug Events ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Control Group ◽  
Upper Respiratory Infection ◽  
Primary Care Clinics ◽  
Ed Visits ◽  
The Impact ◽  
Order Set

Abstract Background Inappropriate antibiotic use is a growing problem in the outpatient setting. Approximately 90% of all antibiotics are prescribed in outpatient practices. Nonetheless, 30–70% of antibiotic prescriptions (ARx) are unnecessary. Outpatient antimicrobial stewardship (AS) is much needed and the best approach is unknown. We used a bundle approach to outpatient AS during the winter months, by implementing a peer comparison (PC) report, upper respiratory infection (URI) order set and broad education. Methods This is a quasi-experimental project during the period October 2018 to March 2019 (FY19) to evaluate the impact of a bundled intervention in primary care clinics at the VA Maryland Health Care System. A historical control group from the same period the previous year (FY18) was used for comparison. The intervention included an AS directed didactic and URI order set followed by an email in 1/2019 with: (1) censored PC report (ARx/1,000 encounters) with outliers defined as above 1.5 × interquartile range, (2) URI order set reminder, and (3) education. The primary outcome was total ARx per 1,000 encounters in primary care clinics. A random sampling of 200 charts was done to compare proportion of antibiotic appropriateness and number of emergency department (ED) visits and adverse drug events (ADEs) in FY19 Q1 and FY19 Q2. Poisson regression was carried out, in addition to Χ2-statistic. Results There were 3,799 vs. 3,429 ARx in FY18 and FY19, respectively, with a rate difference of 3.3 ARx per 1,000 encounters (P = 0.0056). Q1 to Q2 ARx rate increased by 7.8 and 8.0 ARx per 1,000 encounters in FY18 and FY19, respectively. Forty-eight percent (28/58) of the providers confirmed receipt of email. There were 3 and 4 outliers in FY19 Q1 and Q2, respectively. Appropriate ARx for FY19 Q1 and Q2 was found to be 45% and 35% (P = 0.44), respectively. The most common indications were URI (18% vs. 18%), urinary tract infection (13% vs. 21%). ED visits (10% vs. 6%) were uncommon and there were no ADEs. Conclusion E-mail communication with bundled approach had no effect on ARx or antibiotic appropriateness; however general AS presence and URI order set tempered some use. Removing peer censoring, providing face-to-face education and intensifying antibiotic order sets are additional interventions to be implemented. Disclosures All authors: No reported disclosures.

scholarly journals 966. A Closer Look at Antibiotic Prescribing for Upper Respiratory Illnesses (URI) in People with HIV Compared with People Without HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S31-S31
Author(s):  
Anum Abbas ◽  
Mackenzie R Keintz ◽  
Elizabeth Lyden ◽  
Jihyun Ma ◽  
Sara H Bares ◽  
...  
Keyword(s):  
Private Insurance ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Categorical Variables ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Antibiotic Overuse ◽  
Exact Test ◽  
Icd 10

Abstract Background Antibiotic overuse is widespread, increasing healthcare cost and promoting antimicrobial resistance. People with HIV (PWH) who develop URIs may be assumed “higher risk,” compared with non-PWH, but comparative antibiotic use evaluations have not been performed. We evaluated antibiotic prescribing patterns for URI diagnoses (cough, sinusitis, bronchitis, and cold) in PWH and non-PWH. Methods This was an observational, single-center study comparing PWH and non-PWH diagnosed with URI (using ICD 10 codes for URI syndromes: cough, sinusitis, bronchitis, and cold) between January 1, 2014 and April 30, 2018. Patients were empaneled in an outpatient primary care clinic or specialty care clinic in one healthcare system. Appropriateness of antibiotic prescribing was defined based on published guidelines. Fisher’s exact test compared categorical variables with antibiotic prescribing patterns. Each encounter was considered an independent event. Results The two groups (PWH and non-PWH) were similar, with 34% of subjects in both groups being female. PWH had median CD4+ count of 610 cells/mm3 with 91% on antiretrovirals and 77% with HIV RNA < 20 copies/mL. Overall, 37% of visits resulted in antibiotic prescriptions, 92% of which were inappropriate (discordant with guidelines). Antibiotics were prescribed slightly more frequently in non-PWH (40% vs. 33%, P = 0.056; Figure 1) and inappropriate more often in non-PWH (37% vs. 30%, P = 0.029). Over 20% of PWH antibiotic prescriptions were too long, and 22% of non-PWH received the wrong drug (Figure 2; P = 0.011). 47% of the non-PWH receiving antibiotics for URI had private insurance (compared with other payers; P < 0.0001) vs. 33% in PWH (P = 0.32) (Figure 3). Conclusion Outpatient antibiotic overuse remains prevalent among patients evaluated for URIs. This is the first study, to our knowledge, comparing antibiotic use for URIs in PWH compared with non-PWH. Counterintuitively, we found less-frequent inappropriate antibiotic use in PWH. We speculate that PWH are more likely to be evaluated by infectious disease/HIV specialists, possibly explaining the lower rate of antibiotic prescriptions for URIs in this population. Future analyses will evaluate the association between provider specialty and inappropriate antibiotic use. Disclosures All Authors: No reported Disclosures.

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