SARS-CoV-2 Seroprevalence among Healthcare Workers

Background. Monitoring COVID-19 infection risk among health care workers (HCWs) is a public health priority. We examined the seroprevalence of SARS-CoV-2 among HCWs following the fall infection surge in Minnesota, and before and after COVID-19 vaccination. Additionally, we assessed demographic and occupational risk factors for SARS-CoV-2 infection. Methods. We conducted two rounds of seroprevalence testing among a cohort of HCWs: samples in round 1 were collected from 11/22/20 - 02/21/21 and in round 2 from 12/18/20 - 02/15/21. Demographic and occupational exposures assessed with logistic regression were age, sex, healthcare role and setting, and number of children in the household. The primary outcome was SARS-CoV-2 IgG seropositivity. A secondary outcome, SARS-CoV-2 infection, included both seropositivity and self-reported SARS-CoV-2 test positivity. Results. In total, 459 HCWs were tested. 43/454 (9.47%) had a seropositive sample 1 and 75/423 (17.7%) had a seropositive sample 2. By time of sample 2 collection, 54% of participants had received at least one vaccine dose and seroprevalence was 13% among unvaccinated individuals. Relative to physicians, the odds of SARS-CoV-2 infection in other roles were increased (Nurse Practitioner: OR[95%CI] 1.93[0.57,6.53], Physician's Assistant: 1.69[0.38,7.52], Nurse: 2.33[0.94,5.78], Paramedic/EMTs: 3.86[0.78,19.0], other: 1.68[0.58,4.85]). The workplace setting was associated with SARS-CoV-2 infection (p=0.04). SARS-CoV-2 seroprevalence among HCWs reporting duties in the ICU vs. those working in an ambulatory clinic was elevated: OR[95%CI] 2.17[1.01,4.68]. Conclusions. SARS-CoV-2 seroprevalence in HCW increased during our study period which was consistent with community infection rates. HCW role and setting - particularly working in the ICU - is associated with higher risk for SARS-CoV-2 infection.

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The ‘Parent's Kiss’: An Effective Way to Remove Paediatric Nasal Foreign Bodies

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x300966 ◽

2008 ◽

Vol 90 (5) ◽

pp. 420-422 ◽

Cited By ~ 12

Author(s):

Neeraj Purohit ◽

Shalina Ray ◽

Tom Wilson ◽

OP Chawla

Keyword(s):

Foreign Body ◽

General Anaesthesia ◽

Prospective Observational Study ◽

Primary Outcome ◽

Foreign Bodies ◽

Secondary Outcome ◽

General Anaesthetic ◽

Number Of Children ◽

Accident And Emergency ◽

Successful Removal

INTRODUCTION The objectives of this study were to: (i) evaluate the effectiveness of ‘parent's kiss’ as a technique for removal of nasal foreign bodies in children; and (ii) determine whether this technique reduces the number of children requiring general anaesthesia for their removal. PATIENTS AND METHODS This was a prospective observational study in the accident and emergency and ENT departments at Luton and Dunstable Hospital. The participants were 31 children with nasal foreign bodies, under the age of 5 years, presenting via the acute services over a 6-month period. The primary outcome measured was successful removal of nasal foreign body with the ‘parent's kiss’ technique. Secondary outcome was reduction in the number of general anaesthetics following introduction of the technique. RESULTS The technique was successful in 20 out of the 31 children (64.5%) in the study group. Only one patient required general anaesthesia for removal of nasal foreign body (3%). This compares with a rate of 32.5% requiring removal under general anaesthetic in the preceding 6-month period. The ‘parent's kiss’, when not successful, seemed to improve the visibility of the foreign body making their subsequent removal easier. CONCLUSIONS The ‘parent's kiss’ is an effective technique. It is non-traumatic, both physically and emotionally, for the child subjected to it. We advocate that it should be used routinely as a first line of management in children with a nasal foreign body in the primary care setting.

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Bronchodilator Response to Salbutamol Delivered by Metered Dose Inhaler with Spacer and Dry Powder Inhaler in Acute Asthma In Children: A Comparative Study

Bangladesh Journal of Child Health ◽

10.3329/bjch.v38i2.21138 ◽

2014 ◽

Vol 38 (2) ◽

pp. 68-73

Author(s):

Md Saifuddin Khaled ◽

Firoza Akter ◽

Khadija Rahman ◽

Mohammad Shahid Ullah ◽

Md Hamidur Rahman

Keyword(s):

Primary Outcome ◽

Acute Asthma ◽

Dry Powder Inhaler ◽

Secondary Outcome ◽

Outcome Variable ◽

Dose Inhaler ◽

Primary Outcome Variable ◽

Bronchodilator Response ◽

Before And After ◽

Metered Dose

Background: Salbutamol inhalation is the mainstay of treatment for acute exacerbation of asthma. A number of delivery systems for asthma medication have been developed for children, each having its own advantages and disadvantages. This study was done to compare the bronchodilator effect of salbutamol inhalation delivered through metered dose inhaler (MDI) with spacer and dry powder inhaler (DPI) in children presenting with mild and moderate acute asthma. Methodology: Children of 6 to 15 years of age with mild or moderate acute exacerbation of asthma were assessed primarily and randomly distributed into two groups having equal number of patients and received 400micro-gram of salbutamol delivered by either MDI with spacer or DPI device. The primary outcome variable was peak expiratory flow rate (PEFR) and secondary outcome variables were percent predicted PEFR, heart rate, respiratory rate, oxygen saturation, wheezing and accessory muscle scores. Changes in primary and secondary outcome variables, before and after drug intervention were recorded and subjected to statistical tests for significance. Separate analyses were done for mild and moderate asthma patients. Results: The changes in primary outcome variable (PEFR) in both groups before and after intervention was 179.19 ± 33.27 vs. 197.52 ± 57.01 liters/min and 184.81 ± 59.65 vs. 202.83 ± 64.76 liters/min respectively, which was statistically highly significant (P= 0.001). Similar significant changes were also observed in case of secondary outcome variables. Conclusion: Bronchodilator response to salbutamol in mild or moderate acute asthma in children is similar when equal amount of drug is delivered either through an MDI with spacer or a DPI DOI: http://dx.doi.org/10.3329/bjch.v38i2.21138 Bangladesh J Child Health 2014; VOL 38 (2) : 62-67

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Evaluating Adherence to Guideline-Directed C Difficile Infection Management Pre- and Postimplementation of an Electronic Order Set

Journal of Pharmacy Practice ◽

10.1177/0897190020903854 ◽

2020 ◽

pp. 089719002090385

Author(s):

Aamer Attaar ◽

Juanqin Wei ◽

Luigi Brunetti

Keyword(s):

Infectious Disease ◽

Primary Outcome ◽

Secondary Outcome ◽

Single Center ◽

Clostridioides Difficile ◽

Order Sets ◽

Before And After ◽

Clostridioides Difficile Infection ◽

Electronic Order ◽

Order Set

Background: After publication of the Clostridioides difficile infection (CDI) guidelines by the Infectious Disease Society of America (IDSA) in early 2018, we identified that many prescribers at our institution continued to practice using the older guidelines. Objective: This study aimed to determine whether the implementation of an electronic order set for CDI would increase prescriber compliance to current IDSA recommendations for CDI management. Methods: This was a single-center, prospective cohort study of adult inpatients with a confirmed CDI. The study was conducted between March 1, 2018, and April 1, 2019. Patients were stratified into a preintervention and postintervention group before and after order set implementation. The primary outcome was a composite of appropriate CDI therapy selection and discontinuation of nonessential antimicrobials and acid-suppressive agents. The secondary outcome evaluated appropriate CDI therapy medications prescribed at hospital discharge. Results: Of the 149 patients included in this study, 96 were included in a preintervention group and 53 included in a postintervention group. The primary outcome was met in 45% of patients in the preintervention group and 66% of patients in the postintervention group ( P = .01). The secondary outcome occurred in 86% of patients in the preintervention group and 100% of patients in the postintervention group ( P = .02). Conclusion: Implementation of a CDI electronic order set and alert bundle was associated with enhanced prescriber adherence to guideline-directed therapy. Our results suggest that order sets not only improve inpatient compliance to guidelines but may also improve medication-related adherence to guideline recommendations upon discharge.

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Antiplatelet therapy following ischaemic stroke – Continue or change pre-existing therapy?

European Stroke Journal ◽

10.1177/2396987316678728 ◽

2016 ◽

Vol 2 (1) ◽

pp. 31-36

Author(s):

Wardati Mazlan-Kepli ◽

Rachael L MacIsaac ◽

Matthew Walters ◽

Philip MW Bath ◽

Jesse Dawson

Keyword(s):

Ischaemic Stroke ◽

Antiplatelet Therapy ◽

Primary Outcome ◽

Secondary Outcome ◽

Ischaemic Event ◽

Antiplatelet Treatment ◽

Before And After ◽

Index Stroke ◽

Event Rates ◽

First 90 Days

Introduction Antiplatelet therapy is routinely prescribed early after ischaemic stroke. Many patients will already be taking antiplatelet therapy and it is unknown whether these patients should continue the same antiplatelet treatment or switch to a different regimen. Methods We selected patients with ischaemic stroke from the Virtual International Stroke Trials Archive database who were prescribed antiplatelets both before and after their stroke and who had detailed records of adverse events after stroke. We compared patients who changed to a new antiplatelet regimen after their stroke to those who continued the same regimen. The primary outcome was recurrent ischaemic stroke within 90 days after their index stroke and the secondary outcome was intracranial haemorrhage (ICH) or extracranial haemorrhage (ECH). We used logistic regression analysis and adjusted for age and baseline NIHSS. Results A total of 1129 participants were included. Of these, 538 subjects changed antiplatelet regimen post stroke and 591 continued the same regimen. A recurrent ischaemic event occurred in 4.1% of subjects who changed regimen and 4.3% who continued unchanged (adjusted OR = 0.93; 95% CI 0.54–1.75, p = 0.929). The incidence of ICH and ECH within the first 90 days was similar in both groups (2.4% vs. 2.6% (adjusted OR = 1.02; 95% CI 0.48–2.18, p = 0.955) and 4.7% vs. 2.9% (adjusted OR = 1.82; 95% CI 0.96–3.43, p = 0.065), respectively). Discussion The analysis was performed using a non-randomised registry data. Conclusion In patients who suffer ischaemic stroke whilst taking antiplatelets, a change in antiplatelet regimen was not associated with an altered risk of early recurrent ischaemic stroke rate or bleeding. However, the results must be interpreted in view of the low event rates.

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Rationale, baseline characteristics and methodology of the non-interventional VIVA study in postmenopausal osteoporosis

Osteologie/Osteology ◽

10.1055/s-0037-1620027 ◽

2014 ◽

Vol 23 (01) ◽

pp. 49-55

Author(s):

L. C. Hofbauer ◽

D. Felsenberg ◽

M. Amling ◽

A. Kurth ◽

P. Hadji

Keyword(s):

Quality Of Life ◽

Postmenopausal Osteoporosis ◽

Primary Outcome ◽

Osteoporosis Treatment ◽

Secondary Outcome ◽

Matched Pairs ◽

Fracture History ◽

Baseline Characteristics ◽

Study Inclusion

SummaryIt is important to understand compliance and persistence with medication use in the clinical practice of osteoporosis treatment. The purpose of this work is to describe the “intravenous ibandronate versus oral alendronate” (VIVA) study, a non-interventional trial to assess the compliance and persistence of osteopenic postmenopausal women with treatment via weekly oral alendronate or intravenous ibandronate (Bonviva®) every three months.4477 patients receiving ibandronate 3 mg i. v. quarterly and 1491 patients receiving alendronate 70 mg orally weekly were included in the study. Matched pairs of 901 subjects in each group were also generated. Matching was performed on the basis of age, body mass index, fracture history at study inclusion, prior treatment with bisphosphonates and the number of concomitant disorders. Secondary outcome measures of osteoporosis related fractures, mobility restriction and pain, analgesia, quality of life questionnaires as well as attitudes to medications were assessed. The primary outcome parameters of compliance and persistence will be tracked in these subjects.At baseline, the entire collectives differed significantly on body weight (less in ibandronate group), duration since osteo - porosis diagnosis (longer in ibandronate), and incidence of prior osteoporotic fracture (higher in ibandronate group). The matched-pairs differed only on mobility restriction and quality of life (both worse in ibandronate group).The results from the VIVA study trial will provide scientific rationale for clinical recommendations in the pharmacological treatment of postmenopausal osteoporosis.

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Kepuasan Masyarakat Terhadap Pelayanan Kelurahan Setelah Pemekaran Di Tangerang Selatan

Liquidity ◽

10.32546/lq.v2i2.117 ◽

2018 ◽

Vol 2 (2) ◽

pp. 151-159

Author(s):

Pitri Yandri

Keyword(s):

Public Perception ◽

Service Personnel ◽

Urban Services ◽

Hospitality Workers ◽

Care Workers ◽

Before And After ◽

Cartesian Diagram ◽

Better Than

The purpose of this study is (1) to analyze public perception on urban services before and after the expansion of the region, (2) analyze the level of people's satisfaction with urban services, and (3) analyze the determinants of the variables that determine what level of people's satisfaction urban services. This study concluded that first, after the expansion, the quality of urban services in South Tangerang City is better than before. Secondly, however, public satisfaction with the services only reached 48.53% (poor scale). Third, by using a Cartesian Diagram, the second priority that must be addressed are: (1) clarity of service personnel, (2) the discipline of service personnel, (3) responsibility for care workers; (4) the speed of service, (5) the ability of officers services, (6) obtain justice services, and (7) the courtesy and hospitality workers.

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Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.ewh1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Edward W. Holt ◽

Kidist K. Yimam ◽

Hanley Ma ◽

Richard E. Shaw ◽

Richard A. Sundberg ◽

...

Keyword(s):

Bowel Preparation ◽

Primary Outcome ◽

Secondary Outcome ◽

Polyp Detection ◽

Cross Sectional ◽

Quality Outcomes ◽

Negative Experience ◽

Polyp Detection Rate ◽

Patient Reported ◽

Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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57. Evaluating the Utility of a Penicillin Allergy Reconciliation Program within an Infectious Diseases Consult Population in a Community Health System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.102 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S49-S50

Author(s):

Bruce M Jones ◽

Emily Plauche ◽

Susan E Smith ◽

Christopher M Bland

Keyword(s):

Infectious Diseases ◽

Health System ◽

Community Health ◽

Intervention Program ◽

Primary Outcome ◽

Panel Member ◽

Penicillin Allergy ◽

Secondary Outcome ◽

Research Support ◽

Research Grant

Abstract Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to reconcile and intervene when necessary. Information is collected by interview, electronic medical record (EMR) review, prescription outpatient fill history. This study evaluated reconciliations with and without a PARP in patients in a community health system. Methods This was a retrospective study that compared reconciliations performed on adult patients admitted at least once in 2019 with a self-reported penicillin allergy and ID physician consult at a hospital with a PARP (Institution 1) and one without a formal evaluation and intervention program (Institution 2) within the same community health system with same ID physicians. The primary outcome was documented reconciliation of a patient’s penicillin allergy during an inpatient visit in 2019. Reconciliation was defined as an edit or clarification (updating the severity, reaction, or comments section, as well as deleting) to a patient’s penicillin allergy in the EMR. The secondary outcome evaluated the percentage of total and ID consult patients with a penicillin allergy. Results There were 245 patients who met criteria and were included in the study, 113 from Institution 1 and 132 from Institution 2. For the primary outcome, there were 82 (72.6%) reconciliations at Institution 1 and 15 (11.4%) reconciliations at Institution 2 (p < 0.001). Interventions at Institution 1 and 2 resulted in 74 EMR updates and 8 removals and 14 EMR updates and 1 removal, respectively. Reconciliation was performed on the same visit as the ID consult in 59/82 patients (72%) at Institution 1 and 11/15 patients (73.3%) at Institution 2. All reconciliations at Institution 2 were made by pharmacist (10) or nurses (5). For the secondary outcome, 10.9% of patients with an ID consult and 12.6% of all patients admitted in 2019 had a penicillin allergy (p=0.027). Conclusion A PARP led by an ID pharmacist and students was an effective method to perform penicillin allergy reconciliations, even in the presence of active ID consultation. Disclosures Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

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Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017341 ◽

2021 ◽

pp. neurintsurg-2021-017341

Author(s):

Devin V Bageac ◽

Blake S Gershon ◽

Jan Vargas ◽

Maxim Mokin ◽

Zeguang Ren ◽

...

Keyword(s):

Primary Outcome ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Anterior Circulation ◽

Guide Catheter ◽

Catheter Failure ◽

Catheter Technology ◽

Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

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Association between Dietary Inflammatory Index and kidney stones in US adults: Data from the NHANES 2007-2016

Public Health Nutrition ◽

10.1017/s1368980021000793 ◽

2021 ◽

pp. 1-27

Author(s):

Chichen Zhang ◽

Shi Qiu ◽

Haiyang Bian ◽

Bowen Tian ◽

Haoyuan Wang ◽

...

Keyword(s):

National Health ◽

Kidney Stones ◽

Primary Outcome ◽

Secondary Outcome ◽

Nutrition Examination Survey ◽

Dietary Inflammatory Index ◽

Inflammatory Index ◽

Health And Nutrition ◽

Multivariate Adjustment ◽

Increased Risk

Abstract Objective: We evaluate the association between the Dietary Inflammatory Index (DII) and kidney stones. Design: We performed a cross-sectional analysis using data from National Health and Nutrition Examination Survey. Dietary intake information was assessed using first 24-HR dietary recall interviews, and the Kidney Conditions was presented by questionnaire. The primary outcome was to investigate the association between DII and incidence of kidney stones, and the secondary outcome was to assess the association between DII and nephrolithiasis recurrence. Setting: The National Health and Nutrition Examination Survey (NHANES), 2007-2016. Participants: The study included 25984 NHANES participants, whose data on DII and kidney stones were available, of whom 2439 reported a history of kidney stones. Results: For the primary outcome, after fully multivariate adjustment, DII score is positively associated with the risk of kidney stones (OR = 1.07; 95% CI: [1.04–1.10]). Then, compared Q4 with Q1, a significant 38% increased likelihood of nephrolithiasis was observed. (OR=1.38; 95% CI: [1.19–1.60]). For the secondary outcome, the multivariate regression analysis showed that DII score is positively correlated with nephrolithiasis recurrence (OR=1.07; 95% CI: [1.00–1.15]). The results noted that higher DII scores (Q3 and Q4) are positively associated with a significant 48% and 61% increased risk of nephrolithiasis recurrence compared with the reference after fully multivariate adjustment. (OR=1.48; 95% CI: [1.07–2.05]; OR=1.61; 95% CI: [1.12–2.31]). Conclusions: Our findings revealed that increased intake of pro-inflammatory diet, as a higher DII score, is correlated with increased odds of kidney stones incidence and recurrence.

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