scholarly journals POS1450 PATIENTS’ SAFETY SKILLS ASSESSMENT WITH BIOLOGICS AND JAK INHIBITORS: UPDATE OF THE BIOSECURE QUESTIONNAIRE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1009.1-1009
Author(s):  
C. Beauvais ◽  
V. Gaud-Listrat ◽  
J. Sellam ◽  
F. Fayet ◽  
M. Beranger ◽  
...  
Keyword(s):  
Steering Committee ◽  
Infectious Complications ◽  
Professional Communication ◽  
Cold Chain ◽  
Prevention Measures ◽  
Safety Skills ◽  
Jak Inhibitors ◽  
Safety Issues ◽  
Increased Risk ◽  
Patient Health

Background:Biologic disease-modifying anti-rheumatic drug (bDMARDs) and JAK inhibitors (JAKi) may lead to an increased risk of infections, which could be prevented by enhancing patients’ safety skills (ref). We developed a self-administered questionnaire (BioSecure1, ref) in 2013 to assess the patients’ safety skills (Table 1). Following the appearance of new bDMARDs and JAKi and new information on safety, this questionnaire needed updating.Table 1.Nine domains of core safety skills and number of corresponding questions in BioSecure questionnaires.Domain of competenceBioSecure1BioSecure2General knowledge42Dealing with infectious symptoms and fever1011Dealing with other infectious symptoms44Dealing with injuries, preventing infectious complications, vaccinations88Dental hygiene, preventing infectious complications, information to share with the dentist22Planning surgery, information to share with the surgeon/anesthesiologist77Planning child conception21Communication: who to contact?22Subcutaneous treatments: cold chain/cold storage, subcutaneous injection techniques30Objectives:To update the BioSecure questionnaire assessing patients’ safety skillsMethods:Four steps by a 10 participants multidisciplinary steering committee. Step1: critical analysis of content and formulations of BioSecure1 on the basis of i) the participants’ own experience of the questionnaire use in current practice (5/10 participants) or research (6/10 participants) ii) assessment of BioSecure1 consistency with current guidelines for management of targeted drugs. Step2: development of a first updated version by a core group of 10 persons. Step3: comments by an extended panel of rheumatology teams interested in therapeutic patient education (TPE). Step4: testing of the final version (Biosecure2) by ten patients through cognitive debriefing.Results:In total, 10 rheumatologists, 6 rheumatology nurses, 1 pharmacist and 1 patient from a patient association participated. Inadequate formulations were reported regarding some situations for which recommendations had the most shifted since Biosecure1 development such as planning pregnancy, remission management and prevention measures before surgery. Features of some infectious conditions were clarified; barriers measures against infection and complications such as sigmoiditis and Herpes Zoster infection were added. BioSecure2 continues to assess the 9 domains of core safety skills (Table 1). The questionnaire was shortened to 50 items (mean filling in time is 10 minutes) with a good understanding and scoring was simplified (mean scoring time 3.5 minutes).Conclusion:BioSecure2 represents an updated outcome measure to evaluate the patient’s skills to prevent adverse events with targeted therapies. This questionnaire can be useful in the context of patient-health professional communication, and as a tool to measure TPE on safety issues.References:[1]Gossec et al, Joint Bone Spine. 2013;80:471–476Disclosure of Interests:None declared

scholarly journals Immune Dysregulation and Infectious Complications in MPN Patients Treated With JAK Inhibitors

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniele Cattaneo ◽  
Alessandra Iurlo
Keyword(s):  
Signaling Pathway ◽  
Current Knowledge ◽  
Myeloproliferative Neoplasms ◽  
Infectious Complications ◽  
Janus Kinase ◽  
Dramatic Improvement ◽  
Loss Of Function ◽  
Jak Inhibitors ◽  
Increased Risk ◽  
Stat Signaling

BCR-ABL1-negative myeloproliferative neoplasms are burdened by a reduced life expectancy mostly due to an increased risk of thrombo-hemorrhagic events, fibrotic progression/leukemic evolution, and infectious complications. In these clonal myeloid malignancies, JAK2V617F is the main driver mutation, leading to an aberrant activation of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. Therefore, its inhibition represents an attractive therapeutic strategy for these disorders. Several JAK inhibitors have entered clinical trials, including ruxolitinib, the first JAK1/2 inhibitor to become commercially available for the treatment of myelofibrosis and polycythemia vera. Due to interference with the JAK-STAT pathway, JAK inhibitors affect several components of the innate and adaptive immune systems such as dendritic cells, natural killer cells, T helper cells, and regulatory T cells. Therefore, even though the clinical use of these drugs in MPN patients has led to a dramatic improvement of symptoms control, organ involvement, and quality of life, JAK inhibitors–related loss of function in JAK-STAT signaling pathway can be a cause of different adverse events, including those related to a condition of immune suppression or deficiency. This review article will provide a comprehensive overview of the current knowledge on JAK inhibitors’ effects on immune cells as well as their clinical consequences, particularly with regards to infectious complications.

Thrombosis in IBD in the Era of JAK Inhibition

2020 ◽  
Vol 22 (1) ◽  
pp. 126-136
Author(s):  
Virginia Solitano ◽  
Gionata Fiorino ◽  
Ferdinando D’Amico ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Small Molecules ◽  
Arterial Thrombosis ◽  
Protective Role ◽  
Jak Inhibitors ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Thrombotic Complications ◽  
Inflammatory Bowel ◽  
Inflammatory Effect

: Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has been extensively studied. It is well-known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNF were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.

scholarly journals Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January–May 2018

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Vivian Ntono ◽  
Daniel Eurien ◽  
Lilian Bulage ◽  
Daniel Kadobera ◽  
Julie Harris ◽  
...  
Keyword(s):  
Health Workers ◽  
Clinical Sample ◽  
Health Centre ◽  
Skin Lesions ◽  
Suspected Case ◽  
Prevention Measures ◽  
Multiple Exposures ◽  
Increased Risk ◽  
Control And Prevention ◽  
Cutaneous Anthrax

Abstract Background On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures. Methods We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test. Results We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018–May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1–6.7), dissecting (RR = 3.0, 95% CI = 1.2–7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9–5.9). We found evidence of animal remains on pastureland. Conclusion Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

Patients’ safety skills assessment with biologics and JAK inhibitors: update of the BioSecure questionnaire

2021 ◽  
pp. 105215
Author(s):  
Beauvais Catherine ◽  
Véronique Gaud-Listrat ◽  
Jérémie Sellam ◽  
Françoise Fayet ◽  
Martine Béranger ◽  
...  
Keyword(s):  
Skills Assessment ◽  
Safety Skills ◽  
Jak Inhibitors

scholarly journals Patient health engagement model: explaining citizens noncompliance and maladaptive behaviors

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Graffigna ◽  
S Barello ◽  
L Palamenghi ◽  
M Savarese ◽  
G Castellini
Keyword(s):  
Healthcare Services ◽  
Cross Sectional Study ◽  
Health Prevention ◽  
Prevention Measures ◽  
Cross Sectional ◽  
Health Authorities ◽  
Patient Health ◽  
Public Health Authorities ◽  
High Level ◽  
Restrictive Measures

Abstract Background At the end of February 2020 a new case was diagnosed with COVID-19 in north Italy, suddenly followed by new cases. Italian health authorities decided to enforce restrictive measures. Northern areas of Italy were identified as “red areas” to slow down the epidemic and its impact on the healthcare system. From this perspective, the COVID-19 epidemic in Italy constitutes a testing ground for the assessment of the ability of consumers to cope with this health risk. Methods A cross-sectional study on a representative sample of 1000 Italian citizens was conducted over the period 27 February- 5 March exploring the following hypotheses: 1) less engaged individuals are more concerned for the health emergency and feel more vulnerable; 2) less engaged have higher probability to develop negative attitudes and dysfunctional behaviors. Results only the 16% the interviewees presented a high level of engagement. Lower levels of engagement were measured in the southern parts of Italy (not yet touched by the epidemics at the time of data collection). People with lowers levels of engagement reported higher fears for the contagion and sense of vulnerability. Furthermore, they showed the lower levels of trust in the Public Health Authorities, in medical research and in vaccines. Finally, they appeared more dismissive in their preventive behaviors and more disorganized in the fruition of the healthcare services. Conclusions A psychological analysis of processes of attitudinal and role change in the direction of becoming more engaged in health prevention is worthy in order to forecast potential dysfunctional reactions to restrictive health prevention measures and to orient personalized education initiatives to consumers with different level of engagement. Key messages Profiling based on the levels of health engagement is important in order to plan more effective healthcare measures during epidemics. Targeted educational initiatives should take into account citizens' engagement profiles.

ID: 3522307 LIVER TRANSPLANT PATIENTS WITH INTRAHEPATIC STRICTURES ARE AT INCREASED RISK OF POST-ERCP INFECTIOUS COMPLICATIONS

2021 ◽  
Vol 93 (6) ◽  
pp. AB133
Author(s):  
Ian Holmes ◽  
Muhammad Bashir ◽  
Thomas E. Kowalski ◽  
David E. Loren ◽  
Anand Kumar ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Infectious Complications ◽  
Transplant Patients ◽  
Increased Risk

scholarly journals Recognizing Common Skin and Soft Tissue Infections in the Nephrology Clinic

2018 ◽  
Vol 47 (1-3) ◽  
pp. 259-264 ◽  
Author(s):  
Karen M.  Van de Velde-Kossmann
Keyword(s):  
Renal Failure ◽  
Soft Tissue ◽  
Early Recognition ◽  
Soft Tissue Infections ◽  
Patient Morbidity ◽  
Cost Of Health Care ◽  
Increased Risk ◽  
Patient Health ◽  
Common Skin ◽  
The Cost

Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the conditions causing the renal failure as well as complications of treatment and renal failure’s innate effects on patient health. These infections have a significant impact on patient morbidity, increased hospital and procedural demands, and the cost of health care. Many renal failure patients are seen regularly by their nephrology clinic caregivers due to the need for frequent dialysis and transplant monitoring. Familiarity with common skin and soft tissue infections by these caregivers allowing enhanced patient education, optimal infection prevention, and early recognition could significantly reduce the morbidity and cost of these disorders, such as diabetic foot syndrome, necrotizing fasciitis, and herpetic infections.

Outbreak of Escherichia coli O157:H7 Infections Associated with Nonintact Blade-Tenderized Frozen Steaks Sold by Door-to-Door Vendors

2005 ◽  
Vol 68 (6) ◽  
pp. 1198-1202 ◽  
Author(s):  
ELLEN SWANSON LAINE ◽  
JONI M. SCHEFTEL ◽  
DAVID J. BOXRUD ◽  
KEVIN J. VOUGHT ◽  
RICHARD N. DANILA ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Single Case ◽  
Escherichia Coli O157 ◽  
Processing Methods ◽  
Safety Issues ◽  
The Public ◽  
Department Of Health ◽  
Increased Risk ◽  
Beef Products ◽  
Uremic Syndrome

Steaks have not been recognized as an important vehicle of Escherichia coli O157:H7 infection. During 11 to 27 June 2003, the Minnesota Department of Health (MDH) identified four O157 infection cases with the same pulsed-field gel electrophoresis (PFGE) subtype. All four case patients consumed brand A vacuum packed frozen steaks sold by door-to-door vendors. The steaks were blade tenderized and injected with marinade (i.e., nonintact). Information from single case patients in Michigan and Kansas identified through PulseNet confirmed the outbreak. The MDH issued a press release on 27 June to warn consumers, prompting a nationwide recall of 739,000 lb (335,506 kg) of frozen beef products. The outbreak resulted in six culture-confirmed cases (including one with hemolytic uremic syndrome) and two probable cases in Minnesota and single confirmed cases in four other states. The outbreak PFGE subtype of O157 was isolated from unopened brand A bacon-wrapped fillets from five affected Minnesota households. A fillet from one affected household was partially cooked in the laboratory, and the same O157 subtype was isolated from the uncooked interior. The tenderizing and injection processes likely transferred O157 from the surface to the interior of the steaks. These processing methods create new challenges for prevention of O157 infection. Food regulatory officials should reevaluate safety issues presented by nonintact steak products, such as microbiologic hazards of processing methods, possible labeling to distinguish intact from nonintact steaks, and education of the public and commercial food establishments on the increased risk associated with undercooked nonintact steaks. Information on single cases of O157 infection in individual states identified through PulseNet can be critical in solving multistate outbreaks in a timely manner.

Since blood transfusion is linked to the magnitude of the surgical procedure, comparing transfused patients to untransfused patients will always be confounded by infection risks due to factors related to the procedure. To control for these factors one must compare patients transfused with red cells from different sources or prepared in a manner which minimize infection risk. Patients transfused with homologous blood have infection rates several fold higher than recipients of equal values of autologous blood undergoing the same operative procedure (20-23). Homologous blood recipients have significantly longer hospital stays attributed to treating infections. The cost of a blood transfusion exceeds the cost of collection, storage and administration because of transfusion's association with length of stay. In this era of cost-containment the association with prolonged stay may ultimately curtail the use of blood. Homologous blood can be filtered to remove donor leukocytes which may be contributing to immune suppression and infection risk. A prospective randomized trial comparing the infection rates among colorectal cancer patients receiving filtered and unfiltered blood has been conducted (9). There were 17 infectious complications among the 56 recipients of whole blood and one infectious complication among the 48 recipients of filtered blood. Infections were prevented by the seemingly simplistic addition of a $25/filter to every bag of blood transfused. These clinical studies are very convincing: homologous blood transfusion is associated with increased risk of infection in every clinical situation examined. In multivariate analyses transfusion was a significant predictor of infection after consideration of other variables measured and in the majority of those studies transfusion was the single most significant factor. Patients receiving homologous blood exhibited an incidence of infectious complications that was approximately four times higher than patients receiving autologous blood. The association of transfusion with infection is found among patients undergoing surgery for cardiac, orthopedic and gastrointestinal disorders and for trauma as well as among unoperated patients transfused for bums and gastrointestinal bleeding. The observation that nosocomial infections are increased in these studies argues strongly that the association of transfusion with infection is not simply a reflection of transfusion as a marker of tissue destruction and contamination. Infections that develop in transfused patients away from the site of trauma or in the absence of trauma, cannot be attributed to the quantity of tissue destroyed or to the degree of bacterial contamination. Filtered blood can remove leukocytes and prevent postoperative infections. Since filtering blood can significantly reduce the incidence of infection among transfused patients, all transfused blood will be passing through filters in the very near future. EXPERIMENTAL STUDIES RELATING BLOOD TRANSFUSION TO INCREASED RISK OF INFECTION Patients are extremely heterogeneous and even in prospective randomized trials, factors which influence patients' participation affect the outcome despite double-blinding and randomization. In animal studies using syngeneic strains with identical housing, lighting, access to food and water, control over the extent of injury, use of antibiotics and exposure to other variables the influence of a single variable such as blood transfusion can be measured. Dr. Waymack's laboratory has intensively studied parameters which interact with transfusion in

1995 ◽  
pp. 296-296
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Infection Risk ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Homologous Blood ◽  
Increased Risk ◽  
The Cost
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