scholarly journals Some Thoughts on Administering the Sacrament of the Anointing of the Sick to Hospitalized Patients with COVID-19

2021 ◽  
pp. 001258062110148
Author(s):  
William Newton
Keyword(s):  
Infectious Diseases ◽  
Careful Analysis ◽  
Hospitalized Patients ◽  
Sacramental Theology ◽  
Safe Distance ◽  
Tentative Conclusion

The COVID-19 pandemic has raised questions about access to the Sacraments, particularly the Sacrament of Anointing of the Sick. To stop the transmission of infectious diseases by the minister, it has been suggested that the priest could use a nurse to apply the sacred oils to the patient or recipient while he remains in the vicinity but a medically safe distance from the bedside, using a phone to communicate with the patient. Whether or not such a protocol would invalidate the Sacrament requires an investigation of some foundational principles of Sacramental theology, including the use of instruments in the execution of Sacraments, how the form of a Sacrament must be conveyed, and the requisite proximity of the minister to the recipient. A careful analysis of these principles, in light to the suggested protocol, leads to the surprising (although tentative) conclusion that the Sacrament would be valid if executed in this manner.

scholarly journals 42. A Pharmacist-Led Intervention to Decrease Anaerobic Coverage for Hospitalized Patients with Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S44-S45
Author(s):  
Maxx O Enzmann ◽  
Courtney M Pagels ◽  
Emily J Perry ◽  
Justin Jones ◽  
Paul Carson
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
American Thoracic Society ◽  
Hospitalized Patients ◽  
Guidance Document ◽  
Antibiotic Exposure ◽  
Antibiotic Regimen ◽  
Days Of Therapy

Abstract Background Community-acquired pneumonia (CAP) is frequently mis-categorized as aspiration pneumonia, prompting the addition of anaerobic coverage to the antibiotic regimen. In our institution, this usually takes the form of adding metronidazole to ceftriaxone. The 2019 American Thoracic Society and Infectious Diseases Society of America CAP guidelines recommend anaerobic coverage only for hospitalized patients with a suspected lung abscess or empyema. The objective of this study was to determine if a pharmacist-led workflow could increase adherence to the 2019 CAP guideline recommendations by limiting anaerobic coverage to those rare occasions. Methods The hospital antimicrobial stewardship committee approved a pharmacist workflow and guidance document which outlines criteria to evaluate appropriateness of anaerobic coverage for hospitalized patients with CAP and no other indications for antibiotics. If anaerobic coverage is not indicated, the pharmacist submits a standardized message to the treating provider via the electronic medical record, recommending discontinuation of metronidazole. This workflow was implemented on October 3, 2019. Metronidazole days of therapy (DOT) per 1000 patient days in quarters 1 through 4 of 2019 and quarter 1 of 2020 were collected as well as percent acceptance of documented pharmacist interventions from October 3, 2019 until March 31, 2020. Results Between October 3, 2019 and March 31, 2020, a total of 221 interventions were made by pharmacists to discontinue metronidazole in hospitalized CAP patients where anaerobic coverage was not indicated. Out of those 221 interventions, 164 (74%) were accepted by providers and only 57 (26%) were rejected. The DOT per 1000 patient days of metronidazole was assessed for the three quarters prior to our intervention and the two quarters after the intervention. Compared to the three quarters prior, metronidazole DOT per 1000 patient days decreased by 26.6% for the two quarters following implementation of the pharmacist-led intervention (Figure 1). Figure 1: Metronidazole DOT per 1000 patient days from January 1, 2019 through March 31, 2020. Vertical line indicates when pharmacist workflow was implemented. Conclusion A pharmacist antimicrobial stewardship intervention at our institution increased adherence to CAP guidelines and decreased unnecessary antibiotic exposure in hospitalized CAP patients when anaerobic coverage was not indicated. Disclosures All Authors: No reported disclosures

scholarly journals 772. Factors Associated With Healthcare Delay of Active Pulmonary Tuberculosis After Hospitalization

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S276-S277
Author(s):  
Jaijun Han ◽  
Se Yoon Park ◽  
Jebyung Park ◽  
So Young Lee ◽  
Gil Eun Kim ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Infectious Diseases ◽  
Early Recognition ◽  
Multivariate Logistic Regression Analysis ◽  
Hospitalized Patients ◽  
Pulmonary Tb ◽  
Active Pulmonary Tuberculosis ◽  
Factors Associated ◽  
Delayed Recognition ◽  
Significant Factors

Abstract Background Hospitals are undesirable reservoirs for a respiratory outbreak. Active pulmonary tuberculosis (TB) can be readily transmitted among hospitalized patients. Early recognition of pulmonary TB is an essential priority against transmission. The aim of this study was to evaluate factors associated with delayed identification of pulmonary TB in hospital settings. Methods Medical records of newly diagnosed TB patients admitted to a referral hospital from January 2015 through December 2017 were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days after admission. We analyzed clinical, microbiological, radiological, and healthcare factors associated with delayed recognition of pulmonary TB. Patients who were not suspected of having active pulmonary TB had no remarks about TB on their initial chest radiograph interpretation by radiologists. Multivariate logistic regression analysis was performed with significant factors included. Results A total of 136 patients were analyzed who had positive sputum acid-fast bacilli (AFB) cultures. Of these, 45 (33%) patients were isolated 3 days after admission and had longer days of exposure before isolation (median 9, interquartile range [IQR] 6–14, P < 0.001) in comparison to others (median 0, IQR 0–1). Patients with older age (odds ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.08, P = 0.01), patients who were admitted to departments other than infectious diseases or pulmonology (OR = 6.23, 95% CI 2.17–17.89, P = 0.001) and patients who were not suspected of having active pulmonary TB by radiologists (OR = 11.36, 95% CI 4.11–31.39, P < 0.001) were more likely to have delayed recognition of pulmonary TB. Conclusion In a country with intermediate TB prevalence, better awareness for pulmonary TB is required for all hospitalized patients who are admitted to departments other than infectious diseases or pulmonology. Although active pulmonary TB is not suspected by a radiologist, sputum AFB smear, and culture are necessary when new lesions are present in chest radiographs. Disclosures All authors: No reported disclosures.

scholarly journals A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

2020 ◽  
Vol 64 (8) ◽  
Author(s):  
Jacqueline T. Bork ◽  
Kimberly C. Claeys ◽  
Emily L. Heil ◽  
Mary Banoub ◽  
Surbhi Leekha ◽  
...  
Keyword(s):  
Propensity Score ◽  
Infectious Diseases ◽  
Propensity Score Matching ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Hospitalized Patients ◽  
Audit And Feedback ◽  
Medical Specialties ◽  
Infectious Diseases Consultation ◽  
The Impact

ABSTRACT Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.

Hegel’s Bathetic Sublime

2016 ◽  
Vol 46 (3) ◽  
pp. 217-236
Author(s):  
Martin Donougho ◽  
Keyword(s):  
Careful Analysis ◽  
Safe Distance ◽  
Objective World ◽  
The Sublime ◽  
Persian Poetry ◽  
The Individual

Little attention has been paid to Hegel’s version of the sublime. I argue that the sublime plays a very marginal role in the Berlin lectures on aesthetics and on religion; in particular, Hegel ignores the “Romantic” sublime popular among his contemporaries. The sublime he locates in Persian poetry and more properly in Biblical Psalmody. After surveying his various articulations of the sublime, I turn to Hegel’s careful analysis of how the Psalms achieve their peculiar effects and note his focus on the “individual.” Paradoxically, while close to Romantic “subreption” (Kant’s term for subjective projection on objective world or word), their complex play with voice—and Hegel’s explication—both keep a safe distance, I contend. Turning finally to the question of anachronism and the sublime as a historical category, I suggest in a brief postscript how effects analogous to the Psalms’ rhetoric may nevertheless be detected in Terry Malick films.

scholarly journals Acute kidney injury in hospitalized patients frequency of various etiologies.

2019 ◽  
Vol 26 (11) ◽  
pp. 1952-1957
Author(s):  
Shahzad Alam Khan ◽  
Ahsan-Ullah Mirbahar ◽  
Mehboob Qadir
Keyword(s):  
Acute Kidney Injury ◽  
Infectious Diseases ◽  
Respiratory Tract ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Diabetic Patients ◽  
Respiratory Tract Diseases ◽  
Medical Unit ◽  
Medical Disorders ◽  
Study Results

Objectives: To identify magnitude of various etiologies causing acute kidney injury (AKI) in hospital admitted patients at Nishtar hospital, Multan. Study Design: Cross sectional observational study. Setting: Medical Unit-IV, Nishtar Hospital and Medical University, Multan. Period: The study span was six month extending from February 2018 to July 2018. Material and Methods: In our setting, we took a sample of 383 patients admitted to medical unit- IV for variety of medical conditions using non-probability purposive sampling technique. Patients having an age range of 30-70 years and either gender were taken. Those patients who had previously deranged kidney functions, Reno grafting, snake envenomation and kalapathar (PPD) poisoning were not considered for study. Results: The age of patients ranged from 36 years to 62 years and had a mean of 47.94±8.14 years. There were54% male and 46% female patients in our setting. The most common presenting medical disorders requiring indoor admission were pulmonary diseases seen in 38.9% patients then hepatobiliary disorders 27.4%, infections 24% and diabetes 9.6%. Out of 383 patients, 107(27.9%) patients had AKI. It was more prevalent (p=0.000) diabetic patients 46%, hepatobiliary disorders 36.1%, infectious diseases 27.1% and then respiratory tract diseases 18.1%. While working on etiological causes of AKI, we found drugs were frequent inciting factor, present in 39.3% patients then was sepsis 19.6%, volume loss 17.7% and hypotension 8.5%. Combined fluid depletion plus sepsis was noted in 6.5% patients followed by sepsis plus drugs in 4.6% and sepsis plus drugs plus hypotension seen in 3.7% patients. However, drugs were major contributory factor of AKI in patients having hepatobiliary diseases 65.8% and diabetes 35.3%. In patients of respiratory tract diseases having AKI, fluid loss 36.0% and sepsis 28.6% were recurring findings. Among patients of infectious diseases, sepsis 40% and drugs 28% were more common. Conclusion: Occurrence of Acute kidney injury among hospitalized patients was statistically significant (p=0.000) in patients with diabetes mellitus and hepatobiliary disease at the time of admission. While noting etiological factors, it was seen that drugs were the most prevalent followed by septicemia, then hypovolemia among the factors responsible for AKI.

Impact of the inpatient infectious disease consultations at a tertiary care university hospital

2019 ◽  
Author(s):  
Rami Waked ◽  
Danielle Jaafar ◽  
Marie Chedid ◽  
Gebrael Saliba ◽  
Elie Haddad ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Therapeutic Approaches ◽  
Infectious Diseases Consultation ◽  
Disease Specialist

Abstract The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting.METHODS This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit (changing the type, dose or range of the antibiotic when applicable, modifying the duration of antibiotic use), whenever the antibiotic usage was switched to a mono or bi-therapy.RESULTS The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6% of cases and Quinolones discontinuation accounted for 22.7% of cases.CONCLUSION Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

scholarly journals Prevalence of Oral Lesions in Hospitalized Patients with Infectious Diseases in Northern Brazil

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Karina Gemaque ◽  
Gustavo Giacomelli Nascimento ◽  
José Luiz Cintra Junqueira ◽  
Vera Cavalcanti de Araújo ◽  
Cristiane Furuse
Keyword(s):  
Infectious Diseases ◽  
Periodontal Diseases ◽  
Total Sample ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Oral Lesions ◽  
Oral Manifestations ◽  
Oral Manifestation ◽  
Northern Brazil ◽  
The University

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Pará, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Pará, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P>0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.

scholarly journals Impact of the inpatient infectious disease consultations at a tertiary care university hospital

10.3823/844 ◽  
2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Rami Waked ◽  
Danielle Jaafar ◽  
Marie Chedid ◽  
Gebrael Saliba ◽  
Elie Haddad ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Inpatient Setting ◽  
Therapeutic Approaches ◽  
Infectious Diseases Consultation ◽  
Disease Specialist

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

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