Evaluation of Antibiotic Initiation Tools in End-of-Life Care

2021 ◽  
pp. 104990912110278
Author(s):  
Matthew D. Clark ◽  
Zachery Halford ◽  
Chris Herndon ◽  
Ellen Middendorf
Keyword(s):  
Descriptive Analysis ◽  
Course Completion ◽  
Infectious Complications ◽  
Appropriate Use ◽  
Eligibility Criteria ◽  
Symptom Resolution ◽  
Number Of Patients ◽  
Hospice Patients ◽  
Minimum Criteria ◽  
Antibiotic Courses

Background: Hospice patients are frequently confronted with potentially infectious complications necessitating antibiotic consideration. Information regarding the appropriate use of antibiotics and their impact on symptom management in hospice patients are unknown. Objectives: This study aimed to evaluate and describe the use of an antibiotic initiation tool in patients admitted to outpatient hospice services. The primary outcome assessed the percentage of antibiotics that were appropriately initiated based on Loeb’s Minimum Criteria (LMC) for Antibiotic Initiation Tool. Secondary outcomes included the number of patients with documented symptom resolution following antibiotic completion, the number of antibiotic courses that were successfully completed, and treatment-related adverse events. Methods: This was a retrospective, multisite, descriptive analysis of hospice patients treated with antibiotics between April 2019 and September 2020. Results: Two hundred and thirty patients were assessed for inclusion, with 172 meeting eligibility criteria and receiving a total of 201 antibiotic courses. Based on LMC, 84 of the 201 (42%) antibiotics ordered were appropriate, with 60% of these LMC-approved courses resulting in symptom resolution. Out of 201 total courses, 99 (49%) resulted in symptom resolution. Overall, 160 (80%) antibiotic courses were successfully completed. Conclusion: In this study, antibiotic initiation in hospice patients frequently did not meet LMC. Less than half of the antibiotics prescribed led to symptom resolution despite antibiotic course completion in most patients. There is no consensus or guidelines directing appropriate antibiotic decision-making in hospice patients. The appropriate use of antibiotics in terminally ill patients warrants additional research.

scholarly journals Evaluation of the efficacy of a novel perfusion solution for normothermic ex vivo lung perfusion compared with Steen solution™ (animal experimental study)

2021 ◽  
Vol 23 (3) ◽  
pp. 82-89
Author(s):  
S. V. Gautier ◽  
O. M. Tsirulnikova ◽  
I. V. Pashkov ◽  
N. V. Grudinin ◽  
D. O. Oleshkevich ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Diseases ◽  
Ex Vivo ◽  
Infectious Complications ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
Perfusion Solution ◽  
Number Of Patients ◽  
Donor Lung ◽  
End Stage

Respiratory diseases, together with infectious complications and hereditary lung diseases, rank third in international mortality statistics. Today, lung transplantation is a recognized method of treating end-stage lung diseases. However, the number of transplant surgeries performed is not much. This is down to the high requirements on the condition of a potential lung donor and directly on the quality of the donor lung. This has significantly limited the number of optimal donors. Rehabilitation of donor lungs to optimal gas exchange indicators can be achieved and objectively assessed in the course of ex vivo lung perfusion (EVLP). The EVLP procedure is widespread in leading transplantation centers in Europe and North America. It allows to significantly expand the pool of donor lungs, thereby serving a greater number of patients in need of lung transplantation. The possibility of EVLP procedure using publicly available perfusion equipment was demonstrated. The optimized protocol fully demonstrated its reliability and efficiency. The developed perfusion solution had no statistically significant differences in comparison with the Steen SolutionTM, which in the future will serve as an alternative for EVLP procedure.

scholarly journals Rancang Bangun Sistem Informasi Administrasi Vaksinasi Meningitis Berbasis Web di Kantor Kesehatan Pelabuhan Kelas III Banda Aceh

2017 ◽  
Vol 5 (2) ◽  
pp. 131-137
Author(s):  
Dedi Apriyandi ◽  
Kusworo Adi ◽  
Aris Puji Widodo
Keyword(s):  
Information System ◽  
Descriptive Analysis ◽  
Weighted Average ◽  
Test System ◽  
Fast Method ◽  
Class Iii ◽  
Research Subjects ◽  
Number Of Patients ◽  
Banda Aceh ◽  
Port Health

Meningitis vaccination service in Polyclinic of Class III Port Health Office (KKP) of Banda Aceh almost annually has increased the number of patients. There are several problems in the administration information system of meningitis vaccination that is currently running which officer is taking a long time to monitor the stock of vaccine and searching patient’s data that has been vaccinated. In the other hand, the data and information produced has yet incomplete, inaccurate and inconforn according within user system problems, Inaccurate timing for reporting and resulted to the inforrmation’s inconsistency. The purpose of this research is to produce an web-based information system of vaccine administration of meningitis at Polyclinic Class III Port Health Office of Banda Aceh.     The type of researchs used are qualitative and quantitative. This research design using one group pre and post test, system development using FAST method (Framework for the Application of System Techniques). Research subjects consisted of 8 respondents who work in Polyclinic Port Health Office Banda Aceh. The result of observation and interview is conducted by the method of content analysis and descriptive analysis by using the weighted average. Descriptively, the results of data analysis shows which overall weighted average value of quality information before the development of 1.91 system and after the development of 3.64 system with a difference of 1.73. The average calculation of time required to perform services to patients to be faster 4.9 minutes.     There is need support and commitment from the Class III Port Health Office Banda Aceh for implementing the administration information system of meningitis vaccination that has been developed optimally. Monitoring and evaluating users of the system should be performed periodically by Port Helath Office of Banda Aceh.

scholarly journals Excretion of ropivacaine with breast milk during prolonged analgesia of a postoperative wound

2021 ◽  
Vol 14 (3) ◽  
pp. 149-155
Author(s):  
А. А. Vinokurova ◽  
M. A. Hofenberg ◽  
V. A. Bagin ◽  
S. G. Dubrovin ◽  
V. A. Rudnov
Keyword(s):  
Breast Milk ◽  
Continuous Infusion ◽  
Spinal Anesthesia ◽  
Infectious Complications ◽  
Loading Dose ◽  
Wound Infiltration ◽  
Mass Selective Detector ◽  
Number Of Patients ◽  
Selective Detector ◽  
The Mean

The aimof our study was to evaluate the safety of ropivacaine given to lactating patients as a continuous infusion according to the selected local continuous wound infiltration (CWI) protocol after cesarean section (CS). Materials and methods.Elective CSs were performed under spinal anesthesia with bupivacaine 5% -2 ml at the L2L3 level. At the end of the operation, a 22 cm multiperforated catheter was placed in the surgical wound under the aponeurosis. 3 hours after spinal anesthesia a loading dose 8 ml of 0.2% ropivacaine was administered and followed by continuous infusion at rate 4 mL/h for 48 hours. Aside from CWI, all patients received systemic anesthesia: acetaminophen 4000 mg per os, ketorolac 90 mg IV and rescue opioid tramadol up to 400 mg (as-needed) daily. Breast milk (colostrum) samples were collected after 24 and 48 hours after a loading dose and were analyzed by gas chromatography with a mass selective detector for total ropivacaine concentrations. Results.The number of patients included in the study was 8. During the study neither cases of the onset of symptoms associated with systemic toxicity of ropivacaine, nor allergic and infectious complications, were observed. The mean +- SD Cmax total colostrum ropivacaine concentration was 0.005 0.002 (0.002 0.007) g / ml. Conclusion.In this limited sample, increasing the concentration or/and infusion rate seems to be a safe (for both mother and newborn) alternative or adjunct to standard systemic analgesia after CS in order to provide proper postoperative pain control.

scholarly journals Survival of COVID-19 with Multimorbidity Patients

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1423
Author(s):  
E. Bustos-Vázquez ◽  
E. Padilla-González ◽  
D. Reyes-Gómez ◽  
M. C. Carmona-Ramos ◽  
J. A. Monroy-Vargas ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Survival Rates ◽  
Hospitalized Patients ◽  
Sample Population ◽  
Mechanical Ventilators ◽  
Number Of Patients ◽  
Regression Test ◽  
Main Variable ◽  
Logistic Regression Test

Background: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

Abstract 21: Heart Failure and Shared Decision-making: Patients’ Perspectives Regarding Medication-related Cost Discussions

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Birju Rao ◽  
Neal W Dickert ◽  
Alanna A Morris ◽  
Candace Speight ◽  
Graham Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Financial Burden ◽  
Descriptive Analysis ◽  
Cost Benefit ◽  
Patient Specific ◽  
Medication Cost ◽  
Eligibility Criteria ◽  
Reduced Ejection Fraction ◽  
Medication Costs

Background: Patients with heart failure with reduced ejection fraction (HFrEF) take on average 6 medications daily and can face considerable out-of-pocket medication costs. This issue has become particularly salient as newer medications such as sacubitril-valsartan have emerged as beneficial. As clinicians attempt to maximize benefits for this population, discussions of medication costs between patients and clinicians are critical. However, cost discussions are known to be infrequent and often suboptimal. Objective: To explore patients’ perspectives on discussing out-of-pocket medication costs with clinicians. Methods: 49 adults, aged 44-70, with HFrEF meeting general eligibility criteria for sacubitril-valsartan were recruited from outpatient heart failure clinics and inpatient services. Descriptive quantitative analysis of closed-ended and multiple-choice responses was conducted. Qualitative descriptive analysis of open-ended text data was performed. Results: About half (49%) of participants reported any previous discussion with clinicians about out-of-pocket cost related to medication. These participants described their experience with cost discussions at the time of prescription as generally positive. Specific ways these discussions were helpful included clarifying cost-benefit tradeoffs and identifying opportunities for cost reduction. Most participants (96%) were open to cost discussions with their clinician, and many (69%) specifically preferred that clinicians initiate discussions regarding medication cost. There were no differences in cost discussion preferences between participants who employed different decision-making approaches about initiation of sacubitril-valsartan or across levels of financial burden. Conclusion: Out-of-pocket cost is a relevant component of patient-centered medical decisions, particularly for patients with HFrEF. These data suggest patients with HFrEF are receptive to incorporating cost discussions into care and identify some of the ways these discussions may be helpful. Further research is needed to clarify how best to identify patient-specific cost at the time of clinical encounters and how to work with patients to make cost-benefit assessments.

scholarly journals OTHR-12. DRIVING RECOMMENDATIONS IN PATIENTS WITH NEWLY DIAGNOSED BREAST CANCER BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i20-i20
Author(s):  
Leigh Swartz ◽  
Heidi Egloff ◽  
Aki Morikawa ◽  
Catherine Van Poznak
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Seizure Activity ◽  
Descriptive Analysis ◽  
Brain Lesion ◽  
Primary Objective ◽  
Develop Breast Cancer ◽  
Newly Diagnosed ◽  
Eligibility Criteria ◽  
Breast Cancer Brain Metastases

Abstract BACKGROUND: Approximately 5% of all patients with breast cancer develop breast cancer brain metastases (BCBM). Medical and legal guidance on health conditions associated with driving may vary by state. The paucity of data to guide clinicians’ recommendations on driving in the setting of BCBM prompted this review of clinical practice. The primary objective is to determine the frequency of provider-documented driving recommendations with secondary objectives to define associated clinical factors. METHODS: University of Michigan’s (UM) DataDirect tool retrospectively searched records dated 11/30/2012 to 11/30/2018 using ICD 9 and 10 codes for breast cancer (C50.912, C50.911, C50.919, 174.9, 175.9) and for brain metastases (C79.31, D49.6, D43.2, 198.3, 239.6). Eligibility criteria were: age ≥ 18, BCBM, UM pathology confirmation of breast cancer, CNS imaging at time of diagnosis performed or reviewed at UM, and UM consultation with medical oncology, radiation oncology, neuro-oncology, neurosurgery, or neurology within 4 weeks of BCBM diagnosis. Chart abstraction included clinical and demographic factors for descriptive analysis. RESULTS: Only 87 of the 188 identified subjects (46%) met eligibility criteria. The most common exclusions were non-breast cancer brain lesion (n=40), neither UM imaging nor pathology (n=23) and no intra-parenchymal brain metastases (n=22). Of the 87 eligible subjects, 21 (24%) had documented recommendations against driving. Five of the 7 subjects with documented seizure history within 4 weeks of diagnosis also had documented recommendations against driving. There were 32 of 87 subjects on anti-epileptics of which 13 had documented driving recommendations. CONCLUSIONS: The minority of patients (24%) with newly diagnosed BCBM had a documented recommendation against driving. Seizure activity was strongly associated with documentation of driving recommendations. Other than seizure activity, general parameters regarding the safety of driving with newly diagnosed BCBM are not well defined. Prospective study is indicated to provide data supported recommendations regarding driving with BCBM.

Animal-Assisted Activity in Critically Ill Older Adults: A Randomized Pilot and Feasibility Trial

2020 ◽  
Vol 22 (3) ◽  
pp. 412-417
Author(s):  
Sandy Branson ◽  
Lisa Boss ◽  
Shannan Hamlin ◽  
Nikhil S. Padhye
Keyword(s):  
Stress Responses ◽  
Feasibility Trial ◽  
Eligibility Criteria ◽  
Hospital Policy ◽  
Related Factors ◽  
Icu Patients ◽  
Indwelling Catheters ◽  
Control Intervention ◽  
Number Of Patients ◽  
Before And After

Background: Limited evidence suggests the efficacy of animal-assisted activities (AAA) in improving biobehavioral stress responses in older patients in intensive care units (ICUs). Objectives: To assess the feasibility of an AAA (dog) intervention for improving biobehavioral stress response, measured by self-reported stress and anxiety and salivary cortisol, C-reactive protein, and interleukin-1β in older ICU patients, we examined enrollment, attrition, completion, data collection, and biobehavioral stress responses. Methods: ICU patients ≥60 years old were randomly assigned to a 10-min AAA intervention or control/usual ICU care. Attitudes toward pets were assessed before the intervention. Self-reported stress and anxiety and salivary stress biomarkers were collected before and after the intervention and the usual care condition. Results: The majority of patients were ineligible due to lack of decisional capacity, younger age, inability to provide saliva specimens, or critical illness. Though 15 participants were randomly allocated (AAA = 9; control = 6), only 10 completed the study. All participants completed the questionnaires; however, saliva specimens were significantly limited by volume. AAA was associated with decreases in stress and anxiety. Biomarker results were variable and revealed no specific trends associated with stress responses. Conclusions: Barriers to recruitment included an insufficient number of patients eligible for AAA based on hospital policy, difficulty finding patients who met study eligibility criteria, and illness-related factors. Recommendations for future studies include larger samples, a stronger control intervention such as a visitor without a dog, greater control over the AAA intervention, and use of blood from indwelling catheters for biomarkers.

scholarly journals Time Required by Dental Post Graduates and Graduates for Direct Patient Care in Peripheral Outreach Centre - A Comparative Work Sampling Analysis

2016 ◽  
Vol 04 (03) ◽  
pp. 152-155
Author(s):  
Bhumika Rathore ◽  
Sireesha Sadasivan ◽  
Vinay Bhardwaj
Keyword(s):  
Oral Health ◽  
Health Services ◽  
Patient Care ◽  
Undergraduate Students ◽  
Descriptive Analysis ◽  
Work Force ◽  
Primary Objective ◽  
Direct Patient Care ◽  
Number Of Patients ◽  
Oral Health Services

AbstractBackground: The inequity of oral health services persist due to inadequate dentist to patient ratio in the peripheral areas. The possibility of management of more number of patients lies within an efficient work force, in order to render oral health services in a well-organised manner. Objectives: The research was taken up with the primary objective of determining the most time efficient manpower in a peripheral dental unit. Secondary objective was to determine the time spent in each treatment procedure in proportion to total time involved in direct patient care. Third objective, was to recommend an appropriate range of sample for further similar studies using observatory methodology in peripheral centres. Methodology: Work measurement was done for the postgraduate and the undergraduate students for the treatments performed by them in the unit. Participatory observations were made on randomly selected days, and timings were recorded using standardised stop watch. Descriptive analysis was performed for the data obtained using Statistical Package for Social Science (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.). Results: Mean timing was found to be highest for all treatment procedures amongst graduates when compared to the postgraduates and maximum proportion of time was spent for extractions amongst all the treatments performed. Conclusion: Availability of speciality services will help the hospitals render more proficient services to the rural masses.

Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme

2020 ◽  
Vol 44 (2) ◽  
pp. 304
Author(s):  
Dina Eka Putri ◽  
Estie Kruger ◽  
Marc Tennant
Keyword(s):  
Descriptive Analysis ◽  
First Year ◽  
Publicly Funded ◽  
Eligibility Criteria ◽  
Dental Services ◽  
Access To Dental Care ◽  
Using Data ◽  
The Cost ◽  
Child Oral Health ◽  
Government Website

Objective The Child Dental Benefit Scheme (CDBS), which provides dental services for targeted children in Australia, was implemented in 2014. Currently there is no information available on the cost and utilisation patterns of this publicly funded scheme. This study aimed to analyse the pattern of dental visits under the CDBS, as well as the cost of the CDBS over the first 2 years of operation. Methods This study was a retrospective descriptive analysis, using data from Medicare Statistics (an Australian Government website) from two calendar years (2014 and 2015). Results Nationally, the number of CDBS patients declined by 16.3% after the first year, and patients were predominantly aged 5–14 years. Preventive services were the most used service, and contributed to approximately 30% of total expenditure. Conclusion The utilisation of CDBS is considered to be low. What is known about the topic? Previous government dental schemes in Australia resulted in inequalities in utilisation of the scheme by targeted groups. The CDBS was implemented with an extension of eligibility criteria and services offered as a means to improve access to dental care. What does this paper add? There is no information available on the utilisation and cost patterns of the CDBS; hence, this study analysed the pattern of utilisation and the cost of the CDBS over the first 2 years of operation. What are the implications for practitioners? It is important that practitioners promote the scheme among those eligible to enable targeted populations access to the scheme and to ultimately improve child oral health.

scholarly journals Clinical Characteristics and Management of the Hydatid Cyst of the Liver: A Study from a Tertiary Care Center in Nepal

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Utsav Joshi ◽  
Roshan Subedi ◽  
Amar Jayswal ◽  
Vishakha Agrawal
Keyword(s):  
Hydatid Cyst ◽  
Imaging Finding ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Imaging Studies ◽  
Abdominal Ultrasonography ◽  
Number Of Patients

A hydatid cyst of the liver is a significant yet neglected public health problem in Nepal. The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid cyst of the liver in the setting of a developing country. It was a retrospective, descriptive analysis of 53 patients admitted in the department of surgery with the diagnosis of hydatid cyst of the liver based on clinical manifestations, imaging studies, or serology between 2016 and 2019. The median age of the patients was 36 years, with the age group of 25-45 years being the most commonly affected (23, 43.4%). 58.5% of the patients were female. Abdominal pain (49, 92.5%) and a palpable liver (17, 32.1%) were the most common complaint and physical finding in our study population, respectively. Abdominal ultrasonography and computed tomography scan were the major imaging studies used to establish a diagnosis. A unilocular and anechoic cystic lesion was the most frequent imaging finding. The right lobe of the liver harbored the cysts in the maximum number of patients. Surgery was the preferred modality of treatment (23, 43.4%), with pericystectomy being the most common form of surgical intervention. The hydatid cyst of the liver is a common cause of morbidity in Nepal. Clinical evaluation supplemented by imaging studies is required for diagnosis, and surgery remains the treatment of choice in most cases. To explain the epidemiological pattern of the disease, multicentric studies involving a larger sample of patients should be conducted.

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