The Impact of a Highly Adjustable Chair and Office Ergonomics Training on Musculoskeletal Symptoms: Two-Month Post Intervention Findings

A possible association between night shift work and musculoskeletal disorder has been suggested. This study aimed to evaluate the impact of decreased night work on musculoskeletal pain. Difference-in-difference estimation was used to compare changes in musculoskeletal pain between shift workers (N = 122) and non-shift workers (N = 170) in a manufacturing company before and after the introduction of a new shift system eliminating overnight work. Musculoskeletal pain was measured by a questionnaire asking if workers had symptoms in specific body parts, including the neck, shoulder, arm/elbow, wrist/hand, back, and leg/foot, over the past year. Generalized estimating equation models were used to estimate changes in pre- versus post-intervention musculoskeletal pain rates between the treated and control group. In the difference-in-difference (DID) models, prevalence of musculoskeletal pain for shoulder (−10.3%), arm (−12.9%), all sites combined (−9.2%), and upper extremity combined (−14.8%) showed significant decreases from pre- to post-intervention among the treated group (shift workers) compared to the control group (non-shift workers) after controlling for age and weekly working hours. Decreasing night work was related to improvement in musculoskeletal pain in shift workers.

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Ergonomics Interventions in the Manual Harvest of Wine Grapes

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120004402235 ◽

2000 ◽

Vol 44 (22) ◽

pp. 628-630 ◽

Cited By ~ 8

Author(s):

Ira Janowitz ◽

Diana G Tejeda ◽

John A Miles ◽

Victor Duraj ◽

...

Keyword(s):

Field Testing ◽

Musculoskeletal Symptoms ◽

Post Intervention ◽

Conveyor System ◽

Work Related ◽

High Incidence ◽

The University ◽

Permanent Workers ◽

The Impact

Winegrape operations, especially at harvest, produce a high incidence of work-related musculoskeletal disorders, predominantly involving back injury. The Agricultural Ergonomics Research Center of the University of California initiated a study of vineyard operations and recruited four cooperating growers representing 191 permanent workers. The goal was to develop, field-test, and evaluate interventions to reduce ergonomics risk factors for WRMSD's during winegrape harvest. We assessed pre- and post-intervention injury records and other indicators of musculoskeletal symptoms to monitor the impact of interventions on involved workers, and used biomechanical, metabolic, and postural analyses to evaluate the effectiveness of various approaches for handling cut grapes during vineyard harvest. We introduced a smaller, lighter tote bin with improved handles, reducing the average full bin load from 25.5 kg to 20.9 kg. The proportion of workers reporting pain lasting more than a week dropped from 61% to 26%. Biomechanical and metabolic assessments indicated reduced risk for WRMSD's. We are currently field-testing a conveyor system to reduce the height at which the bins are dumped.

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Metagenomic Analysis of the Fecal Archaeome in Suckling Piglets Following Perinatal Tulathromycin Metaphylaxis

Animals ◽

10.3390/ani11061825 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1825

Author(s):

Mohamed Zeineldin ◽

Ameer Megahed ◽

Benjamin Blair ◽

Brian Aldridge ◽

James Lowe

Keyword(s):

Sequencing Analysis ◽

Metagenomic Sequencing ◽

Post Intervention ◽

Gastrointestinal Microbiome ◽

Health And Wellbeing ◽

Suckling Piglets ◽

And Function ◽

Changes Over Time ◽

And Control ◽

The Impact

The gastrointestinal microbiome plays an important role in swine health and wellbeing, but the gut archaeome structure and function in swine remain largely unexplored. To date, no metagenomics-based analysis has been done to assess the impact of an early life antimicrobials intervention on the gut archaeome. The aim of this study was to investigate the effects of perinatal tulathromycin (TUL) administration on the fecal archaeome composition and diversity in suckling piglets using metagenomic sequencing analysis. Sixteen litters were administered one of two treatments (TUL; 2.5 mg/kg IM and control (CONT); saline 1cc IM) soon after birth. Deep fecal swabs were collected from all piglets on days 0 (prior to treatment), 5, and 20 post intervention. Each piglet’s fecal archaeome was composed of rich and diverse communities that showed significant changes over time during the suckling period. At the phylum level, 98.24% of the fecal archaeome across all samples belonged to Euryarchaeota. At the genus level, the predominant archaeal genera across all samples were Methanobrevibacter (43.31%), Methanosarcina (10.84%), Methanococcus (6.51%), and Methanocorpusculum (6.01%). The composition and diversity of the fecal archaeome between the TUL and CONT groups at the same time points were statistically insignificant. Our findings indicate that perinatal TUL metaphylaxis seems to have a minimal effect on the gut archaeome composition and diversity in sucking piglets. This study improves our current understanding of the fecal archaeome structure in sucking piglets and provides a rationale for future studies to decipher its role in and impact on host robustness during this critical phase of production.

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Care of children with type 1 diabetes mellitus in school – An interventional study

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0334 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Umamaheswari Gurunathan ◽

Hemchand Krishna Prasad ◽

Sherline White ◽

Bala Prasanna ◽

Thangavelu Sangaralingam

Keyword(s):

Type 1 Diabetes ◽

Education Program ◽

School Teachers ◽

Post Intervention ◽

Community Based ◽

Structured Education ◽

Type 1 Dm ◽

The Impact ◽

Determining Factor

AbstractObjectivesPaucity of data from India on care of children with Type 1 diabetes in schools. Aims: To study assess the knowledge, attitude, practices and fear of Type 1 diabetes in school teachers and to assess the impact of an educational model on the fear of teachers and care of children in Type 1 DM at school hours.MethodsA community based study, involving school teachers and the intervention being educating them about diabetes conducted. Data pertaining to basic demography, attitude of teachers towards diabetic children, Hypoglycemia fear factor survey- parent version with worries domain and preparedness of school was collected. An education program was conducted on diabetes care in children. Immediately and after three months, the proforma details and HFSP-W scores reassessed.ResultsForty two teachers (mean age: 38.7±5.4; M:F ratio 2:40) participated in the study. Post intervention, a higher willingness to have the diabetic child in class (100 vs. 57.1%; p>0.05), better support in daily care (100 vs. 92%; p>0.05), participation in sports activities (100 vs. 7.1%; p<0.05) observed. HFSP-W scores were 38.8±4.5 (pre-intervention), 22.5±4.3 (immediate post intervention) and 29.5±3.2 (at 3months) (p<0.05). To study the determinants of improvement in HFSP-W a regression analysis was performed: presence of glucometer the most likely determining factor (T=1.999, p=0.05).ConclusionThere is a significant element of fear in the minds of teachers towards hypoglycemia which improves with a structured education program.

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87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.132 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S60-S60

Author(s):

Noor F Zaidan ◽

Rachel S Britt ◽

David Reynoso ◽

R Scott Ferren

Keyword(s):

Staphylococcus Aureus ◽

Respiratory Infections ◽

Intervention Group ◽

Kidney Injury ◽

Post Intervention ◽

Gram Positive ◽

Stewardship Program ◽

Screening Protocol ◽

The Impact ◽

Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

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1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1528 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S684-S684

Author(s):

Victoria Konold ◽

Palak Bhagat ◽

Jennifer Pisano ◽

Natasha N Pettit ◽

Anish Choksi ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Intervention Group ◽

Post Intervention ◽

Days Of Therapy ◽

New Antibiotics ◽

Core Elements ◽

Quasi Experimental ◽

Empirical Antibiotics ◽

The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

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141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.186 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S81-S82

Author(s):

Grace Mortrude ◽

Mary Rehs ◽

Katherine Sherman ◽

Nathan Gundacker ◽

Claire Dysart

Keyword(s):

Patient Satisfaction ◽

Primary Outcome ◽

Respiratory Infections ◽

Asymptomatic Bacteriuria ◽

Educational Interventions ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Stepped Wedge ◽

Post Intervention ◽

The Impact

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance in the United States. The objective of this study was to design, implement and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the outpatient setting. Methods This randomized, stepped-wedge trial evaluated the impact of educational interventions to providers on adult patients presenting to primary care (PC) clinics for ARIs and ASB from 10/1/19 to 1/31/20. Data was collected by retrospective chart review. An antibiotic prescribing report card was provided to PC providers, then an educational session was delivered at each PC clinic. Patient education materials were distributed to PC clinics. Interventions were made in a step-wise (figure 1) fashion. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper-respiratory infection otherwise unspecified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes included individual components of the primary outcome, a composite safety endpoint of related hospital, emergency department or primary care visit within 4 weeks, antibiotic appropriateness, and patient satisfaction surveys. Figure 1 Results There were 887 patients included for analysis (405 pre-intervention, 482 post-intervention). Baseline characteristics are summarized in table 1. After controlling for type 1 error using a Bonferroni correction the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for bronchitis (20.99% vs 12.66%; p=0.0003). Appropriateness of prescriptions for sinusitis (OR 4.96; CI 1.79–13.75; p=0.0021) and pharyngitis (OR 5.36; CI 1.93 – 14.90; p=0.0013) was improved in the post-intervention group. The composite safety outcome and patient satisfaction survey ratings did not differ between groups. Table 1 Conclusion Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visit or patient satisfaction surveys. Disclosures All Authors: No reported disclosures

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600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.794 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S362-S363

Author(s):

Gaurav Agnihotri ◽

Alan E Gross ◽

Minji Seok ◽

Cheng Yu Yen ◽

Farah Khan ◽

...

Keyword(s):

Hospital Readmission ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Tertiary Care ◽

Intervention Group ◽

Care Hospital ◽

Full Time ◽

Post Intervention ◽

Before And After ◽

The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

Clinical Infectious Diseases ◽

10.1093/cid/ciab126 ◽

2021 ◽

Author(s):

Evan D Robinson ◽

Allison M Stilwell ◽

April E Attai ◽

Lindsay E Donohue ◽

Megan D Shah ◽

...

Keyword(s):

Median Time ◽

Antimicrobial Stewardship ◽

A Priori ◽

Bloodstream Infections ◽

Standard Of Care ◽

Post Intervention ◽

Gram Negative ◽

Stewardship Program ◽

Days Of Therapy ◽

The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P < .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P < .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P < .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

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Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

Scientific Reports ◽

10.1038/s41598-021-90240-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shigeki Koshida ◽

Shinsuke Tokoro ◽

Daisuke Katsura ◽

Shunichiro Tsuji ◽

Takashi Murakami ◽

...

Keyword(s):

Pregnant Women ◽

Maternal Behavior ◽

Multivariable Analysis ◽

Perinatal Outcomes ◽

Fetal Movement ◽

Post Intervention ◽

Fetal Movements ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

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