Reducing Venous Thrombosis with Antithrombin Supplementation in Patients Undergoing Treatment for ALL with Asparaginase Based Regimens

Abstract Introduction The dramatic improvement in outcomes of pediatric patients with acute lymphoblastic leukemia (ALL) has led to the incorporation of asparaginase into adult treatment protocols. However, increased thrombosis rates have been subsequently observed. In an effort to reduce venous thromboembolism (VTE) rates in this high-risk population and minimize the morbidity and cost associated with each event, Froedtert & the Medical College of Wisconsin implemented a practice of three-times weekly antithrombin (AT) activity monitoring with prophylactic AT supplementation (plasma derived antithrombin) for activity less than 50%. The type of AT used for supplementation was Thrombate III (human form) and dosing was weight-based (approximately 3000 units for patients < 70 kg, 4000 units for patients 70-100 kg, and 5000 units for patients > 100 kg) with a target AT activity level of 120%. Similarly, levels of fibrinogen were monitored three times weekly with cryoprecipitate supplementation provided for fibrinogen levels less than 100 if AT was also low. We retrospectively reviewed patient outcomes to determine impact of AT level monitoring with threshold-guided prophylactic AT infusions on VTE rates in patients undergoing asparaginase-based chemotherapy. Methods We conducted a single-center, retrospective, observational cohort study of ALL patients treated with asparaginase between 2009 and 2018. Patients were identified using our institution's hematological malignancy registry. The electronic medical record was reviewed for demographics, VTE events, AT activities, use of AT supplementation, and cryoprecipitate transfusion. Primary outcome was VTE events during treatment with asparaginase. We excluded catheter-related thrombosis from the outcomes. Secondary outcomes included: the number of patients receiving supplemental AT, the mean AT activity level (%) at the time of supplementation, number of asparaginase doses administered per patient, median number of days from asparaginase to VTE, median number of days from asparaginase administration to AT supplementation and the percentage of patients who received cryoprecipitate. The Fisher's exact test was used to compare categorical variables and Student's t-test compared continuous variables. Results A total of 65 patients were included: 20 patients were treated prior to protocol implementation (pre-intervention group), and 45 patients after implementation (post-intervention group). The median age of patients in the pre-intervention and post-intervention group was 35 and 38, respectively. The VTE rates were 50% (10 patients) in the pre-intervention group, and 25% (9 patients) in the post-intervention group (p = 0.02). The median number of days from asparaginase to VTE event was 15 in the pre-intervention group and 16 in the post intervention group. In the post-intervention group, 30 (46%) patients received AT and the mean AT activity level in supplemented patients was 46.7% (ranging from 32% to 64%). The median number of days from asparaginase administration to supplementation with AT concentrate was 8 days. A total of 28 patients (43%) received cryoprecipitate and the average fibrinogen level when patients were supplemented was 86.42 mg/dL. Fibrinogen levels were not monitored in the pre-intervention group. Conclusion Our results demonstrate that monitoring and replacing AT and fibrinogen in patients with ALL receiving asparaginase based regimens reduces the risk of VTE. Disclosures Atallah: Pfizer: Consultancy; Abbvie: Consultancy; Jazz: Consultancy; BMS: Consultancy; Novartis: Consultancy.

Download Full-text

Efficacy of hand washing beeswax food wrap in household use

BCIT Environmental Public Health Journal ◽

10.47339/ephj.2019.42 ◽

2019 ◽

Author(s):

Celine Hsin ◽

BCIT School of Health Sciences, Environmental Health ◽

Dale Chen

Keyword(s):

Cold Water ◽

Intervention Group ◽

P Value ◽

Cross Contamination ◽

Post Intervention ◽

Food Residue ◽

Specific Category ◽

Single Use ◽

The Mean ◽

Post Intervention Group

Background: Over the years, many reusable products have been invented to replace single-use disposable items to reduce waste. One of such products is the reusable beeswax food wrap, which aims to replace plastic film wraps to store food. According to manufacturer instructions, the beeswax wrap can only be washed with cold water and detergent. This presents the question whether the beeswax wrap can be effectively cleaned, as continuous reuse may present cross contamination issues. This study examines if manufacturer instructions is effective in cleaning the beeswax wrap. Methods: ATP analysis was used to determine the level of cleanliness on the beeswax wrap between the pre-intervention and post-intervention treatments. Pre-intervention samples are the new beeswax wraps. Post- intervention samples are wraps that have been contaminated with avocado, washed, and dried. ATP counts (RLU) were measured with Hygiena SystemSURE Plus ATP monitoring system. Paired T-Test was done on NCSS to analyze the results. Results: The mean of the pre-intervention group was measured at 8 RLU, which is considered clean under the Hygiena standard. The mean for the post-intervention group was measured at 67 RLU, which is considered a fail on cleanliness under the Hygiena standard. This shows that the manufacturer instructions on washing the beeswax wrap does not effectively clean the beeswax wrap. Statistical analysis show p-value is 0.000, therefore one can conclude there is a statistically significance difference in the mean ATP count between pre-intervention and post-intervention beeswax wrap samples. Conclusion: Results show that some food residue remained on the wrap after washing. This means manufacturer instructions cannot effectively clean beeswax wrap. Therefore, it is recommended that manufactures should put a label on their packaging to let their customers know that the wrap can’t be thoroughly cleaned, and certain foods should be avoided for its use. During its use, the wraps should be labeled for the specific category of food it is used for. BCCDC can also use this result to add into the reusable container guideline.

Download Full-text

Abstract 15297: A Bundled Approach to Improving Code Team Response for In-hospital Cardiac Arrest to Decrease Overcrowding and Improve Role Clarity and Leadership

Circulation ◽

10.1161/circ.130.suppl_2.15297 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Marion Leary ◽

Daniel N Holena ◽

Stacie Neefe ◽

Leah Davis ◽

Boris Tsypenyuk ◽

...

Keyword(s):

Cardiac Arrest ◽

Role Ambiguity ◽

Intervention Group ◽

Median Number ◽

Secondary Outcome ◽

Categorical Variables ◽

Role Clarity ◽

Continuous Variables ◽

Post Intervention ◽

Hospital Cardiac Arrest

Background: Little is known about how non-technical factors such as inadequate role definition and overcrowding may impact in-hospital cardiac arrest (IHCA) outcomes. Using a bundled intervention, we sought to decrease overcrowding while improving provider role ambiguity and leadership at IHCA events. Objective: To examine interventions targeted at decreasing overcrowding, improving role ambiguity and leadership during IHCA. Methods: As part of a performance improvement initiative, a multidisciplinary team implemented four countermeasures to improve IHCA code response: an MD/RN leadership dyad, assigned optimal team composition, scripted role definitions, and visual (stickers)/verbal (role-checks) cues. Between 4/2013-4/2014, the number and discipline of providers responding to ICHA events were recorded at each pulse check, and a 10-point Likert scale survey assessing communication and leadership was performed pre- and post-intervention. The primary outcome was the number of providers present after the role checks. Secondary outcome examined communication and leadership performance. Mann-Whitney test was used for continuous variables and chi-squared or Fischer’s exact test was used to compare categorical variables. Results: 20 pre-intervention and 34 post-intervention IHCA events were captured. During both periods, MDs and RNs comprised the majority of the total providers present (61%, 57%). The median number of MDs present in the post-intervention group was lower than in the pre-intervention group (4 (IQR 4-5) vs. 7 (IQR 5-9), p= 0.004), as was the number of total overall providers (14 (IQR 12-16) vs. 18 (IQR 14-22), p=0.04). The number of RNs did not differ post-intervention (data not shown). Survey results showed no significant differences in perceptions of communications or physician leadership post-intervention. However, the overwhelming majority of both the MD code leaders (90%) and primary nurses (97%) identified that there was a clear RN leader and rated the leadership provided by RN lead consistently high with a median score of 9 out of 10 possible points. Conclusions: Using an innovative bundle can decrease overcrowding and improve role ambiguity and leadership during non-ICU IHCA events.

Download Full-text

Impact of Educational Intervention on Rational Antibiotic Use In Pediatric Ward

VIMS Health Science Journal ◽

10.46858/vimshsj.8305 ◽

2021 ◽

Vol 8 (3) ◽

pp. 109-114

Author(s):

Dr. Makarand Dharma ◽

Dr. Sachin Vahadane ◽

Dr. Shreya Bhate ◽

Dr. Abhijit Shinde

Keyword(s):

Educational Intervention ◽

Tertiary Care ◽

Intervention Group ◽

Antibiotic Use ◽

Post Intervention ◽

Pediatric Ward ◽

Number Of Patients ◽

Tract Infections ◽

The Impact ◽

Post Intervention Group

Introduction: Antibiotics are a class of natural and synthetic compounds that inhibit the growth of or kill other microorganisms. Overuse of antibiotic is one of the most important factors for the development and spread of resistance in the hospital, as well as in the community. Present study was designed to describe antibiotic use in children and to assess the impact of an educational intervention on antibiotic prescription. Methods: The present study was conducted in pediatric ward of a tertiary care institute. The study population included two groups of children – each having 250 children. The first group consisted of 250 consecutive children admitted in one unit of the pediatric ward and they were analyzed for antibiotic use without any prior priming of the members of the unit regarding rationality of antibiotic use. This was followed by an intervention in the form of a 3hour workshop for all members of the unit. The second group included another 250 children consecutively admitted in the wards after this intervention. Results: In Pre intervention group 55 (44%) children received antibiotics in rational way, while in Post intervention group 90(60.40%) children received antibiotic in rational way. One hundred and thirty-six children (49.4%) received antibiotics for respiratory tract infections, this being the commonest disease for which antibiotics were received. As seen in the table, unindicated use of antibiotic was significantly reduced in Post intervention group (p = 0.03). Conclusion: The present study included 500 children. There were 285 (57%) males and 215 (43%) females. Amongst these 500 patients, 178 (35.6%) were below 1 year of age. This group had the highest number of patients. In the Pre intervention group, 55 (44%) children received antibiotics rationally, while in Post intervention group 90(60.40%) children received antibiotic rationally.

Download Full-text

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

Download Full-text

110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.155 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S69-S70

Author(s):

Katie A McCrink ◽

Kailynn DeRonde ◽

Adriana Jimenez ◽

Gemma Rosello ◽

Yoichiro Natori ◽

...

Keyword(s):

Clinical Outcomes ◽

Antimicrobial Stewardship ◽

Patient Survival ◽

Intervention Group ◽

Culture Collection ◽

Drug Resistant ◽

Intervention Period ◽

Post Intervention ◽

Appropriate Therapy ◽

Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

Download Full-text

Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative

CJEM ◽

10.1017/cem.2016.351 ◽

2016 ◽

Vol 19 (2) ◽

pp. 112-121 ◽

Cited By ~ 10

Author(s):

Tamara McColl ◽

Mathieu Gatien ◽

Lisa Calder ◽

Krishan Yadav ◽

Ryan Tam ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Intervention Group ◽

Critical Conditions ◽

Absolute Difference ◽

Antibiotic Administration ◽

Post Intervention ◽

Sepsis Management ◽

Sepsis Bundle ◽

Post Intervention Group

AbstractBackgroundIn 2008–2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality.MethodsThis before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use.ResultsWe included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8–17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1–65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission.InterpretationThe implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.

Download Full-text

1774. Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1637 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S654-S654

Author(s):

Matthew Moffa ◽

Rawiya Elrufay ◽

Thomas L Walsh ◽

Dustin R Carr ◽

Nathan Shively ◽

...

Keyword(s):

Multiplex Polymerase Chain Reaction ◽

Intervention Group ◽

Turnaround Time ◽

Cns Infection ◽

Chain Reaction ◽

Pcr Assay ◽

Post Intervention ◽

Multiplex Pcr Assay ◽

Polymerase Chain ◽

Post Intervention Group

Abstract Background Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt antimicrobial treatment and diagnostic evaluation. Our health network recently implemented a multiplex polymerase chain reaction (PCR) assay in-house. Methods This was a pre-/post-intervention study evaluating the impact that a multiplex PCR assay had on the clinical management of patients ≥18 years of age admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was Herpes Simplex Virus (HSV) PCR turnaround time (TAT). Secondary outcomes included inpatient length of stay (LOS), total antimicrobial days of therapy (DOT), and antiviral DOT. Patients were excluded if an LP was performed after hospital day 3, if they were on a systemic antimicrobial for a non-CNS indication, if they were a neurosurgical patient, and if they had a fungal CNS infection. Results The pre- and post-intervention groups each had 57 patients. The average age was 51 and 52 years in the pre- and post-intervention groups, respectively. Four patients (7%) in the pre-intervention group were immunocompromised, compared with 9 (16%) in the post-intervention group. Four patients in the pre-intervention group had a positive PCR assay for either HSV or Varicella Zoster Virus (VZV), compared with 5 patients in the post-intervention group. Neither group had a positive cerebrospinal fluid culture, bacterial antigen assay, or bacterial PCR assay. The median (IQR) HSV PCR TAT was significantly longer in the pre-intervention group, 85 (78, 96) vs. 3.9 hours (2.9, 4.7), P < 0.001. The mean LOS was numerically greater in the pre-intervention arm (7 vs. 4.7 days, P = 0.069), as were the total antimicrobial DOT (9 vs. 7.4 days, P = 0.279) and antiviral DOT (3.9 vs. 2.7 days, P = 0.136). Pre-intervention antiviral DOT was significantly greater (3.1 vs. 1.6 days, P = 0.011) in patients without a positive HSV or VZV PCR. Conclusion Implementing a multiplex PCR assay for adults undergoing an LP for a suspected CNS infection significantly reduced the HSV PCR turnaround time. Antiviral DOT was significantly shorter in patients with a negative PCR result post-intervention. We also found a non-significant reduction in LOS, total antimicrobial DOT, and antiviral DOT. Disclosures All authors: No reported disclosures.

Download Full-text

Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

Hospital Pharmacy ◽

10.1310/hpj5203-207 ◽

2017 ◽

Vol 52 (3) ◽

pp. 207-213 ◽

Cited By ~ 6

Author(s):

Christina Miele ◽

Mary Taylor ◽

Aditi Shah

Keyword(s):

Teaching Hospital ◽

Vitamin K Antagonists ◽

Intervention Group ◽

Adult Patients ◽

Patient Specific ◽

Post Intervention ◽

Appropriate Prescribing ◽

The Impact ◽

Post Intervention Group ◽

Community Teaching

Background Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol. Methods Data were collected on adult patients admitted to a community teaching hospital who received DOAC therapy for at least 2 days between January and March 2015 (pre-intervention group) and between January and March 2016 (post-intervention group). These data were analyzed to measure inappropriately prescribed DOACs, defined based on DOAC indication, renal function, drug interactions, and other pertinent patient-specific factors. Prior to the start of data collection for the post-intervention group, a pharmacist-driven protocol was developed and implemented. DOAC education was provided to pharmacists, including an evidence-based prescribing table to guide appropriate DOAC therapy. Comparisons were made between the pre-intervention and post-intervention groups to determine the impact of the pharmacist-driven service on appropriate DOAC prescribing. Results Fifty patients were analyzed in the pre-intervention group compared with 85 patients in the post-intervention group, with a total of 333 and 816 doses administered, respectively. Of the total doses administered, 32.4% were considered inappropriate in the pre-intervention group compared with 13.8% in the post-intervention group (adjusted odds ratio [OR], 0.42, 95% CI, 0.19-0.96; p = 0.039). Conclusions Implementing a pharmacist-driven DOAC service significantly improved appropriate prescribing of these agents. Provider education regarding DOAC use is essential to further increase appropriate prescribing of DOACs, optimize patients' therapy, and prevent adverse drug events.

Download Full-text

1087. Fluoroquinolone Prophylaxis vs. No Bacterial Prophylaxis in Hospitalized Neutropenic Patients Undergoing Induction Chemotherapy for Acute Myeloid Leukemia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.951 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S386-S386

Author(s):

Carley Buchanan ◽

Derek N Bremmer ◽

Anna Koget ◽

Matthew Moffa ◽

Nathan Shively ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Intervention Group ◽

Additional Treatment ◽

Newly Diagnosed ◽

Post Intervention ◽

Number Of Patients ◽

Neutropenic Patients ◽

Acute Myeloid

Abstract Background Despite evidence to support outpatient anti-pseudomonal fluoroquinolone (FQ) prophylaxis in neutropenic patients, limited data exist to support this for inpatients undergoing induction chemotherapy for acute myeloid leukemia (AML). At our institution, we implemented an initiative to replace FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam to be given if a fever occurred. Methods A retrospective chart review was conducted to analyze the outcome differences between patients receiving FQ prophylaxis (pre-intervention) and those who had a conditional order for an anti-pseudomonal β-lactam in place of FQ prophylaxis (post-intervention). Patients were included if they were ≥18 years of age and were newly diagnosed with AML undergoing induction chemotherapy. The primary outcome was 90-day all-cause mortality. Secondary outcomes included the number of patients requiring ICU admission and rate of bacteremic episodes caused by any pathogen and from a Gram-negative rod (GNR). Additionally, ciprofloxacin susceptibility of these pathogens was analyzed. Results There were 35 and 26 patients in the pre- and post-intervention groups, respectively. Between pre- and post-intervention groups, there was no difference in 90-day mortality (20.0% vs. 15.4%; P = 0.745) or ICU admissions (25.7% vs. 23.1%, P = 1), respectively. The rate of any bacteremic episode was similar between the pre- and post-intervention groups (51.4% vs. 65.4%; P = 0.307), but more patients in the post-intervention group developed GNR bacteremia (17.1% vs. 46.2%; P = 0.023). In the patients with GNR bacteremia, the number of ciprofloxacin nonsusceptible isolates was higher in the pre-intervention group (100% vs. 30.7%; P = 0.011). Conclusion Replacing FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam for inpatients newly diagnosed with AML receiving induction chemotherapy is a feasible option to decrease FQ exposure. Though increased episodes of GNR bacteremia were observed, there was no difference in total bacteremic episodes or clinical outcomes, and the improved ciprofloxacin susceptibility patterns will allow for an additional treatment option in this extremely vulnerable patient population. Disclosures All authors: No reported disclosures.

Download Full-text

Effects of Active Video Games on Children’s Psychosocial Beliefs and School Day Energy Expenditure

Journal of Clinical Medicine ◽

10.3390/jcm8091268 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1268 ◽

Cited By ~ 6

Author(s):

Zan Gao ◽

Zachary C. Pope ◽

Jung Eun Lee ◽

Minghui Quan

Keyword(s):

Social Support ◽

Self Efficacy ◽

Intervention Group ◽

Outcome Expectancy ◽

Caloric Expenditure ◽

Post Intervention ◽

Active Video Games ◽

Active Video ◽

School Day ◽

Post Intervention Group

Purpose: Examine the effects of active video games (AVGs) on children’s school-day energy expenditure (EE) and physical activity (PA)-related self-efficacy, social support, and outcome expectancy over 9 months. Method: Participants were 81 fourth grade students ( X ¯ age = 9.23 years, SD = 0.62; 39 girls) from two urban Minnesota elementary schools. A once-weekly 50 min AVG intervention was implemented in the intervention school for 9 months in 2014–2015 while the control school continued regular recess. Children’s school-day EE (daily caloric expenditure) and mean daily metabolic equivalent (MET) values were estimated via accelerometry whereas self-efficacy, social support, and outcome expectancy were assessed with psychometrically-validated questionnaires. All measures were completed at baseline and at the 4th and 9th months. Results: We observed significant interaction effects for daily caloric expenditure, F(1, 58) = 15.8, p < 0.01, mean daily MET values, F(1, 58) = 11.3, p < 0.01, and outcome expectancy, F(1, 58) = 4.5, p < 0.05. Specifically, intervention children had greater increases in daily caloric expenditure (91 kilocalorie/day post-intervention group difference), with control children decreasing daily caloric expenditure over time. We observed identical trends for mean daily MET values (0.35 METs/day post-intervention group difference). Interestingly, we observed outcome expectancy to increase in the control children, but decrease among intervention children, at post-intervention (1.35 group difference). Finally, we observed a marginally significant interaction effect for social support, F(1, 58) = 3.104, p = 0.08, with an increase and decrease seen in the intervention and control children, respectively. We observed no interaction or main effects for self-efficacy. Discussion: Observations suggested an AVG intervention contributed to longitudinal increases in school-day EE and social support compared to the control condition. Future research should examine how self-efficacy and outcome expectancy might be promoted during school-based AVG interventions.

Download Full-text