scholarly journals Improving Residents' Knowledge of Peripheral Smears

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4950-4950
Author(s):  
Sara Ashraf ◽  
Mina Shenouda
Keyword(s):  
Internal Medicine ◽  
Conflicts Of Interest ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Target Cells ◽  
Multiple Choice Questions ◽  
Post Intervention ◽  
Peripheral Smear ◽  
Giant Platelets ◽  
Before And After

Abstract Background: A peripheral smear is an important diagnostic tool, inexpensive, reliable and quick. It reflects the functional status of the bone marrow and can identify many blood disorders, some of which are life threatening and very time sensitive. Peripheral smears are useful to assess cytopenic states (eg, anemia, leukopenia, thrombocytopenia) or identify hematologic emergencies such as thrombocytopenic purpura/hemolytic uremic syndrome, acute myeloid leukemia, and disseminated intravascular coagulation etc. Sometimes it is sufficient to make a diagnosis solely based on them which can be life saving when time is of the essence. Based on our literature search, there are no studies to assess internal medicine residents' knowledge and understanding of peripheral smears. Methods: We created a multiple-choice questions survey of 13 questions for residents to fill out, involving common findings on peripheral smears and those found in hematologic emergencies that every resident should be aware of. Response rate in all three program years (PGY) was 100%. 16/16 PGY-1, 10/10 PGY-2 and 9/9 PGY-3 completed the survey. Results: Average pre-intervention score for PGY-1 was 42%, PGY-2 was 34% and PGY-3 was 30%. Questions most commonly wrong were regarding target cells, metamyelocytes, giant platelets and schistocytes. Most were correct about microcytosis and Auer rods. We then conducted the same survey weeks after our intervention, which was interactive, small group didactics sessions on peripheral smears. We compared results of the survey before and after didactics to check for improvement. Post-intervention score for PGY-1 was 98%, PGY-2 and PGY-3 were 96%. Conclusions: Most medical residents are not aware of common interpretations of peripheral smears and this does not seem to improve with each progressive year. Improving residents' knowledge of peripheral smears is a cost effective and quick measure that can improve patient care, in addition to potentially improving internal medicine board results. In the future, we aim to make a curriculum for peripheral smear review for residents. We can compare results of the survey with hematology oncology fellows. Disclosures No relevant conflicts of interest to declare.

scholarly journals Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome

2007 ◽  
Vol 4 (4) ◽  
pp. 493-502 ◽  
Author(s):  
David Shapiro ◽  
Ian A. Cook ◽  
Dmitry M. Davydov ◽  
Cristina Ottaviani ◽  
Andrew F. Leuchter ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Emotional Regulation ◽  
Partial Remission ◽  
Biological Effects ◽  
Low Frequency ◽  
Cost Effective ◽  
Future Research ◽  
Post Intervention ◽  
Complementary Treatment ◽  
Before And After

Preliminary findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission. The purpose of this article is to present further data on the intervention, focusing on individual differences in psychological, emotional and biological processes affecting treatment outcome. Twenty-seven women and 10 men were enrolled in the study, of whom 17 completed the intervention and pre- and post-intervention assessment data. The intervention consisted of 20 classes led by senior Iyengar yoga teachers, in three courses of 20 yoga classes each. All participants were diagnosed with unipolar major depression in partial remission. Psychological and biological characteristics were assessed pre- and post-intervention, and participants rated their mood states before and after each class. Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability in the 17 completers. Eleven out of these completers achieved remission levels post-intervention. Participants who remitted differed from the non-remitters at intake on several traits and on physiological measures indicative of a greater capacity for emotional regulation. Moods improved from before to after the yoga classes. Yoga appears to be a promising intervention for depression; it is cost-effective and easy to implement. It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study. The physiological methods are especially useful as they provide objective markers of the processes and effectiveness of treatment. These observations may help guide further clinical application of yoga in depression and other mental health disorders, and future research on the processes and mechanisms.

Abstract 173: Simple Guidance Improves Appropriate Telemetry Utilization

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alekhya Potluri ◽  
Mrudula Kudaravalli ◽  
Anthony Defail ◽  
Dilip Prabhakaran ◽  
Sangita Prabhakaran ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Guideline Implementation ◽  
Heart Association ◽  
Limited Resource ◽  
Cost Effective ◽  
Post Intervention ◽  
Qt Interval Prolongation ◽  
Intervention Cost ◽  
Before And After ◽  
Bed Days

Introduction: Cardiac telemetry is an in-hospital monitoring tool intended for ischemia surveillance, monitor QT-interval prolongation, and detect arrhythmias. It is a costly and limited resource that is frequently misused. Inappropriate telemetry use can lead to prolonged hospital stays, patient discomfort, alarm fatigue, and increased healthcare costs. We designed and implemented a telemetry guideline independent of the electronic health record (EHR) in an attempt to increase appropriate telemetry use in non-intensive care unit (ICU) setting Objectives: To design and implement a telemetry guideline. To increase appropriate use of telemetry. To practice cost-conscious, high-value care Aim: Primary Aim: Implement a telemetry guideline using pocket cards and educational conferences and monitor telemetry assignments Secondary Aim: Assess patient outcomes as reflected by the number of codes before and after the intervention Methods: We adopted telemetry criteria based on the American Heart Association guidelines from 2004 and other published literature. Baseline data was collected in November 2015 for all medicine teaching team admissions at our institution that came through the emergency department. Exclusion criteria were ICU transfers, step-down units, and direct admissions. Guidelines were then implemented via educational conferences and pocket card distribution to ED physicians, admitting hospitalists and medicine residents. Post-intervention data was collected from February through March 2016 Results: Of 180 admissions prior to guideline implementation, 93 patients (52%) went to non-telemetry beds and 87 patients (48%) to telemetry beds. Of the telemetry admissions, 60 patients (69%) were appropriately assigned to telemetry while 27 (31%) were not. After the guideline was implemented, 255 patients were reviewed. Of these, 110 (43%) went to telemetry beds, and 86 patients (78%) were appropriately assigned while 24 patients (22%) were not. There was no significant increase or decrease in the number of codes post intervention. Cost analysis revealed 103 telemetry-bed-days saved per month Conclusion: Our intervention resulted in a large (9.1%) but statistically insignificant increase in appropriate telemetry use. Although statistically insignificant, this improvement was durable across two months. Cost analysis revealed 103 telemetry-bed-days saved per month with an estimated savings of $100,000 in unnecessary charges. The relatively simple and cost-effective intervention of creating and implementing a telemetry assignment guideline was effective in changing telemetry ordering behavior. This was done without telemetry assignment logic in the EHR, which can be a tedious and time-consuming endeavor. Future efforts will include the implementation of a telemetry auditing tool, and ultimately the embedded logic to facilitate ordering practices.

scholarly journals Stress, Hope, and Depression Among Older Adults Living in Public Housing

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 338-338
Author(s):  
Mignon Montpetit ◽  
LaKeesha James-Smith ◽  
Amy Gourley
Keyword(s):  
Public Housing ◽  
Life Stress ◽  
Cost Effective ◽  
Well Being ◽  
Short Term ◽  
Post Intervention ◽  
Initial Questionnaire ◽  
Before And After ◽  
The Impact ◽  
The Relationship

Abstract Individuals living in public housing often experience myriad stressors related to poverty and mental illness. The current study explores how hope impacts the relationship between stress and depression in a sample of adults (aged 51-90 years; Mage= 63.3 years; SDage= 8.6 years) living in public housing. Questionnaire data were collected before and after running an intervention geared toward improving residents’ well-being. Results of the initial questionnaire study suggest that hope moderates the stress -> depression relationship (p = .001), with effects in the expected directions: individuals exhibiting higher-than-average levels of stress and below-average hope reported the highest levels of depression. Data further suggest modest increases in hope post-intervention (p = .06). Overall, results suggest that hope may be important in helping mitigate the impact of life stress on vulnerable individuals, and that it can be augmented in the context of a short-term, cost-effective intervention.

scholarly journals The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty

2021 ◽  
Vol 10 (5) ◽  
pp. 971
Author(s):  
Kristoff Hammerich ◽  
Jens Pollack ◽  
Alexander F. Hasse ◽  
André El Saman ◽  
René Huber ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Success ◽  
Cost Effective ◽  
Revision Total Knee Arthroplasty ◽  
Rotational Stability ◽  
X Rays ◽  
Free Interval ◽  
Major Disadvantage ◽  
Cost Effective Approach ◽  
Before And After

Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.

scholarly journals 400 - Effects of Computerized Cognitive Training with an Elderly Community Sample

2020 ◽  
Vol 32 (S1) ◽  
pp. 116-116
Author(s):  
M Pires ◽  
A Antunes ◽  
C Gameiro ◽  
C Pombo
Keyword(s):  
Older Adults ◽  
Cognitive Training ◽  
New Technologies ◽  
Community Sample ◽  
Cost Effective ◽  
Well Being ◽  
Control Group ◽  
Depression Symptoms ◽  
Intensive Training ◽  
Before And After

Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.

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

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

scholarly journals Established an eco-friendly cotton fabric treating process with enhancing anti-wrinkle performance

2021 ◽  
Vol 16 ◽  
pp. 155892502110034
Author(s):  
Xiongfang Luo ◽  
Pei Cheng ◽  
Wencong Wang ◽  
Jiajia Fu ◽  
Weidong Gao
Keyword(s):  
Tensile Strength ◽  
Citric Acid ◽  
Cotton Fabric ◽  
Crosslinking Agent ◽  
Cost Effective ◽  
Waterborne Polyurethane ◽  
Cotton Fabrics ◽  
Wrinkle Resistance ◽  
Before And After ◽  
Strength Retention

This study establishes an eco-friendly anti-wrinkle treating process for cotton fabric. Sodium hydroxide-liquid ammonia pretreatment followed by 6% (w/w) PU100 adding citric acid pad-cure-dry finishing. In this process, citric acid (CA) was used as the fundamental crosslinking agent during finishing because it is a non-formaldehyde based, cost-effective and well wrinkle resistance agent. Environmental-friendly waterborne polyurethane (WPU) was used as an additive to add to the CA finishing solution. Six commercial WPUs were systematically investigated. Fabric properties like wrinkle resistance, tensile strength retention, whiteness, durable press, softness, and wettability were well investigated. Fourier transform infrared spectra and X-ray diffraction spectra were also measured and discussed before and after adding waterborne polyurethane. Tentative mechanism of the interaction among the WPU, CA, and modified cotton fabrics is provided. The effect of cotton fabric pretreatment on fabric performance was also investigated. After the eco-process’s treatment, the fabric wrinkle resistant angle was upgraded to 271 ± 7°, tensile strength retention was maintained at 66.77% ± 3.50% and CIE whiteness was elevated to 52.13 ± 3.21, which are much better than the traditional CA anti-wrinkle finishing based on mercerized cotton fabrics. This study provides useful information for textile researchers and engineers.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

scholarly journals Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

2014 ◽  
Vol 35 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Melissa A. Viray ◽  
James C. Morley ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Control Unit ◽  
Post Intervention ◽  
Icu Patients ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
Surgical Icu ◽  
Time Series Methodology

Objective.Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.Design.Prospective pre-post-intervention study with control unit.Setting.A 1,250-bed tertiary care teaching hospital.Patients.Medical and surgical ICU patients.Methods.Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.Results.The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).Conclusions.Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ethlinn Patton ◽  
Dapo Olaleye ◽  
Stella Smith
Keyword(s):  
Adverse Events ◽  
Major Trauma ◽  
Current Practice ◽  
Oral Intake ◽  
Cost Effective ◽  
Poor Quality ◽  
Ward Round ◽  
Before And After ◽  
Ward Rounds ◽  
Gathering Data

Abstract Aims Methods Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice. Results An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.) Conclusions We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.

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