A nonrandomized study on compliance with IDSA guidelines on the choice and dosing of empiric antibiotics for patients with febrile neutropenia after implementation of a new Computerized Physician Order Entry (CPOE).

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 48-48
Author(s):  
Kapil Meleveedu ◽  
Sai Kaza ◽  
Lisa Phuong ◽  
Edward Belk Perry ◽  
Susan Tannenbaum

48 Background: More than 80% of patients with hematologic malignancies and 10-50% of patients with solid tumors are expected to experience fever after one cycle of chemotherapy. Studies have shown all-cause mortality to be 15% higher in cancer patients with febrile neutropenia than comparably matched patients without febrile neutropenia and compliance for choice of empiric antibiotics in febrile neutropenia to be as low as 56%. Methods: We conducted a retrospective chart review of patients who presented with febrile neutropenia to our institution for one year prior to and after implementation of a CPOE set. Data was collected on basic demographics, oncological diagnosis, labs, choice of antibiotics and dosing frequency. Awareness sessions were conducted among admitting staff following the initial retrospective analysis followed by implementation of a CPOE set in order to improve guideline concordant management of febrile neutropenia patients. The IDSA risk was assessed based on the above data and the pre and post order set compliance with IDSA guidelines were compared. Fisher’s exact test was applied to assess the percentage of compliance before and after implementation of the order set, with significance set at two-sided p value < 0.05. Results: Among the patients managed before order set, 15 of the total 26 (58%) were found to be non compliant with IDSA guidelines in terms of either antibiotic choice or dosing frequency. A post order set analysis showed that only 7/27 (26%) were non compliant with IDSA guidelines. The Fisher exact test showed a statistically significant value of 0.0267 (p < 0.05). Conclusions: Education and implementation of a CPOE order set showed significant improvement in compliance with IDSA guidelines for management of febrile neutropenia. Based on the data from our study an IDSA concurrent institutional guideline for management of febrile neutropenia was formulated and further efforts are under way to incorporate results in our new EMR order set entries.[Table: see text]

2021 ◽  
Author(s):  
CindyLee P Neighbors ◽  
Michael W Noller ◽  
Michael P Avillion ◽  
John W Neighbors ◽  
Mark C Spaw ◽  
...  

ABSTRACT Introduction To compare pain medication refill rates for adult septoplasty and rhinoplasty patients before and after initiating a multimodal analgesic protocol for reducing opioid prescriptions (PROP). Materials and Methods Data from 58 adult patients were retrieved by retrospective chart review (19 septoplasties and 10 rhinoplasties before initiating PROP in September 2018 and 21 septoplasties and 8 rhinoplasties after PROP). We selected consecutive septoplasties and rhinoplasties, at which time a new discharge order set was implemented. The new order set consisted of 10 oxycodone tabs (5 mg), 100 acetaminophen tabs (325 mg), and 28 celecoxib tabs (200 mg). The primary outcome variable was the number of initial opioid prescriptions and refills filled by any provider. Results Among the septoplasties, there was a 46% decrease in total morphine milligram equivalent (MME) prescribed, from a mean of 202.0 mg in the non-PROP group (95% CI, 235.4, 174.6) to 108.6 mg in the PROP group (95% CI, 135.8, 81.4), with no difference in refill rates. Among the rhinoplasties, there was a 51% decrease in total MME prescribed, from a mean of 258.8 mg in the non-PROP group (95% CI, 333.4, 184.1) to 126.6 mg in the PROP group (95% CI, 168.1, 85.0) with no difference in refill rates. Conclusions The outcomes after PROP implementation for septoplasty and rhinoplasty at our institution suggest that opioid prescription rates can be significantly decreased to manage postoperative pain, with no difference in opioid refill rates. The results also warrant further investigation into patient pain, satisfaction, provider efficiency, and healthcare costs.


2021 ◽  
pp. 175342592110299
Author(s):  
Alexander Varzari ◽  
Igor V. Deyneko ◽  
Elena Tudor ◽  
Harald Grallert ◽  
Thomas Illig

Polymorphisms in genes that control immune function and regulation may influence susceptibility to pulmonary tuberculosis (TB). In this study, 14 polymorphisms in 12 key genes involved in the immune response ( VDR, MR1, TLR1, TLR2, TLR10, SLC11A1, IL1B, IL10, IFNG, TNF, IRAK1, and FOXP3) were tested for their association with pulmonary TB in 271 patients with TB and 251 community-matched controls from the Republic of Moldova. In addition, gene–gene interactions involved in TB susceptibility were analyzed for a total of 43 genetic loci. Single nucleotide polymorphism (SNP) analysis revealed a nominal association between TNF rs1800629 and pulmonary TB (Fisher exact test P = 0.01843). In the pairwise interaction analysis, the combination of the genotypes TLR6 rs5743810 GA and TLR10 rs11096957 GT was significantly associated with an increased genetic risk of pulmonary TB (OR = 2.48, 95% CI = 1.62–3.85; Fisher exact test P value = 1.5 × 10−5, significant after Bonferroni correction). In conclusion, the TLR6 rs5743810 and TLR10 rs11096957 two-locus interaction confers a significantly higher risk for pulmonary TB; due to its high frequency in the population, this SNP combination may serve as a novel biomarker for predicting TB susceptibility.


2021 ◽  
Vol 6 (2) ◽  
pp. 111
Author(s):  
Hepti Muliyati ◽  
Menis Mbali ◽  
Hadidja Bando ◽  
Riana Pangestu Utami ◽  
Opyn Mananta

Wasting on children is an important public health problem because of its considerable impact on their health and growth. This problem could lead to iron deficiency which could induce infection disease and probably lower a child’s intelligence as a long-term effect. This study aimed to analyze factors related to wasting on 12-59 months children in Bulili Public Health Center (PHC), Palu City. The analytical descriptive study designed with a cross-sectional approach was applied in this study. One hundred and twenty-one subject was selected from 283 children with purposive sampling technique. Data were analyzed with chi-square and Fisher exact test with significant (p < 0,05). The result showed that most children with low birth weight experienced wasting with a p-value = 0,000. Most of the children from higher-income families did not experience wasting with a p-value = 0,004. Most children who didn’t receive breastfeeding milk did not experience wasting with a p-value = 0,958. This study concluded a correlation between low birth weight and income to wasting, but breastfeeding practice was not related.


Author(s):  
Dewi Pusparani Sinambela ◽  
St. Hateriah

Latar Belakang: Lama Kala II dalam persalinan yaitu jangka waktu mulai dari serviks berdilatasi penuh sampai dengan kelahiran bayi tidak boleh melebihi 2 jam pada primigravidan dan 1 jam pada multigravida. Pemilihan posisi melahirkan sangat dianjurkan untuk memberikan rasa nyaman pada ibu, posisi dapat membantu penurunan janin ke dasar panggul dan mempercepat proses persalinan. Dari data yang diperoleh bulan Januari 2018 jumlah persalinan kala II lama sebanyak 0,30% dari 240 persalinan normal.Tujuan: Menganalisis Perbedaan Posisi Meneran Miring Kiri dan Setengah Duduk Pada Ibu Bersalin Dengan Lama Kala II.Metode: Jenis penelitian ini adalah Analisis kuantitatif. Rancangan penelitian menggunakan quasi eksperiment. Populasi penelitian semua ibu bersalin di RSUD Dr. H. Moch Anshari Saleh Banjarmasin. Pengambilan sebanyak 30 responden. Pengambilan data dilakukan dengan menggunakan ceklist. Analisa data yang dilakukan adalah Analisa Univariat dan Analisa Bivariat dengan uji Fisher Exact Test.Hasil: Responden yang menggunakan posisi meneran miring kiri 15 orang (50%) dan setengah duduk sebanyak 15 orang (50%). Jumlah responden primipara yang mengalami persalinan kala II 60 menit sebanyak 12 orang (40,0%), primipara yang mengalami kala II 60 menit sebanyak 2 orang (6,7%) dan responden multipara yang mengalami kala II 30 menit sebanyak 16 orang (53,3%), multipara yang mengalami kala II 30 menit sebanyak 0 orang (0%) dari hasil uji Fisher Exact Test dengan nilai p sebesar 0,483.Simpulan: Tidak ada perbedaan posisi miring kiri dengan posisi setengah duduk terhadap kemajuan persalinan kala II di RSUD Dr. H. Moch. Anshari Saleh Banjarmasin. Kata Kunci: Lama Kala II, Persalinan, Posisi Meneran.   Analysis of Different Left and Half Posisition Straining on Mother with Second Duration of Labour In RSUD Dr. H. Moch Anshari Saleh BanjarmasinABSTRACT Background: The duration of second stage of labor is the period from the full dilated cervix to the birth of the baby should not exceed 2 hours in primigravida and 1 hour in multigravida. Position selection is very beneficial for giving comfort to the mother, the position can help lower the fetus to the pelvic floor and improve labor. From the data obtained in January 2018 the number of prolonged second stage deliveries was 0.30% of 240 normal deliveries.Objective: Analyze the Differences in Position Meniring Left and Half Seated at the Maternity with Long Time II.Method: This type of research is quantitative analysis. The study design used quasi experiment. The study population of all mothers giving birth at Dr. RSUD H. Moch Anshari Saleh Banjarmasin. Taking as many as 30 respondents. Data retrieval is done using a checklist. Data analysis performed was Univariate Analysis and Bivariate Analysis with Fisher Exact Test.Results: Respondents who used the left oblique piercing position were 15 people (50%) and half sat as many as 15 people (50%). The number of primiparous respondents who increased labor at second time 60 minutes was 12 people (40.0%), primipara who added second stage 60 minutes as many as 2 people (6.7%) and multiparous respondents who used second time 30 minutes as many as 16 people (53.3%), multiparas who replaced time II 30 minutes as many as 0 people (0%) from the results of the Fisher Exact Test with a p value of 0.483.Conclusion: There was no difference in left oblique position with sitting position towards the progress of second stage labor in Dr. Hospital. H. Moch. Ansari Saleh Banjarmasin.  Keywords : Second Duration, Labour, Straining Position 


2020 ◽  
Vol 9 (1) ◽  
pp. 34-42
Author(s):  
Alvian Merza Radi Putra ◽  
Melania Wahyuningsih ◽  
Fajarina Lathu

Diare lebih dominan menyerang anak-anak karena daya tahan tubuh anak-anak yang masih lemah. Faktor penyebab diare pada anak salah satunya pemberian MP-ASI oleh ibu. Dalam praktiknya pengetahuan ibu tentang pemberian MP-ASI masih minim. Tujuan dari penelitian ini adalah untuk mengetahui hubungan tingkat pengetahuan ibu tentang pemberian MP-ASI dengan kejadian diare pada anak usia 6-24 bulan Di Posyandu Padukuhan Pugeran Maguwoharjo Depok Sleman Yogyakarta. Jenis penelitian yaitu kuantitatif observasional analitik dengan rancangan penelitian Cross Sectional. Populasi penelitian ini ibu yang memiliki anak usia 6-24 bulan berjumlah 41 bulan Juli 2019 di Padukuhan Pugeran Maguwoharjo Depok Sleman Yogyakarta. Teknik Sampling menggunakan total sampling. Instrumen pengambilan data berupa kuisioner. Analisa data menggunakan Fisher Exact Test. Hasil menunjukkan ibu yang memiliki pengetahuan baik 28 orang (68,3%) sedangkan yang berpengetahuan cukup sebanyak 13 orang (31,7%). Anak yang tidak pernah mengalami diare dalam kurun waktu 3 bulan terakhir sebanyak 29 anak (70,7%) dan yang pernah mengalami diare dalam kurun waktu 3 bulan terakhir sebanyak 12 anak (29,3%). Didapatkan hasil nilai p value sebesar 0,419. Tidak ada hubungan antara tingkat pengetahuan ibu tentang MP- ASI dengan kejadian diare pada anak usia 6-24 bulan di Padukuhan Pugeran Maguwoharjo Depok Sleman Yogyakarta.


2019 ◽  
Vol 12 (02) ◽  
Author(s):  
Prastiwi Putri Basuki ◽  
Triana Uminingsih

Stunting pada masa balita perlu mendapat perhatian khusus termasuk pada anak usia 24-36 bulan. Usia 24-36 bulan merupakan usia anak yang mengalami perkembangan pesat dalam kemampuan kognitif dan motorik. Banyak faktor yang mempengaruhi terjadinya kejadian stunting pada anak, antara lain karakteristik ibu. Tujuan dari penelitian ini adalah mengetahui kontribusi karakteristik ibu terhadap kejadian stunting pada anak usia 24-36 bulan. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan cross sectional yang dilakukan di Desa Sendang Mulyo Minggir Sleman Yogyakarta. Sampel yang diambil sebanyak 75 anak usia 24-36 bulan dengan teknik purposive sampling. Analisis data  bivariat menggunakan Chi Square dan Fisher Exact Test dan analisis multivariat menggunakan regresi linier. Hasil penelitian menunjukkan bahwa pendidikan ibu (p value=0,000), pengetahuan ibu (p value=0,022) dan pemberian ASI Ekslusif (p value=0,011) yang artinya terdapat hubungan dengan kejadian stunting. Sedangkan status pekerjaan ibu (p value=0,217) tidak signifikan berhubungan dengan kejadian stunting. Berdasarkan analisis multivariat regresi linier menunjukkan hasil bahwa pendidikan ibu, status  pekerjaan ibu, pengetahuan ibu tentang gizi, dan pemberian ASI Ekslusif bersama-sama mempunyai kontribusi terhadap kejadian stunting sebesar 88,2%. Perlu peningkatan program multisektoral dengan melibatkan semua lapisan masyarakat untuk mengurangi kejadian stunting.


1970 ◽  
Vol 2 (1) ◽  
pp. 35-38 ◽  
Author(s):  
E Shrestha

Introduction: Seasonal hyper-acute panuveitis (SHAPU) is a sight-threatening disease and its management is challenging. Objective: To study the profile and evaluate the visual outcome of the patients of clinicallydiagnosed cases of SHAPU after treatment. Subjects and methods: A retrospective interventional hospital-based study was carried out involving 21 subjects with clinically-diagnosed SHAPU. The data were retrieved from the record section of the hospital and analyzed. The variables studied were demographic pattern, clinical condition, duration of presentation and visual acuity before and after the treatment. Statistics: The data were analyzed using Epi Info version 2000. Percentage prevalence, mean values with standard deviation, relative risk, 95% CI and p value were calculated. P value of < 0.05 was considered to be significant. Results: Among the 21 cases, the numbers of male and female were 11 (52.4 %) and 10 (46.7 %) respectively. A comparative analysis of gender in children and adults did not show any significant difference (RR=0.47, 95% CI = 0.22 - 1.01, Fisher exact test: p = 0.14). The mean for all ages was 7 ± 12.68 years, while the mean age in pediatric cases was 4.5 ± 3.91 years. Thirteen (61.9%) cases occurred in children below fifteen years. Fifteen (71.4 %) cases reported during September and October. Presenting visual acuity of all cases was less than 3/60. All of them received medical treatment. By the end of the 4th week, seven (33.3 %) patients regained vision to 6/18. Conclusion: SHAPU is more prevalent in pediatric age group. It is equally prevalent among males and females. The visual acuity can improve with early medical treatment. Keywords: SHAPU; panuveitis; steroid; phthisis bulbi DOI: 10.3126/nepjoph.v2i1.3702 Nep J Oph 2010;2(1) 35-38


2010 ◽  
Vol 76 (7) ◽  
pp. 755-758
Author(s):  
Larry I. Watson ◽  
Christy Spivey ◽  
Cen Rema Menon ◽  
Cyrus A. Kotwall ◽  
Thomas V. Clancy ◽  
...  

Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and χ2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.


2018 ◽  
Vol 6 (2) ◽  
pp. 65-68 ◽  
Author(s):  
Meera Bista ◽  
Toran KC

Background: Otoscopic procedure like tympanoplasty is one of the magic wands that an ear nose throat surgeon possesses to alleviate the suffering of a hearing impaired patient. Endoscopic trans-tympanic pop in technique is an alternative method where tympanic fascial graft is placed medial to tympanic membrane remnant through the perforation without elevation of tympanomeatal flap and angled endoscope is used to assess the ossicular chain.Objective: The study was done to compare the results of endoscope assisted trans-tympanic pop-in tympanoplasty with permeatal underlay tympanoplasty.Methods: The study is a prospective, longitudinal and experimental study conducted in Kathmandu Medical College Teaching Hospital from January 2016 to June 2016. A total of sixty-two patients, thirty-one in study and thirty-one in control group were present. The comparison was made in terms of success rate, decrease in taste sensation and time taken for the procedure. Data analysis was done by SPSS version 20. Categorical data were tested by Fisher Exact test and p-value of <0.005 was considered statistically significant.Result: Among 62 patients, 55 had successful graft uptake (88.7% success rate). Hearing improvement was seen in 51 patients (88.25%). Regarding taste sensation 5 out of 62 had decrease in taste sensation after surgery (8%). Time taken was approximately 30 to 45 minutes (mean =44.1min) in endoscopic transtympanic pop-in type and 60 to 90 minutes (mean =73.8 min) in permeatal underlay type.Conclusion: We can conclude that endoscopic trans-tympanic pop-in tympanoplasty gives similar hearing and graft uptake result but with less time and greater ease as compared to permeatal underlay technique.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18139-e18139 ◽  
Author(s):  
Benjamin Levy ◽  
Nagashree Seetharamu ◽  
Stacie Richardson ◽  
Daniel Jacob Becker ◽  
Walter Choi ◽  
...  

e18139 Background: KRAS mutations are the most common driver mutation indentified in NSCLC, occurring in 20 - 30% of adenocarcinomas. While several studies suggest KRAS predicts for lack of response to TKI therapy, few data exist regarding its association with outcomes for patients treated with cytotoxic chemotherapy. This study explores the association between KRAS mutations and outcomes (RR, PFS) in a cohort of patients treated with frontline platinum/pemetrexed (PPm) based therapy. Methods: In this retrospective chart review, we evaluated RR and PFS for 16 KRAS + EGFR – pts treated with carboplatin (AUC 5-6) or Cisplatin 75mg/m2 and (Pm)pemetrexed (500 mg/m2) +/- (B)bevacizumab 15mg/kg. For comparators, we identified 19 KRAS - EGFR - patients treated with the same regimen. Maintenance therapy with Pm or Pm+B was given at the discretion of the treating physician. KRAS and EGFR mutational status were assessed by RT-PCR on tumor tissue collected at first diagnosis. RR was assessed using RECIST criteria. Kaplan-Meier estimates for PFS were evaluating using log rank test. Fisher exact test was used to assess the association between KRAS mutation status and response rate. Results: The groups were similar in age (KRAS + mean 61 vs. 60; p=0.87), gender (62% vs. 57% F; p= 0.9), ECOG 2 (0 vs. 10%,p=0.47), smoking hx (93% vs. 94% current/former smokers, p=0.7), brain mets (0% vs. 18% p=0.22), mean number induction cycles (4 in each, p=0.6), cisplatin and bevacizumab use (12% vs 10%, p > 0.1;10% vs. 40%, p=0.10). Pm maintenance was used in 31% KRAS+ (5/16) and 26% KRAS-(5/19) (p=0.79). P+B maintenance was used in 12% (2/16) and 5% (1/19) (p=0.70). RR was 56% in the KRAS + (9/16) vs. 36% KRAS- (7/19) respectively (p=0.3). There was a statistically significant improvement in PFS in the KRAS + group (10.3 mos vs. 5.7 mos, p =0.03). Conclusions: In this small retrospective review, KRAS mutations appeared to be associated with a non-significant improvement in RR and significant improvement in PFS for patients treated with frontline PPm based therapy. Future prospective studies should investigate and validate the predictive value of KRAS for this cytotoxic regimen. [Table: see text]


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