Improving vaccine administration in patients with solid malignancies in the outpatient setting.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 194-194
Author(s):  
Mariam Alexander ◽  
Matthew Stuart ◽  
Jose Nahun Galeas ◽  
Roy Browne ◽  
Jim McCarthy ◽  
...  
Keyword(s):  
Nursing Education ◽  
Influenza Season ◽  
Case Fatality ◽  
Outpatient Setting ◽  
Work Flow ◽  
Easy Access ◽  
Optimal Timing ◽  
Dramatic Improvement ◽  
Vaccine Administration ◽  
Nursing Station

194 Background: Pneumococcal and influenza vaccinations are recommended for all patients with any malignancy in accordance with the Infectious Disease Society of America. Patients undergoing chemotherapy for solid tumors have a 40-50 fold higher risk for the development of invasive pneumococcal disease compared to healthy adults with a case fatality rate of 35% and should receive the sequential 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). In the outpatient setting, lack of provider knowledge, complexity of the pneumococcal vaccine regimen and disruption in work-flow of a busy clinic can lead to low rates of administration. Towards this end, we conducted a quality project to improve administration of both pneumococcal and influenza vaccines by at least 50% at one of our outpatient oncology clinics at Montefiore Medical Center in Bronx, NY during a 4 month period. Methods: We first provided provider and nursing education with regard to safety and efficacy of the vaccines in both the clinic as well as the infusion setting. Nurses were then prompted to screen patients and offer the vaccines during intake prior to all infusions and clinic visits. We created bulk orders which allowed nurses greater control of releasing vaccine orders previously entered by the director of the clinic. We also posted “cheat-sheets” on optimal timing, safety and sequence of administration of the vaccines in every patient room and nursing station. After our first cycle, we identified that there was a delay in work-flow in the outpatient clinic with delivery of the vaccines to the clinic from the pharmacy. We therefore obtained a secure vaccine fridge that was placed at the nursing station, which allowed nurses easy access to the vaccines. Results: When vaccine administration during the 2018-2019 influenza season was compared to the 2019-2020 influenza season, we found that these interventions improved the administration of the influenza vaccine by 70%. There was a dramatic increase in the number of PCV-13 vaccines administered by 350% (more than 5-fold) and increase in PPVS-23 by 12.5%. No immediate adverse reactions during this cycle were reported to our nurse manager. Conclusions: A simple intervention of improved work-flow of vaccine administration and increased education of providers and nurses translated to a dramatic improvement in the administration of influenza and PCV-13 vaccines in a busy outpatient oncology clinic.

scholarly journals Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3 cm

2021 ◽  
Author(s):  
Sanjula D. Singh ◽  
Floris H. B. M. Schreuder ◽  
Koen M. van Nieuwenhuizen ◽  
Wilmar M. Jolink ◽  
Jasper R. Senff ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Optimal Timing ◽  
Conservative Approach ◽  
Confounding By Indication ◽  
Hematoma Evacuation ◽  
Ich Guidelines ◽  
Academic Hospitals ◽  
Gcs Score

Abstract Background In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation. Methods We included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome. Results Of 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0–3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0–3). Conclusions While cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.

scholarly journals Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal

Curationis ◽  
2015 ◽  
Vol 38 (2) ◽  
Author(s):  
Nokulunga H. Cele ◽  
Maureen N. Sibiya ◽  
Dudu G. Sokhela
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Nursing Education ◽  
Health Care Providers ◽  
Health Care Services ◽  
Health Care Facilities ◽  
Easy Access ◽  
Care Providers ◽  
Care Services ◽  
Primary Health

Background: Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk.Aim of the study: The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province ofKwaZulu-Natal (KZN).Method: A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis.Results: Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel.Conclusion: Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

Determining the Optimal Timing of Initiation for Venous Thromboembolism (VTE) Anticoagulant (AC) Prophylaxis (proph) after Orthopedic Surgery (OS).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 305-305
Author(s):  
Alejandro Lazo-Langner ◽  
Douglas A. Coyle ◽  
Philip S. Wells ◽  
Dimitrios Scarvelis ◽  
Melissa A. Forgie ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Case Fatality ◽  
Pooled Analysis ◽  
Optimal Timing ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Timing Of Initiation ◽  
Net Clinical Benefit ◽  
Rate Ratios ◽  
Deep Vein

Abstract AC proph after OS results in a decrease in the incidence of VTE with an associated increase in the risk of major bleeding (MB). Several AC agents and schedules are used; however the optimal timing of initiation has not been determined. It is likely that the proximity to the time of surgery might influence both the efficacy and safety of the AC thus altering their risk-benefit profile. Using a clinical cost-effectiveness approach we compared different AC and timings of VTE proph in patients undergoing OS. A meta-analysis of 55 randomized trials was done to estimate the risk (MB) and benefit (averted VTE) of proph in OS using placebo (plac) or different AC (ximelagatranxim, low molecular weight heparin-LMWH, unfractionated heparin-UFH, warfarin-warf and fondaparinux-fonda) and timings of initiation (defined as preoperative (preop) if the first dose of the AC was administered >2 hrs before surgery, perioperative (periop)if between 2 hrs before or up to 12 hrs after the surgery and postoperative (postop) if starting 12 hrs or more after surgery). Means and variances of the MB and VTE estimates were used to parameterize Monte Carlo simulations for a beta distribution using 1,000 replications. Incremental risk, benefit and risk-benefit ratios (compared to placebo) were calculated from the replications. All AC/timing combinations were compared across a range of benefit-risk tradeoff values (risk acceptance) by calculating the percentage of replications with the highest net clinical benefit (NCB; e.g. incremental benefit - incremental risk · tradeoff) for each AC/timing combination. A higher NCB represents a better risk-benefit profile. In addition all anticoagulants were pooled together according to the initial timing of administration and NCB was calculated using random re-sampling of the replications. Analyses were done separately for major VTE (mVTE; proximal deep vein thrombosis (DVT) + pulmonary embolism), and total VTE (tVTE; mVTE + distal DVT) and a sensitivity analysis was done after excluding xim. The reference tradeoff was estimated from the case-fatality rate-ratios of VTE to MB (mVTE/MB=0.39; tVTE/MB=0.10). At the reference tradeoff value, the AC/timing combination with the highest probability of having the best risk-benefit profile was postop xim analyzed by both mVTE and tVTE (99 and 58%, respectively). After excluding xim the AC/timing combination of choice was postop LMWH if analyzed by mVTE (60%) or preop LMWH if analyzed by tVTE (59%). When all AC were pooled those administered postop had the highest probability of having the best risk-benefit profile analyzed by mVTE (48%) and the choice was indifferent between preop (45%) and postop (40%) if analyzed by tVTE. After excluding xim from the pooled analysis the choice was indifferent between preop (40%) and postop (35%) if analyzed by mVTE and if analyzed by tVTE the choice was preop (55%) followed by postop (27%). Our results suggest that: postop administration of AC proph has the best risk-benefit profile; the results are influenced by the event defining benefit (mVTE or tVTE); in some analyses preop administration was best, and; periop administration always had the worst risk-benefit profile. We conclude that periop AC proph after OS should not be used.

scholarly journals Cardiovascular implications of COVID-19 versus influenza infection: a review

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Izza Shahid ◽  
Stefan D. Anker ◽  
Scott D. Solomon ◽  
Orly Vardeny ◽  
...  
Keyword(s):  
Influenza Season ◽  
Transmission Rate ◽  
Influenza Infection ◽  
Vascular Complications ◽  
Case Fatality ◽  
Adverse Outcomes ◽  
Main Body ◽  
High Coverage ◽  
Increased Risk ◽  
Significant Burden

Abstract Background Due to the overlapping clinical features of coronavirus disease 2019 (COVID-19) and influenza, parallels are often drawn between the two diseases. Patients with pre-existing cardiovascular diseases (CVD) are at a higher risk for severe manifestations of both illnesses. Considering the high transmission rate of COVID-19 and with the seasonal influenza approaching in late 2020, the dual epidemics of COVID-19 and influenza pose serious cardiovascular implications. This review highlights the similarities and differences between influenza and COVID-19 and the potential risks associated with coincident pandemics. Main body COVID-19 has a higher mortality compared to influenza with case fatality rate almost 15 times more than that of influenza. Additionally, a significantly increased risk of adverse outcomes has been noted in patients with CVD, with ~ 15 to 70% of COVID-19 related deaths having an underlying CVD. The critical care need have ranged from 5 to 79% of patients hospitalized due to COVID-19, a proportion substantially higher than with influenza. Similarly, the frequency of vascular thrombosis including deep venous thrombosis and pulmonary embolism is markedly higher in COVID-19 patients compared with influenza in which vascular complications are rarely seen. Unexpectedly, while peak influenza season is associated with increased cardiovascular hospitalizations, a decrease of ~ 50% in cardiovascular hospitalizations has been observed since the first diagnosed case of COVID-19, owing in part to deferred care. Conclusion In the coming months, increasing efforts towards evaluating new interventions will be vital to curb COVID-19, especially as peak influenza season approaches. Currently, not enough data exist regarding co-infection of COVID-19 with influenza or how it would progress clinically, though it may cause a significant burden on an already struggling health care system. Until an effective COVID-19 vaccination is available, high coverage of influenza vaccination should be of utmost priority.

scholarly journals Mobile-based Interventions in Nursing Education among Undergraduate Nursing Students: An Analysis

2019 ◽  
Vol 8 (9S3) ◽  
pp. 1336-1343
Keyword(s):  
Nursing Education ◽  
Mobile Technology ◽  
User Satisfaction ◽  
Intervention Studies ◽  
Controlled Trial ◽  
Clinical Skill ◽  
Education Institution ◽  
Skill Learning ◽  
Easy Access ◽  
Undergraduate Nursing

There is an enormous pressure for nursing education institution to become more dynamic to engage in fast-growing educational technology into the curriculum. This study discussed the literature on the implementation of mobile learning intervention in undergraduate nursing education mainly targeting learning outcomes and understanding the features and elements of mobile technology that lead to the success and failure of the interventions. Four main online databases searched; there were Ovid, Scopus, CINAHL and ProQuest. Citation tracking and scrutiny of reference lists were also undertaken in the search for additional papers. We included twelve papers reporting on mobile-based intervention with nursing learning activities. Seven out of twelve reported the employment of quasi-experimental pre-posttest, meanwhile four used randomized-controlled trial, and one experimental pre-posttest. Eight studies were from South Korea, two were from Taiwan, and one was from Finland and Brazil. Four implemented video-based, while the other three were virtual learning object, auditory-based content and communication-based intervention. Among the advantages of mobile technology addressed were easy access and promote learning feedback, which has subsequently resulted in improved retention of knowledge, skill performance, satisfaction and self-efficacy. Meanwhile, the disadvantages were lack of user satisfaction among video-based intervention studies and low skill practice score in auditory- and social network- based intervention studies. In summary, there were no single study claimed that their study as effective for clinical skill learning since the outcomes were unclear, but there is still room for improvement with better intervention design.

scholarly journals Novel Use of Rapid Antigen Influenza Testing in the Outpatient Setting To Provide an Early Warning Sign of Influenza Activity in the Emergency Departments of an Integrated Health System

2020 ◽  
Vol 58 (12) ◽  
Author(s):  
Paige M. K. Larkin ◽  
Vladimir Manuel ◽  
Naureen Hernandez ◽  
Omai B. Garner
Keyword(s):  
Los Angeles ◽  
Influenza A ◽  
Influenza Season ◽  
Point Of Care ◽  
Outpatient Setting ◽  
Warning Sign ◽  
Influenza B ◽  
High Morbidity ◽  
Prevention Measures ◽  
Influenza Activity

ABSTRACT Seasonal influenza virus is associated with high morbidity and mortality especially in vulnerable patient populations. Here, we demonstrate the novel use of Sofia influenza A+B fluorescent immunoassay (FIA), a rapid antigen-based influenza point-of-care test (POCT), combined with Virena software for automatic deidentified tracking of influenza activity across the Los Angeles area and for predicting surges of influenza cases in the emergency department (ED). We divided outpatient clinics into 6 geographic zones and compared weekly influenza activity. In the outpatient setting, there were 1,666 and 274 influenza A and influenza B positives, respectively, across the 2018 to 2019 influenza season and 1,857 and 1,449 influenza A and influenza B positives, respectively, during the 2019 to 2020 influenza season, with zone-specific differences observed. Moreover, we found that a rapid increase in outpatient influenza was followed by an influx in influenza-positive cases in the ED, offering a 1- to 3-week warning sign for ED influx of triple or quadruple the number of influenza cases compared to the prior week. Sofia influenza A+B FIA allows for surveillance of real-time deidentified influenza activity. Tracking of such data may serve as a valuable region-specific influenza indicator and predictor to guide infection prevention measures in both the outpatient and hospital settings. High-impact interventions include designating areas for waiting rooms for influenza-like illnesses, altering staff scheduling in anticipation of surges, and securing sufficient personal protective equipment and antivirals during the height of influenza season.

Prevention of Deaths from Intentional Pesticide Poisoning

Crisis ◽  
2007 ◽  
Vol 28 (S1) ◽  
pp. 10-20 ◽  
Author(s):  
Brian L. Mishara
Keyword(s):  
Rural Areas ◽  
Case Fatality ◽  
Intervention Programs ◽  
Easy Access ◽  
Suicide Method ◽  
Prevention Strategies ◽  
Secure Storage ◽  
Knowledge And Beliefs ◽  
Advance Planning ◽  
Changing Attitudes

Abstract. Ingestion of pesticides is the most common suicide method worldwide, accounting for one third of all suicides, predominantly in Asia, Africa, Central and South America. Case fatalities are high, particularly in rural areas. This high case fatality may explain the similar numbers of male and female suicides in Asia, since more women die from their attempts. In Asia, pesticide suicides are mostly impulsive acts with little advance planning and they are less often associated with mental illness than in Western countries. Pesticides are generally chosen for their easy access. Prevention strategies include treating the problems leading to suicidal behaviors involving pesticides; changing attitudes, knowledge, and beliefs about pesticides; controlling access to dangerous pesticides, including developing secure storage practices (which are currently being evaluated); and improving the medical treatment of poisonings. More research is needed to better understand suicides involving pesticides in their cultural contexts and to evaluate the effectiveness of intervention programs, including assessment of possible substitution of methods. Also, more knowledge about protective factors may help suggest innovative prevention strategies.

Management of acute aluminum phosphide poisoning: Has anything changed?

2021 ◽  
Vol 14 ◽  
Author(s):  
Lokhesh Chockalingam Anbalagan ◽  
Navneet Arora ◽  
Ashok Kumar Pannu
Keyword(s):  
Case Fatality Rate ◽  
Lipid Emulsion ◽  
Case Fatality ◽  
Definitive Treatment ◽  
Easy Access ◽  
Cochrane Library ◽  
Fatality Rate ◽  
Aluminum Phosphide ◽  
High Case Fatality Rate ◽  
Aluminum Phosphide Poisoning

: Due to its easy availability, rapid and severe toxicity, and no specific antidote, aluminum phosphide has emerged as a lethal toxin, commonly used for suicidal intent in agricultural communities. Despite various advances in medicine, this compound’s toxicity is poorly understood, and it still has a very high case fatality rate with no definitive treatment options available. This review aims to understand the mechanism of toxicity, clinical toxidrome of acute aluminum phosphide poisoning, and the available therapeutic options, including recent advances. A literature review was performed searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: (“aluminum phosphide poisoning” OR “aluminum phosphide poisoning toxicity” OR “aluminum phosphide ingestion”) AND (“management” OR “therapy” OR “treatment”). Selected articles were discussed amongst all the authors to shape this review. High case fatality rate and lack of any specific antidote are persisting challenges. Therapeutic measures need to be implemented from all fronts – reducing easy access to the poison, developing less toxic alternatives for use as a pesticide, and more studies directed at developing an effective reversal agent for phosphine. The advent of promising agents like glucose-insulin-potassium infusion and lipid emulsion is a new ray of hope in the complete recovery in this fatal poisoning. The current need of the hour is to find an agent that rapidly and effectively reverses aluminum phosphide's toxic effects. Large multicenter controlled trials are required to establish the role of glucose-insulin-potassium and lipid emulsion.

scholarly journals Management of recurrent or metastatic thyroid cancer

ESMO Open ◽  
2018 ◽  
Vol 3 (Suppl 1) ◽  
pp. e000359 ◽  
Author(s):  
Makoto Tahara
Keyword(s):  
Thyroid Cancer ◽  
Precision Medicine ◽  
New Drugs ◽  
Easy Access ◽  
Optimal Timing ◽  
Molecular Testing ◽  
Watch And Wait ◽  
Serious Adverse Events ◽  
Increased Risk ◽  
Metastatic Thyroid Cancer

Recently, vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) have become available for the treatment of recurrent or metastatic thyroid cancer. However, a number of clinical challenges that impact the use of VEGFR-targeted TKI in daily clinical practice have arisen. Toxicity is considerable, to the extent that most physicians hesitate to start VEGFR-targeted TKI and prefer to continue a watch-and-wait approach until the patient’s disease markedly worsens. This delayed use of VEGFR-targeted TKI leads to a higher incidence of serious adverse events than was reported in clinical trials. Moreover, the watch-and-wait approach has several demerits, including a worsening of quality of life, worsening of outcomes in patients of older age or with follicular thyroid cancer and increased risk of brain metastasis or bleeding. Thus, optimal timing for the start of VEGFR-targeted TKI requires careful consideration. Moreover, management of VEGFR-targeted TKI toxicities requires appropriate supportive care, well-organised infrastructure in the outpatient clinic and patient education. Future treatment will progress to precision medicine based on molecular testing. Promotion of precision medicine requires the establishment of a system of easy access to molecular testing and the promotion of translational research for the development of new drugs.

scholarly journals COVID-19 Pandemic Initial Case-Fatality Risk

2020 ◽  
Author(s):  
Ashraf Abugroun ◽  
Fatima Ahmed ◽  
Manar E Abdel-Rahman ◽  
Khalid M Dousa ◽  
Mohammed Osman ◽  
...  
Keyword(s):  
Low Income ◽  
Case Fatality ◽  
Easy Access ◽  
Continuous Variables ◽  
Sanitation Services ◽  
Wilcoxon Rank Sum Test ◽  
Chi Squared ◽  
Basic Sanitation ◽  
Unsafe Water ◽  
Case Fatality Risk

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic continues to expand at alarming rates. We aimed to identify the effect of various health, economic and demographic indicators on the spread case fatality of COVID-19 during the initial pandemic phase. Methods Pearson's chi-squared (χ2) test and Wilcoxon rank-sum test were used compare categorical and continuous variables respectively. Results A total of 182 countries were included. The globally confirmed COVID-19 cases on March 21, 2020 were 266,073; with 11,183deaths. Countries with high COVID-19 case volumes had higher health expenditure, higher prevalence of smoking and alcohol use, more access to basic sanitation services and higher volume of tourists. Countries with high COVID-19 fatality had significantly lower number of nurses/midwives per 1000 people 2.6 vs 6.4, p = 0.028, higher prevalence of undernourishment 4.5 vs 2.5, p = 0.019, lower access to basic sanitation services 94.2 vs 98.7, p = 0.034 and higher mortality rates due to unsafe water, limited sanitation and lack of hygiene 0.6% vs 0.2%, p = 0.004 and higher number of total tourists’ departures 9.5 vs 5.9 million, p = 0.042. Conclusion Countries with primitive health structure and low income are at high risk for increased mortality. Additional measures to increase nurse staffing and address undernourishment and availability of easy access to basic sanitation services and good hygiene are crucial for pandemic control during initial phase.

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