Improvement in time to oral anticancer agent follow-up.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 235-235
Author(s):  
Emily Johengen ◽  
Arielle Davidson ◽  
Kathleen W. Beekman ◽  
Kelly Hecht ◽  
Emily R. Mackler

235 Background: Use of oral anticancer agents (OAAs) for cancer treatment continues to grow and creates a need for oncology practices to adapt their ambulatory infusion model of care to one that supports patients taking anti-cancer treatment at home. Historically, our practice has had success with care managers supporting infusion treatment patients. A recently published randomized trial has shown considerable benefits of dedicated pharmacist follow-up for patients taking OAAs. As a result, our practice added a dedicated oncology pharmacist to provide education and follow-up for our OAA patients. Methods: This is a single-center, retrospective evaluation of time to first follow up for patients taking OAAs pre-intervention (11/1/20 - 2/28/21) versus post-intervention (3/1/21 - 4/30/21). The intervention consists of structured symptom and adherence monitoring by a dedicated oncology pharmacist as part of our care management team for all patients prescribed an OAA. In the pre-intervention group, OAA monitoring was divided between care team members without a dedicated OAA program. The population consists of 139 patients newly started on OAAs over the 6-month period. “On-time” follow up defined by our practice is follow up that is <10 days from the OAA start date. There were 20 patients (10 per group) excluded from data analysis due to being deceased before follow-up could be assessed (n= 3), transferring oncology care elsewhere (n= 5), or never starting the OAA (n= 12). Results: Pre-intervention, initial follow up occurred via pharmacist or nurse care manager visit (n=47), provider visit (n=29), or unplanned admission (n=3). Post-intervention, all but two initial follow up visits were performed by the designated oncology pharmacist, and there were no unplanned admissions prior to first follow up. The median time to first follow up visit was 8 days (range 2 to 31 days) in the pre-intervention group (n=79) and 7 days (range 3 to 15 days) in the post-intervention group (n=40). Follow up visits occurred within 10 days of OAA initiation for 67.1% of patients in the pre-intervention group and 95% of patients in the post-intervention group (p=<0.001). Follow up occurred within 14 days of initiation for 82.3% of pre-intervention patients and 97.5% of post-intervention patients (p=0.018). Conclusions: Post-intervention assessment showed improvement in the time to follow up for patients taking OAAs. Future analyses will include outcomes, such as interventions at the time of follow-up, length on therapy, and unplanned admissions.

2019 ◽  
Vol 35 (6) ◽  
pp. 235-242
Author(s):  
Mary Joyce B. Wingler ◽  
Kayla R. Stover ◽  
Katie E. Barber ◽  
Jamie L. Wagner

Background: Inpatient HIV-related medication errors occur in up to 86% of patients. Objective: To evaluate the number of antiretroviral therapy (ART)- and opportunistic infection (OI)-related medication errors following the implementation of pharmacist-directed interventions. Methods: This quasi-experiment assessed adult patients with HIV who received ART, OI prophylaxis, or both from December 1, 2014, to February 28, 2017 (pre-intervention) or December 1, 2017, to February 28, 2018 (post-intervention). Pre-intervention patients were assessed retrospectively; verbal and written education were provided (intervention); prospective audit and feedback was conducted for post-intervention patients. The primary outcome was rate of ART errors between groups. Secondary outcomes included rate of OI errors, time to resolution of ART and OI errors, types of errors, and rate of recommendation acceptance. Results: Sixty-seven patients were included in each group. ART errors occurred in 44.8% and 32.8% ( P = .156), respectively. OI prophylaxis errors occurred in 11.9% versus 9% ( P = .572), respectively. Medication omission decreased significantly in the post-intervention group (31.3% vs 11.9%; P = .006). Pharmacist-based interventions increased in the post-intervention group (6.3% vs 52.9%; P = .001). No statistical difference was found in time to error resolution (72 vs 48 hours; P = .123), but errors resolved during admission significantly increased (50% vs 86.8%; P < .001). No difference was found in rate of intervention acceptance (100% vs 97%). Conclusion and Relevance: ART and OI prophylaxis errors resolved a day faster in the pharmacist-led, post-intervention period, and there was a trend toward error reduction. Future interventions should target prescribing errors on admission using follow-up education and evaluation of medication reconciliation practices in HIV-infected patients.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Noor F Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
R Scott Ferren

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


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  

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 &lt; 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


2022 ◽  
Author(s):  
Forouzandeh Soleimanian-Boroujeni ◽  
Negin Badihian ◽  
Shervin Badihian ◽  
Vahid Shaygannejad ◽  
Yousef Gorji

Abstract Introduction: Psychological interventions are shown to be effective in migraine, but not utilized routinely yet. We aimed to evaluate the efficacy of transdiagnostic cognitive behavioral therapy (TCBT) on people with migraine (PwM). Method: This study was conducted on 40 PwM aged 20-50 years. We randomly assigned participants to two groups of intervention, receiving 10 sessions of TCBT, and control. Days with headache, headache severity, migraine-related disability and effects on daily life, number of pain-relivers taken for headache, depression, and anxiety were assessed pre-intervention, post-intervention (three-month follow-up), and one-month after TCBT termination (four-month follow-up).Results: Thirty-five participants suffering moderate to severe migraine completed the study (16 and 19 in TCBT and control groups, respectively). TCBT improved all measured items between study time-points (p<0.05) in the intervention group, while such an improvement was not observed in the control group. Between group comparisons revealed superiority of TCBT group compared to the control group in most measured items at three- and four-month follow-ups (p<0.05).Conclusion: Ten sessions of TCBT improved migraine severity, associated disability, anxiety, and depression in PwM, with persistent effects after one month of therapy termination. TCBT is an affordable, practical, and feasible intervention to be utilized for PwM.Protocol registration: The study protocol was registered in clinicaltrial.gov (NCT03701477) prior to enrollment.


CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Tamara McColl ◽  
Mathieu Gatien ◽  
Lisa Calder ◽  
Krishan Yadav ◽  
Ryan Tam ◽  
...  

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.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Salazar ◽  
V Vilchez-Barboza ◽  
K Saez ◽  
T Paravic

Abstract Objective To establish the effect after 24 months of a face-to-face and telephone nursing counseling intervention, aimed at controlling cardiovascular risk factors (hypertension, dyslipidemia and overweight) and improving health-related quality of life (HRQoL) in patients of the cardiovascular health program of family health centers of Concepciόn, Chile. Methods Randomized controlled clinical trial with a 24 months post-intervention follow-up. 120 patients with cardiovascular risk factors under the cardiovascular health program were recruited from 6 family health centers and randomized into a control group (60) and an intervention group (60). The intervention group received the regular care in addition to face-to-face and telephone nursing counseling. Baseline measurements were taken and also at the end of the intervention (7 months). Participants returned then after 12 and 24 months for follow-up evaluations. A total of 109 subjects completed the intervention at 7 months and 45 returned at 24 months. During follow-up evaluations both groups continued to receive regular care given in the health centers. The measurements consisted of HRQoL (physical and mental health), systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), abdominal circumference (AC), total cholesterol (TC), low density lipoproteins (LDL-Chol), high density lipoprotein (HDL-Chol), atherogenicity index (LDL/HDL), cardiovascular risk factor (TC/HDL), 10-year coronary risk. Ethical requirements were considered and statistical analysis was carried out using MANCOVA and d-Cohen repeated measurements. Results The analysis of the effects of the intervention in the 24-month follow-up showed that subjects in the intervention group only maintained significant improvement of AC over time (F=3.18; p=0.03), compared to the control group. Conclusion Although participants in the intervention group only maintained the AC improvement over time, this can be regarded as an indirect indicator of the presence of intra-abdominal fat that makes it possible to predict and classify the risk of cardiovascular disease. Long-term follow-up studies are required to investigate behaviors and mechanisms that contribute to maintaining improvements in this indicator. Additionally, future research should include reinforcement activities, either face-to-face or by telephone, to help maintain the positive results of interventions. Acknowledgement/Funding Universidad de Concepciόn 214.082.049-1.0


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S654-S654
Author(s):  
Matthew Moffa ◽  
Rawiya Elrufay ◽  
Thomas L Walsh ◽  
Dustin R Carr ◽  
Nathan Shively ◽  
...  

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.


2017 ◽  
Vol 52 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Christina Miele ◽  
Mary Taylor ◽  
Aditi Shah

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.


Neurology ◽  
2018 ◽  
Vol 91 (14) ◽  
pp. e1319-e1327 ◽  
Author(s):  
Jeannine Bergmann ◽  
Carmen Krewer ◽  
Klaus Jahn ◽  
Friedemann Müller

ObjectiveTo determine the effects of 2 weeks of intensive robot-assisted gait training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT).MethodsIn a single-blind, randomized, controlled trial with 2 parallel arms, we compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT (control group). Patients with subacute stroke who had pusher behavior according to the Scale for Contraversive Pushing (SCP) were included. The primary research questions were whether changes in pusher behavior would differ between groups post intervention, and at a follow-up 2 weeks afterward (SCP and Burke Lateropulsion Scale, Class II evidence). Secondary outcomes included the Performance-Oriented Mobility Assessment, the Functional Ambulation Classification, and the Subjective Visual Vertical.ResultsThirty-eight patients were randomized. Thereof, 30 patients received the allocated intervention and were included in the analyses. RAGT led to a larger reduction of pusher behavior than nR-PT at post test (SCP: U = 69.00, r = −0.33, p = 0.037; Burke Lateropulsion Scale: U = 47.500, r = −0.50, p = 0.003) and at follow-up (SCP: U = 54.00, r = −0.44, p = 0.008). Pusher behavior had ceased in 6 of 15 participants in the intervention group and 1 of 15 participants in the control group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, no longer exhibited the behavior.ConclusionsTwo weeks of RAGT seems to persistently reduce pusher behavior, possibly by recalibrating the disturbed inner reference of verticality. The potential benefits of RAGT on pusher behavior and verticality perception require further investigation.Trial registrationGerman Clinical Trials Register (registration number: DRKS00003444).Classification of evidenceThis study provides Class II evidence that RAGT is beneficial to reduce pusher behavior in patients with stroke.


2019 ◽  
Vol 8 (9) ◽  
pp. 1268 ◽  
Author(s):  
Zan Gao ◽  
Zachary C. Pope ◽  
Jung Eun Lee ◽  
Minghui Quan

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.


Sign in / Sign up

Export Citation Format

Share Document