The Second Heart Program—A multidisciplinary team supporting people who inject drugs with infective endocarditis: Protocol of a feasibility study

Introduction Infective endocarditis (IE) is a severe and highly prevalent infection among people who inject drugs (PWID). While short-term (30-day) outcomes are similar between PWID and non-PWID, the long-term outcomes among PWID after IE are poor, with 1-year mortality rates in excess of 25%. Novel clinical interventions are needed to address the unique needs of PWID with IE, including increasing access to substance use treatment and addressing structural barriers and social determinants of health. Methods and analysis PWID with IE will be connected to a multidisciplinary team that will transition with them from hospital to the community. The six components of the Second Heart Team are: (1) peer support worker with lived experience, (2) systems navigator, (3) addiction medicine physician, (4) primary care physician, (5) infectious diseases specialist, (6) cardiovascular surgeon. A convergent mixed-methods study design will be used to test the feasibility of this intervention. We will concurrently collect quantitative and qualitative data and ‘mix’ at the interpretation stage of the study to answer our research questions. Ethics and dissemination This study has been approved by the Hamilton Integrated Research Ethics Board (Project No. 7012). Results will be presented at national and international conferences and submitted for publication in a scientific journal. Clinical trail registrarion Trial registration number: ISRCTN14968657 https://www.isrctn.com/ISRCTN14968657.

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Evaluation of a Multidisciplinary Cachexia and Nutrition Support Service— The Patient and Carers Perspective

Journal of Patient Experience ◽

10.1177/2374373520981476 ◽

2021 ◽

Vol 8 ◽

pp. 237437352098147

Author(s):

Vanessa C Vaughan ◽

Meg Harrison ◽

Anna Dowd ◽

Peter Eastman ◽

Peter Martin

Keyword(s):

Multidisciplinary Team ◽

Cancer Cachexia ◽

Outpatient Service ◽

Support Service ◽

Nutrition Support ◽

Patient Centered ◽

Disease Information ◽

Medicine Physician ◽

Centered Care ◽

Risk Of Cancer

The Barwon Health Cachexia & Nutrition Support Service (CNSS) is an outpatient service focused on improving clinical outcomes and quality of life for patients with or at high risk of cancer cachexia. Patients see a multidisciplinary team, comprising a palliative medicine physician, physiotherapist, dietitian, and nurse practitioner. This study evaluated the service from patient and carer perspectives. In 2016/17, semistructured interviews were conducted with 12 patients and 9 carers attending the service, focusing on: (1) reflection on experience of the CNSS, and (2) describing how a cachexia-specific service can meet their needs and concerns. Analysis generated 4 superordinate themes: evolving perception of service value, empowerment through person-centered care, communication to patients and carers regarding health/disease information, and the importance of the multidisciplinary team-based approach. Generally, patients and carers reported overall positive experiences with the service, particularly with regard to improved communication and management of the patient. Findings confirmed the patient-centered and individualized approaches were particularly valued. These insights are a critical step in the development of recommendations for future clinical management of cancer cachexia.

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Streptococcus pyogenes Infective Endocarditis – Association with Injection Drug Use: Case Series and Review of the Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab240 ◽

2021 ◽

Author(s):

Melanie T Rebechi ◽

Emily L Heil ◽

Paul M Luethy ◽

Sarah A Schmalzle

Keyword(s):

Infective Endocarditis ◽

Streptococcus Pyogenes ◽

People Who Inject Drugs ◽

Local Population ◽

Case Series ◽

Duke Criteria ◽

Group A ◽

Polymicrobial Bacteremia ◽

Predominantly Female ◽

Living With Hiv

Abstract Background Streptococcus pyogenes, or Group A Strep (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution. Methods All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE. Literature on cases of GAS IE was reviewed. Results 18 cases of probable (11) or definite (7) GAS IE were identified; mean age was 38 years, and the population was predominantly female (56%) and Caucasian (67%), which is inconsistent with local population demographics. Sixteen cases were in people who inject drugs (PWID) (89%), 14 were also homeless, six were also living with HIV (33%), and two were also pregnant. Antibiotic regimens were variable due to polymicrobial bacteremia (39%). One patient underwent surgical valve replacement. Four patients (22%) died due to complications of infection. Literature review revealed 42 adult cases of GAS IE, only 17 of which were in PWID (24%). Conclusions The 16 cases of possible and definite GAS IE in PWID over a five-year period in a single institution reported nearly doubles the number of cases in PWID from all previous reports. This suggests a potential increase in GAS IE particularly in PWID and PLWH, which warrants further epidemiologic investigation.

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695. Infective endocarditis in people who inject drugs (PWID) at UK Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.887 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S399-S400

Author(s):

Evelyn Villacorta Cari ◽

John T Henderson ◽

Donna R Burgess ◽

J Zachary Porterfield ◽

Nicole Leedy ◽

...

Keyword(s):

Infective Endocarditis ◽

Tricuspid Valve ◽

Bacterial Infections ◽

Medical Center ◽

Cross Sectional Study ◽

Addiction Medicine ◽

University Of Kentucky ◽

Cross Sectional ◽

Health Crisis ◽

Gram Negative

Abstract Background The Intravenous Drug Use (IVDU) epidemic has been developing into a public health crisis in the last twenty years. As a result, the incidence of severe bacterial infections such as infective endocarditis (IE) has been rising dramatically. Methods Cross-sectional study, we reviewed records of all admissions to University of Kentucky hospitals with IVDU associated ICD9/10 codes who received an Infectious Diseases consult during 2018 and focused on the cases with a diagnosis of IE. We describe associated epidemiologic, clinical, and microbiological features Results We include 391 patients in this cohort, among those 157 patients were for IE. Patients had a median age of 34 years old (range: 20 - 62); 81 (51.5%) were female, and five (6.1%) were pregnant and 153 (97.4%) identified as white. A previous episode of infective endocarditis was reported in 55 (35%) cases. The most common illicit substances used were heroin 68 (43.3%) and methamphetamine 65 (41.45%). Tobacco abuse was reported in 134 (86.4%) cases. Fever reported in 93 (59.8%) cases, shortness of air in 43 (28.0%) cases, and chest pain in 44 (28.6%) cases were the most common symptoms. Hepatitis C antibody was positive in 115/149 (73.2%) and 3/143 (1.9%) were HIV positive. Right-sided IE was more frequent, the tricuspid valve was involved in 94 (59.8%) patients. Gram-positive pathogens were isolated in 139 (88.5%) patients, Staphylococcus aureus was isolated in 102 (64.9%) patients, of which 67 (65.7%) were methicillin resistant. Gram-negative pathogens were isolated in 18 (11.2%) patients. Eighty-eight (56.4%) patients had an addiction medicine consult during their admission, (22.9%) patients left against medical advice and 20 (12.7%) patients needed to be readmitted within 30 days after discharge. Overall mortality was 12.7% and was significantly associated with infection by gram-negative pathogens (RR: 2.5; CI 95% 1.05 – 6.25, p=0.037). Conclusion Infectious endocarditis is a frequent complication in PWID which carries a high risk of mortality and often involves the tricuspid valve. The most common pathogen isolated was S. aureus, isolation of gram-negative pathogens was associated with increased mortality. Disclosures All Authors: No reported disclosures

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A-13 Return-to-Learn: Academic Accommodations for Concussion Recovery

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.13 ◽

2020 ◽

Vol 35 (5) ◽

pp. 609-609

Author(s):

B Davis ◽

K Creed ◽

C Keshvnani ◽

D Blueitt ◽

C Garrison

Keyword(s):

Primary Care ◽

Sports Medicine ◽

Care Center ◽

Care Physician ◽

Cognitive Symptoms ◽

Academic Accommodations ◽

School Work ◽

Medicine Physician ◽

Return To Learn ◽

Concussion Recovery

Abstract Objective To evaluate academic accommodations offered to student athletes following a concussive injury. Method Participants were identified during regularly scheduled visits to the participating fellowship-trained, board-certified primary care sports medicine physician (D.B.). A total of 127 participants (mean ± SD age, 14.8 ± 1.5 years [range, 12–18 years]) diagnosed with a concussion from December 2018 to October 2019 were surveyed. The participants were provided a questionnaire in which the following information was collected: age at injury, date of injury, locations of treatment, cognitive symptoms experienced, academic accommodations received, implementation of accommodation by educators, and school related problems. Results Cognitive symptoms were reported by 117 (92.1%) participants with trouble concentrating (81.2%), and feeling “slow” (78.7%) being the most common. Participants treated at the participating, sports-medicine concussion center had the highest rate of receiving academic accommodations (95.3%), while those also treated at an emergency or acute care center, primary care physician, or pediatrician’s office had significantly lower rates (<5%). Participants reported their accommodations as helpful (94.5%), with extra time (88.2%), and ability to take breaks (80.3%) having the highest frequency of recommendation. While symptomatic, 110 (86.6%) participants reported having difficulty completing school work and tests, 58 (45.7%) reported experiencing anxiety about completing their school work, and 55 (43.3%) reported a decline in their grades. Conclusions These data display the high frequency of cognitive symptoms and hindered academic performance associated with concussion recovery. The implementation of academic accommodations was demonstrated to be beneficial; however, not all medical centers are providing accommodations.

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