scholarly journals Effect of Offering Pneumococcal Vaccines During Specialty Care on Vaccination Rates in Patients Receiving Immunosuppressive

2021 ◽  
Vol 5 (3) ◽  
pp. 250-264
Author(s):  
Joshua Lindsley ◽  
Nathaniel Webb ◽  
Ashleigh Workman ◽  
Thaddeus Miller ◽  
Erica Stockbridge ◽  
...  
Keyword(s):  
Immunization Coverage ◽  
Specialty Care ◽  
Significant Group ◽  
Hospital System ◽  
Care Clinic ◽  
Immunization Status ◽  
Immunosuppressive Medication ◽  
Initial Observation ◽  
Final Observation

Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit (aged 0-64 years [82.1%] ,aged ≥65 years [17.9%]; male [34.3%] female [65.6%%]). Of these, 146 [72.6%] were in the QI group and 55 [27.4%] in the comparison group. Our unadjusted analyses identified no significant group differences in immunization status at initial observation (p=0.329; Table 1). Of the 102 patients in the QI group with no pneumococcal immunizations at initial observation, 80.4% (95% CI: 71.4%, 87.1%) received at least one pneumonia vaccination by the final observation. For the 27 patients in the QI group with partial immunization at project initiation, 85.2% (95% CI: 65.9%, 94.5%) received at least one pneumonia vaccination. Overall, 81.4% (95% CI: 73.6, 87.3) of patients in the QI group without full immunization at initial observation received at least one vaccination by the final observation. Conclusion: These data demonstrate that immunization coverage in patients on immunosuppressive medications can be markedly improved by clinician recommendation with immediate availability of the pneumococcal vaccine during specialty care. Wider adoption of this model and its adaptation to other immunizations and settings is an important opportunity to reduce vaccine-preventable illness, including COVID-19, and improve population health.

scholarly journals A longitudinal study of immunization status and reasons for non-vaccination of children in OPD and pediatric ward of a teaching hospital

2020 ◽  
Vol 7 (9) ◽  
pp. 1853
Author(s):  
Mir Sumsam Ali Khurram ◽  
Khaja Amer Khan
Keyword(s):  
Sampling Method ◽  
Research Work ◽  
Immunization Coverage ◽  
Rural Children ◽  
Age Group ◽  
Medical Sciences ◽  
Vaccine Preventable Diseases ◽  
Immunization Status ◽  
Deccan College

Background: The present study was to find out the immunization status of children in the age group of 0-7 years from OPD and those admitted in hospital attached to Deccan College of Medical Sciences with respect to primary immunization (BCG,OPV/DPT 1, 2, 3, measles), 1st booster dosage of OPV, DPT and also primary doses of Hepatits-B vaccine and coverage of vitamin A with measles vaccine. The objectives of this research work were to study factors which influence the immunization status and to know reasons for partial and non-immunization and their follow up over 2 years. Also, to know proportion of vaccine preventable diseases in children under study group.Methods: An oral questionaire method was adopted for parent of children in the age group 0-7 years to assess their immunization status and social factors influencing immunization coverage. Systemic random sampling method was applied to select 200 chlildren i.e. every 5th child admitted in the age group of 0-7 years was taken for analysis.Results: The study showed that out of 200 children 115 were fully immunized, 78 were partially immunized and 7 were non- immunized, 66 children among male and 49 among females were fully immunized, & the study shows that males had better immunization than females.Conclusions: Out of total 200 cases 57.6% were fully immunized, 38 % were partially immunized while 3.5% were unimmunized. Immunization coverage was better in urban children than rural children.

CIScoSI Study [Children Immunization Status and cases of Systemic Illness]

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Infectious Diseases ◽  
East Asia ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Tertiary Care ◽  
Immunization Coverage ◽  
South East Asia ◽  
Immunization Status ◽  
Tertiary Care Hospitals ◽  
Total Coverage

To determine the immunization status of pediatric patients under age of 5 years visiting pediatric department of tertiary care hospitals in South East Asia. The aim of this study was to appreciate the awareness and implementation of vaccination in pediatric patients who came into pediatric outpatient Department with presenting complain other than routine vaccination. we can also know the count of patients who do not complete their vaccination after birth. we can differentiate between vaccinated and unvaccinated patients and incidence of severe disease in both groups. Immunization is a protective process which makes a person resistant to the harmful diseases prevailing in the community, typically by vaccine administration either orally or intravenously. It is proven for controlling and eliminating many threatening diseases from the community. WHO report that licensed vaccines are available for the prevention of many infectious diseases. After the implementation of effective immunization the rate of many infectious diseases have declined in many countries of the world. South-East Asia is far behind in the immunization coverage. An estimated total coverage is 56%-88% for a fully immunized child, which is variable between countries. Also the coverage is highest for BCG and lowest for Polio.

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

2021 ◽  
pp. 001857872110323
Author(s):  
Preeyaporn Sarangarm ◽  
Timothy A. Huerena ◽  
Tatsuya Norii ◽  
Carla J. Walraven
Keyword(s):  
Group A Streptococcus ◽  
Intervention Group ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Appropriate Prescribing ◽  
Icd 10 ◽  
Group A

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

scholarly journals A Pilot Feasibility Study of Interpersonal Psychotherapy for the Prevention of Excess Weight Gain Among Adolescent Military-dependent Girls

2020 ◽  
Author(s):  
Abigail E Pine ◽  
Natasha A Schvey ◽  
Lisa M Shank ◽  
Natasha L Burke ◽  
M K Higgins Neyland ◽  
...  
Keyword(s):  
Weight Gain ◽  
Treatment Acceptability ◽  
Outcome Data ◽  
Excess Weight ◽  
Group Differences ◽  
Military Dependents ◽  
Significant Group ◽  
Excess Weight Gain ◽  
Military Dependent

ABSTRACT Introduction Adolescent military-dependents face unique psychosocial stressors due to their parents’ careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. Materials and Methods Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher’s exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. Results Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. Conclusions For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.

Quantitative MR spectroscopic imaging in metachromatic leukodystrophy: value for prognosis and treatment

2017 ◽  
Vol 89 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Diane F van Rappard ◽  
Antoine Klauser ◽  
Marjan E Steenweg ◽  
Jaap Jan Boelens ◽  
Marianna Bugiani ◽  
...  
Keyword(s):  
Logistic Regression ◽  
White Matter ◽  
Metachromatic Leukodystrophy ◽  
Spectroscopic Imaging ◽  
Complete Separation ◽  
Significant Group ◽  
Good Outcome ◽  
Poor Outcome ◽  
Metabolite Concentrations

ObjectiveTo determine whether proton magnetic resonance spectroscopic imaging is useful in predicting clinical course of patients with metachromatic leukodystrophy (MLD), an inherited white matter disorder treatable with haematopoietic cell transplantation (HCT).Methods21 patients with juvenile or adult MLD (12 HCT-treated) were compared with 16 controls in the same age range. Clinical outcome was determined as good, moderate or poor. Metabolites were quantified in white matter, and significance of metabolite concentrations at baseline for outcome prediction was assessed using logistic regression analysis. Evolution of metabolic changes was assessed for patients with follow-up examinations.ResultsIn this retrospective study, 16 patients with baseline scans were included, 5 with good, 3 with moderate and 8 with poor outcome, and 16 controls. We observed significant group differences for all metabolite concentrations in white matter (p<0.001). Compared with controls, patients had decreased N-acetylaspartate and glutamate, and increased myo-inositol and lactate, most pronounced in patients with poor outcome (post hoc, all p<0.05). Logistic regression showed complete separation of data. Creatine could distinguish poor from moderate and good outcome, the sum of glutamate and glutamine could distinguish good from moderate and poor outcome, and N-acetylaspartate could distinguish all outcome groups. For 13 patients (8 with baseline scans), one or more follow-up examinations were evaluated, revealing stabilisation or even partial normalisation of metabolites in patients with moderate and good outcome, clearly visible in the ratio of choline/N-acetylaspartate.ConclusionIn MLD, quantitative spectroscopic imaging at baseline is predictive for outcome and aids in determining eligibility for HCT.

Improving specialty care follow-up after an ED visit using a unique referral system

2013 ◽  
Vol 31 (10) ◽  
pp. 1495-1500 ◽  
Author(s):  
Frank C. Messina ◽  
Michele A. McDaniel ◽  
Adam C. Trammel ◽  
Denise R. Ervin ◽  
Mary Ann Kozak ◽  
...  
Keyword(s):  
Specialty Care ◽  
Referral System

scholarly journals Longitudinal choriocapillaris changes in the presence of reticular pseudodrusen

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christoph R. Clemens ◽  
Jost L. Lauermann ◽  
Boris Schmitz ◽  
Nicole Eter ◽  
Florian Alten
Keyword(s):  
Signal Intensity ◽  
Multimodal Imaging ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Significant Group ◽  
Mean Intensity ◽  
Reticular Pseudodrusen ◽  
Time Interaction ◽  
Age Related

AbstractTo determine longitudinal changes in choriocapillaris (CC) measures in eyes with reticular pseudodrusen (RPD) using optical coherence tomography angiography (OCTA). In this observational prospective study, 20 patients with exclusively RPD and no other alteration due to age-related macular degeneration were included. Eight RPD patients were re-examined at 5-year follow-up. Multimodal imaging was performed at baseline and at 5-year follow-up. OCTA CC images were analyzed for number, size and total area of flow deficits (FD), mean signal intensity, signal intensity standard deviation and kurtosis of signal intensity distribution in the ring area between a circle of 4 mm diameter and a circle of 6 mm diameter and in the superior ring quadrant. Area affected by RPD increased from 19.36 ± 8.39 mm2 at baseline to 37.77 ± 9.03 mm2 at 5-year follow-up. At baseline, percent of CC FD area was greater in RPD eyes (quadrant: p < 0.001; ring: p < 0.001) compared to controls. Besides, RPD eyes revealed a lower mean intensity signal (quadrant: p < 0.001; ring: p < 0.001). Evaluation of CC parameters suggested significant group × time interaction effects for CC FD (p = 0.04) and mean intensity signal (p = 0.004), in that RPD eyes presented increased CC FD and decreased mean intensity signal at follow-up. OCTA CC decorrelation signal further decreases in RPD patients over 5 years in both RPD-affected and RPD-unaffected macular areas.

scholarly journals Connecting Medical Personnel to Dentists via Teledentistry in a Children's Hospital System: A Pilot Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Kimberly J. Hammersmith ◽  
Macaire C. Thiel ◽  
Matthew J. Messina ◽  
Paul S. Casamassimo ◽  
Janice A. Townsend
Keyword(s):  
New Technology ◽  
Primary Care Clinic ◽  
Dental Trauma ◽  
Medical Personnel ◽  
Urgent Care ◽  
Hospital System ◽  
Care Clinic ◽  
Children's Hospital ◽  
System A ◽  
Children’S Hospital

Investigators evaluated feasibility, acceptability, and sustainability of a teledentistry pilot program within a children's hospital network between March, 2018, and April, 2019. The program connected dentists to medical personnel and patients being treated in urgent care clinics, a primary care clinic, and a freestanding emergency department via synchronous video consultation. Three separate but parallel questionnaires evaluated caregiver, medical personnel, and dentist perspectives on the experience. Utilization of teledentistry was very low (2%, 14/826 opportunities), but attitudes regarding this service were largely positive among all groups involved and across all survey domains. Uptake of new technology has barriers but teledentistry may be an acceptable service, especially in the case of dental trauma.

Imaginal Retraining Reduces Craving for Tobacco in 1-Year Controlled Follow-Up Study

2021 ◽  
pp. 1-12
Author(s):  
Josefine Gehlenborg ◽  
Anja S. Göritz ◽  
Steffen Moritz ◽  
Thies Lüdtke ◽  
Simone Kühn
Keyword(s):  
Training Group ◽  
Well Being ◽  
Initial Study ◽  
Smoking Behaviour ◽  
Significant Group ◽  
Follow Up Study ◽  
Term Efficacy ◽  
Group Data

<b><i>Introduction:</i></b> Imaginal retraining is a self-help technique that adapts the principles of approach bias modification to the imagination. Imaginal retraining has been shown to reduce craving and addictive behaviours in 3 randomized controlled trials (RCTs) on problematic alcohol consumption, overweight, and tobacco use. To date, there have been no studies evaluating the long-term efficacy of the intervention. The aim of the present study was to generate first hypotheses on the long-term efficacy of imaginal retraining in smokers in a controlled 1-year follow-up study. <b><i>Materials and Methods:</i></b> We recontacted the 345 participants who had taken part in an RCT on imaginal retraining for smokers 1 year later. The survey was carried out online and assessed craving for tobacco (primary outcome), smoking behaviour, well-being, and subjective appraisal. Individuals who applied the technique at least once during the previous year were categorized as the training group, whereas participants who never performed the training were categorized as the no-training group. Data were analysed using linear mixed models (LMMs). The study was preregistered as DRKS00021044. <b><i>Results:</i></b> The completion rate was 45.5%. Less than 40% used the intervention at least once in the previous 12 months. LMM analyses showed a significant reduction in craving for tobacco for the training compared to the no-training group after 1 year. No significant group differences emerged in smoking behaviour, depressive symptoms, or quality of life. Subjective appraisal of the intervention was favorable, similar to the initial study. <b><i>Conclusion:</i></b> The present study provides preliminary support for the long-term efficacy of imaginal retraining on craving for tobacco but not on smoking behaviour, highlighting the importance of multimodal treatment concepts in smoking cessation that target a variety of maintaining factors. Future studies need to investigate the long-term efficacy of the intervention in prospective RCTs that test alternative ways of conveying the technique to improve adherence.

scholarly journals The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB–IIC Patients—Results After 3 Years

2019 ◽  
Vol 27 (5) ◽  
pp. 1407-1417 ◽  
Author(s):  
Eric A. Deckers ◽  
Josette E. H. M. Hoekstra-Weebers ◽  
Samantha Damude ◽  
Anne Brecht Francken ◽  
Sylvia ter Meulen ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Well Being ◽  
Significant Group ◽  
Event Scale ◽  
Free Survival ◽  
Stage Ib ◽  
Ajcc Stage ◽  
Patient Reported ◽  
Melanoma Patients

Abstract Background This study compares well-being, recurrences, and deaths of early-stage cutaneous melanoma patients in follow-up, as recommended in the Dutch guideline, with that of patients in a stage-adjusted reduced follow-up schedule, 3 years after diagnosis, as well as costs. Methods Overall, 180 eligible pathological American Joint Committee on Cancer (AJCC) stage IB–IIC, sentinel node staged, melanoma patients (response rate = 87%, 48% male, median age 57 years), randomized into a conventional (CSG, n = 93) or experimental (ESG, n = 87) follow-up schedule group, completed patient-reported outcome measures (PROMs) at diagnosis (T1): State-Trait Anxiety Inventory–State version (STAI-S), Cancer Worry Scale (CWS), Impact of Event Scale (IES), and RAND-36 (Mental and Physical Component scales [PCS/MCS]). Three years later (T3), 110 patients (CSG, n = 56; ESG, n = 54) completed PROMs, while 42 declined (23%). Results Repeated measures analyses of variance (ANOVAs) showed a significant group effect on the IES (p = 0.001) in favor of the ESG, and on the RAND-36 PCS (p = 0.02) favoring the CSG. Mean IES and CWS scores decreased significantly over time, while those on the RAND-36 MCS and PCS increased. Effect sizes were small. Twenty-five patients developed a recurrence or second primary melanoma, of whom 13 patients died within 3 years. Cox proportional hazards models showed no differences between groups in recurrence-free survival (hazard ratio [HR] 0.71 [0.32–1.58]; p = 0.400) and disease-free survival (HR 1.24 [0.42–3.71]; p = 0.690). Costs per patient after 3 years (computed for 77.3% of patients) were 39% lower in the ESG. Conclusion These results seemingly support the notion that a stage-adjusted reduced follow-up schedule forms an appropriate, safe, and cost-effective alternative for pathological AJCC stage IB–IIC melanoma patients to the follow-up regimen as advised in the current melanoma guideline.

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