scholarly journals Pharmacist-Driven Culture and Sexually Transmitted Infection Testing Follow-Up Program in the Emergency Department

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 72
Author(s):  
Stephanie C. Shealy ◽  
Christine Alexander ◽  
Tina Grof Hardison ◽  
Joseph Magagnoli ◽  
Julie Ann Justo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Rank Test ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Signed Rank ◽  
Outpatient Intervention ◽  
Signed Rank Test ◽  
The Impact

Expanding pharmacist-driven antimicrobial stewardship efforts in the emergency department (ED) can improve antibiotic management for both admitted and discharged patients. We piloted a pharmacist-driven culture and rapid diagnostic technology (RDT) follow-up program in patients discharged from the ED. This was a single-center, pre- and post-implementation, cohort study examining the impact of a pharmacist-driven culture/RDT follow-up program in the ED. Adult patients discharged from the ED with subsequent positive cultures and/or RDT during the pre- (21 August 2018–18 November 2018) and post-implementation (19 November 2018–15 February 2019) periods were screened for inclusion. The primary endpoints were time from ED discharge to culture/RDT review and completion of follow-up. Secondary endpoints included antimicrobial agent prescribed during outpatient follow-up, repeat ED encounters within 30 days, and hospital admissions within 30 days. Baseline characteristics were analyzed using descriptive statistics. Time-to-event data were analyzed using the Wilcoxon signed-rank test. One-hundred-and-twenty-seven patients were included, 64 in the pre-implementation group and 63 in the post-implementation group. There was a 36.3% reduction in the meantime to culture/RDT data review in the post-implementation group (75.2 h vs. 47.9 h, p < 0.001). There was a significant reduction in fluoroquinolone prescribing in the post-implementation group (18.1% vs. 5.4%, p = 0.036). The proportion of patients who had a repeat ED encounter or hospital admission within 30 days was not significantly different between the pre- and post-implementation groups (15.6 vs. 19.1%, p = 0.78 and 9.4% vs. 7.9%, p = 1.0, respectively). Introduction of a pharmacist culture and RDT follow-up program in the ED reduced time to data review, time to outpatient intervention and outpatient follow-up of fluoroquinolone prescribing.

scholarly journals Improving indicators of tuberculosis program cascades by leveraging HIV program strategies

2019 ◽  
Vol 9 (4) ◽  
pp. 191-195
Author(s):  
S. C. Meribe ◽  
E. Harausz ◽  
I. Lawal ◽  
A. Ogundeji ◽  
C. Mbanefo ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Rank Test ◽  
Military Hospitals ◽  
Us Army ◽  
Signed Rank ◽  
Before And After ◽  
Army Medical Research ◽  
Signed Rank Test ◽  
The Impact ◽  
Number Of Individuals

Background: To improve rates of human immunodeficiency virus (HIV) case detection and treatment, the Nigerian Ministry of Defense Health Implementation Program and the US Army Medical Research Directorate-Africa/Nigeria introduced a HIV standard of care (SOC) package. Given the integration of tuberculosis (TB) and HIV programs and evolving policies, we evaluated the impact of this strategy on TB program indicators.Methods: Routine, de-identified program data from 27 Nigerian military hospitals were analyzed. Using Wilcoxon signed-rank test, bivariate analyses were performed to compare data from 12 months before and after implementation of the SOC package.Results: Our data showed improvements post-implementation as follows: the number of individuals receiving antiretroviral therapy (ART) screened for TB increased from 14 530 to 29 467 (P < 0.001); the number of individuals with presumptive TB identified increased from 803 to 1800 (P < 0.001); the number of ART clients bacteriologically tested for TB increased from 746 to 1717 (P < 0.001); and the number of ART clients treated for TB increased from 152 to 282 (P < 0.001). Newly registered or relapsed TB cases increased from 436 to 906 (P < 0.001), the number of TB cases with known HIV status increased from 437 to 837 (P < 0.001), the number of TB-HIV co-infected cases increased from 182 to 301 (P = 0.006), and the number of TB-HIV co-infected clients who started ART increased from 101 to 176 (P = 0.003).Conclusion: The implementation of the updated HIV SOC package led to the improvement in key TB diagnosis and treatment indicators. When emulated, this could help improve the performance of other TB programs in countries other than Nigeria.

scholarly journals Objective Behavioral Measures in Children before, during, and after the COVID-19 Lockdown in Israel

2021 ◽  
Vol 18 (16) ◽  
pp. 8732
Author(s):  
Einat Shneor ◽  
Ravid Doron ◽  
Jonathan Levine ◽  
Deena Rachel Zimmerman ◽  
Julia S. Benoit ◽  
...  
Keyword(s):  
Physical Activity ◽  
Light Exposure ◽  
Vigorous Physical Activity ◽  
Rank Test ◽  
Long Term Effects ◽  
Wake Time ◽  
Signed Rank ◽  
Social Restriction ◽  
Signed Rank Test ◽  
The Impact

Studies using questionnaires report that COVID-19 restrictions resulted in children spending significantly less time outdoors. This study used objective measures to assess the impact of pandemic-related restrictions on children’s behavior. A total of 19 healthy 8–12-year-old boys were observed before and during social restriction periods. Of these, 11 boys were reassessed after restrictions were lifted. For each session, Actiwatches were dispensed for measures of time outdoors, activity, and sleep. Changes overall and by school status were assessed using signed-rank test and Wilcoxon rank sum tests. During restrictions, children spent significantly less time outdoors (p = 0.001), were less active (p = 0.001), and spent less time engaged in moderate-to-vigorous physical activity (p = 0.004). Sleep duration was not significantly different between sessions (p > 0.99), but bedtime and wake time shifted to a later time during restrictions (p < 0.05 for both). Time outdoors and activity returned close to pre-pandemic levels after restrictions were lifted (p > 0.05 for both). Children’s behaviors significantly changed during the COVID-19 pandemic. The reduction in outdoor light exposure is of importance due to the role of light in the etiology of myopia and vitamin D production. The reduction in physical activity may have negative health effects in terms of obesity and depression, although further research is required to ascertain the long-term effects.

scholarly journals Clinical and doppler monitoring of patients with Takayasu arteritis with ITAS 2010 and CDUS-K score respectively following medical intervention: a 12 months follow-up study

2018 ◽  
Vol 6 (11) ◽  
pp. 3602
Author(s):  
Debanjali Sinha ◽  
Sumantro Mondal ◽  
Arijit Nag ◽  
Debasish Lahiri ◽  
Alakendu Ghosh
Keyword(s):  
Disease Activity ◽  
Disease Progression ◽  
Takayasu Arteritis ◽  
Medical Intervention ◽  
Matched Pair ◽  
Rank Test ◽  
Colour Doppler ◽  
Signed Rank ◽  
Signed Rank Test

Background: The objective of the present study was to monitor the disease activity of Takayasu arteritis clinically by the Indian Takayasu Activity Score 2010 (ITAS) and ultra sonographically by Colour Doppler Ultrasound-Kolkata (CDUS-K) Score after 12months of treatment with methotrexate and steroid, and to find the correlation between these two scores.Methods: Around 25 Angiographically proven Takayasu arteritis patients were treated with Methotrexate (15mg weekly) and Steroids (1mg/kg/day for 6weeks and then tapered) for 12months. Wilcoxon matched pair signed rank test was done to assess the change in ITAS 2010 with treatment. A correlation study was done between ITAS 2010 and change in CDUS-K scores at the end of 12months.Results: By Wilcoxon’s matched pair signed rank test, a non-significant change of ITAS 2010 (p=0.066) was observed at the end of 12months, which means that the treatment helps to control the disease progression by preventing a significant increase in ITAS 2010. Strong correlation (correlation coefficient of 0.878, 95% CI = 0.602 to 1.000) was found between the ITAS 2010 and change in CDUS-K scores at 12months follow up.Conclusions: The combination of Methotrexate and steroids helps to control the disease progression in Takayasu arteritis. Colour doppler ultrasonography may serve as a reliable and safe surrogate disease activity measure at follow up, as it avoids the radioactivity exposure and invasiveness of angiography.

scholarly journals Assessing a Novel Method to Reduce Anesthesia Machine Contamination: A Prospective, Observational Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Chuck J. Biddle ◽  
Beverly George-Gay ◽  
Praveen Prasanna ◽  
Emily M. Hill ◽  
Thomas C. Davis ◽  
...  
Keyword(s):  
Low Cost ◽  
Bacterial Species ◽  
Intervention Group ◽  
Anesthesia Machine ◽  
Rank Test ◽  
Anesthetic Care ◽  
Signed Rank ◽  
Signed Rank Test ◽  
Anesthesia Machines ◽  
The Impact

Background. Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. Methods. In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect “hot spots” were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student’s t-tests. Results. There was a statistically significant reduction in CFU density and diversity when the AMW was employed. Conclusion. The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.

scholarly journals The Effect of Courageous Learning on the Clinical Practice Ability of Midwifery Students During the Covid-19 Pandemic

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Dewi Nurlaela Sari
Keyword(s):  
Online Learning ◽  
Clinical Practice ◽  
Clinical Skills ◽  
Health Sector ◽  
Rank Test ◽  
P Value ◽  
Normality Test ◽  
Signed Rank ◽  
Signed Rank Test ◽  
The Impact

Online learning is one of the learning efforts developed during the COVID-19 pandemic. Online learning is felt to be effectiveat all levels of education. However, this is not the case with vocational education, especially in the health sector. Onlinelearning can also have an impact on the competencies that students must achieve because there is no direct interactionbetween students, lecturers, props/phantoms and place settings that can support the implementation of clinical skills. Thepurpose of this study was to determine the effect of online learning on the Practice Ability of Midwifery Students during theCovid-19 Pandemic . The type of research method used is pre eksperimental . Sampling was done by using purposivesampling totaling 30 respondents . The instrument used to measure students ' clinical practice skills is a checklist forchildbirth assistance, the statistical test carried out is through the normality test stages using Shapiro Wilk with the resultsof the data not being normally distributed so that an analysis test is carried out using the Wilcoxon Signed Rank Test. Theresults of the study obtained a p-value of 0.000 < from the alpha value (0.05). It can be concluded that there is asignificant influence between students ' ability to perform midwifery care related to the impact of online learning duringmidwifery clinical practice . It is hoped that the results of this study can be used as the basis for policies regarding thedevelopment of online learning methods that can support the achievement of competencies, especially clinical skills.

scholarly journals Change in cigarette dependence among a cohort of smokers following COVID-19 diagnosis in Kashmir valley: An observational follow-up study

2021 ◽  
Vol 12 (11) ◽  
pp. 22-28
Author(s):  
Asif Jeelani ◽  
Shafat Sideeq Lone ◽  
Hilal Rather
Keyword(s):  
Univariate Analysis ◽  
Supplemental Oxygen ◽  
Rank Test ◽  
Newly Diagnosed ◽  
Health Providers ◽  
Signed Rank ◽  
Signed Rank Test ◽  
Older Subjects ◽  
Cigarette Dependence

Background: COVID-19 diagnosis should serve as an impetus for smokers to discontinue its use. The study was conducted to estimate the change in cigarette dependence among newly diagnosed COVID-19 cases. Aims and Objectives: COVID-19 diagnosis should serve as an impetus for smokers to discontinue its use. The study was conducted to estimate change in cigarette dependence among newly diagnosed COVID-19 cases. Materials and Methods: Study was conducted between October and December 2020 and newly diagnosed male COVID-19 patients who were current smokers at diagnosis were recruited from two hospitals involved in testing and treatment of COVID-19. Baseline socioclinical information was recorded at diagnosis in addition to the estimation of cigarette dependence using Fagerstrom Test for Nicotine Dependence (FTND) and health status using Post-COVID-19 Functional Scale (PCFS). Follow-up was done at 2 weeks after recovery using both FTND and PCFS scales. Wilcoxon signed-rank test, paired t-test, and ANOVA were used for univariate analysis and multivariate regression was done. Results: A total of 171 subjects with mean age of 43.79 years were included in the study. FTND scores decreased significantly from the day of diagnosis to follow-up visit with 79% of subjects reporting a decrease. On univariate analysis, decrease in FTND had a significant association with presence of comorbidity, any symptoms, presence of respiratory symptoms, and if supplemental oxygen was administered. On multivariate analysis, symptomatic COVID-19 disease, higher age, PCFS at baseline, and PCFS at follow-up had a significant association with decreased PCFS values at follow-up. Conclusion: COVID-19 diagnosis was followed by significant decrease in FTND score, particularly for symptomatic and older subjects. Post-COVID follow-up visits should be used asan opportunity by health providers to ensure its sustainability and for achieving cessation.

scholarly journals The effectiveness of the Montessori training programme for mothers

2020 ◽  
Vol 10 (4) ◽  
pp. 166-156
Author(s):  
Fatma Ülkü Yıldız ◽  
Aysel Cagdas ◽  
Gokhan Kayili
Keyword(s):  
Daily Living ◽  
Training Programme ◽  
Daily Living Skills ◽  
Rank Test ◽  
Montessori Education ◽  
School Year ◽  
Signed Rank ◽  
Signed Rank Test ◽  
Living Skills

It was the aim of this study to follow-up for 2 years the mathematics and daily living skills of children whose mothers participated in the Montessori training programme for mothers (MTPM) and to determine whether the children still maintained these skills 2 years after the intervention. In 2016–2017, the MTPM was administered to the mothers of 4–5-year-old children who received Montessori education at preschool. The first follow-up was carried out 6 months after the training programme was completed; the second follow-up took place 6 months after the first follow-up and the third one was carried out12 months after the second follow-up. Eleven children included in the study group in the 2016–2017 school year were all reached. ‘Basic School Skills Inventory 3 – Mathematics and Daily Living Skills subtests – Age 4–8 years’ were used for data collection. The data were provided by the teachers. Statistical analysis of the data was carried out using Wilcoxon’s signed-rank test and Statistical Package for the Social Sciences 20.0 data analysis package programme. The results showed that the MTPM maintained its effect on mathematics and daily living skills of the experimental group children 24 months after the implementation of the programme.   Keywords: Montessori training programme for mothers, mathematics, daily living skills.

scholarly journals Efficacy of Microneedling with Dermaroller Alternating with CROSS Peeling with 30% TCA in Management of Acne Induced Scarring

2019 ◽  
Vol 7 (4) ◽  
pp. 299-303
Author(s):  
Nadia Waqas ◽  
Muhammad Amer Saleem
Keyword(s):  
Rank Test ◽  
Acne Scar ◽  
Signed Rank ◽  
Wilcoxon Signed Rank Test ◽  
Signed Rank Test ◽  
Acne Scarring ◽  
Grade Ii ◽  
Skin Scar ◽  
Grade Iii

Objective: To study the effect of combination of two therapies i.e. Microneedling with Dermaroller alternating with Chemical Reconstruction Skin Scar (CROSS) peeling with 30% TCA in management of acne induced scarring.Patients and Methods: This experimental study was conducted in the department of Dermatology, Benazir Bhutto Hospital, Rawalpindi from March 2017 to December 2017. A total of 20 patients underwent microneedling with dermaroller at week=0 (baseline) and were subjected to CROSS peeling with 30% TCA on follow up after 2 weeks. Four sessions of each procedure were repeated at 2 weeks’ interval. Photographs were taken at baseline and 4 weeks after the end of therapy (week=18). The baseline and final photographs were assessed for acne scar grading as per Goodman and Baron qualitative scale by two dermatologists who were blinded to the whole study.Results: Out of 20 patients, 16 (80%) of the patients had grade IV acne scarring and 4 (20%) had grade III scarring at baseline (week=0). On assessment at 4 weeks after the end of therapy (week=18), 16 patients who were having grade IV acne 6 (37.5%) improved to grade III, and 10 (62.5%) improved to grade II. Out of 4 patients who were initially having grade III at week=0, all 4 (100%) improved to grade II by week=18. A Wilcoxon signed rank test showed highly significant improvement in the grading of scarring (z=-3.92, p=0.00008).Conclusion: The combination therapy of microneedling with dermaroller, alternating with CROSS peeling with 30% TCA was highly effective in treating all types of atrophic acne scarring.

scholarly journals Follow-up study on serum cholesterol profiles in recovered COVID-19 patients

2020 ◽  
Author(s):  
Wenbin Tan ◽  
Guiling Li ◽  
Li Du ◽  
Xiuqi Wei ◽  
Xiaoling Cao ◽  
...  
Keyword(s):  
White Blood Cells ◽  
Recovery Process ◽  
Serum Levels ◽  
Rank Test ◽  
Reactive Protein ◽  
Follow Up Study ◽  
Laboratory Values ◽  
Signed Rank ◽  
Signed Rank Test

Abstract Background: COVID-19 patients develop hypolipidemia. However, it is unknown whether lipid levels have improved in recovered patients.Objective: In this follow-up study, we evaluated serum lipidemia and other physiopathological laboratory values in recovered patients.Methods: A 3–6 month follow-up study was performed between June 15 and September 3, 2020, to examine serum levels of laboratory values in 107 discharged COVID-19 patients (mild = 59; severe/critical = 48; diagnoses on admission). 61 patients had a revisit chest CT scan. A Wilcoxon signed-rank test was used to analyze changes in laboratory values at admission and follow-up.Results: LDL-c and HDL-c levels were significantly higher at follow-up than at admission in severe/critical cases (p < 0.05). LDL-c levels were significantly higher at follow-up than at admission in mild cases (p < 0.05). With adjustment of the factor of traditional Chinese medicine, LDL-c and HDL-c levels were significantly improved at follow-up than at admission in severe/critical cases (p < 0.05). Coagulation and liver laboratory values were significantly lower at follow-up than at admission for patients (p < 0.05). Increases in HDL-c significantly correlated with increases in numbers of white blood cells (p<0.001) and decreases in levels of C-reactive protein (p < 0.05) during patients’ recovery. Residue lesions were observed in CT images in 69% (42 of 61) of follow-up patients.Conclusions: Improvements of LDL-c, HDL-c and incomplete absorption of lung lesions were observed at 3–6 month follow-up for recovered patients, indicating that a long-term recovery process could be required.

Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department

2019 ◽  
Vol 31 (2) ◽  
pp. 166-173
Author(s):  
Eleanor P Bergquist ◽  
Anne Trolard ◽  
Anne S Kuhlmann ◽  
Travis Loux ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Pregnant Women ◽  
Retrospective Cohort ◽  
Multiple Logistic Regression ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Appropriate Care ◽  
Appropriate Treatment

The objective of this study is to evaluate whether pregnant women receive appropriate treatment, undertreatment, or overtreatment in the emergency department (ED) when they are tested for chlamydia and gonorrhea as compared to non-pregnant women. In a retrospective cohort study, we analyzed visits made to an urban ED from 1 July 2012 to 30 June 2014, with testing for chlamydia and gonorrhea (n = 3908). Using multiple logistic regression, we compared undertreatment and overtreatment in women controlling for pregnancy, age, race, and sexually transmitted infection International Statistical Classifications of Diseases (ICD)-9 coded diagnosis. Pregnant women were significantly more likely to be undertreated when positive for infection as compared to non-pregnant women (OR 2.94; 95% CI, 1.47–5.95) and significantly less likely to be overtreated when negative for infection (OR 0.40; 95% CI, 0.31–0.53) as compared to non-pregnant women. Pregnant women may not be receiving appropriate treatment when they present to the ED with chlamydia or gonorrhea. Attention should be paid to this group when administering chlamydia and gonorrhea treatment to ensure appropriate care and follow-up.

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