Chapter 3. Data and Figures from a Seven Years Implementation Period

Objectives: Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. Methods: An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. Results: Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. Conclusion: A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.

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1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1492 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S667-S668

Author(s):

Ann-Marie Idusuyi ◽

Maureen Campion ◽

Kathleen Belusko

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Area Under The Curve ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Total Daily Dose ◽

Therapeutic Goals ◽

Academic Medical ◽

Progress Notes ◽

Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

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Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Journal of General Internal Medicine ◽

10.1007/s11606-020-06543-1 ◽

2021 ◽

Author(s):

Sachin R. Pendharkar ◽

Evan Minty ◽

Caley B. Shukalek ◽

Brendan Kerr ◽

Paul MacMullan ◽

...

Keyword(s):

Health System ◽

Acute Care ◽

Care Physician ◽

System Capacity ◽

Medical Emergency ◽

Physician Workforce ◽

Future Health ◽

Academic Health ◽

Response Planning ◽

Implementation Period

Abstract Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

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Albanian National Action Plan for Roma Inclusion 2016–2020: A Study on the Program Achievements at the Halfway Mark

SAGE Open ◽

10.1177/21582440211036107 ◽

2021 ◽

Vol 11 (3) ◽

pp. 215824402110361

Author(s):

Gentian Qejvanaj

Keyword(s):

Action Plan ◽

Communist Regime ◽

Background Information ◽

Structured Interviews ◽

National Action Plan ◽

Current State ◽

The Us ◽

Implementation Period ◽

Education And Employment

Roma segregation in Albania has been causing growing concern since the fall of the communist regime. In this study, we analyze the effectiveness of the Albanian national action plan for Roma inclusion 2016–2020, in 2018, halfway in its implementation period. We gathered data on education and employment from the pre-implementation period (2015) and compared it with the latest available data in 2018. Interviews with local experts and surveys by the Balkan Barometer will provide background information to assess the current state of Roma integration in Albania. Moreover, descriptive statistics from national and international institutions and structured interviews will draw an independent narrative of Roma affairs. In our conclusion, we suggest moving beyond the “us and them” approach with programs run on inertia; our findings highlight that although encouraging achievements have been reached under the 2016–2020 action plan, real inclusion is still far, as statistical achievements do not say much about the quality of the education or job training provided under the 2016–2020 action plan.

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Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

Antibiotics ◽

10.3390/antibiotics10050470 ◽

2021 ◽

Vol 10 (5) ◽

pp. 470

Author(s):

Dipu T. Sathyapalan ◽

Jini James ◽

Sangita Sudhir ◽

Vrinda Nampoothiri ◽

Praveena N. Bhaskaran ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Care ◽

Successful Implementation ◽

Loading Dose ◽

Antimicrobial Stewardship Program ◽

Entire Study ◽

Stewardship Program ◽

South Indian ◽

Implementation Period ◽

The Right

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

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Achievement of Students With IEPs and Associated Relationships With an Inclusive MTSS Framework

The Journal of Special Education ◽

10.1177/0022466919897408 ◽

2020 ◽

Vol 54 (3) ◽

pp. 157-168

Author(s):

Jeong Hoon Choi ◽

Amy B. McCart ◽

Wayne Sailor

Keyword(s):

Reading Performance ◽

State Assessment ◽

Reading Scores ◽

Individualized Education Programs ◽

Assessment Scores ◽

Math Scores ◽

Inclusive School ◽

Implementation Period ◽

Reform Model ◽

Fidelity Implementation

The present study investigated the effectiveness of an equity-based inclusive school reform model nested within a multitiered system of support (MTSS) framework on the improvement of math and reading performance of students with Individualized Education Programs (IEPs). Descriptive statistics revealed that math state assessment scores of students with IEPs increased over the implementation period. Results of multilevel modeling demonstrated that the model’s fidelity of implementation scores positively and significantly predicted state assessment math scores. A further analysis examining the effectiveness of the model in three schools that implemented with adequate fidelity compared with nonimplementing schools indicated students with IEPs in implementing schools increased their math scores at a greater rate than their peers in comparison schools; however, effects on reading scores were equivocal. Findings are discussed in the context of inclusion and efforts to support high fidelity implementation of MTSS.

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The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1723037 ◽

2021 ◽

Author(s):

Lise D. Cloedt ◽

Kenza Benbouzid ◽

Annie Lavoie ◽

Marie-Élaine Metras ◽

Marie-Christine Lavoie ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Post Intervention ◽

Number Of Patients ◽

Implementation Period ◽

Short And Long Term ◽

The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

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Results of the project «Optimization of the process of obtaining the service OCT “ (project implementation period 20.06.2019–08.10.2019)

Medsestra (Nurse) ◽

10.33920/med-05-2109-03 ◽

2021 ◽

pp. 29-37

Author(s):

Irina Aleksandrovna Rakitina ◽

Alfiya Gumyarovna Iskhakova ◽

Evgeny Andreevich Zamytsky ◽

Marina Vladimirovna Makolina ◽

Farida Sagitovna Goleeva ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Anterior Segment ◽

Contact Method ◽

Optical Coherence ◽

Non Invasive ◽

Risk Of Injury ◽

Eye Tissues ◽

Implementation Period ◽

Project Optimization ◽

Theoretical Foundations

Optical Coherence Tomography (OCT) is a modern, highly accurate, non-invasive study of various eye structures. OCT is a non-contact method that allows a specialist to visualize eye tissue with a very high resolution (1–15 microns), the accuracy of which is comparable to microscopic examination. The theoretical foundations of the OCT method were developed in 1995 by the American ophthalmologist K. Pulafito, and already in 1996–1997 Carl Zeiss Meditec introduced the first device for optical coherence tomography into clinical practice. Today, OCT devices are used to diagnose various diseases of the fundus and anterior segment of the eye. Due to the maximum accuracy, the method of light scanning greatly simplifies the diagnosis of pathologies of the organs of vision, regardless of the cause of their occurrence and the stage of the course. In terms of information content, the technique is not inferior to histology, but the advantage of OCT is the absence of the risk of injury to the eye tissues [1, 2].

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ON THE WAY TO AN INNOVATIVE ECONOMY: PROSPECTS AND CHALLENGES

The economy of the North-West: problems and prospects of development ◽

10.52897/2411-4588-2021-2-35-50 ◽

2021 ◽

Vol 2 (65) ◽

pp. 35-50

Author(s):

Anatoly I. Kotov ◽

Keyword(s):

Economic Development ◽

Innovation Policy ◽

Innovation Activity ◽

Special Role ◽

Innovative Development ◽

The Past ◽

Implementation Period ◽

The Russian Federation ◽

Innovative Economy

Recognizing the special role of innovations in ensuring the economic development of Russia, the state authorities have been intensively looking for ways and means to strengthen innovation activity in Russia over the past decade. The main document proclaiming the goals and main directions of innovation policy is the Strategy of innovative development of the Russian Federation for the period up to 2020. Due to the fact that the implementation period has expired, the author analyzes the achievement of the goals and indicators defined in the strategy, and also draws some conclusions about the outcomes obtained by the analysis of the development of innovation activity in Russia.

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Abstract TP292: Effect of Improved Management Strategies on Study Retention Rates

Stroke ◽

10.1161/str.51.suppl_1.tp292 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael Dela Cruz ◽

Kinga Aitken ◽

Ka-Ho Wong ◽

Theodore Rock ◽

Jennifer J Majersik

Keyword(s):

Clinical Research ◽

Research Team ◽

Retention Rate ◽

Management Strategies ◽

Retention Rates ◽

Stroke Patients ◽

Trial Duration ◽

Implementation Period ◽

Stroke Center ◽

Stroke Trial

Introduction: Average national dropout rates of participants enrolled in a research trial are reported to be 30%. Factors contributing to loss of stroke patient retention include the lack of understanding of study expectations, lack of relationship building between patient and clinical research team, and inefficient management processes. There has been little research into interventions to improve retention. Focusing on these 3 factors may increase the likelihood of stroke patients adhering to and completing participation in stroke trials. The University of Utah Stroke Center became a StrokeNet regional coordinating center in October 2013. As study trials increased, we recognized the need to implement new trial management strategies and did so in January 2016. Methods: Stroke trial metrics were compared between the pre-implementation period (7/1/2012 - 12/31/2015) and a post-implementation period (1/7/2016 - 7/1/2019). The size of clinical research team personnel remained the same across the two periods: 4 coordinators and 9 physicians. Standardization of enrollment processes in stroke trials occurred during the post-implementation period. Three key aspects addressed in the post-implementation period were building rapport, setting realistic expectations, and properly educating patient and family members. The clinical research team incorporated these factors when approaching patients regardless of type of stroke trial (acute, subacute, or observational). Results: During the pre-implementation period, the Stroke Center research team managed 8 stroke studies with 52 patients consented with average trial duration of 23 months (SD); in the post-implementation period, there were 15 studies with 99 patients consented, with average trial duration of 22 months (SD). Retention improved after the intervention from a mean (SD) retention rate of 79.5 (29.7) %. to 90.8 (17.2) %. Although this difference was not significant, it represented meaningful change to the research staff and helped us achieve StrokeNet retention goals. Conclusion: Implementation of effective management strategies leads to higher retention rates of stroke patients despite no change in the size of the clinical research team.

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