scholarly journals Evaluating the Incidence of Sepsis Post–Central Catheter Removal When Using Prophylactic Vancomycin in the Neonatal Intensive Care Unit

2021 ◽  
Vol 26 (7) ◽  
pp. 728-733
Author(s):  
Van L. Tran ◽  
Joy Greenberg ◽  
Andrew Nuibe
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Venous Catheter ◽  
Clinical Sepsis ◽  
Suspected Infection ◽  
Patient Demographics ◽  
Secondary Outcomes ◽  
Time To Onset

OBJECTIVE With no consensus, the practice of using prophylactic antibiotics prior to central venous catheter (CVC) removal in NICU patients remains controversial. The objective of this study was to compare the incidence of sepsis post–CVC removal in those who received a dose of vancomycin prophylactically with those who did not. METHODS This single-center, retrospective chart review included NICU patients who had CVCs removed. Patients were excluded if they had a confirmed or suspected infection at the time of CVC removal or if the indwelling CVC was removed prior to 30 days from insertion. Primary outcome was the occurrence of a sepsis evaluation within 72 hours from CVC removal. Secondary outcomes included the development of acute kidney injury, source and identification of positive cultures, time to onset of suspected or confirmed sepsis, and the appropriate administration of intravenous vancomycin. RESULTS Eighty-two CVC removals received prophylactic vancomycin (P-VAN), and 22 CVCs did not receive prophylactic vancomycin (NP-VAN) prior to CVC removal. There were no significant differences in patient demographics between groups and median duration of indwelling CVC. Two clinical sepsis evaluations occurred in the P-VAN group compared with none in the NP-VAN group. Of all the P-VAN CVC removals, 45 (55%) received vancomycin appropriately. There were no statistical differences in all evaluated secondary outcomes. CONCLUSIONS Vancomycin administered prophylactically prior to CVC removal did not reduce the number of subsequent clinical sepsis evaluations or infections in NICU patients.

Late-onset pubic-phallic idiopathic edema in premature recovering infants

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Late Onset ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Genital Area ◽  
Level 3 ◽  
Prolonged Observation ◽  
Idiopathic Edema

AbstractObjectiveSeveral cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.Study designA retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.ResultsA total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].ConclusionsTo our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids

2021 ◽  
Vol 17 (6) ◽  
pp. 445-453
Author(s):  
Angelina Vascimini, PharmD ◽  
Kevin Duane, PharmD ◽  
Stacey Curtis, PharmD
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Community Pharmacists ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Improvement Project ◽  
System Intervention ◽  
Secondary Outcomes ◽  
Pharmacy Setting

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

scholarly journals 2294. Comparative Evaluation of Ertapenem and Clindamycin Plus Gentamicin for the Treatment of Postpartum Endometritis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S786-S786
Author(s):  
Krislyn Schweiger ◽  
Henry Donaghy ◽  
Natalie Meirowitz ◽  
Seunjun Ahn ◽  
Thien-Ly Doan
Keyword(s):  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Quality Analysis ◽  
Nursing Workload ◽  
Attractive Alternative ◽  
Antimicrobial Use ◽  
Wound Infections ◽  
Once Daily ◽  
Efficacy Parameters

Abstract Background Clindamycin plus gentamicin (C/G) is the most commonly used regimen for the treatment of postpartum endometritis. With a similar spectrum of coverage and once daily dosing, ertapenem is an attractive alternative. The purpose of this study was to evaluate the efficacy of ertapenem compared with C/G, for the treatment of postpartum endometritis. Methods This was a retrospective chart review (IRB-approved) of patients treated with either ertapenem or C/G for endometritis, from July 2017 to July 2018. Patients receiving agents from both groups were excluded. Data collected included: demographics, ante- and intrapartum course, including efficacy parameters and antimicrobial use. Secondary objectives included a safety outcomes and patient quality analysis. Appropriate statistical analysis was performed. Results A total of 81 patients were included (40 in C/G arm, 41 in ertapenem arm). No differences in mean length of stay (5.98 vs. 5.61 days in C/G and ertapenem, P = 0.61), readmission within 14 days, or mortality were seen. No patients developed acute kidney injury, C. difficile infection, or ototoxicity. All patients in the ertapenem arm had appropriate dosing, compared with 27.5% in C/G arm (P < 0.0001). Inappropriate dosing in 79% of C/G group was attributed to under-dosing of gentamicin. For quality measures, patients in C/G arm had more nighttime interruptions (3 vs. 1 interruptions per patient). 46% of patient in the ertapenem group had no overnight interruptions compared with 0% in C/G group. There were 2 suspected wound infections in the C/G group, but none in ertapenem group. Conclusion No difference in efficacy was seen between ertapenem and C/G for treatment of postpartum endometritis Ertapenem was associated with less inappropriate dosing and fewer nighttime interruptions Improvement in patient experience and reduction of nursing workload may outweigh the small additional cost of ertapenem. Disclosures All authors: No reported disclosures.

Surgical treatment for intramedullary spinal cord melanocytomas

2008 ◽  
Vol 9 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Eric M. Horn ◽  
Peter Nakaji ◽  
Stephen W. Coons ◽  
Curtis A. Dickman
Keyword(s):  
Spinal Cord ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Complete Resection ◽  
Intramedullary Spinal Cord ◽  
Local Infiltration ◽  
Patients Âgés ◽  
Patient Demographics

Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1–3, T9–10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Use of Pamidronate for Hypercalcemia of Malignancy in Renal Dysfunction

2019 ◽  
pp. 089719001988316 ◽  
Author(s):  
Sarah J. Norman ◽  
David J. Reeves ◽  
Lindsay M. Saum
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Limited Impact ◽  
Hypercalcemia Of Malignancy ◽  
Baseline Renal Function ◽  
Community Teaching

Background: Few studies have been conducted investigating the use of bisphosphonates in hypercalcemia of malignancy (HCM) in the setting of renal dysfunction. Objective: The primary objective was to compare the incidence of acute kidney injury (AKI) within 7 days of receiving pamidronate for the treatment of HCM with pre-existing renal dysfunction versus normal renal function at the time of pamidronate administration. The secondary objectives explored the effects of pamidronate doses and infusion rates on the safety and efficacy in those with pre-existing renal dysfunction for the treatment of HCM. Methods: A retrospective chart review was conducted on patients who received pamidronate for the treatment of HCM at a community teaching hospital in Indianapolis, Indiana, from January 1, 2013, to May 31, 2017. Results: A total of 141 pamidronate administrations were included (116 patients had normal baseline renal function, and 25 patients had pre-existing renal dysfunction before pamidronate administration for the treatment of HCM). Two (8%) patients developed AKI in the pre-existing renal dysfunction group, compared with 4 (3.4%) patients in those without pre-existing renal dysfunction ( P = .288). For those with pre-existing renal dysfunction, the incidence of AKI did not differ based on the dosage of pamidronate given ( P = .762) or infusion rates ( P = .373). Conclusion: Pamidronate appears to have limited impact on renal function at doses up to 90 mg in the setting of pre-existing renal dysfunction for the treatment of HCM.

A real-world comparison of efficacy and toxicity of FOLFIRINOX and gemcitabine to nab-paclitaxel in treatment of advanced stage pancreatic cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16728-e16728
Author(s):  
Shaik Abdul Samad Shaik Abdul Rashid ◽  
Steven Cohen ◽  
Ida Micaily
Keyword(s):  
Selection Criteria ◽  
Chart Review ◽  
Median Overall Survival ◽  
Chemotherapy Regimen ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
The United States ◽  
Performance Scale

e16728 Background: Pancreatic adenocarcinoma is a dreaded malignancy accounting for 7% of all cancer related deaths in the United States. The two most used chemotherapeutic regimens are a combination of 5- fluorouracil, leucovorin, oxaliplatin and irinotecan (FFX) and a combination of gemcitabine nab paclitaxel (GN). Both improve survival when compared to gemcitabine alone but have not been compared directly. Methods: Retrospective chart review of 83 chemotherapy naïve patients with metastatic cancer of exocrine pancreas who underwent chemotherapy between February 2011 and June 2017. Patients who completed at least one cycle of chemotherapy regimen were included. Characteristics, efficacy and adverse events between the two regimens were compared using appropriate statistical analyses. Results: 83 patients met selection criteria. 39 patients received FFX and 44 received GN. Mean age of FFX and GN patients was 69.7 (SD 8.7) (Median 66) and 72.3 (SD 8.8) (Median 69) yrs respectively (p = 0.100). The proportion of patients with ECOG performance scale ≤1 receiving FFX vs. GN was 50.8% vs. 49.2% and > 2 receiving FFX vs. GN was 33.3% vs 66.7% (p = .286). Of the 23 patients > 75 yrs., 7 received FFX and 16 received GN (p = .086). Median overall survival was 10.1 months (95% CI: 5.4-18.7) in FFX and 7.2 months in GN (95% CI: 5.4-11.3) [p = 0.037]. Median survival based on site of tumor was 10.2 months (95% CI: 6.7-13.8) in head and 10.1 months (95% CI: 4.3-14.7) in body and tail tumors [p = 0.776]. Incidence of vomiting in FFX / GN was 94.1% / 73.7% (p =.027), vomiting requiring hospital admission was 55.9% / 21.1% (p = 0.003). Other events requiring admission included: diarrhea 31.4% / 17.9%; anemia 5.7% / 10.3%; thrombocytopenia 11.4% / 7.7%; febrile neutropenia 28.6% / 12.8% and acute kidney injury 25.7% / 15.4%; no statistically significant differences between groups. Conclusions: Patients treated with FFX had a longer survival in this retrospective review. FFX is associated with an increased incidence of vomiting requiring hospitalization. FFX remains a preferred regimen in treating patients with good performance status regardless of age.

Interaction between Warfarin and Trazodone

2000 ◽  
Vol 34 (6) ◽  
pp. 734-736 ◽  
Author(s):  
Nancy L Small ◽  
Kathy A Giamonna
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Potential Interaction ◽  
Case Summary ◽  
Subsequent Decrease ◽  
Clinically Significant ◽  
Few Data ◽  
Time To Onset ◽  
Potentially Clinically Significant

BACKGROUND: It is well known that there are many drug interactions involving warfarin. However, few data have been supplied to guide clinicians concerning the interaction between trazodone and warfarin. CASE SUMMARY: Three clinically significant cases of suspected trazodone and warfarin interactions were identified in a retrospective chart review based on changes in the prothrombin time (PT) and international normalized ratio (INR) that were not explained by other factors. In each of the cases, the INR changed by ≥1.0 after the initiation or discontinuation of trazodone. In the patients who started trazodone, a subsequent decrease in the PT and INR resulted; conversely, the PT and INR increased in the patient who stopped trazodone therapy. Although none of the patients experienced adverse effects due to the marked changes in PT and INR, the warfarin dosages had to be adjusted accordingly on initiation and discontinuation of trazodone. DISCUSSION: These cases show that there is a potentially clinically significant interaction between trazodone and warfarin. The time to onset of the interaction is variable; the mechanism behind it is not known, but it may involve substrate or protein-binding competition. CONCLUSIONS: The use of trazodone on an as-needed basis for sleep is strongly discouraged in patients who are receiving warfarin, due to the difficulty of achieving a therapeutic PT and INR. Until more is known, patients and clinicians should be educated about this potential interaction and monitor for changes in the anticoagulant effects when trazodone is initiated or stopped.

Donor site morbidities resulting from conchal cartilage harvesting in rhinoplasty

2017 ◽  
Vol 131 (6) ◽  
pp. 529-533 ◽  
Author(s):  
M Y Lan ◽  
J P Park ◽  
Y J Jang
Keyword(s):  
Complication Rate ◽  
Chart Review ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Donor Site Morbidity ◽  
Conchal Cartilage ◽  
Patient Demographics ◽  
Morbidity Data

AbstractObjective:Conchal cartilage is frequently used in rhinoplasty, but donor site morbidity data are seldom reported. This study aimed to investigate the complications of conchal cartilage harvesting in rhinoplasty.Methods:A retrospective chart review of 372 patients who underwent conchal cartilage harvesting for rhinoplasty was conducted. Data regarding patient demographics, types of nasal deformities, graft usage and complications were analysed.Results:A total of 372 patients who underwent conchal cartilage harvesting for rhinoplasty were enrolled. The harvested conchal cartilage tissues were used in a variety of applications: tip graft, dorsal graft, septal reinforcement and correction of nostril asymmetry. Nine cases (2.4 per cent) with donor site morbidities were identified, including four cases (1.1 per cent) with keloids and five cases (1.3 per cent) with haematomas.Conclusion:Conchal cartilage harvesting is a safe and useful technique for rhinoplasty, with a low complication rate. However, patients should be informed about the possibility of donor site morbidities such as keloids and haematomas.

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