scholarly journals Determinants of antimicrobial use practices among veterinary clinicians at The University of Tennessee Veterinary Medical Center

2017 ◽  
Author(s):  
John Eddie Ekakoro ◽  
Chika C Okafor
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Human Subjects ◽  
Antimicrobial Use ◽  
Antimicrobial Drugs ◽  
University Of Tennessee ◽  
Modifiable Factors ◽  
Cumulative Logit ◽  
The University ◽  
Antimicrobial Prescription

Background. Antimicrobial drugs in veterinary medical practice are primarily prescribed for the purposes of maintaining or improving health and increasing productivity. However, their value is being eroded by antimicrobial resistance (AMR). Indiscriminate use of antimicrobial drugs is suggested as one of the modifiable factors contributing to the development of AMR. To reduce indiscriminate use and to improve antimicrobial use, veterinary practices are encouraged to adopt good stewardship practices. Therefore, the objectives of this study were: to identify factors influencing clinician decisions to begin using antimicrobials as well as the choice of antimicrobials used at The University of Tennessee Veterinary Medical Center (UTVMC); to evaluate the practices, perceptions, opinions and concerns of veterinary clinicians at UTVMC concerning antimicrobial use, antimicrobial stewardship, and AMR. Methods. This study’s protocol was approved by the University of Tennessee Knoxville IRB for the Protection of Human Subjects in Research. Survey software was used to send a questionnaire to 121 eligible participants, where all were UTVMC faculty with clinical appointments and house officers. Cumulative logit models were fitted to investigate associations between categorical explanatory variables and ordinal response variables. Results. A response rate of 51.24% was achieved. Of the 62 respondents, 47 (75.81%) reported that bacteriological culture and antimicrobial susceptibility test results were extremely important in their antimicrobial prescription decision-making. Thirty-two (51.61%) respondents believed antimicrobials are being over-prescribed. The cephalosporin class was the most preferred antimicrobial class, while the lincosamide class was the least preferred. From the multivariable cumulative logit model, year of graduation from veterinary school (P = 0.034) and clinicians’ primary patient load (P = 0.009) were significantly associated with clinicians’ degree of concern about AMR. Conclusions and clinical relevance. The findings suggest a need for more awareness about AMR among veterinary clinicians. Improvements in antimicrobial stewardship are needed, especially among veterinary clinicians who graduated after 1999. Educational practices that target modification of antimicrobial prescription practices of veterinary clinicians would likely improve a Good Stewardship Practice (GSP) mindset. GSP is important in prolonging the efficacy of currently available antimicrobial drugs.

scholarly journals Determinants of antimicrobial use practices among veterinary clinicians at The University of Tennessee Veterinary Medical Center

2017 ◽  
Author(s):  
John Eddie Ekakoro ◽  
Chika C Okafor
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Human Subjects ◽  
Antimicrobial Use ◽  
Antimicrobial Drugs ◽  
University Of Tennessee ◽  
Modifiable Factors ◽  
Cumulative Logit ◽  
The University ◽  
Antimicrobial Prescription

Background. Antimicrobial drugs in veterinary medical practice are primarily prescribed for the purposes of maintaining or improving health and increasing productivity. However, their value is being eroded by antimicrobial resistance (AMR). Indiscriminate use of antimicrobial drugs is suggested as one of the modifiable factors contributing to the development of AMR. To reduce indiscriminate use and to improve antimicrobial use, veterinary practices are encouraged to adopt good stewardship practices. Therefore, the objectives of this study were: to identify factors influencing clinician decisions to begin using antimicrobials as well as the choice of antimicrobials used at The University of Tennessee Veterinary Medical Center (UTVMC); to evaluate the practices, perceptions, opinions and concerns of veterinary clinicians at UTVMC concerning antimicrobial use, antimicrobial stewardship, and AMR. Methods. This study’s protocol was approved by the University of Tennessee Knoxville IRB for the Protection of Human Subjects in Research. Survey software was used to send a questionnaire to 121 eligible participants, where all were UTVMC faculty with clinical appointments and house officers. Cumulative logit models were fitted to investigate associations between categorical explanatory variables and ordinal response variables. Results. A response rate of 51.24% was achieved. Of the 62 respondents, 47 (75.81%) reported that bacteriological culture and antimicrobial susceptibility test results were extremely important in their antimicrobial prescription decision-making. Thirty-two (51.61%) respondents believed antimicrobials are being over-prescribed. The cephalosporin class was the most preferred antimicrobial class, while the lincosamide class was the least preferred. From the multivariable cumulative logit model, year of graduation from veterinary school (P = 0.034) and clinicians’ primary patient load (P = 0.009) were significantly associated with clinicians’ degree of concern about AMR. Conclusions and clinical relevance. The findings suggest a need for more awareness about AMR among veterinary clinicians. Improvements in antimicrobial stewardship are needed, especially among veterinary clinicians who graduated after 1999. Educational practices that target modification of antimicrobial prescription practices of veterinary clinicians would likely improve a Good Stewardship Practice (GSP) mindset. GSP is important in prolonging the efficacy of currently available antimicrobial drugs.

NEWS AND ANNOUNCEMENTS

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 504-506
Keyword(s):  
Pediatric Cardiology ◽  
Medical Center ◽  
Newborn Infants ◽  
Heart Association ◽  
University Of Tennessee ◽  
Children's Hospital ◽  
Hospital Medical ◽  
Clinical Cardiology ◽  
Children’S Hospital ◽  
The University

Conference on Newborn Infants: The University of Tennessee College of Medicine will present the Fourth Memphis Conference on the Newborn at the Holiday Inn-Rivermont, Memphis, Tennessee, on September 21, 1972. Faculty will include Drs. Marshall Klaus, Leo Stern, and Paul Swyer. For further information write the Division of Continuing Education and Conferences, The University of Tennessee Medical Units, 800 Madison Avenue, Memphis, Tennessee 38103. Problems in Pediatric Cardiology: The American Heart Association Council on Clinical Cardiology, the Council on Rheumatic Fever and Congenital Heart Disease, and the Departments of Pediatrics, Surgery, and Pathology of Children's Hospital Medical Center and Harvard Medical School, in cooperation with the Massachusetts Heart Association, will cosponsor a course: Problems in Pediatric Cardiology, September 25-27, 1972, at Children's Hospital Medical Center, Boston, Massachusetts.

Neonatal Physician Scheduling at the University of Tennessee Medical Center

2016 ◽  
Vol 46 (2) ◽  
pp. 168-182 ◽  
Author(s):  
Melissa R. Bowers ◽  
Charles E. Noon ◽  
Wei Wu ◽  
J. Kirk Bass
Keyword(s):  
Medical Center ◽  
University Of Tennessee ◽  
The University ◽  
Physician Scheduling

scholarly journals Impact of the Sequence of Norepinephrine and Vasopressin Discontinuation in Patients Recovering From Septic Shock

2018 ◽  
Vol 55 (1) ◽  
pp. 26-31
Author(s):  
Benjamin E. Bredhold ◽  
Shauna D. Winters ◽  
John C. Callison ◽  
Robert E. Heidel ◽  
Lauren M. Allen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Medical Condition ◽  
Medical Center ◽  
Secondary Outcome ◽  
University Of Tennessee ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
The University ◽  
The Impact

Background: Septic shock is a serious medical condition affecting millions of people each year and guidelines direct vasopressor use in these patients. However, there is little information as to which vasopressor should be discontinued first. Objective: The objective of this study was to assess the impact of the sequence of norepinephrine and vasopressin discontinuation on intensive care unit (ICU) length of stay. Methods: This was a single-center retrospective cohort study conducted at The University of Tennessee Medical Center in Knoxville, Tennessee. Patients included in this study were adults 18 years of age and older with a diagnosis of septic shock who received norepinephrine in combination with vasopressin. Patients were excluded if norepinephrine or vasopressin were not the last 2 vasoactive agents used or if the patient expired or care was withdrawn. Measurements and Main Results: A total of 86 patients were included in this study, with 34 patients in the norepinephrine discontinued first group (NDF) and 52 in the vasopressin discontinued first group (VDF). For the primary outcome of ICU length of stay, no statistically significant difference was found between the NDF and the VDF groups (9.38 days vs 11.07 days, P = .313). The secondary outcome of the dose of norepinephrine at which vasopressin was initiated was also found to not be significant between the NDF and VDF groups (22 µg/min vs 31.1 µg/min, P = .11). The rates of hypotension within 24 hours of discontinuation of the first agent were also not significant between the NDF and VDF groups (17% vs 31%, P = .38). Conclusions: Based on the results of this study, there was significant no difference in ICU length of stay based on the sequence of discontinuation between norepinephrine and vasopressin in patients recovering from septic shock.

Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriuria

2014 ◽  
Vol 35 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Denise Kelley ◽  
Patrick Aaronson ◽  
Elaine Poon ◽  
Yvette S. McCarter ◽  
Ben Bato ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Educational Initiative ◽  
Educational Initiatives ◽  
Academic Medical ◽  
Inappropriate Treatment

An antimicrobial stewardship educational initiative provided to physicians and pharmacists was evaluated at an academic medical center to minimize inappropriate treatment of asymptomatic bacteriuria (ASB). A significant decrease in empirical antimicrobial use for ASB was observed after education. Multifaceted educational initiatives can reduce inappropriate antimicrobial treatment of ASB.

The University of Tennessee Medical Center at Knoxville

2012 ◽  
Vol 78 (9) ◽  
pp. 909-914
Author(s):  
Mitchell H. Goldman
Keyword(s):  
Medical Education ◽  
Health Services ◽  
Graduate School ◽  
Medical Center ◽  
Research Center ◽  
University Of Tennessee ◽  
School Of Medicine ◽  
The University

The University of Tennessee Medical Center at Knoxville hosts the University Health Services and the University of Tennessee Graduate School of Medicine. Founded in 1956, the center along with the Department of Surgery has grown in size and in academic stature to become an outstanding tertiary clinical, medical education, and research center.

Financial Conflicts of Interest in Human Subjects Research: The Problem of Institutional Conflicts

2002 ◽  
Vol 30 (3) ◽  
pp. 390-402 ◽  
Author(s):  
Mark Barnes ◽  
Patrik S. Florencio
Keyword(s):  
Conflicts Of Interest ◽  
Medical Center ◽  
Human Subjects ◽  
The United States ◽  
Human Subjects Research ◽  
Human Research ◽  
University Of Oklahoma ◽  
Financial Conflicts Of Interest ◽  
Oklahoma Health ◽  
The University

In both academic literature and the media, financial conflicts of interest in human subjects research have come center-stage. The cover of a recent edition of Time magazine features a research subject in a cage with the caption human guinea pigs, signifying perhaps that human research subjects are no more protected from research abuses than are laboratory animals. That magazine issue highlights three well-publicized cases of human subjects research violations that occurred at the University of Oklahoma, the University of Pennsylvania, and Johns Hopkins University.At St. John Medical Center in Tulsa, Oklahoma, a study that was co-sponsored by the University of Oklahoma Health Sciences Center investigated an experimental vaccine for malignant melanoma. In that case, the chair of the university's institutional review board (IRB) — the committee within each medical institution charged with ethics review of human research projects undertaken at that institution — and the dean of the University's College of Medicine allegedly concealed from both the IRB and the United States Food and Drug Administration (FDA) a report by an outside consulting firm that had found severe deficiencies with the melanoma vaccine study being conducted at the medical center.

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

2021 ◽  
pp. 089719002199700
Author(s):  
Brian C. Bohn ◽  
Elizabeth A. Neuner ◽  
Vasilios Athans ◽  
Kaitlyn R. Rivard ◽  
Allison R. Riffle ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Academic Medical ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

scholarly journals Postprescription Review With Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

2020 ◽  
Author(s):  
Nandita S Mani ◽  
Kristine F Lan ◽  
Rupali Jain ◽  
Chloe Bryson-Cahn ◽  
John B Lynch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Medical Center ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Percentage Change ◽  
Antimicrobial Use ◽  
Sustained Reduction ◽  
Days Of Therapy ◽  
The University ◽  
The Impact

Abstract Background Following a meropenem shortage, we implemented a postprescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses &gt; 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and postintervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1000 patient-days, and data were analyzed by an interrupted time series. Results There were 4066 and 2552 patients in the pre- and postintervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1000 patient-days occurred at both hospitals (UWMC: percentage change −72.1% (95% confidence interval [CI] −76.6, −66.9), P &lt; .001; HMC: percentage change −43.6% (95% CI −59.9, −20.7), P = .001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the postintervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P &lt; .001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P &lt; .001) at HMC. Conclusions PPRF and mandatory ID consultation for meropenem and imipenem use beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage.

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