Median Compliance Rate Research Articles

The Implementation of a Pediatric Nonaccidental Trauma Evaluation Protocol: A Quality Improvement Analysis.

Pediatric nonaccidental trauma (NAT) accounts for more than 1500 deaths annually and is a source of incalculable lifelong morbidity. Evidence-based NAT evaluation protocols are available; however, compliance studies are lacking. Here, we analyze the quality of implementation of a new NAT evaluation protocol. A review of registry data from a level 3 trauma center was performed for patients with a suspicion of NAT from September 2014 to May 2016. Compliance rates and results of 2 new age-based evaluation protocols were examined before (phase 1) and after (phase 2) a multidisciplinary conference was initiated to improve performance. Seventy-five children underwent evaluation for NAT during the study period. In phase 1, median compliance rates with all of the protocol elements were low (63%). After a bimonthly multidisciplinary conference was initiated, compliance rates improved to 75%. Some elements, which were often missed, were found to be clinically irrelevant. If only clinically relevant elements were included, median compliance in phase 2 is 86%. Compliance with a new protocol for NAT was improved with the institution of a multidisciplinary conference. Protocol elements, which are shown to be clinically unnecessary, have also been identified and will be eliminated.

OptimalTTF-1: Enhancing tumor treating fields therapy with skull remodeling surgery. A clinical phase I trial in adult recurrent glioblastoma

BackgroundPreclinical studies suggest that skull remodeling surgery (SR-surgery) increases the dose of tumor treating fields (TTFields) in glioblastoma (GBM) and prevents wasteful current shunting through the skin. SR-surgery introduces minor skull defects to focus the cancer-inhibiting currents toward the tumor and increase the treatment dose. This study aimed to test the safety and feasibility of this concept in a phase I setting.MethodsFifteen adult patients with the first recurrence of GBM were treated with personalized SR-surgery, TTFields, and physician’s choice oncological therapy. The primary endpoint was toxicity and secondary endpoints included standard efficacy outcomes.ResultsSR-surgery resulted in a mean skull defect area of 10.6 cm2 producing a median TTFields enhancement of 32% (range 25–59%). The median TTFields treatment duration was 6.8 months and the median compliance rate 90%. Patients received either bevacizumab, bevacizumab/irinotecan, or temozolomide rechallenge. We observed 71 adverse events (AEs) of grades 1 (52%), 2 (35%), and 3 (13%). There were no grade 4 or 5 AEs or intervention-related serious AEs. Six patients experienced minor TTFields-induced skin rash. The median progression-free survival (PFS) was 4.6 months and the PFS rate at 6 months was 36%. The median overall survival (OS) was 15.5 months and the OS rate at 12 months was 55%.ConclusionsTTFields therapy combined with SR-surgery and medical oncological treatment is safe and nontoxic and holds the potential to improve the outcome for GBM patients through focal dose enhancement in the tumor.

Achieving 100 percent compliance to perioperative antibiotic administration: a quality improvement initiative.

Timely administration of prophylactic antibiotics within 60 minutes before surgical incision is important for reducing surgical site infections. This quality improvement initiative aimed to work towards achieving 100% compliance with perioperative antibiotic administration. We examined the workflow in our Anaesthesia Information Management System (AIMS) and proposed interventions using cause-and-effect analysis of anonymised anaesthetic records from eligible surgical cases extracted from AIMS. This ultimately led to the implementation of an antibiotic pop-up reminder. The overall process was done in a few small plan-do-study-act cycles involving raising awareness, education and reorganisation of AIMS before implementation of the antibiotic pop-up reminder. Data analysis took place from August 2014 to September 2016. Compliance was defined as documented antibiotic administration within 60 minutes before surgical incision, or as documented reason for omission. The median monthly compliance rate, for 33,038 cases before and 28,315 cases after the reminder was implemented, increased from 67.0% at baseline to 94.5%. This increase was consistent and sustained for a year despite frequent personnel turnover. Documentation of antibiotic administration also improved from 81.7% to 99.3%, allowing us to identify and address novel problems that were initially not apparent, and resulting in several department recommendations. These included administering antibiotics later for cases with predicted longer-than-expected preparation times and bringing forward antibiotic administration in lower-segment Caesarean sections. The use of information technology and implementation of an antibiotic pop-up reminder on AIMS streamlined our work processes and brought us closer to achieving 100% on-time compliance with perioperative antibiotic administration.

1293. The Next Step in PrEP: Evaluating Outcomes of a Pharmacist-Run HIV Pre-Exposure Prophylaxis (PrEP) Clinic

BackgroundPrEP has been proven as an effective option for preventing the transmission of HIV; however, there are limited numbers of providers willing to prescribe PrEP. Pharmacists are an underutilized resource that are able to provide PrEPservices in many states. In Albuquerque, New Mexico, one of the nation’s first pharmacy-run HIV PrEP clinics was established in July 2015. The objective of this study was to describe the outcomes of an alternative model for HIV prevention.MethodsThe electronic medical record was used to identify and retrospectively review patients of the PrEP clinic from July 2015 to July 2017. Pertinent information including: risk factors for HIV acquisition, sexually transmitted infections (STIs) history, laboratory and medication-related data were captured. Data on partner HIV status and HAART regimen was collected when available. Adherence was evaluated by self-reported missed doses and the compliance rate was calculated from the patient’s medication fill history. Descriptive statistics was performed using SPSS.ResultsThe first PrEP appointment was attended by 136 patients during study period. Baseline demographics are reported in Table 1. Two patients tested positive for HIV at baseline. PrEP was started in 127 patients with tenofovir/emtricitabine(TDF/FTC). There were no HIV seroconversions among those who started PrEP. Only one patient discontinued due to side effects. No significant elevation in Scr was noted over time. Overall, patients demonstrated a high adherence rate with an average of <1 missed doses per month and a median compliance rate of 0.99.ConclusionA pharmacist run PrEP clinic is an alternative model to increase patient access to PrEP. TDF/FTC was provided to high-risk individuals and well-tolerated. Providers were able to promote high level of adherence.Table 1. Baseline Demographics N = 136Average age34 years [20–73]Males (self-identified)117 (86.1%)Race n (%)Hispanic57 (42)White53 (39)American Indian Alaskan Native13 (10)Black/African American5 (4)Other4 (3)Unknown4 (3)HIV Risk Factorn (%)Total high-risk MSM117 (86)HIRI-MSM score (mean ± SD)17.7 ± 7.54High-risk transgender10 (7)Sero-discordant couples40 (29)Transactional sex3 (2)Drug use5 (4)History of STI12 (9)Previous PEP use2 (2)Disclosures All authors: No reported disclosures.

Assessing the effectiveness of structured teaching on knowledge of hand hygiene among healthcare workers

Assessing the effectiveness of structured teaching on knowledge of hand hygiene among healthcare workers

A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings

Handoffs represent a critical transition point in patient care that play a key role in patient safety. Our quality improvement project was a descriptive observational study aimed at standardizing pediatric...

Abstract PR525

Background & Objectives: To help readers assess validity, a checklist for consistent reporting in clinical pharmacokinetics (PK) studies was recently developed.1 The objective of this study was to assess compliance with the ClinPK Statement of clinical PK studies conducted in adult intensive care units for selected analgesics and sedatives delivered for 24h or more. Materials & Methods: We performed a literature search of study articles using MEDLINE (1946-Oct 2015) and EMBASE (1974-Oct 2015). All studies published in English and Chinese, conducted in adult intensive care units with patients sedated with midazolam, propofol, dexmedetomidine, sufentanil, alfentanil, morphine or fentanyl infusion for 24h or more, and reporting PK parameters were included. For each study, three independent reviewers assessed the applicability and compliance with each item in the ClinPK checklist. Chi-square tests were used to compare the compliance rates for each item between our study and those of the general clinical PK studies reported by Kanji et al.1 Results: Of the 1039 unique studies identified, 28 studies (published between 1985 and 2013) were included. The median compliance rate among studies was 80.5% (IQR 67.0% to 86.0%). Fifteen studies were deemed to be compliant, i.e. reporting > 80% of necessary items. Six items had < 60% compliance rate in current study (Table 1).Table 1.: Comparison of itemized compliance with ClinPK by studyConclusion: Most prolonged sedation and analgesia studies were substantially compliant with the ClinPK Statement, however, important missing data, such as appropriate identification of co-variates, reporting of study withdrawals, and funding sources and conflict of interests for authors were common. There were differences in study reporting rates, likely because of study selection.

A meta-analysis of public compliance to boil water advisories

Water utilities that generally provide continuous and reliable service to their customers may sometimes issue an advisory notification when service is interrupted or water quality is compromised. When the contamination is biological, utilities or the local public health agencies issue a 'boil water advisory' (BWA). The public health effectiveness of a BWA depends strongly on an implicit public understanding and compliance. In this study, a meta-analysis of 11 articles that investigated public compliance to BWA notifications was conducted. Awareness of BWA was moderately high, except in situations involving extreme weather. Reported rates of compliance were generally high, but when rate of awareness and non-compliant behavior such as brushing teeth were factored in, the median effective compliance rate was found to be around 68 percent. This does not include situations where people forgot to boil water for some part of the duration, or ingested contaminated water after the BWA was issued but before they became aware of the notification. The two-thirds compliance rate is thus an over-estimate. Results further suggest that timeliness of receipt, content of the advisory, and number of sources reporting the advisory have a significant impact on public response and compliance. This analysis points to improvements in the phrasing and content of BWA notices that could result in greater compliance, and recommends the use of a standard protocol to limit recall bias and capture the public response accurately.

Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy

Objective To determine the efficacy of 16 hour nicotine patches among pregnant smokers, with the dose individually adjusted according to saliva cotinine levels (potential range 10-30 mg/day). Design Randomised, double...

Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units*

Clinical guidelines should provide a framework for managing patients hospitalized in intensive care units. Little is known about guideline compliance in real-life practice. To evaluate compliance rates for a large bundle of intensive care unit practice guidelines and determine factors associated with noncompliance to these guidelines. A bundle of 13 clinical guidelines was elaborated by a group of senior physicians. Four external consultants validated the process. Then, a 1-day audit was performed at 66 participating adult intensive care units in 39 institutions by a group of 64 junior investigators supervised by senior intensivists. At the bedside, investigators collected data from 625 patients hospitalized in those units. The eligibility and compliance rates were determined for each clinical recommendation. The rate of full compliance to each eligible clinical guideline was calculated. Mortality data were requested 28 days after the completion of the audit. The eligibility rate ranged from 11% (sepsis bundle) to 80% (identified closest relative). The median compliance rate was 75% (60-100), ranging from 24% (sedation monitoring) to 96% (identified closest relative and bacteriological sampling before initiating antibiotics). Our results showed that only 24% (20-27) of patients in our cohort received fully compliant care. The 28-day survival probability was .77 (.73-.80). At the bedside, clinical guidelines are fully applied in 24% of patients. Our study underlines the need to both improve the process of implementation and become cognizant of excessive proliferation of clinical guidelines.

A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer

Curcumin, a plant-derived natural polyphenol, could be a promising anti-cancer drug and shows synergic effects with cytotoxic agents. We evaluated the safety and feasibility of combination therapy using curcumin with gemcitabine-based chemotherapy. Gemcitabine-resistant patients with pancreatic cancer received 8g oral curcumin daily in combination with gemcitabine-based chemotherapy. The primary endpoint was safety for phase I and feasibility of oral curcumin for phase II study. Twenty-one patients were enrolled. No dose-limiting toxicities were observed in the phase I study and oral curcumin 8g/day was selected as the recommended dose for the phase II study. No patients were withdrawn from this study because of the intolerability of curcumin, which met the primary endpoint of the phase II study, and the median compliance rate of oral curcumin was 100% (Range 79-100%). Median survival time after initiation of curcumin was 161days (95% confidence interval 109-223days) and 1-year survival rate was 19% (4.4-41.4%). Plasma curcumin levels ranged from 29 to 412ng/ml in five patients tested. Combination therapy using 8g oral curcumin daily with gemcitabine-based chemotherapy was safe and feasible in patients with pancreatic cancer and warrants further investigation into its efficacy.

Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care

To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. We included 96 empirical studies, the majority (n = 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n = 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results. Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

Mechanical diagnosis and therapy in back pain: Compliance and social cognitive theory

The aim of this study was to describe social cognitive theory (SCT) constructs and exercise compliance, and to explore relations between SCT variables and exercise compliance in patients with lumbar derangement syndrome during mechanical diagnosis and therapy (MDT) treatment. Fifty-eight subjects completed the study. The data collection included measures relevant to SCT constructs and compliance: outcome expectations and expectancies, self-efficacy expectations, behavioural capability, and self-reported frequency of exercise occasions, as well as treatment outcomes regarding pain intensity and disability. Data were collected at five occasions during treatment and during a 2-month follow-up period. The subjects received a mean of three movements (range one to five) as home exercises. The mean number of weeks with these exercises was 4 (range 1–6). High median scores were found in all variables related to SCT. The median compliance rates varied between 79% (week 1) and 91% (week 3) during treatment. During ...

Psychological services for people with stroke: compliance with the UK National Clinical Guidelines

The UK National Clinical Guidelines for Stroke (2000) include recommendations on psychological services. The third National Sentinel Audit of Stroke was completed in 2001-2002. To examine the extent to which UK stroke services complied with the national guidelines. Use of three retrospective case note audits of hospital admissions, covering the period from admission to six months after discharge, and audits of how stroke services were organized. Hospitals within England, Wales, Northern Ireland, the Channel Islands and the Isle of Man. Stroke patients admitted consecutively within a three-month time frame. Compliance with the guidelines on mood disorders and cognitive impairments, and changes between audits. The 2001-2002 audit provided data on 60% of possible participants, from 145 hospitals and 5152 patients. Compliance with the guideline to screen for mood disturbance was poor; the median patient compliance rate of hospitals was 50%. More hospitals (88%) had a locally agreed cognitive assessment protocol in 2001-2002 than in 1998 (68%) and in 1999 (82%). However, actual rates of screening for cognitive difficulties were lower than implied by the existence of a local protocol. There were no strong case-mix associates of mood and cognitive screening. Access to clinical psychologists was poor. Mood and cognitive assessment rates were not much better for stroke units with access to clinical psychologists than for units without access (mood: p = 0.6, cognition: p = 0.09). Although compliance with some of the guidelines has improved, many areas in current psychological services for stroke urgently need attention.

Evaluation of client compliance with short-term administration of antimicrobials to dogs

To describe the degree of and variability in the level of client compliance and identify determinants of client compliance with short-term administration of antimicrobial medications to dogs. Prospective study. 90 owners of dogs prescribed antimicrobials. Eligible clients were invited to participate when antimicrobial medications were dispensed. Data were collected during a follow-up appointment by use of a client questionnaire, residual pill count, and return of an electronic medication monitoring device. Attending veterinarians also completed a questionnaire that asked them to predict client compliance. Methods of assessing compliance were compared with nonparametric tests. Generalized estimating equations were used to investigate potential determinants of compliance. Median compliance rates of 97% of prescribed container openings, 91% of days when the correct number of doses were given, and 64% of doses given on time as assessed by the electronic medication monitoring devices were significantly lower than the median compliance rates of 100% for client self-report of missing doses and pill count. Veterinarians were unable to predict client compliance. The dosage regimen significantly determined compliance. Clients giving antimicrobials once or twice daily were 9 times more likely to be 100% compliant, compared with 3 times daily dosing. The combination of reported missed doses and pill counts was a significant predictor of compliance as measured by electronic monitoring. Electronic monitoring caps provided useful information only when they were used appropriately. Asking clients about missed doses and performing pill counts are the most practical assessments of compliance in practice.

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids

To evaluate compliance and the change in serum albumin associated with essential amino acid (EAA) therapy in hypoalbuminemic hemodialysis subjects. Open label, single intervention, pilot study conducted at 2 outpatient hemodialysis centers located in Baltimore, Maryland. Eighteen patients with a mean 3-month prestudy serum albumin of <3.8 g/dL and a mean Kt/V of > or =1.0, without any recent hospitalizations or infections, who provided informed consent, and who demonstrated > or =90% compliance rate during a 2 week run-in period, were enrolled in the study. The mean age was 61.3 years, 44% were male, 78% were black, and 50% were diabetic. Subjects were instructed to take 3 Aminess N tablets (Recip AB, Stockholm, Sweden) 3 times each day with meals (total of 6.8 g of EAA per day) for 4 months. Median 4-month compliance and the change in mean follow-up serum albumin levels (mean of the serum albumin levels at day 30, day 60, day 90, and day 120 after the start of therapy) compared with mean baseline serum albumin levels (mean of the serum albumin levels at day -90, day -60, day -30, and day 0 before therapy). Secondary outcomes included changes in grip strength and body weight. Data was also collected on C-reactive protein levels, dialysis adequacy (Kt/V), and serum bicarbonate. A 2-day dietary recall was obtained at both the start and finish of the study. Monthly compliance with EAA tablets remained relatively stable over the study period, with median compliance rates of 86%, 88%, 82%, and 82% at months 1 through 4, and an overall median compliance of 82%. Seventy-eight percent of patients had an overall compliance rate of 70% or greater. Serum albumin improved from baseline to follow-up by a mean (95% confidence interval) of 0.20 g/dL (95% confidence interval, 0.04 to 0.30; P =.001). Lowest postdialysis weight increased from a mean of 74.5 kg to 77.1 kg (P =.05), and there was a nonsignificant increase in grip strength. C-reactive protein levels increased in 33%, remained constant in 11%, and decreased in 56% of subjects, and there was no significant correlation between change in C-reactive protein levels and improvement in serum albumin. Dietary recalls did not show any significant change in the spontaneous protein or caloric intakes in association with the use of the EAA tablets. Although uncontrolled, these results support the feasibility and benefits of moderate dose oral EAA supplementation in hypoalbuminemic hemodialysis subjects.

Hormone replacement therapy: Prevalence, compliance and the ‘healthy women’ notion

Background The objective of this study was to assess the current trends of hormone replacement therapy (HRT) use, including rates of use, length of use, continuation rates and characteristics of users and non-users and to examine the hypothesis that ‘healthy women’ are more likely to be users of HRT.Methods Analysis was carried out of three representative South Australian population studies in 1991, 1993 and 1995 comprising 3019, 3004 and 3016 personal interviews, respectively.Results Current use (and ever-use) of HRT in all women aged 50 years and over rose from 13. 2% (26. 7%) in 1991, to 21. 2% (31. 9%) in 1993 and 26. 0% (40. 5%) in 1995. Highest use is now in the 55-59-year age group where, in 1995, current use was 50. 9% and ever use was 69. 0%. Median compliance rates with HRT rose from 24 months in 1991 to 60 months in 1995 for current users aged 50 years of age or above. The pattern of increasing use of HRT is not consistent across age groups. Analyses of the 1995 data show that, in contrast with increasing rates of current use in women over 55 years, there was no overall change in rates for women below this age. There were no statistically significant differences in health indicators, e. g. blood pressure, smoking, cholesterol levels or body mass index between users and non-users of HRT. However, users reported significantly higher rates of previous osteoporosis and hysterectomy.Conclusions Prevalence rates of HRT use are increasing together with compliance rates and this may reflect increased confidence with HRT therapy. Users of HRT have an increased rate of mammography compared to non-users and this may contribute to earlier detection and, therefore, increased estimates of breast cancer in HRT users. There was no support from the 1995 data for a ‘healthy women’ hypothesis among HRT users.