Standardized Data Collection Tool Research Articles

111. Outcomes Related to COVID-19 Among People Living with HIV: Cohort from a Large Academic Center

BackgroundThe COVID-19 pandemic has resulted in nearly 8 million cases and close to 500,000 deaths globally. Little is known about risk factors for favorable or adverse outcomes from COVID-19 among people living with HIV (PWH). Small case series have described outcomes for hospitalized PWH with COVID19.MethodsThis is a retrospective chart review of PWH with confirmed diagnosis of COVID-19 from 2 HIV ambulatory clinics from March 1 to May 31, 2020 in a large urban academic center that serves a substantial proportion of underserved minorities. Data on demographics, clinical characteristics, and outcomes were abstracted using a standardized data collection tool. Bivariate analysis was performed to identify correlates of hospitalization.ResultsAmong the clinic cohort of 1469 PWH, 94 (6.4%) were tested for SARS-CoV-2 and 40 (42.5%) were positive. Fifty-percent were women, 65% were 50 years and older, 65% were black, 65% were former or active smokers, and 40% were active alcohol or substance users. The majority (90%) were on ART and 87.5% had HIV viral suppression (< 50 copies/ml). Among comorbidities, 50% had hypertension, 42.5% chronic lung disease, 42.5% cardiovascular disease (CVD), 40% obesity, 27.5% diabetes (DM), and 20% chronic kidney disease (CKD). Hospitalization occurred in 19 patients (47.5%) and of those, 4 (21%) required escalation of care. The median length of stay was 12 days (IQR5.5–15.5) and there was no inpatient mortality. Among the 12 PWH who had HIV viral load test during hospitalization, 11 (91.7%) maintained viral suppression and none of the 19 patients had ART interruption. Those who were hospitalized were more likely to be >50 years old (p=0.02); have CVD (p=0.003), DM (p=0.01), and CKD (p=0.02); or have multiple comorbidities (p=0.007) compared to those managed as outpatients. Furthermore, incremental numbers of comorbidities were associated with hospitalization (p=0.009). A history of AIDS, black race, obesity, smoking, and substance use disorders were not associated with hospitalization or adverse outcome.ConclusionIn this initial and to our knowledge largest cohort in an urban academic center, PWH with COVID-19 had favorable short-term outcomes. The risk factors associated with hospitalization were older age and multiple non-HIV related comorbidities.Disclosures All Authors: No reported disclosures

Abusive Head Trauma in Day Care Centers.

Abusive head trauma (AHT) warrants particular attention in terms of prevention. One of the key questions asked is how often AHT occurs in infant day care centers compared with private parental or nonparental homes. To investigate this, we studied the caretaking arrangement and child's location at the time of injury in a cohort of cases involving AHT from the courts. This multicenter retrospective study covering an 18-year period included all medical and court records of 323 children (2.5 months to 3 years) with AHT, confirmed by the authors acting as medical experts. All markers for abuse and forensic written reports were analyzed by using a standardized data collection tool. The usual child care arrangement and the child's location at the time of injury were noted. The percentage of day care centers found in the study was compared to the expected rate in the French population (19.5%) by using the χ2 test. In 317 AHT cases (98.5%), the assault occurred in a private home (4 in other indoor settings and 1 with missing data). In only 1 case, shaking occurred in a day care center when the nurse was alone with the infant for a few minutes. In 317 cases (98.5%), the usual child care arrangement was by a single adult in charge of 1 or more children. The fact that AHT is an unusual occurrence in day care centers could help social service agencies make decisions in terms of prevention. Recent government policies regarding stay-at-home orders during a pandemic have given this issue new relevance.

Reduction of phone interruptions post implementation of a central call center in community pharmacies of an academic health system.

A pharmacy services call center (PSCC) was implemented to centralize pharmacy phone calls and reduce interruptions of dispensing activities in 7 community pharmacies of an academic health center. An evaluation was conducted to define, quantify, and compare the numbers and types of phone interruptions before and 3 months after PSCC implementation. Through structured, direct observation of pharmacy staff, the numbers and types of "breaks in task" (BIT) due to phone interruptions and other distractions were identified. A standardized data collection tool formatted on tablet computers was used by trained observers to document BIT for 3-hour time blocks on 5 consecutive business days (2 days of pharmacist observation and 3 days of technician observation, for a total of 10 observation days per pharmacy). Over 5,000 prescriptions were processed during 414 hours of observation (13.3 prescriptions per observation hour). Overall, BIT due to phone interruptions totaled 2.2 BIT per observation hour, with those interruptions reduced by 46.4% overall after PSCC implementation (by 30.0% in 4 small pharmacies and by 57.5% in 3 large pharmacies). Technicians were more likely than pharmacists to be interrupted by phone vs nonphone BIT (eg, distraction by another technician, pharmacist, or patient). Comparison of phone vs nonphone BIT suggested an overall 46.0% reduction in phone BIT in all pharmacies (reductions of 42.4% and 45.0% in large and small pharmacies, respectively). PSCC implementation noticeably decreased the amount of phone interruptions and distractions for employees.

Thromboembolic Outcomes of Hospitalized COVID-19 Patients in the 90-Day Post-Discharge Period: Early Data from the Northwell CORE-19 Registry

IntroductionThromboembolic outcomes have emerged as an important issue in sick hospitalized patients with COVID-19. Multiple pathogenetic mechanisms for thrombosis have been implicated, including endothelial dysfunction, increased von Willebrand factor (vWF), interleukin-6 release, and activation of/interaction between macrophages, monocytes, endothelial cells, platelets and lymphocytes. The actual rate of arterial and venous thromboembolic events (ATE and VTE) in hospitalized patients with COVID-19, especially in the immediate post-hospital discharge period, has not been fully elucidated, with most of the data derived from retrospective studies with small sample sizes.MethodsAgainst this background, we have designed and implemented an ongoing prospective registry (CORE-19) consisting of 11,249 consecutive hospitalized patients with COVID-19 from March 1st 2020 through May 31st 2020 using data derived from the Northwell Health System and the COVID-19 Research Consortium to study through 90-days post-discharge the rate of VTE and ATE, major bleeding, all-cause mortality, and other complications. We are capturing data of interest including demographic characteristics, co-morbidities, relevant medications, hospital setting, in-hospital treatment, thromboprophylaxis usage, key laboratory parameters, and 90-day thromboembolic and other key outcomes. A unified data repository (datamart) of hospitalized COVID-19 patients across multiple datasets from electronic health records, health informatics exchange, a dedicated radiology database, and a standardized data collection tool in REDCap, that includes telephonic calls up to 90 days post-discharge, is being implemented. A common data model (CDM) is utilized to ensure semantic interoperability between data originating from disparate sources. Northwell Health protocols stipulate the use of post-discharge low-molecular weight heparin, direct oral anticoagulants, or baby aspirin in hospitalized COVID-19 patients with high thrombotic risk features.ResultsOur cohort as of August 7, 2020 consists of complete follow up in 4,100 patients with a mean age of 61.0 years (SD: 17.0) with 54.7% males (Table 1). Preliminary data show an all-cause mortality rate of 4.29%, an overall thromboembolic rate of 3.51% (2.41% VTE and 1.10% ATE), a major bleeding rate of 1.61%, and a rehospitalization rate of 12.85%. Of patients with either DVT or PE post-discharge, 13.43% (9/67) died. The full dataset, including risk factors, comorbidities, key in-hospital and post-discharge medications including anticoagulant and antiplatelet agents, will be available at the time of presentation to the ASH congress.ConclusionOur ongoing registry is a large prospective study evaluating the rate of overall thromboembolic complications and all-cause mortality in hospitalized COVID-19 patients through 90 days post discharge. Current rates of thromboembolic events signify the importance of post-discharge surveillance and, potentially, post-discharge extended thromboprophylaxis, in this acutely ill medical population.DisclosuresAllen:Bristol Myers Squibb: Current equity holder in publicly-traded company. Spyropoulos:Janssen, Boehringer Ingelheim, Bayer, BMS, Portola, ATLAS Group: Consultancy; Janssen, Boehringer Ingelheim: Research Funding.

Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: a systematic literature review

BackgroundFor every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth.MethodsWe systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted.ResultsIncluded were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies.ConclusionsThere is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity.Systematic review registration numberPROSPERO CRD42018079526.

Prevalence of gram negative bacteria causing community acquired pneumonia among adults in Mwanza City, Tanzania

BackgroundCommunity acquired pneumonia (CAP) in adults is still a common and serious illness in the sub-Saharan Africa. Identification of the pathogens is crucial in the management of CAP. This study was done to determine the common bacterial pathogens, treatment outcomes and associated factors for microbiological confirmed CAP among adults attending the Bugando Medical Centre and Sekou Toure hospital in the city of Mwanza, Tanzania.MethodsThis was a hospital based cross sectional study involving patients with community acquired pneumonia attending Bugando Medical Centre and Sekou Toure regional Hospital. Demographic and other data were collected using standardized data collection tool. Sputum culture was done followed by identification of the isolates and antibiotics susceptibility testing.ResultsA total of 353 patients were enrolled in the study. Out of 353 sputum samples, 265(75%) were of good quality. Of 353 non-repetitive sputum cultures, 72/353 (20.4, 95% CI: 16.2–24.6) were positive for the bacterial pathogens with five patients having more than one pathogen. Good quality sputa had significantly higher yield of pathogenic bacteria than poor quality sputa (26.1% vs.3.4%, P = 0.001). The majority 64 (83.1%) of the isolates were gram negative bacteria. Common bacteria isolated were Klebsiella pneumoniae 23/77(29.9%), Streptococcus pyogenes 10/77 (13.0%), Pseudomonas aeruginosa 9/77 (11.7%) and Escherichia coli 7/77 (9.1%). Of 23 K. pneumoniae isolates, 20/23 (87.0%) were resistant to ceftriaxone. Resistance to ceftriaxone was found to be associated with prolongation of CAP symptoms (p = 0.009).ConclusionGram negative bacteria resistant to ampicillin, amoxicillin/clavulanic acid and ceftriaxone were most frequently isolated bacteria among adults’ patients with CAP attending BMC and Sekou Toure hospital. Routine sputum culture should be performed to guide appropriate treatment of CAP among adults in developing countries.

Management of neutropenic fever in a private hospital oncology unit.

Neutropenic fever is a medical emergency, which poses a significant morbidity and mortality risk to cancer patients receiving chemotherapy. National guidelines recommend that patients presenting with suspected neutropenic fever receive appropriate intravenous antibiotics within 60 min of admission. We aimed to investigate the management of neutropenic fever in a large private oncology centre. A retrospective audit of all patients who presented to St John of God Hospital, Subiaco, in the 2017 calendar year, with a known solid organ malignancy and a recorded diagnosis of neutropenic fever was conducted. Patients were identified through the hospitals Patient Administration System and ICD-10 codes. Information was collected from the hospital medical records using a standardised data collection tool. There were 98 admissions relating to 88 patients with neutropenic fever during the study period. The median age was 64 years (range: 23-85 years) with 57 (65%) females. Antibiotic selections consistent with the Australian guidelines were made in 88 (89%) admissions. The mean time to antibiotic administration was 279 min, with a median of 135 min (range: 15-5160 min). Antibiotics were administered within the recommended time frame in only eight (11%) admissions. Clinicians prescribed antibiotics in accordance with national guidelines; however, there were systemic inefficiencies which resulted in delayed antibiotic initiation. This has resulted in implementation of strategies to minimise delay.

Can Paramedics Safely Screen Patients for Transport to a Mental Health Crisis Center? Evidence from California

Research ObjectiveHistorically, ambulances have only transported patients to emergency departments (EDs). By 2017, at least 64 ambulance providers across the United States were transporting patients to facilities other than EDs, including outpatient mental health crisis centers, urgent care centers, and physician offices. In 2020, Medicare’s new Emergency Triage, Treat, and Transport Model will reimburse ambulance providers for transporting patients to alternative destinations. This study analyzed data from four ambulance providers in California to assess whether paramedics can accurately identify patients who can be treated safely in a mental health crisis center without first being transported to an ED for medical clearance.Study DesignData regarding transports to mental health crisis centers in the four communities were collected as part of an evaluation of 20 pilot projects in California that are testing multiple concepts for utilizing paramedics outside their traditional roles. All four projects have trained paramedics to implement a screening protocol to determine whether patients with mental health needs could be treated safely in a crisis center. Patients whose vital signs are within the parameters of the protocol and do not have symptoms of injury or physical illness are offered transport to a crisis center instead of an ED.Pilot projects used a standardized data collection tool to report data regarding the numbers of patients enrolled, the numbers transported to an ED within six hours of admission to a crisis center, reasons for ED transports, and the disposition of patients transported to an ED. Descriptive statistics were tabulated.Population Studied911 calls involving people with suspected mental illness.Principal FindingsThe four projects transported 3,087 patients to a mental health crisis center between September 2015 and September 2019. In all four communities, the majority of patients were uninsured or enrolled in Medicaid. Crisis centers accepted almost all patients transported to them, with rare exceptions related to resources (eg, not able to dispense methadone) and patient insurance type. Across all four projects, 65 patients (2%) were transported to an ED within six hours of admission to a crisis center. Patients were transported to an ED for a range of reasons including elevated vital signs, pain, seizure, urinary incontinence, and alcohol withdrawal. Among the 65 patients transported to an ED, 38 were treated in an ED and released, 21 were treated and transferred back to the crisis center or to an inpatient psychiatric facility, and 6 (0.2% of all patients) were admitted to a hospital for inpatient medical care.ConclusionsThe experience of California’s four pilot projects suggests that paramedics can apply a protocol to identify patients with suspected mental illness who can be treated safely in a mental health crisis center instead of an ED. Patients were rarely transported to an ED, and ED visits rarely resulted in an inpatient admission.Implications for Policy or PracticeTransporting patients experiencing a mental health crisis directly to a crisis center enables them to obtain mental health services more quickly and in a calmer, less costly environment than an ED and can help reduce ED overcrowding. States should consider requiring payers to reimburse ambulance providers for these transports.Primary Funding SourceCalifornia Health Care Foundation.

Development of a Standardized Data Collection Tool for Evaluation and Management of Coronavirus Disease 2019.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) is responsible for coronavirus disease 2019 (COVID-19), a disease that had not been previously described and for which clinicians need to rapidly adapt their daily practice. The novelty of SARS-CoV-2 produced significant gaps in harmonization of definitions, data collection, and outcome reporting to identify patients who would benefit from potential interventions.MethodsWe describe a multicenter collaboration to develop a comprehensive data collection tool for the evaluation and management of COVID-19 in hospitalized patients. The proposed tool was developed by a multidisciplinary working group of infectious disease physicians, intensivists, and infectious diseases/antimicrobial stewardship pharmacists. The working group regularly reviewed literature to select important patient characteristics, diagnostics, and outcomes for inclusion. The data collection tool consisted of spreadsheets developed to collect data from the electronic medical record and track the clinical course after treatments.ResultsData collection focused on demographics and exposure epidemiology, prior medical history and medications, signs and symptoms, diagnostic test results, interventions, clinical outcomes, and complications. During the pilot validation phase, there was <10% missing data for most domains and components. Team members noted improved efficiency and decision making by using the tool during interdisciplinary rounds.ConclusionsWe present the development of a COVID-19 data collection tool and propose its use to effectively assemble harmonized data of hospitalized individuals with COVID-19. This tool can be used by clinicians, researchers, and quality improvement healthcare teams. It has the potential to facilitate interdisciplinary rounds, provide comparisons across different hospitalized populations, and adapt to emerging challenges posed by the pandemic.

Standardization of an Ambulatory Hand Hygiene Observation Program

<h3>Background</h3> Hand hygiene (HH) is the single most important infection prevention practice to prevent the transmission of organisms to patients and employees in a healthcare setting. Hand hygiene compliance monitoring in our diverse pediatric ambulatory network has occurred since 2011 via staff observation or family feedback forms. A review of HH data collected in 2018 for 97 ambulatory locations raised concerns about data integrity and reliability. <h3>Methods</h3> In partnership with ambulatory network leaders, sixteen (16) locations were selected for targeted observations of the data collection process due to data integrity concerns including: data saturation due to over submission of observation data, consistent high compliance of sites, consistent low compliance of sites, failure to submit data, and incorrect submission of HH moments. Our HH program manager visited each site to interview and observe staff responsible for onsite HH monitoring. <h3>Results</h3> Each of the 16 locations had variable data collection processes. Targeted observations identified errors in the data submission process, an incomplete understanding of the number of observations to be performed, and inconsistencies in defining HH breaches. Qualitative interviews with staff elicited lack of formal training on how to observe, collect, and enter data. Staff also expressed discomfort providing feedback when HH breaches/misses are observed. A standard operating procedure (SOP) was developed to address inconsistency in knowledge and practice. Issues with submission and compliance inconsistencies were addressed through mistake proofing the database where collected HH data are submitted. <h3>Conclusions</h3> Comprehensive rounding of HH data collection across a diverse pediatric ambulatory network revealed need for standardized education and data collection methods and tools for ambulatory hand hygiene observers. Consistent communication and continued interfacing with staff and leadership has increased the capability of the collection of reliable HH data across a variety of ambulatory practice settings.

An Evaluation of Syndromic Surveillance-Related Practices Among Selected State and Local Health Agencies.

Syndromic surveillance consists of the systematic collection and use of near real-time data about health-related events for situational awareness and public health action. As syndromic surveillance programs continue to adopt new technologies and expand, it is valuable to evaluate these syndromic surveillance systems and practices to ensure that they meet public health needs. This assessment's aim is to provide recent information about syndromic surveillance systems and practice characteristics among a group of state and local health departments. Information was obtained between November 2017 and June 2018 through a telephone survey using an Office of Management and Budget-approved standardized data collection tool. Participants were syndromic surveillance staff from each of 31 state and local health departments participating in the National Syndromic Surveillance Program funded by the Centers for Disease Control and Prevention. Questions included jurisdictional experience, data sources and analysis systems used, syndromic system data processing characteristics, data quality verification procedures, and surveillance activities conducted with syndromic data. Practice-specific information such as types of systems and data sources used for syndromic surveillance, data quality monitoring, and uses of data for public health situational awareness (eg, investigating occurrences of or trends in diseases). The survey analysis revealed a wide range of experiences with syndromic surveillance. Participants reported the receipt of data daily or more frequently. Emergency department data were the primary data source; however, other data sources are being integrated into these systems. All health departments routinely monitored data quality. Syndromes of highest priority across the respondents for health events monitoring were influenza-like illness and drug-related syndromes. However, a wide variety of syndromes were reported as priorities across the health departments. Overall, syndromic surveillance was relevantly integrated into the public health surveillance infrastructure. The near real-time nature of the data and its flexibility to monitor different types of health-related issues make it especially useful for public health practitioners. Despite these advances, syndromic surveillance capacity, locally and nationally, must continue to evolve and progress should be monitored to ensure that syndromic surveillance systems and data are optimally able to meet jurisdictional needs.

Traumatic pneumothorax mapping using computed tomography to assess optimal area to scan with POCUS

It is traditionally taught that the location to place an ultrasound probe to detect a pneumothorax with point-of-care ultrasound (POCUS) is the anterior chest, given the theory that air will collect at the least dependent area in the supine patient. There is a wide variety of scanning protocols with varying accuracy and completeness. We sought to assess the optimal area to scan for diagnosing pneumothorax by mapping the location of traumatic pneumothorax on computed tomography (CT). Patients were selected after a retrospective cohort of adult patients who presented to a regional trauma center with a pneumothorax diagnosed on CT. Data were extracted using a standardized data collection tool, and 20% of charts were reviewed by two reviewers. Predefined zones were used to map the areas of pneumothoraces. Theoretical sensitivity and 95% confidence intervals (CIs) are reported. A total of 203 traumatic pneumothoraces were reviewed from 2006 to 2016. The majority of the pneumothoraces were found in an area defined by the para-sternal border and the mid-clavicular line from the inferior aspect of the clavicle to the physiologic lung point (liver on the right, heart on the left). The theoretical sensitivity for pneumothorax of scanning this area was 91.6% (95% CI, 86.9-95%). This study suggests any POCUS scanning protocol for traumatic pneumothorax should include an area from the inferior border of the clavicle at the parasternal border down to the liver or cardiac lung points and then the mid clavicular line down to the liver or cardiac lung points.

A cross-sectional study of USFDA warning letters issued for cGMP violations pertaining to medical devices

Most of the prior studies concentrated on warning letters issued for clinical investigation, Institutional review board, and infringement of promotional claims, no studies assessed the warning letters issued for infringements of Current Good Manufacturing Practice (cGMP) pertaining to medical devices. Hence, there is a need to carry out a crosssectional study of these warning letters. Publically available U.S. Food & Drug Administration (USFDA) letters under the law of the freedom of Information Act sent to the pharmaceutical company were accessed from the USFDA website. A standard data collection tool (Excel Spreadsheet) with all letters of warning issued from January 2008 to July 2018 was developed. Letters have been manually screened. Warning letters related to medical device breaches of cGMP were screened based on the letter's subject and content. Overall, 669 warning letters issued for medical device cGMP violations were reviewed between January 2008 and November 2018. From 2008 to 2013, there was a downward trend in the issuance of warning letters. The number of warning letters issued in 2014 was 101, followed by 106 in 2015, as the USFDA focused more on data integrity issues, while the number decreased to 53, 27, and 19, respectively, in 2016, 2017, and 2018. The highest number of warning letters were issued to manufacturers located in the USA (379), followed by Canada (52), and China (37). Section 820.30 of Title 21 CFR was found to be most violated with 603 infringements. This section represents the design control requirements for cGMP. Class 2 type of medical devices were found to be most violated (82%), followed by Class 3 with 7%. Only 32% of the companies responded to the warning letters although 52% Not Issued the closeout letter followed by 16% of the letters were considered as non-applicable letters. With the time, scientific developments and increased awareness of both regulatory authorities and industries/academic organizations, overall improvement are observed with significant decrease in the number of warning letters.

Antibiotic prescribing in patients who presented to the emergency department with dog bites: A descriptive review of current practice.

To describe the current practice of prophylactic antibiotic prescribing for patients presenting to the ED with a dog bite, and compare management against existing guidelines. We performed a descriptive retrospective study on all consecutive patients who presented to one tertiary teaching hospital and one regional district hospital in Southeast Queensland between 1 July 2017 and 30 June 2018 with a presentation of a dog bite. Data on demographics and management were collected from the electronic medical record using a standardised data collection tool. Risk factors supporting prophylaxis were taken from the electronic Therapeutic Guidelines. Of the 336 patients included for analysis, 299 received antibiotics, of which 23 were for established infection. A total of 276 (82% of overall cohort) received a prescription for prophylactic antibiotics, either in hospital (ED or admitting ward) and/or on discharge. Of the 178 patients who received prophylactic antibiotics in hospital, 91 (51.1%) received intravenous antibiotics. Of the patients who presented to ED without a previously established infection 271 (86.6%) received prophylactic antibiotics on discharge. Over one quarter (27.5%) of patients who were given prophylactic antibiotics did not meet any high-risk factors as outlined in guidelines. Prophylactic antibiotics are extensively used for patients with dog bites. There is scope to rationalise antibiotic use and route of antibiotic administration in patients with dog bites.

Importance of using standardised data collection tool to submit data for quality assurance and benchmarking

Importance of using standardised data collection tool to submit data for quality assurance and benchmarking

Prevalence and Factors Associated with Rotavirus Infection among Vaccinated Children Hospitalized for Acute Diarrhea in Mwanza City, Tanzania: A Cross Sectional Study

Introduction: Rotavirus infection is a leading cause of severe diarrhea culminating to dehydration among children under five years of age. Understanding trends and factors that could assist towards devising effective preventive strategies of Rotavirus infection beyond vaccination is crucial. Objectives: This study was done in an attempt to determine the prevalence and associated factors of Rotavirus infection among vaccinated children aged between 6 weeks and 24 months admitted with acute diarrhea Mwanza, Tanzania. Material and Methods: Across sectional study involving vaccinated children aged 6 weeks to 24 months was conducted in three selected hospitals from July 2017 to January 2018. Socio-demographic and other relevant clinical information were collected using a standardized data collection tool adopted from WHO Rotavirus surveillance tool. Rotavirus infection from the stool was detected using an enzyme immunoassay. Data were analyzed using STATA version 13. Results: A total of 301 vaccinated children with acute diarrhea with a median age of 12 [IQR: 8 - 17] months were enrolled. Nine (3.0%) and 292 (97.0%) had received one dose and two doses of Rotavirus vaccine, respectively. The prevalence of Rotavirus infection was 74 (24.6%) [95% CI: 20.0 - 29.8]. Independent predictors of Rotavirus infection were: dry season (OR 6.9; 95% CI: 2.9 - 16.0; p - 4.2; p = 0.043) and vomiting (OR 3.6; 95% CI 1.1 - 12.6; p = 0.045). Children with Rotavirus infection had a significantly shorter hospital stay than those without Rotavirus infection (3 [2 - 4] days versus 3 [3 - 5] days; p = 0.0297). Conclusions: The prevalence of Rotavirus infection has declined among vaccinated children in Mwanza, Tanzania with significant decrease in the hospital stay. Dry seasons, three or more children indwelling in the same house and vomiting were independent predictors of Rotavirus infection. There is a need to sustain the coverage of rotavirus vaccination in low-income countries in order to significantly reduce associated morbidity and mortality.

Frequency of Advanced Cardiac Life Support Medication Use and Association With Survival During In-hospital Cardiac Arrest

PurposeCardiopulmonary resuscitation is common in the United States, with >200,000 people experiencing an in-hospital cardiac arrest (IHCA) annually. Recent medication shortages have raised the question of the frequency and type of medication used during cardiac arrest resuscitation. We sought to determine the frequency and quantity of medications used during IHCA. MethodsThis retrospective, single-center, medical record review was performed at a large, urban teaching hospital. Adults ≥18 years old who had an IHCA with confirmed loss of pulse between January 2017 and March 2018 were identified. A standardized data collection tool was used to extract data from the electronic medical record. The primary outcome was the frequency and quantity of medications used during the IHCA. Secondary outcomes included median time to defibrillation and frequency of sodium bicarbonate use, including among patients with end-stage renal disease (ESRD). FindingsCriteria were met for 181 IHCA events. Demographic characteristics were 71% black, 17% white, mean age of 65 years, and 46% women. Epinephrine was given in 86.7% of the arrests, with a mean cumulative dose of 4.2 mg. Sodium bicarbonate was given in 63.5% of the arrests, with a mean cumulative dose of 9.0 g (1.9 amps). Amiodarone was given in 30.9% of the arrests, with a mean cumulative dose of 311.8 mg. Median time to defibrillation was 2 min (interquartile range, 1–4 min). Preexisting ESRD was present in 24.8% of patients, of whom 71.1% received sodium bicarbonate. Sodium bicarbonate administration was associated with a lower likelihood of survival to discharge (odds ratio [OR] = 0.27; 95% CI, 0.11–0.66) as well as a lower rate of return to spontaneous circulation (ROSC) (OR = 0.35; 95% CI, 0.13–0.95). Magnesium administration was associated with a lower rate of ROSC (OR = 0.39; 95% CI, 0.15–0.98). Of note, in patients with preexisting ESRD, no medications were significantly associated with a change in likelihood of survival to discharge or rate of ROSC. In patients without preexisting ESRD, magnesium was associated with a lower rate of ROSC (OR = 0.23; 95% CI, 0.08–0.77). ImplicationsWe found that in a hospital with established rapid response and code blue teams, numerous medications that are not recommended for routine use in cardiac arrest are still administered at significant frequencies. Furthermore, substantial amounts of drugs with known recent shortage are used in IHCA. Inc.

Diagnostic Value of Clinical and Laboratory Findings in Childhood Meningitis

Abstract Objective Acute meningitis in childhood is a serious infectious disease that requires immediate medical assessment to ensure appropriate treatment and healthy outcomes. The aim of this retrospective study was to evaluate clinical and laboratory findings in the diagnosis of acute meningitis in children. Materials and Methods Between February 2011 and March 2013, 258 children aged between 1 month and 18 years who were admitted to Konya Training and Research Hospital, Turkey, with clinically suspected meningitis and undergoing lumbar puncture were enrolled in the study. Patient charts were reviewed using a standardized data collection tool. Fifty-nine patients were excluded because of incomplete data or because they did not meet the enrollment criteria. Further statistical analysis was conducted on the remaining 199 patients. The diagnostic values of clinical and laboratory findings for acute meningitis were investigated. IBM SPSS 21.0 for Windows was used for the statistical analysis. Results Of the 199 patients (61.3% male; median age: 24 months), 101 (50.8%) were diagnosed with meningitis. A definitive diagnosis of bacterial meningitis was made in 16 patients, while 5 patients had probable bacterial meningitis. In addition, 80 patients diagnosed as aseptic meningitis and 47 of these patients had human enterovirus meningitis. Headache was more common in patients with meningitis. In patients without meningitis, the most common complaints were seizures or seizures accompanied by fever. Erythrocyte sedimentation rates (ESR), levels of cerebrospinal fluid protein, and cell counts in cerebrospinal fluid examinations were higher in the meningitis group. C-reactive protein, ESR, and procalcitonin higher than 22.55 mg/L, 36.5 mm/hour, and 6.795 mg/mL, respectively, indicated bacterial meningitis. Conclusion Our results showed that a combination of clinical and laboratory markers could facilitate recognition of bacterial meningitis in children.

Hepatitis C Screening in Community-Based Voluntary Counselling and Testing Services in Europe: An Observational Study from the COBATEST Network 2014-2018.

The COBATEST Network links community-based voluntary counselling and testing (CBVCT) services in the European region and collects testing data using standardised data collection tools. This study aims to describe the population being screened for anti-HCV antibodies in the COBATEST Network and identify risk factors associated with a reactive HCV screening test result in the period 2014–2018. Clients aged > 16 screened for HCV in the period 2014–2018 at one of the Network’s CBVCT services were included in the study. In the 5 year period, 7426 clients were screened for HCV in 22 centres in 10 countries and anti-HCV antibodies were detected in 113 (1.5%). The majority of people screened were aged 25–44, men who have sex with men (MSM), not HIV+ , not reporting a history of injecting drug use or sex work. Detection of anti-HCV antibodies was associated with being HIV + MSM (aOR 9.1, 95% CI 3.8; 21.8 compared to HIV-clients) and being a person who injects drugs (PWID, aOR 28.1, 95% CI 17.6; 45.0, compared to people with no history of injecting drug use). This study demonstrates that HIV-MSM with no history of injection drug use are using CBVCT services for HCV screening, but reactive screening test is associated with being HIV+ or PWID. The integration of HCV screening into the CBVCT service model may widen access to testing for populations that may otherwise not be tested.Electronic supplementary materialThe online version of this article (10.1007/s10900-019-00780-0) contains supplementary material, which is available to authorized users.

2022. Antibiotic Prescribing Behavior Among Surgeon

BackgroundA comparative study was conducted to evaluate prescribed antibiotic (AB) use in surgical patients with the Transtheoretical Model of Behavior (TTM) and Theory of Planned Behavior (TPB).MethodsA survey was conducted at Thammasat University Hospital from January 1 to 31, 2019. We evaluated the appropriateness of AB uses in the surgical department reported per the hospital’s Drug Use Evaluation (DUE) form. After review of the DUE, in-depth interviews were conducted to all prescribers to explore antibiotic prescribing behavior based on TTM vs. TPB, using a standardized data collection tool. Data collected included demographics, indications, appropriateness of AB uses, the individual prescriber’s behavior based on TTM and TPB. The five TTM stages of change were categorized precontemplation, contemplation, preparation, action, and maintenance. In TPB assessment, we evaluated attitude toward AB uses, subjective norm to AB uses behavior, and perceived behavior control of AB uses behavior.ResultsThere were 92 AB uses from 64 prescribers; 70 (70/92; 76%) used antibiotics appropriately. The majority of AB uses (62/92; 67%) were for treatment of infections. The most common reasons for inappropriate AB uses included inappropriate AB choices for treatment and prophylaxis of SSIs (n = 11, 50%) and inappropriate duration (n = 8, 36%). Physicians categorized in higher stages of TTM (action and maintenance) were strongly correlated with appropriate AB uses, while there was no correlation between the total TPB score and appropriateness of AB uses. By multivariate analysis, the TTM action and maintenance (aOR = 7.95; P = 0.02) and self-reported prescribers who considered patients as first priority (aOR = 4.02; P = 0.04) were associated with appropriate AB uses, while neurosurgical procedures (aOR = 0.13; P = 0.003) and antibiotic prescriptions for surgical prophylaxis (aOR = 0.15; P = 0.04) were associated with inappropriate AB uses.ConclusionAntibiotic prescribers categorized by TTM stages strongly correlated with appropriate AB uses. Additional studies to assess appropriate AB prescribing behavior, based on TTM stages of change, offer an opportunity to optimize surgical care.Disclosures All authors: No reported disclosures.