Three-month Observational Study Research Articles

Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps

This study describes individual cancer patients' nonuse of extended-release or long-acting (ER/LA) opioids, including periods of gap between opioid doses taken. Secondary analysis of a three-month observational study of prescribed ER/LA opioids monitored using electronic pill caps. Two outpatient oncology clinics of a large health system in the Mid-Atlantic region. Inclusion was based on self-identified African Americans and whites, at least 18 years old, diagnosed with solid tumors or multiple myeloma. For the current analysis, the additional inclusion criterion was prescription of an oral ER/LA opioid for cancer pain to be taken around the clock. The electronic monitoring period for each study participant was partitioned into intervals of days between days with one or more openings (using medication event monitoring systems) representing rates of ER/LA opioid nonuse over consecutive days and over time. Of the sample (N = 109), two-thirds of the cancer patients had some nonuse of prescribed ER/LA opioids, with one in four having nonuse during 31.5-87.5% of their electronic-monitoring periods. Nonuse over periods of five or more, six or more, and seven or more consecutive days occurred for 37.6%, 34.9%, and 30.3% of the participants, respectively. About one in three ambulatory cancer patients in this study had substantial gaps between days of ER/LA opioid use, potentially resulting in risk of overdose depending upon the prescribed ER/LA opioid type, dose, and length of the time the opioid was stopped and resumed at the previous dose. This phenomenon has received little to no attention in the opioid safety discourse.

Hand Hygiene in Pediatric Emergency Care Unit in a Teaching Hospital in Benin

Introduction: Appropriate hand hygiene reduces healthcare associated infections (HCAI). The present study was an attempt to determine the real knowledge and practices of healthcare professionals of pediatric emergency care unit in Benin. Methods: This was a three-month observational study. First a trained interviewer observed both the premises and the healthcare professionals during their administering treatment, without their knowledge. Second, their level of knowledge about HCAI was examined using a self-administered questionnaire. Finally, bacteria were cultured/measured from their hands before and after hand-washing through swab samples. Outcome: The modes of microorganism transmission were poorly known (21.6%), but knowledge about the 5 moments for hand hygiene was satisfactory (84.1%). Hand hygiene adherence rate was 6.9% in the study population. Simple hand-washing was prevalent (82%). The healthcare professionals did not adhere to the recommended duration for hand-washing. The required hand-washing equipment was inadequate, and alcohol-based handrub dispenser was unavailable. Microorganism isolated from healthcare professionals before hand-washing included Klebsiella pneumonia and Enterobacter Cloacae. After hand-washing, the transient flora decreased. Conclusion: Hand hygiene adherence rate is low in the study population. An immediate action is required to improve observance of hand-washing. This may include: training healthcare professionals, displaying visual behavior reminder posters, providing alcohol-based handrub.

A comparison of passive and active estimates of sleep in a cohort with schizophrenia

Sleep abnormalities are considered an important feature of schizophrenia, yet convenient and reliable sleep monitoring remains a challenge. Smartphones offer a novel solution to capture both self-reported and objective measures of sleep in schizophrenia. In this three-month observational study, 17 subjects with a diagnosis of schizophrenia currently in treatment downloaded Beiwe, a platform for digital phenotyping, on their personal Apple or Android smartphones. Subjects were given tri-weekly ecological momentary assessments (EMAs) on their own smartphones, and passive data including accelerometer, GPS, screen use, and anonymized call and text message logs was continuously collected. We compare the in-clinic assessment of sleep quality, assessed with the Pittsburgh Sleep Questionnaire Inventory (PSQI), to EMAs, as well as sleep estimates based on passively collected accelerometer data. EMAs and passive data classified 85% (11/13) of subjects as exhibiting high or low sleep quality compared to the in-clinic assessments among subjects who completed at least one in-person PSQI. Phone-based accelerometer data used to infer sleep duration was moderately correlated with subject self-assessment of sleep duration (r = 0.69, 95% CI 0.23–0.90). Active and passive phone data predicts concurrent PSQI scores for all subjects with mean average error of 0.75 and future PSQI scores with a mean average error of 1.9, with scores ranging from 0–14. These results suggest sleep monitoring via personal smartphones is feasible for subjects with schizophrenia in a scalable and affordable manner.

Current practice in continuous renal replacement therapy: An epidemiological multicenter study

ObjectiveThe aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. MethodsA non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. Inclusion criteria: patients aged ≥16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. ResultsA total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. ConclusionsCurrent practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT.

Manejo actual de las terapias continuas de reemplazo renal: Estudio epidemiológico multicéntrico

ObjectiveThe aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. MethodsA non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. Inclusion criteria: patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. ResultsA total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. ConclusionsCurrent practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT.

The slaughter of increased numbers of pregnant cows in Tanga abattoir, Tanzania: A cause for concern?

Information on the level of foetal wastage in slaughtered cattle in Tanzania is limited. A three-month observational study (April – June 2014) of animals slaughtered at the Tanga abattoir in Tanga region, Tanzania was carried out to determine the number of pregnant cows slaughtered. The total number of cattle slaughtered during the study period was 3643, representing a monthly kill average of 1214 and a daily kill average of 40. Over 98% of the cattle presented to the abattoir for slaughter were local breed (Tanzania shorthorn zebu) and most were above 3 years of age. Improved breeds of cattle represented only 1.3% of all slaughters. Of the cattle slaughtered, 2256 (61.9%) were female and 1387 (38.1%) were male. A total of 655 slaughtered cows were pregnant, representing a foetal wastage of 29.1%. Of the 655 recovered foetuses, 333 (50.8%) were male and 322 (49.2%) were female. Of the recovered foetuses, 25.8% were recovered in the first, 42.7% in the second and 31.6% in the third trimester. This study indicates cases of significant foetal losses, negatively impacting future replacement stock as a result of the slaughter of pregnant animals. The indiscriminate slaughter of pregnant cows suggests that existing animal welfare legislation is not sufficiently enforced and routine veterinary ante-mortem inspection of trade animals is failing to prevent the high level of foetal wastage.

Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS®) in a three-month observational study

The Patient-Reported Outcomes Measurement Information System (PROMIS®) is an NIH Roadmap initiative devoted to developing better measurement tools for assessing constructs relevant to the clinical investigation and treatment of all diseases—constructs such as pain, fatigue, emotional distress, sleep, physical functioning, and social participation. Following creation of item banks for these constructs, our priority has been to validate them, most often in short-term observational studies. We report here on a three-month prospective observational study with depressed outpatients in the early stages of a new treatment episode (with assessments at intake, one-month follow-up, and three-month follow-up). The protocol was designed to compare the psychometric properties of the PROMIS depression item bank (administered as a computerized adaptive test, CAT) with two legacy self-report instruments: the Center for Epidemiological Studies Depression scale (CESD; Radloff, 1977) and the Patient Health Questionnaire (PHQ-9; Spitzer et al., 1999). PROMIS depression demonstrated strong convergent validity with the CESD and the PHQ-9 (with correlations in a range from .72 to .84 across all time points), as well as responsiveness to change when characterizing symptom severity in a clinical outpatient sample. Identification of patients as “recovered” varied across the measures, with the PHQ-9 being the most conservative. The use of calibrations based on models from item response theory (IRT) provides advantages for PROMIS depression both psychometrically (creating the possibility of adaptive testing, providing a broader effective range of measurement, and generating greater precision) and practically (these psychometric advantages can be achieved with fewer items—a median of 4 items administered by CAT—resulting in less patient burden).

Untersuchung in Berliner Geburtskliniken und Geburtshäusern über den Stillbeginn und mögliche Einflussfaktoren

The aim of this study was to collect information on and to evaluate the impact of the timing of first suckling and breast-feeding initiation in Berlin and to assess the practicability and acceptance of using a short questionnaire to collect breast-feeding data in hospitals and birth centres. A three-month observational study was conducted in 19 maternity units and 4 birth centres, using a short questionnaire to collect quantitative data on the timing of first suckling and breast-feeding from mother-child pairs on the day of discharge. The data indicate a breast-feeding rate of 96.1% at discharge. Infants born in birth centres were more frequently put to their mother's breast within the first hour after birth (p<0.05), and were more frequently mainly (p<0.05) or exclusively (p<0.01) breast-fed at discharge than infants born in hospitals. Hospitals' breast-feeding policies (i.e., following the 'ten steps to successful breast-feeding') were not associated with a higher prevalence of early first suckling and any breast-feeding at discharge, but rather with exclusivity of breastfeeding (p<0.001). Breast-feeding initiation rates are satisfactorily high in Berlin. Rates of early first suckling and (exclusive) initial breast-feeding are highest in birth centres. No consistent association was found between hospitals' breast-feeding policy and initial breast-feeding variables. The questionnaire was well accepted and is deemed suitable for monitoring purposes.