Potential Ceiling Effect of Healthcare Worker Influenza Vaccination on the Incidence of Nosocomial Influenza Infection

2016 ◽  
Vol 37 (7) ◽  
pp. 840-844 ◽  
Author(s):  
Brandon Dionne ◽  
Meghan Brett ◽  
Karissa Culbreath ◽  
Renee-Claude Mercier
Keyword(s):  
Influenza Vaccination ◽  
Healthcare Worker ◽  
Vaccination Coverage ◽  
Medical Center ◽  
Influenza Infection ◽  
Fluorescent Antibody ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Cross Sectional

OBJECTIVETo evaluate the effect of healthcare worker (HCW) influenza vaccination on the incidence of nosocomial influenzaDESIGNRetrospective cross-sectional studySETTINGA 550-bed tertiary-care academic medical centerMETHODSAll admitted patients with a direct fluorescent antibody (DFA) or polymerase chain reaction (PCR) assay positive for influenza ordered between October 1 and May 31 from 2010 to 2015 were eligible for inclusion. Nosocomial influenza was defined as a positive influenza test collected ≥48 hours after admission in patients without influenza-like illness present within 24 hours of admission. Relative nosocomial influenza frequency was calculated by dividing the number of nosocomial cases by the total number of admitted patients with influenza for each season. A univariate logistic regression was used to determine the association between HCW influenza vaccination coverage and nosocomial influenza.RESULTSOver 5 seasons, 533 patients had positive influenza tests during their hospitalization; 29 of these patients (5.4%) acquired influenza during their hospitalization. HCW vaccination coverage increased over the 5 seasons from 47% to 90% (P<.001). Despite an initial decrease in relative nosocomial influenza frequency during the first year (9% to 4.9%), subsequent seasons failed to show an additional decrease in nosocomial infections (4.3%, 5.2%, and 4.8%, respectively); the overall decrease in nosocomial influenza from the first season to the final season was not significant (P=.282). No association was detected between HCW vaccination coverage and nosocomial influenza (odds ratio [OR], 0.990; 95% confidence interval [CI], 0.970–1.011).CONCLUSIONHCW vaccination >50% may not have a significant effect on nosocomial influenza.Infect Control Hosp Epidemiol 2016;37:840–844

scholarly journals Evaluation of Antimicrobial Therapy Orders Circumventing an Antimicrobial Stewardship Program: Investigating the Strategy of “Stealth Dosing”

2007 ◽  
Vol 28 (05) ◽  
pp. 551-556 ◽  
Author(s):  
Lori Ann LaRosa ◽  
Neil O. Fishman ◽  
Ebbing Lautenbach ◽  
Ross J. Koppel ◽  
Knashawn H. Morales ◽  
...  
Keyword(s):  
Study Design ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Stewardship Program ◽  
Prior Approval

Objective. Prior-approval antimicrobial stewardship programs (ASPs) improve patient outcomes and decrease antimicrobial resistance. These benefits would be limited if physicians circumvented ASP efforts. We evaluated whether prescribers wait until after the prior-approval period to order restricted antimicrobial therapy that is in conflict with guidelines or unnecessary. Design. A cross-sectional study design and a retrospective cohort study design. Setting. A tertiary care, academic medical center with a prior-approval ASP that was active between 8 AM and 10 PM. Methods. We evaluated whether there was an increase in the proportion of orders for antimicrobial therapy that involve restricted (vs nonrestricted) antimicrobials during the first hour that the ASP is inactive (ie, the first hour that prior approval is not required), compared with the remainder of the day. We also evaluated whether restricted antimicrobial therapy ordered during this first hour is less likely to be continued when the ASP becomes active the next day, compared with that ordered during the preceding hour. Results. A greater proportion of the antimicrobial therapy orders placed between 10:00 PM and 10:59 PM were for restricted agents, compared with orders placed during other periods (57.0% vs 49.9%; P = .02). Surgical patients for whom antimicrobial therapy orders were placed between 10:00 PM and 10:59 PM were less likely to have that antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (60.0% vs 98.1%; P &lt;.001). Nonsurgical patients whose therapy orders were placed between 10:00PM and 10:59 PM were also less likely to have the ordered antimicrobial therapy continued, compared with patients whose therapy was ordered between 9:00 PM and 9:59 PM (70.8% vs 84.2%; P = .01). Conclusion. Physicians avoid having to obtain prior approval for therapy involving restricted antimicrobials by waiting until restrictions are no longer active to place orders. Compared with restricted antimicrobial therapy ordered when the ASP is active, these courses of therapy are less often continued by the ASP, suggesting that they are more likely to be in conflict with guidelines or unnecessary.

Compliance and Adherence to Treatment in Hypertensive Patients in different Tertiary Care Hospitals in Lahore

2021 ◽  
Vol 15 (8) ◽  
pp. 1858-1860
Author(s):  
Junaid Mushtaq ◽  
Israr-Ul- Haq ◽  
Waqas Mahmood ◽  
Mujtaba H. Siddiqui ◽  
Atiq Ahmad ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Educational Status ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Adherence To Treatment ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Hospital Doctors ◽  
Tertiary Care Hospitals

Aim: To determine the factors that affect compliance and adherence to medications of hypertensive patients visiting OPD clinics. Study design: Descriptive-cross sectional study. Place and duration of study: Department of Medicine, Unit 1, Lahore General Hospital, Doctors Hospital & Medical Center and Farooq Hospital Lahore from 1st January 2019 to 31st December 2019. Methodology: One hundred and sixty five patients with hypertension were handed over questionnaire socio-demographic, compliance and adherence were recorded. Results: Patients who maintained BP charting were only 13(7.9%) and those without BP charting were 152(92.1%). Patients taking regular medications were only 20(12.1%). Forgetfulness in taking medications was found in 47.3% of patients. 20.6% of patients were unable to purchase medicines because of financial reasons. Thirty two patients (19.4%) thought that they should not take medicines as they were not having any symptoms. Conclusion: Major causes of non-adherence were expense of medications, lack of symptoms, lack of money, forgetfulness, lack of awareness due to poor educational status and nature of job. Keywords: Compliance, Adherence, Medications, Hypertension, Forgetfulness

scholarly journals Trends, Coverage and Influencing Determinants of Influenza Vaccination in the Elderly: A Population-Based National Survey in Spain (2006–2017)

Vaccines ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 327
Author(s):  
Silvia Portero de la Cruz ◽  
Jesús Cebrino
Keyword(s):  
Influenza Vaccination ◽  
Chronic Diseases ◽  
Vaccination Coverage ◽  
Public Health Problem ◽  
Risk Groups ◽  
The Elderly ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Significant Public Health

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to report the coverage of influenza vaccination in Spain among the population aged ≥65 years and high-risk groups for suffering chronic diseases, to analyze the time trends from 2006 to 2017 and to identify the factors which affect vaccination coverage. A nationwide cross-sectional study was conducted including 20,753 non-institutionalized individuals aged ≥65 years who had participated in the Spanish National Health Surveys in 2006, 2011/2012, and 2017. Sociodemographic, health-related variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with influenza vaccination. Influenza vaccination coverage was 60%. By chronic condition, older people with high cholesterol levels and cancer had the lowest vaccination coverage (62.41% and 60.73%, respectively). This coverage declined from 2006 to 2017 in both groups. Higher influenza vaccination was associated with males, Spanish nationality, normal social support perceived, polypharmacy, worse perceived health, participation in other preventive measures, and increasing age and the number of chronic diseases.

scholarly journals A Study on Knowledge Towards Brain Death among Residents in Indonesia

2020 ◽  
Vol 56 (2) ◽  
pp. 140
Author(s):  
Asra Al Fauzi ◽  
Christrijogo Sumartono Waloejo ◽  
Abdulloh Machin ◽  
Muhammad Ja'far Shodiq
Keyword(s):  
Brain Death ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Research Subjects ◽  
Cross Sectional ◽  
Academic Medical ◽  
Center Hospital ◽  
Level 3 ◽  
Level 2

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

scholarly journals Essential Oil Olfactory Test: Comparison of Affordable Rapid Olfaction Measurement Array (AROMA) to Sniffin’ Sticks 12

OTO Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 2473974X2096246
Author(s):  
Jennifer Li ◽  
Gracie Palmer ◽  
Suraj Shankar ◽  
Mark R. Villwock ◽  
Alexander G. Chiu ◽  
...  
Keyword(s):  
Essential Oil ◽  
Medical Center ◽  
Low Cost ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Moderate Correlation ◽  
Cross Sectional ◽  
Percent Correct ◽  
Olfactory Testing ◽  
Snot 22

Objectives To further demonstrate the validity of Affordable Rapid Olfaction Measurement Array (AROMA), an essential oil−based smell test, and compare it to the Sniffin’ Sticks 12 Test (SST12). Study Design Prospective cross-sectional study. Setting Academic medical center. Methods Fifty healthy individuals without sinonasal disease were recruited to the study. AROMA has been previously validated against the University of Pennsylvania Smell Identification Test. The current study tests 2 additional higher concentrations to increase the ability to detect olfactory reserve. Healthy participants completed AROMA, SST12, Sino-Nasal Outcome Test (SNOT-22), and Questionnaire of Olfactory Disorders (QoD). Spearman correlations were used to evaluate AROMA, SST, SNOT-22, and QoD. Results AROMA demonstrated strong test-retest reliability ( r = 0.757, P < .01). AROMA showed a moderate correlation to SST12 (ρ = 0.412, P < .01). Age and SNOT-22 were significantly correlated ( P < .05) with AROMA (ρ = −0.547, −0.331, respectively), and age was weakly correlated with SST (ρ = −0.377, P < .01). Median percent correct scores were as follows: SST12 identification, 92%; AROMA detection, 90%; and AROMA identification, 81%. Median correct odor identification of AROMA concentrations at 1×, 2×, 4×, and 8× were 64%, 75%, 92%, and 92%, respectively. Conclusion AROMA has a moderate correlation with SST12. AROMA is more strongly correlated than SST12 to age and SNOT-22. AROMA’s stronger correlation with subjective olfactory status, low cost, and adaptability may help remove barriers to routine olfactory testing in the clinic.

scholarly journals Can online self-reports assist in real-time identification of influenza vaccination uptake? A cross-sectional study of influenza vaccine-related tweets in the USA, 2013–2017

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024018 ◽  
Author(s):  
Xiaolei Huang ◽  
Michael C Smith ◽  
Amelia M Jamison ◽  
David A Broniatowski ◽  
Mark Dredze ◽  
...  
Keyword(s):  
Social Media ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Real Time ◽  
Vaccination Coverage ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Twitter Data ◽  
The Usa

IntroductionThe Centers for Disease Control and Prevention (CDC) spend significant time and resources to track influenza vaccination coverage each influenza season using national surveys. Emerging data from social media provide an alternative solution to surveillance at both national and local levels of influenza vaccination coverage in near real time.ObjectivesThis study aimed to characterise and analyse the vaccinated population from temporal, demographical and geographical perspectives using automatic classification of vaccination-related Twitter data.MethodsIn this cross-sectional study, we continuously collected tweets containing both influenza-related terms and vaccine-related terms covering four consecutive influenza seasons from 2013 to 2017. We created a machine learning classifier to identify relevant tweets, then evaluated the approach by comparing to data from the CDC’s FluVaxView. We limited our analysis to tweets geolocated within the USA.ResultsWe assessed 1 124 839 tweets. We found strong correlations of 0.799 between monthly Twitter estimates and CDC, with correlations as high as 0.950 in individual influenza seasons. We also found that our approach obtained geographical correlations of 0.387 at the US state level and 0.467 at the regional level. Finally, we found a higher level of influenza vaccine tweets among female users than male users, also consistent with the results of CDC surveys on vaccine uptake.ConclusionSignificant correlations between Twitter data and CDC data show the potential of using social media for vaccination surveillance. Temporal variability is captured better than geographical and demographical variability. We discuss potential paths forward for leveraging this approach.

Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation

2017 ◽  
Vol 26 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Carolyn Bradley ◽  
Michelle Keithline ◽  
Meghan Petrocelli ◽  
Mary Scanlon ◽  
Janet Parkosewich
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Child ◽  
Cross Sectional Study ◽  
Sources Of Information ◽  
Cross Sectional ◽  
Family Presence ◽  
Adult Sibling ◽  
Academic Medical

Background Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. Objective To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. Methods A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. Results About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20–45 years old) were 6.28 times more likely than those ≥ 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence. Conclusion Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.

scholarly journals Otolaryngologists and the Early Diagnosis of Mucopolysaccharidoses: A Cross-Sectional Study

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 187 ◽  
Author(s):  
Danielle de Araujo Torres ◽  
Anneliese Lopes Barth ◽  
Mariana Pires de Mello Valente ◽  
Paulo Pires de Mello ◽  
Dafne Dain Gandelman Horovitz
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Inborn Errors ◽  
Cross Sectional ◽  
Academic Medical ◽  
Fatal Course ◽  
History Of ◽  
Nose And Throat

Mucopolysaccharidoses (MPS) are a group of inborn errors of metabolism with an aggressive and usually fatal course. Therefore, early treatment is essential because the involvement of head and neck structures is almost always present in MPS. Our study aimed to retrospectively assess—via a chart review and a survey of caregivers—the history of ear, nose and throat (ENT) symptoms, the number of otolaryngology visits prior to diagnosis, and whether otolaryngologists diagnosed the disease in a cohort of MPS patients followed at an academic medical center. Twenty-three patients were evaluated. Age at diagnosis ranged from 0.2 to 33.0 years (median, 3.2 years). Prior to being diagnosed with MPS, 20/23 (87%) patients presented with at least one episode of otalgia, airway disorder, sleep disturbance, speech delay or suspected hearing loss. One patient had an adenotonsillectomy with paracentesis of tympanic membranes. Ten of the 23 patients (43%) were seen by an otolaryngologist before the diagnosis of MPS, none of which had the disease suspected during these visits. Notwithstanding limitations, our results suggest that increased awareness of MPS among otolaryngologists may allow for earlier diagnosis and better management of these patients.

Prognostic Awareness, Disease and Palliative Understanding Among Caregivers of Patients With Dementia

2019 ◽  
Vol 37 (9) ◽  
pp. 683-691 ◽  
Author(s):  
Jennifer Gabbard ◽  
Devin Johnson ◽  
Greg Russell ◽  
Shenita Spencer ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Medical Center ◽  
Functional Limitations ◽  
Academic Medical Center ◽  
Symptom Burden ◽  
Routine Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Academic Medical ◽  
Trends Over Time

Background: Persons with dementia (PwD) often have significant cognitive deficits and functional limitations, requiring substantial caregiver assistance. Given the high symptom burden and terminal nature of dementia, good prognostic awareness and integration of palliative care (PC) is needed. Objective: To evaluate prognostic awareness, disease, and PC understanding among caregivers of PwD and to assess for improvements in routine care. Design: A cross-sectional study of 2 cohorts at a single-academic medical center. Surveys were mailed to 200 caregivers of PwD in 2012 (cohort 1). Surveys were sent to new subset of caregivers of PwD (n = 80) in 2018 (cohort 2) to assess trends over time. Results: A total of 154 of caregivers completed the survey (response rate 55%). Compared to 2012, a higher proportion of caregivers in 2018 reported having conversations about prognosis with PwD’s physicians (25% in 2012 vs 45% in 2018; P = .027). However, a large percentage (43% in 2012 and 40% in 2018) of caregivers reported no understanding of the PwD’s prognosis. Despite most stating dementia was not curable, only 39% in 2012 and 52% in 2018 ( P = .015) understood that dementia was a terminal disease. In addition, only 32% in 2012 and 40% in 2018 ( P = .39) felt that they were knowledgeable about PC. Conclusions: Prognostic discussions between caregivers of PwD and the PwD’s physicians may be occurring more often; however, a high percentage of caregivers report a poor understanding about the terminal nature of dementia and the role of PC.

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