scholarly journals Going back to prospectively collected results with a probiotic for primary prevention of Clostridium difficile infection at a tertiary-care medical center

2018 ◽  
Vol 39 (11) ◽  
pp. 1392-1393
Author(s):  
Noam Ship ◽  
Serge Carrière
Keyword(s):  
Primary Prevention ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center

scholarly journals Development and Validation of a Clostridium difficile Infection Risk Prediction Model

2011 ◽  
Vol 32 (4) ◽  
pp. 360-366 ◽  
Author(s):  
Erik R. Dubberke ◽  
Yan Yan ◽  
Kimberly A. Reske ◽  
Anne M. Butler ◽  
Joshua Doherty ◽  
...  
Keyword(s):  
High Risk ◽  
Clostridium Difficile ◽  
Prediction Model ◽  
Risk Prediction ◽  
Predictive Accuracy ◽  
Medical Center ◽  
Tertiary Care ◽  
Risk Prediction Model ◽  
Brier Score ◽  
Tertiary Care Medical Center

Objective.To develop and validate a risk prediction model that could identify patients at high risk for Clostridium difficile infection (CDI) before they develop disease.Design and Setting.Retrospective cohort study in a tertiary care medical center.Patients.Patients admitted to the hospital for at least 48 hours during the calendar year 2003.Methods.Data were collected electronically from the hospital's Medical Informatics database and analyzed with logistic regression to determine variables that best predicted patients' risk for development of CDI. Model discrimination and calibration were calculated. The model was bootstrapped 500 times to validate the predictive accuracy. A receiver operating characteristic curve was calculated to evaluate potential risk cutoffs.Results.A total of 35,350 admitted patients, including 329 with CDI, were studied. Variables in the risk prediction model were age, CDI pressure, times admitted to hospital in the previous 60 days, modified Acute Physiology Score, days of treatment with high-risk antibiotics, whether albumin level was low, admission to an intensive care unit, and receipt of laxatives, gastric acid suppressors, or antimotility drugs. The calibration and discrimination of the model were very good to excellent (C index, 0.88; Brier score, 0.009).Conclusions.The CDI risk prediction model performed well. Further study is needed to determine whether it could be used in a clinical setting to prevent CDI-associated outcomes and reduce costs.

Effectiveness of Probiotic for Primary Prevention of Clostridium difficile Infection: A Single-Center Before-and-After Quality Improvement Intervention at a Tertiary-Care Medical Center

2018 ◽  
Vol 39 (07) ◽  
pp. 765-770 ◽  
Author(s):  
William E. Trick ◽  
Stephen J. Sokalski ◽  
Stuart Johnson ◽  
Kristen L. Bunnell ◽  
Joseph Levato ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Primary Prevention ◽  
Clostridium Difficile ◽  
Incidence Rate ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Quality Improvement Intervention ◽  
Tertiary Care Medical Center ◽  
Before And After ◽  
Improvement Intervention

OBJECTIVETo evaluate probiotics for the primary prevention of Clostridium difficile infection (CDI) among hospital inpatients.DESIGNA before-and-after quality improvement intervention comparing 12-month baseline and intervention periods.SETTINGA 694-bed teaching hospital.INTERVENTIONWe administered a multispecies probiotic comprising L. acidophilus (CL1285), L. casei (LBC80R), and L. rhamnosus (CLR2) to eligible antibiotic recipients within 12 hours of initial antibiotic receipt through 5 days after final dose. We excluded (1) all patients on neonatal, pediatric and oncology wards; (2) all individuals receiving perioperative prophylactic antibiotic recipients; (3) all those restricted from oral intake; and (4) those with pancreatitis, leukopenia, or posttransplant. We defined CDI by symptoms plus C. difficile toxin detection by polymerase chain reaction. Our primary outcome was hospital-onset CDI incidence on eligible hospital units, analyzed using segmented regression.RESULTSThe study included 251 CDI episodes among 360,016 patient days during the baseline and intervention periods, and the incidence rate was 7.0 per 10,000 patient days. The incidence rate was similar during baseline and intervention periods (6.9 vs 7.0 per 10,000 patient days; P=.95). However, compared to the first 6 months of the intervention, we detected a significant decrease in CDI during the final 6 months (incidence rate ratio, 0.6; 95% confidence interval, 0.4–0.9; P=.009). Testing intensity remained stable between the baseline and intervention periods: 19% versus 20% of stools tested were C. difficile positive by PCR, respectively. From medical record reviews, only 26% of eligible patients received a probiotic per the protocol.CONCLUSIONSDespite poor adherence to the protocol, there was a reduction in the incidence of CDI during the intervention, which was delayed ~6 months after introducing probiotic for primary prevention.Infect Control Hosp Epidemiol 2018;765–770

Dilemmas in the diagnosis of clostridium difficile at a tertiary care medical center

1991 ◽  
Vol 19 (2) ◽  
pp. 109
Author(s):  
D. Crimmins ◽  
B. Raucher ◽  
S. Marchione ◽  
F.W. McKinley ◽  
B. Dillon
Keyword(s):  
Clostridium Difficile ◽  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center

Abstract 14217: Subsequent Sustained Ventricular Arrhythmia in Patients With Transposition of the Great Arteries Undergoing Device Implantation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gautam V Shah ◽  
Alex Grubb ◽  
Richard A Krasuski
Keyword(s):  
Primary Prevention ◽  
Ventricular Arrhythmia ◽  
Secondary Prevention ◽  
Ventricular Dysfunction ◽  
Medical Center ◽  
Heart Defects ◽  
Tertiary Care ◽  
Icd Implantation ◽  
Atrioventricular Valve Regurgitation ◽  
Tertiary Care Medical Center

Introduction: Current guidelines recommend prophylactic implantable cardioverter-defibrillator (ICD) for patients with an ejection fraction <35%. Whether this applies to patients with transposition of the great arteries (TGA) and ≥moderately depressed systemic ventricular dysfunction is uncertain. Methods: From an electrophysiologic database at a large, tertiary care medical center, we identified 71 patients with TGA (40 D-TGA and 31 L-TGA) receiving an implantable cardiac device from 1996-2014. Electronic and paper medical records were fully reviewed and device interrogation data was collected to assess the frequency of sustained ventricular arrhythmia. Results: Patients were 31±15 years of age, 32% were women, 53% had ≥moderate systemic ventricular dysfunction and 38% had ≥moderate systemic atrioventricular valve regurgitation. Sixteen (23%) had an ICD placed initially. Of the 55 with a pacemaker as their first device 9 were later upgraded to an ICD for primary prevention of sudden death and 1 patient had sustained arrhythmia and an ICD was placed afterwards. Thus, of the 26 patients who eventually underwent ICD implant, 20 received it for primary prevention and 6 for secondary prevention. Interrogation follow-up data spanned 214 patient-years for primary prevention and 41 patient-years for secondary prevention. Only 2 patients received ICD discharges in the primary prevention group and both were inappropriate. In the secondary prevention group, 67% of patients underwent appropriate ICD discharge (0.39 shocks per patient-year, p<0.001 compared to primary prevention). Patients with ICD discharge were older (49±5 vs. 30±15 years, p=0.011) and more likely to have concomitant heart defects (100% vs. 30%, p=0.011). Conclusion: Patients with TGA and sustained ventricular arrhythmia are at high risk for subsequent events and benefit from ICD implantation. The role of prophylactic ICD implant in this patient population, however, remains uncertain.

scholarly journals EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Factors Associated ◽  
Tertiary Care Medical Center

scholarly journals Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

2021 ◽  
Vol 09 (06) ◽  
pp. E888-E894
Author(s):  
Nichol S. Martinez ◽  
Sumant Inamdar ◽  
Sheila N. Firoozan ◽  
Stephanie Izard ◽  
Calvin Lee ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Medical Center ◽  
Tertiary Care ◽  
Plastic Stents ◽  
Metal Stents ◽  
Limited Data ◽  
Sems Group ◽  
Tertiary Care Medical Center ◽  
Stent Type ◽  
Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

Utility of electroencephalography: Experience from a U.S. tertiary care medical center

2016 ◽  
Vol 127 (10) ◽  
pp. 3335-3340 ◽  
Author(s):  
Kapil Gururangan ◽  
Babak Razavi ◽  
Josef Parvizi
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center
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