Persistent Environmental Contamination with USA300 Methicillin-ResistantStaphylococcus aureusand Other Pathogenic Strain Types in Households withS. aureusSkin Infections

2014 ◽  
Vol 35 (11) ◽  
pp. 1373-1382 ◽  
Author(s):  
Samantha J. Eells ◽  
Michael Z. David ◽  
Alexis Taylor ◽  
Nancy Ortiz ◽  
Neha Kumar ◽  
...  
Keyword(s):  
Los Angeles ◽  
Environmental Contamination ◽  
Household Member ◽  
Medical Centers ◽  
Academic Medical ◽  
Adults And Children ◽  
Baseline Factors ◽  
Strain Type ◽  
Prospective Longitudinal

Objective.To understand the genotypic spectrum of environmental contamination ofStaphylococcus aureusin households and its persistenceDesign.Prospective longitudinal cohort investigation.Setting.Index participants identified at 2 academic medical centers.Participants.Adults and children withS. aureusskin infections and their household contacts in Los Angeles and Chicago.Methods.Household fomites were surveyed for contamination at baseline and 3 months. All isolates underwent genetic typing.Results.We enrolled 346 households, 88% of which completed the 3-month follow-up visit.S. aureusenvironmental contamination was 49% at baseline and 51% at 3 months. Among households with a USA300 methicillin-resistantS. aureus(MRSA) body infection isolate, environmental contamination with an indistinguishable MRSA strain was 58% at baseline and 63% at 3 months. Baseline factors associated with environmental contamination by the index subject’s infection isolate were body colonization by any household member with the index subject’s infection isolate at baseline (odds ratio [OR], 10.93 [95% confidence interval (CI), 5.75–20.79]), higher housing density (OR, 1.47 [95% CI, 1.10–1.96]), and more frequent household fomite cleaning (OR, 1.62 [95% CI, 1.16–2.27]). Household environmental contamination with the index subject’s infection strain at 3 months was associated with USA300 MRSA and a synergistic interaction between baseline environmental contamination and body colonization by any household member with the index subject’s infection strain.Conclusions.We found that infectingS. aureusisolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenicS. aureusstrain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.Infect Control Hosp Epidemiol2014;35(11):1373–1382

Persistent Environmental Contamination with USA300 Methicillin-Resistant Staphylococcus aureus and Other Pathogenic Strain Types in Households with S. aureus Skin Infections

2014 ◽  
Vol 35 (11) ◽  
pp. 1373-1382 ◽  
Author(s):  
Samantha J. Eells ◽  
Michael Z. David ◽  
Alexis Taylor ◽  
Nancy Ortiz ◽  
Neha Kumar ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Los Angeles ◽  
Environmental Contamination ◽  
Household Member ◽  
Skin Infections ◽  
Methicillin Resistant ◽  
Medical Centers ◽  
Academic Medical ◽  
Adults And Children ◽  
Prospective Longitudinal

Objective.To understand the genotypic spectrum of environmental contamination ofStaphylococcus aureusin households and its persistenceDesign.Prospective longitudinal cohort investigation.Setting.Index participants identified at 2 academic medical centers.Participants.Adults and children withS. aureusskin infections and their household contacts in Los Angeles and Chicago.Methods.Household fomites were surveyed for contamination at baseline and 3 months. All isolates underwent genetic typing.Results.We enrolled 346 households, 88% of which completed the 3-month follow-up visit.S. aureusenvironmental contamination was 49% at baseline and 51% at 3 months. Among households with a USA300 methicillin-resistantS. aureus(MRSA) body infection isolate, environmental contamination with an indistinguishable MRSA strain was 58% at baseline and 63% at 3 months. Baseline factors associated with environmental contamination by the index subject’s infection isolate were body colonization by any household member with the index subject’s infection isolate at baseline (odds ratio [OR], 10.93 [95% confidence interval (CI), 5.75–20.79]), higher housing density (OR, 1.47 [95% CI, 1.10–1.96]), and more frequent household fomite cleaning (OR, 1.62 [95% CI, 1.16–2.27]). Household environmental contamination with the index subject’s infection strain at 3 months was associated with USA300 MRSA and a synergistic interaction between baseline environmental contamination and body colonization by any household member with the index subject’s infection strain.Conclusions.We found that infectingS. aureusisolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenicS. aureusstrain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.Infect Control Hosp Epidemiol2014;35(11):1373–1382

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

2020 ◽  
Vol 77 (12) ◽  
pp. 938-942
Author(s):  
Lydia Noh ◽  
Kristina Heimerl ◽  
Rita Shane
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Acute Care ◽  
Academic Medical Centers ◽  
Quality Improvement Initiative ◽  
Medical Centers ◽  
Academic Medical ◽  
Risk Patients ◽  
The Impact

Abstract Purpose This multicenter quality improvement initiative aims to measure and quantify pharmacists’ impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). Methods This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. Results A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. Conclusion The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists’ value in transitions of care and assist in expanding pharmacist services.

The impact of an expert exchange-based educational initiative on urologist confidence and knowledge in implementing immunotherapy for bladder cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23001-e23001
Author(s):  
Susan H. Gitzinger ◽  
Bryan Carson Taylor ◽  
Joan B. Fowler ◽  
Vanessa Carranza ◽  
Rebecca Weaver
Keyword(s):  
Bladder Cancer ◽  
Statistical Testing ◽  
Academic Medical Centers ◽  
Educational Activities ◽  
Medical Centers ◽  
Activity Assessment ◽  
Academic Medical ◽  
Post Test ◽  
Chi Square Analysis

e23001 Background: The rapid and robust emergence of the immunotherapy era in bladder cancer has prompted a paradigmatic shift in both early and late-stage bladder cancer management. Given this change, it is imperative that members of the bladder cancer care team, most notably urologists, medical oncologists, and urologic oncologists, be well-equipped to safely and effectively integrate immune checkpoint inhibitors into the treatment armamentarium. Methods: CEC Oncology delivered education at select meetings throughout 2019-2021 including ASCO GU, AUA, and SUO Annual Meetings; in addition to live presentations, the content was streamed live and on-demand on www.ceconceptslive.com and endured on myCME.com. Learning and knowledge was objectively assessed by analyzing pre- and post-test results before and after the educational activities. To determine retention of knowledge over time, follow-up assessments were sent to participants after each live activity. Assessment questions in the form of case studies were utilized to gauge whether participants translated knowledge into practice at follow-up. Statistical testing between pre- and post-tests and from pre-test to follow-up were conducted via chi square analysis with a priori significance set at 0.05. Results: Executed five live educational activities and a spin-off enduring component hosted on myCME.com. 765 total clinicians educated across the live elements of the curriculum. Across the curriculum, over 70% of attendees indicated at post-activity assessment that they would use systemic immunotherapy either primarily or exclusively in their practice compared to just 25% at pre-activity. Among urologists practicing at academic medical centers, confidence in appropriate implementation of immunotherapy increased for all participants, and more specifically, for clinicians practicing at academic medical centers (on a 4-point scale, All Participants demonstrated a confidence increase from 2.70 to 2.91; Academic Medical Center clinicians demonstrated an increase of 2.75 to 3.00); 97% said that the initiative increased their knowledge of ongoing ICI clinical trials in bladder cancer; Attendee ability to appropriately manage an irAE increased substantially from pre-test to post-test assessment (37% vs. 63%; P=.057). Clinicians practicing in community settings are the only attendees who did not exhibit an increase in mean confidence in appropriately implementing immunotherapy at post-activity assessment. Conclusions: Our Expert Exchange Bladder Cancer Curriculum precipitated substantive practice advances related to appropriate implementation of ICI therapy. Many of these advances, however, were specific to academic urologists and urologic oncologists; outcomes analyses have revealed tangible educational gaps among community-based urologists.

Abstract WMP116: Multi-center Assessment of Morbidity After Cerebral Arteriovenous Malformation Rupture

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Keiko A Fukuda ◽  
Monica Majumdar ◽  
Hesham Masoud ◽  
Thanh Nguyen ◽  
Amir R Honarmand ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Venous Drainage ◽  
Critical Assessment ◽  
Inclusion Criteria ◽  
Hematoma Evacuation ◽  
Medical Centers ◽  
Academic Medical ◽  
Brain Avms

Background: Previously published single center studies suggest the morbidity associated with brain arteriovenous malformations (AVM) hemorrhage to be lower than assumed. Given the recent controversy over the appropriate management of unruptured brain AVMs, we performed a multi-center critical assessment of the morbidity associated with ruptured brain AVMs. Methods: A retrospective chart review from tertiary care, urban, academic medical centers was performed. Inclusion criteria consisted of patients admitted for intracranial hemorrhage caused by a previously untreated AVM. Thirty-seven variables were analyzed, including patient demographics, imaging findings, clinical course and clinical exams. Results: 101 patients from three medical centers dating from 2008-2014 met the inclusion criteria. Admission NIHSS scores of 0, 1-9 and ≥10 were 26%, 29% and 45% respectively. Hematoma location was parenchymal in 32%, intraventricular in 11%, subarachnoid in 5%, and combined in 52%. Deep venous drainage was present in 43% of cases, and associated aneurysms were present in 44%. Thirty-seven percent underwent emergent hematoma evacuation while 8 patients expired during their admission. At discharge, of those that survived, 69% had a NIHSS ≥ 1, and 23% had a NIHSS ≥ 10. At 90 day follow-up, 27% had a mRS ≥ 3. Patients with admission NIHSS ≥ 10 had significantly higher rates of midline shift, surgical hematoma evacuation, and follow-up mRS ≥ 3( p < 0.05). Conclusion: This multicenter critical assessment of the morbidity associated with brain AVM rupture suggests poorer clinical outcomes than previously assumed and reported. Rupture morbidity should be considered alongside rupture risk and procedural risk when considering preventative anatomic treatment of unruptured brain AVMs.

Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011895
Author(s):  
Andrea Morotti ◽  
Gregoire Boulouis ◽  
Andreas Charidimou ◽  
Qi Li ◽  
Loris Poli ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Hematoma Expansion ◽  
Prognostic Impact ◽  
Replication Cohort ◽  
Medical Treatments ◽  
Similar Frequency ◽  
Medical Centers ◽  
Academic Medical ◽  
Contrast Ct

ObjectiveTo investigatethe prevalence, predictors and prognostic impact of hematoma expansion (HE) inintracerebral hemorrhage (ICH) patients with unclear symptom onset (USO).MethodsRetrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in USA and Italy.HE (volume increase >6 mL and/or >33% from baseline to follow-up non-contrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.ResultsWe enrolled 2,165 subjects, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO respectively. When compared with subjects having a clear symptom onset, USO patients had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among USO patients, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43–4.89, p = 0.002). This finding wassimilar in the replication cohort (OR 3.46, 95% CI 1.86–6.44, p < 0.001). The presence of NCCT hypodensities in USO subjects was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27–5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42–4.17, p = 0.001) population.ConclusionHE is common in USO patients and independently associated with worse outcome. These findings suggest that USO patients may be enrolled in clinical trials on medical treatments targeting HE.

scholarly journals Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial

2021 ◽  
Vol 10 ◽  
pp. 216495612110010
Author(s):  
Julia Loewenthal ◽  
Natalie L Dyer ◽  
Marla Lipsyc-Sharf ◽  
Sara Borden ◽  
Darshan H Mehta ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Psychological Health ◽  
Well Being ◽  
Academic Medical Centers ◽  
Controlled Study ◽  
Medical Centers ◽  
Resident Physicians ◽  
Academic Medical

Background and Objective Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers. Methods We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up. Results Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up. Conclusion This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.

scholarly journals Evaluation of antibiotic escalation in response to nurse-driven inpatient sepsis screen

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Daisuke Furukawa ◽  
Thomas D. Dieringer ◽  
Mitchell D. Wong ◽  
Julia T. Tong ◽  
Isa A. Cader ◽  
...  
Keyword(s):  
Los Angeles ◽  
Positive Screen ◽  
Medical Centers ◽  
Academic Medical ◽  
Multivariable Regression ◽  
Sepsis Screen ◽  
Sepsis Screening ◽  
Infectious Source ◽  
Clinical Diagnostic Criteria ◽  
Abnormal Temperature

Abstract Objective: To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution. Design: Retrospective cohort study. Setting: Two affiliated academic medical centers in Los Angeles, California. Patients: Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards. Methods: We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation. Results: Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria. Conclusions: Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.

Multicenter assessment of morbidity associated with cerebral arteriovenous malformation hemorrhages

2016 ◽  
Vol 9 (7) ◽  
pp. 664-668 ◽  
Author(s):  
Keiko Fukuda ◽  
Monica Majumdar ◽  
Hesham Masoud ◽  
Thanh Nguyen ◽  
Amir Honarmand ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Venous Drainage ◽  
National Institutes Of Health ◽  
Study Patient ◽  
Patient Specific ◽  
Medical Centers ◽  
Imaging Characteristics ◽  
Academic Medical ◽  
Brain Avms

BackgroundThe optimal management strategy for unruptured cerebral arteriovenous malformations (AVMs) is controversial since the ARUBA trial (A Randomized trial of Unruptured Brain AVMs). An accurate understanding of the morbidity associated with AVM hemorrhages may help clinicians to formulate the best treatment strategy for unruptured AVMs.ObjectiveTo determine the morbidity associated with initial cerebral AVM rupture in patients presenting to tertiary medical centers.MethodsRetrospective chart reviews from three tertiary academic medical centers were performed for the period between 2008 and 2014. All patients admitted with intracranial hemorrhage due to untreated AVMs were included in this study. Patient-specific variables, including demographics, imaging characteristics, neurologic examination results, and clinical outcome, were analyzed and recorded.Results101 Patients met the inclusion criteria. Admission National Institutes of Health Stroke Scale (NIHSS) scores were 0, 1–9, and ≥10 in 26%, 29%, and 45% of patients, respectively. Hematoma locations were subarachnoid, intraventricular, intraparenchymal, and combined in 5%, 11%, 32%, and 52% of patients, respectively. Deep venous drainage was present in 43% of AVMs; AVM-associated aneurysms were present in 44% of patients. Emergent hematoma evacuations were performed in 37% of patients and 8% of patients died while in hospital. At discharge, of those who survived, NIHSS scores of ≥1 and ≥10 were found in 69% and 23%, respectively. At the 90-day follow-up, 34% had a modified Rankin Scale (mRS) score >2. Patients with admission NIHSS score ≥10 had significantly higher rates of midline shift, surgical hematoma evacuation, and follow-up mRS ≥3 (p<0.05).ConclusionsThe morbidity associated with cerebral AVM rupture appeared to be higher in our study than previously reported. Morbidity from AVM rupture should be considered as an important factor, together with variables such as risk of AVM rupture and procedural risk, in determining the optimal treatment strategy for unruptured cerebral AVMs.

scholarly journals Resident and Preceptor Perceptions of Preceptor Integration Into Resident Clinic Scheduling Templates

2017 ◽  
Vol 9 (4) ◽  
pp. 497-502
Author(s):  
Halle G. Sobel ◽  
Rachel Swigris ◽  
Karen M. Chacko ◽  
Alison Landrey ◽  
Monica McNulty ◽  
...  
Keyword(s):  
Interpersonal Relationships ◽  
Academic Medical Centers ◽  
Traditional Model ◽  
Residency Programs ◽  
Resident Perceptions ◽  
Medical Centers ◽  
Complex Patients ◽  
Academic Medical

ABSTRACT Background  Some internal medicine residency programs on X+Y schedules have modified clinic preceptor schedules to mimic those of the resident cohort (resident matched). This is in contrast to a traditional model, in which preceptors supervise on the same half-day each week. Objective  We assessed preceptor and resident perceptions of the 2 precepting models. Methods  We surveyed 44 preceptors and 97 residents at 3 clinic sites in 2 academic medical centers. Two clinics used the resident-matched model, and 1 used a traditional model. Surveys were completed at 6 months and 1 year. We assessed resident and preceptor perceptions in 5 domains: relationships between residents and preceptors; preceptor familiarity with complex patients; preceptor ability to assess milestone achievements; ability to follow up on results; and quality of care. Results  There was no difference in perceptions of interpersonal relationships or satisfaction with patient care. Preceptors in the resident-matched schedule reported they were more familiar with complex patients at both 6 months and 1 year, and felt more comfortable evaluating residents' milestone achievements at 6 months, but not at 1 year. At 1 year, residents in the resident-matched model perceived preceptors were more familiar with complex patients than residents in the traditional model. The ability to discuss patient results between clinic weeks was low in both models. Conclusions  The resident-matched model increased resident and preceptor perceptions of familiarity with complex patients and early preceptor perceptions of comfort in assessment of milestone achievements.

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