scholarly journals 84. T2Candida Panel Use Evaluation: a Quality Improvement Project

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
Erika Reategui Schwarz ◽  
Meenakshi Rana ◽  
Rachel Chasan ◽  
Melissa R Gitman
Keyword(s):  
Invasive Candidiasis ◽  
Retrospective Chart Review ◽  
Blood Cultures ◽  
Negative Group ◽  
Improvement Project ◽  
Positive Group ◽  
Negative Results ◽  
Risk Patients ◽  
Life Threatening ◽  
Antifungal Use

Abstract Background Invasive candidiasis is a life-threatening infection with 40% mortality despite antifungal therapy[1] A retrospective chart review of results from our T2Candida Panels from March 2019 to March 2020 was conducted. We compared demographics, co-morbidities, days of antifungal use, length of stay (LOS) and mortality in patients with positive and negative assays. Results 271 assays were performed, 27 were positive and were compared to 81 negatives. Baseline demographics and co-morbidities were similar in both groups. All patients tested had >1 risk factor for candidemia. 78% were positive for C. albicans/C. tropicalis and 11% positive for C. glabrata/C. krusei and C. parapsilosis respectively. Blood cultures were positive in 8 individuals, of which 5 had a positive assay; among the other 3, one grew C. auris. All species in the T2Candida matched the blood cultures when available. β-D-glucan was positive in 82% of patients with positive T2 results vs 46% in the T2 negative group (p = 0.016). Antifungal administration within the time of assay collection was 54% in the negative group vs 74% in the positive group (p = 0.030). Mean duration of antifungal use were significantly lower in the negative group than the positive group (5.98 vs 17.55 days, p = 0.04). Demographics and Comorbidities Outcomes Cultures Conclusion T2Candida was an effective diagnostic and antimicrobial stewardship tool, leading to testing in high risk patients and reducing unnecessary antifungal use. Additional education is required for improved ordering of concurrent blood cultures. Negative results should be interpreted with caution in suspected invasive candidiasis with consideration for species not included in the panel. Disclosures All Authors: No reported disclosures

Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

2021 ◽  
Vol 30 (1) ◽  
pp. 87-91
Author(s):  
Tamer Mohamed ◽  
Ashraf A Askar ◽  
Jamila Chahed
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Armed Forces ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Contamination Rate ◽  
Improvement Project ◽  
Culture Test ◽  
Negative Results ◽  
Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

scholarly journals LO89: A multi-disciplinary quality improvement project to improve adherence to best practice guidelines for emergency department patients with transient ischemic attack

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S40
Author(s):  
A. Verma ◽  
A. Kapoor ◽  
J. Kim ◽  
N. Kujbid ◽  
K. Si ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Retrospective Chart Review ◽  
Stroke Recurrence ◽  
Improvement Project ◽  
Support Tool ◽  
High Risk Patients ◽  
Risk Patients ◽  
Ischemic Attack

Background: Canadian Stroke Guidelines recommend that Transient Ischemic Attack (TIA) patients at highest risk of stroke recurrence should undergo immediate vascular imaging. Computed tomography angiography (CTA) of the head and neck is recommended over carotid doppler because it allows for enhanced visualization of the intracranial and posterior circulation vasculature. Imaging while patients are in the emergency department (ED) is optimal for high-risk patients because the risk of stroke recurrence is highest in the first 48 hours. Aim Statement: At our hospital, a designated stroke centre, less than 5% of TIA patients meet national recommendations by undergoing CTA in the ED. We sought to increase the rate of CTA in high risk ED TIA patients from less than 5% to at least 80% in 10 months. Measures & Design: We used a multi-faceted approach to improve our adherence to guidelines including: 1) education for staff ED physicians; 2) agreements between ED and radiology to facilitate rapid access to CTA; 3) agreements between ED and neurology for consultations regarding patients with abnormal CTA; and 4) the creation of an electronic decision support tool to guide ED physicians as to which patients require CTA. We measured the rate of CTA in high risk patients biweekly using retrospective chart review of patients referred to the TIA clinic from the ED on a biweekly basis. As a balancing measure, we also measured the rate of CTA in non-high risk patients. Evaluation/Results: Data collection is ongoing. An interim run chart at 19 weeks shows a complete shift above the median after implementation, with CTA rates between 70 and 100%. At the time of submission, we had no downward trends below 80%, showing sustained improvement. The CTA rate in non-high risk patients did also increase. Disucssion/Impact: After 19 weeks of our intervention, 112 (78.9%) of high risk TIA patients had a CTA, compared to 10 (9.8%) in the 19 weeks prior to our intervention. On average, 10-15% of high risk patients will have an identifiable lesion on CTA, leading to immediate change in management (at minimum, an inpatient consultation with neurology). Our multi-faceted approach could be replicated in any ED with the engagement and availability of the same multi-disciplinary team (ED, radiology, and neurology), access to CTA, and electronic orders.

scholarly journals Management of invasive candidiasis in nonneutropenic ICU patients

2014 ◽  
Vol 2 (5-6) ◽  
pp. 105-115 ◽  
Author(s):  
Emmanuel Weiss ◽  
Jean-François Timsit
Keyword(s):  
Invasive Candidiasis ◽  
Selective Pressure ◽  
Necrotizing Pancreatitis ◽  
Medical Patients ◽  
Icu Patients ◽  
Preemptive Treatment ◽  
Randomized Controlled ◽  
Risk Patients ◽  
Life Threatening ◽  
Polymerase Chain

Invasive candidiasis (IC) is a leading cause of morbidity and mortality among nonneutropenic ICU patients and these life-threatening nosocomial infections require early diagnosis and prompt treatment. However, none of the predictive tools are sufficiently accurate to identify high-risk patients and the potential interest of IC prophylactic, empirical and preemptive treatment in the nonneutropenic ICU population has not yet been demonstrated. In the case of nosocomial severe sepsis after necrotizing pancreatitis or upper digestive anastomotic leakage, early probabilistic antifungals are probably indicated. In the remaining ICU surgical and medical patients, prophylactic and empirical strategies are highly debated because they may promote antifungal selective pressure through an overuse of these molecules. In this context, non-culture-based methods such as mannan or β-D glucan or polymerase chain reaction tests are promising. However, none of these tests used alone in ICU patients is sufficiently accurate to avoid overuse of empirical/preemptive treatment. The interest of strategies associating predictive clinical scores and non-culture-based methods still needs to be demonstrated by well-conducted randomized, controlled trials. While awaiting these studies, we consider that probabilist treatment should be stopped earlier if IC is not proven.

scholarly journals Eosinophilia: A Poor Predictor ofStrongyloidesInfection in Refugees

2013 ◽  
Vol 24 (2) ◽  
pp. 93-96 ◽  
Author(s):  
Prenilla Naidu ◽  
Stephanie K Yanow ◽  
Kinga T Kowalewska-Grochowska
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Refugee Camps ◽  
Tropical Diseases ◽  
Negative Group ◽  
Positive Group ◽  
The Past ◽  
Canadian Data ◽  
Poor Predictor ◽  
Laboratory Results

BACKGROUND: Canada resettles 10,000 to 12,000 refugees annually. Despite this being a highly vulnerable population, there are little Canadian data on subclinical tropical diseases harboured in this population over the past 20 years.OBJECTIVES: To determine the seroprevalence and predictors ofStrongyloidesinfection in refugees arriving in Edmonton, Alberta.METHODS: A retrospective chart review of all refugees seen at the New Canadians Clinic between March 2009 and April 2010 was performed. Demographic, symptom and physical examination data were collected from the charts. Laboratory results were obtained from the electronic laboratory records.RESULTS: A total of 350 subjects were studied. The overall seroprevalence of strongyloidiasis was 4.6%. Equivocal results were found in 6.3%. In the positive group, the majority were male (62.5%); 75% were born in Africa (P=0.004) and 81.2% lived in refugee camps in Africa (P=0.002). Eosinophilia was present in 25% of the positive subjects (P=0.05), in none of the equivocal group and in 8.7% of the negative group.DISCUSSION: Persistent asymptomaticStrongyloidesinfection is maintained for years through autoinfection. Traditionally, eosinophilia was used as one of the key tools to diagnose chronic but stable diseases, but it was shown to have a poor predictive value for strongyloidiasis in returning expatriates as well as in those presenting with a disseminated form of the disease. It is important to raise awareness of the severe limitations of eosinophilia as a marker for strongyloidiasis when managing patients who either are immunocompromised, or about to start immunosuppressive therapy.CONCLUSIONS: The present study indicated that eosinophilia is a poor predictor of seropositivity and, thus,Strongyloidesinfection. Residence in Africa (birth/refugee camps) proved to be a significantly better predictor ofStrongyloidesseropositivity.

scholarly journals Evaluation of a Rapid Fungal Detection Panel for Identification of Candidemia at an Academic Medical Center

2019 ◽  
Vol 58 (3) ◽  
Author(s):  
John P. Bomkamp ◽  
Rand Sulaiman ◽  
Jennifer L. Hartwell ◽  
Armisha Desai ◽  
Vera C. Winn ◽  
...  
Keyword(s):  
Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Blood Cultures ◽  
Predictive Values ◽  
Negative Results ◽  
Source Of Infection ◽  
Days Of Therapy ◽  
Sensitivity Specificity

ABSTRACT This study was conducted to assess the utility of the T2Candida panel across an academic health center and identify potential areas for diagnostic optimization. A retrospective chart review was conducted on patients with a T2Candida panel and mycolytic/fungal (myco/f lytic) blood culture collected simultaneously during hospitalizations from February 2017 to March 2018. The primary outcome of this study was to determine the sensitivity, specificity, and positive and negative predictive values of the panel compared to myco/f lytic blood culture. Secondary outcomes included Candida species isolated from culture or detected on the panel, source of infection, days of therapy (DOT) of antifungals in patients with discordant results, and overall antifungal DOT/1,000 patient days. A total of 433 paired T2Candida panel and myco/f lytic blood cultures were identified. The pretest likelihood of candidemia was 4.4%. The sensitivity and specificity were 64.7% and 95.6%, respectively. The positive and negative predictive values were 40.7% and 98.5%, respectively. There were 16 patients with T2Candida panel positive and myco/f lytic blood culture negative results, while 6 patients had T2Candida panel negative and myco/f blood culture positive results. The overall antifungal DOT/1,000 patient days was improved after implementation of the T2Candida panel; however, the use of micafungin continued to decline after the panel was removed. We found that the T2Candida panel is a highly specific diagnostic tool; however, the sensitivity and positive predictive value may be lower than previously reported when employed in clinical practice. Clinicians should use this panel as an adjunct to blood cultures when making a definitive diagnosis of candidemia.

Clinical Relevance and Prognostic Value of Persistently Negative (1,3)-β-D-Glucan in Adults With Candidemia: A 5-year Experience in a Tertiary Hospital

2019 ◽  
Vol 70 (9) ◽  
pp. 1925-1932 ◽  
Author(s):  
Caroline Agnelli ◽  
Emilio Bouza ◽  
María del Carmen Martínez-Jiménez ◽  
Raquel Navarro ◽  
Maricela Valerio ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Relevance ◽  
Tertiary Hospital ◽  
Blood Cultures ◽  
University Hospital ◽  
Negative Group ◽  
Adequate Treatment ◽  
Positive Group ◽  
Clinical Presentations ◽  
Comparative Group

Abstract Background The clinical relevance and the potential prognostic role of persistently negative (1,3)-β-D-glucan (BDG) in adults with proven candidemia is unknown. Methods This retrospective study included all adults diagnosed with candidemia our tertiary university hospital from 2012–2017 who had at least 2 serum BDG determinations throughout the episode of fungemia (Fungitell Assay; positive cut-off ≥80pg/mL). Epidemiology and clinical outcomes were compared between patients with all negative versus any positive BDG tests. Poor clinical outcomes included complications due to candidemia or 30-day all-cause mortality. Results Overall, 26/148 (17.6%) candidemic adults had persistently negative BDG tests. These patients were less likely to present Candida growth in all 3 sets of blood cultures (15.4% vs 45.1%; P = .005) and had less severe clinical presentations (median Pitt score, 0 [interquartile range {IQR} 0–1] vs 1 [IQR 0–2] in patients with any positive BDG test; P = .039). Although adequate treatment was equally provided to both groups (96.2% in persistently negative group vs 93.4 in positive group; P = .599), the persistently negative group had a higher rate of microbiological clearance in the first follow-up blood cultures (92.3% vs 69.7% in positive group; P = .005), fewer complications due to candidemia (7.7% vs 33.6% in positive group; P = .008), a lower 30-day mortality rate (3.8% vs 23.8% in positive group; P = .004), and a shorter in-hospital stay (34 days [IQR 18–55] vs 51 days [IQR 35–91] in positive group; P = .003). In the multivariate analysis, persistently negative BDG tests were independently associated with better prognoses (odds ratio 0.12, 95% confidence interval 0.03–0.49; P = .003). Conclusions Candidemic patients with persistently negative BDG tests present a better prognosis than the comparative group, probably due to a lower systemic fungal burden. In this context, the appropriate use of persistently negative BDG results could be an aid to individualize therapeutic management in the near future.

Linkage between H. pylori Infection and TNF-α polymorphism in The Pregnant Women

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ghaidaa Raheem Lateef ◽  
Azhar Omaran Al-Thahab
Keyword(s):  
Pregnant Women ◽  
Serum Antibody ◽  
Rapid Test ◽  
Negative Group ◽  
Positive Group ◽  
Gynecology And Obstetrics ◽  
Tnf Α ◽  
Significant Difference ◽  
Pcr Products ◽  
H Pylori

A study was performed on 100 pregnant women in the outpatient department of gynecology and obstetrics of Maternity and Children Hospital in Al-Diwaniya City during the period between (March to September 2016). One hundred blood samples (50 for patients and 50 for control) were collected under the supervision of the treating gynecologist. The detection of Helicobacter. pylori was done by the use of the serum antibody Rapid test. The results showed that 50 (100%) were positive and 50 (100%) were negative for H. pylori in above method.All blood of patients and control samples were used for the extraction of genomic DNA,where the 107 bp PCR product size. Genotyping of the TNF-α-308 SNP (G/A)was performed by restriction fragment length polymorphism PCR (RFLP-PCR). PCR products were digested with restr NcoI iction enzyme. Individuals with the TNF-α-308(GG) homozygote produced digested DNA bands at 80,and 20 bp bp. A heterozygous genotype ofTNF-α-308 (GA)produced 107 bp,80 bp,and 20 bp bands. Individuals with the TNF-α-308 (AA) homozygote genotype had no amplicon digested and generated only one band of 107 bp. There was a significant difference in the frequency of the TNF-α-308(GG)genotype between H. pylori positive group and H. pylori negative group(72%,78% respectively). Also for GA genotype,there was a significant difference between H. pylori positive group and H. pylori negative group(24%,18% respectively). Concerning the frequency of the TNF-α-308 (AA)genotype between H. pylori positive group and H. pylori negative group,there was no significant difference between the two groups.

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

Potential application of dynamic contrast enhanced ultrasound in predicting microvascular invasion of hepatocellular carcinoma

2021 ◽  
pp. 1-9
Author(s):  
Yi Dong ◽  
Yijie Qiu ◽  
Daohui Yang ◽  
Lingyun Yu ◽  
Dan Zuo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Area Under The Curve ◽  
Microvascular Invasion ◽  
Contrast Enhanced Ultrasound ◽  
Negative Group ◽  
Clinical Value ◽  
Positive Group ◽  
Quantitative Perfusion ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

OBJECTIVE: To investigate the clinical value of dynamic contrast enhanced ultrasound (D-CEUS) in predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC). PATIENTS AND METHODS: In this retrospective study, 16 patients with surgery and histopathologically proved HCC lesions were included. Patients were classified according to the presence of MVI: MVI positive group (n = 6) and MVI negative group (n = 10). Contrast enhanced ultrasound (CEUS) examinations were performed within a week before surgery. Dynamic analysis was performed by VueBox ® software (Bracco, Italy). Three regions of interests (ROIs) were set in the center of HCC lesions, at the margin of HCC lesions and in the surrounding liver parenchyma accordingly. Time intensity curves (TICs) were generated and quantitative perfusion parameters including WiR (wash-in rate), WoR (wash-out rate), WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve) and WiPi (wash-in perfusion index) were obtained and analyzed. RESULTS: All of HCC lesions showed arterial hyperenhancement (100 %) and at the late phase as hypoenhancement (75 %) in CEUS. Among all CEUS quantitative parameters, the WiAUC and WoAUC were higher in MVI positive group than in MVI negative group in the center HCC lesions (P <  0.05), WiAUC, WoAUC and WiPI were higher in MVI positive group than in MVI negative group at the margin of HCC lesions. WiR and WoR were significant higher in MVI positive group. CONCLUSIONS: D-CEUS with quantitative perfusion analysis has potential clinical value in predicting the existence of MVI in HCC lesions.

Need for Confirmatory Neutralization Tests for Hepatitis B Surface Antigen Tests in Populations with Intermediate Prevalence

2021 ◽  
Author(s):  
Min Young Lee ◽  
So Young Kang ◽  
Woo In Lee ◽  
Myeong Hee Kim
Keyword(s):  
Hepatitis B ◽  
Surface Antigen ◽  
Neutralization Test ◽  
Hepatitis B Surface Antigen ◽  
False Negative ◽  
Confirmatory Test ◽  
Negative Group ◽  
Positive Group ◽  
Test Kit ◽  
Antigen Tests

Abstract Objective Hepatitis B surface antigen (HBsAg) is known as the hallmark of hepatitis B virus (HBV) infection. This study aimed to determine whether an HBsAg neutralization test is necessary to accurately interpret HBsAg test results. Methods Initially reactive HBsAg specimens from a 5-year period, with cutoff index values between 1.0 and 2.0, were subjected to neutralization confirmatory testing using an Elecsys HBsAg Confirmatory test kit (Roche Diagnostics GmbH. Mannheim, Germany). Results The neutralization test showed 46.1% positive (confirmed positive group) and 53.9% negative (confirmed negative group) results from the total specimens. Among the confirmed negative group, 79.5% of patients were confirmed to be negative for the current infection, whereas 4 patients in the chronic hepatitis B subgroup showed a neutralization percentage close to 40%. More than half of patients in the confirmed positive group were considered to be in the hepatitis B e antigen-negative inactive HBsAg carrier phase. Conclusion In populations with intermediate HBV prevalence, a neutralization test is necessary to confirm an HBsAg result and reduce the false positive and false negative rates of initial HBsAg tests.

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