Influence of drug class and healthcare setting on systemic antifungal expenditures in the United States, 2005–15

2017 ◽  
Vol 74 (14) ◽  
pp. 1076-1083 ◽  
Author(s):  
Margaret A. Fitzpatrick ◽  
Katie J. Suda ◽  
Charlesnika T. Evans ◽  
Robert J. Hunkler ◽  
Frances Weaver ◽  
...  
Keyword(s):  
United States ◽  
Drug Class ◽  
Healthcare Setting ◽  
The United States

scholarly journals A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009

2012 ◽  
Vol 68 (3) ◽  
pp. 715-718 ◽  
Author(s):  
K. J. Suda ◽  
L. A. Hicks ◽  
R. M. Roberts ◽  
R. J. Hunkler ◽  
L. H. Danziger
Keyword(s):  
United States ◽  
Healthcare Setting ◽  
The United States

scholarly journals Antibiotic Expenditures by Medication, Class, and Healthcare Setting in the United States, 2010–2015

2017 ◽  
Vol 66 (2) ◽  
pp. 185-190 ◽  
Author(s):  
Katie J Suda ◽  
Lauri A Hicks ◽  
Rebecca M Roberts ◽  
Robert J Hunkler ◽  
Linda M Matusiak ◽  
...  
Keyword(s):  
United States ◽  
Healthcare Setting ◽  
The United States ◽  
Medication Class

What Do Women Want? Consent for the Use of Electronic Fetal Monitoring

2021 ◽  
Vol 11 (3) ◽  
pp. 145-153
Author(s):  
Sonya Dal Cin ◽  
Lisa Kane Low ◽  
Denise Lillvis ◽  
Megan Masten ◽  
Raymond De Vries
Keyword(s):  
United States ◽  
Healthcare Providers ◽  
Fetal Monitoring ◽  
Healthcare Setting ◽  
Professional Associations ◽  
The United States ◽  
Cesarean Birth ◽  
Electronic Fetal Monitoring ◽  
Risk Patients

BACKGROUNDGuidelines published by professional associations of midwives, obstetricians, and nurses in the United States recommend against using continuous cardiotocography (CTG) in low-risk patients. In the United States, CTG or electronic fetal/uterine monitoring (EFM) rather than auscultation with a fetoscope or Pinard horn is the norm. Interpretation of the fetal heart rate (FHR) and uterine activity (UA) tracings provided by continuous EFM may be associated with the decision for a cesarean birth. Typically, consent is not sought in the decision about type of monitoring. No studies were identified where women's attitudes about the need to consent to the type of fetal monitoring used during labor have been explored. Therefore, the purpose of this research was to examine women's attitudes about the use of EFM in a healthcare setting.METHODSWe asked a sample of women aged 18–50 years to respond to one of three monitoringscenarios. The scenarios were used to distinguish between attitudes about monitoring in general, monitoring the health of a mother in labor, and monitoring the health of the fetus during labor. Wemeasured their level of interest in being monitored and their opinions about whether healthcare providers should be required to obtain consent for the monitoring described in the scenario.RESULTSInterest in receiving monitoring (across all three scenarios) was moderate, with the highest level of interest in monitoring the fetus during labor and the least interest in monitoring a general health context. Across all scenarios, 82% of respondents believed that practitioners should obtain consent for monitoring, 14% were unsure, and 4% said there should not be a requirement for consent. While low (6%), the percentage responding that consent was not needed was highest in monitoring a fetus in labor.CONCLUSIONSWomen in our study expressed a strong preference for the opportunity to consent to the use of monitoring regardless of the healthcare scenario. There is findings suggest the need for further research exploring what women do and do not know about CTG and what their informed performance are a pressing need to rethink the role of a pressing need to rethink the role of shared decision-making and informed consent about the type of monitoring use during labor.

Real-World Renal Function Among Patients with Multiple Myeloma in the United States

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Joseph Mikhael ◽  
Erin Singh ◽  
Megan Rice
Keyword(s):  
United States ◽  
Multiple Myeloma ◽  
Renal Function ◽  
Combination Therapy ◽  
Renal Impairment ◽  
Drug Class ◽  
The United States ◽  
Second Line ◽  
Renal Response ◽  
Treatment Line

Background Multiple myeloma (MM) is the second most common hematologic malignancy and is associated with significant patient burden. Renal impairment has been shown to affect up to 50% of patients (pts) with MM. Renal impairment is an independent predictor of poor survival outcomes for pts with MM, with a median survival of approximately half that of pts without renal impairment. Aims To assess change in renal function by treatment line and drug class among pts with MM and renal impairment (defined as eGFR <50 mL/min/1.73 m2 using the Modification of Diet in Renal Disease equation [eGFR-MDRD]), and to assess real-world outcomes by baseline renal status, renal response, and drug class. Methods Using the nationwide Flatiron Health EHR-derived de-identified database based in the United States, we identified MM pts diagnosed and treated between January 2011 and November 2019 who received ≥1 line of MM therapy and had information on race. We assessed the distribution of pts by eGFR-MDRD level at the start of the first and second line of therapy and the distribution of therapy use (ie, proteasome inhibitor [PI], immunomodulatory drug [IMiD], monoclonal antibody [mAb]). We also evaluated overall survival (OS) by treatment line, stratified by eGFR at the start of each treatment line. Complete renal response (CRR) was assessed in pts with eGFR-MDRD <50 mL/min/1.73 m2; using International Myeloma Working Group recommendations, responders were defined as pts with ≥1 eGFR measurement ≥60 mL/min/1.73 m2 during the treatment line. Logistic regression models were used to examine the association between treatment class and complete renal responder status adjusted for other treatment classes received, age, sex, race, practice type, year of therapy line, and cytogenetic risk. Cox proportional hazard models were used to examine OS by treatment and renal response, adjusted for other treatment classes received, age, sex, race, practice type, year of therapy line, and cytogenetic risk. Flatiron Health, Inc., did not participate in the analysis of this data. Results For the 6990 pts included in the analysis, the mean age at start of initial therapy was 68 years, 46% were female, and 17% were Black. At start of treatment lines 1 and 2, approximately 25% had eGFR-MDRD <50 mL/min/1.73 m2. At treatment initiation, pts with renal impairment were older (71 vs 67 years) and were more likely to present with ISS stage III at diagnosis (38% vs 10%). Pts with renal impairment at the start of each treatment line exhibited decreased OS. Among pts with renal impairment, pts with PI use in first (adjusted odds ratio [aOR] 1.36; 95% CI, 1.04-1.77) or second line (aOR 2.09; 95% CI, 1.38-3.16) were significantly more likely to have a CRR than those without PI use. Pts with IMiD use in first (aOR 2.14; 95% CI, 1.68-2.72) and second (aOR 1.61; 95% CI, 1.10-2.36) line were significantly more likely to have a CRR than those without IMiD use. When classified by both PI and IMiD use, pts with both PI and IMiD use were significantly more likely to have a CRR than those without use of either in the first (aOR 2.35; 95% CI, 1.54-3.60) and second line (aOR 3.89; 95% CI, 1.71-8.86). Pts with PI and IMiD use as well as a CRR also had greater OS in the first (adjusted hazard ratio [aHR] 0.52; 95% CI, 0.37-0.73) and second line (aHR 0.53; 95% CI, 0.32-0.88) vs pts without either PI or IMiD use and no CRR. The use of available mAbs in line 1 or line 2 was not significantly associated with renal response. Lower mAb use, especially in earlier treatment lines, prevented further analyses by mAb combination therapies. Conclusion In this study, MM pts with renal impairment were more likely to be older and to present with ISS stage III at diagnosis. Pts with decreased renal function exhibited decreased OS compared with non-renally impaired pts. Pts who were treated with combination therapy that included PIs and IMiDs together in early treatment lines were more likely to have a CRR and OS was prolonged among these pts, highlighting the benefits of combination therapy. These data suggest that treatment inducing a renal response may result in improved outcomes. Future investigations with larger datasets may improve the understanding of the prognostic value of renal impairment and optimal combination treatment regimens for these pts. Disclosures Mikhael: Amgen, Celgene, GSK, Janssen, Karyopharm, Sanofi, Takeda: Honoraria. Singh:Sanofi-Genzyme: Current Employment. Rice:Sanofi: Current Employment.

scholarly journals 731. The Emergence of Mobile Colistin Resistance (mcr) Genes among Enteric Pathogens in the United States — 2008–2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S416-S416
Author(s):  
Farrell A Tobolowsky ◽  
Cindy R Friedman ◽  
Matthew Ryan ◽  
Meseret Birhane ◽  
Jessica Chen ◽  
...  
Keyword(s):  
United States ◽  
Healthcare Setting ◽  
The United States ◽  
Multidrug Resistant ◽  
Enteric Pathogens ◽  
Urgent Care ◽  
Emergency Rooms ◽  
Colistin Resistance ◽  
E Coli ◽  
Bacterial Sources

Abstract Background Colistin, once seldom used clinically, has resurged as a “last resort antibiotic” for multidrug-resistant infections and is still used in animal agriculture in countries outside the United States. During 2015–2018, 8 plasmid-mediated, mobile colistin resistance genes (mcr-1 to mcr-8) were each found in one or more clinical, animal, food, and environmental bacterial sources. We describe the epidemiology of mcr genes in enteric pathogens from US patients. Methods State public health laboratories have performed whole-genome sequencing on enteric bacterial pathogens since 2015, and some have sequenced older isolates. We screened sequences of isolates collected through 2019 for mcr genes using a workflow based on ResFinder 3.0. State health officials interviewed patients for clinical and epidemiologic information, including demographics, hospitalization, and travel history. Results We identified 41 patient isolates with mcr genes collected from stool, urine, and blood during 2008–2019. These included 37 nontyphoidal Salmonella (31 mcr-1, 6 mcr-3), 2 Vibrio (both mcr-4), and 2 Shiga toxin-producing E. coli (both mcr-1). The median patient age was 34 years (interquartile range: 24–54) and 54% were female. Of 23 patients with comorbidity data, 2 (9%) had immunodeficiency, 2 (9%) had past abdominal surgeries, and 1 (4%) had cancer. Patients sought care at doctor’s offices (46%), emergency rooms (35%), and urgent care clinics (19%); 24% were hospitalized for the enteric illness. None died. Among 36 with information, 35 (97%) travelled internationally in the 12 months before illness; 30 (94%) of 32 traveled in the 7 days before. Only 4 (15%) of 27 had contact with a healthcare setting during their trip; common destinations were the Dominican Republic (35%), Vietnam (24%), Thailand (15%), and China (12%). Conclusion The data strongly suggest that many patients acquired infection abroad. Nearly one in four were hospitalized, raising concerns that plasmids carrying mcr genes could spread among patients hospitalized with infections caused by multidrug-resistant pathogens for which colistin is the only available treatment. The acquisition of mcr genes by US travelers highlights the need for a global approach to antimicrobial stewardship. Disclosures All Authors: No reported disclosures

scholarly journals Effects of Initial Antihypertensive Drug Class on Patient Persistence and Compliance in a Usual-Care Setting in the United States

2007 ◽  
Vol 9 (9) ◽  
pp. 692-700 ◽  
Author(s):  
Bimal V. Patel ◽  
Rosemay A. Remigio-Baker ◽  
Devi Mehta ◽  
Patrick Thiebaud ◽  
Feride Frech-Tamas ◽  
...  
Keyword(s):  
United States ◽  
Usual Care ◽  
Antihypertensive Drug ◽  
Care Setting ◽  
Drug Class ◽  
The United States ◽  
Antihypertensive Drug Class

scholarly journals Drive-through Satellite Testing: An Efficient Precautionary Method of Screening Patients for SARS-CoV-2 in a Rural Healthcare Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272094796
Author(s):  
Paul E. Molling ◽  
Tanner T. Holst ◽  
Benjamin G. Anderson ◽  
Kevin Fitzgerald ◽  
Megan Eddy ◽  
...  
Keyword(s):  
United States ◽  
Rural Community ◽  
Community Setting ◽  
Healthcare Setting ◽  
The United States ◽  
Community Based ◽  
Global Pandemic ◽  
Large Patient ◽  
Community Transmission ◽  
Testing Site

The first documented case of COVID-19 in the United States occurred on January 30th, 2020. Soon after, a global pandemic was declared in March 2020 with each state issuing stay at home orders based on population, risk for community transmission and current number of positive cases. A priority for each region was to develop efficient systems for testing large patient volumes in a safe manner to reduce the risk of community transmission. A community based United States health care system in the upper mid-west implemented a drive through testing site in an attempt to divert suspected cases of COVID-19 away from larger patient areas while protecting staff and patients. This commentary outlines the planning, work flow and challenges of implementing this drive through testing site in a rural community setting.

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