المؤلفون: Livorsi, Daniel J, Merchant, James A, Cho, Hyunkeun, Goetz, Matthew Bidwell, Alexander, Bruce, Beck, Brice, Goto, Michihiko

المصدر: Clinical Infectious Diseases ; ISSN 1058-4838 1537-6591

الوصف: Background Antibiotic overuse at hospital discharge is common, but there is no metric to evaluate hospital performance at this transition of care. We built a risk-adjusted metric for comparing hospitals on their overall post-discharge antibiotic use. Methods This was a retrospective study across all acute-care admissions within the Veterans Health Administration during 2018-2021. For patients discharged to home, we collected data on antibiotics and relevant covariates. We built a zero-inflated negative binomial mixed-model with two random intercepts for each hospital to predict post-discharge antibiotic exposure and length of therapy (LOT). Data were split into training and testing sets to evaluate model performance using absolute error. Hospital performance was determined by the predicted random intercepts. Results 1,804,300 patient-admissions across 129 hospitals were included. Antibiotics were prescribed to 41.5% while hospitalized and 19.5% at discharge. Median LOT among those prescribed post-discharge antibiotics was 7 (IQR 4-10). The predictive model detected post-discharge antibiotic use with fidelity, including accurate identification of any exposure (area under the precision-recall curve=0.97) and reliable prediction of post-discharge LOT (mean absolute error = 1.48). Based on this model, 39 (30.2%) hospitals prescribed antibiotics less often than expected at discharge and used shorter LOT than expected. Twenty-eight (21.7%) hospitals prescribed antibiotics more often at discharge and used longer LOT. Conclusion A model using electronically-available data was able to predict antibiotic use prescribed at hospital discharge and showed that some hospitals were more successful in reducing antibiotic overuse at this transition of care. This metric may help hospitals identify opportunities for improved antibiotic stewardship at discharge.

الإتاحة: https://doi.org/10.1093/cid/ciae224Test

المؤلفون: O'Shea, Amy M. J., Gibson, Mikayla, Merchant, James, Rewerts, Kelby, Miell, Kelly, Kaboli, Peter J., Shimada, Stephanie L.

المساهمون: Office of Research and Development, U.S. Department of Veterans Affairs

المصدر: The Journal of Rural Health ; ISSN 0890-765X 1748-0361

الوصف: Background The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans. Purpose To examine veteran‐reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality. Methods Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30‐min computer‐assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in‐person or by video). Counts and weighted percentages are reported. Findings After accounting for survey weights, 96.2% of respondents had in‐home internet access and 89.5% reported functional connection speeds. However, rural‐ compared to urban‐residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in‐person visits, rural versus urban‐residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) ( p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet‐enabled device (25.9%). Conclusions Though rural‐residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.

الإتاحة: https://doi.org/10.1111/jrh.12805Test

المؤلفون: Sekar, Poorani, Merchant, James, Alexander, Bruce, Miell, Kelly, Beck, Brice, Nair, Rajeshwari, Suh, Daniel, Richards, Christopher, Puig-Asensio, Mireia, Pugely, Andrew, Walhof, Julia, Dukes, Kimberly, Schweizer, Marin

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background PJI occurs in 0.5-2% of Joint Arthroplasty. Patients with acute non-Staphylococcal PJI who undergo DAIR are treated with 6 weeks of antimicrobials after which CAS may be considered. We aimed to compare the incidence of treatment failure between people who received CAS and those who did not. Methods This is a retrospective cohort study of patients admitted to Veterans Affairs (VA) hospitals from 2003-2017 with a non-Staphylococcal PJI, underwent DAIR and received 6 weeks of antimicrobial treatment (Table 1). CAS was defined as at least 30 days of oral antibiotics after 6 weeks of antimicrobial treatment. Duration of CAS was categorized as short (1-3 months), moderate (3-6 months) and long ( >6 months) (Fig 1). Patients were followed for 5 years. Treatment failure was defined as microbiologically confirmed recurrent PJI, additional debridement or re-operation at the same site. Cause-specific Kaplan-Meier curves were used to compare treatment failure rates between those who did and did not receive CAS, censoring on death. Results Among 468 patients with non-staphylococcal PJI who underwent DAIR, 208 (44.4%) received CAS. Patients with Enterococcus PJI were statistically more likely to receive CAS. K-M curves showed patients on CAS had a higher estimated failure free survival probability at 5 years when compared to those who did not get CAS (66% vs. 55%, p< 0.01) (Fig 2). When antibiotic use was considered as a time-dependent covariate, CAS was associated with a decreased hazard of treatment failure (hazard ratio (HR): .47 (95% confidence interval [CI]: 0.29, 0.76). After statistically adjusting for surgical site, severity of illness, and alcohol abuse, a short duration of CAS was significantly associated with decreased treatment failure (HR=0.24; 95% CI: 0.11, 0.52). There was no significant association between moderate or long duration of CAS and treatment failure (Table 2) Table 2 Conclusion A short duration of CAS may be beneficial among patients with non-Staphylococcal PJI who ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.1145Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.1145/53762555/ofad500.1145.pdfTest

المؤلفون: O'Shea, Amy M. J., Gibson, Mikayla, Merchant, James, Rewerts, Kelby, Miell, Kelly, Kaboli, Peter J., Shimada, Stephanie L.

المصدر: Journal of Rural Health; Jun2024, Vol. 40 Issue 3, p438-445, 8p

مصطلحات موضوعية: EVALUATION of medical care, INTERNET access, HEALTH services accessibility, MEDICAL care of veterans, RESEARCH funding, INTERNET, DESCRIPTIVE statistics, PSYCHOLOGY of veterans, TELEMEDICINE, RURAL population, TECHNOLOGY, COMPARATIVE studies, PATIENTS' attitudes

الشركة/الكيان: UNITED States. Dept. of Veterans Affairs

مستخلص: Background: The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans. Purpose: To examine veteran‐reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality. Methods: Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30‐min computer‐assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in‐person or by video). Counts and weighted percentages are reported. Findings: After accounting for survey weights, 96.2% of respondents had in‐home internet access and 89.5% reported functional connection speeds. However, rural‐ compared to urban‐residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in‐person visits, rural versus urban‐residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet‐enabled device (25.9%). Conclusions: Though rural‐residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Rural Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Merchant, James

المصدر: ISBN 9781421450414 9781421450407.

الإتاحة: https://doi.org/10.56021/9781421450407Test

المؤلفون: Cercone, Jessica L, Kram, Shawn J, Trammel, Morgan A, Rackley, Craig R, Lee, Hui-Jie, Merchant, James, Kram, Bridgette L

المصدر: Journal of cardiothoracic and vascular anesthesia ; 36 ; 9 ; 3561 ; 3569 ; United States

مصطلحات موضوعية: ARDS, ECMO, activated partial thromboplastin time, heparin, transfusion

الوصف: Objective To evaluate the effect of anticoagulation targets and intensity on bleeding events, thrombotic events, and transfusion requirements in patients with acute respiratory distress syndrome (ARDS) receiving venovenous extracorporeal membrane oxygenation (ECMO) and continuous-infusion heparin. Design A retrospective cohort study. Setting At a single-center, large academic medical center. Participants One hundred thirty-six critically ill patients. Interventions The following three therapeutic targets were implemented over time and evaluated: (1) no protocol (September 2013-August 2016): no standardized anticoagulation protocol or transfusion thresholds; (2) <50 seconds (September 2016-January 2018): standardized activated partial thromboplastin time (aPTT) goal of <50 seconds, maximum heparin infusion rate of 1,200 units/h, transfusion threshold of hemoglobin (Hgb) <8 g/dL; and (3) 40-to-50 seconds (February 2018-December 2019): aPTT goal of 40-to-50 sec, no maximum heparin infusion rate, transfusion threshold of Hgb <7 g/dL. Measurements and Main Results Continuous variables were compared using the Kruskal-Wallis test, and categorical variables were compared using Fisher exact tests. The primary endpoint, an incidence of at least 1 bleeding event, was highest in the no-protocol group though not statistically different among groups (39.3% v 26.7% v 34%, p = 0.5). Thrombotic complications were similar. The median units of packed red blood cells transfused were highest in the no-protocol group (3 v 2 v 0.5, p < 0.001). Conclusion Anticoagulation protocols standardizing aPTT goals to <50 or 40-to-50 seconds may be a reasonable strategy for patients receiving venovenous ECMO for ARDS. More restrictive hemoglobin transfusion thresholds, in combination with lower aPTT targets, may be associated with a reduction in transfusion requirements. ; https://doi.org/10.1053/j.jvca.2022.05.012Test

العلاقة: Journal of Cardiothoracic and Vascular Anesthesia; http://hdl.handle.net/10713/19595Test

الإتاحة: https://doi.org/10.1053/j.jvca.2022.05.012Test
http://hdl.handle.net/10713/19595Test

المؤلفون: Pearce, Neil, Blair, Aaron, Vineis, Paolo, Ahrens, Wolfgang, Andersen, Aage, Anto, Josep M, Armstrong, Bruce K, Baccarelli, Andrea A, Beland, Frederick A, Berrington, Amy, Bertazzi, Pier Alberto, Birnbaum, Linda S, Brownson, Ross C, Bucher, John R, Cantor, Kenneth P, Cardis, Elisabeth, Cherrie, John W, Christiani, David C, Cocco, Pierluigi, Coggon, David, Comba, Pietro, Demers, Paul A, Dement, John M, Douwes, Jeroen, Eisen, Ellen A, Engel, Lawrence S, Fenske, Richard A, Fleming, Lora E, Fletcher, Tony, Fontham, Elizabeth, Forastiere, Francesco, Frentzel-Beyme, Rainer, Fritschi, Lin, Gerin, Michel, Goldberg, Marcel, Grandjean, Philippe, Grimsrud, Tom K, Gustavsson, Per, Haines, Andy, Hartge, Patricia, Hansen, Johnni, Hauptmann, Michael, Heederik, Dick, Hemminki, Kari, Hemon, Denis, Hertz-Picciotto, Irva, Hoppin, Jane A, Huff, James, Jarvholm, Bengt, Kang, Daehee, Karagas, Margaret R, Kjaerheim, Kristina, Kjuus, Helge, Kogevinas, Manolis, Kriebel, David, Kristensen, Petter, Kromhout, Hans, Laden, Francine, Lebailly, Pierre, LeMasters, Grace, Lubin, Jay H, Lynch, Charles F, Lynge, Elsebeth, 't Mannetje, Andrea, McMichael, Anthony J, McLaughlin, John R, Marrett, Loraine, Martuzzi, Marco, Merchant, James A, Merler, Enzo, Merletti, Franco, Miller, Anthony, Mirer, Franklin E, Monson, Richard, Nordby, Karl-Cristian, Olshan, Andrew F, Parent, Marie-Elise, Perera, Frederica P, Perry, Melissa J, Pesatori, Angela Cecilia, Pirastu, Roberta, Porta, Miquel, Pukkala, Eero, Rice, Carol, Richardson, David B, Ritter, Leonard, Ritz, Beate, Ronckers, Cecile M, Rushton, Lesley, Rusiecki, Jennifer A, Rusyn, Ivan, Samet, Jonathan M, Sandler, Dale P, de Sanjose, Silvia, Schernhammer, Eva, Costantini, Adele Seniori, Seixas, Noah, Shy, Carl, Siemiatycki, Jack, Silverman, Debra T

المصدر: Environmental health perspectives. 123(6)

مصطلحات موضوعية: Humans, Neoplasms, Carcinogens, Environmental, Public Health, Biomedical Research, Publications, International Agencies, Environmental Sciences, Medical and Health Sciences, Toxicology

الوصف: BackgroundRecently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.ObjectivesThe authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed.DiscussionWe concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed.ConclusionsThe IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public's health.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/8pc2q1f8Test

المؤلفون: Hii, King-Ching, Robie, Emily R., Saihidi, Izreena, Berita, Antoinette, Alarja, Natalie A., Xiu, Leshan, Merchant, James A., Binder, Raquel A., Goh, Johnny Keh-Tun, Guernier-Cambert, Vanina, Galán, Diego, Gregory, Michael J., Gray, Gregory C.

المساهمون: naval medical research unit—2

المصدر: Tropical Diseases, Travel Medicine and Vaccines ; volume 7, issue 1 ; ISSN 2055-0936

مصطلحات موضوعية: Infectious Diseases, Public Health, Environmental and Occupational Health

الوصف: Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To better understand the burden of disease and associated risk factors, we evaluated 147 patients presenting with clinical leptospirosis to local hospitals in Sarawak, Malaysia for the presence of Leptospira and associated antibodies. Sera and urine specimens collected during the acute illness phase were assessed via a commercially available rapid diagnostic test (Leptorapide, Linnodee Ltd., Antrim, Northern Ireland), an ELISA IgM assay ( Leptospira IgM ELISA, PanBio, Queensland, Australia) and a pan- Leptospira real-time PCR (qPCR) assay to estimate disease prevalence and diagnostic accuracy of each method. Microagglutination testing was performed on a subset of samples. Results Overall, 45 out of 147 patients (30.6%) showed evidence of leptospires through qPCR in either one or both sera (20 patients) or urine (33 patients), and an additional ten (6.8%) were considered positive through serological testing, for an overall prevalence of 37.4% within the study population. However, each diagnostic method individually yielded disparate prevalence estimates: rapid test 42.2% for sera and 30.5% for urine, ELISA 15.0% for sera, qPCR 13.8% for sera and 23.4% for urine. Molecular characterization of a subset of positive samples by conventional PCR identified the bacterial species as Leptospira interrogans in 4 specimens. A multivariate risk factor analysis for the outcome of leptospirosis identified having completed primary school (OR = 2.5; 95 CI% 1.0–6.4) and weekly clothes-washing in local rivers (OR = 10.6; 95 CI% 1.4–214.8) with increased likelihood of leptospirosis when compared with those who had not. Conclusion Overall, the data suggest a relatively high prevalence of leptospirosis in the study population. The low sensitivities of the rapid diagnostic test and ELISA assay against qPCR highlight a need for better screening tools.

الإتاحة: https://doi.org/10.1186/s40794-021-00154-2Test

المؤلفون: Raikundalia, Milap D., Huang, Ryan J., Chan, Lyndon, Truong, Tracy, Kuchibhatla, Maragatha, Merchant, James, Hachem, Ralph Abi, Codd, Patrick J., Zomorodi, Ali R., Teitelbaum, Jordan I., Goldstein, Bradley J., Jang, David W.

المصدر: Allergy & Rhinology ; volume 12, page 215265672110450 ; ISSN 2152-6567 2152-6567

مصطلحات موضوعية: Otorhinolaryngology, Immunology and Allergy

الوصف: Objective To assess olfactory outcomes as measured by an olfactory-specific quality of life (QOL) questionnaire in patients undergoing EESBS for sellar lesions. Design Retrospective case series. Setting Tertiary academic medical center. Participants In total, 36 patients undergoing EESBS for lesions limited to the sella were evaluated. Main Outcome Measures The following were performed before and three months after surgery: 22-Item Sinonasal Outcomes Test (SNOT-22), University of Pennsylvania Smell Identification Test (UPSIT), and the Assessment of Self-reported Olfactory Functioning (ASOF), which has three domains: subjective olfactory capability scale (SOC), smell-related problems (SRP), and olfactory-related quality of life (ORQ). Results Median age at surgery was 52.5 years, with a median tumor size of 1.8 cm (range: 0.2 to 3.9 cm). Pre- and postoperative median scores were 35 [34, 36.2] and 34.5 [32, 36] for UPSIT, 21 [7.5, 33.5] and 21.5 [6.8, 35.7] for SNOT-22, 10 [9, 10] and 9 [8, 10] for ASOF-SOC, 5 [4.8, 5] and 4.5 [4, 5] for ASOF-SRP, and 5 [5, 5] and 5 [4.5, 5] for ASOF-ORQ. There was no significant change in the two of the three domains of the ASOF. Correlation between ASOF and UPSIT scores were weak. Older age and larger tumor size were associated with worsened olfaction after surgery. Conclusions Patients did not experience significant changes in olfactory-specific QOL three months after EESBS, as measured by two domains of the ASOF. The ASOF may serve as a useful adjunctive tool for assessing olfaction after surgery. The lack of correlation between UPSIT and ASOF suggests the need for more research in subjective olfactory-related quality of life after surgery.

الإتاحة: https://doi.org/10.1177/21526567211045041Test

المؤلفون: Cercone, Jessica, Kram, Shawn, Trammel, Morgan, Rackley, Craig, Lee, Hui-Jie, Merchant, James, Kram, Bridgette

المصدر: Critical Care Medicine ; volume 50, issue 1, page 487-487 ; ISSN 0090-3493

الإتاحة: https://doi.org/10.1097/01.ccm.0000810248.81423.bbTest