Oct 192014
 

Management bundles for candidaemia: the impact of compliance on clinical outcomes.

J Antimicrob Chemother. 2014 Oct 17;

Authors: Takesue Y, Ueda T, Mikamo H, Oda S, Takakura S, Kitagawa Y, Kohno S, on behalf of the ACTIONs Project

Abstract
OBJECTIVES: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes.
METHODS: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012.
RESULTS: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P = 0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia.
CONCLUSIONS: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.

PMID: 25326087 [PubMed - as supplied by publisher]

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Oct 192014
 

MELD score and antibiotics use are predictors of length of stay in patients hospitalized with hepatic encephalopathy.

BMC Gastroenterol. 2014 Oct 17;14(1):185

Authors: Martel-Laferrière V, Homberger C, Bichoupan K, Dieterich DT

Abstract
BACKGROUND: Hepatic encephalopathy (HE) represents a significant burden to the healthcare system. The aim of this study was to determine factors influencing the hospital length of stay among patients hospitalized with HE.
METHODS: A data warehouse query was performed to identify 316 patients with a first hospitalization during which HE occurred, between April 2010 and February 2012. Baseline and hospitalization characteristics were collected with IRB approval. A negative binomial multivariable model was used to control for potential confounders on the length of hospitalization.
RESULTS: Median age was 59 years, and 60.4% of admitted patients were male. The median MELD score was 22 (IQR: 17-28). Median length of stay was 8 days (IQR: 3.25-14.25). After controlling for MELD score, female gender (2.2 days; p = 0.04), being initially admitted for a reason other than HE (liver-related: 7.6 days; p < 0.01 and non liver-related 10.7 days; p < 0.01) and receiving antibiotics other than rifaximin (10.5 days; p < 0.01) were associated with longer length of stay whereas hepatitis C (-3.1 days; p < 0.01) was associated with a shorter length of stay.
CONCLUSIONS: MELD score, gender, use of antibiotics other than rifaximin, reason for admission and hepatitis C are predictors readily available in clinic that can help identify patients at risk for longer length of stay.

PMID: 25326084 [PubMed - as supplied by publisher]

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Oct 192014
 
Related Articles

Evaluating warfarin management by pharmacists in a community teaching hospital.

Consult Pharm. 2014 Feb;29(2):95-103

Authors: Chilipko AA, Norwood DK

Abstract
OBJECTIVE: The purpose of this study was to evaluate warfarin management by pharmacists compared with physicians through an inpatient anticoagulation management service (AMS).
DESIGN: Retrospective cohort study.
SETTING: Community teaching hospital.
PATIENTS, PARTICIPANTS: Patients were randomly selected from the Inpatient AMS from January 1, 2009 to January 1, 2011. Patients were included if they were 18 of age years or older and received warfarin for at least three days and excluded for indefinite warfarin discontinuation or an indication following orthopedic surgery. A total of 179 patients were included in each group.
INTERVENTIONS: The electronic medical record was reviewed for demographics, warfarin indication and goal range, international normalized ratios (INRs), albumin, drug-drug interactions, bleeding, and thrombotic rates.
MAIN OUTCOME MEASURES: Primary endpoints included mean time to therapeutic INR, mean time within goal, frequency of supratherapeutic INRs, bleeding, thrombotic rates, and mean INR on discharge.
RESULTS: There was no statistically significant difference in the time required to reach a therapeutic INR; 3.17 vs. 2.65 days (95% confidence interval -0.09-1.13; P = 0.093). However, the pharmacist group resulted in a lower frequency of supratherapeutic INRs and significantly more time within goal range.
CONCLUSION: Similar results were observed for pharmacist-managed and physician-managed patients for INR monitoring and outcome rates. However, the pharmacist-managed patients demonstrated a lower incidence of supratherapeutic INRs and significantly more time within goal.

PMID: 24513419 [PubMed - indexed for MEDLINE]

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Oct 192014
 
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Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011.

BMC Infect Dis. 2013;13:146

Authors: Di Bella S, Musso M, Cataldo MA, Meledandri M, Bordi E, Capozzi D, Cava MC, Chiaradonna P, Prignano G, Petrosillo N

Abstract
BACKGROUND: In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found.
METHODS: Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded.
RESULTS: A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%).
CONCLUSIONS: A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable.

PMID: 23522431 [PubMed - indexed for MEDLINE]

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Oct 192014
 

Influence of Hospitalization for Cardiovascular versus Noncardiovascular Reasons on Subsequent Mortality in Patients with Chronic Heart Failure Across the Spectrum of Ejection Fraction.

Circ Heart Fail. 2014 Oct 17;

Authors: Desai AS, Claggett B, Pfeffer MA, Bello N, Finn PV, Granger CB, McMurray JJ, Pocock S, Swedberg K, Yusuf S, Solomon SD

Abstract
BACKGROUND: -Noncardiovascular (non-CV) comorbidities may contribute to hospitalizations in patients with heart failure (HF). We examined the incidence of mortality following hospitalization for cardiovascular (CV) versus non-CV reasons in the CHARM Program.
METHODS AND RESULTS: -First hospitalizations for CV or non-CV reasons during the CHARM trial (N=7599) were related to subsequent risk of all-cause death using time-updated proportional hazards models. Over median 37.7 month follow up, 2816 subjects (37.1%) were not hospitalized, 2893 (38.1%) were first hospitalized for CV reasons and 1890 (24.9%) for non-CV reasons. The death rate (per 100-pt yrs) amongst those not hospitalized was 2.8 compared with 17.8 after CV and 16.5 after non-CV hospitalization (both p<0.001 versus not hospitalized). Mortality at 30-days was higher after CV than non-CV hospitalization; however, amongst 30-day survivors of CV and non-CV hospitalization, rates of subsequent mortality were similar (14.5 vs. 14.6 per 100-pt yrs, p=0.62). Rates of CV hospitalization were higher for those with EF≤40% than those with EF>40% (p<0.001), but rates of non-CV hospitalization did not vary by EF. Low EF patients had higher risk for mortality than preserved EF patients after any hospitalization, but within each EF subgroup, mortality in 30-day survivors of CV versus non-CV hospitalization was similar.

CONCLUSIONS: -Non-CV hospitalization is frequent in patients with symptomatic heart failure and associated with risk of subsequent mortality similar to CV hospitalization across the spectrum of EF. These findings may have implications for developing strategies to prevent readmissions. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00634309 (CHARM-Added), NCT00634712(CHARM-Preserved), NCT00634400 (CHARM-Alternative).

PMID: 25326006 [PubMed - as supplied by publisher]

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Oct 182014
 
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Does a non-invasive hemoglobin monitor correlate with a venous blood sample in the acutely ill?

Intern Emerg Med. 2014 Oct 17;

Authors: von Schweinitz BA, De Lorenzo RA, Cuenca PJ, Anschutz RL, Allen PB

Abstract
Non-invasive hemoglobin measuring technology has potential for rapid, portable, and accurate way of providing identification of blood loss or anemia. Our objective is to determine if this technology is reliable in critically ill patients presenting to the Emergency Department. Prospective cross-sectional observational study was done at an urban level-one trauma center, 135 subjects were conveniently sampled, suspected of having active bleeding, sepsis, or other critically ill condition. Non-invasive measurements with Masimo (Irvine, CA, USA) Radical-7 and Rad-57 hemoglobin monitors were compared with the Beckman-Coulter LH-550 (Brea, CA, USA) clinical laboratory blood cell analyzer. The primary outcome was the relationship of the non-invasive device to the clinical laboratory results. Secondary evaluations included the effect of pulse rate, systolic BP, respiratory rate, temperature, capillary refill, skin color, nail condition, extremity movement. The Radical-7 was able to capture reading in 78 % (88/113) of subjects, and the Rad-57 in 65 % (71/110) of subjects. The correlation (R(2)) of the device Hb was 0.69 and 0.67 (p < 00.01) for the Radical-7 and Rad-57, respectively. The coefficient of variation for the Radical-7 was 18 %, and for the Rad57 it was 13 %. Univariate analysis shows none of the observed factors is associated with the difference values between the device Hb and laboratory Hb. Our results show that Radical-7 and Rad-57 devices do not report readings in 29 % of patients and accuracy is significantly lower than reported by the manufacturer with over 50 % of readings falling outside of ± 1 g/dL. We determined that none of the several potential factors examined are associated with the degree of device accuracy.

PMID: 25322853 [PubMed - as supplied by publisher]

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