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  • 1
    Online Resource
    Online Resource
    Effect of rapid methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction screening on vancomycin use in the intensive care unit
    Oxford University Press (OUP) ; 2021
    In:  American Journal of Health-System Pharmacy Vol. 78, No. 24 ( 2021-12-09), p. 2236-2244
    Details
    In: American Journal of Health-System Pharmacy, Oxford University Press (OUP), Vol. 78, No. 24 ( 2021-12-09), p. 2236-2244
    Abstract: To determine the impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) screen on vancomycin duration in critically ill patients with suspected pneumonia. Methods This was a retrospective, quasi-experimental study at a 613-bed academic medical center with 67 intensive care beds. Adult patients admitted to the intensive care unit (ICU) between 2017 and 2019 for 24 hours or longer and empirically started on intravenous vancomycin for pneumonia were included. The primary intervention was the implementation of a MRSA nasal PCR screen protocol. The primary outcome was duration of empiric vancomycin therapy. Secondary outcomes included the rate of acute kidney injury (AKI), the number of vancomycin levels obtained, the rate of resumption of vancomycin for treatment of pneumonia, ICU length of stay, hospital length of stay, the rate of ICU readmission, and the rate of in-hospital mortality. Results A total of 418 patients were included in the final analysis. The median vancomycin duration was 2.59 days in the preprotocol group and 1.44 days in the postprotocol group, a reduction of approximately 1.00 day (P & lt; 0.01). There were significantly fewer vancomycin levels measured in the postprotocol group than in the preprotocol group. Secondary outcomes were similar between the 2 groups, except that there was a lower rate of AKI and fewer vancomycin levels obtained in the postprotocol group (despite implementation of area under the curve–based vancomycin dosing) as compared to the preprotocol group. Conclusion The implementation of a pharmacist-driven MRSA nasal PCR screen was associated with a decrease in vancomycin duration and the number of vancomycin levels obtained in critically ill patients with suspected pneumonia.
    Type of Medium: Online Resource
    ISSN: 1079-2082 , 1535-2900
    URL: Article
    DOI: 10.1093/ajhp/zxab296
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    SSG: 15,3
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  • 2
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    Mass identification of potential service sector donors of personal protective equipment from an online directory during the COVID-19 pandemic
    Springer Science and Business Media LLC ; 2020
    In:  Canadian Journal of Public Health Vol. 111, No. 3 ( 2020-06), p. 404-405
    Details
    In: Canadian Journal of Public Health, Springer Science and Business Media LLC, Vol. 111, No. 3 ( 2020-06), p. 404-405
    Type of Medium: Online Resource
    ISSN: 0008-4263 , 1920-7476
    URL: Article
    DOI: 10.17269/s41997-020-00334-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2599345-8
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  • 3
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    1489. Safety and Performance of a Pharmacist-Driven Nasal MRSA PCR Protocol for De-escalation of Empiric Vancomycin for Suspected Pneumonia at an Academic Medical Center
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S746-S747
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S746-S747
    Abstract: Limited published data supports the de-escalation of empiric anti-methicillin resistant Staphylococcus aureus (MRSA) antibiotics for suspected pneumonia upon negative nasal MRSA screening. Besides limited sample sizes, special populations, such as those who are immunocompromised and/or critically ill, have been underrepresented in these reports. We describe real-world efficacy and safety of a pharmacist-driven nasal MRSA PCR testing protocol implemented at Stanford Health Care in May 2018 across a diverse patient population. Methods This was an observational cohort study of adult patients who received vancomycin for empiric pneumonia before (PRE) vs after (POST) implementation of a pharmacist-driven nasal MRSA PCR testing protocol (between 05/01/2017 - 08/31/2017 (PRE) and 5/7/2018 - 12/31/2019 (POST). The primary outcome measure was duration of vancomycin administration. Secondary outcomes included time to vancomycin discontinuation, frequency of restarting vancomycin for empiric pneumonia within 7 days, acute kidney injury (defined as “risk” by RIFLE criteria), and MRSA respiratory cultures. Statistical methods are described in Figure A. Figure A. Statistical methods Results Total of 610 patients were included in this study with 116 in the PRE group and 494 in the POST group. Over 40% were critically ill and approximately 37% were immunocompromised in both groups (Table 1). For the primary outcome, median vancomycin duration was significantly shorter in the POST group (1.29 days; 95% CI 1.13-1.45) vs. PRE group (1.98 days; 95% CI 1.49-2.46) (p & lt; 0.0005), a 34.8% reduction (Figure 1). Median vancomycin duration was lower in patients with a negative vs positive nasal MRSA PCR (1.20 days [95% CI 1.08-1.33] vs 2.53 days [95% CI 1.77-3.29] , p & lt; 0.0005), a 52.6% reduction (Figure 2). MRSA was recovered in respiratory cultures in 1.7% vs 1.4% in the PRE vs POST groups. One (0.002%) patient had a negative nasal MRSA PCR but culture-confirmed MRSA pneumonia and recovered after completing a treatment course. Secondary safety outcomes were similar between groups (Table 2). Tables 1 and 2: Baseline Characteristics and Secondary Outcomes Figure 1. Primary Outcome: Kaplan–Meier Estimates of Cumulative Active Vancomycin Therapy Before and After Implementation of Nasal MRSA PCR protocol Figure 2. Secondary Outcome: Figure 2. Kaplan–Meier Estimates of Cumulative Active Vancomycin Therapy in Patients with Negative vs Positive Nasal MRSA PCR Conclusion Pharmacist-driven nasal MRSA PCR testing is effective and safe in early de-escalation of empiric vancomycin used for pneumonia treatment in a diverse population including critically ill and immunocompromised patients. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1670
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
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  • 4
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    Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018
    BMJ ; 2022
    In:  Regional Anesthesia & Pain Medicine Vol. 47, No. 2 ( 2022-02), p. 100-104
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 47, No. 2 ( 2022-02), p. 100-104
    Abstract: While popularly consumed for its perceived benefits as a sleeping aid, the impact of cannabis on sleep-wake regulation in clinical studies is inconclusive. The purpose of this study was to determine the relationship between cannabis use and nightly sleep duration in a nationally representative dataset. Methods A cross-sectional analysis of adults was undertaken using the National Health and Nutrition Examination Survey data from 2005 to 2018. Respondents were dichotomized as recent users or non-users if they had used or not used cannabis in the past 30 days, respectively. The primary outcome was nightly sleep duration, categorized as short ( 〈 6 hours), optimal (6–9 hours), and long ( 〉 9 hours). Multinomial logistic regression was used to adjust for sociodemographic and health-related covariates, and survey sample weights were used in modeling. Results From a sample representing approximately 146 million adults in the USA, 14.5% reported recent cannabis use. In an adjusted analysis, recent users were more likely than non-users to report both short sleep (OR 1.34, 95% CI 1.12 to 1.59, p 〈 0.001) and long sleep (OR 1.56, 95% CI 1.25 to 1.96, p 〈 0.001). Heavy users (≥20 of the past 30 days) were even more likely to be at the extremes of nightly sleep duration. Discussion Recent cannabis use was associated with the extremes of nightly sleep duration in a nationally representative sample of adults, with suggestions of a dose–response relationship. Our findings highlight the need to further characterize the sleep health of regular cannabis users in the population.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2021-103161
    DOI: 10.1136/rapm-2021-103161.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2028901-7
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  • 5
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    Reply to: ‘Co-use of opioids with cannabis – evaluating risks and benefits’
    BMJ ; 2023
    In:  Regional Anesthesia & Pain Medicine
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    DOI: 10.1136/rapm-2023-104626
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2028901-7
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  • 6
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    Co-use of cannabis and prescription opioids in adults in the USA: a population-based, cross-sectional analysis of the NHANES from 2009 to 2018
    BMJ ; 2023
    In:  Regional Anesthesia & Pain Medicine Vol. 48, No. 4 ( 2023-04), p. 145-149
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 48, No. 4 ( 2023-04), p. 145-149
    Abstract: Cannabis and cannabinoids continue to gain popularity as adjuncts or alternatives to opioids in pain management, with evolving evidence of effectiveness. The relationship between cannabis and opioid use has previously been investigated in smaller cohorts or ecological samples, but not yet in a nationally representative sample. Methods A cross-sectional analysis of adults in the USA was undertaken using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018. The primary exposure was self-reported use of at least one opioid-containing prescription medication in the 30 days prior to survey administration. The outcome of interest was self-reported cannabis use in the same period. Multivariable logistic regression was used to adjust for sociodemographic and health-related covariates, and NHANES survey sample weights were included in modeling. Prescription opioid users were then subclassified as short-term users ( 〈 90 days) or chronic users (≥90 days) in secondary analysis. Results A total 10,928 survey respondents were included in analyses, representing 110 million adults in the USA aged 18–59. In this weighted cohort, 5.6%±0.4% reported a recent opioid prescription. Among prescription opioid users, 18.4%±3.1% reported recent cannabis use, not significantly different from 17.7%±0.7% among non-users (OR 1.05, 95% CI 0.81 to 1.36, p=0.714). After adjustment for covariates, opioid users were significantly less likely to have recently used cannabis (adjusted OR, aOR 0.70, 95% CI 0.51 to 0.97, p=0.032). When opioid users were subclassified by duration of prescription, there was no detectable difference in recent cannabis use between chronic opioid users and short-term opioid users (aOR 1.11, 95% CI 0.70 to 1.78, p=0.649). Conclusion Recent prescription opioid use was associated with decreased odds of cannabis use in this cross-sectional analysis of a nationally representative cohort. These findings suggest that use of cannabis or prescription opioids may not independently promote use of the other.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2022-103933
    DOI: 10.1136/rapm-2022-103933.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2028901-7
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  • 7
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    Recent cannabis use and nightly sleep duration in adults: an infographic
    BMJ ; 2022
    In:  Regional Anesthesia & Pain Medicine Vol. 47, No. 2 ( 2022-02), p. 105-105
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 47, No. 2 ( 2022-02), p. 105-105
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    DOI: 10.1136/rapm-2021-103294
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2028901-7
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  • 8
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    The Use of Three-Dimensional Printing in Cardiac Structural Disease: A Review
    SAGE Publications ; 2023
    In:  Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Vol. 18, No. 2 ( 2023-03), p. 132-143
    Details
    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, SAGE Publications, Vol. 18, No. 2 ( 2023-03), p. 132-143
    Abstract: Three-dimensional printing (3DP), or additive fabrication, is a process in which a physical 3D model is created using a multitude of 2-dimensional images. This process has been applied to numerous surgical subspecialties with growing interest for the use of 3DP in adult structural heart disease. This scoping review evaluates the use of 3DP in transcatheter and surgical aortic and mitral valve interventions as well as left atrial appendage occlusion in terms of its practical and clinical application. Methods: Articles were identified through PubMed and Embase using MeSH search terms as well as independent searches. A total of 645 articles were screened, and 37 were retained for qualitative analysis. Results: Operative planning was coded in 100% of articles, complication prevention in 43%, medical education in 5.4%, patient education in 0%, and simulation in 5.4%. Conclusions: The main uses of 3DP in acquired structural heart disease are centered around operative planning and complication prevention, with moderate use regarding surgical simulation and infrequent use regarding medical and/or patient education. Although patient anatomy varies greatly, deploying 3DP as a large-scale tool remains a possibility. The more 3D models are made, the more can be learned about demographic subsets of patient populations. Due to the lack of standard operating procedures for the creation of 3DP models, the cost-effectiveness of these models is hard to determine and likely center specific. More research into this facet could inform centers that wish to implement this tool.
    Type of Medium: Online Resource
    ISSN: 1556-9845 , 1559-0879
    URL: Article
    DOI: 10.1177/15569845231161287
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2223439-1
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  • 9
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    Preoperative depression and outcomes after metabolic and bariatric surgery: A systematic narrative review
    Wiley ; 2024
    In:  Obesity Reviews Vol. 25, No. 7 ( 2024-07)
    Details
    In: Obesity Reviews, Wiley, Vol. 25, No. 7 ( 2024-07)
    Abstract: Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient‐reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta‐analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies ( n  = 3390) the associations between preoperative depression and weight loss outcomes at 6–72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non‐randomized Studies ‐ of Exposure (ROBINS‐E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient‐important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations.
    Type of Medium: Online Resource
    ISSN: 1467-7881 , 1467-789X
    URL: Issue
    URL: Article
    DOI: 10.1111/obr.v25.7
    DOI: 10.1111/obr.13743
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2020497-8
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  • 10
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    The relationship between cannabis use and legalization frameworks: A cross-sectional analysis using a nationally representative survey
    Elsevier BV ; 2022
    In:  Preventive Medicine Vol. 156 ( 2022-03), p. 106978-
    Details
    In: Preventive Medicine, Elsevier BV, Vol. 156 ( 2022-03), p. 106978-
    Type of Medium: Online Resource
    ISSN: 0091-7435
    URL: Article
    DOI: 10.1016/j.ypmed.2022.106978
    RVK:
    XF 1500
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1471564-8
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