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  • 1
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    Online Resource
    Impact of Culturing All Uncomplicated Urinary Tract Infections on the Estimated Prevalence Of Resistance in the Primary Care Setting
    Oxford University Press (OUP) ; 2017
    In:  Open Forum Infectious Diseases Vol. 4, No. suppl_1 ( 2017-10-01), p. S349-S349
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 4, No. suppl_1 ( 2017-10-01), p. S349-S349
    Abstract: Urine cultures to confirm a urinary tract infection (UTI) are not consistently collected in the primary care setting; thus estimates of the prevalence of resistance in uropathogens may be biased. As part of an ongoing study, microbiologic cultures were collected for all patients presenting with uncomplicated UTI at primary care clinics over a six-month period to assess the potential misclassification in frequency of resistance. Methods Data from an electronic health record repository were used to identify clinic encounters for women with a diagnosis code for unspecified UTI or cystitis from six primary care clinics between October 1, 2015 and February 28, 2017 in this cross-sectional study. Prior to August 22, 2016, urine microbiology cultures were collected at the discretion of the provider (usual care period), and from August 22, 2016 to February 28, 2017 urinary microbiology cultures were collected from all patients suspected of having uncomplicated UTI (full culturing period). Urinary microbiology culture and pharmacy data occurring within three days of the encounter were collected. Antibiotic susceptibility data was summarized for isolated Enterobacteriaceae. Frequency of susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin, and fluoroquinolones were compared between usual care vs. the full culturing periods using a chi-square test. Results We identified 131 urine microbiology cultures in the usual care period and 104 in the full culturing period with 61.1% and 55.8%, respectively, being positive cultures. Enterobacteriaceae were isolated from 85.0% of positive cultures in the usual care period and 86.2% in the full culturing period. Between the usual and full culturing periods, antibiotic susceptibility in the Enterobacteriaceae did not differ statistically for TMP-SMX (85.1% vs.. 88.0%; P = 0.65), nitrofurantoin (98.5% vs. 94.0%; P = 0.19), and fluoroquinolones (89.6% vs. 90.0%; P = 0.94). Conclusion Full culturing did not significantly change estimates of the prevalence of antibiotic resistance among Enterobacteriaceae isolated from urine samples. Current urine culturing practices provide adequate susceptibility information to inform empiric prescribing for women with uncomplicated UTIs. Disclosures J. C. McGregor, Merck & Co.: Grant Investigator, Research grant
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofx163.839
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2757767-3
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  • 2
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    Online Resource
    Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care
    Mary Ann Liebert Inc ; 2017
    In:  Journal of Palliative Medicine Vol. 20, No. 11 ( 2017-11), p. 1225-1230
    Details
    In: Journal of Palliative Medicine, Mary Ann Liebert Inc, Vol. 20, No. 11 ( 2017-11), p. 1225-1230
    Type of Medium: Online Resource
    ISSN: 1096-6218 , 1557-7740
    URL: Article
    DOI: 10.1089/jpm.2016.0487
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 2017
    detail.hit.zdb_id: 2030890-5
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  • 3
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    Online Resource
    Frequency and Characteristics of Patients Prescribed Antibiotics on Admission to Hospice Care
    Mary Ann Liebert Inc ; 2021
    In:  Journal of Palliative Medicine
    Details
    In: Journal of Palliative Medicine, Mary Ann Liebert Inc
    Type of Medium: Online Resource
    ISSN: 1096-6218 , 1557-7740
    URL: Article
    DOI: 10.1089/jpm.2021.0062
    Language: English
    Publisher: Mary Ann Liebert Inc
    Publication Date: 2021
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  • 4
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    Frequency of Outpatient Antibiotic Prescription on Discharge to Hospice Care
    American Society for Microbiology ; 2014
    In:  Antimicrobial Agents and Chemotherapy Vol. 58, No. 9 ( 2014-09), p. 5473-5477
    Details
    In: Antimicrobial Agents and Chemotherapy, American Society for Microbiology, Vol. 58, No. 9 ( 2014-09), p. 5473-5477
    Abstract: The use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were 〉 65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR] = 7.00; 95% confidence interval [95% CI] = 4.68 to 10.46), discharge to home hospice care (AOR = 2.86; 95% CI = 1.92 to 4.28), and having a cancer diagnosis (AOR = 2.19; 95% CI = 1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.
    Type of Medium: Online Resource
    ISSN: 0066-4804 , 1098-6596
    URL: Article
    DOI: 10.1128/AAC.02873-14
    RVK:
    XA 24552
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2014
    detail.hit.zdb_id: 1496156-8
    SSG: 12
    SSG: 15,3
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  • 5
    Online Resource
    Online Resource
    Gambling and Increased Sexual Desire With Dopaminergic Medications in Restless Legs Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Clinical Neuropharmacology Vol. 30, No. 5 ( 2007-09), p. 249-255
    Details
    In: Clinical Neuropharmacology, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 5 ( 2007-09), p. 249-255
    Type of Medium: Online Resource
    ISSN: 0362-5664
    URL: Article
    DOI: 10.1097/wnf.0b013e31804c780e
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 2048796-4
    SSG: 15,3
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  • 6
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    Online Resource
    200. Frequency and Characteristics of Patients Switched from Intravenous to Oral Antibiotic Therapy on Discharge to Nursing Homes
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S104-S105
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S104-S105
    Abstract: Determining eligibility for intravenous (IV) to oral (PO) antibiotic conversion is challenging in patients transitioning to nursing homes (NHs) due to atypical infection presentation, increased diagnostic uncertainty, and multimorbidity. Understanding current practice and patient characteristics influencing prescriber behavior is necessary to provide effective antibiotic stewardship in this vulnerable population. We compared the frequency and characteristics of patients discharged with IV antibiotics to those switched from IV to PO therapy. Methods This was a retrospective cohort study of Oregon Health & Science University Hospital patients treated with IV antibiotics and discharged to a NH from 1/1/2016-12/31/2018. We focused on IV to PO antibiotic switch within 48 hours of discharge. Using a repository of electronic health record data, we collected patient demographic, diagnosis, length of stay, and treatment duration data. Results Among 2,410 patients discharged to a NH on antibiotics, 1,483 (61.5%) received an IV antibiotic within 48 hours of discharge. IV to PO switch occurred in 46.7% of patients prior to discharge, and these patients had fewer baseline comorbidities (Table 1). Of those continuing IV antibiotics, 96.1% were prescribed a different PO medication at discharge indicating potential to take PO medications. Cephalosporins (45%) and penicillins (22%) were the most commonly prescribed IV antibiotics, with IV to PO conversion rates of 26% and 46%, respectively. The median (interquartile range) outpatient duration of therapy was 21 (12–33) days for IV antibiotics and 7 (4–10) days for PO antibiotics. Osteomyelitis diagnosis was more frequent among IV therapy patients; pneumonia and urinary tract infections were more frequent in IV to PO switch patients. IV to PO switch patients were less likely to experience a hospital stay & gt; 7 days or receive an infectious disease consult (p & lt; 0.001). Table 1. Comparison of Patient and Treatment Characteristics among IV and Oral Antibiotic Prescriptions on Discharge Conclusion The proportion of patients discharged to a NH on IV antibiotics remains high, even among patients able to tolerate PO medication. Continuing IV therapy was associated with longer treatment durations, hospital stays, and broad spectrum regimens, while patients with IV to PO switch had a higher comorbidity burden at baseline. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.244
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
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  • 7
    Online Resource
    Online Resource
    Clinical Outcomes of the Oral Suspension vs Delayed-Release Tablet Formulations of Posaconazole for Prophylaxis of Invasive Fungal Infections
    Oxford University Press (OUP) ; 2017
    In:  Open Forum Infectious Diseases Vol. 4, No. suppl_1 ( 2017-10-01), p. S86-S86
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 4, No. suppl_1 ( 2017-10-01), p. S86-S86
    Abstract: Posaconazole is effective prophylaxis for invasive fungal infections (IFIs). We compared incidence of breakthrough IFI (bIFI) and early posaconazole discontinuation between patients receiving delayed-release tablet and oral suspension formulations. Methods This was a retrospective cohort study of patients receiving posaconazole at Oregon Health & Science University Hospital between 1/1/2010 and 6/30/2016. Oral suspension was the preferred formulation until 2/2014; afterwards the tablet was preferred. We included all courses of primary prophylaxis for each patient during the study period. Data were extracted from an electronic health record repository and via chart review. Three independent reviewers identified bIFI using European Organization for Research and Treatment of Cancer criteria. We assessed rationale for early discontinuation of posaconazole for patients that were still indicated for antifungal prophylaxis based on National Comprehensive Cancer Network (NCCN) criteria. Results 547 patients received 859 courses of posaconazole (53% oral suspension and 48% tablet). Prophylaxis was indicated according to NCCN criteria in 91% of courses. The primary indications for prophylaxis were acute myelogenous leukemia (68%), graft-vs-host disease (18%), and myelodysplastic syndrome (3%). There were no significant differences in demographics or indication between patients receiving the different formulations. The overall incidence rate of bIFI was 4.15/10,000 posaconazole-days (16 total bIFI events). Incidence of bIFI was not significantly different between patients receiving the different formulations (P = 0.92). Posaconazole was discontinued early in 147 (17%) courses; frequency of discontinuation was not significantly different between the tablet (20%) and oral suspension (15%) formulations (P = 0.10). The primary reasons for early discontinuation were elevated liver function tests or QT prolongation (25%), inability to take an oral formulation (17%), and drug cost (17%). Conclusion Among patients receiving posaconazole prophylaxis, incidence of bIFI was low and not significantly different between those receiving the tablet vs oral suspension formulations. Disclosures J. P. Furuno, Merck & Co.: Consultant and Grant Investigator, Consulting fee, Research grant and Speaker honorarium. J. S. Lewis II, Merck & Co.: Consultant, Consulting fee. J. C. McGregor, Merck & Co.: Grant Investigator, Research grant
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofx163.039
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
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  • 8
    Online Resource
    Online Resource
    Clinical Outcomes of Oral Suspension versus Delayed-Release Tablet Formulations of Posaconazole for Prophylaxis of Invasive Fungal Infections
    American Society for Microbiology ; 2018
    In:  Antimicrobial Agents and Chemotherapy Vol. 62, No. 10 ( 2018-10)
    Details
    In: Antimicrobial Agents and Chemotherapy, American Society for Microbiology, Vol. 62, No. 10 ( 2018-10)
    Abstract: Posaconazole is used for prophylaxis for invasive fungal infections (IFIs) among patients with hematologic malignancies. We compared the incidence of breakthrough IFIs and early discontinuation between patients receiving delayed-release tablet and oral suspension formulations of posaconazole. This was a retrospective cohort study of patients receiving posaconazole between 1 January 2010 and 30 June 2016. We defined probable or proven breakthrough IFIs using the European Organization for Research and Treatment of Cancer (EORTC) criteria. Overall, 547 patients received 860 courses of posaconazole (53% received the oral suspension and 48% received the tablet); primary indications for prophylaxis were acute myeloid leukemia (69%), graft-versus-host disease (18%), and myelodysplastic syndrome (3%). There were no significant differences in demographics or indications between patients receiving the different formulations. The incidence and incidence rate of probable or proven IFIs were 1.6% and 3.2 per 10,000 posaconazole days, respectively. There was no significant difference in the rate of IFIs between suspension courses (2.8 per 10,000 posaconazole days) and tablet courses (3.7 per 10,000 posaconazole days) (rate ratio = 0.8, 95% confidence interval [CI] = 0.3 to 2.3). Of the 14 proven or probable cases of IFI, 8/14 had posaconazole serum concentrations measured, and the concentrations in 7/8 were above 0.7 μg/ml. Posaconazole was discontinued early in 15.5% of courses; however, the frequency of discontinuation was also not significantly different between the tablet (16.5%) and oral suspension (14.6%) formulations (95% CI for difference = −0.13 to 0.06). In conclusion, the incidence of breakthrough IFIs was low among patients receiving posaconazole prophylaxis and not significantly different between patients receiving the tablet formulation and those receiving the oral suspension formulation.
    Type of Medium: Online Resource
    ISSN: 0066-4804 , 1098-6596
    URL: Article
    DOI: 10.1128/AAC.00893-18
    RVK:
    XA 24552
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2018
    detail.hit.zdb_id: 1496156-8
    SSG: 12
    SSG: 15,3
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  • 9
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    Cytomegalovirus serologic matching in deceased donor kidney allocation optimizes high- and low-risk (D+R− and D−R−) profiles and does not adversely affect transplant rates
    Elsevier BV ; 2020
    In:  American Journal of Transplantation Vol. 20, No. 12 ( 2020-12), p. 3502-3508
    Details
    In: American Journal of Transplantation, Elsevier BV, Vol. 20, No. 12 ( 2020-12), p. 3502-3508
    Type of Medium: Online Resource
    ISSN: 1600-6135
    URL: Article
    DOI: 10.1111/ajt.15976
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2045621-9
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  • 10
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    Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care
    Wiley ; 2019
    In:  Journal of the American Geriatrics Society Vol. 67, No. 6 ( 2019-06), p. 1258-1262
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 67, No. 6 ( 2019-06), p. 1258-1262
    Abstract: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN Retrospective cohort study. SETTING A 544‐bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication‐related decisions. RESULTS Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2019.67.issue-6
    DOI: 10.1111/jgs.15860
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2040494-3
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