Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains

Purpose The aim of this study is to report the efficacy of long subcutaneous tunnelling of external ventricular drains in reducing rates of infection and catheter displacement in a paediatric population. Methods In children requiring external ventricular drainage, a long-tunnelled drain was placed and managed according to a locally agreed guideline. End points were novel CSF infection incurred during the time of drainage and re-operation to re-site displaced catheters. Data were compared to other published series. Results One hundred eighty-one long-tunnelled external ventricular drains (LTEVDs) were inserted. The mean age was 6.6 years (range 0-15.5 years). Reasons for insertion included intraventricular haemorrhage (47 %), infection (27 %), tumour-related hydrocephalus (7.2 %), as a temporising measure (17 %) and trauma (2.2 %). The overall new infection rate for LTEVD was 2.76 %. If the 48 cases where LTEVDs were inserted to treat an existing infection are excluded, the infection rate was 3.8 % (5/133). The mean duration of insertion was 10 days (range 0-42 days). Four LTEVDs (2.2 %) were inadvertently dislodged, requiring reinsertion. Thirteen patients required removal of EVD alone.There was a significant difference (p < 0.05) when comparing our infection rate to 14 publications of infection rates in short-tunnelled EVDs; however, there was no difference when comparing our data to three publications using LTEVDs. Conclusion The use of an antibiotic-impregnated LTEVD, managed according to a predefined guideline, is associated with significantly reduced infection and displacement rates when compared with contemporary series. It is suggested that this reduction is of both clinical and economic benefits

Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management

Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR). Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR). Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to$193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs

From the Editors

Welcome to the latest edition of the JCIPE Interprofessional Education and Care Newsletter! Since our last edition, we have had some changes at JCIPE. First, founding Co-Director Dr. Molly Rose has begun a phased retirement and stepped down from her JCIPE position. Although parting is always bittersweet, we are thrilled that Molly is continuing to champion interprofessional education from her position in the Jefferson School of Nursing (JSN), and also still serving as chair of our Evaluation Workgroup. At the same time, transitions bring us the joy of new partners – and we are delighted to introduce Elizabeth Speakman, EdD, RN, CDE, ANEF as the new Co-Director of JCIPE. Liz has been a nurse educator for 27 years. She came to JSN in 2003. She has served as Assistant Dean of the RN-to-BSN program and most recently as Associate Dean for Student Affairs

From the Editors

Welcome to the Fall 2013 edition of the Jefferson Interprofessional Education and Care newsletter. In this edition you will read about Collaborating Across Borders, IV, the largest IPE meeting to date, where the work of developing, integrating, and sustaining interprofessional education and collaborative practice was shared by over 700 participants. The clear message of CAB IV – interprofessional education is being recognized and adopted by health professions education programs in a way not seen before, but the work of clearly identifying optimum education strategies and documenting impact on patient care must be a high priority for all of us in the IPE community

Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief