Evaluation of surgical antibiotic prophylaxis at a large, tertiary medical center

Emily Fox, PharmD, PGY-1 Pharmacy Resident Brent Footer, PharmD, BCPS; Angel Mendez, Pharmacy Student Providence Portland Medical Center, Portland, Oregon Evaluation of surgical antibiotic prophylaxis at a large, tertiary medical center Surgical site infections (SSI) are a significant cause of morbidity, prolonged hospitalization, and mortality. The cost of a single SSI is estimated to be upward of $25,000 and increases a patient’s length of hospital stay by ~10 days. Our institution has identified inappropriate or less than optimal antimicrobial prophylaxis as a potential contributor in several recent SSI cases. Current literature on this topic has found that there may be a role for clinical pharmacists in cyclic auditing to improve surgical antibiotic prophylaxis guideline adherence. This retrospective analysis of hysterectomy, colorectal, and spinal surgeries aims to review surgical antimicrobial prophylaxis for appropriateness based on patient-specific factors and published system and national guidelines. This is an IRB-approved, single institution retrospective chart review of surgical antibiotic prophylaxis regimens for adult patients that underwent hysterectomy, colorectal, or spinal surgery between the months of June and August 2019. Specific surgery types were chosen based on requests by surgery leadership and highest potential for quality improvement. Patients were identified by surgery classification via the electronic medical record (EMR). Other relevant data was obtained via the EMR including: surgeon, anesthesiologist, antibiotic regimen, dose, administration time, ordering method, and patient weight. Additional chart review was required for other relevant factors including history of multi-drug resistant organisms and allergy history/severity. The primary outcome measured was compliance to hospital system guidelines, accounting for antibiotic selection, administration timing, and dosing. Primary outcome adherence rates varied greatly depending on the type of surgery. For hysterectomy, 62 of 141 surgeries (44%) achieved the primary outcome, with the primary contributor of non-compliance being selection of an antibiotic regimen inconsistent with system-wide guidelines. For colorectal surgeries, 21 of 35 (60%) achieved the primary outcome, with the primary reason for non-compliance being inappropriate antibiotic administration timing. Additionally, it was identified that history of resistant infections was not properly accounted for when making antibiotic prophylaxis choices, with 3 SSIs resulting from multi-drug resistant organisms in patients with MDRO history. Spinal surgery compliance to the primary outcome was less-clear, as guidelines are not as well-defined. However, MRSA colonization status was not determined via PCR when appropriate for 31 of 148 (21%) of surgeries. Opportunities for pharmacist intervention and education were identified for implementation after chart review of each surgery. Each surgery requires a unique intervention. Primary outcome data and proposed interventions for each surgery was presented to the institutional surgical site infection committee, which met quarterly. Pharmacist cyclic auditing of antibiotic prophylaxis choices resulted in increased discussion and education. Proposed changes are still being considered by surgery department leadership, including a change in antibiotic choice for colorectal surgeries. Future data collection will be performed after changes are implemented to determine improved guideline adherence.https://digitalcommons.psjhealth.org/pharmacy_PGY1/1013/thumbnail.jp

Marketing digital y la captación de clientes en los centros de impresiones del distrito de San Juan De Lurigancho, 2021

El desarrollo de la investigación tuvo como objetivo general determinar la relación entre el marketing digital y captación de clientes en los centros de impresiones del distrito de San Juan de Lurigancho, 2021; la metodología fue tipo aplicada, de enfoque cuantitativo, correlacional, diseño no experimental de corte transversal. Asimismo, se tomó en cuenta a una población de 50 clientes de los centros de impresiones, por tal, se trabajó con un muestreo por conveniencia debido a la pandemia presentada. Además, la técnica que aplicó fue la encuesta y como instrumento de medición se utilizó el cuestionario que estuvo compuesto por 55 ítems, los cuales fueron validados por el juicio de expertos. Así mismo, se obtuvo el Rho de Spearman un valor de 0.553 y una Sig. (Bilateral) de 0.000 lo cual indicó existe una correlación positiva considerable entre el marketing digital y captación de clientes en los centros de impresiones, llegando a la conclusión que, ante un buen manejo del marketing digital, se incrementa captación de clientes de los centros de impresiones en estudio

Occupational Therapy Strategies for Postural Orthostatic Tachycardia Syndrome

Effectiveness of occupational therapy strategies with adults with postural orthostatic tachycardia syndrome

IFN-γ-producing CD4+ T cells promote experimental cerebral malaria by modulating CD8+ T cell accumulation within the brain.

It is well established that IFN-γ is required for the development of experimental cerebral malaria (ECM) during Plasmodium berghei ANKA infection of C57BL/6 mice. However, the temporal and tissue-specific cellular sources of IFN-γ during P. berghei ANKA infection have not been investigated, and it is not known whether IFN-γ production by a single cell type in isolation can induce cerebral pathology. In this study, using IFN-γ reporter mice, we show that NK cells dominate the IFN-γ response during the early stages of infection in the brain, but not in the spleen, before being replaced by CD4(+) and CD8(+) T cells. Importantly, we demonstrate that IFN-γ-producing CD4(+) T cells, but not innate or CD8(+) T cells, can promote the development of ECM in normally resistant IFN-γ(-/-) mice infected with P. berghei ANKA. Adoptively transferred wild-type CD4(+) T cells accumulate within the spleen, lung, and brain of IFN-γ(-/-) mice and induce ECM through active IFN-γ secretion, which increases the accumulation of endogenous IFN-γ(-/-) CD8(+) T cells within the brain. Depletion of endogenous IFN-γ(-/-) CD8(+) T cells abrogates the ability of wild-type CD4(+) T cells to promote ECM. Finally, we show that IFN-γ production, specifically by CD4(+) T cells, is sufficient to induce expression of CXCL9 and CXCL10 within the brain, providing a mechanistic basis for the enhanced CD8(+) T cell accumulation. To our knowledge, these observations demonstrate, for the first time, the importance of and pathways by which IFN-γ-producing CD4(+) T cells promote the development of ECM during P. berghei ANKA infection

Risk factors for brain health in agricultural work: a systematic review

Includes bibliographical references.Certain exposures related to agricultural work have been associated with neurological disorders. To date, few studies have included brain health measurements to link specific risk factors with possible neural mechanisms. Moreover, a synthesis of agricultural risk factors associated with poorer brain health outcomes is missing. In this systematic review, we identified 106 articles using keywords related to agriculture, occupational exposure, and the brain. We identified seven major risk factors: non-specific factors that are associated with agricultural work itself, toluene, pesticides, heavy metal or dust exposure, work with farm animals, and nicotine exposure from plants. Of these, pesticides are the most highly studied. The majority of qualifying studies were epidemiological studies. Nigral striatal regions were the most well studied brain area impacted. Of the three human neuroimaging studies we found, two focused on functional networks and the third focused on gray matter. We identified two major directions for future studies that will help inform preventative strategies for brain health in vulnerable agricultural workers: (1) the effects of moderators such as type of work, sex, migrant status, race, and age; and (2) more comprehensive brain imaging studies, both observational and experimental, involving several imaging techniques

Differences in electronic personal health information tool use between rural and urban cancer patients in the United States: Secondary data analysis

BACKGROUND: Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. OBJECTIVE: Few studies have explored whether there is a difference in cancer patients\u27 current use of health information technology tools by residential location. METHODS: Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. RESULTS: Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). CONCLUSIONS: The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions

Optimización, del diseño de equipo hidráulico para el ensayo de laboratorio orificios de caída libre

El proyecto de “optimización del diseño de equipo hidráulico para el ensayo de laboratorio de orificios de caída libre”. Se encuentra fundamentado en estudiar el comportamiento del fluido, este análisis se hace mediante el paso de un líquido a través de un área o sección contraída siguiendo un patrón o trayectoria perpendicular en la cual intervienen varios tipos de varíales; entre los cuales se encuentran: velocidad, coeficientes de contracción, coeficiente de velocidad, coeficiente de descarga, caudal y fenómenos naturales como la presión atmosférica. Este tipo de ensayo está dirigido y fundamentado al transporte de aguas las cuales deben recorrer tramos y distancias prolongadas y superficiales. En algunos casos son aguas subterráneas o submarinas. Se busca construir y presentar un equipo, cuyo propósito sea la verificación de los fenómenos que se producen en este tipo de ensayo, y a su vez intervenir el equipo de manera tal que pueda mejorar su eficacia. Esto se planea realizar implementando una maquina Hidráulica (moto bomba) de medio caballo de fuerza, que permitirá que el fluido contenido en los tanques este en constante circulación manteniendo el volumen de líquido requerido para poder completar el ensayo, se optó por implementar un sistema de ruedas que permita transporta el equipo volviendo este mucho más maniobrable y acto para su respectivo uso. La estructura del equipo será fabricada con Angulo galvanizado de calibre 1-1/2”x3/16" lo cual ofrece y brinda estabilidad y seguridad que deben tener este tipo de equipos. La estructura será recubierta en pintura epoxica para evitar y prevenir a futuro una posible corrosión. Los tanques de descarga, el canal de salida, y el tanque de aforo del caudal serán construidos en dos diferentes tipos de materiales vidrio templado transparente de 6mm y acrílico transparente de 6mm los cuales son el material dispuesto para la fabricación de este tipo de equipos

IL-27 receptor signaling regulates CD4+ T cell chemotactic responses during infection.

IL-27 exerts pleiotropic suppressive effects on naive and effector T cell populations during infection and inflammation. Surprisingly, however, the role of IL-27 in restricting or shaping effector CD4(+) T cell chemotactic responses, as a mechanism to reduce T cell-dependent tissue inflammation, is unknown. In this study, using Plasmodium berghei NK65 as a model of a systemic, proinflammatory infection, we demonstrate that IL-27R signaling represses chemotaxis of infection-derived splenic CD4(+) T cells in response to the CCR5 ligands, CCL4 and CCL5. Consistent with these observations, CCR5 was expressed on significantly higher frequencies of splenic CD4(+) T cells from malaria-infected, IL-27R-deficient (WSX-1(-/-)) mice than from infected wild-type mice. We find that IL-27 signaling suppresses splenic CD4(+) T cell CCR5-dependent chemotactic responses during infection by restricting CCR5 expression on CD4(+) T cell subtypes, including Th1 cells, and also by controlling the overall composition of the CD4(+) T cell compartment. Diminution of the Th1 response in infected WSX-1(-/-) mice in vivo by neutralization of IL-12p40 attenuated CCR5 expression by infection-derived CD4(+) T cells and also reduced splenic CD4(+) T cell chemotaxis toward CCL4 and CCL5. These data reveal a previously unappreciated role for IL-27 in modulating CD4(+) T cell chemotactic pathways during infection, which is related to its capacity to repress Th1 effector cell development. Thus, IL-27 appears to be a key cytokine that limits the CCR5-CCL4/CCL5 axis during inflammatory settings