Outpatient antibiotic prescription trends in the United States: A national cohort study

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589</jats:sec

Short-term rotations using the forage legume Lablab have a place in Central Queensland farming systems

Soil nitrogen fertility decline is a problem for the farmers of Central Queensland (CQ). Nitrogen fertilisers are now widely used, but an erratic climate means that economic returns are not always achieved. Two farmer groups in CQ have ongoing experiments to make economic comparisons between a lablab/cereal rotation and conventional grain cropping regimes. At Fernlees, a sequence of lablab/sorghum/wheat is being compared with wheat/sorghum/chickpea on a low fertility open downs soil. At Theodore, an unfertilised lablab/sorghum rotation is being compared with continuous fertilised sorghum. Results after three seasons indicate that the nitrogen benefit to subsequent crops plus returns from a ley legume phase can offset the opportunity cost of not growing a grain crop on a low fertility soil

Local and Global Distinguishability in Quantum Interferometry

A statistical distinguishability based on relative entropy characterises the fitness of quantum states for phase estimation. This criterion is employed in the context of a Mach-Zehnder interferometer and used to interpolate between two regimes, of local and global phase distinguishability. The scaling of distinguishability in these regimes with photon number is explored for various quantum states. It emerges that local distinguishability is dependent on a discrepancy between quantum and classical rotational energy. Our analysis demonstrates that the Heisenberg limit is the true upper limit for local phase sensitivity. Only the `NOON' states share this bound, but other states exhibit a better trade-off when comparing local and global phase regimes.Comment: 4 pages, in submission, minor revision

The Cathode Strip Chamber Data Acquisition System for CMS

The Cathode Strip Chamber (CSC) [1] Data Acquisition (DAQ) system for the CMS [2] experiment at the LHC [3] will be described. The CSC system is large, consisting of 218K cathode channels and 183K anode channels. This leads to a substantial data rate of ~1.5GByte/s at LHC design luminosity (1034cm-2s-1) and the CMS first level trigger (L1A) rate of 100KHz. The DAQ system consists of three parts. The first part is on-chamber Cathode Front End Boards (CFEB)[4], which amplify, shape, store, and digitise chamber cathode signals, and Anode Front End Boards (AFEB)[5], which amplify, shape and discriminate chamber anode signals. The second part is the Peripheral Crate Data Acquisition Motherboards (DAQMB), which control the onchamber electronics and the readout of the chamber. The third part is the off-detector DAQ interface boards, which perform real time error checking, electronics reset requests and data concentration. It passes the resulting data to a CSC local DAQ farm, as well as CMS main DAQ [6]. All electronics in the system employ FPGAs allowing programmability. In addition, several high-speed serial interface technologies are employed

Low knowledge of HIV PrEP within a midwestern US cohort of persons who inject drugs

We interviewed persons who inject drugs (PWID) to understand perceptions of pre-exposure prophylaxis (PrEP) to prevent HIV infection. Knowledge of PrEP was poor. Patients felt that PrEP was for sexual intercourse rather than injection drug use, and PWID managed on medications for opioid use disorder felt that they had no need for PrEP

Use of ICD-10 codes for identification of injection drug use-associated infective endocarditis is nonspecific and obscures critical findings on impact of medications for opioid use disorder

Background: No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use-associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods: We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results: ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48-2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19-1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed ( Conclusions: Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed

Self-illuminating 'glow-in-the-dark' vitrectomy trocar cannulas: A pilot study

Letter to the EditorWeng Onn Chan, Melissa K. Shields, Robert J. Casson, Shane R. Durki

Experiences using a multidisciplinary model for treating injection drug use associated infections: A qualitative study

Background: Over the past two decades, the United States has experienced a dramatic increase in the rate of injection drug use, injection associated infections, and overdose mortality. A hospital-based program for treating opioid use disorder in people who inject drugs presenting with invasive infections was initiated at an academic tertiary care center in 2020. The goal of this program was to improve care outcomes, enhance patient experiences, and facilitate transition from the hospital to longer term addiction care. The purpose of this study was to interview two cohorts of patients, those admitted before vs. after initiation of this program, to understand the program\u27s impact on care from the patient\u27s perspective and explore ways in which the program could be improved. Methods: Thirty patients admitted to the hospital with infectious complications of injection drug use were interviewed using a semi-structured format. Interviews were transcribed and coded. Emergent themes were reported. Limited descriptive statistics were reported based on chart review. Results: Thirty interviews were completed; 16 participants were part of the program (admitted after program implementation) while 14 were not participants (admitted prior to implementation). Common themes associated with hospitalization included inadequate pain control, access to medications for opioid use disorder (MOUD), loss of freedom, stigma from healthcare personnel, and benefits of having an interprofessional team. Participants in the program were more likely to report adequate pain control and access to MOUD and many cited benefits from receiving care from an interprofessional team. Conclusions: Patients with opioid use disorder admitted with injection related infections reported improved experiences when receiving care from an interprofessional team focused on their addiction. However, perceived stigma from healthcare personnel and loss of freedom related to hospitalization were continued barriers to care before and after implementation of this program

Value of packaged testing for sexually transmitted infections for persons who inject drugs hospitalized with serious injection-related infections

Background: Persons who inject drugs (PWID) are frequently admitted for serious injection-related infections (SIRIs). PWID are also at risk for sexually transmitted infections (STIs). Methods: We conducted a multicenter quality improvement project at 3 hospitals in Missouri. PWID with SIRI who received an infectious diseases consultation were prospectively identified and placed into an electronic database as part of a Centers for Disease Control and Prevention-funded quality improvement project. Baseline data were collected from 8/1/2019 to 1/30/2020. During the intervention period (2/1/2020-2/28/2021), infectious diseases physicians caring for patients received 2 interventions: (1) email reminders of best practice screening for HIV, viral hepatitis, and STIs; (2) access to a customized EPIC SmartPhrase that included checkboxes of orders to include in assessment and plan of consultation notes. STI screening rates were compared before and after the intervention. We then calculated odds ratios to evaluate for risk factors for STIs in the cohort. Results: Three hundred ninety-four unique patients were included in the cohort. Initial screening rates were highest for hepatitis C (88%), followed by HIV (86%). The bundled intervention improved screening rates for all conditions and substantially improved screening rates for gonorrhea, chlamydia, and syphilis (30% vs 51%, 30% vs 51%, and 39 vs 60%, respectively; Conclusions: PWID admitted for SIRI frequently have unrecognized STIs. Our bundled intervention improved STI screening rates, but additional interventions are needed to optimize screening