Search

The Centers for Disease Control and Prevention estimates that half of the antibiotic prescriptions for acute respiratory tract infections (ARTIs) in ambulatory care settings are unnecessary. To better understand the quality-of-care implications of prescription patterns for ARTIs, we conducted a retrospective chart review of outpatient ARTI visits, across a large integrated health system, and examined the association of patient characteristics with receiving antimicrobials, as well as the association between receiving antimicrobials and healthcare utilization (outpatient and emergency department visits). We found that 55.4% of all ARTI outpatients were treated with antimicrobials. There was no association between patient demographics and antimicrobial prescriptions on either the first (p < .0771) or follow-up (p < .6316) visits. A lower comorbidity score was significantly associated with receiving antimicrobials (p < .0022). Patients who received antimicrobials at the first visit had significantly higher number of follow-up visits (p < .005) and more follow-up antimicrobial prescriptions (p < .0066) as compared with patients who did not receive antimicrobials at the first visit. Our results highlight the potential for clinicians to improve quality of care in ARTI management.

INTRODUCTION Acute pancreatitis (AP) is understudied in the pediatric population despite increasing incidence. Although many cases are mild and resolve with supportive care, severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. There is a lack of pediatric-specific predictive tools to help stratify risk of SAP in children. METHODS A retrospective cohort study of patients with AP or recurrent AP at Cohen Children's Medical Center between 2011 and 2016 was performed. Lipase level and the presence of pediatric systemic inflammatory response syndrome (SIRS) on admission were examined as potential predictors of SAP and length of stay (LOS). A multivariate logistic regression or analysis of covariance was used to conduct the multivariate analysis. RESULTS Seventy-nine pediatric patients met inclusion criteria. Approximately 37% (29/79) had SIRS on admission, 22% (17/79) developed SAP, and there were no mortalities. In both the univariate and multivariate models, SIRS was a predictor of SAP. Mean (SD) LOS for patients with SIRS compared with without SIRS was 9.6 ± 8.3 compared with 6.3 ± 6.9 days (P

Background: The “drip and ship” protocol is an important treatment for acute ischemic stroke patients who do not have immediate access to comprehensive stroke centers (CSC). Intravenous thrombolysis is initiated at a primary stroke center followed by expeditious transfer to a CSC typically during the tPA infusion. National guidelines recommend attention to blood pressure control ( Methods: This is a retrospective analysis of 130 consecutive “drip and ship” patients transferred to North Shore University Hospital between July 2012 to June 2014. BP upon arrival to CSC was used to determine adherence to BP guidelines. Poor patient outcome was defined as discharge to hospice or expired, discharge modified Rankin score (mRS) >2, and symptomatic intracerebral hemorrhage (sICH). Results: A total of 123 patients were confirmed to have an ischemic stroke (7 stroke mimics were excluded). Blood pressure was available for 120 patients. Mean age of the cohort was 62.7 years (range 24 to 100 years). Mean CSC admission NIHSS was 11.0 (range 0 to 28). Mean BP upon CSC arrival was 143.3/77.8 (systolic range 90 to 200 mmHg/diastolic range 44 to 112 mmHg). Mean mRS at discharge was 2.76. Blood pressure parameter violations were documented in 15 (12.5%) patients. Of these, 7 (46.7%) were discharged to hospice or expired, whereas 9/105 (8.6%) without blood pressure parameter violation were discharged to hospice or expired. This difference was statistically significant (p2, compared to 54/103 (52.4%) patients without BP parameter violation (not significant). Conclusions: Post thrombolysis blood pressure guideline violations during drip and ship transfer were significantly associated with in hospital mortality or discharge to hospice, but not with high discharge mRS or symptomatic ICH. Larger studies are needed to confirm these results.

OBJECTIVE: To identify changes over the past decade in physicians’ attitudes regarding the use of immunomodulatory agents for the treatment of children with inflammatory bowel disease (IBD), we surveyed the membership of the North American Society for Pediatric Gastroenterology and Nutrition and compared the responses to those from an identical survey performed in 1990. METHODS: Surveys were mailed to 718 physicians in January, 2000. All surveys returned by mid-February were analyzed, and results compared to those obtained in the 1990 survey. RESULTS: Thirty-nine percent (278/718) of surveys were returned, compared to 27% (105/385) in 1990. Overall, 93% of the current survey’s respondents agreed with the statement “immunomodulatory agents are effective in the treatment of children and adolescents with IBD.” Compared to 1990, significant increases (p < 0.0001) were noted in the percentage of respondents who prescribe immunomodulatory agents to children with all forms of IBD. Indications for immunomodulation that showed significant increases (p < 0.001) since 1990 included treatment of perianal and nonperianal fistulae; growth failure; use as initial, primary therapy; and use as prophylaxis against postoperative recurrence. 6-Mercaptopurine and azathioprine continue to be the agents prescribed by the greatest percentage of respondents. More physicians are willing to use immunomodulatory agents in children younger than 5 yr, and duration of use is longer than in 1990. Currently, physicians seem to favor the use of immunomodulatory agents over colectomy for children with either intractable ulcerative or Crohn’s colitis. Most respondents remain concerned about potential bone marrow and immune suppression, but concerns regarding malignancy, teratogenicity, and infertility have lessened. CONCLUSION: These survey findings document that pediatric gastroenterologists have widely accepted the use of immunomodulators in the treatment of children and adolescents with IBD.

Objective: To characterize Alzheimer9s disease (AD) progression using proton magnetic resonance spectroscopy ( 1 H MRS) and cognitive measures in mild-moderate AD patients treated with open-label memantine in addition to cholinesterase inhibitor (ChEI). Background While cross-sectional studies have shown reduced N-acetylaspartate (NAA) and elevated myo-inositol (mI) in AD patients, the feasibility of 1 H MRS as a longitudinal biomarker for clinical trials remains to be elucidated. Design/Methods: 11 subjects with mild-moderate AD (baseline MMSE 21.9 ± 3.0) were on stable dose ChEI for at least 3 months prior to study entry. Neuropsychometric testing and single-voxel 1 H MRS from the precuneus and posterior cingulate region were performed at baseline, after 24 weeks of ongoing ChEI monotherapy, and after another 24 weeks of open-label memantine in addition to ChEI. Baseline 1 H MRS metabolite [NAA, mI, choline (Cho), and creatine (Cr)] ratios in AD subjects were compared to 29 age-matched, cognitively normal controls (MMSE 28.3 ± 1.6). Results: Compared to controls, AD subjects had significantly higher mI/Cr (p=0.0155) and lower NAA/Cr (p=0.0487), NAA/Cho (p=0.0222) and NAA/mI (p=0.0105). In AD subjects, baseline Alzheimer9s Disease Cooperative Study Activities of Daily Living (ADCS-ADL) scores significantly correlated with NAA/Cr (Spearman r = 0.80, p=0.0032), mI/Cr (Spearman r = -0.73, p=0.0115), and NAA/mI (Spearman r = 0.83, p=0.0014). Baseline cognitive measures did not correlate with metabolite ratios. There was no significant change in neuropsychometric test performance on combination therapy as compared with ChEI monotherapy. There was a decrease in NAA/mI on combination therapy as compared with ChEI monotherapy, but this was not significant after correction for multiple comparisons. Conclusions: We found significant differences in 1 H MRS metabolite ratios between mild-moderate AD and control subjects. Baseline 1 H MRS metabolite ratios correlated with function (ADCS-ADL). There was no significant change in neuropsychometric performance or 1 H MRS metabolite ratios when open-label memantine was added to stable dose ChEI. Supported by: Forest Research Institute. Disclosure: Dr. Gordon has received personal compensation for activities with Accera Inc. and Eli Lilly & Company as a consultant. Dr. Gordon has received research support from Forest Laboratories and Eli Lilly & Company. Dr. Kingsley has nothing to disclose. Dr. Goldberg has received personal compensation for activities with Merck & Co., Inc. as a consultant. Dr. Koppel holds stock and/or stock options in Eli Lilly & Company. Dr. Christen has nothing to disclose. Dr. Keehlisen has nothing to disclose. Dr. Kohn has nothing to disclose. Dr. Davies has has received (royalty or license fee or contractual rights) payments from Eli Lilly.Dr. Davies has received research support from Eli Lilly.