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777 results on '"Kramer, Jennifer R."'

11. Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria

Author

Drekonja, Dimitri M, Grigoryan, Larissa, Lichtenberger, Paola, Graber, Christopher J, Patel, Payal K, Van, John N, Dillon, Laura M, Wang, Yiqun, Gauthier, Timothy P, Wiseman, Steve W, Shukla, Bhavarth S, Naik, Aanand D, Hysong, Sylvia J, Kramer, Jennifer R, and Trautner, Barbara W

Subjects
Health Services and Systems, Nursing, Health Sciences, Patient Safety, Clinical Research, Infectious Diseases, Infection, Antimicrobial Stewardship, Asymptomatic Infections, Attitude of Health Personnel, Bacteriuria, Hospitals, Veterans, Humans, Inappropriate Prescribing, Patient Care Team, Practice Patterns, Nurses', Practice Patterns, Physicians', Prospective Studies, Safety Management, Surveys and Questionnaires, United States, Unnecessary Procedures, Medical and Health Sciences, Epidemiology, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveIn preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).DesignProspective surveys during January-June 2018.SettingAll acute and long-term care units of 4 Veterans' Affairs facilities.MethodsThe survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).ResultsA total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.ConclusionsOur survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.

Published
2019

12. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria

Author

Trautner, Barbara W, Prasad, Pooja, Grigoryan, Larissa, Hysong, Sylvia J, Kramer, Jennifer R, Rajan, Suja, Petersen, Nancy J, Rosen, Tracey, Drekonja, Dimitri M, Graber, Christopher, Patel, Payal, Lichtenberger, Paola, Gauthier, Timothy P, Wiseman, Steve, Jones, Makoto, Sales, Anne, Krein, Sarah, Naik, Aanand Dinkar, and The Less is More Study Group

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Clinical Sciences, Prevention, Clinical Research, Antimicrobial Resistance, Health Services, Infectious Diseases, Infection, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Anti-Infective Agents, Bacteriuria, Catheter-Related Infections, Feedback, Female, Hospitalists, Hospitals, Hospitals, Veterans, Humans, Inappropriate Prescribing, Male, Medical Audit, Middle Aged, United States, Urinary Catheterization, Urine, Antibiotic stewardship, Asymptomatic bacteriuria, Audit and feedback, Guidelines implementation, Dissemination, Urinary tract infection, Less is More Study Group, Information and Computing Sciences, Medical and Health Sciences, Health Policy & Services, Biomedical and clinical sciences, Psychology
Abstract

BackgroundAntimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability.MethodsThis project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes.DiscussionThis project moves from a proof-of-concept effectiveness study to implementation involving significantly more sites, and uses the General Theory of Implementation to embed the intervention into normal processes of care with usual care providers. Aspects of implementation that will be explored include dissemination, internal and external facilitation, and organizational partnerships. "Less is More" is the natural next step from our prior successful Kicking CAUTI intervention, and has the potential to improve patient care while advancing the science of implementation.

Published
2018

15. A Randomized Trial of Off‐Site Collaborative Care for Depression in Chronic Hepatitis C Virus

Author

Kanwal, Fasiha, Pyne, Jeffrey M, Tavakoli‐Tabasi, Shahriar, Nicholson, Susan, Dieckgraefe, Brian, Storay, Erma, Goetz, Matthew Bidwell, Kramer, Jennifer R, Smith, Donna, Sansgiry, Shubhada, Tansel, Aylin, Gifford, Allen L, and Asch, Steven M

Subjects
Health Services and Systems, Health Sciences, Health Services, Chronic Liver Disease and Cirrhosis, Hepatitis - C, Hepatitis, Liver Disease, Clinical Trials and Supportive Activities, Mental Health, Prevention, Brain Disorders, Depression, Clinical Research, Infectious Diseases, Emerging Infectious Diseases, Behavioral and Social Science, Digestive Diseases, Prevention of disease and conditions, and promotion of well-being, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Infection, Mental health, Good Health and Well Being, Female, Hepacivirus, Hepatitis C, Chronic, Hospitals, Veterans, Humans, Male, Mass Screening, Middle Aged, Referral and Consultation, Self Report, Surveys and Questionnaires, Physical health, depression, hepatitis C, Public Health and Health Services, Policy and Administration, Health Policy & Services, Health services and systems, Policy and administration
Abstract

ObjectiveTo test the effectiveness of a collaborative depression care model in improving depression and hepatitis C virus (HCV) care.Data sources/study settingHepatitis C virus clinic patients who screened positive for depression at four Veterans Affairs Hospitals.Study designWe compared off-site depression collaborative care (delivered by depression care manager, pharmacist, and psychiatrist) with usual care in a randomized trial. Primary depression outcomes were treatment response (≥50 percent decrease in 20-item Hopkins Symptoms Checklist [SCL-20] score), remission (mean SCL-20 score,

Published
2018

25. Cost of Care for Patients With Cirrhosis.

Author

Kanwal, Fasiha, Nelson, Richard, Liu, Yan, Kramer, Jennifer R., Hernaez, Ruben, Cholankeril, George, Rana, Abbas, Flores, Avegail, Smith, Donna, Cao, Yumei, Beech, Bettina, and Asch, Steven M.

Published
2024
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29. Cost of Care for Patients with Cirrhosis

Author

Kanwal, Fasiha, primary, Nelson, Richard, additional, Liu, Yan, additional, Kramer, Jennifer R., additional, Hernaez, Ruben, additional, Cholankeril, George, additional, Rana, Abbas, additional, Flores, Avegail, additional, Smith, Donna, additional, Cao, Yumei, additional, Beech, Bettina, additional, and Asch, Steven M., additional

Published
2023
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31. 732 COST OF CARE FOR PATIENTS WITH CIRRHOSIS

Author

Kanwal, Fasiha, primary, Nelson, Richard, additional, Liu, Yan, additional, Kramer, Jennifer R., additional, Hernaez, Ruben, additional, Cholankeril, George T., additional, Smith, Donna L., additional, Cao, Yumei, additional, and Asch, Steven M., additional

Published
2023
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37. Supplementary Data from Immunogenetic Determinants of Susceptibility to Head and Neck Cancer in the Million Veteran Program Cohort

Author

Liu, Yanhong, primary, Kramer, Jennifer R., primary, Sandulache, Vlad C., primary, Yu, Robert, primary, Li, Guojun, primary, Chen, Liang, primary, Yusuf, Zenab I., primary, Shi, Yunling, primary, Pyarajan, Saiju, primary, Tsavachidis, Spyros, primary, Jiao, Li, primary, Mierzwa, Michelle L., primary, Chiao, Elizabeth, primary, Mowery, Yvonne M., primary, Shuman, Andrew, primary, Shete, Sanjay, primary, Sikora, Andrew G., primary, and White, Donna L., primary

Published
2023
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38. Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria

Author

Amenta, Eva, primary, Grigoryan, Larissa, additional, Rajan, Suja S., additional, Ramsey, David, additional, Kramer, Jennifer R., additional, Walder, Annette, additional, Chou, Andrew, additional, Van, John N., additional, Krein, Sarah L., additional, Hysong, Sylvia, additional, Naik, Aanand D., additional, and Trautner, Barbara W., additional

Published
2023
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48. Immunogenetic Determinants of Susceptibility to Head and Neck Cancer in the Million Veteran Program Cohort

Author

Liu, Yanhong, primary, Kramer, Jennifer R., additional, Sandulache, Vlad C., additional, Yu, Robert, additional, Li, Guojun, additional, Chen, Liang, additional, Yusuf, Zenab I., additional, Shi, Yunling, additional, Pyarajan, Saiju, additional, Tsavachidis, Spyros, additional, Jiao, Li, additional, Mierzwa, Michelle L., additional, Chiao, Elizabeth, additional, Mowery, Yvonne M., additional, Shuman, Andrew, additional, Shete, Sanjay, additional, Sikora, Andrew G., additional, and White, Donna L., additional

Published
2022
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