- The study examined 183 geriatric hip fracture patients to determine the prevalence of urinary tract infection (UTI) on admission and whether routine screening for UTI led to reduced rates of catheter-associated UTI (CAUTI).
- 36.1% of patients had a UTI on admission based on urinalysis screening. 4.4% of patients developed CAUTI.
- Patients with UTI on admission had a significantly longer median ICU length of stay compared to those without UTI on admission. No other significant differences were found between groups.
Effect of nursing intervention on clinical outcomes and patient satisfaction ...Alexander Decker
1) The study aimed to determine the effect of nursing intervention on clinical outcomes and patient satisfaction among patients with upper gastrointestinal bleeding.
2) A quasi-experimental study was conducted on 50 patients divided into a study group that received nursing intervention and a control group.
3) Statistically significant differences were found between the groups in clinical outcomes like bleeding, vital signs, and lab tests as well as higher patient satisfaction scores in the study group compared to the control group, showing that nursing intervention improved patients' outcomes and satisfaction.
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly looks at longer postoperative duration, usually days after surgery.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L ...
A Global Survey on the Impact of COVID-19 on Urological ServicesValentina Corona
1. A global survey of 1004 urology healthcare professionals found that COVID-19 profoundly impacted urological care worldwide.
2. 41% reported their hospital staff being diagnosed with COVID-19, and 26% had to be deployed to care for COVID-19 patients. Only 33% felt they had adequate protective equipment.
3. COVID-19 reduced urological services globally, including outpatient clinics (28% delay), investigations and procedures (30% delay), and surgeries (31% delay over 8 weeks). Reductions were greater for benign than malignant conditions and in areas with more COVID-19 cases.
4. While 47% believed the backlog could be addressed, 50%
St. Mary's Hospital tracks surgical site infections (SSIs) using several methods, but lacks complete data on post-discharge infections. Other hospitals are implementing innovative solutions like remote wound monitoring and strict post-op follow up protocols to better detect SSIs. Nationwide, SSIs contribute greatly to healthcare costs and readmissions. Improved post-discharge surveillance is critical for accurately assessing SSI rates and reducing avoidable readmissions.
Impact of a designed nursing intervention protocol about preoperative liver t...Alexander Decker
This document summarizes a study that assessed the impact of a designed nursing intervention protocol on patient outcomes for liver transplantation. The study was conducted at a university hospital in Egypt and included 14 adult patients scheduled for liver transplantation. Patients who received the nursing intervention protocol were compared to a control group of 52 past patients from the previous 3 years. Outcomes measured included changes in patient knowledge and practice scores before and after the intervention, as well as post-operative complication rates. The results showed statistically significant improvements in knowledge and practice scores for patients who received the protocol, as well as lower rates of respiratory and rejection complications compared to the control group. The study concluded the nursing intervention protocol had a positive impact on patient outcomes.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
Effect of nursing intervention on clinical outcomes and patient satisfaction ...Alexander Decker
1) The study aimed to determine the effect of nursing intervention on clinical outcomes and patient satisfaction among patients with upper gastrointestinal bleeding.
2) A quasi-experimental study was conducted on 50 patients divided into a study group that received nursing intervention and a control group.
3) Statistically significant differences were found between the groups in clinical outcomes like bleeding, vital signs, and lab tests as well as higher patient satisfaction scores in the study group compared to the control group, showing that nursing intervention improved patients' outcomes and satisfaction.
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly looks at longer postoperative duration, usually days after surgery.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L ...
A Global Survey on the Impact of COVID-19 on Urological ServicesValentina Corona
1. A global survey of 1004 urology healthcare professionals found that COVID-19 profoundly impacted urological care worldwide.
2. 41% reported their hospital staff being diagnosed with COVID-19, and 26% had to be deployed to care for COVID-19 patients. Only 33% felt they had adequate protective equipment.
3. COVID-19 reduced urological services globally, including outpatient clinics (28% delay), investigations and procedures (30% delay), and surgeries (31% delay over 8 weeks). Reductions were greater for benign than malignant conditions and in areas with more COVID-19 cases.
4. While 47% believed the backlog could be addressed, 50%
St. Mary's Hospital tracks surgical site infections (SSIs) using several methods, but lacks complete data on post-discharge infections. Other hospitals are implementing innovative solutions like remote wound monitoring and strict post-op follow up protocols to better detect SSIs. Nationwide, SSIs contribute greatly to healthcare costs and readmissions. Improved post-discharge surveillance is critical for accurately assessing SSI rates and reducing avoidable readmissions.
Impact of a designed nursing intervention protocol about preoperative liver t...Alexander Decker
This document summarizes a study that assessed the impact of a designed nursing intervention protocol on patient outcomes for liver transplantation. The study was conducted at a university hospital in Egypt and included 14 adult patients scheduled for liver transplantation. Patients who received the nursing intervention protocol were compared to a control group of 52 past patients from the previous 3 years. Outcomes measured included changes in patient knowledge and practice scores before and after the intervention, as well as post-operative complication rates. The results showed statistically significant improvements in knowledge and practice scores for patients who received the protocol, as well as lower rates of respiratory and rejection complications compared to the control group. The study concluded the nursing intervention protocol had a positive impact on patient outcomes.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
1) Inguinal hernias have traditionally been repaired surgically due to beliefs that complications like bowel obstruction are likely if left untreated and that surgical repair is low risk. However, recent randomized controlled trials have questioned these beliefs.
2) Two randomized controlled trials compared watchful waiting to surgical repair and found low rates of complications like bowel obstruction for untreated hernias, with rates under 2 events per 1000 patients per year. Patients reported similar pain levels and quality of life whether they had immediate repair or watchful waiting.
3) The trials provide new evidence that watchful waiting may be a reasonable option for asymptomatic or minimally symptomatic inguinal hernias, challenging traditional views that all hernias require immediate
This study aimed to identify independent risk factors for surgical site infection (SSI) after low transverse cesarean section by conducting a retrospective case-control study of 1,605 women. The study found that development of a subcutaneous hematoma, an operation performed by the university teaching service, and a higher pre-admission body mass index were independent risk factors associated with increased risk of SSI. Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI. Use of staples for skin closure was associated with a marginally increased risk of SSI. Identifying these risk factors can help in developing targeted strategies to reduce the risk of SSI after cesarean section.
The document discusses sharps associated infections (SAIs) among emergency department healthcare workers (EDHCWs). It finds that EDHCWs face high risk of SAIs due to the large volumes of high-risk patients and invasive procedures in the ED. Compliance with universal precautions among EDHCWs is poor. The document recommends a three-pronged approach of education, enforcement of safety policies, and engineering controls like safety devices to help prevent SAIs among EDHCWs.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
This document discusses a quality improvement initiative to reduce hospital acquired venous thromboembolism (VTE). VTE includes deep vein thrombosis and pulmonary embolism, which can be fatal. The document outlines Donabedian's framework for assessing healthcare quality using structure, process, and outcomes measures. It then applies this framework to assess the structure, processes, and intended outcomes of a VTE prevention strategy implemented at a healthcare organization. This included compulsory VTE risk assessment, appropriate prophylaxis ordering and administration, staff education, and ongoing performance monitoring to continuously improve outcomes of reducing hospital acquired VTE events.
This document summarizes a study examining surgical site infections following caesarean sections through post-discharge surveillance across multiple hospitals in the UK. The study found that 13.6% of women who had c-sections developed wound problems, with 84% occurring after discharge. Applying standardized definitions, 8.9% met criteria for surgical site infections. However, rates varied significantly between hospitals, from 2.9% to 17.9%. The study identified several risk factors associated with higher infection rates, including BMI, age, blood loss during surgery, wound closure method, and emergency procedures. The results suggest c-section morbidity has been underestimated without post-discharge monitoring, and that antibiotic prescribing after discharge could be reviewed given
REVIEW CENTRAL LINE-ASSOCIATED BLOODSTREAM2REVIEW CENTRAL .docxzmark3
REVIEW: CENTRAL LINE-ASSOCIATED BLOODSTREAM2
REVIEW
CENTRAL LINE-ASSOCIATED BLOODSTREAM2
Central Line-Associated Bloodstream Infections
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM 2
October 9, 2018
CLABSI Supporting Literature
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter (CVC), refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the major themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. There were 200 articles that were established to talk about the CVCs, CLABSIs, risk factors, intervention, and benefits of preventive measures. Through inclusion and exclusion criteria many journal articles were left out because of being written in other languages rather than English. Therefore, the use of the English language index the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to search related journal articles. Other search tools includeThe National Center for Biotechnology Information (NCBI) – PubMed. Studies older than five years were excluded to ensure that the research remained current and up to date. Using real-time cases or conditions helps to improve the quality and validity of the resulted research.
Questions Posed in the Studies
Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure and CVCs have.
Education, Simulated Training, Experience, and Knowledge
Kadium (2015) inquired into how the education program for one month, based on the evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care? Other researchers that focus on how education, experience, and workshops enhance prevention or reduction of CVC infections include; El-Sol & Badawy, (2017), Leistner, Thürnagel, Schwab, Gastmeier, & Geffers (2013), and Soffle, Hayes, & Smith (2018). Dougherty (2014) questions the potential solutions in reducin.
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document presents a literature review and proposal for a study to evaluate the effectiveness of home telemonitoring using an ECG monitor in reducing hospital readmission rates among patients aged 65 and older with heart failure. Heart failure results in many hospitalizations and readmissions that cost the healthcare system billions each year. The literature suggests that telemonitoring allows for early detection of exacerbations and improved management of heart failure symptoms, leading to fewer hospitalizations. The proposed study would compare readmission rates over 4 months for heart failure patients who use home ECG telemonitoring versus the standard telemonitoring system, with the hypothesis that ECG telemonitoring would reduce readmission rates.
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Troducing A Care bundle To prevent pressure injury
TACT) in at-risk patients: A protocol for a cluster
ndomised trial
endy Chaboyer a,b,c, Tracey Bucknall d,f, Joan Webster a,g,
zabeth McInnes e,h, Merrilyn Banks g, Marianne Wallis b,i,
gid M. Gillespie a,b,c, Jennifer A. Whitty a,c,j, Lukman Thalib k,l,
elley Roberts a,b,c,*, Nicky Cullum m
MRC Centre of Research Excellence in Nursing, Griffith University, Australia
tre for Health Practice Innovation, Griffith University, Australia
nzies Health Institute Queensland, Griffith University, Australia
red Health, Australia
ool of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
ool of Nursing and Midwifery, Deakin University, Australia
yal Brisbane and Women’s Hospital, Australia
rsing Research Institute, St Vincent’s Health Australia (Sydney), Australia
versity of the Sunshine Coast, Australia
versity of Queensland, Australia
ulty of Medicine, University of Kuwait, Kuwait
ffith University, Australia
iversity of Manchester, United Kingdom
T I C L E I N F O
le history:
ived 19 September 2014
ived in revised form 16 April 2015
pted 28 April 2015
ords:
bundle
ent centred care
ent participation
sure injury prevention
sure ulcer prevention
A B S T R A C T
Background: Pressure injuries are a significant clinical and economic issue, affecting both
patients and the health care system. Many pressure injuries in hospitals are facility
acquired, and are largely preventable. Despite growing evidence and directives for
pressure injury prevention, implementation of preventative strategies is suboptimal, and
pressure injuries remain a serious problem in hospitals.
Objectives: This study will test the effectiveness and cost-effectiveness of a patient-
centred pressure injury prevention care bundle on the development of hospital acquired
pressure injury in at-risk patients.
Design: This is a multi-site, parallel group cluster randomised trial. The hospital is the unit
of randomisation.
Methods: Adult medical and surgical patients admitted to the study wards of eight
hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility),
(b) expected to stay in hospital for �48 h, (c) admitted to hospital in the past 36 h; and (d)
able to provide informed consent will be eligible to participate. Consenting patients will
receive either the pressure injury prevention care bundle or standard care. The care bundle
contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a
healthy diet. Nurses will receive education about the intervention. Patients will exit the
study upon development of a pressure injury, hospital discharge or 28 days, whichever
Corresponding .
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS3PROVIDERS CHALLENGE.docxwoodruffeloisa
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 3
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 15
Providers Challenge for Treating Infectious Disease
Amy Nicole Elders
Grand Canyon University
Science Communication & Research
Bio- 317V-0500
Michael Rothrock
September 6, 2019
Abstract
Running head: PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 1
High mortality results from infection within healthcare institutions whether community or hospital acquired. Hospitalists provide inpatient care with increasing frequency due to the overwhelming workload upon primary care physicians. However, hospitalists are generalists and are minimally prepared to attend patients with serious infections which may rapidly overwhelm particularly in vulnerable populations. Duplication of diagnostic testing, prolonged length of stay drives up costs for institutions and patients. Erroneous or inadequate prescription of antibiotics costs lives, Infectious disease specialists are inadequately utilized despite statistical evidence that such specialty care improves outcomes. Education, collaboration between providers, and prescribing guidelines are recommended to address these needs.
Providers Challenge for Treating Infectious Disease
Technology has become increasingly advanced and the ability to diagnose, treat, and manage patients is ever evolving. Although advancements in imaging, surgical procedures and medication therapies make possible a better quality of life, they are often required to self-manage very serious disease and infection. Insurance companies and healthcare regulations often guide the path providers must take to care for patients. The length of stay in hospitals are decreasing and patients are being treated on an outpatient basis. Patients often receive care in outpatient rehabs, infusion centers, and home health agencies with medications supplied by specialty pharmacies. Drug resistant organisms are becoming more common and the risks associated with treating these organisms can often be challenging to manage. Treatment is often received for an extended amount of time and many primary care providers no longer see patients on an inpatient basis. This means that hospitalists assume care when they are admitted into the hospital but are unable to follow the patient for the remainder of treatment when they are discharged. When complications arise for these patients, they have limited ways of seeking help. There is fragmented care and lack of continuity. In the case of patients diagnosed with infection, questions about when hospitalists should consult specialists such as infectious disease physicians often occur. Mortality and morbidity for patients as well as hospital stays and readmission are decreased when an Infectious Disease physician is consulted early (CDC, 2013). Research is focused on the education of these two types of physicians, why some providers decide not to pursue a specialty, as well as success rates of patients treated by both. Fact ...
This article summarizes the use of a patient group direction (PGD) at a hospital to provide pre-operative Staphylococcus aureus decolonization treatment to patients undergoing spinal surgery to reduce their risk of surgical site infection. Staff were trained to distribute the PGD in pre-operative clinics and patients self-administered the treatment at home for 5 days before surgery. An audit found that over 50% of eligible patients received the PGD, and infection rates decreased from 2.4% to 0.6% after implementation. Both staff and patients reported that the PGD was well-explained and adhered to.
Explain in your own words why it is important to read a statistical .docxAlleneMcclendon878
Explain in your own words why it is important to read a statistical study carefully. Can you think of circumstance where it might be okay to misrepresent data?
Video Reflection 12 -
Do you think it is possible to create a study where there really is no bias sampling done? How would you manage to create one?
Video Reflection 13 -
What are your thoughts on statistics being misrepresented/ how does it make you feel? Why do you think the statistic are often presented in this way?
.
Explain how Matthew editedchanged Marks Gospel for each of the fol.docxAlleneMcclendon878
Explain how Matthew edited/changed Mark's Gospel for each of the following passages, and what reasons would he have had for doing that? What in Mk’s version was Mt trying to avoid – i.e., why he might have viewed Mk’s material as misleading, incorrect, or problematic? How did those changes contribute to Matthew’s overall message? How did that link up with other parts of Mt’s message?
Use both the following two sets of passages to support your claim, making use ONLY of the resources below, the Bible, textbooks and Module resources.
1. How did Matthew edit/change Mark 6:45-52 to produce Matthew 14:22-33 – and why?
2. How did Matthew edit/change Mark 9:2-10 to produce Matthew 17:1-13 – and why?
The paper should 350-750 words in length, double-spaced, and using MLA formatting for reference citations and bibliography. Submit the completed assignment to the appropriate Dropbox by
no later than Sunday 11:59 PM Eastern.
Resources for this paper:
See the ebook via SLU library:
New Testament History and Literature
by Martin (2012), pp. 83-88,105-108.
See the ebook via SLU library:
The Gospels
by Barton and Muddiman (2010), p. 53,56-57,102,109.
.
Explain the degree to which media portrayal of crime relates to publ.docxAlleneMcclendon878
Explain the degree to which media portrayal of crime relates to public fear of crime and explain how.
Explain whether public fear of crime might influence individual behavior or not and explain how or how not.
Share an insight about whether media should be responsible or not for the portrayal of crime as it relates to public fear of crime.
2 Pages in APA Format
.
Explain the difference between genotype and phenotype. Give an examp.docxAlleneMcclendon878
Explain the difference between genotype and phenotype. Give an example of each and describe both in an account that relates to you personally, the
paper should be 2-3 pages in length (not counting the title and resources pages), APA style (no abstract required), and should be supported with appropriate citations.
.
1) Inguinal hernias have traditionally been repaired surgically due to beliefs that complications like bowel obstruction are likely if left untreated and that surgical repair is low risk. However, recent randomized controlled trials have questioned these beliefs.
2) Two randomized controlled trials compared watchful waiting to surgical repair and found low rates of complications like bowel obstruction for untreated hernias, with rates under 2 events per 1000 patients per year. Patients reported similar pain levels and quality of life whether they had immediate repair or watchful waiting.
3) The trials provide new evidence that watchful waiting may be a reasonable option for asymptomatic or minimally symptomatic inguinal hernias, challenging traditional views that all hernias require immediate
This study aimed to identify independent risk factors for surgical site infection (SSI) after low transverse cesarean section by conducting a retrospective case-control study of 1,605 women. The study found that development of a subcutaneous hematoma, an operation performed by the university teaching service, and a higher pre-admission body mass index were independent risk factors associated with increased risk of SSI. Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI. Use of staples for skin closure was associated with a marginally increased risk of SSI. Identifying these risk factors can help in developing targeted strategies to reduce the risk of SSI after cesarean section.
The document discusses sharps associated infections (SAIs) among emergency department healthcare workers (EDHCWs). It finds that EDHCWs face high risk of SAIs due to the large volumes of high-risk patients and invasive procedures in the ED. Compliance with universal precautions among EDHCWs is poor. The document recommends a three-pronged approach of education, enforcement of safety policies, and engineering controls like safety devices to help prevent SAIs among EDHCWs.
The document discusses guidelines for deep vein thrombosis (DVT) prophylaxis for orthopedic trauma patients. It notes that many existing guidelines do not adequately address trauma patients, who have higher DVT risks due to immobility from injury. A review found that 77% of patients transferred to the authors' hospitals did not receive pre-transfer DVT prophylaxis, including 67% of hip fracture patients despite being at high risk. The authors developed new DVT prophylaxis guidelines for orthopedic trauma patients to help standardize care and lower DVT risks.
This document discusses a quality improvement initiative to reduce hospital acquired venous thromboembolism (VTE). VTE includes deep vein thrombosis and pulmonary embolism, which can be fatal. The document outlines Donabedian's framework for assessing healthcare quality using structure, process, and outcomes measures. It then applies this framework to assess the structure, processes, and intended outcomes of a VTE prevention strategy implemented at a healthcare organization. This included compulsory VTE risk assessment, appropriate prophylaxis ordering and administration, staff education, and ongoing performance monitoring to continuously improve outcomes of reducing hospital acquired VTE events.
This document summarizes a study examining surgical site infections following caesarean sections through post-discharge surveillance across multiple hospitals in the UK. The study found that 13.6% of women who had c-sections developed wound problems, with 84% occurring after discharge. Applying standardized definitions, 8.9% met criteria for surgical site infections. However, rates varied significantly between hospitals, from 2.9% to 17.9%. The study identified several risk factors associated with higher infection rates, including BMI, age, blood loss during surgery, wound closure method, and emergency procedures. The results suggest c-section morbidity has been underestimated without post-discharge monitoring, and that antibiotic prescribing after discharge could be reviewed given
REVIEW CENTRAL LINE-ASSOCIATED BLOODSTREAM2REVIEW CENTRAL .docxzmark3
REVIEW: CENTRAL LINE-ASSOCIATED BLOODSTREAM2
REVIEW
CENTRAL LINE-ASSOCIATED BLOODSTREAM2
Central Line-Associated Bloodstream Infections
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM 2
October 9, 2018
CLABSI Supporting Literature
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter (CVC), refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the major themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. There were 200 articles that were established to talk about the CVCs, CLABSIs, risk factors, intervention, and benefits of preventive measures. Through inclusion and exclusion criteria many journal articles were left out because of being written in other languages rather than English. Therefore, the use of the English language index the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to search related journal articles. Other search tools includeThe National Center for Biotechnology Information (NCBI) – PubMed. Studies older than five years were excluded to ensure that the research remained current and up to date. Using real-time cases or conditions helps to improve the quality and validity of the resulted research.
Questions Posed in the Studies
Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure and CVCs have.
Education, Simulated Training, Experience, and Knowledge
Kadium (2015) inquired into how the education program for one month, based on the evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care? Other researchers that focus on how education, experience, and workshops enhance prevention or reduction of CVC infections include; El-Sol & Badawy, (2017), Leistner, Thürnagel, Schwab, Gastmeier, & Geffers (2013), and Soffle, Hayes, & Smith (2018). Dougherty (2014) questions the potential solutions in reducin.
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document presents a literature review and proposal for a study to evaluate the effectiveness of home telemonitoring using an ECG monitor in reducing hospital readmission rates among patients aged 65 and older with heart failure. Heart failure results in many hospitalizations and readmissions that cost the healthcare system billions each year. The literature suggests that telemonitoring allows for early detection of exacerbations and improved management of heart failure symptoms, leading to fewer hospitalizations. The proposed study would compare readmission rates over 4 months for heart failure patients who use home ECG telemonitoring versus the standard telemonitoring system, with the hypothesis that ECG telemonitoring would reduce readmission rates.
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Troducing A Care bundle To prevent pressure injury
TACT) in at-risk patients: A protocol for a cluster
ndomised trial
endy Chaboyer a,b,c, Tracey Bucknall d,f, Joan Webster a,g,
zabeth McInnes e,h, Merrilyn Banks g, Marianne Wallis b,i,
gid M. Gillespie a,b,c, Jennifer A. Whitty a,c,j, Lukman Thalib k,l,
elley Roberts a,b,c,*, Nicky Cullum m
MRC Centre of Research Excellence in Nursing, Griffith University, Australia
tre for Health Practice Innovation, Griffith University, Australia
nzies Health Institute Queensland, Griffith University, Australia
red Health, Australia
ool of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
ool of Nursing and Midwifery, Deakin University, Australia
yal Brisbane and Women’s Hospital, Australia
rsing Research Institute, St Vincent’s Health Australia (Sydney), Australia
versity of the Sunshine Coast, Australia
versity of Queensland, Australia
ulty of Medicine, University of Kuwait, Kuwait
ffith University, Australia
iversity of Manchester, United Kingdom
T I C L E I N F O
le history:
ived 19 September 2014
ived in revised form 16 April 2015
pted 28 April 2015
ords:
bundle
ent centred care
ent participation
sure injury prevention
sure ulcer prevention
A B S T R A C T
Background: Pressure injuries are a significant clinical and economic issue, affecting both
patients and the health care system. Many pressure injuries in hospitals are facility
acquired, and are largely preventable. Despite growing evidence and directives for
pressure injury prevention, implementation of preventative strategies is suboptimal, and
pressure injuries remain a serious problem in hospitals.
Objectives: This study will test the effectiveness and cost-effectiveness of a patient-
centred pressure injury prevention care bundle on the development of hospital acquired
pressure injury in at-risk patients.
Design: This is a multi-site, parallel group cluster randomised trial. The hospital is the unit
of randomisation.
Methods: Adult medical and surgical patients admitted to the study wards of eight
hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility),
(b) expected to stay in hospital for �48 h, (c) admitted to hospital in the past 36 h; and (d)
able to provide informed consent will be eligible to participate. Consenting patients will
receive either the pressure injury prevention care bundle or standard care. The care bundle
contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a
healthy diet. Nurses will receive education about the intervention. Patients will exit the
study upon development of a pressure injury, hospital discharge or 28 days, whichever
Corresponding .
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS3PROVIDERS CHALLENGE.docxwoodruffeloisa
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 3
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 15
Providers Challenge for Treating Infectious Disease
Amy Nicole Elders
Grand Canyon University
Science Communication & Research
Bio- 317V-0500
Michael Rothrock
September 6, 2019
Abstract
Running head: PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 1
High mortality results from infection within healthcare institutions whether community or hospital acquired. Hospitalists provide inpatient care with increasing frequency due to the overwhelming workload upon primary care physicians. However, hospitalists are generalists and are minimally prepared to attend patients with serious infections which may rapidly overwhelm particularly in vulnerable populations. Duplication of diagnostic testing, prolonged length of stay drives up costs for institutions and patients. Erroneous or inadequate prescription of antibiotics costs lives, Infectious disease specialists are inadequately utilized despite statistical evidence that such specialty care improves outcomes. Education, collaboration between providers, and prescribing guidelines are recommended to address these needs.
Providers Challenge for Treating Infectious Disease
Technology has become increasingly advanced and the ability to diagnose, treat, and manage patients is ever evolving. Although advancements in imaging, surgical procedures and medication therapies make possible a better quality of life, they are often required to self-manage very serious disease and infection. Insurance companies and healthcare regulations often guide the path providers must take to care for patients. The length of stay in hospitals are decreasing and patients are being treated on an outpatient basis. Patients often receive care in outpatient rehabs, infusion centers, and home health agencies with medications supplied by specialty pharmacies. Drug resistant organisms are becoming more common and the risks associated with treating these organisms can often be challenging to manage. Treatment is often received for an extended amount of time and many primary care providers no longer see patients on an inpatient basis. This means that hospitalists assume care when they are admitted into the hospital but are unable to follow the patient for the remainder of treatment when they are discharged. When complications arise for these patients, they have limited ways of seeking help. There is fragmented care and lack of continuity. In the case of patients diagnosed with infection, questions about when hospitalists should consult specialists such as infectious disease physicians often occur. Mortality and morbidity for patients as well as hospital stays and readmission are decreased when an Infectious Disease physician is consulted early (CDC, 2013). Research is focused on the education of these two types of physicians, why some providers decide not to pursue a specialty, as well as success rates of patients treated by both. Fact ...
This article summarizes the use of a patient group direction (PGD) at a hospital to provide pre-operative Staphylococcus aureus decolonization treatment to patients undergoing spinal surgery to reduce their risk of surgical site infection. Staff were trained to distribute the PGD in pre-operative clinics and patients self-administered the treatment at home for 5 days before surgery. An audit found that over 50% of eligible patients received the PGD, and infection rates decreased from 2.4% to 0.6% after implementation. Both staff and patients reported that the PGD was well-explained and adhered to.
Explain in your own words why it is important to read a statistical .docxAlleneMcclendon878
Explain in your own words why it is important to read a statistical study carefully. Can you think of circumstance where it might be okay to misrepresent data?
Video Reflection 12 -
Do you think it is possible to create a study where there really is no bias sampling done? How would you manage to create one?
Video Reflection 13 -
What are your thoughts on statistics being misrepresented/ how does it make you feel? Why do you think the statistic are often presented in this way?
.
Explain how Matthew editedchanged Marks Gospel for each of the fol.docxAlleneMcclendon878
Explain how Matthew edited/changed Mark's Gospel for each of the following passages, and what reasons would he have had for doing that? What in Mk’s version was Mt trying to avoid – i.e., why he might have viewed Mk’s material as misleading, incorrect, or problematic? How did those changes contribute to Matthew’s overall message? How did that link up with other parts of Mt’s message?
Use both the following two sets of passages to support your claim, making use ONLY of the resources below, the Bible, textbooks and Module resources.
1. How did Matthew edit/change Mark 6:45-52 to produce Matthew 14:22-33 – and why?
2. How did Matthew edit/change Mark 9:2-10 to produce Matthew 17:1-13 – and why?
The paper should 350-750 words in length, double-spaced, and using MLA formatting for reference citations and bibliography. Submit the completed assignment to the appropriate Dropbox by
no later than Sunday 11:59 PM Eastern.
Resources for this paper:
See the ebook via SLU library:
New Testament History and Literature
by Martin (2012), pp. 83-88,105-108.
See the ebook via SLU library:
The Gospels
by Barton and Muddiman (2010), p. 53,56-57,102,109.
.
Explain the degree to which media portrayal of crime relates to publ.docxAlleneMcclendon878
Explain the degree to which media portrayal of crime relates to public fear of crime and explain how.
Explain whether public fear of crime might influence individual behavior or not and explain how or how not.
Share an insight about whether media should be responsible or not for the portrayal of crime as it relates to public fear of crime.
2 Pages in APA Format
.
Explain the difference between genotype and phenotype. Give an examp.docxAlleneMcclendon878
Explain the difference between genotype and phenotype. Give an example of each and describe both in an account that relates to you personally, the
paper should be 2-3 pages in length (not counting the title and resources pages), APA style (no abstract required), and should be supported with appropriate citations.
.
Explain the history behind the Black Soldier of the Civil War In t.docxAlleneMcclendon878
Explain the history behind the Black Soldier of the Civil War
In this forum look beyond the book for information on specific units, soldiers and even the reasons for why Lincoln allowed the African American to service in the war.
Soldiers - the trained and untrained
Initial post of at least 300 words due by Friday.
Darlene Hine, William Hine, and Stanley Harrold.
The African-American Odyssey: Volume I, 6th ed. New Jersey: Pearson 2014.
.
Explain the fundamental reasons why brands do not exist in isolation.docxAlleneMcclendon878
Explain the fundamental reasons why brands do not exist in isolation but do exist in larger environments that include other brands. Provide two (2) specific recommendations or solutions that can help a health care facility improve patient satisfaction.
Assess the value of Lederer and Hill's Brand Portfolio Molecule when used to understand brand relationships. Provide at least two (2) specific examples of strategic or tactical initiatives within a health care organization.
.
Explain the difference between hypothetical and categorical imperati.docxAlleneMcclendon878
Hypothetical imperatives are conditional principles that apply if one wants to achieve a goal, while categorical imperatives are unconditional moral rules. This distinction could be used to argue that placing violent prisoners in solitary confinement is a hypothetical imperative to maintain safety, but it may violate the categorical imperative of respecting human dignity for all.
Explain in 100 words provide exampleThe capital budgeting decisi.docxAlleneMcclendon878
Explain in 100 words provide example
The capital budgeting decision techniques that we've discussed all have strengths and weaknesses, but they do comprise the most popular rules for valuing projects. Valuing entire businesses, on the other hand, requires that some adjustments be made to various pieces of these methodologies. For example, one alternative to NPV used quite frequently for valuing firms is called Adjusted Present Value (APV).
What is APV, and how does it differ from NPV?
.
Explain how Supreme Court decisions influenced the evolution of the .docxAlleneMcclendon878
Explain how Supreme Court decisions influenced the evolution of the death penalty.
Explain the financial impact of the death penalty on society. Include at least one specific cost associated with the death penalty.
Explain the social impact of the death penalty on society. Provide examples and use Learning Resources to support your statements. 2 pages in APA format
.
Explain how an offender is classified according to risk when he or s.docxAlleneMcclendon878
Explain how an offender is classified according to risk when he or she is placed on probation or parole. Include how static and dynamic factors are taken into account by the supervising officer when both determining the level of supervision an offender needs and in developing the case-supervision plan for the offender. Include a discussion on the various levels of probation/parole supervision and the amount of surveillance and contact with the offender involved with each level. Do you agree or disagree with how often probation and parole officers have contact with high-risk offenders? Make sure to support your opinion.
.
Explain a lesson plan. Describe the different types of information.docxAlleneMcclendon878
Explain a lesson plan. Describe the different types of information found in a detailed lesson plan. Include in your discussion a design document and its usefulness. (A Minimum 525 Words)
Reference:
Noe, R. A. (2013). Employee training and development (6th ed.). New York, NY: McGraw-Hill.
.
explain the different roles of basic and applied researchdescribe .docxAlleneMcclendon878
explain the different roles of basic and applied research
describe the different criteria for success of basic and applied research
explain why government policymakers seem to prefer applied research
describe how basic research reflects liberal democratic values
Over fifty years ago, Vannevar Bush released his enormously influential report, Science, the Endless Frontier, which asserted a dichotomy between basic and applied science. This view was at the core of the compact between government and science that led to the golden age of scientific research after World War II—a compact that is currently under severe stress. In this book, Donald Stokes challenges Bush’s view and maintains that we can only rebuild the relationship between government and the scientific community when we understand what is wrong with that view.
Stokes begins with an analysis of the goals of understanding and use in scientific research. He recasts the widely accepted view of the tension between understanding and use, citing as a model case the fundamental yet use-inspired studies by which Louis Pasteur laid the foundations of microbiology a century ago. Pasteur worked in the era of the “second industrial revolution,” when the relationship between basic science and technological change assumed its modern form. Over subsequent decades, technology has been increasingly science-based. But science has been increasingly technology-based–with the choice of problems and the conduct of research often inspired by societal needs. An example is the work of the quantum-effects physicists who are probing the phenomena revealed by the miniaturization of semiconductors from the time of the transistor’s discovery after World War II.
On this revised, interactive view of science and technology, Stokes builds a convincing case that by recognizing the importance of use-inspired basic research we can frame a new compact between science and government. His conclusions have major implications for both the scientific and policy communities and will be of great interest to those in the broader public who are troubled by the current role of basic science in American democracy.
Why the distinction between basic (theoretical) and applied
(practical) research is important in the politics of science
.
Explain the basics of inspirational and emotion-provoking communicat.docxAlleneMcclendon878
Explain the basics of inspirational and emotion-provoking communication.
Explain the key features of a power-oriented linguistic style.
Explain the six basic principles of persuasion.
Evaluate basic approaches to resolving conflict and negotiating.
Choose one of the above topics
1 Paragraph
1 APA citation
.
Explain how leaders develop through self-awareness and self-discipli.docxAlleneMcclendon878
This paper discusses how leaders develop through self-awareness, self-discipline, education, experience, and mentoring. It will explain and classify different types of leadership development programs and discuss the importance of leadership succession planning. The paper will be 3-4 pages long using APA style and citing at least 4 sources.
Explain five ways that you can maintain professionalism in the meeti.docxAlleneMcclendon878
Explain five ways that you can maintain professionalism in the meeting and convention planning industry.
1.
Order of precedence
2.
Titles and styles of address
3.
Invitations
4.
Flags
5.
Religious, cultural and ritual observations
.
Explain security awareness and its importance.Your response should.docxAlleneMcclendon878
Explain security awareness and its importance.
Your response should be at least 200 words in length.
Explain network and data privacy policies.
Your response should be at least 200 words in length.
Explain the different security positions within information security.
Your response should be at least 200 words in length.
Explain what a security incident response team handles.
Your response should be at least 200 words in length.
.
Experimental Design AssignmentYou were given an Aedesaegyp.docxAlleneMcclendon878
Experimental Design Assignment
You were given an
Aedes
aegypti
gene of unknown function. Using Blast you were able to find the homologs of your gene. You have done research regarding the function of the homologs. Using this information:
A.Construct
a hypothesis
Give a hypothesis on the function of your gene SHAKER is in Aedesaegypti.
B.Design
an experiment to test your hypothesis.
Include a
labeled
sketch and written summary of experiment. (
include drawing of all conditions
, negative/positive etc)
C. Variables
List the Dependent and Independent
List Control variable
List a Positive and /or Negative controls
D.
Create a
data
set
and figure
Create a graph that clearly conveys to the reader what your experiment is about.
F.Interpretation
Give an interpretation of the possible meaning of your data. (although this isn’t conclusive since we are not doing statistics) . Does it align with your hypothesis?
G.Self-critique
and follow-up questions:
Why might your conclusion be wrong, what other questions do you have.
.
Expand your website plan.Select at least three interactive fea.docxAlleneMcclendon878
This document recommends selecting at least three interactive features to add to a website, identifying the purpose each feature would serve visitors, and how they would be constructed. Potential interactive features could include a contact form to collect visitor information, an events calendar to promote upcoming activities, and a feedback survey to gather user opinions.
Exercise 7 Use el pronombre y la forma correcta del verbo._.docxAlleneMcclendon878
Este documento presenta 22 oraciones con pronombres y verbos en forma personal que deben completarse correctamente. Las oraciones contienen sujetos como "yo", "nosotros", "ellos", etc. y verbos como "gustar", "faltar", "quedar", etc. que deben conjugarse de acuerdo al sujeto para completar cada oración.
Exercise 21-8 (Part Level Submission)The following facts pertain.docxAlleneMcclendon878
Exercise 21-8 (Part Level Submission)
The following facts pertain to a noncancelable lease agreement between Windsor Leasing Company and Sheridan Company, a lessee.
Inception date:
May 1, 2017
Annual lease payment due at the beginning of
each year, beginning with May 1, 2017
$21,737.01
Bargain-purchase option price at end of lease term
$3,800
Lease term
5
years
Economic life of leased equipment
10
years
Lessor’s cost
$68,000
Fair value of asset at May 1, 2017
$93,000
Lessor’s implicit rate
10
%
Lessee’s incremental borrowing rate
10
%
The collectibility of the lease payments is reasonably predictable, and there are no important uncertainties surrounding the costs yet to be incurred by the lessor. The lessee assumes responsibility for all executory costs.
Click here to view factor tables
(c)
Your answer is partially correct. Try again.
Prepare a lease amortization schedule for Sheridan Company for the 5-year lease term.
(Round present value factor calculations to 5 decimal places, e.g. 1.25125 and Round answers to 2 decimal places, e.g. 15.25.)
SHERIDAN COMPANY (Lessee)
Lease Amortization Schedule
Date
Annual Lease Payment Plus
BPO
Interest on
Liability
Reduction of Lease
Liability
Lease Liability
5/1/17
$
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record depreciation.)
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record interest.)
1/1/18
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record second payament.)
Question 27
Pearl Corporation manufactures replicators. On January 1, 2017, it leased to Althaus Company a replicator that had cost $100,000 to manufacture. The lease agreement covers the 5-year useful life of the replicator and requires 5 equal annual rentals of $40,200 payable each January 1, beginning January 1, 2017. An interest rate of 12% is implicit in the lease agreement. Collectibility of the rentals is reasonably assured, and there are no important uncertainties concerning costs.
Prepare Pearl’s January 1, 2017, journal entries.
(Credit account titles are automatically indented when amount is entered. Do not indent manually. If no entry is required, select "No Entry" for the account titles and enter 0 for the amounts. Round present value factor calculations to 5 decimal places, e.g. 1.25124 and the final answer to 0 decimal places e.g. 58,971
.
)
Click here to view factor tables
Date
Account Titles and Explanation
Debit
Credit
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record the lease.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record cost.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record first lease payment.)
6 years ago
16.01.2017
8
Report Issue
Answer
(
0
)
Bids
(
0
)
other Questions
(
10
)
what can i bring to class that symbolizes growth and change
calculate it.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
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How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
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Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
2. 2010). The Centers for Medicare & Medicaid has deemed
that CAUTI is a “reasonably preventable” inhospital com-
plication and has terminated reimbursements for these
events since 2008 (CDC, 2019). The mean cost of UTI is
$862 to $1007 per UTI (Bail et al., 2015; CDC, 2019; Scott,
2010), whereas a systematic review found that the mean
cost of CAUTI can exceed $10,000 per CAUTI based on
the clinical status of the patient (Hollenbeak & Schilling,
2018).
A vast majority of patients who suffer hip fractures
undergo a surgical repair after admission (Bliemel et al.,
2017; Johnstone, Morgan, Wilkinson, & Chissell, 1995;
Wallace et al., 2019). These repairs have an elevated risk
of causing postoperative urinary retention due to the
ABSTRACT
Background: Catheter-associated urinary tract infection
(CAUTI) is a noted complication among geriatric hip fracture
patients. This complication results in negative outcomes
for both the patients and the institution providing care.
Screening measures to identify predisposing factors, with
early diagnosis and treatment of urinary tract infection (UTI)
present on admission, may lead to reduced rates of CAUTI.
Objective: The goals of this study were to determine the
prevalence of UTI on admission among geriatric hip fracture
patients and whether routine screening for UTI or predisposing
factors at presentation resulted in reduced rates of CAUTI.
Methods: A retrospective observational study of geriatric hip
fracture patients from January 2017 to December 2018 at a
Level I trauma center was performed. Rates of UTI on
admission
and CAUTI were calculated using routine admission urinalysis.
Results: Of the 183 patients in the sample, 36.1% had UTI
on admission and 4.4% of patients developed CAUTI. There
3. were no significant differences in patient demographics,
comorbidities, and complications between those with UTI on
admission and those without.
Conclusions: Urinary tract infection on admission may
be present among a large portion of geriatric hip fracture
patients, leading to increased rates of CAUTI. Routine
screening for UTI and its predisposing factors at admission
can identify these patients earlier and lead to earlier
treatments and prevention of CAUTI.
Key Words
Catheter-associated urinary tract infections, CAUTI,
Complications, Elderly, Geriatric, Hip fracture, Hospital costs,
Trauma, Urinary tract infections
Author Affiliation: Department of Surgery, Nassau University
Medical
Center, East Meadow, New York.
The content of this article does not substantially overlap with
previously
published or submitted work, to the best of the authors’
knowledge.
Authors Shridevi Singh, MD, and Swapna Munnangi, PhD, had
full access
to all the data in this study and take responsibility for the
integrity of the
data and the accuracy of the data analysis. The data that support
the
findings of this study are available from the correspondi ng
author L.D.
George Angus, MD, upon reasonable request.
The authors declare no conflicts of interest.
5. (Aubron et al., 2012; Bliemel et al., 2017; Zielinski et al.,
2015). Elderly patients tend to be institutionalized with
lower mobility or have medical comorbidities such as hy-
pertension, diabetes, stroke, or dementia that predispose
these patients to bladder or bowel incontinence and UTI
(Foxman, 2014; Mody & Juthani-Mehta, 2014; Woodford
& George, 2009). In addition, less attention to sanitary
precautions further predisposes this specific patient pop-
ulation to high rates of UTIs (Alpay et al., 2018).
Although current guidelines do not recommend treat-
ing asymptomatic bacteriuria (Zalmanovici Trestioreanu,
Lador, Sauerbrun-Cutler, & Leibovici, 2015), this specific
population subset may not be able to vocalize or validate
symptoms due to altered mental status and communica-
tion incapability as a result of dementia, stroke, etc. (Tsu-
da et al., 2015). Hence, we presume that in this specific
patient population, UTI is a missed diagnosis because
of the missed clinical correlation needed as per current
UTI diagnostic criteria guidelines (CDC, 2019; Rowe &
Juthani-Mehta, 2014). Failure in early diagnosis and treat-
ment in this specific elderly patient population results in
morbid outcomes for patients and significant financial
penalties for institutions (Detweiler et al., 2015; Thakker
et al., 2018; Zielinski et al., 2014). However, the question
arises whether a CAUTI diagnosis is truly the progres-
sion of asymptomatic bacteriuria due to the indwelling
catheter or is rather a result of comorbid UTI at admis-
sion. Therefore, we propose that by screening geriatric
hip fracture patients with a urinalysis (UA) within 24 hr of
an indwelling urinary catheter that is placed at admission,
we will find there is a significant frequency of patients
who present with either UTI on admission or with UA
findings that could predispose patients to a UTI with an
indwelling urinary catheter.
6. METHODS
A retrospective observational study of patients at an ur-
ban Level I trauma center, as verified by the American
College of Surgeons, was performed. The trauma center is
a 500-bed public safety-net hospital that serves 1.4 million
people, with approximately 75,000 emergency depart-
ment visits and approximately 1,700 trauma admissions
each year.
After obtaining approval from the Institutional Review
Board (19-205), the trauma registry was queried by us-
ing ICD-10 codes S72.001-S72.26 for hip fracture for all
patients 65 years and older from January 1, 2017, through
December 31, 2018, which were the first 2 years that
routine screening UA was included as a component of
the multidisciplinary geriatric hip fracture comanagement
protocol at this institution (Wallace et al., 2019). Routine
screening UAs were obtained within 24 hr of admission.
Demographic information, comorbid conditions, prein-
jury medications, mechanism of injury, vital signs, Abbre-
viated Injury Score, Injury Severity Score, Revised Trau-
ma Score, Glasgow Coma Scale, admission disposition,
hospital course, intensive care unit (ICU) length of stay,
hospital length of stay, complications, disposition, and
outcome were extracted from the trauma registry supple-
mented by direct review of the electronic medical record.
Initially, 193 patient records were identified. However, 10
of these patient records were deemed incomplete and
were excluded, as they either did not have at least one of
the above data points available or the screening UA per-
formed, leaving 183 patients for the final sample. There
was no historical control group, as the frequency of UTI
and asymptomatic bacteriuria at the time of admission
were the variables of interest. All patients were admitted
to the ICU as part of our institution's protocol for geriatric
hip fracture patients.
8. The diagnosis of UTI in this study was made based on
the following UA results regardless of clinical symptoms:
white blood cells >10/high-power field (hpf), +nitrites,
+bacteria. Comparisons of outcomes were then com-
pared to subgroups within the data collected. Patients di -
agnosed with UTI were treated with antibiotics.
Statistical Analysis
Descriptive statistics were used to summarize the demo-
graphic and clinical variables in the study sample. Con-
tinuous variables were summarized by presenting mean
and standard deviation. Categorical variables were sum-
marized using frequency and percentages. The study
sample was stratified into two groups based on whether
or not the patient had a UTI upon admission. Continu-
ous variables were compared using unpaired Student's
t-test. The Fisher exact test or Pearson χ2 test was used
to examine the association of categorical variables with
UTI on admission. A p value < .05 was considered sta-
tistically significant. Statistical analysis was performed
using SAS version 9.4 (SAS Institute, Cary, NC).
RESULTS
The study sample consisted of 183 hip fracture patients
who met the inclusion criteria. Of these 183 patients,
36.07% had a UTI on admission, and 63.93% did not.
Table 1 depicts the baseline clinical and demographic
characteristics of the study sample stratified by the UTI
TABLE 1 Demographic and Clinical Characteristics
Variable
Total Sample
9. (n = 183)
n (%)
UTI on Admission
(n = 66; 36.07%)
n (%)
No UTI on Admission
(n = 117; 63.93%)
n (%) p Value
Age, M (SD), year 84.9 (8.0) 86.2 (7.5) 84.2 (8.3) .108
Sex
Female 140 (76.5) 53 (80.3) 87 (74.4) .363
Male 43 (23.5) 13 (19.7) 30 (25.6)
Mechanism of injury .715
Fall from bed 5 (2.7) 1 (1.5) 4 (3.4)
Fall from chair 10 (5.5) 3 (4.5) 7 (6.0)
Fall from stairs 19 (10.4) 7 (10.6) 12 (10.3)
Fall from toilet 2 (1.1) 2 (1.1) 1 (0.8)
Fall same level 141 (77.0) 50 (75.8) 91 (77.8)
Fall unspecified 2 (1.0) 1 (1.5) 1 (0.8)
Other 4 (2.2) 3 (4.5) 1 (0.8)
10. Mortality 8 (4.4) 4 (6.1) 4 (3.4) .401
ICU length of Stay, Mdn (IQR), day 3 (1.0) 3 (3.0) 2 (1.0) .004
Hospital length of stay, Mdn (IQR), day 4 (4.0) 5 (5.0) 4 (3.0)
.118
CAUTI 8 (4.4) 0 (0.0) 8 (6.8)
Foley days, Mdn (IQR), day 2 (1.0) 2 (1.0) 2 (1.0) .593
Injury Severity Score, M (SD) 9.9 (2.9) 10.2 (3.1) 9.7 (2.8)
.307
Glasgow Coma Scale, M (SD) 14.7 (1.2) 14.5 (1.6) 14.8 (.88)
.219
Hospital disposition .806
Acute rehabilitation 91 (49.7) 29 (43.9) 62 (53.0)
Died full code/withdrawal of care 8 (4.4) 4 (6.1) 4 (3.4)
Home 4 (2.2) 2 (3.0) 2 (1.7)
Skilled nursing facility 15 (8.2) 6 (9.1) 9 (7.7)
Subacute rehabilitation 61 (33.3) 24 (36.4) 37 (31.6)
Other nursing facility 4 (2.2) 1 (1.5) 3 (2.6)
Note. CAUTI = catheter-associated urinary tract infection; ICU
= intensive care unit; IQR = interquartile range; UTI = urinary
tract infection.
12. sample. The inhospital complications were not signifi-
cantly different between those who had a UTI on admis-
sion and those who did not.
DISCUSSION
The elimination of all CAUTI is not attainable; however,
it is necessary to take “reasonable preventive” measures
TABLE 2 Comorbidities
Comorbidity
Total Sample
(n = 183)
n (%)
UTI on Admission
(n = 66; 36.07%)
n (%)
No UTI on Admission
(n = 117; 63.93%)
n (%) p Value
Anticoagulation 48 (26.2) 20 (30.3) 28 (23.9) .347
Bleeding disorder 3 (1.6) 1 (1.5) 2 (1.7) .920
CHF 37 (20.2) 14 (21.2) 23 (19.7) .802
Chronic renal failure 15 (8.2) 5 (7.6) 10 (8.5) .217
Cirrhosis 2 (1.1) 0 (0.0) 2 (1.7) .536
15. CAUTI during their hospital course, and 66 of 183 (36%,
Table 1) patients had UTI on admission. The increased
incidence of CAUTI seen in previous studies compared
to our data supports the theory that the colonization of
urine with bacteria might have already been present and
untreated. It is generally recommended that patients with
asymptomatic bacteriuria should not be treated, and for
the nonelderly hip fracture patient, we agree. The limita-
tion in obtaining symptomatology history in this specific
patient population due to their comorbidities (e.g., de-
mentia) and the significant incidence of positive UA at
admission in this study supports the theory that the clini -
cal diagnosis of UTI should be assessed objectively and
thus treated appropriately in elderly hip fracture patients.
Study Limitations
The retrospective design of the study is a limitation in
itself. Our data were collected by analyzing medical re-
cords, which intrinsically lends itself to systematic bias.
The validity of data relating to such things as laboratory
values and interpretation can therefore not be fully guar-
anteed. Our sample size was also small, and we hope to
elaborate with future studies. However, as a pilot study,
we believe that publishing our findings will engage the
academic community and help determine future study
parameters. Furthermore, as a descriptive, observational
study, there are limitations as there are no control groups,
and interpretation of results is therefore theoretical.
CONCLUSIONS
Based on our findings, we strongly believe that if an ad-
mission UA was conducted for elderly hip fracture patients
and positive results were treated accordingly, there would
be a significant reduction in the diagnosis of CAUTI. An
indwelling urinary catheter is commonly placed in elderly
16. hip fracture patients, increasing their inherent risk for a
UTI based on catheter placement alone. This study has
also demonstrated the increased incidence of positive
UA as an additional theoretical risk factor for CAUTI in
these patients. Because of potential for serious complica-
tions, mortality, and financial burden on institutions, early
identification of urinary tract infection or asymptomatic
TABLE 3 Inhospital Complications
Complication
Total Sample
(n = 183)
n (%)
UTI on Admission
(n = 66; 36.07%)
n (%)
No UTI on Admission
(n = 117; 63.93%)
n (%) p Value
Cardiac arrest with CPR 2 (1.0) 1 (1.5) 1 (0.8) .464
Myocardial infarction 1 (0.5) 0 (0.0) 1 (0.8) .639
Unplanned intubation 4 (2.2) 2 (3.0) 2 (1.7) .322
Unplanned return to OR 4 (2.2) 0 (0.0) 4 (3.4) .164
Unplanned return to ICU 1 (0.5) 1 (1.5) 0 (0.0) .361
18. We thank the patients at Nassau University Medical Cent-
er for trusting us with their care. We also thank the staff
of the trauma department at Nassau University Medical
Center for their continued commitment to patient care.
KEY POINTS
• Catheter-associated urinary tract infections (CAUTIs) are a
well-known complication among the geriatric hip fracture
population.
• CAUTI has negative consequences for both the patient and
the institution and may be due to urinary tract infection
(UTI) present on admission.
• This study observed outcomes in geriatric hip fracture
patients who underwent routine UTI screening on admission.
• The results of this study suggest reduced rates of CAUTI
compared to previously published literature.
• The results suggest there may be a role in routine UTI
screening for geriatric hip fracture patients.
TABLE 4 Comorbidities With CAUTI But No UTI on
Admission
Comorbidity
CAUTI (n =8; 4.4%)
n (%)
No UTI on Admission Excluding
CAUTI (n = 109)
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Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and
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28. Article reuse guidelines:
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Research Report
Introduction
Urinary tract infections (UTIs) cause significant morbidity
and mortality in older adults, accounting for an estimated
15.5% of hospitalizations and 6.2% of infectious disease–
related deaths in patients 65 years and older.1 Among insti-
tutionalized adults, UTIs are the most common type of
infection and account for one-third of all infections.1 Older
adults are at higher risk for UTI because of increasing inci -
dence of urinary incontinence and retention, use of urinary
catheters, vaginal atrophy in postmenopausal women, long-
term institutionalization, and reduced immune function.1,2
Prophylactic antibiotics are often utilized in older
adults with recurrent UTIs. A retrospective cohort study
evaluated more than 19 000 patients ≥65 years old with
recurrent UTI who received prophylaxis with either trim-
ethoprim, cephalexin, or nitrofurantoin.3 Prophylaxis was
associated with a reduction in the risk of UTIs and UTI-
related hospitalizations.3
Currently, there are no treatment guidelines for the pre-
vention of recurrent UTIs. A major concern with use of
prophylactic antibiotics is antimicrobial resistance and
other adverse effects, including Clostridioides difficile.1
Antimicrobial resistance in community-acquired urinary
organisms is increasing in the United States. In nursing
home settings, colonization with multidrug-resistant organ-
isms is common.1
29. Methenamine is a Food and Drug Administration (FDA)-
approved medication used for the prevention of UTIs in
persons 6 years and older.4 The recommended dosing of
886308AOPXXX10.1177/1060028019886308Annals of
PharmacotherapySnellings et al
research-article2019
1University of Colorado, Aurora, CO, USA
Corresponding Author:
Danielle R. Fixen, Department of Clinical Pharmacy, Skaggs
School
of Pharmacy and Pharmaceutical Sciences, University of
Colorado,
Anschutz Medical Campus Mail Stop C238, 12850 E Montview
Blvd,
Aurora, CO 80045, USA.
Email: [email protected]
Effectiveness of Methenamine for UTI
Prevention in Older Adults
Marina S. Snellings, PharmD1, Sunny A. Linnebur, PharmD1,
Scott M. Pearson, PharmD1, Jeff I. Wallace, MD, MPH/MSPH1,
Joseph J. Saseen, PharmD1, and Danielle R. Fixen, PharmD1
Abstract
Background: Methenamine is a drug used for the prevention of
lower urinary tract infections (UTIs). However, efficacy
has not been established in older adults or patients with varying
degrees of kidney function. Objective: To evaluate the
effectiveness of methenamine for the prevention of UTI in
adults 60 years and older. Methods: This was a retrospective,
pre-post, observational study. The study included primary care
patients 60 years and older who were taking methenamine
30. between January 1, 2015, and September 30, 2018. The pri mary
outcome was the time to first UTI after methenamine
initiation compared with the average time between UTIs in the
12 months prior to methenamine initiation. Results: Of
434 patients reviewed, 150 met inclusion criteria. The average
time to UTI was 3.3 months prior to methenamine initiation
compared with 5.5 months after methenamine initiation (P =
0.0004). There were 33 patients (22%) who did not have
a UTI after methenamine initiation. Also, 14 patients (9.3%)
had a calculated CrCl <30 mL/min at baseline. The average
time to UTI in these patients was 3.3 months prior to
methenamine initiation compared with 12.7 months after
initiation
(P < 0.0001). Conclusion and Relevance: Methenamine use was
associated with a longer time to UTI in older adults
with varying degrees of kidney function. The effectiveness of
methenamine appeared to be similar regardless of kidney
function, which is new evidence. Because of a lack of acquired
resistance, methenamine may be an effective option for UTI
prophylaxis in older adults.
Keywords
methenamine, urinary tract infections, geriatrics, renal
insufficiency
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360 Annals of Pharmacotherapy 54(4)
methenamine hippurate for UTI prophylaxis according to
FDA labeling is 1 g by mouth twice daily. Methenamine
31. acts via conversion of hexamine to formaldehyde in the
bladder, which in turn acts as a bacteriostatic agent.4 Unlike
other antimicrobials, acquired resistance has not been dem-
onstrated with methenamine use, making it an attractive
option for UTI prophylaxis.5 FDA labeling for methena-
mine states that use is contraindicated in patients with a cre-
atinine clearance (CrCl) less than 30 mL/min; therefore, the
safety and efficacy of methenamine in this population
remains largely unknown.4
Prior studies evaluating the efficacy of methenamine for
UTI prophylaxis were often small and/or had mixed results.6
Furthermore, efficacy of methenamine has not been studied
specifically in older adults with varying degrees of kidney
function. The objective of this study was to determine the
effectiveness of methenamine for the prevention of UTIs in
older adults.
Methods
Study Design and Setting
This was a retrospective, pre-post, observational study of
methenamine for UTI prevention in older adults receiving
primary care at University of Colorado Health (UCHealth).
UCHealth is an integrated health system across Colorado
with more than 900 primary care clinics utilizing the elec-
tronic health record (EHR) EPIC (Verona, WI). Patients
aged 60 to 89 years prescribed methenamine between
January 1, 2015, and September 30, 2018, were identified
through an EHR report. Manual verification of study crite-
ria was completed via EHR review. Patients had to be
actively prescribed methenamine during the study period,
but records were reviewed for the entire time the patient
was prescribed methenamine. The study protocol was
reviewed and determined to be exempt by the Colorado
32. Multiple Institutional Review Board.
Participants
Patients were included if they were 60 years and older,
were prescribed methenamine for UTI prophylaxis, and
received care in a UCHealth primary care clinic. Patients
were required to have documentation of recurrent UTI,
defined as 2 or more UTIs in the 12 months prior to methe-
namine initiation. In addition, participants had to be a
UCHealth patient for at least 12 months prior to methena-
mine initiation or have outside records available in the
EHR. Exclusion criteria included spinal cord or urological
structural abnormalities, immunocompromised state, use
of other antimicrobial agents for UTI prophylaxis, no
serum creatinine (SCr) in the EHR within 12 months of
methenamine initiation, or evidence that the patient was
not adherent to methenamine.
Outcomes
The primary outcome was time to first UTI after methena-
mine initiation compared with the time between UTIs in the
12 months prior to methenamine initiation. UTI was defined
as one of the following: (1) antibiotic prescription with an
associated International Classification of Diseases diagno-
sis code for UTI, (2) bacteriuria with >100 000 colony-
forming units (cfu)/mL plus either an antibiotic prescription
or urinary symptoms, or (3) emergency department visit or
hospitalization for UTI. Secondary outcomes included
effectiveness of methenamine in patients with CrCl <30
mL/min compared with CrCl ≥30 mL/min and adverse
effects associated with methenamine.
Data Collection and Analysis
33. Patients were identified from an EHR report, and demo-
graphic data, pertinent lab values, methenamine prescribing
information, and UTI data were collected and recorded
using Microsoft Excel. Number of UTIs in the 12 months
prior to methenamine initiation and time to first UTI after
methenamine initiation were determined. Time between
UTIs in the 12 months prior to methenamine initiation was
calculated by dividing 12 months by the number of UTIs
during that time period to determine an average. In patients
who did not have a UTI after initiation of methenamine,
time to UTI was measured from methenamine initiation
date to date of data collection. Other variables collected
during the EHR review included the following: methena-
mine index (date first prescribed) and discontinuation dates,
height, weight, SCr at index date and highest SCr while on
methenamine, methenamine dose, provider type for methe-
namine prescription, reason for discontinuation, adverse
effects, type of UTI (symptomatic or asymptomatic), bacte-
ria identified in urine culture, antibiotics used for treatment
of UTI, source of antibiotic prescription, use of antibiotics
for other indications, catheter use, and use of other medica-
tions that increase risk of UTI (eg, corticosteroids, sodium-
glucose cotransporter-2 inhibitors). The baseline and lowest
CrCl were manually calculated using the Cockroft-Gault
equation by using the SCr at initiation and highest SCr
while on methenamine.
As our data were normally distributed, a 2-tailed paired
t-test was used for the primary outcome, with a P value of
<0.05 considered statistically significant. Descriptive sta-
tistics were used for demographic and clinical data.
Proportions were used for nominal data.
Results
A total of 434 patients were screened, of whom 150 patients
34. were included (Figure 1). Baseline characteristics are sum-
marized in Table 1. The mean age was 77 years, and the
majority of patients were white and female. The mean CrCl
Snellings et al 361
at time of methenamine initiation was 54 mL/min.
Urologists (66.7%) were the most common prescriber of
methenamine, followed by primary care physicians
(16.7%). The majority of patients (88.7%) were prescribed
methenamine hippurate 1 g by mouth twice daily, with 1 g
by mouth once daily being the second most common dosing
at the time of methenamine initiation (10.7%). There were
25 patients (16.7%) who used antibiotics for other indica-
tions while taking methenamine, and 17 patients (11.3%)
were taking medications that increased risk for UTIs (eg,
corticosteroids). Urinary catheters were utilized in 26
patients (17.3%) prior to methenamine initiation.
Primary Outcome
The average time to recurrent UTI was 3.3 months prior to
methenamine initiation compared with 11.2 months after
methenamine initiation (P < 0.0001; Table 2). There were 33
patients (22%) who did not have a UTI after methena mine
initiation. Of the 117 patients who had a UTI after methena-
mine initiation, 98 (83.8%) were symptomatic, 6 (5.1%) were
asymptomatic, and in 13 (11.1%), it was unknown.
Escherichia coli was the most common bacteria on urine cul -
ture (47%), followed by Klebsiella pneumoniae (12.8%).
Secondary Outcomes
A total of 14 patients (9.3%) had a calculated CrCl <30
35. mL/min at baseline. The average time to UTI recurrence in
these patients was 3.3 months prior to methenamine initia-
tion compared with 12.7 months after initiation (P <
0.0001). Of the 136 patients with CrCl ≥30 mL/min, the
average time to UTI was 3.3 months prior to methenamine
initiation compared with 11 months after initiation (P <
0.0001; Table 2). Adverse events occurred in 16 patients
(10.7%) and led to discontinuation of methenamine in 15
of these patients. The most common adverse events
included gastrointestinal effects and dysuria (Table 3). Of
the 16 patients with adverse effects, 1 patient had CrCl
<30 mL/min.
Discussion
In this retrospective analysis, the use of methenamine for
UTI prophylaxis led to a significantly longer time to UTI
recurrence in older adults with varying degrees of kidney
function. Our results are consistent with prior studies that
have found benefit of using methenamine for UTI prophy-
laxis.5-8 Importantly, the effectiveness and tolerability of
methenamine appeared to be similar regardless of kidney
function. Therefore, the avoidance of methenamine pre-
scribing in patients with decreased kidney function because
of lack of data may not be justified.
Our study evaluated average time to UTI recurrence
before and after methenamine initiation, whereas previous
studies have mostly evaluated the reduction in incidence of
UTI or bacteriuria after initiation of methenamine. A review
of adults 58 years and older, using methenamine for UTI
prophylaxis, found a reduction in incidence of UTI or bac-
teriuria.7 A Cochrane systematic review that included 13
studies and a total of 2032 patients found that methenamine
was effective for UTI prophylaxis in patients without renal
tract abnormalities (symptomatic UTI: RR = 0.24, 95% CI
36. = 0.07 to 0.89; bacteriuria: relative risk (RR) = 0.56, 95%
CI = 0.37 to 0.83).6 Another analysis evaluated rates of
reinfection during a 6-month period of prophylaxis with
methenamine compared with infection rates in the 6 months
prior to methenamine in 52 older women with recurrent
434 pa�ents
screened
150 pa�ents
included
284 pa�ents excluded
• Unclear if ≥2 UTIs prior to methenamine
ini�a�on (n=104)
• Lack of informa�on in EHR (n=104)
• No SCr (n=21)
• Taking other an�bio�cs for prophylaxis (n=20)
• Documenta�on of methenamine non-
adherence (n=18)
• Immunocompromised (n= 13)
• Other (n=4)
Figure 1. Patient screening.
Abbreviations: EHR, electronic health record; SCr, serum
creatinine;
UTI, urinary tract infection.
Table 1. Baseline Characteristics at the Time of Methenamine
Initiation.
Characteristic Patients (n = 150)
Age: mean (years) ± SD 77 ± 8
37. Sex, n (%)
Female 133 (88.7)
Race, n (%)
White 142 (94.7)
CrCl, mean (mL/min) ± SD 54.3 ± 21
Catheter use, n (%) 26 (17.3)
Patients taking medications that increase
risk of UTI, n (%)
17 (11.3)
Methenamine dose, n (%)
1 g Twice daily 133 (88.7)
1 g Daily 16 (10.7)
500 mg Twice daily 1 (0.7)
Provider type for prescription, n (%)
Urologist 100 (66.7)
Primary care physician 25 (16.7)
Urogynecologist 15 (10)
Infectious disease 5 (3.3)
Inpatient provider 4 (2.7)
Oncologist 1 (0.7)
Abbreviations: CrCl, creatinine clearance; UTI, urinary tract
infection.
362 Annals of Pharmacotherapy 54(4)
UTI hospitalized in a long-term care facility.8 Patients were
categorized into 1 of 3 groups based on degree of inconti -
nence and immobility (normal, partial, or total). There was
a lower rate of total reinfection cases per person in each
group over the 6-month period of prophylaxis with methe-
namine compared with when not on treatment (normal
38. [0.45 vs 2.82], partial [0.58 vs 4.33], and total [0.29 vs
5.24]).8 Finally, a case series of 4 patients, 89 years or older,
with history of multidrug-resistant UTIs found that methe-
namine appeared to be safe and effective for prevention of
recurrent UTIs.5
Our study found that patients had a mean of 4.4 UTIs per
year prior to methenamine initiation. This is similar to pre-
vious studies evaluating effectiveness of other prophylactic
agents. A retrospective analysis of 82 renal transplant recip-
ients with recurrent UTI showed that prophylaxis with cran-
berry juice significantly reduced annual number of UTI
episodes from 3.6 ± 1.4 per year to 1.3 ± 1.3 per year (P <
0.001).9 Prophylaxis with l-methionine also significantly
reduced annual UTIs from 3.9 ± 1.8 per year to 2.0 ± 1.3
per year (P < 0.001).9 Another study of 252 postmeno-
pausal women with recurrent UTI randomized patients to
either trimethoprim-sulfamethoxazole or lactobacillus for
prophylaxis.10 The mean number of symptomatic UTIs in
the 12 months prior to initiation of prophylaxis was 7 in the
trimethoprim-sulfamethoxazole group and 6.8 in the lacto-
bacillus group compared with 2.9 (95% CI = 2.3 to 3.6) and
3.3 (95% CI = 2.7 to 4.0) during 12 months of prophylaxis,
respectively. Median time to first UTI was 6 months for
trimethoprim-sulfamethoxazole and 3 months for lactoba-
cillus.10 Our study found a longer mean time to first UTI of
11.2 months with methenamine prophylaxis.
Regardless of kidney function, patients in our study
tolerated methenamine treatment with minimal adverse
effects. Our data are consistent with previous studies that
have shown low rates of adverse events with use of methe-
namine with adequate kidney function, but the finding in
patients with a CrCl <30 mL/min is new.5-8 Other antibiot-
ics that are used for UTI prophylaxis (trimethoprim-sulfa-
39. methoxazole, nitrofurantoin, and cephalexin) often have
higher rates of adverse effects, drug-drug interactions, and
concern for antimicrobial resistance.9-12
FDA labeling for methenamine states that use is contrain-
dicated in patients with CrCl <30 mL/min because of lack of
data and potential for adverse effects, with no dosage adjust-
ments provided for patients with kidney dysfunction.4 Our
study included 14 patients (9.3%) with CrCl <30 mL/min.
Although overall numbers were small, we found that methe-
namine was effective in patients with CrCl <30 mL/min.
Only 1 of 14 patients (7%) with CrCl <30 mL/min had a
documented adverse event, compared with 15 of 136 patients
(11%) with higher levels of kidney function. Interestingly, 16
patients were prescribed a reduced dose of methenamine 1 g
by mouth daily, but only one had a CrCl <30 mL/min.
Despite FDA labeling stating that use is contraindicated in
renal impairment, our results suggest that methenamine was
safe and effective in persons with reduced renal function.
Future studies with a larger number of patients are needed to
determine true efficacy and safety of methenamine in patients
with moderate to severe kidney dysfunction.
Our study has several advantages. In contrast to other
published studies, we used a pre-post study design, where
patients served as their own controls to assess effectiveness
of methenamine for UTI prophylaxis. We also collected
data on other potential confounders that could increase risk
of UTI, including catheter use and use of other medications
(eg, corticosteroids) known to cause UTI. In addition, our
study categorized patients based on CrCl at the time of
methenamine initiation. Our study specifically evaluated
effectiveness in adults 60 years of age and older, which is a
population at high risk for recurrent UTIs as well as for
negative outcomes from antibiotic use.
40. Our study has some limitations. The observational nature
of the study with retrospective analysis and manual EHR
review may have introduced bias. Determination of methena-
mine adherence, discontinuation, and adverse effects relied
on record review alone, which may have underreported these
measures. Determination of UTI relied on patients reporting
a UTI to a provider within the health system or having an
Table 2. Study Outcomes Based on Renal Function.
n (%)
Average Time to UTI Prior to
Methenamine Initiation (months)
Average Time to UTI After
Methenamine Initiation (months) P Value
All patients 150 (100) 3.3 11.2 <0.0001
CrCl <30 mL/min 14 (9.3) 3.3 12.7 <0.0001
CrCl ≥30 mL/min 136 (90.7) 3.3 11.0 <0.0001
Abbreviations: CrCl, creatinine clearance; UTI, urinary tract
infection.
Table 3. Adverse Events.
Adverse Event n (%)
Gastrointestinal effects 9 (56.3)
Dysuria 3 (18.8)
Hand/feet swelling 1 (6.3)
Insomnia 1 (6.3)
Fatigue 1 (6.3)
Elevated liver function tests 1 (6.3)
41. Snellings et al 363
office visit or emergency department visit where a UTI was
diagnosed. Additionally, some antibiotic prescriptions may
not have been captured if they were prescribed outside the
UCHealth system. Because this was a retrospective study, not
all patients had a UTI at the time of methenamine initiation,
which may have underestimated time to first UTI. In addi-
tion, there were 33 patients who did not have a UTI after
methenamine initiation. For these patients, time to first UTI
was measured from methenamine initiation date to date of
data collection, which likely underestimated time to first
UTI. Finally, asymptomatic bacteriuria was treated in several
patients, which may have overestimated the time to first UTI
after methenamine initiation.
Conclusion and Relevance
Our findings suggest that use of methenamine for UTI pro-
phylaxis in older adults was effective by significantly
extending time to UTI. This benefit was observed in patients
with normal and reduced kidney function, which is a new
finding. Clinicians should consider prescribing methena-
mine for UTI prophylaxis in older adults. Future prospec-
tive randomized controlled trials in patients with impaired
kidney function are needed to confirm efficacy and safety
of methenamine in this patient population.
Acknowledgments
The authors wish to thank the Health Data Compass Colorado
Center for Personalized Medicine for their help in creating a
data
report to identify eligible patients.
42. Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with
respect
to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research,
author-
ship, and/or publication of this article.
ORCID iD
Danielle R. Fixen https://orcid.org/0000-0002-7193-1756
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